OCtC -# /3'35 3*5 L 111 .A3 1960-1962 United States. Dept, of Health, Education, and Annual report of the U.S Department of Health, VOLS. HEIGHT COLOR LIB IMPRINT NONE BOUND BEFORE SEE OLD COVER SEE RUB NO LETTERING SEE S. B. DO NOT COLLATE DO NOT REMOVE ADS OR COVERS CRITERION BINDING CHARGE HAND SEWING SHELF NOS. EXTRA THICKNESS STUBBING HINGING LETTERING IMPRINT EXTRA TIME PREPARING, ETC. 2 SEPARATE SET BY PEELING AT THIS SHEET AND BREAKING SPOT PASTING IN STUB U.S. DEPARTMENT OF bO 1960 HEALTH, EDUCATION, AND WELFARE ANNUAL REPORT ( p, n q - a \ For sale by the Superintendent of Documents U.S. Government Printing Office Washington 25, D.C. - Price $1.00 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1960 Arthur S. Flemming, Secretary Bertha S. Adkins, Under Secretary OFFICE OF THE SECRETARY Robert A. Forsythe . . . . Edward Foss Wilson . . . . Vacancy . Byron E. Harter . Jarold A. Kieffer . Jack Tait . Parke M. Banta . Rufus E. Miles, Jr . . . . Chester B. Lund . Harvey A. Bush . Frederick H. Schmidt . . . Assistant Secretary ( for Legislation). Assistant Secretary. Special Assistant for Health and Medical Affairs. Legislative Liaison Officer. Assistant to the Secretary ( for Program Analysis). Assistant to the Secretary ( for Public Affairs). General Counsel. Director of Administration. Director of Field Administration. Director of Public Information. Director of Security. SOCIAL SECURITY ADMINISTRATION William L. Mitchell . . . . Joseph H. Meyers . Victor Christgau . . . Kathryn D. Goodwin . . J. Deane Gannon .... Katherine B. Oettinger. Commissioner of Social Security. Deputy Commissioner of Social Security. Director, Bureau of Old-Age and Survivors In¬ surance. Director, Bureau of Public Assistance. Director, Bureau of Federal Credit Unions. Chief, Children’s Bureau. PUBLIC HEALTH SERVICE Leroy E. Burney . John D. Porterfield . . . James V. Lowry . . . Charles E. Burbridge David E. Price . . . James A. Shannon . . Surgeon General. Deputy Surgeon General. Chief, Bureau of Medical Services. Superintendent, Freedmen’s Hospital. Chief, Bureau of State Services. Director, National Institutes of Health. OFFICE OF EDUCATION Lawrence G. Derthick . . . Commissioner of Education. Wayne O. Reed . Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION George P. Larrick . Commissioner of Food and Drugs. John L. Harvey . Deputy Commissioner of Food and Drugs. iii IV Department of Health , Education , and Welfare, 1960 OFFICE OF VOCATIONAL REHABILITATION Mary E. Switzer . Director of Vocational Rehabilitation. E. Emory Ferebee . Deputy Director of Vocational Rehabilitation SAINT ELIZABETHS HOSPITAL Winfred Overholser .... Superintendent. Vacancy . Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Finis Davis . Superintendent , American Printing House for the Blind. Leonard M. Elstad . President, Gallaudet College. Mordecai W. Johnson . . . President, Howard University. REGIONAL DIRECTORS Lawrence J. Bresnahan . . Joseph B. O’Connor . . . . Edmund W. Baxter . Richard H. Lyle . Melville H. Hosch . James W. Doarn . James H. Bond . Albert H. Rosenthal . . . . Fay W. Hunter . Region I, Boston, Mass. Region II, New York, N.Y. Region III, Charlottesville, Va. Region IV, Atlanta, Ga. Region V, Chicago, III. Region VI, Kansas City, Mo. Region VII, Dallas, Tex. Region VIII, Denver, Colo. Region IX, San Francisco, Calif. Letter of Transmittal Department of Health, Education, and Welfare, Washington , D.C. , December i, 1960. Dear Mr. President: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1960. Respectfully, The President, The White House, W ashington, D.C. VI ALASKA HAWAII Contents Page Office of the Secretary . 1 Social Security Administration . 11 Public Health Service . 93 Office of Education . 179 Food and Drug Administration . 231 Office of Vocational Rehabilitation . 261 Saint Elizabeths Hospital . 287 American Printing House for the Blind . 297 Gallaudet College . 299 Howard University . 301 JA detailed listing of the contents of this report, hyl Itopic headings, will be found on pages 307-314.] vii . Office of the Secretary The Office of the Secretary consists of the immediate offices of the Secretary and Under Secretary and also includes a number of staff functions that are concerned with matters of departmentwide im¬ portance. The principal staff officers in the Office of the Secretary are the Assistant Secretary (assigned to matters concerning security, civil defense, and international activities) ; the Assistant Secretary for Legislation; the General Counsel; the Special Assistant to the Secre¬ tary for^Health and Medical Affairs ; the Assistants to the Secretary for Program Analysis and for Public Affairs; and the Directors of Administration, Field Administration, Special Staff on Aging, and Public Information. In addition to administering the Department, the Secretary serves as the Chairman of several interdepartmental committees. These include: The Federal Radiation Council, established to advise the President with respect to radiation matters directly or indirectly affecting health; the Interdepartmental Committee on International Health Policy, which advises the Secretary of State as to objectives, establishing long-range goals, and planning programs in the field of international health; and the Federal Council on Aging, established to carry on continuing reviews of Federal programs for the aging and to make recommendations to the President and to the agencies as appropriate. The Secretary is a member of the President’s Council on Youth Fitness. The Under Secretary serves as the Acting Secretary in the absence of the Secretary and has also been given primary responsibility for specific programs in the Department. The Under Secretary co¬ ordinates, guides, and evaluates the Department’s programs and ac¬ tivities in the field of aging; has general supervision of the Special Staff on Aging; serves as Chairman of the Working Group of the 1 2 Department of Health , Education , and Welfare , I960 Federal Council on Aging ; and was responsible for the Department’s activities concerning the 1961 White House Conference on Aging and the 1960 White House Conference on Children and Youth. The Under Secretary represents the Department on a number of interdepartmental committees, including the Rural Development Program, a cooperative effort of Federal, State, and local govern¬ ments, and civic leaders to help low-income rural families ; the Inter¬ departmental Committee to Coordinate Federal Urban Area Assist¬ ance Programs in behalf of communities suffering persistent unem¬ ployment ; the Outdoor Recreation Resources Review Committee ; the Advisory Board on Economic Growth and Stability, which assists the Council of Economic Advisers to the President; and the Board of the Federal Woman’s Award. The Under Secretary also has received Presidential assignments as Chairman, President’s Committee on Fund-Raising Within the Federal Service; Member, U.S. official delegation to Poland for an exchange visit with Polish officials; U.S. Delegate, United Nations Seminar on Participation of Women in Public Life, Bogota, Colombia, May 1959; and U.S. Delegate, Eleventh General Conference of UNESCO, Paris, France, November-December 1960. Office of Assistant Secretary ( Security , Civil Defense , International Activities ) The Department and its operating agencies participate directly in international activities through the United Nations and its specialized agencies, the Organization of American States and other inter- Ameri¬ can groups, and a variety of governmental and nongovernmental, technical, scientific, and professional international bodies and regional associations which conduct programs of primary interest to this Department. Department officials took part in 188 international meetings during fiscal year 1960. In addition, Department personnel have conducted surveys and studies for a wide variety of international agencies or served as advisers and specialists on technical assistance programs. In the foreign policy field the Department serves in an advisory capacity to the Department of State. In fiscal year 1960, 6,256 foreign nationals from more than 60 coun¬ tries and non-self- governing territories received training or orienta¬ tion by agencies of the Department — an increase of approximately 26 percent over fiscal year 1959. The Office of Internal Security is responsible for establishing and maintaining an effective internal security program and has both staff and operational responsibilities. The Office handled more than 5,000 security investigations during the year. Office of the Secretary 3 The Office of Defense Coordinator is responsible for day-to-day relations with all the defense activities of the Department and repre¬ sents the Secretary on numerous planning and review boards and committees presided over by the Office of Civil and Defense Mobiliza¬ tion (OCDM). This Office also supervises a small permanent cadre at a relocated headquarters site and conducts an annual test program. Planning was advanced during the year for the conversion of Depart¬ ment manpower and resources to provide emergency health and wel¬ fare services in the event of an attack. Office of Assistant Secretary ( for Legislation ) This Office assists the Secretary and other officials in formulating the Department’s legislative program and presenting it to the Bureau of the Budget and to Congress and also coordinates and reviews all legislative proposals on which the Congress requests the Depart¬ ment’s views. The Office of the Assistant Secretary (for Legislation) includes the Congressional Liaison Office, which serves as the focal point for communications between Congress and the Department; keeps the Secretary and Assistant Secretary advised of congressional reaction to and status of legislation in Congress ; and advises officials of needs for development of information to assure proper congressional un¬ derstanding of Department programs. Since the creation of the Department in 1953, dramatic progress has been made in the national effort to achieve improved health, better education, and greater economic security. The administration has supported and obtained legislation to strengthen the Nation’s educational system, broaden coverage and increase benefits under social security, expand the rehabilitation program which offers new hope for the disabled, strengthen our research efforts in science and medi¬ cine, provide more adequate health services and facilities, provide improved protection to consumers against harmful or mislabeled foods, drugs, and cosmetics, and provide improved medical aid to the aged. Office of General Counsel The General Counsel is the chief legal officer of the Department, and his office furnishes all legal services to the various operating agen¬ cies and units of the Department. During fiscal year 1960, litigation arising out of the old-age, sur¬ vivors, and disability insurance program continued to increase dra¬ matically to the point where it exceeded in volume that in any other single area in which suits are brought against the Government. 4 Department of Health , Education , and Welfare, 1960 Eighty percent of the 637 actions instituted in the past year involved the disability freeze and benefit provisions of the law — provisions which, with the recent removal of the 50-year age limitation, can be expected to generate more and more complex and time-consuming litigation. Another area of ever-growing importance is that of enforcement of the Water Pollution Control Act. Formal hearings were called at Sioux City, Iowa, and St. Joseph and Kansas City, Missouri, involv¬ ing the interstate effects of pollution originating at those cities. In the case of St. Joseph it became necessary to request the Attorney General to institute suit to secure abatement of pollution. This liti¬ gation, now pending in the United States District Court for the Western District of Missouri, is the first of its kind. In important litigation under the Federal Food, Drug, and Cos¬ metic Act, the Office successfully defended the Department’s action in revoking certificates for coal-tar dyes which had been issued before their danger became known. It won a protracted case against one of the most widely distributed nostrums for arthritis, Tri-Wonda, by establishing that the drug was a totally worthless one. It established the criminal responsibility of a medical doctor for dispensing am¬ phetamines outside the course of his professional practice ; it completed its program of finally closing the notorious Hoxsey Cancer Clinic in Dallas, Texas ; and it is proceeding vigorously with an important test case involving slack-filled packages. In the first court test in the program of school construction in federally affected areas, the Commissioner of Education’s denial of a school construction grant to a local educational agency was upheld by the U.S. Court of Appeals on the ground that the agency had not met the showing required by law of an undue financial burden on its taxing and borrowing authority. Special Assistant to the Secretary ( Health and Medical Affairs) The Office of the Special Assistant reviews the health and medical programs of the Department and advises the Secretary with respect to the improvement of such programs and on necessary legislation in the health and medical fields. Liaison is maintained with profes¬ sional and voluntary medical, hospital, and other health organizations, with other organizations and associations concerned with health af¬ fairs, with other Government agencies, and with Members of Congress and congressional committees. Special service rendered by this office involves coordination of departmental activities in radiological health including staff work in connection with activities of the Federal Radiation Council. Office of the Secretary 5 Office of Assistant to the Secretary (/or Program Analysis ) This Office aids the Secretary in identifying major emerging prob¬ lems, policy issues, and gaps in Department programs ; helps the Sec¬ retary appraise program needs and recommends program action in¬ cluding new legislation ; provides staff assistance to the Secretary and other top staff in the review and development of Department policies ; analyzes the Federal-State implications of programs and program changes ; and maintains departmental liaison with the Advisory Com¬ mission on Intergovernmental Relations and with private foundations. During the year three publications, the annual “Health, Education, and Welfare Trends,” the monthly “Health, Education, and Welfare Indicators,” and the annual “Handbook on Programs of the U.S. De¬ partment of Health, Education, and Welfare,” were revised and expanded. Office of Administration This Office is the Secretary’s principal staff unit for the Depart¬ ment’s fiscal, management, personnel, and housekeeping operations. The Office carries out these operations through the Office of Financial Management, Office of Management Policy, Division of Personnel Management, and the Division of General Services. It participates actively in the formulation of Department policy; manages the De¬ partment’s money; establishes Department personnel policies; is in charge of such specific functions as management analysis, incentive awards, and records management ; and operates a central library and other services for the Department. The Office of Management Policy staff conducts surveys and studies of significant organization and management problems which cut across operating agency lines. During the past year, this staff conducted a comprehensive survey of construction and leasing activities through¬ out the Department and developed materials to assist operating per¬ sonnel in the preparation and review of construction proposals ; in co¬ operation with the Division of Personnel Management, launched a study of data-processing needs for personnel management to develop a more economical and efficient system of processing personnel actions and to develop an improved personnel reporting system; and con¬ ducted an organization study of the audit of grants and contracts for research and training by nonprofit institutions as a basis for im¬ provement of the audit function. Two documents were issued by the Office of Management Policy to provide general guidelines for the improvement of data-processing activities within the Department. 6 Department of Health , Education , and Welfare , 1960 The Division of Personnel Management is primarily responsible for providing overall direction, coordination, and policy leadership. One development that has received wide attention in and out of Government is a plan for the gradual retirement of older workers who do not want to stop working altogether when they reach retirement age. Under this plan the length of the workday or workweek can be adapted to the current abilities and energy of the retiring worker, or other appropriate adjustments can be made in work activities. The Office of Financial Management is concerned with all aspects of fiscal administration. It is responsible for analyses of the De¬ partment’s program budgets, development of fiscal policy and pro¬ cedures, and conduct of internal audit. The Director is also the Budget Officer for the Department and represents the Secretary at the Bureau of the Budget, with the Congress, and with operating agency heads during negotiations or hearings on budget matters. During fiscal year 1960, this Office has conducted several reviews and made many evaluations. A major financial management study of Gallaudet College was made in cooperation with the Bureau of the Budget. A study was launched to investigate the requirements and problems in converting the payroll operation to an automatic data-processing system. The Division of General Services is responsible for the develop¬ ment and administration of departmental policies and procedures in the areas of real and personal property management, procurement and supply management, printing management, communications, li¬ brary services, and visual aids. The Division is also responsible for the administration of a working capital fund which is the financing medium for the bulk of administrative services provided for head¬ quarters’ units. In fiscal 1960 the Division issued new and revised policies and guide¬ lines to improve administrative functions. A major step forward was the modernization of the Department’s printing plant to afford better and more timely service to expanding operating programs. Office of Field Administration This Office is responsible for the general supervision and coordina¬ tion of the activities of the Department’s nine regional offices and pro¬ vides specialized services through four divisions. The Regional Directors, as the principal representatives of the Sec¬ retary in their respective regions, work with Governors and principal State and local officials on matters involving Federal-State and local Office of the Secretary 7 problems; and make available to these officials, community groups, and others information regarding the activities of the Department. During the year the Division of Field Management established committees in the regional offices for rural and urban area assistance. The Division of Grant-in-Aid Audits reviewed expenditures total¬ ing approximately $4.75 million under the Department’s 33 grant programs. Under the direction of the Division of Surplus Property Utiliza¬ tion, personal property donations reached $400,660,692 as measured by acquisition cost, and real property transfers reached $23,355,370. Five years ago these figures were $204,497,417 and $13,567,628, re¬ spectively. Approximately 78 percent of the personal property was distributed to educational institutions, 10 percent to health institu¬ tions, and 12 percent to civil defense organizations. Donations of equipment useful in science teaching programs and machine tools use¬ ful in vocational education continued to play an increasingly im¬ portant part in the overall program. The Division of State Merit Systems reviews State personnel plans and operations, certifies compliance with Federal standards, and pro¬ vides technical assistance for improvement of administration. During the fiscal year the majority of State personnel plans were reviewed, and examination materials were prepared and supplied to 41 States for 490 classes of positions. Technical advice plus the examination material assisted the States in their recruiting and selection pro¬ grams involving 900,000 job applicants. Special Staff on Aging The Special Staff on Aging, established in 1956, coordinates the development of Department policies and programs in the field of aging. This unit has representatives in each of the nine regional offices of the Department and works closely with the States and with national organizations in establishing programs on aging throughout the country. During the year the Special Staff on Aging was concerned princi¬ pally with preparations for the 1961 White House Conference on Aging; served as secretariat to the National Advisory Committee for the White House Conference on Aging; made grants totaling $759,200 to States and Territories to assist them in preparing for the White House Conference, and prepared for publication reports and recom¬ mendations submitted by the States and Territories. Also during the year the Special Staff issued a number of new publications and ex¬ panded the Department’s monthly bulletin, “Aging.” 8 Department of Health , Education , and Welfare , 1960 Assistant to the Secretary (/or Public Affairs ) The Assistant to the Secretary for Public Affairs serves as the Secretary’s principal staff adviser on major public relations policy; helps formulate Department policy relating to public information affairs; and as occasion arises serves as the Secretary’s spokesman in discussions with heads of operating agencies, Members of Con¬ gress, and others on matters involving the Secretary’s and the De¬ partment’s public information policies. Office of Public Information The Director of Public Information is the chief information officer of the Department. He advises the Secretary on Depart¬ ment policies and operations involving public information, publica¬ tions, reports, and other information matters, and directs the Office of Public Information, which coordinates all information policies, services, and activities of the Department. During 'the year, the Office of Public Information participated in the preparation of more than 60 statements issued by the Secretary at 24 news conferences, prepared or reviewed and issued more than 500 press releases, and reviewed and approved for publication ap¬ proximately 300 printed documents produced by the Department and its operating agencies. Also during the year, the Office par¬ ticipated extensively in preparing for and conducting the public information aspects of the White House Conference on Children and Youth and in similar preparations for the 1961 White House Confer¬ ence on Aging ; answered hundreds of written and oral inquiries about Department activities and materials; prepared or assisted in the preparation of 50 or more addresses by Department officials; and prepared about 25 articles for encyclopedias and other publications. The Office also inaugurated a study to determine the extent to which existing review policies meet the current needs of the Department and its operating agencies in the field of public information. Office of the Secretary 9 Table I. — Grants to States: Total grants under all Department of Health , Education , and Welfare programs, fiscal year 1960 [On checks-issued basis] States, Territories, and possessions Total Social Secu¬ rity Admin¬ istration Public Health Service 1 Office of Education Office of Vocational Rehabili¬ tation White House Confer¬ ence on Aging Ameri¬ can Print¬ ing House for the Blind 2 Total.. . . $2,730,641,306 $2, 106, 328, 929 $217, 515, 554 $357, 020, 720 $48, 606,903 $759,200 $410,000 Alabama . 80, 435, 586 63, 329, 492 6, 438, 838 8, 608, 552 2, 036, 745 15,000 6, 959 10, 029, 944 2, 263, 427 147, 546 7, 492, 974 110,997 15, 000 Arizona _ _ .. 26; 380; 743 16, 340; 457 1,827,698 7, 765, 577 428, 577 15, 000 3, 434 Arkansas . . 43, 272, 823 34, 141, 571 4, 467,808 3,531,233 1,111,893 15, 000 5,318 California _ 282,010,464 225, 581,317 10, 812, 725 42, 789, 413 2, 778, 184 15,000 33, 825 Colorado .. ... _ 47, 447, 460 36, 896, 039 2, 152, 706 7, 823, 727 555, 794 15,000 4, 194 Connecticut . . 21, 433, 998 16,299,036 2, 026, 545 2, 692, 535 391, 157 15,000 9,725 Delaware.. 4, 392, 609 2, 502, 713 637, 750 1,057, 488 181, 212 12, 200 1,246 District of Colum- bia _ . ... 10, 685, 771 9, 132, 640 956, 478 347, 915 232, 887 15, 000 851 Florida . . . 80,253, 332 62, 705, 676 6, 534, 488 9,262, 718 1, 723, 567 15, 000 11,883 Georgia . . 85, 869, 533 68,153, 335 7,113, 633 8,258, 474 2, 318, 545 15,000 10, 546 Hawaii _ _ 10, 355, 045 4,218,072 2, 010, 927 3, 884, 371 224, 851 15, 000 1,824 Idaho _ 12, 524, 026 7, 232, 904 2, 202, 876 2, 896, 786 175, 639 15, 000 821 Illinois . . .. 109, 932, 768 91,552,225 9,045, 299 7, 243, 650 2,055,837 15, 000 20, 757 37, 279, 673 25, 880, 790 5, 568, 056 5, 318, 647 505, 008 7, 172 Iowa _ 3L 998; 452 30, 439, 559 3, 520, 957 3, 033, 531 984,968 15,666 4, 437 Kansas _ _ 36, 951,262 25, 793, 666 3, 318, 554 7, 223, 855 595, 537 15, 000 4, 650 Kentucky _ 57, 735,472 48, 243, 310 5, 174, 215 3, 760, 073 537, 586 15,000 5, 288 Louisiana _ ... 118, 134,250 106, 120, 910 6, 544, 010 4, 222, 103 1,225,024 15,000 7, 203 Maine. _ _ 19, 304, 006 14, 667,494 1,870,622 2,465,039 284, 848 15,000 1,003 Maryland . . 33, 012, 630 18,886,595 2, 679, 368 10, 835, 351 587, 867 15,000 8,449 Massachusetts ... 75, 464,095 62, 682, 190 4, 593, 776 7, 322, 255 831,394 15, 000 19, 480 Michigan _ _ 79,119, 054 61,300, 489 7, 984, 797 8, 384, 575 1,415, 442 15,000 18, 751 Minnesota . . 47, 556,910 38, 258, 776 4, 646, 362 3, 547, 570 1,081,635 15, 000 7, 567 Mississippi- . . . 50, 383, 829 39, 648, 235 4, 490, 785 5, 347, 098 878, 152 15,000 4,559 Missouri . . 104, 146,041 90, 545, 309 6, 680, 405 6, 016, 035 882, 606 15, 000 6, 686 Montana _ 12, 365, 905 6,931,859 1,563,611 3, 644, 597 219, 197 5,000 1,641 Nebraska. . . . 20, 315, 768 14,500, 815 2, 261, 512 3, 188, 832 346, 995 15, 000 2, 614 Nevada _ _ 5, 209, 352 2, 742,311 633, 348 1, 755, 544 62, 663 15, 000 486 New Hampshire _ 7, 902, 131 4, 703, 412 1,399,932 1, 676, 519 108, 992 12,000 1,276 New Jersey _ 37,867,831 26,388, 160 3, 462,067 6, 788,097 1, 199, 616 15,000 14, 891 New Mexico _ ... 27,312, 517 16, 587, 936 948, 394 9, 515, 050 242, 885 15,000 3, 252 New York. ... . . 172,021,517 145, 977, 389 10,054,368 12, 717, 548 3, 213, 541 15, 000 43, 671 North Carolina . . _ 72, 622, 368 53, 143, 250 9, 464, 723 7, 852, 948 2, 133, 440 15,000 13, 007 North Dakota _ 10, 976, 131 7, 264, 619 1,409,867 2, 021,073 264, 630 15, 000 942 Ohio _ 104, 464, 228 85, 083, 904 8, 930, 002 9, 237, 922 1, 175, 245 15, 000 22, 155 Oklahoma _ . . 91,941,263 75, 748, 634 3, 002, 982 11, 955, 298 1, 216, 553 15, 000 2, 796 Oregon _ _ _ 23, 392, 863 18, 122, 832 2, 054, 792 2,531,096 663, 369 15, 000 5, 774 Pennsylvania _ 115, 585, 901 88,300, 385 11,632, 104 12, 379, 236 3, 229, 667 15, 000 29, 509 Rhode Island _ 14, 234, 067 9, 781, 006 1, 616, 798 2, 512, 691 307, 417 15, 000 1,155 South Carolina _ 31, 157, 832 22, 338, 305 3,054,807 4, 937, 695 807, 740 15, 000 4,285 South Dakota _ 13, 908, 160 8, 844, 371 1,388, 275 3, 371, 863 287, 223 15, 000 1,428 Tennessee _ ... 57, 682, 702 44,015, 341 6, 822, 179 5, 317, 888 1,504, 149 15, 000 8, 145 Texas _ _ _ 163, 035, 141 127, 162, 691 9, 507, 601 24, 697, 763 1, 638, 653 15,000 13,433 Utah _ 14, 669, 990 9, 718, 679 1, 585, 925 3,040,395 308, 502 15, 000 1,489 Vermont _ 6, 784, 297 5, 001,624 974, 565 607, 691 184, 961 15,000 456 Virginia _ 46,992, 566 18, 475, 788 6,293, 569 20,920,009 1,280,329 15,000 7, 871 Washington . . 55, 304, 921 40, 156, 326 3, 399, 824 10,803,087 923, 208 15, 000 7,476 West Virginia . . 37,034, 631 28, 826, 502 4, 192,444 2, 790, 286 1,205,719 15,000 4,680 Wisconsin . . 40, 004, 855 30, 426, 601 4, 298, 815 4, 147, 257 1, 109, 615 15,000 7, 567 Wyoming _ 6,015, 552 3,098, 479 1, 347, 231 1, 456, 812 97, 392 15,000 638 Canal Zone _ 91 91 Guam _ . 1,764, 955 189, 743 141,025 1, 375, 853 58, 334 Puerto Rico _ 17, 327, 638 9, 598, 741 2, 581, 265 4, 471, 427 658, 561 15,000 2,644 Virgin Islands . 636, 357 382, 999 46, 305 174, 698 22, 355 10,000 i Excludes $242,255 paid to water pollution interstate agencies. ^Includes permanent annual appropriation of $10,000. 573826—61—2 • . Social Security Administration Social Security in 1960 Social security is today an accepted part of our culture and an essential bulwark of our economy. So affirmed the Secretary of Health, Education, and Welfare on the occasion of 1960 observances marking a quarter century since the August 14, 1935 signing of the Social Security Act. Fittingly, this year’s report takes stock of the achievements of the past 12 months against a background of social security’s 25 years of progress toward the place it now occupies in American life. Elaborating on the twenty-fifth anniversary theme, the Commis¬ sioner of Social Security pointed out that the Social Security Act recognized the national interest in and the national scope of the problem of income security. In the midst of immediate need of devastating proportions, it established programs to prevent future dependency. The social insurance programs started in 1935 have since proven their value in periods of economic prosperity as well as tempo¬ rary economic downturn. The principle of shared responsibility for public assistance for needy persons and for health and welfare services manifested in the Federal grants to the States under the Social Security Act has also been firmly established. In the years since 1935, programs established by the Social Security Act have been expanded and new programs added. Old-age benefits have become old-age, survivors, and disability insurance, and its coverage has been extended to almost the entire working population. Benefits have been increased not only to adjust to the changed value of the dollar but also to reflect in part the rising level of living for the population as a whole. In our total social security system, primary reliance and emphasis have been placed on the contributory earnings-related programs — 11 12 Department of Health , Education, and Welfare, 1960 old-age, survivors, and disability insurance and unemployment in¬ surance — as the basic source of protection, for almost all Americans, against commonly shared risks to income. Under both of these pro¬ grams, Americans earn their security as they earn their living, and benefits paid are varied — within limits — with the individual’s cus¬ tomary level of living and his economic contribution to society as measured by his earnings. Because benefits under old-age, survivors, and disability insurance and unemployment insurance are payable when due no matter what nonwork income the individual may have, the social insurance programs have served to encourage other means of protection, through private employee-benefit plans and individual action. No preventive measures, however, can anticipate all problems of need. An essential part of our social security system therefore is a flexible program of public assistance. Assistance can seek to rehabil¬ itate and to avert perpetuation of poverty and dependency through successive generations. The Federal Government for many years now has shared with the States in the cost of aid to the permanently and totally disabled as well as old-age assistance, aid to dependent children, and aid to the blind. The Federal share in the assistance programs has been increased over the years and provision has been made for proportionately more help to those States where need is greatest and income and fiscal ability least. Payment for medical care through public assistance has been made easier by the provision for Federal matching of direct payments to the suppliers of such service. From the beginning, the Social Security Act has provided encour¬ agement and support for health and welfare services. The programs for maternal and child health services and crippled children’s services have expanded in scope. Both in these and in the child welfare serv¬ ices program, Federal financial support and Federal leadership have served to stimulate State and local action. Explicit recognition of the importance of services to promote self-help and increase the inde¬ pendence of persons receiving public assistance was written into the Federal act in 1956. The Social Security Amendments of 1960, in the process of enact¬ ment at the end of the fiscal year and signed into law by President Eisenhower during the 25th anniversary year, will further improve the social security status of the American people. Among the several improvements are provisions for increased Federal participation in the financing of State payments to suppliers of medical care for the needy aged and for inauguration of Federal grants to States for programs for the aged who do not receive old-age assistance but who are unable to pay medical bills. Social Security Administration 13 For the aged who are able to provide for their maintenance but who do not have sufficient income or other resources to provide neces¬ sary medical care, the new law can operate as follows : • States starting such^programs have wide latitude in determining under what conditions aged persons can qualify for benefits. Each State develops its own test. • States decide what hospital, medical, and surgical benefits are available to persons who qualify. The benefits are as liberal as the States wish to make them. The only Federal requirement as to scope of services is that the program must include both institutional and noninstitutional services. • To help finance the program, the Federal Government makes available, beginning October, 1960, whatever funds are necessary to pay from 50 to 80 percent of the cost of the benefits, with the exact percentage determined on the basis of the per capita income of each State. The Social Security Amendments of 1960 also increase to $25 million each the ceilings on the amounts authorized to be appropriated an¬ nually for maternal and child health services, crippled children’s services, and child welfare services. Additionally, research or demon¬ stration projects grants to institutions of higher learning and other agencies and organizations are authorized in the field of child welfare. In the old-age, survivors, and disability insurance program, the law makes these changes: • Most importantly, the age 50 limitation for disability benefits is eliminated. Disabled workers and their dependents no longer have to wait for the otherwise eligible disabled worker to become 50 years of age to receive benefits. • The retirement test is liberalized effective January 1961. Before this date a worker under age 72 earning more than $1,200 would lose 1-month’s benefit for every $80 or fraction of $80 by which his earn¬ ings went over $1,200. Now the law provides that $1 in benefits will be withheld for every $2 of earnings between $1,200 and $1,500, and $1 in benefits will be withheld for each $1 in earnings above $1,500. Thus a beneficiary can work in a job paying more than $1,200 know¬ ing that he will always have more in benefits and earnings combined than he would have if he limited his earnings to that figure. The provision that full benefits are payable for any month in which earn¬ ings do not exceed $100 remains in effect. • Monthly benefit amounts for children of deceased workers are increased to an amount equal to three-fourths of the worker’s benefit amount, subject to the maximum family benefit. 14 Department of Health , Education , and Welfare , I960 • Certain work requirements determining eligibility under the program are liberalized. • Benefit payments can go to survivors — most of them aged widows — of workers who had acquired 6 quarters of coverage and who died before 1940. Among the anticipated results upon the effective dates of these changes, were these: 125,000 additional disabled workers and a like number of their dependents — a total of 250,000 persons — would qualify for disability benefits; increased benefits would go to about 400,000 children; 425,000 additional people — workers, dependents, and sur¬ vivors — would become eligible for benefits. These potential beneficiaries would now be added to the 14.3 million persons already receiving old-age, survivors, and disability insur¬ ance benefits at the end of the fiscal year, or 1.1 million more bene¬ ficiaries of this income maintenance program than a year before. Benefit payments during the fiscal year were being made at an annual rate of $10.8 billion. Of those receiving benefits, 11.5 million were age 62 or over, 2.4 million were young survivors and dependents, and 371,000 were disabled workers age 50-64. In the public assistance programs, almost 2.4 million persons were receiving old-age assistance, more than 3 million children and their adult caretakers were receiving aid to dependent children, 363,000 persons were receiving aid to the permanently and totally disabled, and 108,000 were in receipt of aid to the blind. In addition, some 971,000 persons were receiving general assistance financed from State and local funds. June payments under the four federally aided public assistance programs were made at an annual rate of $3,358 million, $131 million above the June 1959 rate. Data for fiscal year 1960 show that the Federal share of these payments totaled 58.6 percent, the State share was 33.7 percent, and the local share 7.7 percent. In all, almost 7 in 8 of the Nation’s 15.7 million persons 65 and over at the end of the year had income from social insurance and related programs, public assistance, or both. This is in contrast to the situ¬ ation at the end of 1934 when little more than 10 percent of all aged persons had income from such sources and about half, it is estimated, were mainly or wholly dependent on relatives or friends for their support. At the end of fiscal year 1960, total payments under social security and related programs were made at an annual rate of $26 billion, $2.1 billion above the July 1959 rate. Rising old-age, survivors, and dis¬ ability insurance benefits accounted for over half of the increase. Social security payments represented 6.4 percent of total personal Social Security Administration 15 income in June 1960, compared with 6.2 percent in that month a year earlier and 6.6 percent in June of recession year 1958. Federal credit unions, by promoting systematic savings and the use of funds thus accumulated for consumer loans at reasonable rates of interest, continued their part in promoting the Social Security Act objective of increasing family security. Continued growth of these credit unions brought their aggregate assets to almost $2.4 billion at the end of 1959 and membership to 5y2 million. The Social Security Administration had 26,071 employees on duty at the end of fiscal year 1960. The great majority of these employees were in district offices and other offices of the Bureau of Old-Age and Survivors Insurance. The White House Conference on Children and Youth, held in Washington from March 27 to April 2, brought together individuals and groups sharing a deep concern over the opportunities for children and youth to realize their full potential for a creative life in freedom and dignity. About 7,600 persons attended the meetings, including 1,400 youngsters and 500 visitors from foreign countries. National organizations, State and local groups, and Federal agencies were represented. The two advisory councils created by the 1958 amendments to the Social Security Act submitted their recommendations and findings to the Secretary of Health, Education, and Welfare and to Congress at the end of 1959. The Advisory Council on Public Assistance reviewed the status of the public assistance program in relation to old-age, survivors, and disability insurance, the fiscal capacities of the States and the Federal Government, and other factors affecting the Federal and State shares in the program. The Advisory Council on Child Welfare Services reviewed the child welfare provisions of the Social Security Act, the current child welfare programs, and made recom¬ mendations for future changes in these provisions. At fiscal year’s end, active preparations for the 1961 White House Conference on Aging were under way at community, State, and na¬ tional levels. The theme of the conference is “Aging with a future — every citizen’s concern.” While the principal concern of the Social Security Administration at the conference will be with matters affect¬ ing income security, its overall objectives encompass social as well as economic needs. The March 1960 report of hearings of the subcommittee of the Ways and Means Committee of the House of Representatives to study the administration of the social security laws stated that the disability insurance program, on the whole, has been fairly administered with great capacity by excellent public officials. 16 Department of Health, Education, and Welfare, 1960 Hearings and Appeals Old-age, survivors, and disability insurance claimants are guaran¬ teed tlie right of appeal and review. Largely as a result of the addi¬ tion of disability benefits to the program in 1956, requests for hear¬ ings increased 512 percent in 3 years, from 3,800 in 1955 to 23,250 in 1958. The hearing workload on J uly 1, 1959, was 12,445 cases, of which 9,475 were related to disability issues. During the fiscal year 13,355 additional requests for hearings were received, 9,540 of them on dis¬ ability issues. By the end of the year the pending load had been reduced to 5,960. Bequests for Appeals Council review of hearing examiners’ deci¬ sions increased from 1,780 in 1957 to 5,000 in 1958. During fiscal year 1960, 7,300 cases were received for Appeals Council action, of which 5,650 were on disability issues. The pending load of 2,510 cases on July 1, 1959, was reduced to 1,685 by July 1, 1960. After reviewing the program operations, the Subcommittee on the Administration of the Social Security Laws of the House Ways and Means Committee reported that “by and large, the subcommittee is satisfied that the Social Security Administration has done an admi¬ rable job in handling the ‘appeals crisis’ occasioned by the disability provisions. The subcommittee believes that the great majority of hearing examiners are performing an exceedingly difficult task with tact and competency. Our random survey of disability applicants who have had hearings shows that the great preponderance believed they had been treated courteously and afforded a fair hearing. This is true even though a great many were not satisfied with the result in their case.” International Activities The Social Security Administration, through participation in inter-* national activities relating to social security, again added to mutual knowledge and insights on social welfare matters among nations of the world. Increased international cooperation was evident in Social Security Administration participation in expert groups concerned with program development, recruiting specialists for the United Nations, and providing training services for foreign nationals coming to the United States through both governmental and nongovernmental programs. Prominent among the wide range of international organization functions in which top Social Security Administration officials and specialists participated were meetings and other activities sponsored by the International Social Security Association, United Nations agencies, the International Labor Organization, and the Organization of American States. Such participation included attendance of the Social Security Administration 17 Commissioner of Social Security at the October 30-November 9 Rome meeting of the Bureau of the International Social Security Associa¬ tion, the Commissioner’s appointment to the International Labor Organization’s Committee of Social Security Experts, and the Chief Actuary’s chairing of the Second International Conference of Social Security Actuaries and Statisticians, in Rome, October 22-October 28. As in past years, the Social Security Administration cooperated with the International Cooperation Administration in recruiting ex¬ perts in the fields of social welfare and maternal and child health. Fourteen experts were assigned to ICA overseas missions for some period during the year. The experts served in nine countries. There was increased cooperation in recruiting for United Nations social welfare positions. Cooperation was also given to the Depart¬ ment of State in recruiting social workers for overseas teaching positions. The Social Security Administration cooperated with the Depart¬ ment of State in developing U.S. materials for the next United Nations Biennial Report on Family and Child Welfare and other special international studies. Increased interest in social welfare I internationally was reflected in a number of United States Information i Agency requests for assistance in overseas exhibits. Social Security Administration programs became a part of the cur¬ riculum of the State Department’s Foreign Service Institute for the I first time, with an International Service staff member presenting ma- | terials and leading discussions. During the fiscal year the Social Security Administration’s In- i ternational Service planned training programs or conducted training sessions for 1,040 visitors from 75 countries. Requests for the train¬ ing came through the International Cooperation Administration, the United Nations, the World Health Organization, and increasingly through Department of State exchange programs, and various foun¬ dations and agencies. Of the nations represented by the trainees, 18 were Asian countries, 14 were African, 20 were European, and 18 were Latin American. Ethiopia, French West Africa, Guinea, Malta, and Nicaragua sent representatives for the first time. Old-age, survivors, and disability insurance benefits at the end of the fiscal year were being paid at the rate of $5.9 million a month to more than 90,000 beneficiaries in 101 countries. Teams of experts from the Bureau of Old-Age and Survivors Insurance visited points in the Pacific area and Hong Kong during the year in connection with administration of the benefits. Other intercountry interests and activities included Children’s Bureau consultation to numerous agencies in connection with inter- country adoptions and Bureau of Public Assistance cooperation with 18 Department of Health, Education, and Welfare, 1960 the Department of State in developing plans for assistance and serv¬ ices for repatriated American nationals. Old-Age, Survivors, and Disability Insurance In commenting recently on the significant advances made in the old-age, survivors, and disability insurance program, the Director of the Bureau of Old-Age and Survivors Insurance noted that “Today, 25 years after the enactment of the original Social Security Act, the old-age, survivors, and disability insurance program is firmly estab¬ lished as the basic method in the United States of assuring income to individuals and families who suffer a loss of earnings when the worker retires, becomes disabled, or dies.” At the close of the fiscal year, more than 14 million people were receiving old-age, survivors, and disability insurance benefits, and this number was increasing by about 90,000 a month. On January 1, 1960, 72 percent of the people aged 65 and over were eligible for old-age and survivors insurance benefits; 90 percent of the mothers and children in the Nation could count on monthly benefits if the family earner dies, and about 46 million workers were insured against loss of earnings because of disability. A significant development soon after the close of the fiscal year was the enactment of the Social Security Amendments of 1960. This new legislation eliminated the age-50 restriction on the payment of disability benefits, changed the retirement test provision so as to improve incentives to work, and liberalized the insured status re¬ quirements. The amendments also included provisions to encourage disabled people who are doubtful as to whether their work attempts will be successful to return to work ; to make some further extension of coverage; to increase benefit amounts for children of deceased workers in certain cases; to improve the benefit protection for de¬ pendents and survivors of insured workers in specified situations ; to simplify the method of computing benefit amounts; and to make several changes of a technical nature removing anomalies in the law and facilitating administration of the program. During the year, the Subcommittee on the Administration of the Social Security Laws of the Committee on Ways and Means of the House of Representatives surveyed Bureau administration of the disability insurance program. At the conclusion of the hearings, the chairman of the subcommittee stated that “. . . on the whole the program has been administered very fairly and with great ca¬ pacity by excellent public officials.” A preliminary report of the Social Security Administration 19 hearings recommended that several areas of administration be taken under study. Several of the recommendations made by the subcommittee resulted in legislative proposals that were adopted and enacted in the 1960 amendments. Other recommendations were administrative; some of these have already been put into operation. The Bureau’s Central Study Staff which had been organized in January 1959 to conduct a detailed study of the entire old-age, sur¬ vivors, and disability insurance claims process from receipt of applica¬ tion to certification of payment recommended that the Bureau proceed with all possible speed toward the fullest use of integrated and auto¬ matic data processing systems. The recommendation was approved by the Director and the Commissioner, and a Bureau Central Plan¬ ning Staff was established to spearhead the planning and coordination essential to the successful execution of the recommendation. The initial application of electronic data processing to payment center operations was installed in the Baltimore Payment Center during fiscal 1960 and will be extended to the other payment centers in January 1961. The new Social Security Building in Baltimore County was com¬ pleted during the year. Relocation of the Bureau staff, except the Baltimore Payment Center and operating segments of the Division of Disability Operations, was completed in April 1960. A contract has been let for construction of an annex to house the Division of Disability Operations and the Baltimore Payment Center; occupancy of the annex is planned for the spring of 1962. The consolidation of Bureau operations will bring about greater efficiency and improved service to the public. Total administrative expenses of the Bureau in fiscal year 1960 amounted to approximately 2.03 percent of tax contributions and 2.05 percent of benefit payments. What the Program Is Doing Beneficiaries and benefit amounts. — During the fiscal year ended June 30, 1960, benefits paid under the old-age, survivors, and disability insurance program totaled $10,798 million. Monthly benefit pay¬ ments during the 12 months were 15 percent greater than the amount for the preceding fiscal year and totaled $10,632 million ; this amount includes $528 million paid to disabled workers aged 50-64 and their dependents. Lump-sum death payments rose 11 percent to $166 million. The number and amount of monthly benefits in current-payment status showed substantial gains. In June 1960 almost 14.3 million beneficiaries were receiving benefits at a monthly rate of $889.9 20 Department of Health , Education, and Welfare, 1960 million — increases from June 1959 of 1.1 million in number of bene¬ ficiaries and $84.3 million in amount of monthly benefits. The in- | crease in number was 8 percent, and the rise in the monthly amount i almost 11 percent. The increase in the monthly rate resulted from (1) the growth in the total number of beneficiaries and (2) the rising proportion of benefits based on recent higher earnings with as many as 5 years of lowest earnings and periods of total disability omitted from the benefit calculation. Men aged 65 or over and women aged 62 or over made up almost , 11.5 million (80 percent) of the beneficiaries — 7.8 million of them were retired workers and 3.7 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 2.8 million (20 percent), 1.9 million were children, about 534,000 were mothers, and 371,000 were disabled workers aged 50-64. About 2.2 million monthly benefits were awarded in fiscal year 1960. New highs were reached for child’s benefits (380,000) and mother’s benefits (94,000) . Contributing to the record number of child’s bene¬ fit awards were the 62,000 made to children under age 18 of disabled- worker beneficiaries and the 33,000 to disabled dependent children aged 18 or over of disabled, deceased, or retired workers. Monthly benefits were awarded to 17 6,000 disabled workers aged 50-64. Lump-sum death payments during fiscal year 1960 numbered 819,000, about 62,000 more than the previous high established in fiscal year 1959. About 788,000 deceased workers were represented in these awards. The average lump-sum amount per worker was $210.40. In June 1960, the average old-age insurance benefit paid to a retired worker who had no dependents also receiving benefits was $70 a j month. When the worker and his wife both received benefits, the average family benefit was $123. Families consisting of a widowed mother and two children received on the average $173. Among beneficiaries on the rolls at the end of June 1960, whose benefits are based on earnings after 1950, the average for a retired worker with no dependents receiving benefits was about $78, for an aged couple about $133, and for a widowed mother and two children about $199. Disability provisions. — During the fiscal year, about 190,000 workers — those under age 50 as well as those aged 50 or over — were found to be disabled; their social security records were frozen to protect their benefit rights. Those aged 50-64 qualified for monthly disability benefits calculated as though the worker had already reached retirement age at the time his disability began. Applications from about 105,000 workers were denied because of failure to meet the test of disability. The number of disabled workers aged 50-64 receiving disability in¬ surance benefits rose 35 percent in the fiscal year and totaled 371,000 21 ) Social Security Administration in June. About 151,000 benefits were being paid in J une to dependents I of disabled-worker beneficiaries. Moreover, on June 30, 1960, there were an estimated 101,000 disabled workers under age 50 with an | established disability freeze. By the end of 1959, the latest date for which this information is | available, about 68,500 persons were receiving old-age benefits in¬ creased by an average $9.41 a month because their social security records were frozen for periods while they were disabled before reach¬ ing retirement age. The higher benefits were attributable both to the exclusion of a period of disability, and to the dropping of as many as 5 years of lowest earnings in computing the worker’s average monthly | wage in cases where the worker had retired without qualifying for a , dropout and eligibility for the dropout therefore stemmed from the ! disability freeze. About 22,900 wives and young children of retired workers and about 26,900 widows, children, and dependent parents of workers who had their social security records frozen before death were also receiving larger monthly benefits because of the freeze. F or the same reason, lump-sum death payments in 1959 based on the earn¬ ings records of 13,800 deceased workers were increased by an average of $23.33 per worker. Child’s monthly benefits are payable to disabled persons aged 18 or over — dependent sons and daughters of deceased, disabled, or retired I insured workers — whose disability began before age 18. During the j fiscal year 28,000 persons met the disability requirements for child’s i benefits and 4,000 failed to meet the test of disability. By the end of June 1960 such child’s monthly benefits were being paid to 95,000 persons at a monthly rate of $4.1 million. About 13,600 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 68 million were insured at the beginning of the calendar year 1960. Some 34 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 their 'families are protected if they die. (Included in this total were some three- fourths of a million women aged 62-64 who were al¬ ready eligible for old-age benefits but on a reduced basis.) The re¬ maining 34 million were insured but must continue in covered work for an additional period to be insured permanently. 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 46 million of the insured persons under age 65 also met the insured status requirements for protection against the risk of long-term and severe disability. 22 Department of Health , Education , and Welfare, 1960 Of the 15.7 million people aged 65 or over in the United States at the beginning of 1960, 72 percent were eligible for benefits under the program. Sixty-four percent were actually receiving benefits, and 8 percent were not receiving benefits because they or their husbands were receiving substantial income from work. Taking into account the liberalization in the requirement for fully insured status provided by the 1960 amendments, the percentage of aged persons who will be eligible for benefits at the beginning of 1961 is estimated to be 77. This percentage is expected to rise to 82 by the beginning of 1966. The coverage of the 'program. — An estimated 75 million persons worked under old-age, survivors, and disability insurance during the calendar year 1959. In addition, about 1 million persons employed 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 nonprofit em¬ ployees for whom coverage is available on a group-election basis and members of the Armed Forces, nine-tenths of all persons in paid em¬ ployment in the United States were covered or eligible for coverage under the program. Of workers not covered and not eligible for coverage, about one-third were covered by Federal, State, or local retirement systems. The re¬ maining two-thirds — 7 percent of the Nation’s paid employment — ’ consisted generally of persons who are not regular workers and are for the most part self-employed persons and domestic and farm workers who did not meet certain requirements of the law as to the amount of their earnings or the length of time worked. Income and disbursements. — Expenditures from the Federal Old- Age and Survivors Insurance Trust Fund during the fiscal year totaled $11,055 million, of which $10,270 million was for benefit payments,]: $583 million for transfers to the railroad retirement account and $202 million, including Treasury Department costs, for administrative expenses. Total receipts were $10,343 million including $9,843 million in net contributions and $500 million in interest on investments. | Disbursements exceeded receipts by $713 million, the amount of the decrease in the trust fund during the year. At the end of June 1960 this fund totaled $20.8 billion. Total assets of the old-age and survivors insurance trust fund, except for $1,080 million held in cash, were invested in United States Govern¬ ment securities as required by law ; $3.3 billion were invested in public issues (identical to Treasury securities owned by private investors), and $16.4 billion were invested in securities of varying maturities is¬ sued 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 2.63 percent. Social Security Administration 23 The Federal Disability Insurance Trust Fund was created by the Social Security Amendments of 1956. Contributions to this fund first i became payable in January 1957. Benefit disbursements began in ! August 1957. Expenditures from the Federal Disability Insurance [ Trust Fund during fiscal year 1960 totaled $560 million, of which | $528 million was for benefit payments and the remainder — some $32 million — for administrative expenses. Total receipts were $1,061 i million, including $987 million in net contributions, $26 million in ! transfers from the railroad retirement account, and $48 million in net interest. Receipts exceeded disbursements by $501 million, the amount of increase in the fund during the year. At the end of June 1960, the fund totaled $2,167 million. Assets of the disability insurance trust fund consisted of $2,101 million in U.S. Government securities and a cash balance of $66 ; million. The invested assets consisted of $83 million in public issues I and $2,017 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 2.64 percent. Administering the Program The Bureau’s planning theme for fiscal year 1960 was based on the premise of a relatively normal workload situation and called for continuation of efforts to achieve the best possible level of internal administration and service to the public. By the beginning of the fiscal year, new workloads stemming from the 1958 amendments had been well assimilated and the amount of work on hand at various work stations was generally current. Workload receipts during the year were slightly lower than expected and the workload-to-staff 1 relationship was more favorable than in recent years, when staffing was undesirably tight. As a result, the Bureau was able to intensively study its operations and to take steps to achieve improvement. Bureau staff at the end of the fiscal year totaled 25,079, not including 77 employees for whose services the Bureau is reimbursed. Man¬ power used during the year totaled 25,878 man-years, including 538 man-years of overtime. Overtime, however, as a percent of over-all staff time totaled only 2.0 percent, continuing the decreasing pattern of the past few years. In 1957, for example, overtime usage was equivalent to 9.4 percent of the total staff time. In the course of the year, the Bureau received more than 2,451,000 claims for old-age and survivors insurance benefits and approximately 438,000 claims for disability insurance benefits and the disability freeze. More than 3,345,000 new social security accounts for indi¬ viduals were established and over 2,915,000 duplicate account number 24 Department of Health, Education, and Welfare, 1960 cards were issued during the year. In addition, approximately 263,000,000 earnings items were received for posting to individual earnings records. The Bureau also processed 2,388,290 requests for changes in personal data pertinent to the records of individual ac¬ counts and issued approximately 1,370,000 statements of earnings. During the same period, district offices received more than 10,320,000 I inquiries concerning the old-age, survivors, and disability insurance program. The subcommittee appointed by the Chairman of the Committee i on Ways and Means to study the administration and operations of the social security laws started hearings in November 1959 on Bureau administration of disability insurance. As mentioned earlier, several of the subcommittee’s recommendations were adopted and enacted in the 1960 amendments. Much Bureau staff time had been devoted prior to the hearings to the preparation of a large volume of technical and program material required by the subcommittee in its study. This material furnished the basis for a “Disability Insurance Fact Book” released by the sub¬ committee in September 1959. The fact book, containing background information about the disability program, was designed to serve as a ready reference guide for the subcommittee members and their staff. The interest expressed by the subcommittee concerning the avail¬ ability to the public of rulings and procedures governing adminis¬ tration of the old-age, survivors, and disability insurance program gave added impetus to the Bureau’s three-fold program for publica¬ tion of these materials. This continuing program includes the first edition of the “Social Security Bulings, ” a revised edition of the “Social Security Handbook,” and the updating and expansion of the Social Security Kegulations. The first quarterly issue of “Social Security Kulings,” containing rulings in various areas, announcements of changes in the Social Security Act and Social Security Regulations, and items of public in¬ terest, was distributed in July. The new edition of the “Social Secu¬ rity Handbook” was also completed, and the revised issue distributed shortly after the end of the year. The Handbook, containing 242 pages of text, a detailed index of subject matter, and a chapter on related programs, is directed to people who want a more thorough understanding of the program than can be obtained from informa¬ tional pamphlets. The work of updating and expanding the Kegula¬ tions was started early in the fiscal year and was well under way by June. A draft of major additions to that part of the Kegulations pertaining to rights and benefits based on disability was prepared by the end of the fiscal year and was being cleared for publication. Pursuant to a recommendation of a committee of business leaders under the chairmanship of Mr. Reinhard A. Hohaus which studied Social Security Administration 25 Bureau operations in fiscal year 1958, a Central Study Staff was organized in January 1959 to conduct a detailed study of the entire old-age, survivors, and disability insurance claims process from re¬ ceipt of claim to certification of payment. The Study Staff submitted its formal report to the Director in September 1959, recommending “that the Bureau proceed with all possible speed toward the fullest exploitation of integrated and automatic data processing equipment and systems and that the Bureau make such changes in process, as¬ signment of functions, and organization as may be necessary and feasible.” The recommendation was approved, and a Central Plan¬ ning Staff was established to spearhead the planning and coordina¬ tion essential to the successful execution of the recommendation. The recommendation calls for an ultimate claims system in which all action stations will be linked by a data transmission system and for the use of electronic data processing equipment in the preparation of earnings statements, beneficiary recordings, claims payment, and ad¬ justment processes. During the fiscal year, much of the planning and testing for the development of this system was completed. The initial application of electronic data processing to payment center operations was installed in the Baltimore Payment Center be¬ ginning with certification of disability insurance benefit payments for September 1959. In May 1960, electronic data processing operations were extended to old-age and survivors insurance claims serviced by this payment center. Accounting records controlling the disability beneficiary roll and the roll of beneficiaries living abroad were con¬ verted from punch cards to magnetic tape, and programs and proce¬ dures were installed to perform on electronic data processing equip¬ ment the accounting and certification operations essential to the pay¬ ment of these claims. These new techniques have resulted in simplified operations and the reduction of processing time, as well as permitting electronic updating of beneficiary rolls. Because punch cards used in check writing are now being produced as a by-product of electronic data processing operations, the Treasury Department was able to con¬ vert its payment records from addressograph plates to tabulating cards. In addition, the magnetic tape records in the Baltimore Pay¬ ment Center have been expanded to include additional data such as name and address for check writing purposes and for use in auto¬ matic preparation of certificates of award and related forms and no¬ tices. Electronic data processing is scheduled for extension to other payment centers in fiscal year 1961. Most of the basic planning for the transitional phase of electronic data processing operations has, likewise, been completed. During the fiscal year, extensive research on the feasibility and general outline of a national data transmission system was conducted with communications companies, and a pilot installation was designed. 573826—61 - 3 26 Department of Health , Education, and Welfare, 1960 The pilot system, involving 26 district offices in one region, 3 payment centers, one regional office, and headquarters offices in Baltimore, will be operated from July through December 1960. Data and experience obtained from the pilot test will serve as guides in the development of equipment needs, circuitry and procedures, in establishing the final nationwide system. One of the highlights of the year was the completion of the new Social Security Building on the outskirts of Baltimore. Relocation of the Bureau staff, except the Baltimore Payment Center, and oper¬ ating segments of the Division of Disability Operations, from 11 scattered locations in downtown Baltimore occurred in January through April 1960 with no interruption of operations. During the next fiscal year, the organizational and functional changes resulting from the move will be surveyed to identify any additional changes which appear to be warranted and would result in an improved opera¬ tion. On Saturday, June 18, a Family Day Open House was con¬ ducted and about 6,000 visitors toured the building. A formal dedication ceremony was held on July 1, and a Community Open House on August 16 provided further opportunity for some 3,600 guests to visit the building. To date, there have been visitors from 22 States, Washington, D.C., Puerto Rico, and several foreign nations. Construction of an annex to house the Baltimore Payment Center and operating segments of the Division of Disability Operations will be started in the fall of 1960, with completion scheduled for the spring of 1962. The establishment of these units in 1954 and 1958 increased space needs beyond the capacity of the new building as originally planned in 1953 and necessitated this additional construction. Significant improvements in the earnings record operation were achieved in fiscal year 1960 through the use of new and improved electronic data processing equipment and the extension of electronic data processing operations resulting from the introduction of this equipment. During the year, 3 Model III-IBM-705 electronic com¬ puters were placed in operation in the new Social Security Building, replacing 2 Model II computers of lesser speed and capacity. The installation of these machines was timed to coincide with occupation of the new building. The new computers presented opportunities for increased speed and efficiency in the mass processing of earnings record data; two of the most important of the improvements are described below. In the first half of the fiscal year, a series of pilot tests was conducted to validate programs and procedures developed for the extension of electronic data processing in the operations concerning the processing of earnings record items. The use of electronic data processing was introduced into the processing function immediately after initial punching of earnings cards. Subsequent operations, formerly per- Social Security Administration 27 formed on punch card equipment, required physical manipulation of individual cards for each item, and a series of electric accounting machine reproducing, sorting, tabulating, re-sorting, listing, and auditing processes. With the use of magnetic tape, the data are now processed through a series of operations on the IBM Model III-705 computer; the manipulation of data and the sorting and balancing operations are performed by the computer itself. Another important improvement resulting from use of the Model III-705 is in file reference techniques. The Model III has made it possible to search the entire reference file for summary earnings data (to be used primarily in connection with applications for benefits and requests for earnings statements) within 2 days at less cost than the former search requiring 3 days. Plans are now being developed to perform the complete file search on a daily basis. The Bureau has relieved employers using electronic data processing systems compatible with Bureau equipment of some of their reporting burden by permitting them to submit their quarterly wage reports on magnetic tape. Currently 17 employers who report approximately 1,480,000 earnings items quarterly are reporting by this means. The tapes are processed through the Model II 1-705 and all necessary proc¬ essing operations are performed electronically. This system of re¬ porting has resulted in reducing both the cost and the time required to process the earnings items without placing any additional burden on the employers. During recent years, considerable progress has been made in obtain¬ ing quarterly earnings reports earlier and in a form that permits more rapid posting to individual accounts. A system was inaugurated during the past year whereby quarterly earnings reports from 16 employers having 50,000 or more employees are transmitted via the servicing district offices rather than through the Internal Revenue Service. These employers currently report approximately 1,800,000 items quarterly. Quarterly tax reports are thereby received earlier — the average time was improved by 14 days in the quarter ending December 1959 — assuring a more level workload at the start of the quarter and thus making more efficient use of staff and equipment. During the coming year, plans have been made for extending this procedure to employers with 20,000 or more employees. It is esti¬ mated that the planned extension will result in the direct submittal of approximately 1,500,000 earnings items from 87 additional employers. With a large part of the earnings record operations now highly automated, the Bureau has been giving careful consideration to the manual operations still remaining. Among these, top priority is being given to studies seeking an acceptable microfilm substitute for the SS-5 file, which occupies approximately 36,000 square feet of floor space and is used to house all original applications for social security account 28 Department of Health , Education , and Welfare , 1960 numbers and subsequent changes in these records. The Bureau is col¬ laborating with private industry in the research and development of the special photo-electronic process required for this project. A gen¬ eral description of the file and its usage has been provided to engineers conducting the research and development of the special processes. In the meantime, detailed cost estimates for the operation and mainte¬ nance of the present file are being developed for comparison and evalu¬ ation of any proposals that may be developed. During the year, the Bureau continued efforts to have greater em¬ phasis placed on complete and accurate wage and self-employment income reporting, and auditing activities. The Bureau prepared a detailed proposal under which the Internal Revenue Service would undertake a number of canvassing, auditing, and returns-processing activities designed to serve old-age and survivors insurance needs. The proposal was submitted to Internal Revenue Service for considera¬ tion as a budget item in the development of their own plan for im¬ provement in the collection of social security tax contributions. In addition, the Bureau has prepared specifications under which the Bureau would do the canvassing, auditing, and processing activities that seem to be essential to complete coverage, proper reporting, and prompt and accurate processing of tax returns. All of these activities will be studied and developed in greater detail in the coming fiscal year as a joint effort of the Bureau and the Internal Revenue Service. An on-the-spot study and evaluation of the program in Europe was conducted in the summer of 1959. A survey team of two Bureau representatives visited Italy, France, Spain, and Greece to explore ways and means of facilitating the claims process and expediting service to claimants and beneficiaries in Europe as well as to insure the validity of benefits being paid. After returning to the United States in September 1959, the survey team made interim reports to the Bureau executive staff and an informational report was prepared for all Bureau employees. The final report was submitted to the Office of the Director in May 1960 and is now under study. Of the 14.3 million persons receiving old-age, survivors, and dis¬ ability benefits at the end of fiscal year 1960, 93,600 — about one-half of one percent — were living outside the United States. This figure includes persons traveling or living abroad temporarily. During the year, an agreement was negotiated with the Veterans Administration whereby its staff and facilities in the Philippines will be utilized, on a reimbursable basis, for services in connection with old-age, survivors, and disability insurance affairs originating in that area. F olio wing negotiation of the agreement, a Bureau team was sent to Manila to coordinate the transfer of functions, train the Veterans Administration staff in old-age, survivors, and disability Social Security Administration 29 insurance program and procedures, and to survey and report on problems of program administration in the Far East. The Veterans Administration office in Manila was opened to the public for old-age, survivors, and disability insurance business in May 1960. Legislative Developments During the Year The most important measure affecting old-age, survivors, and dis¬ ability insurance was the enactment, soon after the end of the fiscal year, of P.L. 86-778, the Social Security Amendments of 1960. This legislation was signed by the President on September 13. PROVISIONS OF THE 1960 AMENDMENTS Liberalizing the insured status requirements. — The work require¬ ments are liberalized so that, to be eligible for benefits, a person needs one quarter of coverage for every 3 calendar quarters elapsing after 1950 (or after the year in which he attained age 21, if that is later) and before the year in which he reached retirement age or died, whichever first occurred. In any case, as before, a person needs not less than 6 nor more than 40 quarters of coverage. (Calendar quarters in a period of disability are not counted as elapsed quarters unless they are quarters of coverage.) Under prior law, the require¬ ment was one quarter for every 2 elapsed quarters before the quarter in which those events occurred. About 400,000 additional people — workers, dependents, and sur¬ vivors — were made immediately eligible for monthly benefits as a result of this change. Of this total, about 250,000 were aged 65 and over. By January 1, 1966, an estimated 1,000,000 persons will be eligible for monthly benefits who would not qualify under prior law. Of this total, some 700,000 will be aged 65 and over. Improving incentives to work under the retirement test. — The re¬ tirement test — the provision in the law under which old-age and survivors insurance benefits are paid only to those people (under age 72) who have retired or who do not have substantial earnings from work — is charged beginning with 1961 by eliminating the requirement for withholding a month’s benefit for each $80 of earn¬ ings above $1,200 and providing instead for withholding $1 in benefits for each $2 of earnings between $1,200 and $1,500, and for each $1 of earnings above $1,500. There has been no change in the provision which specifies that regardless of the amount of annual earnings no benefits will be withheld for any month in which the beneficiary neither earns wages of more than $100 nor renders substantial serv¬ ices in self-employment. The new test reduces the deterrent to work that existed under the prior test, since a beneficiary can accept a job at any earnings level 30 Department of Health , Education, and Welfare, 1960 above $1,200 knowing that he will always have more in combined benefits and earnings than he would have if he limited his earnings to $1,200. Under the new test about 400,000 people will start to get benefits or will get more benefits for 1961 than they would if the law had not been changed. A test of this general sort was discussed in the Department’s report on the retirement test that was submitted to the Committee on Ways and Means of the House of Representatives in March 1960. Increasing the benefit amounts for children in certain survivor cases. — The benefit of each child of a deceased worker is now three- fourths of the primary insurance amount of the deceased worker (subject to the maximum amount payable to the family). Hereto¬ fore, it had been one-half of the primary insurance amount, plus one- fourth of the primary insurance amount divided by the number of children. About 400,000 children will receive higher benefits as a result of this change, beginning with the check for December 1960. Improving the benefit protection available to dependents and sur¬ vivors of insured workers in specified situations. — Benefits are now provided for the survivors of workers who had acquired 6 quarters of coverage and who had died before 1940. (Under prior law, monthly survivor benefits were payable only in the case of deaths after 1939.) About 25,000 people — most of them aged widows — were made eligible for benefits by this change. Benefits are also now payable to a person as the wife, husband, widow, or widower of a worker if this person had gone through a mar¬ riage ceremony in good faith in the belief that it was valid, if the mar¬ riage would have been valid had there been no impediment, and if the couple had been living together at the time of the worker’s death or at the time an application for benefits was filed. Benefits can also be paid to the child or stepchild of a couple who had gone through a marriage ceremony even though an impediment prevented the cere¬ mony from resulting in a valid marriage. For the purposes of these provisions, an impediment is defined as an impediment resulting from a previous marriage — its dissolution or lack of dissolution — or resulting from a defect in the procedure followed in connection with the marriage. A child can now get benefits based on his father’s earnings even though, at the time of his father’s death, he was living with and being supported by his stepfather. The change extends to the child living with his stepfather the protection already afforded on the father’s earnings for other children, including children living with and being supported by other relatives. A wife, husband, or stepchild can become entitled to benefits based on the earnings of a retired or disabled worker if the relationship to the worker has existed for at least one year. This time requirement in Social Security Administration 31 cases where the worker is alive is the same as that which now applies when the worker is deceased. Simplifying the method of computing the average monthly wage , on which benefit amounts are based. — Under the previous law, a per¬ son’s average monthly wage was computed over a span of time that varied with the age of the person at the time he filed an application for benefits or for a benefit recomputation (and could also vary de¬ pending on whether he worked before attaining age 22) . Asa result, a person’s benefit amount could vary with the date on which he ap¬ plied for benefits. Thus, a person who did not understand the rather complicated provisions of the law, or did not knowT what his earnings would be in future years, occasionally could find that he had not ap¬ plied for benefits at the most advantageous time. The average monthly wage now is figured from a constant number of years for each particular person, regardless of when he actually applies for benefits. The number is generally equal to five less than the number of years after 1950 and before the year in which the worker attained retirement age (65 for men and 62 for women) . Elimination of age-50 requirement for eligibility for disability in¬ surance benefits. — Benefits for disabled workers under age 50 will be payable for the first time for November 1960. The elimination of the requirement that a person must have attained age 50 in order to be eligible for disability insurance benefits closes an important gap in the protection offered under the old-age, survivors, and disability in¬ surance program. The need for benefits is as great, or greater, for the severely disabled under age 50 as it is for those age 50 or over. Disabled workers under age 50 are more likely than the older disabled workers to have a dependent family and less likely to have savings. Perhaps 125,000 workers — and at least that many dependents of these workers — will be able to qualify for benefits immediately. Trial period of work for disability beneficiaries. — Under the new law, beneficiaries who go to work despite severe handicaps can con¬ tinue to be paid their benefits for 12 months — whether they go to work under a vocational rehabilitation plan or on their own. Before the enactment of the amendments only disabled persons who returned to work under a State-approved vocational rehabilitation plan could continue to draw benefits during such a trial work period. On the basis of the first 9 months — not necessarily consecutive — in which they work, a decision will be made as to whether the work done by the beneficiary shows that he has regained his ability to work. If he is found able to engage in substantial, gainful activity, and therefore is no longer disabled within the meaning of the law, he will still receive benefits for 3 additional months. The amendments also provide that beneficiaries who recover from their impairments before they have worked 9 months, as well as beneficiaries who recover before 32 Department of Health , Education, and Welfare, 1960 they have tested their ability to work, will receive benefits for 3 months after recovery. This provision for the payment of benefits after recovery recognizes that a person who recovers from a severe and long-term impairment, especially if he has spent a long period in a hospital or a sanitarium, may require benefits for a brief interval during which he is becoming self-supporting. For disability beneficiaries on the benefit rolls at time of enactment of the legislation, the first month a trial-work period can begin is October 1960. For future cases the period will begin with the month in which a person becomes entitled to benefits on account of disability. Modification of ivaiting period in cases of recurring disability. — The amendments provide that workers who become disabled a second (or subsequent) time will not be required to undergo another six-months’ waiting period if the prior period of disability was terminated no more than 5 years before the onset of the current disability. The provision is designed to remove a possible deterrent to the disabled individual’s return to work in cases where he is in doubt as to whether his attempt to work will prove successful. Family employment. — The family employment exclusion is changed to provide coverage for certain services performed after 1960 by parents in the employ of their adult children. The services covered are those performed by the parent in the course of the employer’s trade or business. Domestic services in or about the child’s home and other work not in the course of the child’s trade or business continue to be excluded. Guam and American Samoa. — The amendments extend coverage to about 8,000 employees and self-employed persons in Guam and about 2,000 in American Samoa. In general, coverage is effective beginning January 1, 1961. Employees and officers of the Government of Guam will be covered on a compulsory basis but their coverage will not be¬ come effective until the Governor of Guam certifies that the Guam¬ anian Government wants its officers and employees to be covered. A comparable provision is included for employees of the Government of American Samoa. Filipino workers who come to Guam under contracts to work temporarily are excluded from coverage. Employees of nonprofit organizations. — The amendments eliminate the requirement that two-thirds of the employees of a nonprofit or¬ ganization must concur for the organization to elect coverage for its employees. Another provision permits certain earnings reported by nonprofit organizations (that failed to comply with the requirements for extending coverage to these employees) to be credited to the worker’s account. Ministers. — Most ministers and Christian Science practitioners who have had earnings for at least 2 years were, prior to the passage of the amendments, barred from electing coverage. The amendments Social Security Administration 33 permit them an additional opportunity, generally until April 15, 1962, to make the election. Employees of foreign governments and international organiza¬ tions. — The amendments extend coverage on a compulsory basis to service performed within the United States by United States citizens in the employ of foreign governments or their wholly-owned instru¬ mentalities and of international organizations. These employees, numbering about 5,000, will be covered as though they are self-em¬ ployed persons. Coverage is effective beginning with taxable years ending on or after December 31, 1960. Employees of State and local governments. — The 1960 amendments contain a number of provisions that are designed to facilitate the cov¬ erage of public employees. The most important of these is a provi¬ sion permitting groups of public employees who are brought under the program after 1959 to have their coverage begin as early as the first day of the fifth year preceding the year in which their coverage is arranged (but not before 1956) . Another provision places a time limi¬ tation on the period within which the Secretary may assess unpaid social security contributions and on the period during which contri¬ butions that a State has erroneously paid may be refunded. This pro¬ vision is comparable to the statute of limitations of the Internal Reve¬ nue Code applying to nongovernmental employment. Employees of Farm Credit Banks. — Other legislation enacted by the 86th Congress (P.L. 86-168) provides coverage for persons who first enter after December 31, 1959, the employ of Federal land banks, Federal intermediate credit banks, and banks for cooperatives. Implementing certain recommendations made by the Advisory Council on Social Security Financing. — In general, the procedure re¬ lating to the investment of the old-age, survivors, and disability in¬ surance trust funds is strengthened by making the interest earnings of the trust funds more nearly equivalent to the rate of return being re¬ ceived by people who buy Government obligations in the open market. Miscellaneous. — Other changes, mostly of a technical nature, were made to simplify the law and make it fairer and to facilitate adminis¬ tration of the program. Special Study Requested by the Congress The Committee on Ways and Means of the House of Representa¬ tives, in connection with its consideration of proposed changes in the Social Security Act, requested that the appropriate Federal agencies accelerate their efforts in finding a workable and sound solution to the problem of providing old-age, survivors, and disability insurance pro¬ tection for Federal civilian employees, and to report it to the Con¬ gress at the earliest opportunity. 34 Department of Health , Education, and Welfare, 1960 Surveys of the Status of Beneficiaries Under the Old - Age , Survivors , and Disability Insurance Programs The Bureau of Old-Age and Survivors Insurance is conducting surveys of the resources of beneficiaries, from several different aspects. One type of survey, conducted periodically between the years 1941 and 1957, has provided a picture of the economic situation of bene¬ ficiaries in a given year. Another type of survey, to be conducted for the first time in the spring of 1961, is designed to show what happens to retired people over the course of years. The Bureau in its earlier surveys has obtained information on the sources and amount of the income of beneficiaries, the extent of their home ownership, the amount of their other assets and liabilities, and their expenditures on such items as housing, medical care, and health insurance. In the forthcoming retirement history study the Bureau will attempt to obtain similar information but over a prolonged period of years. To do this, a sample of persons will be interviewed shortly after they come on the benefit rolls, and again a year later and every 2 or 3 years thereafter for a period of 12 years, to measure the long-term changes in the situation of beneficiaries and their adjustments to such changes. In the field of disability, a survey has been planned in order to remedy the lack of information on the economic situation of persons drawing disability benefits. The survey has been designed to obtain current data as well as information needed to plan a long-term study of a sample of disabled persons. A study of persons recently granted public assistance is being planned by the Bureau of Public Assistance and the Bureau of Old- Age and Survivors Insurance, to determine why some public assistance recipients do not receive old-age, survivors, and disability insurance benefits and why some old-age, survivors, and disability insurance beneficiaries require public assistance. After a representative sample of persons granted assistance is obtained from the State public as¬ sistance agencies, information regarding the old-age, survivors, and disability insurance status of these recipients will be obtained from Bureau of Old-Age and Survivors Insurance records and through home interviews. Another study in preparation by the Bureau of Old-Age and Survivors Insurance is a survey of State and local government re¬ tirement systems, which has been designed to compare the benefits and contributions of these systems before old-age, survivors, and dis¬ ability insurance coverage with the combined benefits and contribu¬ tions under both old-age, survivors, and disability insurance and State and local systems. Social Security Administration 35 Program Simplification Considerable progress was made in the Social Security Amend¬ ments of 1960 under the Bureau’s program for achieving a simpler old-age, survivors, and disability insurance program — one that is easier to understand, accept, and administer. Major simplifications were achieved in the computation of benefits, the payment of the lump-sum death benefit, and the amount of the benefit payable to surviving children. Other simplifications made in the 1960 amendments involved (1) the conditions under which a benefit amount can be recomputed, (2) the dependency requirements of a child on his natural or adopting father, (3) the determination of fully insured status, (4) the granting of quarters of coverage for cases of maximum earnings in years before 1951, (5) the duration-of -relationship requirements, and (6) the de¬ termination as to whether an individual entitled to disability insurance benefits is able to engage in substantial gainful activity. Other simplification proposals were also developed but because of time limitations and other factors they were not submitted to the Congress during the 1960 legislative session. As a result, there is now accumulated a backlog of these proposals, and they will be available for presentation to the Congress when revisions of the Social Security Act are again considered. Financing the Program The old-age, survivors, and disability insurance system, as modified by P.L. 86-778, has an estimated benefit cost that is very closely in balance with contribution income. In enacting the 1960 amendments Congress again made clear its intent that the program be self-sup¬ porting from contributions of covered workers and employers. Care¬ ful review was given to long-range actuarial cost estimates prepared for use of the congressional committees in their legislative considera¬ tions. The program as amended continues to be financed on an actuarially sound basis. The difficulties involved in making exact predictions of the actuarial status of a program that reaches into the distant future are widely recognized. If different assumptions as to, say, interest, mortality, retirement, disability, or earnings had been used, different results would have been obtained. Accordingly, no one set of estimates should be looked upon as final. It is the Department’s policy con¬ tinually to re-examine the long-range cost estimates of the program in the light of the latest information available. Old-age and survivors insurance benefits. — The level-premium cost of old-age and survivors insurance benefits after 1959, on an interme- 36 Department of Health, Education, and Welfare, 1960 diate basis, assuming interest at 3.02 percent and earnings at about the levels that prevailed during 1959, is estimated at 8.42 percent of payroll (after adjustments to allow for administrative expenses and interest earnings on the existing trust fund) . The level contribution rate, equivalent to the graduated rates in the law, is estimated at 8.18 percent of payroll, leaving a small actuarial insufficiency of 0.24 per¬ cent of payroll. In view of the very long range over which these projections are made, and the many variable factors included, the insufficiency is so small that the system may be considered in 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 (ad¬ justed to allow for administrative expenses and interest) on an intermediate basis is 0.56 percent of payroll. Contribution income has been specifically allocated to finance these benefits ; this income is equivalent to 0.50 percent of payroll, leaving a small actuarial insufficiency of 0.06 percent of payroll. Considering the possible variability of cost estimates for disability benefits over the long-range future* this small deficiency is not significant. Public Assistance The 25th anniversary of the federally aided public assistance pro¬ grams in August 1960, and preparation of special reports and other technical materials for Congress during the year served to focus at¬ tention on program evaluation. The concentrated study of many facets of the program revealed the important role of public assistance in meeting individual want during the past quarter century, identified areas still needing consideration, and produced guidelines for further developments that can have significant impact on the lives of many in the Nation in the years ahead. Congressional consideration of various proposals for helping to meet the medical care needs of the American people also resulted in the passage of legislation in August 1960 making more adequate provi¬ sion for the medical care of old-age assistance recipients, as well as of the aged who can meet their maintenance needs but do not have sufficient resources for the costs of their medical care, A Quarter Century in Retrospect The flexibility inherent in the public assistance programs has per¬ mitted their adaptation to changing needs in the rapid economic and social change of the past quarter century. For example, between February 1936, when public assistance payments were first made with Social Security Administration 37 Federal financial participation, and January 1940, when the first monthly benefits were paid under old-age and survivors insurance, the public assistance programs carried major responsibility for providing basic economic security to the needy aged and blind and for needy children in their own homes deprived of parental support or care because of the death, disability, or absence of a parent. However, as amendments in the ensuing years liberalized insurance benefits and extended coverage (until 9 out of 10 persons in the work¬ ing force and their dependents are now covered), the public assist¬ ance programs shifted into the secondary and supplementary role originally intended. By June 1960, fewer than 6 million persons were receiving federally aided public assistance in contrast to over 14 mil¬ lion receiving insurance benefits. Similarly, adaptations have been made in the coverage and the services provided under the public assistance programs as the major factor contributing to dependency has changed from unemployment in the early 1930's to disability, chronic illness, advanced age, and family disruption in the 1950’s. LEGISLATIVE CHANGES Legislative changes prior to I960 which broadened the scope and coverage of the public assistance programs include : 1. establishment of a new federally aided category of aid to the permanently and totally disabled in 1950 ; 2. extension of the federally aided assistance programs to Puerto Rico and the Virgin Islands in 1950, and to Guam in 1958 ; 3. provision for F ederal financial participation in State public assistance expenditures for : a. aged, blind, or disabled recipients who are patients in public medical institutions, in 1950 ; b. costs of medical care or other remedial care paid directly to doctors, hospitals, and other suppliers of such services, in 1950 ; c. needy adult caretakers of children in the ADC program, in 1950; and d. children 16 and 17 years of age without regard to school attendance, and children living with first cousins, nieces, and nephews (in addition to previously specified relatives) in the ADC program, in 1956 ; and 4. emphasis on the provision of social services to help recipients achieve increased self-care, self-support, and stronger family life, in 1956, by : a. clarifying the objectives of public assistance as including both financial assistance and other services, and b. recognizing that the cost of providing such services is a proper cost of administering public assistance. 38 Department of Health , Education, and Welfare, 1960 Other amendments from 1939 through 1958 made various changes that increased Federal grants to the States by: 1. raising the maximum on the monthly amount of assistance for which Federal financial participation would be available (e.g., from $30 a month for an individual old-age assistance pay¬ ment in 1935 to a $65 monthly average payment per recipient in 1958); 2. increasing the proportion of Federal participation in that part of the assistance payment subject to Federal sharing (e.g., from % of the monthly money payment to old-age assistance re¬ cipients in 1935 up to 4/5 of the first $30 a month average pay¬ ment plus half the balance for money payments to recipients up to a $60 maximum, and half of separate payments to vendors for medical and remedial care up to $6 per recipient in 1956) ; and 3. changing the basis of Federal financial participation in the second part of the payment (1958) so that : a. the Federal share was related to a single maximum aver¬ age expenditure per recipient for both money payments to re¬ cipients and vendor payments for medical care ; b. the maximum amount of State expenditures for public as¬ sistance, including medical care, in which the Federal Government will participate was established for each program at an amount equal to $65 a month times the number of aged, blind, and dis¬ abled recipients in the State and to $30 times the number of re¬ cipients in ADC ; and c. the fiscal ability of each State was taken into account in de¬ termining the F ederal share of that part of a State’s average ex¬ penditure per recipient above $30 in the adult categories and $17 in aid to dependent children. Amendments to the Social Security Act in August 1960 made it pos¬ sible for the Federal Government to help States provide more medical care for older people after October 1, 1960. (See details on pages 47-48.) INCREASING ACCEPTANCE OF PUBLIC WELFARE MEASURES Changes in the public assistance provisions of the Social Security Act reflect changing attitudes toward the alleviation of destitution. As the Nation became industrialized, we moved from the earlier gen¬ eral belief that almost everyone could achieve security for himself and his family through his own effort and that most people who needed community help were shiftless or lazy, to a growing awareness that individuals were increasingly subject to the impersonal forces of a money economy. The typical American family changed from a large, highly integrated, self-sufficient farm family to a smaller city family dependent on wages and subject to strains that weaken family co- Social Security Administration 39 hesion. Many individuals and families became less able to provide for their own economic security in the face of hazards encountered by most people from time to time. The depression years in the 1930’s also helped to change the thinking of many, for there was much evidence that destitution can result not only from personal inadequacies but from forces over which the indi¬ vidual has little or no control. The growing number of dependent aged persons and young children also created new economic and social problems. Increasing acceptance of the concept that it is economically unsound as well as morally wrong to let people go without needed help led to the planning which culminated in the passage of the Social Security Act. Higher regard for the individual. — Many provisions of the public assistance titles of the Social Security Act also reflect increasing con¬ cern about the importance of respecting the dignity of the individual and recognizing his rights as well as his responsibilities. For ex¬ ample, the definition of assistance as a money payment, in contrast to the earlier usual relief in kind, leaves with the needy person respon¬ sibility, like that of others in the community, for deciding how best to use his income to meet his basic maintenance needs. Provision is made for a hearing before the State agency to protect individual rights when a needy person has been denied aid or is dissatisfied with the amount of his assistance payment, or when his application has not been acted upon with reasonable promptness. To safeguard his privacy, disclosure by the agency of personal information is prevented for purposes other than the administration of the program. To raise standards for the care and protection of needy people in institutions, a 1950 amendment requires the State to designate an authority respon¬ sible for establishing and maintaining standards for institutions in which recipients of federally aided assistance reside. Provisions for costs of medical care improved. — Amendments to the act in 1950, 1956, and 1958 were designed to improve medical care pro¬ visions for the needy. In 1950, the definition of “assistance” was broadened to include vendor payments ( payments for medical care and other remedial care made directly to the suppliers of such services). However, the amount subject to Federal financial participation had to come within the maximum individual assistance payments specified in the act. In 1956, in addition to Federal participation in individual money payments, provision was made for separate Federal sharing in a State’s total expenditures for vendor payments under each pro¬ gram 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. In 1958, the basis for Federal sharing in State expendi¬ tures was changed to bring both money and vendor payments within a new single averaging formula. This made it possible for the Federal 40 Department of Health , Education , and Welfare , I960 Government to share with the States in larger medical expenses in in¬ dividual cases. (For provisions of 1960 amendments relating to medi¬ cal care, see pages 47-48.) By June 1960, 44 out of 54 jurisdictions had some provision in their public assistance programs for costs of medical care through the ven¬ dor payment. This method of payment was used for hospitalization in 33 jurisdictions, for practitioners’ services in 30, and for nursing home care in 15 ; and a combination of the vendor method of payment and the money payment (within the limits of the State’s maximum on individual assistance payments) was used by 7 jurisdictions to meet an established rate for nursing home care. Some of the 44 jurisdic¬ tions using the vendor payment, and 6 out of the 10 remaining juris¬ dictions, also provided for some items of medical care in the money payment to the recipient. Welfare services strengthened. — A 1956 amendment clarified the scope of Federal financial participation in the costs of providing staff services in addition to financial aid. This legislation stimulated or renewed activities by the States in helping needy persons to find and use their own strengths and other available resources to develop their potential for more satisfying and independent living. Although the extent and quality of services vary greatly across the country, heart¬ ening advances are being made. More people are being helped to greater self-sufficiency, with some savings in assistance costs ; and the benefits of cooperative effort by public and voluntary agencies and other groups in the community are being demonstrated. Services most generally provided have been in relation to the health needs of children and adults, and to the improvement of home condi¬ tions for children. For example, public assistance workers have in¬ creasingly provided or arranged for services that enable the needy aged or disabled person to remain in his own home and with his family and friends as long as possible. Some skilled workers have helped with more intangible but equally serious emotional problems. Projects in several States have arranged for specialized services and home-helps that enable some aged persons in nursing homes and mental hospitals to return to normal living patterns in the community. Other projects, using a team including doctors, rehabilitation and employment counselors, and social workers to consider latent ca¬ pacities and resources of handicapped individuals, have helped some disabled persons to become self-supporting or to embark on plans for at least partial rehabilitation. AREAS IDENTIFIED AS NEEDING FURTHER CONSIDERATION The 25th anniversary of the federally aided public assistance pro¬ grams marked a significant milestone of progress in the Nation’s concern for its needy. But it also identified groups for whom public Social Security Administration 41 assistance is not generally available, as well as program areas needing further strengthening. State and/or locally financed general assistance or institutional care is provided for many temporarily or permanently unemployable needy persons not included within the scope of the federally aided public assistance programs. However, no provision is made for gen¬ eral assistance in 17 States for employable persons and their families who are needy and have no other resources available to them even when limited education, lack of job skills, or discrimination prevents their earning enough to live decently and healthfully; or when they are unemployed, even though they are ineligible for unemployment insurance, receive benefits too small to maintain them, or have ex¬ hausted their benefits. In a few States, only some of these people in the direst circumstances can receive some assistance at some time. Nonresidents in most States are aided only in emergencies, and effort is made to return them to their State of residence as quickly as possible; only 13 jurisdictions have no durational residence require¬ ment. Limited, if any, financial assistance is available under private auspices to most of these needy persons. In many States, public assistance programs have come a long way during the past 25 years in providing more help and in extending such help to additional groups of needy people. Federal, State, and local governments have increased their expenditures substantially. But with limited funds, rising costs, and the shrinking value of the dollar, fewer than half the States are fully meeting “need,” 1 judged by standards they themselves have set. The other States either impose maximums on the monthly amount of assistance any individual or family may receive or meet only a specified proportion of need. In some States the standards themselves are inadequate. They either have not been revised in content or priced recently enough to maintain their currency in providing generally accepted and validated essentials of living. Other inadequacies result from State policies for evaluating the resources of recipients — for example, counting as income from relatives expected contributions that fail to materialize. Only limited funds are available for general assistance in many States. Therefore, stringent standards are applied in determining the degree of destitution that must exist before such assistance is granted. The amount of the assistance payment is necessarily at a level below those in the federally aided programs. The estimated average amount of general assistance per case in June 1960 was $67.48 (nearly half are family cases with about 4.6 persons per family) , com¬ pared with $58.06 per recipient of federally aided old-age assistance (excluding vendor payments for medical care under each program). 1 “Need” is defined here as the gap in income between the total cost of living essentials set by the State and the individual’s resources to meet that cost. 573826—61 - 4 42 Department of Health , Education , and Welfare, 1960 Inadequate 'provision to meet medical care costs. — Although some progress has been made in providing for more medical care services for more needy persons, wide variations exist both among the States and among the categories of needy persons in the types and quantities of medical care provided through public assistance or other State and local resources. Medical care provisions in most public assistance programs include only a few medical services. For example, in June 1960, 8 of the 33 jurisdictions that provided for hospitalization through public assist¬ ance vendor payments restricted their payment to care necessitated by acute illness or injury. (Seven of the 20 jurisdictions without provi¬ sion for hospitalization under public assistance have other State sys¬ tems of hospital care or other known sources available to needy persons.) The amount provided for medical care within the money payment is sometimes limited by the State’s maximum on assistance payments. Average monthly expenditures per assistance recipient for vendor pay¬ ments for medical care in June 1960 were $11.67 for the disabled, $10.52 for the aged, $6.36 for the blind, and $1.71 for a recipient of aid to dependent children. Comparable averages for recipients of general assistance are not available. Because of the high cost of medical care, it is evident that the unmet need is still considerable, since public assistance recipients include persons most in need of medical care and yet least able to pay for it. The increased Federal help to the States authorized by the 1960 amendments should make it possible for States to raise both the quality and quantity of medical care for many in need of such care. Disparity between provisions for the Tieedy aged and those for de¬ pendent children. — The national average monthly payment, including vendor payments for medical care, amounts to $67.90 for an aged recipient compared with the $29.08 payment per recipient of aid to dependent children (June 1960). This disparity may be related, to some extent, to the greater need of the aged for medical care and the availability of more care for them in many States. But undoubtedly it also reflects greater public acceptance of old age as a reason for dependency than of divorce, separation, desertion, or unmarried parenthood — the causes for the dependency of about 60 percent of the children receiving aid to dependent children today. Inadequate provision of other social services by qualified staff. — The 1956 “services amendment” stimulated increased planning for the provision of other welfare services to help needy persons increase their capacity for self-care or self-support and to maintain and strengthen family life. However, because of staff limitations and heavy work¬ loads, many States’ services plans, in general, attempt to define real- Social Security Administration 43 istically their responsibility by limiting the problems for which serv¬ ices would be provided, limiting services to those required in the de¬ termination of eligibility for money payments, or giving only those services that can be provided during regular contacts for eligibility determination. The States are increasingly aware of the importance of making staff time available for supportive services in addition to financial aid needed by many of the aged, the disabled, and one-parent families. But large caseloads, high staff turnover, and lack of staff skills also limit the availability and quality of services that can be provided by most agencies, since this kind of help often requires additional time and usually needs the knowledge and skill that come from professional social work training. The fact that only about 2 percent of public assistance caseworkers have had full social work training and only 15 percent partial training reflects not only the nationwide shortage of social workers but also the handicap under which public assistance agencies labor because of their relatively low salaries (in comparison with those in other governmental and voluntary agencies), heavy workloads, and the complex of professional and clerical content in the job. Although the “training amendment” in 1956 authorized additional Federal funds to help States to increase the number of persons quali¬ fied for work in the public assistance programs, no funds have been appropriated. Considerations for the Future Recommendations for dealing with some of the problem areas iden¬ tified through its study of the programs are included in the report of the Advisory Council on Public Assistance. This Council was estab¬ lished under a 1958 amendment to the Social Security Act to review the status of the public assistance program in relation to old-age, survivors, and disability insurance, the fiscal capacities of the States and the Federal Government, and any other factors bearing on the amount and proportion of the Federal and State shares in the public assistance program. Their report, Public Assistance — A Report of the Advisory Council on Public Assistance , submitted to Congress on December 31, 1959, including recommendations that reflect the consensus of a 12-member group with wide diversity of backgrounds and interests, points up significant areas for further consideration. For, while most of the recommendations deal with Federal- State methods of sharing the financial burden of assisting persons in need, they do so with a focus on finding ways of meeting unmet needs, improving assistance stand- 44 Department of Health , Education , and Welfare , I960 ards, and strengthening family life. They recommend, for example, that — Coverage be extended to all needy persons regardless of the cause of their need by : a. using Federal grants-in-aid to encourage States to include additional needy persons, such as the unemployed, the under¬ employed, and the less seriously disabled (and to reevaluate ex¬ clusions now in the law specifically directed to needy persons in certain institutions and foster homes) — giving the States freedom of choice in determining whether to administer public assistance as a single program or as separate categorical programs, and sug¬ gesting several options : a single category for all financially needy persons, adding a new category of general assistance to existing categories, retaining one or more existing categories and consoli¬ dating remaining needy groups in a single category, or expanding existing federally aided categories to include additional needy persons ; b. expanding the aid to dependent children program to in¬ clude any financially needy children living with any relative in their own home ; and c. limiting the use of Federal grants-in-aid to State programs imposing no residence requirements for eligibility. Standards of assistance be raised by : a. creating greater public understanding as to what consti¬ tutes a level of living sufficient to maintain health and well-being, with Federal leadership in (1) the development of up-to-date budget guides for typical families, (2) requiring States to report on the relationship of their own budgets and actual payments in relation to these budgets, and (3) publishing the data from indi¬ vidual State reports; b. extending the scope and improving the quality of medical care for which assistance payments are made without reducing money payments to recipients (through cooperative efforts of Federal and State governments and voluntary agencies, with greater Federal leadership and the help of a broadly consti¬ tuted Medical Care Advisory Committee) ; c. raising Federal matching maximums per recipient high enough so as not to hamper State efforts to provide assistance at levels adequate for health and well-being and to meet rising costs of basic living requirements and medical care; d. raising Federal matching maximums per recipient for ADC to an equitable relationship with the other programs, with any differences reasonably related to differences among the groups in the cost and content of their living requirements; and Social Security Administration 45 e. encouraging the States to apply the same assistance stand¬ ards to all categories of needy persons and to ensure that similar treatment is accorded to persons in similar circumstances. Individual and family life be strengthened by : a. appropriating funds authorized by Congress in 1956 for research and demonstration projects relating to strengthening family life and the reduction and prevention of dependency ; b. establishing a national institute (comparable to the Na¬ tional Institutes of Health) to conduct studies and demonstra¬ tion projects leading to strengthening of family life ; c. urging the Federal Government to encourage States to utilize appropriate available services of voluntary agencies, as well as involving them in studying problems of family disintegra¬ tion and breakdown and in developing coordinated programs for strengthening of family life; and d. assisting the States to increase the number of staff quali¬ fied to provide services needed by public welfare recipients to help prevent dependency and promote social rehabilitation by: (1) providing 100 percent Federal funds both to States for train¬ ing public welfare personnel and to accredited graduate schools of social work for training in strengthening family life and car¬ ing for the needs of the aging; and (2) encouraging States to establish and maintain salaries of public welfare personnel at levels required to obtain and retain competent personnel. Other recommendations concerning fiscal and administrative op¬ erations include support of the “open-end” method of appropriating Federal funds and the statement that the proportionate Federal share of the Nation’s total public assistance expenditures, including general assistance, should not be less than is provided under the Social Se¬ curity Amendments of 1958. Measures are also recommended to ex¬ tend coverage and increase social insurance benefits with a particular view toward reducing the need for public assistance. The Federal Government was also urged to encourage the States to establish ap¬ propriate advisory committees and in other ways to stimulate public interest and increase public knowledge of the role of public welfare programs, since “the more a community becomes a part of a public welfare program, the better it will be.” Similarly, the Bureau’s report, Illegitimacy and Its Impact on the Aid to Dependent Children Program , gives many significant guide¬ lines that can contribute to a better understanding of illegitimacy and to plans for dealing with it more constructively. This report, prepared by the Bureau of Public Assistance at the request of a congressional committee and issued in April 1960, out¬ lines factors contributing to the increase in illegitimacy. It identi- 46 Department of Health , Education, and Welfare, 1960 fies the problem of illegitimacy as one that long preceded the estal> lishment of public assistance programs ; and is a social problem at all income levels, with many underlying causes. It also points out that the concentration within aid to dependent children of families whose need is associated with socially disapproved behavior has increasingly made this program a target of criticism as more information has be¬ come available about the causes of dependency. Earlier concern related more to families where the father deserted ; recently, attention has been focused largely on families where the father has not married the mother. One in 25 of our Nation’s children is illegitimate; one in each 200 illegitimate children is in need. The socially unacceptable behavior of the parents of needy illegitimate children has been widely publi¬ cized and used by some as the basis of proposed legislation and admin¬ istrative regulations directed against the aid to dependent children program in general. Most of these State legislative proposals have never become operative. But others, which indirectly control the assistance payment through eligibility conditions and low payments, have resulted in depriving already disadvantaged children of needed support and care. The focus of concern — the 1 in 6 children receiving aid to dependent children whose need is directly related to unmarried parenthood — while of grave significance, has tended to obscure the value of the program in sustaining hundreds of thousands of needy children and in helping thousands of families to remain together — a sound investment in the physical and emotional well-being of our growing generation. The report also cautions that the problem of the child or the com¬ munity is not solved by denying assistance while leaving the child in endangering conditions. It suggests that any lasting solution must deal with the causative factors and must move forward on many fronts. The report, Characteristics of General Assistance in the United States , prepared by the Bureau and printed by the Senate Special Committee on Unemployment Problems in November 1959, provides a compilation of information about the basic characteristics of general assistance on a nationwide basis which can be helpful in the considera¬ tion of measures to deal with the needs of individuals not included within the scope of the federally aided public assistance programs. Information for each State, as of January 1959, includes a general description, conditions of eligibility, standards of assistance and pay¬ ment, and administration under general assistance; as well as infor¬ mation about other aid from public funds. In 1960, published information on the Nation’s public assistance pro¬ grams was more comprehensive than ever before. In addition to the material already mentioned, Characteristics of State Public Assistance Plans , a periodic publication of the Bureau of Public Assistance cover- Social Security Administration 47 ing the federally aided programs, was reissued in March 1960. A re¬ lease, Summary Information on Medical and Remedial Care Provided in Approved State Public Assistance Plans , was prepared as of June 1960. The December 1959 issue of the Trend Report — Graphic Pres¬ entation of Public Assistance and Related Data (published annually for the past 5 years) also provides selected data on the development of the special types of public assistance under the Social Security Act since 1935. Developments in 1960 NEW LEGISLATION In the closing days of the 86th Congress, the widespread consider¬ ation given to various methods of helping to meet the medical care needs of the aged resulted in amendments to the Social Security Act which provide for a new program of medical assistance for the aged, effective October 1, 1960. Under a revised Title I, “Old-Age Assistance and Medical Assist¬ ance for the Aged,” Federal funds are available to the States to enable them to provide assistance for persons 65 years of age and over who are not recipients of old-age assistance but who, although able to meet normal expenses, have insufficient income and resources to meet the costs of necessary medical services. Under the new pro¬ gram, the basis of eligibility is intended to be more liberal than under old-age assistance, a durational residence requirement is pro¬ hibited, and the types of medical care provided must include non- institutional as well as institutional care. Federal participation in payments made by the State to suppliers of medical care is not re¬ stricted by any specific maximum on either individual or average payments. The Federal share ranges from 50 to 80 percent depend¬ ing upon the relationship between the per capita income in the State and the national per capita income. The amendments also provide for increased Federal financial par¬ ticipation, effective October 1, 1960, in payments made by the States to suppliers of medical care in behalf of recipients of old-age assist¬ ance. In addition to the usual share in assistance payments up to a monthly maximum of $65 per aged recipient, the Federal Govern¬ ment will provide an additional amount based on expenditures for payments to suppliers of medical care up to a monthly maximum of $12 per recipient. For States with average monthly payments of $65 or more, the Federal share of the average amount of vendor medical payments up to $12 that brings the average payment above $65 will be the Federal medical percentage (ranging from 50 percent to 80 percent, depending on the State’s per capita income), or 15 48 Department of Health , Education , and Welfare, 1960 percent of the average vendor medical payment up to $12, whichever is the larger. For States with average monthly payments under $65, the additional Federal share will be 15 percent of the average vendor medical payment up to $12. The 1960 amendments also permit Federal financial participation for the first time in State vendor medical care payments (under both the new medical care program and the old-age assistance program) in behalf of patients in a medical institution as a result of a diagnosis of tuberculosis or psychosis for 42 days after such diagnosis. To help Puerto Rico, the Virgin Islands, and Guam provide more medical care, the 1960 amendments increase the dollar limitation on the total amounts of Federal funds they may receive annually. How¬ ever, the increase is available only for medical care payments made in behalf of recipients of old-age assistance to cover the costs of the Federal share above that otherwise applicable. Expenditures under the new program of medical assistance for the aged do not come under this dollar limitation. To help States evaluate and improve their public assistance pro¬ grams and their programs of medical assistance for the aged, the De¬ partment was directed to develop, or make revisions in, recommended guides or standards relating to the level, content, and quality of medical care and medical services, and to collect and publish informa¬ tion related thereto. Amendments to the Social Security Act also provide that, effec¬ tive July 1, 1962, a State agency in determining need for blind assist¬ ance, must disregard the first $85 of earned income per month plus one-half of earned income in excess of $85. Until then, beginning October 1, 1960, a State is 'permitted to disregard the first $85 per month and one-half of the excess or to continue to apply the $50 per month exemption as under the old law. Special legislation providing for the approval of the Missouri and Pennsylvania blind assistance plans, due to expire June 30, 1961, was extended to June 30, 1964. Legislation was also passed by the 86th Congress authorizing the Department of Health, Education, and Welfare to provide reception service and hospitalization at Saint Elizabeths Hospital, or elsewhere, for repatriated mentally ill Americans. (See pages 55-56 for further information on this provision.) TRENDS IN CASELOADS AND EXPENDITURES With the initiation during the year of the four federally aided, pub¬ lic assistance programs in Guam, and the establishment of an aid to the permanently and totally disabled program in Iowa, 54 jurisdic¬ tions now administer federally aided programs of old-age assistance, aid to dependent children, and aid to the blind; and 50 jurisdictions Social Security Administration 49 administer federally aided programs for needy persons who are permanently and totally disabled. General assistance in some form for some persons is available in all 54 jurisdictions.2 About 6.8 million persons were receiving aid in June 1960 under the five public assistance programs (including general assistance). This total is only slightly higher (19,000) than a year earlier. Two federally aided programs showed increases in caseloads in June 1960; aid to dependent children, with 3,025,000 persons in 794,- 000 families including 2,330,000 children — a 3.3 percent, 2.2 percent, and 3.7 percent increase respectively; and aid to the permanently and totally disabled, with 362,800 persons — a 7 percent increase. The other federally aided programs showed decreases ; old-age assistance, with 2,358,600 persons — a drop of 2.5 percent; and aid to the blind, 108,000 persons — a drop of 1.3 percent. Similarly, the 971,000 per¬ sons (in 367,000 cases) receiving State and/or locally financed gen¬ eral assistance in June 1960 represented a 5.3 percent and a 3.7 percent drop, respectively, compared with June 1959. Total assistance expenditures, including vendor payments for medi¬ cal care for all five programs for the fiscal year 1960 were $3,705 million — a 3.6 percent increase over expenditures in 1959, reflecting in part the effort of some States to offset the continuing rise in living costs. In aid to dependent children, the national average payment was $29.08 per recipient in June 1960, compared with $28.38 a year earlier. State average payments ranged from a low of $9.50 in Alabama (ex¬ cept for $3.85 in Puerto Rico) to a high of $46.53 in the State of Washington. In old-age assistance, the average payment was $67.90 per recipient in June 1960, compared with $64.76 in June 1959. Average payments ranged from a low of $29.75 in Mississippi (except for $8.24 in Puerto Rico) to $109.11 in Colorado. In aid to the permanently and totally disabled, the average payment per recipient was $65.74 in June 1960, compared with $63.37 a year earlier. The average payment varied from a low of $30.33 in Missis¬ sippi (except for $8.75 in Puerto Rico) to $128.62 in Connecticut. In aid to the blind, the average payment per recipient was $72.81 in June 1960, compared with $69.04 a year earlier. Average payments ranged from a low of $38.65 in Mississippi (except for $8.27 in Puerto Rico) to $125.73 in Massachusetts. 2 General assistance, which is wholly State and/or locally financed, is administered by the State public assistance agency through its local offices in 19 jurisdictions ; supervised by the State public assistance agency through local offices which are branches of county or municipal government, usually also servicing federally aided programs, in 9 : administered by the local political jurisdiction in 9, with specifically limited responsi¬ bility exercised by the State public assistance agency ; and administered by the local agency in 17, with no responsibility exercised by the State agency. 50 Department of Health , Education , and Welfare , I960 In State and/or locally financed general assistance, excluding vendor payments for medical care, the average payment per case was $67.48 in June 1960, compared with $65.78 in June 1959 (46 percent were family cases including an average of 4.6 persons per family) . Average pay¬ ments ranged from a low of $12.67 per case in Alabama (except for $12.65 in Puerto Rico) to $102.78 per case in New Jersey. The number of beneficiaries receiving old-age assistance to supple¬ ment their social insurance benefits continued to increase. In Febru¬ ary 1960, about 675,600 old-age assistance recipients, or 28.5 percent (compared with 26.7 percent in 1959 and 19.2 percent in 1955) were receiving assistance to supplement insurance benefits because these benefits and other personal resources were insufficient to meet their basic and/or special needs, such as medical care. The percentage of recipients of other types of public assistance who also received old-age, survivors, and disability insurance benefits was considerably smaller; for example, 16 percent of those receiving aid to the blind, 7 percent of those receiving aid to the permanently and totally disabled, and 5.2 percent of all families receiving aid to dependent children. Source of funds for public assistance payments . — Of $3,705 mil¬ lion expended for the five public assistance programs in fiscal 1960, about 51.9 percent or a little over $1,922 million came from Federal funds, 36.3 percent, or $1,343 million, from the States, and 11.9 per¬ cent, or $440 million, from the localities (of which $425 million was spent for general assistance) . For the four special types of public assistance, the Federal share of total costs was 58.6 percent; the State share, 33.7 percent; and the local share, 7.7 percent. PROGRAM AND ADMINISTRATIVE DEVELOPMENTS The influence of study and evaluation was also reflected in various program developments. Efforts to learn more about the causes of dependency and characteristics of persons receiving public assistance, which sharpened the outline of areas of need and made more clearly visible significant factors contributing to dependency, have already resulted in advances in implementing recommendations growing out of the past year’s study. For example, a staff paper was developed establishing a position on each of the 20 recommendations made by the Advisory Council on Public Assistance, and work was initiated on several. These included exercising greater leadership in working with the States to improve standards of assistance, medical care, and the administration of the aid to dependent children program, especially in relation to provision of services, policies relating to problems of “unmarried parenthood,” and community planning. Social Security Administration 51 In addition, since many States are concerned about “suitability of home” provisions, and a few have considered or enacted legislation making “suitability of the home” a condition for receipt of assistance under the aid to dependent children program, consideration was given to policy questions involved, and to planning to meet the needs of children affected by such provisions. Cooperative activity continued with the Children’s Bureau toward the goal of utilizing the full potentials of both the aid to dependent children and the child welfare services programs in dealing construc¬ tively with the factors contributing to the dependency of children. Further interpretation was made of the policy statement on Public Assistance-Children’s Bureau program relationships prepared for the use of the States in clarifying the functions and responsibilities of each program in providing services to children in their own homes, and help was given to States to achieve more effective day-by-day coopera¬ tion between public assistance and child welfare services at State and local levels. The Bureau also participated in the development by the National Social Welfare Assembly of an interpretative document on the aid to dependent children program to encourage understanding and sup¬ port and cooperative service from local voluntary agencies. The re¬ sulting pamphlet, ADC : A Family Service — The Community Re¬ sponsibility , has had wide distribution and use. Bureau staff participated in several areas for the White House Con¬ ference on Children and Youth held in the spring of 1960. Materials were provided for use in preparation for the conference, and con¬ ference materials were distributed to State welfare agencies for their use. Several members of the Bureau staff served as delegates or re¬ source persons in workshops and helped in providing facilitating services. Follow-up activity included participation with the In¬ terdepartmental Committee on Children and Youth in planning for an evaluation of the conference and in implementation of recommendations. Efforts were also continued in strengthening services for the needy aged and the ill and disabled through joint activity with interested national groups, preparation of informational and interpretive ma¬ terials, and consultation to the States. A specialist on aging was also added to the Bureau staff. Bureau activity in preparations underway for the White House Conference on Aging, to be held in January 1961, included staff serv¬ ing as Technical Director for the Conference Section on Family Life, Family Relationships, and Friends, and on the Technical Committee for the Conference Section on Social Services; preparation of back¬ ground papers on income maintenance, social services, and family life 52 Department of Health , Education, and Welfare, 1960 for use of the States in planning for the Conference ; participation in planning the general and orientation sessions of the Conference, the outlines of content for small work groups, selection of speakers and discussion leaders, and identification of possible resource persons; and work with the Special Staff on Aging of the Department and the SSA Committee on Aging in reviewing and commenting on various aspects of overall Conference planning. Cooperative work with other organizations in this area included planning a seminar on casework services for older persons with the National Social Welfare Assembly, American Public Welfare As¬ sociation, and the Family Service Association of America; partici¬ pation with the American Public Welfare Association in preparation of a statement on the social service needs of older people and the role of public welfare ; and leading institutes and giving papers on various aspects of aging at meetings sponsored by various organizations. The Bureau has also continued active participation on the executive com¬ mittee of both the National Conference on Homemaker Services and the National Committee on Homemaker Service to assist in the de¬ velopment of plans for a permanent organization which would pro¬ mote and coordinate homemaker services at the national level. Through preparation of informational and interpretative materials and consultation, help was also given to the States in the provision of services to the needy aging and to the ill and disabled. For ex¬ ample, a pamphlet was issued on Services for Older People , interpret¬ ing the roles of the public assistance programs and the Bureau of Public Assistance in relation to older persons. Interpretative and standards material in relation to the development of homemaker services to meet the needs of families, the ill, and older persons was also provided for the use of interested States. Implementation of a plan of exploration with each State with reference to the service aspects of its programs, evaluation of its ex¬ perience in providing services, determining next steps, and identify¬ ing ways in which the Bureau can be helpful, revealed great interest and activity and identified specific areas for further Bureau planning. Evidence of increasing interest in State public assistance agencies in developing homemaker services is especially heartening. So is the joint planning by the Bureau and the Office of Vocational Rehabili¬ tation in connection with study of Arizona’s services to the blind to strengthen the work of both agencies with the States in their use of vocational rehabilitation resources for helping handicapped public assistance recipients, and to help State welfare staffs develop ap¬ propriate social services aimed at rehabilitation. Continuing effort was made to improve staff competence in State and local agencies by encouraging State agencies to provide for aca¬ demic training under the 50-50 Federal matching provisions for the Social Security Administration 53 costs of administration, by developing other methods of improving staff competence, and by making more effective utilization of profes¬ sionally trained staff. The Bureau also provided two short-term train¬ ing seminars for approximately 100 State public assistance field repre¬ sentatives ; follow-up sessions were planned for October and November 1960. The first seminars were focused on ways of helping State and local staff further the program objectives of helping public assistance recipients achieve increased capacity for self-support, self-care, and strengthened family life. Emphasis for the second sessions was to be on methods used in carrying out the State field representative’s job, and in deepening knowledge about policy development, community planning and supervision especially in relation to group training. Orientation was also provided in Washington by central office staff for new State -administrators. They were introduced to sources of information available to help them understand the mutual and related responsibilities of the State and Federal Governments in administer¬ ing the public assistance and child welfare programs, and acquainted with the specialized services available to the States from the central office, and how these services support and supplement the work of the regional staff. Consultation and technical assistance was given to States to improve their administrative management and to make more effective use of staff. Studies of organization and procedures were made to help States simplify the work of professional staff through reducing the volume of paper work, streamlining procedures, and transferring non¬ professional functions to clerical workers. An ad hoc committee on workload standards, with representation from public and voluntary agencies, participated in considering methods of establishing appro¬ priate workload standards for public assistance agencies. A group of 31 welfare finance officers and tabulating equipment supervisors from 19 States with centralized fiscal operations also met in Washington to consider how State agency fiscal operations can be carried out most effectively and what planning should be undertaken prior to deciding on installing electronic data processing equipment. In addition, mate¬ rials were developed to help States improve their supervision of local agencies, simplify the work of professional staff, and determine when they should convert machine operations to automatic data processing systems. Continuing efforts were made to improve methods for conducting the administrative review of State and local operations. They in¬ cluded field testing of work materials and instructions in reviewing practice in relation to the application process, hearings, money pay¬ ments, and guardianship ; and the revision of instructions for broad¬ ening the statewide review of eligibility determination to include social services. 54 Department of Health , Education, and Welfare, 1960 Miss Kathryn D. Goodwin was appointed to the position of Director of the Bureau of Public Assistance in August 1959. A change in Bureau organization structure provided for the establishment of two new positions. One is that of Assistant Director, responsible for (1) providing general direction of the administrative activities of the Bureau and of the civil defense emergency welfare activities as¬ signed to the Bureau, and program planning for repatriation of American nationals and for refugees and immigrants; and (2) as¬ sisting the Director in the direction and coordination of Bureau ac¬ tivities. The other is that of Assistant Director for Program Operations, a position which raises the status of field program opera¬ tions and provides a better basis for coordinating regional activities with top-level planning of the Bureau. A new Civil Defense Emer¬ gency Welfare Services Unit was also established within the Office of the Director. The Unit carries responsibility for developing and maintaining plans for a state of readiness to provide welfare services in a civil defense emergency, and for continuity and restoration of peacetime programs. Civil defense emergency welfare services. — Following limited activity in 1958 in planning for emergency organization and opera¬ tions during a war disaster, activities were resumed early in 1959 on preparations for civil defense emergency welfare activities which the Office of Civil and Defense Mobilization planned to assign to the Department.3 In the latter part of 1959, the Department of Health, Education, and Welfare was given primary responsibility for (1) developing and coordinating the overall emergency welfare pro¬ gram through joint planning with other appropriate Federal agencies and voluntary organizations; and (2) preparing basic national guid¬ ance materials for State and local use.4 Within the Department, primary responsibility for emergency wel¬ fare was assigned to the Bureau of Public Assistance, under the di¬ rection of the Commissioner of Social Security. This assignment was based on the concept of built-in emergency welfare service planning by using fully the regional structure and existing channels of Federal- State-local counterpart relationships in the welfare field. The scope of the assignment includes nationwide guidance to States in planning, mobilizing, and organizing for welfare service responsibilities in re¬ lation to survival aid and services ; feeding ; lodging ; clothing ; locat¬ ing and reuniting families; care of groups needing specialized services, such as unaccompanied children, the aged, the handicapped ; and post-attack transitional financial assistance, counseling, and wel- ? Under an allotment to the Department by the Office of Civil and Defense Mobilization. * Under Emergency Welfare Annex 19 to the National Plan for Civil Defense and Defense Mobilization and a memorandum of understanding between OCDM and the Depart¬ ment of Health, Education, and Welfare. Social Security Administration 55 fare services to families and individuals. It also includes aid to welfare institutions under national emergency or post-attack condi¬ tions; and all other feasible welfare aid and services to people in need during any degree of a national emergency pre- and post-attack. Emphasis during 1960 was focused on organization, recruitment, orientation to the emergency welfare services responsibilities, and development of national guidance materials for use by the States. A Children’s Bureau child welfare specialist prepared the material re¬ lating to the care of children. Draft materials were reviewed in mid- June by an ad hoc advisory committee representing State and local public welfare and civil defense departments, national and local volun¬ tary agencies, a public housing agency, a metropolitan school system, other offices of DHEW, OCDM, the Department of the Army, Hous¬ ing and Home Finance Agency, and the Post Office Department. 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 the past year, assistance was requested by the Department of State in behalf of 63 cases involving 126 individuals from 27 different countries. Through the cooperation and help given by public and private welfare agencies, primarily in New York, it was possible to secure emergency reception services, transportation, hospitalization, and other services in behalf of these repatriates. However, many repatriates no longer can claim State residence and are not eligible for public aid or hospitalization in States which have residence requirements for the receipt of such services. This, plus the fact that there are no Federal funds for this purpose, makes the development of satisfactory relocation plans a time-consuming and difficult process, and places an unusually heavy burden upon health and welfare facilities in the port of entry. Late in the fiscal year, regional offices were provided with copies of the Department of the Army’s draft plan for assistance to the Depart¬ ment in the reception and provision of services to American civilians repatriated from foreign countries during a period of international tension or emergency. The operation of DHEW plans in this regard, which envisage the cooperation of State and local public and private welfare agencies, requires the enactment of legislation to provide a statutory base and appropriation authority to enable the Federal Gov¬ ernment to assume its proper share of the expenses of the services required by repatriates. Legislation to facilitate the repatriation of all United States na¬ tionals, which was submitted to the Congress in 1959 culminating a long period of program development and interdepartmental negotia¬ tion, passed the Senate but did not secure House Committee action during the last session of Congress. The 86th Congress, however, did 56 Department of Health , Education , and Welfare 1960 take action to assist one group of repatriates by passing Public Law 86-571 on July 5, 1960, authorizing the Department to provide for reception and hospitalization at Saint Elizabeths Hospital, or else¬ where, of repatriated mentally ill Americans. This authority, when supported by an appropriation, will facilitate the repatriation of the mentally ill. Services to refugees and immigrants. — Following active participa¬ tion in the 1957 temporary program of the President’s Committee on Hungarian Refugees, and in the 1958 sessions of the Departmental Committee on Refugees and Immigrants established to implement a task force report on the Department’s role in future refugee activities, Bureau activity during the past year was directed primarily toward developing statements and position papers on proposed legislation and program planning for services to refugees and immigrants. It also prepared comments on a 1959 draft Joint Congressional Resolution to provide for the resettlement in the United States of 1,000 difficult- to-resettle refugees, and developed a plan of follow-up steps based on a study of sample cases referred by the Department of State. International activities. — Cooperative work with the SSA Office of International Activities during the past year included central office planning for and consultation to foreign visitors, and interpretation of U.S. social welfare programs to individuals and international groups referred by various Government agencies. Bureau staff in regional offices also provided consultation and planned or arranged observation programs in cooperation with State and local public and voluntary welfare agencies for visitors from 20 countries. Bureau staff prepared comments on various United Nations’ docu¬ ments, provided material required by the United Nations for their World Report on Social Development, and prepared pertinent sec¬ tions of the United Nations Biennial Report on Family and Child Welfare (1960). A Bureau staff member served as one of the eight United States Government representatives to the 11th Pan American Child Congress held in Bogota, Colombia, in November 1959. She also participated, prior to the Congress, in the preparation of the United States’ official report on social welfare programs for children and, subsequently, in outlining the major results of the Congress to be re¬ ported to the Department of State. Children’s Bureau Some Facts and Figures About Parents and Children Births continue to be more than 4 million a year but the crude birth rate and the rate per thousand women of child bearing age have dropped slightly since the peak of the 1950 ’s. Social Security Administration 57 The estimated number of children under 18 in the civilian popula¬ tion of the United States in 1959, including Alaska but not Hawaii, was 64 million, 36.5 percent of the total population. Provisional statistics indicate that the infant mortality rate for 1959 and the early months of 1960 has decreased slightly from the high point of 27.1 per thousand live births in 1958. Death rates for babies less than 3 days old have changed very little in the past 2 decades. Nonwhite infants still have a higher mortality rate than white infants. Numbers, rates, and ratios of births out of wedlock continue to increase. The estimated number for 1958 was 208,800. The ratio per 1,000 live births increased over 1957 from 47.4 to 49.6 and the rate per 1,000 unmarried women aged 15-44 years from 20.9 to 21.0. While 40 percent of these births were to mothers under 20 years of age, the rate for such mothers declined slightly from 1957 to 1958. In March 1959, 13.6 million married women were in the labor force and of these, 12.2 million had husbands living at home. Thirty-one percent of all wives were in the labor force. A large part of the in¬ crease in 1959 over 1958 occurred among married women 35 years old and over; relatively few of these women have children of pre¬ school age. However, nearly 7.5 million mothers with children under 18 and nearly 3 million with children under 6 were in the labor force in March 1958. In 1958, for the 10th consecutive year, juvenile delinquency cases increased over the previous year. The increase for 1958 was 7 per¬ cent when traffic cases were excluded. The rise, however, was much less than in other recent years and exceeded only slightly the 6 per¬ cent estimated increase in the child population. Arrest data for 1959 (preliminary) reported by the Federal Bureau of Investigation for 980 cities show that the arrests of children under 18 years in¬ creased by 5 percent over 1958. This is the lowest percentage increase noted for any year since 1954. Major Trends — - ] The Golden Anniversary White House Conference on Children and Youth held in Washington March 27-April 2, 1960 was the high point of the year for the Children’s Bureau. Many months of plan¬ ning involving hundreds of thousands of people preceded it. Bureau personnel were involved in Conference preparation in a wide variety of ways. Regional staff worked actively with State Committees for Children and Youth and State public agencies in support of these Committees. Many of the technical specialists in the central office contributed to Conference publications, and recom¬ mended speakers, work group leaders, and resource persons. The Bureau provided the technical staff for preparation of the chartbook 573826 — 61 - 5 58 Department of Health, Education, and Welfare, 1960 sponsored by the Federal Interdepartmental Committee on Children and Youth. At the close of the year, the Bureau was making an intensive ex¬ ploration as to how the findings of the White House Conference might be implemented through its various programs. Unquestion¬ ably, these findings will influence child life throughout the Nation and throughout the world for years to come. The review of the White House Conference findings was being undertaken in relation to the statement of 10 year goals developed by the Bureau during fiscal years 1959 and 1960. Undoubtedly the goals’ document will prove to be a benchmark for the Bureau as an interpretation of how Bureau programs can and should meet the needs of children in the years ahead. Two reports to the Congress — The Report of the Advisory Council on Child Welfare Services and the Joint Children’s Bureau-Na¬ tional Institute of Mental Health Report on Juvenile Delinquency — represented major Bureau accomplishments during fiscal 1960. During fiscal 1960 the Children’s Bureau and the Women’s Bureau of the Department of Labor were actively planning together for the National Conference on Day Care to be held November IT and 18, 1960 in an effort to stimulate the development of day-care services throughout the country. Legislative Developments During the Year The year 1960 marks a milestone in the legislative history of the Children’s Bureau. For the first time in many years, legislation was enacted which substantially broadened the statutory authority under which the Bureau operates, thereby enabling the Bureau to serve chil¬ dren better. The first piece of this legislation was the International Health Re¬ search Act. This Act grants new powers to the Secretary of Health, Education, and Welfare, in carrying out his responsibilities under the basic 1912 act which established the Children’s Bureau. Among these new powers are authorization for establishing and maintaining fel¬ lowships and making grants for fellowships, and authorization for making grants for research, in carrying out the purposes of the Act. These purposes are twofold: (1) to advance the status of health sciences in the United States and thereby the health of the American people through cooperative endeavor with other countries in health research, and health training; and (2) to advance the international status of the health sciences through cooperative enterprises in health research, research planning, and research training. The second piece of legislation of major significance to the Bureau is contained in the 1960 Amendments to the Social Security Act. Social Security Administration 59 These amendments authorized a new program, with a separate ap¬ propriation in such sums as the Congress may determine, of grants for research or demonstration projects in the field of child welfare. Such grants may be made to public and voluntary agencies and organi¬ zations, and to institutions of higher learning. The health titles were also broadened so that special project grants may be made directly to institutions of higher learning. These amendments also increased the amounts authorized for annual appropriation to $25 million for each of the three grant programs under Title V of the Act which are ad¬ ministered by the Bureau. The amounts of the previous authoriza¬ tions were : maternal and child health services, $21,500,000 ; crippled children’s services, $20,000,000 ; and child welfare services, $17,000,000. On September 7, 1959, the President approved H.J. Res. 317 to change the date of Child Health Day to the first Monday in October. The Department had transmitted a bill for this purpose to the Con¬ gress earlier in the year. The new date will permit the United States to link its Child Health Day observance more closely to Universal Children’s Day, which many nations observe on October 1. 1960 White House Conference on Children and Youth The Golden Anniversary White House Conference on Children and Youth was held March 27-April 2, 1960 in Washington, D.C. This was the sixth White House Conference called by a President of the United States since 1909 for a nationwide stocktaking of the needs of children and youth. The participants numbered 7,600 persons, including 1,400 young people and 548 international guests from 86 countries. The Confer¬ ence theme was : “To promote opportunities for children and youth to realize their full potential for a creative life in freedom and dignity.” A 92-member National Committee appointed by the President was responsible for the direction of the Conference. This Committee was composed of leaders in education, health, social work, recreation, re¬ ligion, and many other fields concerned with children and youth. Statewide committees were appointed by the Governor of each State and Territory at the request of the Secretary of Health, Education, and Welfare. The Children’s Bureau served as the focal point in the Federal Government for the Conference planning and received Con¬ gressional appropriations in 1959, 1960, and 1961 totaling $500,000 for the Conference and its immediate followup activities. Additional funds totaling $568,155 were contributed by foundations, national organizations, industry, and individuals. The Conference opened on Sunday evening, March 27, with a ple¬ nary session attended by 12,000 people and addressed by President Dwight D. Eisenhower. For the next three mornings, Conference par- 60 Department of Health , Education 9 and Welfare , 1960 ticipants gathered first in theme assemblies of 1,500 and then in smaller Forum meetings which averaged 350 each. In the theme assemblies, they heard leading authorities speak on ideals and values, and on eco¬ nomic, social, cultural and technological factors affecting children and youth today. In the F orums, experts presented facts and issues related to specific aspects of the life of children and youth. For three afternoons, the participants joined workgroups of 30 to 35 members; against the background of the morning talks, they dis¬ cussed assigned topics and formulated recommendations for considera¬ tion by the Forums. These totaled 670 and are published in a pam¬ phlet : Recommendations : Composite Report of Forum Findings avail¬ able through the Government Printing Office. The full Conference met at the National Guard Armory on Friday morning for an over¬ view of the findings and an address by the Honorable Arthur S. Flem¬ ming, Secretary of Health, Education, and Welfare. Publications prepared in advance of the Conference include Chil¬ dren in a Changing World , a chart book prepared by the Federal In¬ terdepartmental Committee on Children and Youth; the States Report on Children and Youth , summarizing the content of the 55 State and Territory reports; Focus on Children and Youth , based on materials submitted by the national organizations; Children and Youth in the 1960's and Reference Papers on Children and Youth , prepared by spe¬ cialists to supply information on specific questions in the Conference program; and The Nation's Children , a three volume collection of background essays outlining major developments relating to children and youth in the past decade. A volume of Conference Proceedings will be released in the early fall of 1960. The National Committee worked through a series of committees of its own membership. In addition, it used the auspices of three major bodies to assure full participation in Conference preparation: (1) National Council of State Committees for Children and Youth, con¬ sisting of Governor-appointed committees in 50 States, 3 Territories, the District of Columbia, and the Commonwealth of Puerto Eico ; (2) the Council of National Organizations for Children and Youth, with a membership of nearly 600 national lay and professional groups con¬ cerned with the physical, mental and spiritual well-being of children and youth; and (3) the Federal Interdepartmental Committee on Children and Youth which is an affiliation of 34 agencies of Govern¬ ment having programs affecting children and youth. At the request of the National Committee and in conjunction with it, the two national councils and the Interdepartmental Committee have jointly established the National Committee for Children and Youth to stimulate and coordinate the effective utilization of the Con¬ ference findings and forum recommendations during the decade ahead. Social Security Administration 61 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, held regular monthly meetings during the past year. Its major activity during fiscal 1960 was related to preparation for the 1960 White House Conference in response to the request of the President’s National Com¬ mittee for the Interdepartmental Committee to serve as the main channel for Federal agency participation in the Conference. One of its major contributions was the development of the chart book, Children in a Changing World. In addition it made available to the National Committee the knowledge, experience, and resources of the Government agencies. Over 400 persons from Federal agencies at¬ tended the Conference. Key persons from many agencies contributed professional papers for the background publications of the Confer¬ ence and served as speakers and resource consultants. Programs of the Bureau RESEARCH IN CHILD LIFE The Bureau’s research staff has a major responsibility for carrying out the legislative mandate “to investigate and report upon all matters pertaining to the welfare of children.” In addition to conducting its own studies and cooperating in joint studies, the Bureau stimulates other agencies to undertake research in child life by formulating the questions needing study, developing research methods, and providing technical advice and assistance. Among studies receiving major emphasis were a study of infant mortality trends and a pilot survey, preparatory to a national study, of the incidence and prevalence of cystic fibrosis — a major child¬ hood disease. Work continued on devising statistical measures of child health and health services, on the uses of maternity statistics, and on the revision of the diagnostic classification of crippled children. Another fact-finding study centered on children with congenital heart disease treated at regional heart centers. In response to a Congressional request the Bureau, in conjunction with the National Institute for Mental Health, conducted numerous studies and reviews in the area of juvenile delinquency. The Bureau helped prepare The Report to the Congress on Juvenile Delinquency and has published a series of 16 pamphlets addressed to a technical audience entitled Juvenile Delinquency : Facts and Facets. In order to obtain basic data on youth attitudes and values, arrangements have 62 Department of Health , Education , and Welfare, 1960 been made with Washington University in St. Louis to begin one of the studies of teenage culture which it is hoped to initiate in several communities. Other projects included participation in the Department’s work on the National Survey of Social Welfare Manpower, a national survey of licensed day-care facilities, and preparing the report on the study of the outcome of independent adoptions. During the year, the Bureau compiled and published current sta¬ tistical data received from State agencies administering the maternal and child health, crippled children’s, and child welfare programs. It also published statistical data on voluntary child welfare services, the work of juvenile courts and public training schools for juvenile de¬ linquents, and on adoption programs. During fiscal 1960 a publica¬ tion, Trends — Child Welfare Services , Juvenile Court Cases , Crippled Children’s Services , Maternal and Child Health Services supple¬ mented and summarized these reports. As part of its research interpretation activities the Bureau helped prepare the chart book and produced a number of Fact Sheets for the Golden Anniversary White House Conference on Children and Youth. Working papers were prepared for the Advisory Council on Child Welfare Services. Progress continued on the revision of Prenatal Care and work began on the revision of Yow Child From One to Six , two among many of the publications for parents on child growth and development. Two issues of Research Relating to Children , an inven¬ tory of current research in child life, were published during fiscal 1960 and a special listing Research Relating to Mentally Retarded Children was prepared. Also published was Some Guide Lines for Evaluative Research , an examination of the problems in research on evaluating efforts to bring about social or emotional change in individuals. The research staff worked with or gave consultation requested by State health and welfare departments, national organizations, and university groups on studies of such subjects as accident prevention, correlates of handicapping conditions in childhood, cultural aspects of delinquency, child-rearing practices, illegitimacy, marital prob¬ lems, adoption, and day-care services. MATERNAL AND CHILD HEALTH SERVICES All States, the District of Columbia, Puerto Rico, the Virgin Is¬ lands, and Guam receive F ederal funds to extend and improve services for promoting health of mothers and children. For the fiscal year 1960, the appropriation for maternal and child health increased to $17,500,000, with $1 million earmarked for services to mentally retarded children. The infant mortality rate which went up in 1957 for the first time in 22 years continues at a relatively high level. Social Security Administration 63 The 1956 rate was 26.0; in 1957 it was 26.3; in 1958, 27.1. The pre¬ liminary rates for 1959 and 1960 are: 26.4 and 25.7 (7 monthly only) respectively. In 1957, for the first time in 29 years, the maternal mortality rate did not fall but rather stood still for a year, i.e., the rate remained 4.1 for both 1956 and 1957 ; in 1958 it declined again to 3.8. The lack of progress shown in 1957 was due to an increase of non white rates from 11.1 in 1956 to 11.8 in 1957 ; the maternal mortality rate for white mothers decreased from 2.9 to 2.8 in these years. Concern regarding the relatively high level of infant mortality has been reflected in increased activity in State programs, including studies and services. Some of the studies aimed at pinpointing spe¬ cific problems, needs and gaps in services have included surveys of communities to locate those women with no or inadequate prenatal care, the characteristics of these women, their pregnancy outcome in comparison to the community as a whole. Because the great bulk of infant deaths now occur very early in the first year of life, more than one-third on the first day, approximately half in the first three days, nine out of ten in the first five months, and because nearly three times as many deaths are due to prenatal and natal causes as to postnatal causes, major program emphasis is on the mother before the birth of the child. Extension of prenatal services to population groups, not previously receiving care, in both urban and rural communities, including renewed efforts of public health agencies to bring services to mothers early in pregnancy, is an example of wide¬ spread State activity. The increase in maternity services is reflected in the number of women who received maternity medical clinic service in 1958, viz., 266,028 mothers, an increase of 10.7 percent over 1957 when 240,630 mothers received such care. Nursing services to maternity patients increased even more, viz., 25.9 percent from 446,843 mothers visited in 1957 to 562,487 in 1958. Dental treatment to maternity patients more than doubled between 1957 and 1958. Mothers receiving hospital inpatient care under the maternal and child health program, chiefly hospitalization for complications of pregnancy, increased from 39,562 in 1957 to 40,910 in 1958. An important factor in both maternal and infant health and ma¬ ternity care has been the sheer number of births, especially since 1946 when birth rates have been at a consistently high level. In the 12 years (1946-1957) the number of births increased by almost 30 per¬ cent and by nearly a million births. Certain other demographic changes also point to reasons for the intensification of services. Neither the infant mortality level nor the rate of decline are uniform for all areas or population groups. In 1958 the infant mortality rate for the State with the highest rate, 64 Department of Health , Education, and Welfare, 1960 Mississippi, 41.0 was nearly double that for the State with the lowest rate, Rhode Island, 21.3. The infant mortality rate for nonwhite infants in 1958 was close to twice that for white infants, 45.7 and 23.8 respectively. In addition, the nonwhite infant mortality rate did not decline (1956-57). Between 1950 and 1958 nonwhite births increased from 13.8 percent to 15.0 percent of total births ; the estimated number of births to unwed mothers increased from 141,600 to 208,700; births to women under 20 increased from 12.1 percent in 1950 to 13.5 percent in 1958 ; family size increased as illustrated by the fact that the num¬ ber of fifth and later pregnancies increased from 12.5 percent in 1950 to 16.1 percent in 1958 — all of which are factors contributing to higher infant mortality rates. Services to children under the maternal and child health program (except for services to mentally retarded children) were not increased in all categories. Nearly 1.45 million children received services in well-child conferences in 1958, a 9.2 percent increase over 1957 ; the number of infants seen increased somewhat more than the number of preschool children, 10.6 percent as compared to 8.2 percent. Nursing service was given to more than 3 million in 1957. The number of premature infants hospitalized increased by 11.3 percent to a total of 5,794 infants. The number of children receiving dental treatments remained about the same, an increase of 0.4 percent to nearly 509,000 in 1958. On the other hand, the number of children receiving pediatric clinic service declined 1.2 percent to about 145,000 and of those receiving hospital inpatient care (exclusive of prematures) 28 percent, to about 21,000. School health examinations increased by 17.5 percent; physicians giving examinations to nearly 2.6 million children in 1958. More than 5.0 million school children received visual screening tests, a 23.5 percent increase ; nearly 3 y2 million had audiometer screening tests, a 19.4 percent increase. The number of children immunized against smallpox, 2.7 million ; diphtheria, 3.2 million ; pertussis, 2.3 million, and tetanus, 3.0 million, increased. Although the number immunized against polio was 5.2 million (greater than the number immunized against any of the above diseases) , it represented a 56 percent decrease in the number of chil¬ dren immunized against polio (11.8 million in 1957 to 5.2 million in 1958) and as contrasted to 13.2 million in 1956. States showed increased interest in broadening their programs to areas which have heretofore been considered ancillary to maternal and child health such as homemaker and day-care services and parent education. Social Security Administration 65 During the past year, clinic services including complete evaluation, diagnosis, and followup care were provided through special programs of maternal and child health for almost 9,000 mentally retarded chil¬ dren and their families. In addition, over 1,800 requests for services which could not be handled were received by these programs. The movement toward earlier casefinding and identification of retarded children is continuing and is reflected by statistics on new cases seen in these special programs (31.2 percent were under 4 years of age and 75.6 were under 9 years of age) . The increase in numbers of children served directly by these special programs is primarily a reflection of greater selectivity and flexibility in the use of diagnostic approaches coming with staff experience. Actual expansion of services to mentally retarded children and their families during the past year through this program has occurred pri¬ marily through the greater involvement of local resources and the concentration of project staff time on inservice training programs. These efforts have resulted in the tremendous increase in the availa¬ bility of services to the retarded provided by local individuals and agencies which previously had not been interested or had not felt competent to provide such services. Interest in developing screening, detection, and treatment programs for phenylketonuria has continued to mount on the part of State and local health services. While screening programs for well baby populations have been developed in almost half of the States, the major efforts during the past year have been on screening high risk groups (institutions for the mentally retarded and retarded children in special classes). In such groups the incidence of the condition is about 1 percent of the population. Such screening permits easy loca¬ tion of families in which the condition occurs and, on this basis, it is possible to locate infants in these families who may have the condition and can be treated. This type of pursuit of high risk groups has yielded a high return of infants who have the condition and in whom it is believed mental retardation can be prevented through a special diet. Spot surveys seem to indicate that as many as 12 to 15 percent of the children in affected families located through high risk group surveys have the condition but are undiagnosed and untreated. 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 sur¬ gical treatment, and alleviation of unfavorable social and psychologi- 66 Department of Health , Education , and Welfare, 1960 cal influences which adversely affect the degree and duration of the disability. The appropriation for crippled children’s services is $16 million, $4 million less than the amount authorized. State crippled children’s programs throughout the country served more than 325,000 children in 1958, an increase of 3.9 percent over the year before. This represents over 50 percent more children receiv¬ ing physician’s services in 1958 than at the beginning of the decade. During these years the number of handicapped children under care in official programs rose from 3.9 per 1,000 children under 21 in the United States to 4.8 per 1,000. Broadening the crippled children’s program to include children handicapped with conditions not formerly covered continues. Exam¬ ples of categories receiving increased attention by States are : cystic fibrosis, nephrosis, and neurological defects. Services for children with multiple handicaps, such as the so-called brain-damaged child and the deaf-blind child, are increasing. Physician’s services to children increased whether given in the clinic, office, home, hospital, or convalescent home. Though the num¬ ber of children receiving care in hospitals or convalescent homes increased slightly, the trend toward smaller average number of days of care in hospitals and convalescent homes continued. The proportion of children with congenital malformations con¬ tinues to increase so that they now constitute 26.4 percent of the total cared for under the crippled children’s program (1958). One of the largest increases in the number of children with any one condi¬ tion was in children with congenital malformation of the circulatory system. Beflecting scientific advances in the treatment of congenital heart disease and the availability of services made possible through a special appropriation for services to these children, plus use of some regular crippled children’s funds, the number of children served increased from 2,200 in 1950 to more than 12,000 in 1958, an in¬ crease of about 450 percent. The increase in funds for congenital heart disease made it possible for regional heart centers to reduce the backlog of cases waiting for treatment ; the additional funds also relieved in most States the criti¬ cal shortage of funds which was resulting in curtailment of services for all crippled children. As more hospitals throughout the country meet the standards of the American Heart Association for centers performing heart surgery, an increasing number of States are able to treat children in their own facilities. As State maternal and child health programs of hearing conserva¬ tion have expanded the need for standardization of screening pro¬ cedures has become more urgent. Therefore, the Children’s Bureau arranged a conference of nationally recognized leaders in the hearing field. They reviewed the present status of hearing testing programs Social Security Administration 67 and developed a set of recommendations covering the technical aspects of testing procedures for hearing loss. To bring latest advances in hearing aids and surgery of the ear to children who need them, the State crippled children’s agencies are caring for an increasing number of children with hearing loss and diseases of the ear, viz., 19,700 in 1958 as compared to 12,500 in 1950. The extensive problem of chronic middle ear infection in certain children, such as the Indian children of the Southwest, children in Alaska, Hawaii, and Guam is being reduced. CHILD WELFARE SERVICES The report of the Advisory Council on Child Welfare Services, transmitted to the Secretary and the Congress on December 28, 1959, was an event of major significance for child welfare programs through¬ out the country. Both the accomplishments and inadequacies of the Nation’s child welfare programs were studied by the Council. The 15 recommendations made by the Council range from a new, broad definition of child welfare services to urging that the Children’s Bureau be expanded so that it could continue in its national leader¬ ship role. In what is doubtless the Council’s most controversial recommenda¬ tion, it proposed that the Federal Government pay part of the total cost of public child welfare services of each State through grants-in- aid on a variable matching basis and with provision for an open-end appropriation. However, pending passage of such Federal participa¬ tion in the total cost of child welfare services, the Council recom¬ mended “That the authorization and appropriation for child welfare services be raised substantially.” The Council declared that the goals set forth for improvement in the structure and implementation of child welfare services “represent stern reality in that they reflect the changes in our society in the last decade.” To meet these changes “will require the most imaginative and creative planning that our nation can muster.” Good progress was made in the further implementation of the 1958 amendments to Title V, part 3 of the Social Security Act. The Federal share provision became effective July 1, 1959. An evalua¬ tion of the first year’s experience was being made at the close of this fiscal year. The reallotment provision, based upon the experience in 1959 and 1960, has proved on the whole to be useful and effective. Four States released $130,650. This money was allocated to 18 States as an addition to their initial allotment. While none of the 18 States received the full amount they requested, allocations ranged from $1,023 to $16,693. 68 Department of Health, Education, and Welfare, 1960 Although the $13,000,000 appropriation for the 1960 fiscal year was the largest ever made for the child welfare services program, it was not sufficient to make fully effective the new allotment formula. As a result 36 States received the “base allotment,” as provided in the 1958 amendments. State plans and budgets provided for some new developments, but the Federal allotments for the most part were used to meet the costs of the on-going child welfare programs. State reports continue to stress the drain on State health, welfare, and education appropriations caused by the increasing child popula¬ tion. That the States have need for additional funds and the ability to use them is evidenced by the following tabulation : Appropria¬ tion Payments In Federal Treasury, June 30 Amount Percentage $13,000,000 12,000,000 $12,902,037 11, 833, 299 $97, 963 166, 701 0.8 1.4 The balance of 0.8 percent remaining in the Federal Treasury this year represents a record “low.” A great number of shifts in top State welfare personnel this past i year accelerated the joint planning by the Children’s Bureau and the Bureau of Public Assistance for orientation of new State ad¬ ministrators. The Division of Social Services within the Children’s Bureau made arrangements for orientation of four administrators under this plan. The Division also developed a plan for orientation of new child wel¬ fare directors to the Children’s Bureau. Three groups were brought into the Bureau during the year and arrangements were made for one director on an individual basis. States represented included Maine, Michigan, New Hampshire, Ohio, Rhode Island, Tennessee, West Vir¬ ginia, Utah, and Virgin Islands. The difficulty of maintaining consistent, overall leadership in State child welfare programs is underscored by the situation in Regions I and V. New administrative people were appointed in 5 of the 6 States in Region I. There have been 3 new directors of child welfare in Region V this past year, with Ohio announcing late this spring a second change in less than a year. Such changes not only influence program development but affect considerably the focus of consultation to States by the F ederal staff. Relatively little substantive legislation affecting child welfare was passed in the States this fiscal year. Many of the State legislatures were not in session or were in session for consideration of special budget matters. Perhaps the most significant law in terms of its im- Social Security Administration 69 plications for children was one enacted in New York — the Interstate Compact on Child Placement. The Compact was developed by the State of New York Joint Legislative Committee on Interstate Co¬ operation, affiliated with the Council of State Governments. The purpose of the Compact is to protect children involved in interstate placements, so that they will have “the maximum opportunity to be placed in a suitable environment and with persons or institutions hav¬ ing appropriate qualifications and facilities to provide a necessary and desirable degree and type of care.” It relates specifically to situ¬ ations where appropriate public officials or social agencies are respon¬ sible for the placement. The hazards would be reduced by the pro¬ vision for uniform and orderly procedures, defining responsibilities of sending and receiving States, and providing penalties for non¬ performance. These protections were agreed upon at a conference called by the New York Joint Legislative Committee. Participants included State Attorneys General, public and voluntary child-placing agencies from the northeast States, plus staff from the Children’s Bureau and Child Welfare League of America. The New York bill becomes effective September 1, 1960. It is hoped that other States will adopt the Compact as quickly as their State situations permit. The need for qualified personnel in child welfare continues to be acute. Several States during the past year have planned for a sub¬ stantial expansion of educational leave programs. This represents a positive step forward toward the goal of improved child welfare services. New York, New Jersey, Ohio, and Pennsylvania are all making provision for an increased number of individuals to attend schools of social work; it is estimated that over 175 staff members will be in school from these 4 States alone. Ohio’s 50 represent more than twice the number of educational leave grants from this State in years past. In adding to actual numbers of staff, progress nationally was slow. As of June 1958, there were 6,631 full-time child welfare staff. In June 1959, the number was 7,026. Staff needs, on the other hand, were rapidly increasing in regard to coverage of existing services and for extending both basic and specialized child welfare services. A pamphlet, In Search of Staff for Child Welfare , prepared by the Bureau’s specialist on staff development this year, brings together a number of recruitment methods which have proven successful in the public child welfare programs. Heartening gains were made on both the Federal and State level in joint planning for the welfare of families and children. The Children’s Bureau-Public Assistance policy statement on Social Serv¬ ices to Families and Children was released on September 14, 1959. Staff of the two Bureaus, both in Washington and in the Regions, have been considering how best to implement the new policy state- 70 Department of Health , Education, and Welfare, 1960 ment. Children’s Bureau and Public Assistance staff in Regions III, IV and V report fruitful joint discussion and exploration with States in these regions on the implications of the document, particu¬ larly on how to strengthen services in ADC families. Child welfare and public assistance personnel in those States in which “suitability of home” legislation was passed have been par¬ ticularly active in working together. They are concerned, as are the two Federal Bureaus, that every effort be made to offer as much protection as possible to children and families in the administration of these laws. Preparation of a Technical Manual on Social Services for Emer¬ gency Welfare Services represented another cooperative planning and work area for the two Bureaus. A child welfare specialist on civil defense planning was employed by the Children’s Bureau for this purpose. This specialist and other Children’s Bureau staff partici¬ pated in an Ad Hoc Advisory Committee on Emergency Welfare Services to review the manual material. Development within the States of other services to children in their own homes, such as day care and homemaker services, continued to be uneven. Major problems continue to block effective development of homemaker services, including (1) financing; (2) a functional defi¬ nition of homemaker services acceptable to both the health and welfare fields; (B) a strong national voluntary agency to take leadership; and (4) limited service from public agencies at all governmental levels. Following the National Conference on Homemaker Service in Feb¬ ruary 1959, both the National Committee on Homemaker Service and the Executive Committee of the National Conference have continued meeting to plan for the development of a national homemaker service organization. Recently a proposal has been adopted by the Executive Committee that such a permanent organization be established to co¬ ordinate homemaker services at the national level and offer consultant services to communities wishing to develop these services. The Chil¬ dren’s Bureau as well as other national public and voluntary agencies are represented on the Executive Committee. The decision to hold a national day care conference in Washington during November 1960 was made with the hope that such a conference will center attention on “an urgent and growing national need.” It is being called under the joint sponsorship of the Children’s Bureau and the Women’s Bureau of the Department of Labor. A number of reports and papers are being prepared for the use of participants and a special day care film, produced cooperatively with the Pennsylvania Department of Public Welfare, will be available for showings. Responses to the national Children’s Bureau- Women’s Bureau day care survey made last year indicated that resources exist throughout the country that could provide support for needed pro- Social Security Administration 71 grams if interpretation of the need and the vehicles for coordination of effort were to be increased and strengthened. Several noteworthy advancements can be reported in other child welfare areas : 1. An important step toward improvement of adoption services was taken at a 1-day meeting called by the Bureau in May 1960. Repre¬ sentatives of the American Medical Association, the American Acad¬ emy of Pediatrics, the American Academy of General Practice, the American College of Obstetrics and Gynecology, the American Bar Association and the Child Welfare League of America considered concrete ways of achieving cooperation among these national organ¬ izations in the field of adoptions. It was the first time that these na¬ tional medical groups and the American Bar Association have met together on this subject. 2. Joint meetings of Children’s Bureau and Public Assistance staff in Regions I and V were held to review a statement developed by central office specialists of the Children’s Bureau and the Bureau of Public Assistance on Services to Unmarried Parents; More Effective Approaches Through Public Welfare. 3. Some movement occurred in the development of much-needed small group homes for adolescents, primarily under voluntary aus¬ pices. Agencies in Connecticut, Illinois, Virginia, and Wisconsin are involved. 4. The Bureau’s specialist on social services to mentally retarded children gave consultation to the Southern Regional Educational Board on setting up a joint training project for attendant personnel in southeastern institutions for the mentally retarded. Immediate objectives were to develop a core curriculum and to train key person¬ nel to administer and supervise the teaching process. Conferences were also held with the National Institute of Mental Health and the Office of Vocational Rehabilitation in regard to training needs of social workers and rehabilitation counselors in providing services for the mentally retarded. 5. Division of Social Services staff have participated in a number of special meetings called to consider the needs of children of migra¬ tory workers. Among these were a meeting of the President’s Com¬ mittee on Migratory Labor and the Migrant Ministry of the National Council of Churches, and an Atlantic Seaboard conference called by the Council of State Governments to consider day care needs of these children. Concern regarding the adequacy of care available for children whose mothers are employed in the domestic agricultural field has led the Senate Appropriations Committee to direct the Chil¬ dren’s Bureau to report by February 1, 1961 “on this problem and the measures to alleviate the adverse conditions which exist.” 72 Department of Health , Education , and Welfare , I960 An appreciable and increasing amount of staff time of tbe Division of Social Services was devoted to activities in the international area. Highlights include : participation by the Bureau’s specialist on group care in the Eleventh Pan American Child Congress in Bogota, Co¬ lumbia; preparation by Division staff of materials for the official United States reports to the above Congress and to the Lisbon meet¬ ing of the International Union for Child Welfare being held in July 1960; preparation of materials for special United Nations reports. State and local community planning efforts for children this past year were focused, in the main, upon preparation for the 1960 White House Conference on Children and Youth. Having returned to their local communities, the many citizens and agencies are now turning their efforts to “follow-up.” By the end of the fiscal year State com¬ mittees were in the process of putting the Conference recommenda¬ tions into effect. Indications are that an encouraging number of permanent organizations have already been established or are being planned. Greatest expressed needs are for dynamic leadership and consul¬ tation from the national level, plus funds from State sources to con¬ tinue committee work. Division of Social Services staff, both cen¬ tral office and regional, participated in the Conference and accepted special work assignments during the sessions. Two of the Division’s specialists shared authorship on a paper dealing with care of children away from their own homes for the White House Conference volume Reference Papers on Children and Youth. JUVENILE DELINQUENCY SERVICE Juvenile delinquency continues to be a subject of great public inter¬ est and concern. Congress continued to be active. One bill (S. 694) passed the Senate. It provided for Federal assistance for projects which will demonstrate or develop techniques leading to the solution of delinquency control problems. Several bills essentially the same were introduced in the House. One bill (H.B. 12108) , reported out of committee, provided for Federal grants or contracts to carry out proj¬ ects with respect to techniques and practices for the prevention, dim¬ inution and control of juvenile delinquency, and for training of personnel. That the interest of States continues is evidenced by the fact that the National Governors’ Conference passed a resolution establishing a committee on juvenile delinquency “to help marshal all public and private efforts to combat juvenile delinquency and to serve as liaison with the several agencies of the Federal Government, with the several State governments and with the public and private agencies working in the field of juvenile delinquency prevention.” Social Security Administration 73 During the year, a considerable amount of staff time was devoted to the Joint Report of the Children’s Bureau-National Institute of Mental Health on Juvenile Delinquency. This involved attendance at meetings, development of material, as well as consultation and re¬ view of material. Staff specialists in juvenile delinquency also devoted time to White House Conference planning, involving consul¬ tation and participation in the Conference as resource persons. Because of the above activities and work planning, which empha¬ sized the development of written material, the volume of consultation was slightly less this year. Consultation, either in the field, by cor¬ respondence, or office interviews wTas provided in response to almost 700 requests. All but three of the States received some type of con¬ sultation service during the year. In addition, over 50 foreign visitors, representing 26 countries, were provided program information and technical assistance through office interviews. In the spring of 1959, with the aid of Children’s Bureau staff, a meeting was convened in Washington attended by staff members of municipal and State youth commissions having delinquency preven¬ tion responsibilities. Its purpose was to exchange information and discuss problems of mutual concern. This was the first joint meeting of State and municipal commission representatives as each group met separately the previous year. Forty-four participants from 19 States, 17 representing local commissions, and 23 State commissions, took part. Of particular interest at the local level is the establishment of metropolitan government in the greater Miami area. Progress to date has been confined pretty much to physical services such as water supply, sewage disposal, and fire and insect control. Some indica¬ tions exist of the possible development of a metropolitan system of youth services and programs. Such a development would have sig¬ nificance for all social services. In February, the Children’s Bureau convened a 2-day conference of a small group composed of social workers, law enforcement officers and probation personnel to identify and discuss the problems which inhibit the development of close working relationships between law enforcement officers and youth workers, particularly those working with hostile anti-social gangs. The trend for police departments to drop certain activities related to recreation or social services con¬ tinues. The International Association of Chiefs of Police has re¬ cently indicated its position that the provision of such services are not appropriate departmental functions. A major staff project in the area of training this year was the conducting of a week-long National Workshop on Training for Pro¬ bation Services in Juvenile Courts. This workshop, made possible 573826—61 - 6 74 Department of Health, Education, and Welfare, 1960 by a Ford Foundation grant, was sponsored jointly by the Children’s Bureau, the National Council on Crime and Delinquency, the Coun¬ cil on Social Work Education, and Wayne State School of Social Work. The purpose of the workshop was to reexamine the knowledge, skills, and attitudes needed to work with children on probation and to develop effective ways through professional education and in- service training of getting such knowledge and skills to probation officers without professional training. The workshop was attended by 24 participants, educators, and program personnel from 18 different States. In addition to the above project, the staff conducted nu¬ merous workshops and institutes. Another significant trend is the growing awareness on the part of schools of social work of the needs of the correctional field, and their expanding activity in this area. More schools of social work are be¬ ginning to develop field work placements in corrections, add faculty members with correctional competence and develop an educational partnership with State and local correctional agencies. Several States are adding facilities for the care of delinquent chil¬ dren. Interest in the use of camps for the care and treatment of de¬ linquent children also has continued. Since work on written guides was emphasized during the year and because of the great demand for consultation concerning the establishment and operation of camps, a substantial block of time was devoted to the development of a new publication, Camps for Delinquent Youth: A Guide to Planning. Another new publication, Detention Planning , was produced to help meet the ever increasing requests for consultation on detention care and planning. Because of general interest of citizens in juvenile de¬ linquency, another non-technical publication, A Look at Juwenile De¬ linquency , was produced. Ten other articles on juvenile delinquency were written by Bureau staff and appeared in professional publica¬ tions or were issued as one of the Facts and Facets series. Cooperative work was carried on with the National Council on Crime and Delinquency, American Correctional Association, Coun¬ cil on Social Work Education, Child Welfare League, the National Council of Juvenile Court Judges, National Social Welfare Assem¬ bly, and the Family Service Association of America. INTERNATIONAL COOPERATION The usual fall and spring sessions of the Executive Board of UNICEF were held with the Chief and the Deputy Chief of the Bureau on the United States delegation. Beginning in 1961 only one main meeting a year, in J une, will be held to consider policy, with two meetings per year of the Program Committee to pass on projects. This change in procedure is expected to produce more efficient oper- Social Security Administration 75 ation. The United States contribution increased to $12,000,000 but the percent which this may be of the total contributions by all coun¬ tries was reduced to 48 percent. Though it appeared at first that all the United States money could not be taken up by UNICEF, before the close of the year contributions from other Governments were sufficient to make the full United States amount available. At the spring session, the United States had the satisfaction of see¬ ing the first fruits of its efforts to launch UNICEF into social services for children. Four projects were approved, all rather simple begin¬ nings, but soundly planned by an expert consultant working through the Bureau of Social Affairs. With 10 years experience in a long-range program, UNICEF is undertaking two program studies, one on training projects to which it has given assistance, with a view to recommendations on the future of this activity, and the other a study of children’s needs carried out in a manner to help countries assess their own needs and make plans to meet them. The Chief of the Bureau headed the official United States Dele¬ gation to the Eleventh Pan American Child Congress in Bogota, Colombia. A member of the Division of Social Services was also a delegate. Other staff members attended the Second World Confer¬ ence on Medical Education in Chicago, the Ninth International Con¬ gress of Pediatrics in Montreal, and the First International Medical Conference on Mental Retardation in Portland, Maine. A Bureau proposal for a United States-Russian Exchange in the area of maternal and child health was requested by the Public Health Service and was developed. An Exchange with Russia was subse¬ quently arranged by the Public Health Service on maternal and child care and related research and the Children’s Bureau will be repre¬ sented on the United States team. Preparation of material for reports to the United Nations required an unusually large amount of time this year. In addition to the United Nations Biennial Report on Family, Youth, and Child Wel¬ fare and Administration of Social Services, material was prepared for the United Nations Yearbook on Human Rights. The United Nations also requested a special report, for this year only, on Expe¬ rience in the Field of Social Development of Potential Assistance to Underdeveloped Countries. Comments on documents and position papers related to the International Labor Organization, the F ood and Agriculture Organization, and the World Health Organization were prepared. Material was also prepared for the use of the delegates to the Pan American Child Congress in Bogota, and for a United States Delegate at meetings of the South Pacific Commission. 76 Department of Health, Education, and Welfare, 1960 Working relationships, including correspondence and exchange of materials, have continued with the Inter- American Children’s Insti¬ tute, the Pan American Health Organization, and a number of inter¬ national voluntary organizations whose program, in whole or in part, is related to children. Under the continuing cooperative program with the International Cooperation Administration, the Bureau’s staff in its Division of International Cooperation recruits United States specialists for ma¬ ternal and child health and child welfare positions abroad, provides technical materials, advice, and information as requested, and plans and arranges training programs for persons from other countries. Seven maternal and child health and child welfare specialists recruited and backstopped by the Bureau worked as consultants in seven countries. A maternal and child health nurse was in Guatemala and a pediatric nurse in India. A medical social worker was in Peru, a child welfare worker in El Salvador, and a consultant on juvenile delinquency in Korea. There were two maternal and child health physicians, one in Iraq and one in Paraguay. Of the 76 students for whom the training branch of the Division arranged long-term programs of study and observation during the year, 36 were doctors, 17 were nurses, 1 was a health educator, and 22 were social workers. The International Cooperation Administration was the sponsoring agency for 50 of the participants, the United Nations for 9, and the World Health Organization for 12. Three Swedish child welfare workers were sponsored by the International Education Exchange Service of the Department of State. One physician came through the Asia Foundation, another was sponosored by the American Asso¬ ciation of University Women. The trainees came from 38 countries, with Indonesia having sent the largest number, 10 ; Thailand and India, 8 each ; and Brazil, 6. The 36 physicians were interested in increasing their competency in pediatrics, maternal and child health, or obstetrics and gynecology. The field of interest for most of the nurses was pediatric nursing, with a few in maternity or a combination of maternity and pediatric nurs¬ ing. All of the social workers had a primary interest in training for work with children. Of the 22 social workers, 3 had major interest in group work with children, 1 was a medical social worker, and 1 a psychiatric social worker. The majority of the social workers came for general child welfare. For a variety of reasons — the language problem, the accreditation status of the trainees’ former education, the time span permitted, and the type of training requested by the sponsoring agency — most of the trainees who take academic work enter the schools of medicine, nurs¬ ing, and social work as special students and not as candidates for de- Social Security Administration 77 grees. During the year, however, two students obtained master’s degrees in social work, one nursing student received a bachelor’s de¬ gree, and two physicians received the degree of master of public health. The trend toward training physicians in the specialties of obstetrics and pediatrics to equip them to teach in medical schools continued. This effort to upgrade medical education is now being extended to nursing education in the same countries. One hundred and fifty-eight short-term visitors from 60 countries came to the Bureau during the year. These were visitors studying in this country under the auspices of another Federal agency such as the International Educational Exchange Service of the Department of State, a private organization such as the National Council of Jewish Women, other agencies within the Department of Health, Education, and Welfare, or who are on their own. Their one common interest is some aspect of services for children which leads them to the Bureau for orientation to its programs, for consultation with Bureau special¬ ists, and for conferences with staff of other agencies arranged by the Bureau. Federal Credit Unions The accomplishments of the Federal credit union program during the 1950’s, spectacular though they were, served merely as a jumping- off point to even greater achievements in the years that lie ahead. The Federal credit union program rounded out a quarter of a century of service to the members in 1959, and by the end of that year, more than 9,400 Federal groups were serving 5% million members. During this first 25-year span of operations, the Federal program has grown from a handful of change — $7.75 worth — pooled in 1934 by a few persons in Texarkana, Texas, to start Federal Credit Union Number 1 to a total of $2,353 million in assets at the end of 1959. The decade ahead will present new challenges and new problems, but at the same time it will afford even greater opportunities for service to the members, not only in the financial field, but in the broad area of social welfare services as well. Continuing encouragement of thrift and expansion of financial counseling to members of Federal credit unions are only two of the services provided by these groups. Early in fiscal year 1960, Congress provided the impetus for an expanded Federal credit union program by passing, without a single dissenting vote, a modern Federal Credit Union Act1 which places greater responsibilities on the Federal credit union officials and enables them to provide better services to the members. The new act stream¬ lines administration of the program, thereby increasing efficiency of 1 PubUc Law 86-354, signed by the President on September 22, 1959. 78 Department of Health , Education, and Welfare, 1960 operations with concomitant reduction in operating expenses. Savings thus achieved will enure to the benefit of the members in the form of expanded services. The Federal credit union program is designed to serve two primary purposes: (1) To encourage thrift through systematic saving, and (2) to provide a source of credit to the members through loans for provident and productive purposes. The data in Table 11 reveal to some extent the progress that has been made in these areas. Growth is further revealed in the averages that follow : Year ended Dec. 31— Average mem¬ bership Average shares Average loans Year ended Dec. 31— Average mem¬ bership Average shares Average loans 1934 . ____ . _ 83 $7 0) 1947 _ 376 $133 $194 1935 _ _ 156 19 (i) 1948. . _ 401 144 227 1936 _ 180 28 (i) 1949 405 157 260 1937 _ _ _ 213 37 (i) 1950 427 170 299 1938 _ 230 43 (i) 1951 456 185 297 1939 . . . . 268 51 0) 1952 _ 482 209 351 1940 _ _ _ 302 58 (i) 1953 . . 495 236 388 1941 _ _ _ 337 (i) 1954 . 498 259 394 1942 _ _ 331 81 (i) 1955 517 282 447 1943 . . . 337 90 $112 1956 . 539 303 479 1944 _ 344 102 118 1957.. _ _ 561 324 516 1945 . 324 116 130 1958 _ _ 577 348 535 1946 . . . 346 123 159 1959 . . . 597 368 593 1 Basic data not available. By the end of 1959, average savings (shares) of Federal credit union members had risen to $868, and loans to members averaged $593. Aggregate savings, meanwhile, passed the $2-billion mark in 1959, and loans to members stood at $1.7 billion at the year-end. The Bureau of Federal Credit Unions, which is charged with the responsibility for administering the Federal Credit Union Act, is constantly alert to the changing conditions and new problems cre¬ ated by growth of the credit unions. Examination and supervision of the Federal groups represents the major phase of Bureau opera¬ tions, and is carried on through 10 regional offices. Field examiners, who work out of these offices, represent the Bureau’s primary con¬ tact with the Federal credit unions, and training programs con¬ ducted by the Bureau are consequently directed principally to the examiners. The Bureau’s goal is to examine all active groups at least annually, though difficulty in recruiting and maintaining a full staff of examiners sometimes results in a completion rate somewhat below 100 percent. In fiscal year 1960, for example, 92 percent of the scheduled examinations were completed. In addition to the continuing growth in the program throughout the fiscal year, it was necessary to set aside staff time during the last half of the period to implement the 1959 amendments to the Federal Credit Union Act. Development of new standard bylaws for Fed¬ eral credit unions to reflect changes in the law and revision of most Social Security Administration 79 of the Bureau’s publications were accomplished by fiscal year’s end. Improvement of communications between the Bureau and Federal credit unions, and between the Bureau and the general public repre¬ sents an area of emphasis that received attention during fiscal year 1960, and this activity will continue throughout the ensuing fiscal year. An important step in this area was preparation of a special 25th Anniversary issue of the Bureau’s annual Report of Operations — Federal Credit Unions. The Report , which normally presents data for the current calendar year, was expanded to include a brief sum¬ mary of legislative and other developments during the first 25-year span of operations; also, selected data for each year 1935-59 were presented in 20 supplementary tables which are intended to serve as a source for research and other purposes. A companion report on I State-chartered credit unions was in preparation as the fiscal year ended. The Federal Credit Union Act of 1959 represents a major step forward in Federal credit union operations. It does not, however, change the nature and scope of Federal credit unions, which are pri¬ vately owned corporations designed to function in the short-term consumer credit area. Table 1. — Social Security Administration: Funds available and obligations incurred , fiscal years 1960 and 1959 1 (In thousands, data as of June 30, 1960) Item Funds available * Obligations incurred 1960 1959 1960 1959 Total _ -- $2, 274,364 $2, 181,896 $2,268,911 $2, 180,025 Grants to States: Public assistance - - - Old-age assistance 2,037,500 1,957,960 2,033, 761 1, 157, 523 48,824 660,232 167, 182 46, 218 17, 443 15,873 12, 902 188,932 602 180, 476 2,280 2, 278 198 3,098 1,957,098 1, 132. 194 47,619 626, 546 150,739 44,728 16, 494 16, 401 11,833 178, 199 596 170,087 2, 142 2, 165 150 3, 059 Aid to the blind _ Aid to dependent children _ ... .. . . _ Aid to the permanently and totally disabled ... Maternal and child health and welfare services . Maternal and child health services . Services for crippled children _ _ Child welfare services . . . . . . Administrative expenses: * - - - - - Office of the Commissioner 1 * * 4 - - - Bureau of Old-Age and Survivors Insurance 4 * * 8 _ Bureau of Public Assistance _ _ Children’s Bureau 9 _ .. _ White House Conference on Children and Youth.. Bureau of Federal Credit Unions. _ _ 46.500 17. 500 16,000 13,000 190,364 613 181,600 2, 345 2,300 200 3, 306 45,000 16,500 16, 500 12,000 178, 936 610 170, 614 2,164 2,172 150 3,226 1 Funds available and obligations reported by administrative agencies. * Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. * Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and all other objects of expenditure. 4 Appropriations by Congress from general revenues accounted for approximately 55 percent of the ad¬ ministrative expenses of the Office of the Commissioner in 1959 and 1956; balance from old-age and sur¬ vivors insurance trust fund. 4 Administrative costs of the old-age, survivors, and disability insurance program which involved benefit payments of $9,388,000,000, in 1959 and $10,798,000,000, in 1960. Does not include construction costs of new buildings as follows: Funds available: 1959, $8,979,461; 1960, $7,633,774. Obligations incurred: 1959, $1,345,587; 1960, $2,454,189. 8 Includes expenses for investigating and reporting on matters pertaining to the welfare of children au¬ thorized by the act of 1912, as well as expenses for administration of grants to States. 80 Department of Health , Education, and Welfare, 1960 Table 2. — Financing social insurance under the Social Security Act: Contribu¬ tions collected and trust fund operations, fiscal years 1958—60 [In millions; independently rounded] Item 1960 1959 1958 Contributions collected under— Federal Insurance Contributions Act 12 - - - - $10,830 $8, 460 $8, 193 Federal Unemployment Tax Act 3 . . . 341 324 336 State unemployment insurance laws 46 _ _ _ 2, 165 1,675 1,500 Old-age and survivors insurance trust fund: Receipts, total.. . . . . - . . . 10, 342 8, 109 7,824 Net appropriations and deposits _ _ _ 9,843 7, 565 7, 267 Net interest and profits on investments 8 _ _ _ 500 540 557 Expenditures, total _ _ _ _ _ 11, 055 9, 377 8,041 Monthly benefits and lump-sum payments 2 . . 10, 270 9,049 7,875 Transfers under financial interchange with railroad retire¬ ment account _ 583 121 Administration _ _ 202 206 166 Assets, end of year. . . . . . . . . 20, 829 21, 541 22, 813 Disability insurance trust fund: Receipts, total - - - . 1,061 928 942 Net appropriations and deposits - 987 895 926 Transfers under financial interchange with railroad retire¬ ment account _ 26 Net interest and profit . . . . 48 33 16 Expenditures, total - - - - - - 560 360 180 Monthly benefits.— - - - - 528 339 168 Administration - - - - - - - 32 21 12 Assets, end of year - - - - - - - - 2, 167 1,667 1,099 State accounts in unemployment trust fund: Receipts, total.—. . . . . . . 2, 351 2, 126 1,794 Deposits 5 . . . 2, 169 1,946 1, 575 Interest . . . . . . . . . 182 179 220 Withdrawals for benefit payments _ 2, 366 6, 673 2, 797 6, 688 2, 926 7,360 Assets, end of year _ _ _ _ 1 Contributions on earnings up to and including $4,200 a year in 1958, and $4,800 a year beginning Jan 1, 1959. Contribution rate paid by employers and employees: 2\i percent each beginning Jan. 1, 1957; 2 H percent each beginning Jan. 1, 1959; 3 percent each beginning Jan. 1, 1960. Contribution rate paid by self- employed: 3% percent beginning Jan. 1, 1957; 3% percent beginning Jan. 1, 1959; 4 Vi percent beginning Jan. 1, 1960. Includes deposits by States under voluntary agreements for coverage of State and local employees. Includes deductions to adjust for reimbursements to general funds of the Treasury of the estimated amount of employee taxes subject to refund on wages in excess of wage base. 2 Includes old-age and survivors insurance and, beginning Jan. 1, 1957, disability insurance contributions. 3 Prior to 1957 tax could be paid in quarterly installments by employers of 8 or more: beginning Jan. 31, 1957, tax payable annually on preceding year’s wages by employers of 4 or more. Rate is 3 percent on first $3,000 a year of wages paid to each employee by subject employer. Because of credit offset of up to 90 per¬ cent of amount assessed that is permitted for contributions paid under State unemployment insurance laws (or for full contribution if reduced by State experience rating provisions), effective rate is 0.3 percent of such wages. 4 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 3 Contributions and deposits by States usually differ slightly, because of time lag in making deposits. Deposits in the State accounts also include loans from the Federal unemployment account of the unemploy¬ ment trust fund and the distribution of Federal tax collections among the States under the Employment Security Administrative Financing Act of 1954. 8 For 1958 includes interest transferred from the railroad retirement account under the financial inter¬ change provisions of the Railroad Retirement Act, as amended in 1951 and 1956. ? Represents checks issued. Source: Compiled from Final Statement of Receipts and Expenditures of the United States Government, other Treasury reports, and State agency reports. Social Security Administration 81 Table 3. — Old-age , survivors , and disability insurance: Number of families and beneficiaries receiving benefits and average monthly benefit in current-pay¬ ment status , by family group , end of December 1959 and November 1958 1 [In thousands, except for average benefit] Family classification of beneficiaries December 31, 1959 November 30, 1958 • Number of families Number of benefi¬ ciaries Average monthly amount per family Number of families Number of benefi¬ ciaries Average monthly amount per family Total . . . 10, 112. 8 13, 703. 9 9, 189. 5 12, 430. 1 Retired- worker families _ _ _ 7, 525. 6 9, 931. 6 6, 920. 7 9, 147. 3 Worker only.. _ 5, 320. 7 5, 320. 7 $68. 70 4, 871.8 4, 871.8 $62. 60 Male _ _ _ _ 2, 755. 3 2, 755. 3 78.00 2, 587. 3 2, 587. 3 70. 70 Female _ 2, 565. 4 2, 565. 4 58. 70 2, 284. 5 2, 284. 5 53.50 Worker and aged wife _ _ _ 2,029.4 4, 058. 8 121.60 1, 901.5 3, 803. 0 111.20 Worker and young wife 1 2 _ ..... .8 1.6 118.60 .7 1.4 105. 20 Worker and aged dependent husband. 14.7 29.3 103. 60 14.3 28.5 94. 40 Worker and 1 or more children _ 44.8 102.5 118. 90 30.0 71.1 109. 80 Worker, wife aged 65 or over, and 1 or more children... _ _ 13.0 39.9 157. 30 10.3 32.5 140. 30 Worker, young wife, and 1 or more children _ _ _ 102.1 378.3 151. 70 92.0 338.7 132. 50 Worker, husband, and 1 or more children _ _ _ _ _ .2 .5 123. 70 .1 .2 126. 70 Survivor families _ 2, 252. 8 3, 312. 0 2,031. 1 3, 014.9 Aged widow 3 _ _ _ _ 1,380.1 1, 380. 1 56. 70 1, 224. 0 1, 224. 1 51.90 Aged widow and 1 or more children... 11.4 23.6 111.20 6.9 14.2 105. 50 Aged widow and 1 or 2 aged dependent parents _ . _ .1 .3 130. 50 (*) (4) (4) Aged dependent widower _ _ 1.9 1.9 53. 40 1.6 1.6 48.90 Widower and 1 or more children _ (4) («) 92.60 (5) (4) 86.90 Widowed mother only 2... .. _ . 1.1 1.1 55. 40 1.2 1.2 51.00 Widowed mother and 1 child. . ... _. 159.7 319.4 129. 70 149.0 298.0 117. 00 Widowed mother and 2 children 3 _ 106.4 319.2 170. 70 104.4 313.2 151.70 Widowed mother and 3 or more children3. . _ _ _ ... 108.2 520.1 178. 60 99.1 473.6 150.70 Widowed mother, 1 or more children, and 1 or 2 aged dependent parents . .4 1.6 219. 40 (4) (4) (4) Divorced wife and 1 or more children. .3 .9 166. 80 .3 .9 141.40 1 child only * . . . ... ... 282.6 282.6 56. 90 261.1 261.1 51.80 2 children _ _ _ _ _ 110.4 220.8 101. 30 100.0 200.1 88.90 3 children _ _ _ 36.1 108.4 129. 50 34.0 102.1 115. 40 4 or more children _ _ 21.6 97.1 148.00 21.3 94.9 125.50 1 or more children and 1 or 2 aged dependent parents _ .8 1.8 136. 80 (4) (4) (4) 1 aged dependent parent.. _ 29.8 29.8 59. 60 26.5 26.5 53. 30 2 aged dependent parents _ _ 1.7 3.3 104. 80 1.7 3.4 97.60 Disabled-worker families. _ _ 334.4 460.4 237.7 268. 1 Worker only _ 275.3 275.3 87. 90 223.2 223.2 81.70 Male _ 206.3 206.3 91.90 175.6 175.6 84.70 Female. . . . . . 69.0 69.0 76.10 47.7 47.7 70. 60 Worker and aged wife _ _ 17.4 34.8 135. 90 4.8 9.7 128. 80 Worker and young wife 2 . .... . .2 .5 133. 20 0 0 0 Worker and aged dependent husband. .2 .3 116. 60 i4) (4) 101.60 Worker and 1 or more children _ 11.2 28.2 153. 90 2.3 5.6 146. 70 Worker, wife aged 65 or over, and 1 or more children _ _ (4) .1 204.00 (4) (4) 197. 00 Worker, young wife, and 1 or more children _ _ 30.1 121.1 185. 60 7.4 29.5 167.80 1 To effect the benefit increases provided by the 1958 amendments, certain operations affecting statistical data on monthly benefits in current-payment status were suspended for December 1958; figures on benefits in current-payment status as of the end of December 1958 are therefore not available, but the corresponding data as of the end of November 1958 are shown in their place. 2 Benefits to children were being withheld. 3 For November 30, 1958, includes a few cases where there is also a parent’s benefit in current-payment status. 4 Not available. Data for families with parent’s and other survivors’ benefits in current -payment statu on November 30, 1958 are included in other family groups; see footnote 3. s Less than 50. Table 4. — Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1960 and amount of benefit payments in fiscal year 1960, by State 1 [In thousands] 82 Department of Health, Education, and Welfare, 1960 Benefit payments in fiscal year 1960 ►-H A $528,304 ooNoo^HOijiciHtofflNinNHioooooa^ooo-^iowaH MHOOM»ININNNiOiNH«OMiONO®rt(NOOe®>oa>CiO r-T •^ioo5«^i-TT-T»c^>-H“>--rodw»o-^creoe Lump-sum death pay¬ ments $165, 772 ®^ow>o<0(Oinoo«^'HOOHMioiOHio®0(N(N®C0TH'#00®MNiO® 05CSCOrrCOOiOrHt^-"*l-'3'GiOOOO-'4<>OCO'c)o oo'o r-^ 05 iOOOHOOt-NCOCOCOi-lC001®OOMiOO®05NNOt-®^X I-I 00 T-( COH CO 05 rH rH T-( 1-1 rHCO'S'05 05 Total $10, 797, 995 >CI®OC5NOOCMH'lON tC^Ho^Hofi>rco^ru^'coc®otCcoeoo5cot^'eo'-Hor^H'd;'^-ror'2co'T-t CO CO 03 CO 00 05 CO CO 05 CO CD rH 00 CO CO rH t- O O ,-1 00 CO OS rH 00 rH COrH OMrtHHH C5 Monthly benefits in current-payment status, June 30, 1960 s Monthly amount o 00 & (M^cDHOiDOOOON-^ONNCOOMOOlNNCOOOCOOOCOOON^ T^H^HOOCCHOOlNWDNDOiOO^NiOtNClOOiOCOOMHOO 00 co^oocqio H CO GO OD^WOODtNiOHCD^^ClHH OXOCO-<»,®‘0«00®CD C^COt^ rH CD t-H C0c0rH000500t^C0C0iO05 oo'tod'i'HdiocddQodHcqodcoeoffldNocdoi'^-^'^ rH h*i rH r-l CO -cti CO 05 05 CO 05 05 CO OO h*i CO 05 00 t- 00 t- f- i® 05 05 HOHC5 ^05 t> CO 05 rH 05 r-l r-l TjH co 05 r-l CO rH Total Monthly amount CO CD 00 NfflffiH<®®0®C5NCOMOOeOl005®ffl'#>n®N»®N®N OCOrHTfHCCIHCOOOHlOINlCOnCOXl-ONNCOXiOOlO® 05C5®iOO05'#OXH®®H®Xt'ON05M®O®H,NiO>OiO 05 oo GO 5— 1 ^ ^ CD CO CO T-I l> iH - cSco dtrfrfeo rf efco‘ nnhw §S§IIsS!1!ssb8!11SIsssIsS1 SS|S'S|S3|='|gSSK83|SS 8'gV'SS‘S SgilsSIsllSsIisllIssIlglll 2S§?S|SS|Sg|SSggBBSa Kg'g'S'Sg *Ss3ElsIlg§sS§g:Il»“"slsSS2 rt COrf of eo rf 50 t- os oo m a> oo oa »o co i'- o> o o r-t >o oo wooooooo £ IslSsSgssIslsSsSsSS^sSlSSS co^*ofg^of®®o^M50 50cc^®coof co jo of of .-T >o lousoooNt^oeoootooiNNOMrqNHiooooooo jVocjHo HNOSNOOcOJOHOOONiOcCW^NCC^HHaW^OOCO SS§S|15ggg|5SgSS|!SS-||g§aS -f -H- 84 Department of Health , Education , and Welfare , I960 Table 5. — Old-age , survivors , and disability insurance: Selected data on em¬ ployers, taxable earnings, and contributions, by State, for specified periods [In thousands, except for average taxable earnings. Includes data for State and local governments covered under elective provisions] State Employers reporting taxable wages July- September 1959 1 * Calendar year 1957 3 Workers with taxable earnings 3 Amount o earnii Total f taxable lgS 4 * 6 * Average per worker Amount of contribu¬ tions 8 4, 140 71,000 $181, 421, 000 $2, 560 $7, 968, 700 59 1,070 2, 160,000 2, 020 95, 100 4 80 176, 000 2, 200 7,800 26 430 942. 000 2,190 41,400 36 530 900,000 1,700 38, 900 368 6,030 15, 863,000 2, 630 696, 800 42 690 1,488,000 2,160 64.600 64 1,180 3,231,000 2,740 142, 800 13 250 621,000 2, 480 27, 500 31 480 1,012,000 2,110 45, 100 126 1,810 3, 423,000 1,890 149,700 85 1,420 2,706,000 1,910 119, 100 11 200 477,000 2, 380 21,000 15 260 546,000 2,100 23,300 227 4, 560 12,169,000 2,670 534, 400 92 1,950 5,079,000 2,600 223, 300 67 1,110 2, 505, 000 2,260 105, 400 51 870 1, 881, 000 2,160 81, 100 60 980 1, 994, 000 2,030 86, 300 64 1,060 2, 213,000 2,090 97, 300 25 400 776,000 1,940 34,000 70 1,200 2, 821,000 2,350 124, 500 122 2, 270 5,647,000 2, 490 249, 900 154 3, 310 9,377,000 2, 830 414, 500 73 1,310 3,111,000 2,370 134,000 37 610 999, 000 1,640 43, 500 108 1,870 4, 314, 000 2,310 188, 600 17 280 632, 000 2, 260 27,100 35 620 1, 232, 000 1,990 52, 300 7 130 280,000 2,150 12, 300 17 280 590,000 2,110 25, 900 152 2,690 7,085, 000 2,630 312, 600 19 300 562, 000 1,870 24, 500 496 8, 210 21,800,000 2, 660 962, 200 94 1,650 3, 218,000 1,950 140, 900 14 240 468,000 1,950 19,000 203 4,030 10, 991,000 2, 730 484, 700 52 870 1,803,000 2,070 78, 400 41 740 1,760,000 2, 380 77,000 249 4, 810 12, 556.000 2,610 554, 000 18 460 452, 000 980 19, 800 21 380 886, 000 2, 330 39, 100 46 800 1, 520, 000 1,900 66, 900 16 240 477,000 1,990 19, 600 75 1,270 2, 513,000 1,980 110, 100 223 3, 540 7, 558,000 2,140 330, 900 17 340 736.000 2,160 32, 300 11 150 314, 000 2,090 13, 700 86 1, 380 2, 811, 000 2, 040 123, 600 1 10 13,000 1,300 500 65 1,160 2, 854,000 2, 460 124, 900 37 690 1, 645, 000 2, 380 72, 700 89 1,580 3, 955, 000 2, 500 171, 900 9 150 298, 000 1, 990 12, 900 90 214, 000 2, 380 9, 500 140 395, 000 2, 820 17, 800 3,510 5, 372,000 1,530 241, 700 Total. Alabama... . Alaska . . . . Arizona. . . . . Arkansas . California . . . Colorado . . . Connecticut . . Delaware _ _ _ _ _ District of Columbia. . . Florida . . . Georgia . . . . Hawaii... . . . . Idaho. . . . . . . Illinois . . . Indiana . . . . Iowa . . . Kansas. . Kentucky _ _ _ Louisiana. . . . . Maine.. . . . Maryland . . . . . Massachusetts . . . . Michigan _ _ _ _ Minnesota... . . . Mississippi . . Missouri. . . . . Montana . . . . Nebraska . . . . Nevada - - - New Hampshire. . . . . New Jersey . . . New Mexico... _ _ New York... _ _ North Carolina.. . . North Dakota _ _ Ohio _ Oklahoma. . . . . Oregon.. . . . . Pennsylvania _ _ _ Puerto Rico _ Rhode Island _ South Carolina _ South Dakota _ Tennessee . . . . . . Texas. . . Utah.. . . . . Vermont _ Virginia . . . . Virgin Islands. . . . . Washington _ _ _ West Virginia . . Wisconsin . . Wyoming _ _ _ _ Foreign « _ _ _ Ocean-borne vessels _ Uniformed services (on basic pay). 1 State data represent number of employers reporting taxable wages by the State of their reporting head¬ quarters. An employer is a legal entity such as a corporation, partnership, or single ownership for which a single tax return is filed. Excludes agricultural employers. 3 Includes self-employment. * State data represent workers employed in the State at some time during the year. Workers employed in more than 1 State are counted once in each of the States in which employed. 4 Represents taxable earnings in the State in which workers were employed. Averages are rounded to nearest $10. 6 Contributions based on a worker’s annual taxable earnings, not more than $4,200 in 1957. Contribution rate was 2 54 percent each for employees and employers, and 3% percent for self-employed persons. • Refers to employment of United States citizens outside listed States or other areas by American employers and their foreign subsidiaries. Social Security Administration 85 Table 6. — Old-age, survivors, and disability insurance: Selected data on ben¬ efits, employers, workers, and taxable earnings for specified periods, 1958—60 [In thousands, except for average monthly benefit and average taxable earnings; corrected to Sept. 29, 1960] Item 1960 1959 1958 Fiscal year Benefits in current-payment status (end of period): Number (OASI and DI)* _ _ _ _ _ 14. 261.8 13,181.4 11,905.3 11,704.9 Number (OASI) _ 13, 740. 3 .521 . 6 12, 820. 2 361.2 Number (DI) . . . . 200.4 7, 813. 0 370. 8 7, 295. 6 275.2 6, 638. 5 200.4 Disability (disabled-worker) _ _ _ Wife’s or husband’s (OASI and DI) _ 2. 279. 9 2, 141. 8 2, 108. 5 33.2 1, 947. 4 1,917.4 Wife’s or husband’s (OASI) _ _ _ _ 2, 223. 5 Wife's or husband’s (DI) _ 56. 4 Child’s (OASI and DI)* * 3 4_ . . . 1,903.5 1, 809. 1 94.4 1, 747. 7 1, 694. 8 52.8 1,571.9 1,571.9 Child’s (OASI)3 _ _ _ _ _ _ Child’s (DI)3.' . . . . . . 1,471.3 387.9 1,322.0 366.5 1, 172.8 Mother’s _ _ 344.9 Parent’s _ _ _ _ _ _ _ _ 35.5 32.7 29.4 Total monthly amount (OASI and DI) _ $889, 863 $851,791 $38. 071 $805, 545 $659, 684 Total monthly amount (OASI) _ $778. 404 $644, 773 Total monthly amount (DI). _ $27, 141 $14,911 $575. 295 $33, 123 $526, 701 $24, 324 $436, 244 Disability (disabled-worker) _ _ _ $14. 911 Wife’s or husoand’s (OASI and DI) .. _ $87, 701 $85. 676 $2, 025 $84, 789 $81,865 $81,295 $80, 096 $67, 821 $67, 821 Wife’s or husband’s (OASI) _ Wife’s or husband’s (DI) $1, 199 Child’s (OASI and DI)3.... . . . $76. 209 $61,471 $61, 471 Child’s (OASI)3 . . . $74, 591 Child’s (DI)3 . . . . $2, 924 $1. 618 Widow’s or widower’s _ $84, 229 $74, 359 $60, 457 Mother’s. . _ _ _ _ _ $22. 609 $20, 760 $1, 896 $72. 19 $17, 241 $1, 538 $65. 71 Parent’s _ _ _ $2, 117 $73. 63 Average monthly amount: Old-age (retired -worker) _ Disability (disabled-worker) _ _ $89. 33 $88. 40 $74 42 Wife’s or husband’s (OASI and DI) .. _ $38. 47 $37. 96 $34. 83 Wife’s or husband’s (OASI) _ $38. 53 $37. 99 $34. 83 Wife’s or husband’s (DI) . _ _ _ _ $35. 92 $36. 09 Child’s (OASI and DI)3 _ _ _ _ $44. 54 $43. 61 $39. 11 Child’s (OASI)3 _ _ _ _ $45. 25 $44. 01 $39. 11 Child’s (DI)3 $30. 98 $30. 62 Widow’s or widower’s . _ _ $57. 25 $56. 25 $51. 55 Mother’s _ _ _ _ _ $58. 29 $56. 65 $49. 99 Parent’s . . _ _ _ $59. 67 $10, 632, 223 $10, 103. 919 $58. 02 $52. 34 Benefit payments during period: Monthly benefits (OASI and DI) _ $9, 238, 753 $7, 900, 638 Monthly benefits (OASI) _ $8. 899. 522 $7. 732, 218 Monthlv benefits (DI)_ . . . $528, 304 $339, 231 $168, 420 Old-age (retired -worker) _ $6, 803, 466 $450. 114 $6. 041,417 $5, 245. 777 Disability (disabled-worker). _ _ $311,105 $168, 420 Supplementarv (OASI and DI). _ $1,183,515 $1, 105, 325 $1.007, 142 $860, 488 Supplementary (OASI).. . _ $979, 016 $860, 488 Supplementary (DI) $78. 190 $28, 126 Survivor _ _ . _ _ $2. 195, 128 $1.879. 089 $1,625, 953 Lump-sum death payments . _ _ $165, 772 $149, 625 $142, 714 Insured workers (midpoint of period— Jan. 1): 3 Fully insured Currcntlv but not fully insured Estimated number of employers reporting taxable wages, 1st quarter of fiscal year. . . _ 4 4, 140 4 4. 090 4 4, 060 Calendar year Estimated number of workers with taxable earnings. _ _ 75, 0C0 $213, 000. 000 73, 000 70, 000 Estimated amount of taxable earnings _ _ $202, 000. 000 $181,000, 000 Average taxable earnings 5 _ _ _ _ $2. 840 $2, 770 $2, 590 • Benefits under the old-aee and survivors insurance COAST) parts of the old-age, survivors, and disabi’ity insurance program are payable from t^e O ASI trust fund to oki-age insurance (retired-worker) beneficiaries and t^eir dependents and to survivors of deceased workers. Benefits under tve disabi’ity insurance (DI) part of the program are payable from the DI trust fund to disability insurance (disabled-worker) beneficiaries and t^eir dependents. * Includes benefits payable to disabled persons aged 18 or over— dependent children of disabled, deceased, or retired workers — whose disabfiity 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 t,-e old-age, survivors, and disabi’ity insurance and railroad retirement pro¬ grams and (2) wage credits for military service. Estimates are only partially ad justed to eliminate duplicate count of persons with taxable earnings reported on more than 1 account number. 4 Excludes agricultural employers. 4 Rounded to nearest $10. Table 7. — Special types of public assistance under plans approved by the Social Security Administration : Number of recipients average payment , June 1960, and total payments to recipients, by program and State, fiscal year 1960 [Includes vendor payments for medical care and cases receiving only such payments; data corrected to October 15, 1960] 86 Department of Health, Education, and Welfare, 1960 Aid to the permanently and totally disabled Payments to recipients Total, fiscal year (in thou¬ sands) $212, 209 244, 664 271, 208 5, 197 3, 181 8, 640 4, 480 3, 445 291 2,415 6, 505 12, 597 11 959 854 17, 497 8 104 4, 206 4, 201 10, 434 1, 624 4, 652 Aver¬ age pay¬ ment, June $60. 69 63.37 65.74 eo i ncNoiNffloo -rn in .— i —h iooh^ co'f i-H i i ^ io oo to n to oo oo tonoo icMcoiNeo if rH cd i i cd cd oo oo cd id cd cd cm i cd H id cd ad id CO i t co o to 04 c N to lO in in OO lOOOOrflO coco Num¬ ber of recipi¬ ents, June 312, 585 339,214 362,832 OO i IH0500M05N OCONIOCD iWt^NOO O i iO(N-HNCh - - iN(Nrf<03 00 CN 1 I (N -h CD rH CO N (N 80 OO^ i CO 04 CD ^ HH C'f i it^oTioc* ofaT r-T i-Tt-Too ! ^i>Tco cacd i-< ' ' JtO O CO O O N lO 00 OJ (N M CO OOtOONCOONlO if lO COHCOOt-NINtNaia id .1 o oo ^ to ■># -cf th oTcd fi co cdrHrt' nn Aid to dependent children Payments to recipients Total, fiscal year (in thou¬ sands) $815,196 956, 380 1,021,097 00 IM CO 00 00 rH ID O O OOCOOCOOOlONlOf. ION ICIOCNCOOI^IONN ID IN I— CO rf no -3* In M IM NOI WlOrHrtrtlOHCOiJICI O 00 ID In 03 00 00 CN ->f CO t— oo" H o' id rH- o' H H tC oT cd eccd'iNcd'cd'03''od'iN com H -^1 rH ,-H |—1 r-H CO rH 1 rH IM rH Aver¬ age pay¬ ment per re¬ cipient, June $27. 28 28. 38 29. 08 OlONOOIN-Hi-tCCtON O 00 -f 03 IN CO ID ID no ooco ■O^CONMrtHOCON NNIOIOONMOOIOOO if if cdiNoedidedcdtN’cdcd cd H cd d cd in id cd H cd in as C»5 CO rH if CD if IM CO — 1 M r-l CO ->f CO M CO CD CN CS M M Aver¬ age pay¬ ment per family, June $102. 39 106. 94 110. 75 NHlNOlMHCOO^Mt O r}4 00 rH CO lO 80 o T-H CO ' oT CO rHtCcOt^^OOCOlO r-To5~ 05 tH 80 80 80 rH CO 05 MN CO ON i-a-'ccec© © © © © r~ 1 i r- CO CO CO © CO t— © CO © IIOK5NN CO CO CO TjH CO 1 1 1 1 1 1 1 1 1 Amount $238, 037 273, 288 302, 925 5, 592 3, 506 10, 363 5, 131 3, 736 349 2, 582 7,248 13, 534 14 1,084 937 19, 605 2 136 4, 549 4, 553 11, 912 1, 781 5, 098 15, 891 4, 857 1,904 Aid to the blind Percent from Federal funds 47.8 49.6 48.9 00 03 00 CO OO rH 05 ^ W050H(NOiC5 00(N *d r^* *d c4 oo* *d oi 05 oo* 03* o>* 05* *d rH *d o cd rfi 05 05* cd cd c4 *d *0 CD CO *0 CO *0 *0 CO N^t00*0*0»0i0 1>*0 co co co *o ^ Amount $92, 549 96, 806 100, 202 (NCO^OOOOONIOCO *CHONO-^N05 0H Hr^(NNCO NOnoNoorH^^orf oo »o oo co co r^r^05cooo t>» CO *0 CO TF 03 03 05 CO rH CO 00 CO CO *C CO COCO rHNCO HO t-H of «HH HW" COr-Hi-H Aid to dependent children Percent from Federal funds 58.7 59. 1 58.9 00HOMH10 05OC0H CO O O 05 *C CO O *0 CO CO NHO'tCO O5*cd*do*dcdcdr-4oo5* *d o 05 rti 03* © oo ^* rj4t^cd*do5 CO I> 00 ^ CO TF CO NiOiO^iOcOCOiONN NCD^*C^ Amount $902, 651 1, 056, 630 1, 130, 515 9, 740 1,644 10, 465 5, 541 162, 680 11, 894 15, 337 1,850 8, 098 21, 415 17. 196 77 4, 433 3, 859 74, 244 15, 495 15, 041 10, 716 19, 541 30, 607 7, 028 14. 197 28, 860 43, 930 19, 329 Old-age assistance Percent from Federal funds ■^COH *d 00 00 *0*0*0 mO>NHOiT(UOiOMN eo © 05 © 00 © tT © CD 00©C. © r- ^ co © © © in ©©©©©©© t- © i> © -^ © © Amount $1,911,217 1, 973, 089 2, 014, 736 rt05H(NMO©COO)CO ^Ol-HCO©HIN»NO © rH © © CO i#OHOrtONOOnO 0r-IC3irt0©NW»0 ©OO-hCOi-h C'- CN © © © © t— GO © t'- 00 rtr^©00©^H©CO © C«5 © N- rH ©■-HOTjr^Tco© cnco~ N-~ hco'hiNWOs'-hV ©t-Tco n7©©©© CO © 00 N © N- © ^ CS CO © Tjs o © CO rH Tt< CO IN © M © (N IN © © © HHHH CO © 1-1 © © 00 CO IN © C<)C^rH©© IN 1—7 i— 7 r-7i-7 hh 1-7 Aid to dependent children $525, 318 626, 546 660,232 Tf C^O(NOC5CDHOOO 05 rH oo t-H CD CO 03 *0H05 10*0 COCO rHGON05 00rHr^(M Cb-^OCIONOOCOO^O C5 000(M05^Tf COOOCO 00 COOCOr-OCOHOO rH05C0 05^ ' rH 258 4,018 1,440 21, 234 8, 199 679 6, 099 5, 382 2, 820 7, 944 1,279 1,511 3, 053 655 3, 730 2, 768 1,331 474 19 2,863 3,325 2,714 1,368 290 2, 318 2, 331 205 513 119 51885*1135 eCef -7- co 101 65 689 90 1,240 3, 199 116 67 4 629 376 401 546 36 8,547 21, 932 1,846 2,852 916 ssssssssss 8i3§i9iS8§ »C'<7|oe^«o joeoi-T 9,536 17, 705 8,542 762 24, 093 57, 292 3, 722 8,699 1,392 2,642 9, 579 6, 272 47, 078 19, 171 4, 307 44,284 51,871 9, 296 25, 191 2,032 3, 597 12, 203 4, 772 22, 363 102, 807 4, 380 2,910 100 6, 012 25, 669 6,829 18,910 1,764 85885 5881888183 -'•£3£stfg‘iSS‘3‘ 8,500 9, 421 21, 428 8, 475 42, 898 124, 697 9, 476 4,719 206 17, 162 38, 905 27, 649 29, 366 2, 852 IlijiJ i > & * & o a> o o o Illl lag- . Zzzzttooo i1!! ti lllljllll Ilf II i& II !* 1 § 573826—61 - 7 90 Department of Health, Education, and Welfare, 1960 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 1960 1 2 [In thousands] State Maternal and child health services Crippled children’s services Child welfare services United States _ $17,442.5 $17,088.1 $12, 902. 0 Alabama _ 544.9 546.4 349.7 60.2 138.6 196.6 161.0 125.3 282.6 260.1 234.9 California _ _ _ . . . 896.6 950.0 589.9 Colorado _ 355.8 214.4 147.7 259.3 232.7 118.2 64.2 106.3 99.2 District of Columbia _ 222.9 200.2 70.3 520.7 342.8 287.3 491.9 538.2 391.2 156.2 148.4 81.8 Triaho . . .... _ . ... _ _ 155.5 115.4 77.0 Illinois _ _ _ _ _ ' _ 462.3 592.7 437.8 Indiana _ 336.7 368.2 314.9 Iowa _ 251.9 356.2 260.6 Kansas _ 202.8 245.8 183.6 Kentucky . 370.0 478.0 350.3 Louisiana _ 370.6 405.2 288.4 Maine _ 146.5 120.7 106.0 Maryland _ 429.2 313.4 192.5 Massachusetts _ 371.3 342.7 150. 5 Michigan _ 663.3 615.5 458.3 Minnesota _ 388.0 546.4 289.4 Mississippi _ 392.0 398.4 315.3 Missouri . . .. . .. . 348.1 331.8 280.8 Montana . _ _ _ _ _ . . ... . _ 129.0 170.8 101.6 Nebraska . _ 130.9 91.8 149.0 Nevada _ 160.6 90.9 43.0 New Hampshire _ 102.2 105.2 75.0 New Jersey 253.2 247.8 211.6 New Me.Yioo 198.6 151.2 114.0 New York _ 773.8 638.9 626.5 North Carolina _ 695.1 643.2 539.5 North Dakota _ 113.4 111.0 114.8 Ohio 670.8 548.8 492.3 Oklahoma _ 249.7 258.8 211.5 Oregon _ 160.8 191.1 164.3 Pennsylvania _ 830.7 714.9 594.4 Rhode Island _ 155.4 110.0 85.6 South Carolina _ 369.6 384.7 314.2 South Dakota _ 56.2 105. 7 110.5 Tennessee 531.7 457.8 358.4 Texas . . . 715.5 953.3 653.3 Utah . . . . 73.7 96.8 108.0 Vermont _ 109.7 97.0 75.8 Virginia 488.4 461.4 365.5 Washington _ 269.7 206.5 192.2 West Virginia _ 230.8 278.9 252.9 Wisconsin _ 322.5 361.0 301.1 Wyoming _ _ _ 102.6 92.8 65.0 Guam 58.3 53.1 Puerto Rico _ 371.6 416.3 310.8 Virgin Islands _ 93.0 89.0 45rl 1 On checks issued basis. 3 Includes $1, 215, 200 derived from $1. 5 million supplemental appropriation to be used only for children with congenital heart diseases to remain available until June 30, 1960. Social Security Administration 91 Table 10. — Federal credit unions: Assets and liabilities , Dec. 31, 1959, and Dec. 31, 1958 Amount Percentage distribution Assets and liabilities Number of operating Federal credit unions . . . Total assets . . . Loans to members . Cash _ United States bonds _ Savings and loan shares _ Loans to other credit unions _ Land and buildings _ Other assets . . . Total liabilities _ Notes payable . . Shares... . Regular reserve... . . . Special reserve for delinquent loans.. Other reserves L.. . Undivided earnings _ Other liabilities . . Dec. 31, 1959 Dec. 31, 1958 Change during year Dec. 31, 1959 Dec. 31, 1958 9, 447 9, 030 417 $2, 352, 813, 400 $2,034,865,575 $317,947,825 100.0 100.0 1,666,525, 512 1, 379, 723, 727 286,801,785 70.9 67.8 137, 677, 971 154, 257, 791 -16,579,820 5.8 7.6 110,328, 752 94, 897, 483 15,431,269 4.7 4.7 363,003, 574 347,411,329 15, 592, 245 15.5 17.1 50,217,364 35, 073, 948 15, 143, 416 2.1 1.7 7, 778, 138 6,084, 555 1,693, 583 .3 .3 17,282,089 17, 416. 742 -134, 653 .7 .8 2, 352, 813, 400 2,034,865, 575 317,947,825 100.0 100.0 58, 427, 188 37,481,165 1,812,017,273 20,946,023 263, 037, 746 2.5 1.8 2, 075,055,019 88.2 89.1 91,733, 369 75, 810, 826 15, 962, 543 3.9 3.7 4, 674, 782 4, 579, 416 95, 366 .2 .2 4, 629, 088 106,259,883 3, 881,182 747, 906 .2 .2 93, 922,039 12, 337, 844 4.5 4.6 11,994,071 7, 173, 674 4, 820, 397 .5 .4 1 Reserve for contingencies and special reserve for losses. Table 11. — Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding, Dec. 31, 1934—59 1 Year Number of operating Federal credit unions Number of members Assets Shares Loans out¬ standing 1934 2 . . . 39 3,240 $23. 300 $23, 100 $15, 400 1935 _ _ 772 119, 420 2, 372, 100 2. 228, 400 1, 834. 200 1936 _ _ 1.751 309. 700 9, 158, 100 ® 510.900 7, 343, 800 1937 _ 2, 313 483, 920 19, 264. 700 17, 649. 700 15, 695. 300 1938 _ _ _ 2, 760 632, 050 29. 629, 000 26, 876, 100 23, 830, 100 1939 _ _ _ 3, 182 850, 770 47, 810, 600 43. 326, 900 37, 673, 000 1940 _ _ _ 3. 756 1, 127. 940 72, 530, 200 65. 805, 800 55. 818, 300 1941 _ 4, 228 1, 408, 880 106, 052, 400 97. 208 900 69. 484, 700 1942 _ _ _ 4, 145 1, 356. 940 119, 591, 400 109. 822, 200 43, 052. 500 1943 _ 3,938 1, 311. 620 127. 329. 200 117,339 100 35, 376, 200 1944 _ _ _ 3, 815 1, 306, 000 144, 365, 400 133. 677. 400 34, 438. 400 1945 _ 3,757 1, 216, 625 153. 103, 120 140, 613. 962 35, 155, 414 1946 _ 3 761 1, 302, 132 173, 166, 459 159. 718, 040 56, 800. 937 1947 _ _ _ 3,845 1. 445, 915 210, 375, 571 192, 410, 043 91. 372, 197 1948 _ _ _ 4, 058 1, 628, 339 258,411. 736 235, 008, 368 137. 642. 327 1949 _ 4, 495 1, 819, 606 316, 362. 504 285. 000. 934 186, 218, 022 1950 _ 4. 984 2. 126, 823 405, 834. 976 361. 924, 778 263, 735. 838 1951 _ 5,398 2, 463, 898 504. 714, 580 457, 402, 124 299. 755. 775 1952 _ 5, 925 2, 853, 241 662, 408, 869 597. 374, 117 415, 062, 315 1953 _ 6, 578 3, 255, 422 854, 232, 007 767, 571. 092 573, 973, 529 1954 _ 7,227 3, 598, 790 1, 033, 179, 042 931. 407. 456 681, 970, 336 1955 _ 7, 806 4, 032, 220 1, 267, 427, 045 1, 135, 164, 876 863, 042, 049 1956 _ 8. 350 4, 502, 210 1. 529 201. 927 1. 366, 258, 073 1, 049, 188, 549 1957 _ _ 8, 735 4, 897. 689 1, 788, 768. 332 1, 589, 190. 585 1. 257, 319. 328 1958 _ 9. 030 5, 209. 912 2. 034, 865. 575 1,812,017,273 1, 379, 723, 727 1959 _ 9,447 5, 643, 248 2, 352, 813. 400 2, 075, 055, 019 1, 666, 525, 512 i Data for 1934-44 on membership, assets, shares, and loans outstanding are partly estimated. * First charter approved October 1, 1934. Public Health Service Health of the Nation The health of the American people continued at a high level during 1960. The utmost vigilance, however, is required not only to maintain personal and community health at this relatively high degree but also to meet the needs that stem from our rapidly changing and in¬ creasingly complex society. In this latter respect, problems which have always been serious have become intensified. This is particularly true in the fields of water and air pollution, sewage treatment requirements, and the chal¬ lenges presented by the Atomic Age. Paradoxically, progress in solving old problems has given rise to a multitude of more resistant new problems. For example, medical science and public health action, by the very act of saving lives, have prolonged the span of life and, thus, have contributed to the steady growth in the number of aged persons in our population. In the years preceding the conquest of the lethal diseases of childhood, a large proportion of aged persons now living wTould not have survived the first decade of life. Now, in the closing years of their lives, they present a complex pattern of chronic disease problems that have usurped the erstwhile supremacy of the infectious diseases. Although these and other conditions constitute health portents of no minor moment for the future, there is every reason to expect that public health and medical science, if consistently sanctioned by the people, strengthened by voluntary groups of health-minded citizens, and responsively supported by funds and legislation, will be enabled to sustain currently favorable health trends and project them into the future. 93 94 Department of Health, Education, and Welfare, 1960 HEALTH RECORD In recent years, reported births, sickness, and death rates have presented markedly changed conditions for the two extremes of life. Great gains in life expectancy for the young have been accompanied by increases in death rates among aged persons. The death rates for infants 1 under 1 year and for mothers in child¬ birth, for example, have declined in the last decade. The infant death rate dropped 10 percent, from 29.2 deaths per 1,000 live births in 1950 to 26.4 in 1959. The maternal mortality rate for 1959 was 3.7 per 10,000 live births compared with 8.3 in 1950 — a 55 percent drop. Deaths from childhood diseases declined sharply. Scarlet fever and streptococcal sore throat, diphtheria, whooping cough, and measles caused about 5 deaths for every 100,000 youngsters under 15 years of age in 1950. In 1959, however, these diseases were responsible for only about 1 death per 100,000 population in this age group. The death rates for a number of infectious diseases which affect the young and the old alike have also dropped since 1950. Thus, the death rate for tuberculosis was 22.5 per 100,000 population in 1950, com¬ pared with 7.1 in 1958, and 6.5 in 1959. There have also been propor¬ tionately fewer deaths from syphilis, particularly among infants. The seasonal influences of influenza were mild in 1959 compared with 1958. The influenza and pneumonia death rate (except for pneu¬ monia of the newborn) dropped from 33.2 per 100,000 population in 1958 to 31.2 in 1959. A similar decline was noted in the number of deaths in older people with cardiovascular disease. Death rates for suicide, homicide, and accidents have decreased since 1950. After increasing to age 65, the suicide rate levels off. The homicide rate is highest among young adults. Most fatal acci¬ dents, except for motor-vehicle accidents, tend to occur at the two ends of life. No definite trend has been apparent for motor- vehicle accidents, but the death rate has remained at a high level. It was 23.1 per 100,000 in 1950 and 21.5 in 1959. For all other accidents, however, the death rate dropped from 37.5 in 1950 to 30.7 in 1959. In contrast to the generally favorable trend of the infectious dis¬ eases, the chronic maladies characteristic of the latter part of life continued to exact a heavy toll of lives. Together, diseases of the heart and blood vessels and cancer accounted for 70 percent of all deaths in 1959. The death rate for the major cardiovascular-renal diseases was 516.2 per 100,000 in 1959, compared with 510.8 in 1950. The 1959 cancer death rate was 147.4, substantially higher than the 139.8 rate of 1950. The trend in the Nation’s health is summed up in the life ex¬ pectancy figure. Over the last few years this indicator has changed * All vital data are for calendar years. The marriage, divorce, and death figures for 1959 are final. Other figures are provisional. Public Health Service 95 only slightly, in contrast to the rapid increase in life expectancy in the first half of the century. The average length of life for the entire population increased from 66.8 years in 1947 to 69.6 years in 1954, but the figure has remained practically unchanged since then. It was 69.6 years in 1956 and 69.4 years in 1958, and a provisional table for 1959, the latest year for which average length of life has been calculated, yields a figure of 69.7 years. The average length of life in 1958 was 67.2 for white males, 73.7 for white females, 60.6 for nonwhite males, and 65.5 for nonwhite females. The average length of life for women has been increasing more rapidly than for men, and the gap between the white and nonwhite population has continued to decrease. BIRTHS, MARRIAGES, AND DIVORCES The Nation’s birth rate has remained at a high level since the end of World War II, while the death rate has declined slightly. In 1959 there were 4,292,000 live births in the United States — 0.9 percent above the total for 1958 and close to the past record (4,308,000) in 1957. These figures include an adjustment for underregistration. The crude birth rate was 24.3 per 1,000 population, compared with rates of 24.6 and 25.3 for 1958 and 1957, respectively. Since there were 9.4 registered deaths per 1,000 people in 1959, the rate of natural increase (the excess of the birth rate over the death rate) came to 14.9 per 1,000 population — nearly the same as the 1958 rate of 15.1. The 1959 figures include Alaska for the first time. The estimated number of marriages performed in 1959 was 1,414,000 or 3.0 percent more than the figure for 1958. The rate per 1,000 pop¬ ulation was 8.5, compared with 8.4 in 1958. The estimated number of divorces, including reported annulments, granted in 1959 was 395,000, 7.3 percent above the figure for 1958. The divorce rate per 1,000 population was 2.2, compared with a rate of 2.1 in 1958. Funds and Personnel In 1960, the total funds available to the Public Health Service amounted to $1,013.6 million (see table 1, page 172) . Of this amount, about $840.8 million were appropriations and authorizations. The balance was made up of repayments for services given other agencies and of unobligated balances from previous years. Approximately 70 percent of the total funds available was disbursed to the States and to agencies and institutions outside the Federal Gov¬ ernment for disease control, general health services, construction of health facilities, environmental sanitation installations, and for med¬ ical and dental research. The remainder was expended to support 96 Department of Health , Education , and Welfare , I960 Public Health Service hospitals, foreign and interstate quarantine activities, Indian health services, and the direct services specified in Federal law as responsibilities of the Service. The Public Health Service had 26,430 full-time employees at the close of fiscal year 1960. The total staff included 1,666 members of the regular Commissioned Corps of the Service, 2,034 members of the Reserve Corps on active duty, 116 members of the Commissioned Re¬ serve on temporary training duty, and 22,614 full-time Civil Service personnel. National Library of Medicine Substantial increases were achieved in the Library’s accessions through development of new bibliographical selection sources and in¬ stitutions offering exchange items. The collection increased to 1,049,- 261 items as of J une 30, 1960. BOARD OF REGENTS The Board of Regents met twice during the year, on November 13, 1959, and April 11, 1960. At the first meeting the Board examined and approved the proposed budget for fiscal year 1961, and inspected the new machine processing system used in publishing the Index Medieus. At the second meeting, the Board observed a demonstra¬ tion of the working prototype of a mobile camera, discussed the ques¬ tion of using* automatic data processing techniques, and reviewed preliminary estimates of the budget for fiscal year 1962. THE NEW BUILDING Only 31 percent of the Library’s new building, begun June 17, 1959, had been constructed by the end of the fiscal year. The building sched¬ ule had specified 54 percent completion by that time. Unexpected blasting operations necessitated by extensive rock formations were principally responsible for this retarded progress. INDEXING SERVICES Mechanization of copy preparation for publication of the Library’s monthly index of medical literature was completed. With the J anu- ary 1960 issue, the old Current List of Medical Literature became the new Index Medieus. In 1961, the Index Medieus is expected to in¬ clude 136,000 journal articles, an increase of almost 15 percent over the number indexed in 1959. ORGANIZATIONAL CHANGES Two major organizational changes were made, so as to accelerate the processing of library materials and to improve services to users. Acquisitioning and cataloging, formerly performed in separate units, were combined in a Technical Services Division. The interlibrary Public Health Service 97 loan program was strengthened by merging functions previously per¬ formed by three separate divisions and giving responsibility for them to a new Circulation Division. INTERLIBRARY LOANS Interlibrary loans increased 30 percent in fiscal year 1960, rising to 95,595 compared to 72,728 for the prior year. This added burden on the Library’s facilities prompted the initiation of a study designed to provide data on which to base the development of more efficient procedures in the servicing and the use of the Library’s collections. PROGRAM STATISTICS During fiscal year 1960 the Library acquired 16,028 books, 69,103 serial pieces, and added 1,090 new serial titles. Four hundred and twenty old and rare items were purchased for the History of Medicine collections. The staff cataloged 22,395 titles, and 2,302 pictures and portraits were added to the art collection. There were 135,366 vol¬ umes circulated; 9,046 reference questions were answered; and 151 bibliographies were prepared on special subjects. A total of 18,168 main entries were published in the 1959 segment of the quinquennial National Library of Medicine Catalog; 112,304 items were published in the Current List of Medical Literature and the Index Medicus from 1,626 journal titles. In response to 90,984 requests, more than 2 million pages of medical literature were microfilmed. For preservation purposes, an addi¬ tional 1.2 million pages were microfilmed. Public Health Methods The Division of Public Health Methods provides staff services to the Surgeon General, develops and conducts research studies directed toward evaluation of health and related problems in the population, and participates in public health planning activities to meet current and foreseeable needs. The Division edits and publishes the monthly Public Health Reports , the official technical journal of the Public Health Service, and conducts the National Health Survey. FUTURE NEEDS FOR PHYSICIANS The Surgeon General’s Consultant Group on Medical Education, appointed in December 1958 to study the question of how the United States is to be supplied with an adequate number of well-qualified phy¬ sicians, submitted its report to the Surgeon General in September 1959. The basic finding is that the United States faces a growing shortage of physicians. Among the consultant group’s recommendations are the establishment of some 20 to 24 new 2-year and 4-year medical schools, expansion of existing schools, and financial aid for both the schools and medical students. 98 Department of Health, Education, and Welfare, 1960 NATIONAL HEALTH SURVEY During the year, the National Health Survey made progress toward all three of its major goals; The Health Interview Survey, the Health Examination Survey, and developmental and evaluation studies. Data from the continuing nationwide health interviewing provided the basis for reports on disability days; limitation of activity and mobility; chronic respiratory conditions; heart conditions and high blood pressure; types of injuries; and volume, interval, and frequency of dental visits. A new series of reports for population groups, the first three of which deal with children and youth, veterans, and Hawaii also made use of these data. Questions on types of accidents causing injuries and on health in¬ surance coverage were added to the interview. The Health Examina¬ tion Survey team, using specially designed mobile equipment, con¬ ducted two “stands” (at Philadelphia, Pennsylvania, and Valdosta, Georgia) of the first cycle of the Health Examination Survey. ENVIRONMENTAL HEALTH STUDY At the request of both Appropriations Committees of the Congress, the Public Health Service conducted a study of environmental health problems and the organization of facilities to jneet them. Among the recommendations of the report of the study, which was submitted to the Congress in January 1960, was the more effective integration of environmental health activities at all levels of government, including the activities of the Public Health Service. The study was centered in the Division, with assistance given by other units of the Service and by a special panel of outside advisors. HOMEMAKER SERVICES The Division prepared and published Homemaker Services — Report of the 1959 Conference. That conference was sponsored by eight constituent units of the Department of Health, Education, and Wel¬ fare and twenty-six national voluntary agencies. In addition, the Division participated in the planning and conduct of two follow-up meetings called by the National Health Council on recommendation of the executive committee of the 1959 conference. The report of the first meeting, which dealt with “Personal Care in Homemaker Service Programs,” was prepared in the Division and published in the July 1960 issue of the American Medical Association’s Homemaker Services Bulletin. The second meeting dealt with the “Role of Voluntary Health Agencies in Homemaker Service Programs.” STUDIES AND REPORTS A new publication in the Health Manpower Source Book series, pre¬ senting basic data pertinent to three health professions — physicians, dentists, and professional nurses — was prepared in cooperation with Public Health Service 99 the Division of Dental Resources and the Division of Nursing Re¬ sources. The data were selected to provide information to persons en¬ gaged in administering health services or in planning educational programs for the large number of health personnel that now are and will be needed to meet the demands of our expanding population. The seventh listing of the Clearinghouse on Morbidity Projects was published. These listings are designed primarily to inform research workers of research projects underway and studies not yet published which may have bearing on their work. Other studies completed during the year include long-term trends in illness levels ; the economic effects of public health programs in un¬ derdeveloped countries ; hospital use in Hagerstown, Maryland ; State and local government expenditures for health and hospitals; and health manpower 1930-75. The Division also provided technical as¬ sistance and consultation as requested by State, regional, and profes¬ sional organizations. WORK IN PROGRESS Work underway includes a national survey of medical group prac¬ tice; work with the Division of Hospital and Medical Facilities and a committee of the Association of American Medical Colleges on the development of guides for the construction of medical schools; com¬ pilation of a textbook on the administration of community health serv¬ ices in cooperation with the City Managers Association and the Ameri¬ can Public Health Association ; a study of trends in medical practice ; a study of social welfare manpower ; a study of practical nurse educa¬ tion in cooperation with the National League for Nursing and the American Nurses’ Association; a study of the baccalaureate origins of physicians; the tenth in the Health Manpower Source Book series, which will present data on physicians, dentists, and veterinarians by county ; and development of a guide for community surveys of long¬ term patients and resources for their care. The National Institutes of Health Medical research throughout the Nation continued to expand during fiscal year 1960, with Government supporting a little more than half. The National Institutes of Health, research arm of the Public Health Service at Bethesda, Maryland, awarded 80 percent of its $430 million total appropriation to aid research projects, training, and construction in non-Federal institutions. In approving the grants, the Surgeon General followed the recommendations of distinguished private citizens composing the National Advisory Councils. NIH pro¬ grams emphasize research on the chronic diseases, which have become increasingly significant as infectious diseases decline. 100 Department of Health, Education, and Welfare, 1960 Substantive highlights of the NIH program included collaborative studies of perinatal disease, the cancer chemotherapy program, collab¬ orative research in psychopharmacology, the field of viruses and cancer, the development of a program in mathematics and physical biology, activities concerning the development of a live-virus polio vaccine, new construction at Bethesda, programs to support research in other countries and exchange of scientists and scientific informa¬ tion, establishment of programs for training in basic sciences, and the program of grants for construction of health research facilities. Grants and training awards were made in unprecedented number — 18,624. Criteria established by the President with a view to assuring program quality despite rapid growth were applied to new grant applications, and the ratio of approvals to applications was about 1 to 2. Totals of all grants and training awards approved for payment from 1960 funds are tabulated (table 3) on page 175. Increased responsibilities have necessitated reorganization of the Office of the Director. As approved by the Surgeon General, the new organizational plan (1) establishes the position of Deputy Director, NIH, with special responsibility for the coordination of policy for extramural programs ; (2) broadens the scope of the associate director for intramural research under the new title Director of Laboratories and Clinics; and (3) provides for five top-level staff positions with titles of Associate Director — four covering extramural activities (re¬ search grants, training, institutional relations, and collaborative re¬ search) and one for the intramural area of clinical care administra¬ tion. Offices for program planning, research information, adminis¬ trative management (headed by the Executive Officer of NIH), and international research activities complete the Director’s Office. The Director is also aided by the Advisory Policy Committee of Institute Directors. Clinical, laboratory, and office facilities are under construction at Bethesda. A four- story surgical wing at the Clinical Center, started in August 1959, will incorporate many innovations for the advance¬ ment of surgery on the heart and nervous system. A two- wing gen¬ eral office building with space for 1,900 employees was started in October 1959. H -shaped, it will consist of a south wing with 11 stories and a north wing with 5. Buildings to house the National Library of Medicine, National Institute of Dental Research, and Di¬ vision of Biologies Standards progressed through the fiscal year. The DBS building was dedicated June 30 by his Majesty Bhumibol Adulyadej, King of Thailand. Other projects included purchase of a 513-acre site near Poolsville, Md., for an animal farm. In light of its expanding extramural programs, NIH recognizes a growing obligation to help grantee institutions sustain initiative. Public Health Service 101 Institutional strength and stability are goals in a strong program of training awards, grants enabling schools to develop ways of producing medical scientists, development of extramural research centers and primate colonies, and a trend toward larger grants for more broadly defined objectives. In addition to the appraisals of the NIH program implicit in the participation of its hundreds of non-Federal advisors, several special appraisals were made by non-Federal groups. For the Senate Ap¬ propriations Committee, consultants under the chairmanship of Dr. Boisfeuillet Jones rendered a comprehensive assessment entitled Fed¬ eral Support of Medical Research . An NIH task force studied the impact of NIH grant programs on medical schools. F orces that may be expected to shape future trends in NIH programs include the need for balanced development of research resources and the opportunities afforded by new techniques and specialties for probing deeper into the unknown. The following reports on the seven Institutes, Clinical Center, and four Divisions represent significant advances in program development as well as in knowledge of health and disease. Division of Biologies Standards The Division is responsible for administering the control require¬ ments with respect to the safety and potency of biological products that are entered into interstate and foreign commerce. The regula¬ tory function is carried out through issuance of establishment and product licenses, following determination that prescribed standards of safety, purity, and potency have been met. At the end of the year, 182 establishment licenses and 1,252 product licenses were in effect. Tests are performed at the rate of approximately 3,400 a year. In addition, approximately 4,000 vials of physical reference standards prepared by the Division are distributed annually to manufacturers and to laboratories engaged in biological standardization. The flexibility of the Division’s research program has made it possible to keep pace with the accelerated production of biological products. The production of inactivated poliomyelitis vaccine con¬ tinued to be closely monitored, but increasing interest in the develop¬ ment of a live attenuated poliovirus vaccine called for intensive study of the three sets of Type 1, 2, and 3 poliovirus strains used in world¬ wide field trials. The Division’s safety testing program, which over the past 4 years has involved the use of 20,000 monkeys, provided invaluable experience in inoculation methods as well as interpreta¬ tion of data on the neurovirulence for monkeys. These data enabled 102 Department of Health , Education , and Welfare , 1960 the PHS Committee on Live Poliovirus Vaccine to recommend virus strains that could be considered as the most satisfactory for the pro¬ duction of such vaccines. The Division’s expanded laboratory facilities have made possible a broader program of investigation in the field of rickettsial diseases, including development of specific requirements for rickettsial antigens. Basic research on the physical and chemical factors that determine the biological properties of bacteria, rickettsia, and viruses, as well as their host cells, has become an integral part of the Division’s research program. A program for the investigation of the immunological and physico¬ chemical properties of blood proteins, including coagulation systems, provides essential information to support control functions in the area of blood and blood products. Biophysical studies in progress include an investigation of the mechanism of thermal inactivation of viruses, determinations of the relative susceptibility of animal viruses to photodynamic inactivation, development of methods for differential inactivation of simian viruses in suspensions of live attenuated polioviruses, and the study of the effects of various physical and chemical stresses upon metabolism of tissue culture cells. Division of General Medical Sciences Established in July 1958, the Division administers NIH grant pro¬ grams for research in the sciences basic to medicine and biology, in environmental and public health, and in certain clinical sciences. The Division also administers the grant programs for training investiga¬ tors in the basic biomedical sciences, provides fellowships for general research training, and directs the NIH Center for Aging Besearch. There was a total increase of more than 21 percent in the research pro¬ gram over the previous year, with particularly noteworthy increments in studies of the chemistry of life processes, biology of human develop¬ ment, and environmental health. A number of important research advances have resulted from the Division’s grant programs. These include new knowledge on the role of ribonucleic acid in defending the body against disease — potentially another step forward in understanding the importance of genetics in man’s health. Another DGMS -supported scientist has found that the juvenile hormone, once thought to exist only in insects, occurs also in human tissue, raising questions about its importance in the biological process of aging. Other recent scientific achievements promoted by the Division’s work relate to the value of folic acid in treating megaloblastic anemia ; Public Health Service 103 new findings in connection with galactosemia; the importance of es¬ sential fatty acids in preventing disease; the mechanism by which reserpine promotes gastric ulcers; the nature of damage caused by chronic lead poisoning to female reproductive functions ; new data on the controlling mechanism of mitosis ; the effects of certain drugs on pregnant women ; the way the unborn child is nourished by the mother ; and the function of the larynx. During the past year the DGMS training programs, which include support for graduate research training and also research fellowships at several levels, were enlarged sharply to help meet national needs. The graduate training program, under which funds are provided to medical schools, universities, and other institutions for the training of investigators in the basic biomedical sciences, increased 75 percent over fiscal year 1959, with relatively great increases in the number of fellowships. At the end of fiscal 1960 these programs were providing various levels of basic training for more than 3,500 persons across the Nation. Since July 1958, when the Division was providing support for gradu¬ ate research training in two areas, Epidemiology and Biometry, the Division has established full-time, regular programs in nine addi¬ tional fields — the Anatomical Sciences, Biochemistry, Developmental Biology, Genetics, Microbiology, Pathology, Pharmacology, Physi¬ ology, and Physical Biology. Three new activities added to the Division’s responsibilities during fiscal 1960 were the Clinical Research Center Program, the Russian Scientific Translation Program, and the Foreign Grants and Awards Program. Establishment of the Clinical Research Center Program by NIH was directed by the Senate Committee on Appropriations (Report 425, 86th Congress, First Session). The purpose of the program is to help meet national needs for specialized facilities in support of clinical research in a broad spectrum of diseases. Grant funds are made avail¬ able to local sponsoring institutions across the country, such as medical schools and research hospitals, for the establishment of special re¬ search facilities, centers, or units. The funds pay for the renovation and equipping of facilities, the major costs of patient care, supporting laboratories, and staff salaries. Grants were made to eight institutions. The Russian Scientific Translation Program, transferred to this Division during the year from the Division of Research Grants, has the assignment of translating, through contracts or grants, Russian documents in the fields of medicine and biology, and distributing them among appropriate groups in the American scientific community. The Foreign Grants and Awards Program, also transferred to DGMS from DRG, has the prime NIH administrative responsibility 104 Department of Health, Education, and Welfare, 1960 for those grants and awards, in research and training, involving for¬ eign nationals. The program also provides the means for outstanding scientists and recent postdoctorates from TJ.S. and foreign institu¬ tions to work at NIH for training purposes for specified periods of time. CENTER FOR AGING RESEARCH Scientific interest in research in aging, as measured by the NIH pro¬ grams, reached a new level during fiscal 1960. The dollar value of all grants for research in aging on January 31, 1960, was approximately $12.5 million. The Center for Aging Research, a component of DGMS, fosters research and research training projects in aging and serves as the NIH focal point for information on the grants and programs in geron¬ tology. In July 1960 the Center published “Research Highlights in Aging” (Public Health Service Publication No. 779), which is a re¬ view of more than 500 selected scientific papers reporting on research projects in aging under support by NIH. Division of Research Grants The Division of Research Grants served as the administrative center of the $302-million extramural grant and award programs of the National Institutes of Health. This dollar total represents the largest increase in funds for medical research in the history of the extramural program. In fiscal 1960 this responsibility included the administra¬ tion of the research grant and fellowship programs, newly assigned functions in the area of research training, and direct management of the $30-million-a-year Health Research Facilities Construction Pro¬ gram. Because the need for research facilities was still acute in 1958, the 86th Congress extended the original three-year Health Re¬ search Facilities program to include fiscal years 1959 through 1961. The Division was assigned in 1960 the administration of the NIH training grant and traineeship awards, in view of the expansion and complexity of supportive training of research manpower. Respon¬ sibilities in this area parallel those of the Division in the research grant program: receiving and assigning applications, reviewing budget requests of applications, establishing policies and procedures for payment and management of grants and awards, maintaining central records, providing information on these programs, and estab¬ lishing review committees. To maintain the high standards of review for the growing number of research grant applications, the Division increased the number of study sections from 32 to 36. These study sections, whose primary function is technical review of applications, have also continued their Public Health Service 105 program activities by stimulating and planning an increased number of meetings and seminars to exchange, gather, and publish informa¬ tion on specific health problems and needs. Division of Research Services An increase in the number of mathematicians on the staff of the Division of Research Services led to a rapid expansion in electronic data processing. As a result, the number, kinds, and complexity of research studies programed on the electronic computer have increased greatly, and the use of the computer approximates the saturation level of three shifts a day. Studies of computer equipment require¬ ments were begun in relation to forecasts of expanded NIII computa¬ tion and data processing needs. The Division expanded its range of services in other areas including scientific instrumentation design, and in the design and planning of laboratory facilities. A master site plan developed for the new animal farm will become the basis for architectural design and construction of research facilities to be located there. The plan is essentially a projection of the building and terrain requirements for studies of animals in their natural environment as well as for long-term holding of large animals, such as cows, horses, and swine, and the production of selected laboratory animals. Clinical Center The Clinical Center continued to fulfill its mission of providing hospital and laboratory research facilities to the seven National In¬ stitutes of Health. Optimal utilization of research beds was main¬ tained for the second year. Physician referrals continued to come from all sections of the United States and many foreign countries. Construction of the new surgical wing, started early in 1959, was about half completed by the end of the fiscal year, and is scheduled for occupancy early in 1961. Intensified efforts were made to expand the sources of recruiting “normal control” patients. A new contract was activated with one university, an expanded contract with another; and special arrange¬ ments with Federal prisons wTere initiated. Consequently the volun¬ teer admissions of normal controls were increased by 20 percent over the previous year. Many well-qualified young physicians continued to seek appoint¬ ments as Clinical Associates or Fellows in the Center’s advanced clinical research training program. During fiscal 1960 approvals were gained from American Boards for two new residency programs, Dermatology and Periodontal Disease. 573826 — 61 - 8 106 Department of Health , Education , and Welfare , 1960 The NIH visitor program, conducted by the Clinical Center since 1958, continues to reflect the widespread interest in basic medical re¬ search and the rapidly increasing volume of clinical research through¬ out the country. During the past year eleven major lectures, medical meetings, and scientific symposia were held. Many distinguished pro¬ fessional and scientific visitors were registered from foreign countries. In addition to the regular annual lectures and symposia, a number of closed-circuit television programs were presented to visitor groups. Institute of Allergy and Infectious Diseases Studies by Institute scientists and grantees during the year chal¬ lenged old concepts, established new knowledge, and gave hope for effective therapy against several infectious diseases. An experimental feat performed in the Institute’s Laboratory of Parasite Chemotherapy — the transmission for the first time of monkey malaria to man through the bite of an infected mosquito — has demon¬ strated the need for re-examining long-established knowledge on the transmission cycle of this disease. Heretofore, malaria investigators throughout the world held that types of malaria which infect animals cannot be transmitted to man by the bite of the infected mosquito. No one can yet say whether this finding will have any practical effect on present worldwide malaria eradication programs. Experimental animal studies have yielded promising results in the treatment of schistosomiasis, a parasitic disease widespread in many parts of the world. The effectiveness of tartar emetic or stibophen, combined with glycerin, against experimental infection of Schistosoma mansoni in mice indicated that glycerin as an adjuvant of heavy-metal compounds could also be tested profitably against other schistosome infections. Investigations by scientists of the Institute, University of Mary¬ land, and the Communicable Disease Center added weight to the thesis that viruses may be an important cause of the respiratory disease in cattle known as shipping fever, and suggest that domestic animals may serve as reservoirs of the parainfluenza 3 virus. The three-year re¬ search program resulted in the recovery of parainfluenza virus from specimens not only from different parts of the United States but from Tahiti and Japan. In the area of diagnosis, Institute scientists developed a simple and rapid test for lupus erythematosus, a connective tissue disease related to rheumatoid arthritis. The new flocculation test seems to be more specific than the widely used cell test. Institute scientists discovered that filarial worms may be visualized by a simple fluorescent method in a patient receiving tetracycline. The finding offers diagnostic and therapeutic possibilities. Public Health Service 107 An investigation by the Institute’s Rocky Mountain Laboratory of outbreaks of Asian influenza on St. Paul and St. Lawrence Islands in the Bering Sea emphasized the value of infectious disease studies in remote communities as a source of epidemiological information. More than 80 percent of the population of each island was infected, and in each case the researchers were able to identify the source of infection and the precise time limits of virus activity. Research by an Institute scientist and a grantee may provide infor¬ mation for future analysis, improvement, and standardization of house dust extracts widely used in allergy diagnosis and desensitization. They reported on a purified polysaccharide fraction that gives a char¬ acteristic skin reaction in specifically sensitive individuals. Bacteriological and virological studies by the Institute’s Middle America Research Unit, Gorgas Hospital, and U.S. Army scientists resulted in the first description of a natural infection of swine with the encephalomyocarditis virus. Further study of the agent, which has been implicated as a cause of human disease, is under way. GRANT-SUPPORTED RESEARCH An Institute grantee at Harvard University developed a simple and reliable test for the detection of early cases of pyelonephritis, a disease which occurs widely in pregnant women and persons suffering from obstructive diseases of the urinary tract. The test, coupled with known therapy, clears the way for the virtual elimination of pyelo¬ nephritis among pregnant women. A study by grantees at the New York Hospital- Cornell Medical Center demonstrated that experimental staphylococcus infections pre¬ viously thought to be penicillin-resistant can be effectively treated by the antibiotic if therapy is begun promptly and administered in suffi¬ cient dosage. Their laboratory experiments significantly reduced the mortality of mice exposed to a highly virulent strain of staphylococcus. Grant-supported investigations at the California State Department of Public Health disclosed that mumps virus may mimic paralytic poliomyelitis. The disclosure resulted from the clinical testing of patients previously diagnosed as having the latter disease. Grantees at Yale University School of Medicine isolated eastern equine encephalitis virus for the first time from the Aedes vexans mosquito. Their findings help clarify the epidemiological significance of this mosquito which feeds readily on man and animals. Institute of Arthritis and Metabolic Diseases In celebrating its tenth anniversary this year, the Arthritis Institute could reflect upon a decade of substantial progress in the fields of arthritis, diabetes, and other fields of interest. 108 Department of Health , Education , and Welfare , I960 ARTHRITIC DISEASES The physician has been provided with a whole spectrum of new anti¬ inflammatory drugs for treating rheumatoid arthritis. These new drugs, which are much more potent than cortisone and produce fewer side effects, received intensive clinical testing at the Institute and other research centers. Although they cannot cure the disease, they provide relief from pain and swelling for thousands of patients. Strong clues to the basic cause of rheumatoid arthritis have been uncovered through intensive laboratory studies. This year, for ex¬ ample, Institute grantees at the Hospital for Special Surgery in New York City were able for the first time to find the rheumatoid factor in tissue cells. Although considerable research has been done on this factor, and its presence in the blood is considered diagnostic of rheu¬ matoid arthritis, the role it plays in the disease is not fully understood. The rheumatoid factor has many of the characteristics of an antibody, a protein substance which in some cases provides immunity to a par¬ ticular disease, such as diphtheria or measles, and in others is the basis for a hypersensitive state such as hay fever or asthma. In rheumatoid arthritis, such antibodylike material suggests the presence of an antigen, or some substance of a deleterious nature to which the body is abnormally sensitive. This theory has now received further support from the discovery of rheumatoid factor in the plasma cells and germinal-center cells of the body, since both of these cell types are usually engaged in antibody production. In addition, in another disease closely related to rheu¬ matoid arthritis, called Sjogren’s syndrome, Institute scientists have found evidence of a basic disorder in antibody production. In studies of gout, Institute scientists have found that an experi¬ mental drug, DON, synthesized by a private pharmaceutical labora¬ tory, can slow the body’s overproduction of uric acid, a common feature of the disease. Although the drug produces undesirable side effects and has little practical value, it points the way toward the development of similar compounds that will slow uric acid production without toxicity. DIABETES Of major research interest to the Institute is diabetes, probably the best known and most important of the metabolic diseases. One of the most dramatic developments in this field has been the recent and wide¬ spread use of oral antidiabetic drugs, which have enabled thousands of diabetics to substitute a tablet for their regular injections of insulin. Three years of experience with these new blood-sugar-lowering com¬ pounds has made it clear that they are not “miracle drugs.” They cannot cure diabetes. They are most valuable in cases of mild, re¬ cently acquired diabetes, and least effective in young patients. One Public Health Service 109 promising application of the oral drugs is in diabetes prevention. Re¬ search results are still inconclusive, but Institute grantees at the Uni¬ versity of Michigan have foimd indications that these compounds cause some improvement in “pre-diabetic” persons who are susceptible to diabetes and may develop the disease later in life. A diabetes study by grantees at Yale University indicated that strict low- fat diets can lower the amount of fatty substances in the patient’s blood, increase the body’s ability to handle excess sugar, and benefit the eye complications that often accompany diabetes and lead to blindness. Other diabetes researchers at Harvard Medical School and Peter Bent Brigham Hospital have found that adipose (fat) tissue, far from being merely a storage place for body fat, may well be a major site of insulin action in the body. OTHER METABOLIC DISEASES, BASIC RESEARCH This year the Institute strengthened its research programs in two other areas, gastroenterology and cystic fibrosis. A new gastroentero¬ logical unit has been established to carry out intensive studies of the diseases grouped under the term “malabsorption syndrome” — dis¬ orders in which the absorptive capacity of the small intestine has been affected. A new pediatric metabolism branch has also been estab¬ lished at the Institute and is concentrating on metabolic studies of cystic fibrosis, an often fatal disease of childhood. During the past year accomplishments in basic research were high¬ lighted by the awarding of the Nobel Prize in Medicine for work done on the synthesis of nucleic acids. This year’s recipients were Dr. Arthur Kornberg, a former chief of one of the Institute’s laboratories and now at Stanford University, and Dr. Severo Ochoa, an Institute grantee at New York University. Other developments in basic research included the discovery of the first eight-cajrbon sugar to be found in nature. The pharmaceutical industry began to market the new Institute- developed pain killer, phenazocine, which is many times more power¬ ful than morphine. Patent rights to this synthetic analgesic have been assigned by its discoverers to the U.S. Government, which in turn has made them available to all countries of the world. Cancer Institute Cancer is one of the major health problems of our time. Annually over 500,000 Americans acquire the disease and about 260,000 die of it. Over $12 billion is lost to the Nation each year because of cancer. To meet this growing problem, the National Cancer Institute has continued to explore the major research areas of prevention, detection, and treatment. Advances in fundamental knowledge of biochem- 110 Department of Health, Education, and Welfare, 1960 istry, tumor-host relationships, and the nature of cellular growth give promise of still greater gains in the attack on malignant dis¬ ease. Research into the causes of cancer may lead to more effective pre¬ vention. Recent studies have centered on viruses as possible causa¬ tive agents in some human malignancies. The National Cancer Insti¬ tute has expanded its virus-cancer program and attracted leading virologists, both here and abroad, to the field. In its new diagnostic research program, the Institute is seeking methods of detecting cancer at the earliest possible stage. Blood and other body fluids from cancer patients and well persons are being studied in an effort to find consistent patterns that will reveal the presence of early malignant disease. Research with exfoliative cytology, the microscopic examination of cells that collect in body fluids, may lead to more prompt detection of cancer of many sites. This technique has been successfully used for several years in the detection of uterine cancer. In the area of treatment, hope for the cancer patient who is beyond the reach of surgery and radiotherapy lies in research to develop new anticancer drugs and improve techniques of administering them. Under the national cancer chemotherapy program, new drugs are being tested at the rate of 50,000 per year, and about 110 drugs are being evaluated in studies involving 8,000 patients. National Cancer Institute scientists continued studies of the polyoma virus, which produces some 23 different forms of cancer in mice and also induces tumors in rats and hamsters. Studies of resistance to the development of tumors in mice showed that mothers exposed to an environment contaminated by the virus conferred greater immu¬ nity to their offspring than did mothers in an uncontaminated environment. Since viruses live and reproduce only within cells, one of the most useful ways of studying them is in tissue culture. For many years blood serum has served as an excellent nutrient for cells cultured in glass. But serum contains inhibitors of viral growth and therefore is not satisfactory as a medium for the culture of viral materials. In an effort to overcome this obstacle, an Institute pathologist developed a medium in which serum is replaced by fat-free milk, which pre¬ sumably does not contain virus inhibitors. Use of this medium may permit more detailed studies of the effects of viruses upon cells, par¬ ticularly the role of viruses in the production of cancer. The use of an alkylating agent, cyclophosphamide, in the treat¬ ment of mice with advanced leukemia increased their average survival time up to 200 percent. The investigations showed that cyclophospha¬ mide gives better results than either of two well-known anticancer Public Health Service 111 drugs, methotrexate and nitrogen mustard. The new drug is being tested in cancer patients, and preliminary results appear encouraging. Malignancies within the central nervous system are not easily acces¬ sible to treatment with anticaneer drugs, because no such drug will pass from the blood to the cerebrospinal fluid. Institute scientists have investigated the so-called “blood-brain barrier,” and have de¬ veloped a method that will quantitatively determine to what degree drugs will pass through it. In these studies, it was found that the blood-brain barrier is not as specific as was once thought and appears to have properties very similar to other biological membranes. With better understanding of the problem and utilization of the new method, it may be possible to develop anticancer drugs that will penetrate the barrier when administered into the blood stream. Normal serum from human and other species was found to exert a lethal effect on mouse tumor cells in the test tube. Tumor cells mixed with human serum failed to grow when injected into mice, while control cells gave rise to progressive growth of tumors within 8 to 12 days after inoculation. A natural antibody from normal serum seemed to be responsible. The investigators conclude that such an antibody may serve as a barrier against invasion by foreign cells. The significance of cancer cells circulating in the blood was further studied. A greater frequency of cancer cells in both peripheral and tumor-area blood was found in patients with inoperable cancer than in patients whose disease could be treated surgically. Research is now aimed at learning how this finding can be useful in the management of malignant disease. An epidemiological study of patients with uterine cancer revealed that the survival rate today is substantially better than it was 25 years ago. The improvement is associated with increased use of surgery and possibly the more widespread use of the cytologic test. The in¬ vestigators showed that the five-year survival rate among patients treated surgically for localized uterine cancer is almost 90 percent. They also pointed out, however, that the mortality rate for breast cancer has not declined in the past quarter-century. They suggested that increased survival rates for breast cancer patients will come from the development of new techniques rather than refinement of those now in use. GRANT-SUPPORTED RESEARCH National Cancer Institute grantees at the University of Southern California reported studies of the irritating effect of cigarette smoke on the lining of the lung. Such irritation is not produced by cigarette smoking alone, but is traceable to other environmental agents as well. The investigators suggested that the actual harm and possible car¬ cinogenic effect of smoking come from the deposition of irritating 112 Department of Health , Education , and Welfare , I960 particles, resulting in impairment of the normal cleaning action of the lungs. Grantees at Harvard University and the Children’s Medical Center showed that administration of the antibiotic, actinomycin D, en¬ hances the effects of radiation treatment. Smaller dosage of radiation can be used in combination with this drug, and hence less damage is done to normal tissue. In addition, favorable results of longer dura¬ tion were achieved by this combination of treatments. Grantees at Tulane University, Charity Hospital, and the U.S. Pub¬ lic Health Service Hospital in New Orleans reported results of an investigation involving isolation-perfusion chemotherapy. This pro¬ cedure involves isolating the tumor-bearing area from the rest of the circulatory system and introducing into it high concentrations of anti¬ cancer drugs. Of 73 patients with various forms of cancer treated in this study, 60 responded favorably and 22 showed complete disap¬ pearance of their disease. Institute of Dental Research The discovery of a means of significantly controlling dental decay by fluoridation does not alter the fact that the causes of this widespread disease are still obscure. Research therefore continues to provide new knowledge to augment or challenge existing concepts of etiology and control of caries and other principal oral diseases. Dental decay has been produced in germf ree animals by inoculating their mouths with a single strain of streptococcus bacteria. Moreover, in conventional animals with a presumed hereditary resistance, it has been possible to initiate carious lesions by exposure to specific bac¬ teria recovered from a caries-susceptible strain. These studies have stimulated interest in the possible transmissible nature of the disease. Investigations using the electron microscope have provided further basic information on the formation and calcification of bones and teeth and on their ultimate structure in the fully mature state. A better understanding of the essential role of connective tissue in periodontal disease has been gained from the development of highly useful histochemical stains. These have made possible the identifica¬ tion of a heretofore unknown connective tissue fiber, observation of previously unrecognized connective tissue changes in a degenerative neurological disease, and diagnostic differentiation between tissue ad¬ jacent to malignant and nonmalignant tumors. Epidemiological studies of oral disease in relation to nutrition have been completed in Alaska, Ethiopia, Peru, Ecuador, Vietnam, and Chile. Results showed caries levels to be generally low by U.S. stand¬ ards, but periodontal disease to be more prevalent and severe. Prom- Public Health Service 113 ising leads suggest correlations of these findings and general oral health with nutritional status. GRANTS AND AWARDS The Institute increased its support of dental research projects, particularly in the broad fields of periodontal disease, oral congenital anomalies, and dental caries. For example, grantees at the Harvard School of Dental Medicine reported on significant electron microscopy studies of calculus, a material associated with periodontal disease. Gains made in the field of cleft lip and palate research were identified with an expanded research program at New York University. And virtually all of the Nation’s dental schools contributed new knowledge in studies of dental and other oral diseases. Progress in the area of training was seen in the establishment of additional research training centers and in supplemental support to current training programs. Heart Institute The National Heart Institute vigorously pursued the conduct and support of research on cardiovascular disease, the leading cause of death in the United States. Arteriosclerosis, the most prevalent form of heart disease, and one of the most difficult to approach because of its gradual onset and com¬ plex physiology, received the greatest research emphasis. In this disease, deposits of fatty materials slowly accumulate on the walls of arteries, impeding blood flow. The year’s progress against arterio¬ sclerosis has been in the understanding of hormones, protein struc¬ tures, enzymes, and physiological mechanisms involved in the storage, transport, and utilization of these fatty substances. For example, previous NHI work had led to the realization that the well-known hormone, adrenalin, is involved in the normal mobili¬ zation of stored fats into the blood to sustain life processes during emergencies. The studies have now shown that excess adrenalin, acting in concert with cortisone, another adrenal hormone, can cause a striking increase in the cholesterol-bearing lipoproteins in the blood. Since secretion of both hormones increases in subjects exposed to physical and emotional stresses, the finding suggests plausible links between high-tension living, high blood cholesterol, and arterioscle¬ rotic deposits. Several methods were developed for lowering blood cholesterol levels through alteration of diet and through certain drugs which inhibit cholesterol synthesis in the body. Studies showed, however, that the latter approach seems to bring about the appearance of cholesterol’s immediate chemical precursor, which is normally absent from the 114 Department of Health , Education , and Welfare , I960 blood. This opened to question the desirability of such practices at the present state of knowledge. Research in the field of hypertension, or high blood pressure, con¬ tinued along two lines : clarification of the processes causing the dis¬ order, and direct attempts to improve hypotensive drug therapy. Trials of members of a new class of compounds, known as monoamine oxidase inhibitors, produced promising results. These substances, which act indirectly on blood-pressure-regulating hormones, enabled scientists to uncover important new physiological information, and offered the prospect of greatly improved drugs for treating patients. Another group of compounds, the decarboxylase inhibitors, which block production of aromatic amines suspected of being important in the development of hypertension, were given clinical trials. Among the year’s developments in the field of surgery was the replacement of a patient’s diseased mitral valve with an artificial one made of flexible plastic foam reinforced with dacron. Another de¬ velopment was establishment of the diagnostic value of radioactive krypton gas for detecting and locating cardiac shunts, or abnormal openings in the partition separating the heart chambers. Other studies showed that the use of potassium citrate for arresting heart¬ beat during surgery entails too much danger of irreversible heart failure and led to the abandonment of the drug by NHI in favor of the anoxic method of cardiac arrest. This method interrupts blood flow through the heart by intermittently clamping off the aorta. Gas chromatography, already shown to be an extremely reliable method for the quantitative and qualitative analysis of fatty com¬ ponents of blood and atherosclerotic deposits, was adapted for the separation and analysis of steroids. Studies in the biology of aging produced the discovery that insolu¬ ble solids called age pigments, long known to be present in some tis¬ sues of aged persons, accumulate in the cells of the human heart muscle at a constant rate throughout life, beginning in the second decade. They ultimately displace as much as ten percent of the cellu¬ lar volume. The accumulation appears to meet criteria set forth for a “basic biological aging process.” GRANT-SUPPORTED RESEARCH Investigations of the delicate balance normally maintained in the blood between coagulation and clot dissolution support the idea that the balance is upset in blood-clotting diseases. Heart Institute grantees at Wayne State University, Detroit, reported in 1960 that they have prepared a clot-dissolving enzyme from thrombin, a blood constituent normally involved in coagulation, and have demonstrated its effectiveness in dogs. The work is believed to open possibilities for human application. Public Health Service 115 Comparison of aortic and coronary atherosclerosis in the United States, J amaica, J apan, and India by a group of grantees at Harvard University showed a greater severity of intimal alteration in the U.S. than in the other groups. The study also showed that in Japan and Jamaica, the atherosclerosis was more severe in the aorta than in the coronaries. In studies at Columbia University, further evidence was found link¬ ing oversecretion of the hormone, aldosterone, with malignant hyper¬ tension through at least initial success in treating patients with “block¬ ing” chemicals which prevent the biological action of the hormone. A three-year study was begun in five PHS hospitals to test various drugs for hypertension. Three hundred outpatients will participate at Staten Island, Baltimore, Norfolk, New Orleans, and San Fran¬ cisco. At the Cleveland Clinic in Cleveland, Ohio, two artificial heart prototypes were designed and tested in dogs and in a mock circulatory system. Several types of artificial heart valves, made from various plastics, were developed by grantees at the University of Mimiesota in Minne¬ apolis. One valve of the “flap” type shows definite clinical promise in severe rheumatic heart disease. At the same institution, a portable, electric cardiac pacemaker was reported for treating patients with complete heart block and found capable of maintaining normal heart rhythm for periods up to fifteen months. Complete heart block may occur as a result of heart surgery, atherosclerosis, infection, or certain drugs. The transistorized pace¬ maker maintains the heart beat until the diseased or injured tissue regenerates and the heart’s own pacemaker can resume normal func¬ tion. A new surgical technique developed at Baylor University, Houston, Texas, is reported to permit removal of atherosclerotic obstructions to blood flow in small arteries. A knitted dacron patch is applied to the incision left after removal of the obstruction. This overcomes the problem formerly posed by constriction of the inner diameter of the artery at the incision site during the healing process. Institute of Mental Health Throughout the Institute special attention was given to problems of current public concern. The Institute collaborated with the Chil¬ dren’s Bureau in drawing up a report to Congress on what can and should be done about juvenile delinquency. Through a grant to the North American Association of Alcoholism Programs, it launched a five-year study of alcoholism in the United States and Canada. The 116 Department of Health , Education , and Welfare , 1960 NIMH program also stressed mental retardation, childhood psy¬ choses, and aging. New and improved methods for the care, treatment, and rehabilita¬ tion of the mentally ill continued to receive great emphasis. Evi¬ dence that past efforts have borne fruit is the fact that in 1959, for the fourth consecutive year, there were fewer patients in mental hos¬ pitals at the end of the year than at the beginning. SUPPORT OF RESEARCH During fiscal year 1960 NIMH supported over 1,000 research grants — in psychiatry, sociology, anthropology, biochemistry, neuro¬ physiology, and more than a score of other disciplines. The breadth and diversity of the research reflects the policy of the Institute to leave no area unexplored that might contribute to the understand¬ ing and amelioration of mental illness. A heavy share of the grant investment was for research into the underlying physiology of schizophrenia. With increased precision of biochemical research, serious doubts have been cast on earlier attempts to relate abnormal body chemistry to mental illness. New evidences of such a relationship, however, continued to emerge from grant-sup¬ ported research. Support was also given to numerous studies of the psychiatric and socio-environmental aspects of schizophrenia. Studies of drugs used in mental illness continued to increase under grants from the Psychopharmacology Service Center. Investiga¬ tions started earlier were beginning to yield results. Some of the most definitive findings came from outpatient studies of the effec¬ tiveness of drugs in treating relatively chronic schizophrenic patients in the community. One such study has conclusively shown that drugs play a very important part in preventing relapse in schizo¬ phrenics released to the community after two or more years of hos¬ pitalization. Many of the grants were for studies concerned with children. Some of them focus on childhood schizophrenia and others on less serious but more prevalent disorders. Juvenile delinquency was un¬ der study in 47 grant-supported projects. Support was also given to studies of normal growth and development, since a more ac¬ curate knowledge of normal physical and psychological function¬ ing at different stages is needed as a baseline against which to meas¬ ure and evaluate behavioral deviations. BASIC RESEARCH In the Institute’s own facilities, work was going forward on a wide variety of basic and clinical investigations. Scientists in a number of basic laboratories are endeavoring to relate brain structure and function to behavior. For example, the Laboratory of Animal Be¬ havior is using experimental animals to study the effects of brain Public Health Service 117 lesions on learning. In the Laboratory of Neurophysiology, scientists are investigating the role of the limbic system (“primitive brain”) in shaping behavior. Other neurophysiological studies have shown that sleep is associated with an alteration of the pattern of cerebral ac¬ tivity, and that normal behavior is at least partially dependent on continuous sensory input of the brain. Investigators at the NIMH Addiction Research Center in Lexing¬ ton, Kentucky, were principally concerned with studies on the addic¬ tion liabilities of new drugs. They conducted several clinical studies on alcoholism. They also investigated psychological and behavioral changes induced by several drugs of particular significance in mental health research, among them LSD-25 (which produces schizophrenia¬ like effects), clilorpromazine (a tranquilizer) , and alcohol. A project for testing research instruments and methods of evaluating the effectiveness of drug use and “milieu therapy” in a mental hospi¬ tal population was conducted by a group of scientists at the Neuro¬ pharmacology Research Center located in Saint Elizabeth Hospital. It showed that such studies can be pursued in a typical State hospital setting, and mapped out a feasible way to conduct them. The Section on Aging in the Laboratoryy of Psychology organized and edited the “Handbook on Aging and the Individual : Psychologi¬ cal and Biological Aspects.” The book is an authoritative technical summary of the scientific and professional literature on the psycho¬ logical and social aspects of human aging. Five of the 24 chapters were written by NIMH staff members. CLINICAL INVESTIGATIONS The Laboratory of Clinical Science concentrated on biochemical research to investigate the possible relationship between some forms of mental illness and biochemical processes in the brain and nervous system. To date, the schizophrenic patients studied, either individu¬ ally or as a group, have shown little abnormality in the research completed. A number of laboratories have participated in an extended study of healthy elderly men and a companion study of men with mild diseases (mostly vascular), which will give insight into the psychological, physiological, psychiatric, and socio-psychological aspects of aging. A monograph is planned to include the results of this collaborative effort. Scientists in the Child Development Section continued intensive research on mother-child relationships and on the ways in which early environmental factors affect intellectual and personality growth. They have developed a research instrument by which they can record and compare research data on the emotional variables that enter into the mother-child relationship. 118 Department of Health, Education , and Welfare, 1960 A new research undertaking, known as the Bio-Social Growth Cen¬ ter, is designed to investigate emotional, biological, and cultural fac¬ tors as they influence personality from the earliest prenatal period of growth through infancy and early childhood. Scientists in the Personality Development Section have carried forward a project for studying the behavior of competent adolescents, and particularly in learning how they cope with the stresses of the transition period from high school to college. They have studied the adaptive behavior and problem-solving techniques of 20 selected stu¬ dents before and during their freshman year. They are further at¬ tempting to make systematic comparisons of these students with some who broke down in the freshman year. COMMUNITY SERVICES F ederal, State, and local funds budgeted by the States for commu¬ nity mental health services reached a new peak of $65 million in fiscal year 1960. Federal grants-in-aid of $5 million represented only 8 percent of the total funds budgeted. Originally, Federal grants-in- aid for community mental health services were offered the States on a 2 : 1 matching basis. The ratio was changed at the beginning of fiscal 1960 to a 1 : 1 matching basis. The Community Services Branch expanded its program of technical and professional assistance to the States through personnel from the central and regional offices and by workshops and conferences con¬ ducted as Technical Assistance Projects. Under the Mental Health Projects Grants Program, NIMH supported 132 projects to develop and test new and improved methods for the care, treatment, and rehabilitation of the mentally ill. TRAINING The Institute made some major adjustments in the timing of the training grants awards and in administrative procedures to accommo¬ date the recipient institutions in developing their programs for train¬ ing students. Funds were granted to projects in several new or ex¬ panded fields of professional training: graduate mental health re¬ search in the biological and social sciences ; the psychiatric training of general practitioners ; and the teaching of undergraduate medical stu¬ dents in the field of human behavior. Institute of Neurological Diseases and Blindness Neurological and sensory disorders constitute the primary cause of permanent crippling in the United States and rank third as the cause of death. New statistics emphasize again the extent to which long¬ term disability is caused by neurological disorders and the importance of the prenatal, birth, and early life period of development. Public Health Service 119 Because researchers are convinced that conditions existing during the early periods of life are responsible for a large percentage of disabilities which may continue throughout life, a major attack has been made in this area by the Institute. The Collaborative Project on Cerebral Palsy, Mental Ketardation, and other Neurological and Sensory Disorders of Infancy and Childhood completed its first year of study in J anuary 1960, after two and a half years of intensive prep¬ aration. In addition to about 5,516 mothers and 4,593 babies studied in the pretest phase of the project, about 8,029 mothers and 4,400 babies had been studied in the study series as of May 31, 1960. In the broadest sense, the objective is to evaluate those factors influencing the health of mothers and children throughout the Nation. Of all the chronic neurological disorders of childhood and adoles¬ cence, mental retardation and cerebral palsy affect the most lives. In mental deficiency, the fact that galactosemia and phenylketonuria can both be ameliorated by special diets has provided increasing in¬ centives and hope in the search for other similar anomalies. A simple mass screening test for phenylketonuria has been developed, and there is now no reason for this cause of mental deficiency to go undetected and bring irreparable brain damage. Technical advances have dem¬ onstrated that mongolism is attributable to a chromosome abnormality which probably develops at the time of ovulation. Up until five years ago, kernicterus was responsible for one percent of admissions to insti¬ tutions for the mentally defective. As a result of the effective cam¬ paign against kernicterus, one institution now reports that over the past three years not a single case of mental retardation or cerebral palsy attributable to kernicterus has been admitted. Studies in neurochemistry relating to epilepsy have revealed that gamma-aminobutyric acid, present in relatively large amounts in the normal brain, may regulate a portion of the available energy and affect levels of functional activity within the brain. Investigators are at¬ tempting to alter the level of this compound to determine the effect of this change on seizure activity. Closely connected with the study of the formation of myelin is the evaluation of “allergic encephalomyelitis” — the inflammatory process through which the myelin is destroyed in certain allergic conditions which have at least superficial resemblances to multiple sclerosis. The method of production of this disease in animals is now well estab¬ lished, and this year brought further clarification of the specific chem¬ ical fraction responsible for producing the destructive reaction. In disorders of vision, an outstanding development in the cataract program is the demonstration of minute changes in the structures and fibers of the cataractous lens. An important cause of blindness in the older age group is glaucoma. Investigations continue on the effects 120 Department of Health , Education , and Welfare, 1960 of various drugs such as acetazolamide on relieving the intra-ocular pressure associated with this disorder. The Institute, in cooperation with the Bureau of State Services, has launched a five-year coopera¬ tive study to evaluate techniques currently used to detect and identify glaucoma. Progress continues in basic research studies of the nerve pathway by which the brain itself controls the sensitivity of hearing. The ar¬ rangement of the nerve terminals and manner of distribution within the ear have been determined. Other connections of the cochlear nucleus have been studied, and two new bundles of efferent nerve fibers have been identified. In addition, the Institute’s collaborative proj¬ ect includes correlations of hearing and speech disorders with events of pregnancy and labor. GRANT-SUPPORTED RESEARCH In the Institute’s cooperative project on aneurysms, the surgical approach to intracranial aneurysms is being evaluated and refined. The initial results of the cooperative anticoagulant study have re¬ vealed that the Use of anticoagulants does not produce a dramatic change in over- all mortality. This study is providing information on certain benefits to be derived from this therapy, its limitations, the types of cases in which therapy is desirable, and the complications to be avoided. This year the Institute has launched a new epidemiological pro¬ gram to determine variations in the incidence and character of cere¬ brovascular disease in different countries. A research grant for the planning of this international study of the epidemiology and neuro¬ pathology of strokes has been awarded by NINDB to the World Federation of Neurology, with headquarters in Antwerp, Belgium. This project proposes to investigate factors which cause strokes in different national, ethnic, racial, and cultural groups throughout the world. Special attention is also being given by the Institute to research directly related to the aging process of the central and peripheral nervous system. Colonies of aging animals are being maintained in various centers for research on alterations in the physical and chemi¬ cal structures of tissues as aging progresses. Bureau of Medical Services The Bureau of Medical Services provides medical and health serv¬ ices to groups of citizens designated by the Congress as beneficiaries of the F ederal Government, conducts clinical research, and maintains training programs for medical and health personnel. Public Health Service 121 Federal beneficiaries include the American Indians and Alaska Natives, American seamen, personnel of the U.S. Coast Guard and Coast and Geodetic Survey, Armed Forces dependents, Federal prisoners, and others. They receive medical care through Public Health Service hospitals and clinics located on Indian reservations, in port cities, Federal prisons and elsewhere. The Public Health Service hospitals are prominent among the Na¬ tion’s primary resources for the training of physicians, nurses, and other health personnel. Clinical research into many aspects of medi¬ cine is conducted in these hospitals, including the specific fields of narcotic addiction and leprosy. The Bureau of Medical Services is also responsible for protecting the United States against quarantinable diseases from abroad, assist¬ ing by means of funds, architectural planning, and expert counsel in the construction of community hospitals and health facilities, and for developing the Nation’s dental and nursing resources. Hospitals and Outpatient Facilities The Division of Hospitals operates a medical care program for an estimated 371,000 persons who are legally entitled to care from the Public Health Service. These include American merchant seamen, officers and enlisted men of the IT.S. Coast Guard, officers and crew members of the U.S. Coast and Geodetic Survey, commissioned officers of the Public Health Service, civilian employees of the Federal Gov¬ ernment injured in performing their work, active and retired members of the Federal uniformed services and their dependents, and several other groups. Patients with leprosy and narcotic drug addicts as defined by Federal law, are cared for in the Division’s special hos¬ pitals. At the end of fiscal 1960, there were 15 Public Health Service hos¬ pitals, 25 outpatient clinics, 110 outpatient offices conducted under contract arrangement with community physicians. The Public Health Service tuberculosis hospital at Manhattan Beach, Brooklyn, New York, was closed June 15, 1960, because the number of patients had been declining for 5 years, while the operating costs had been increasing. At year-end, Public Health Service bene¬ ficiaries in the New York area who have tuberculosis were being ex¬ amined by physicians of the Service hospital on Staten Island to determine whether they would be treated in general hospitals or in the Veterans Administration tuberculosis hospital in West Haven, Connecticut. VOLUME OF SERVICES Admissions to the Public Health Service hospitals in 1960 totaled 50,485— an increase of 1.4 percent over 1959. There were 874 babies 573826—61 - 9 122 Department of Health , Education , and Welfare, 1960 born, compared with 720 the year before. The average daily inpatient census declined 2.8 percent, to 4,994; the greatest decrease was among tuberculosis patients. The number of outpatient visits was about the same — nearly 1,185,800. GENERAL HOSPITALS Admissions to the 12 general hospitals totaled 45,878. Included were both male and female patients of all ages with a wide range of health problems. These hospitals provide general, medical, and sur¬ gical services, and each has an outpatient section. They are located in major port cities — Boston, New York, Baltimore, Norfolk, New Orleans, Galveston, Chicago, Detroit, San Francisco, Seattle — and in Savannah and Memphis. The patients receive care similar to that given in community hos¬ pitals. Among the merchant seamen and Coast Guard members who make up most of the patient census, the five leading causes of admis¬ sion are: diseases of the digestive system, accidents, diseases of the genito-urinary system, respiratory conditions, and diseases of the bones and organs of movement. NARCOTIC ADDICTION The Public Health Service Hospital at Lexington, Kentucky, cele¬ brated its 25th anniversary in May 1960. This hospital and the Service hospital at Fort Worth, Texas, which opened in 1938, are neuropsychiatric hospitals devoted primarily to the treatment of narcotic addiction as defined by Federal law. They also treat persons with mental illness who are entitled to care as beneficiaries of the Federal Government. In 1960, the two hospitals admitted 4,607 patients, an increase of 6.1 percent. Of these, 4,163 were addicted to the use of narcotics; this was an increase of 4.6 percent over the previous year. The average daily census of 1,915 was almost the same as for the previous year. The census of drug- addiction patients was 1,315 — which was 1.3 per¬ cent higher than in 1959. Eighty-seven percent of the patients who were admitted to the two hospitals for treatment of narcotic addiction entered voluntarily, but voluntary patients made up only 37 percent of the average daily patient census. This comparison shows that addict patients who are not required to remain in the hospital usually give up their treatment before they have derived the full benefits from it. Staff members of both hospitals participated in conferences, work¬ shops, seminars, and meetings concerned with problems of narcotic addiction called by agencies in California, New York, Illinois, Ten¬ nessee, and Washington, and gave consultative services in Texas and Kentucky. In November 1959, mental health consultants from Public Health Service 123 Regional Offices of the Department of Health, Education, and Wel¬ fare in San Francisco, Chicago, and New York met at Lexington with representatives of both the Lexington and Fort Worth Public Health Service hospitals, the National Institute of Mental Health, the Office of the Surgeon General, and the Bureau of Medical Services, to exchange information on assistance available to narcotic addicts of community, State, and Federal origin. The urgent need for local post-hospital treatment and follow-up services was a major point of discussion. The Lexington and Fort Worth hospitals provided extensive orien¬ tation and training to more than 50 professional visitors — physicians, public officials, and others — from various States and from Puerto Rico, Brazil, Iran, Belgium, Japan, New Zealand, Scotland, Thai¬ land, and other foreign countries. LEPROSY The Public Health Service Hospital at Carville, Louisiana, is a principal center for the treatment and study of leprosy (Hansen’s Disease) and for investigation of the many social problems that accompany it. In 1960, there were 85 admissions to the Carville hospital compared with 62 the previous year. The average daily inpatient census moved slightly upward from 277 to 281. An epidemiology branch was established and work was started on a national leprosy register. The register will include the more than 2,000 cases admitted in Carville since establishment of the hospital plus other cases known to physicians in the United States; also, identification of the contacts of these cases and the physicians who are keeping them under observation. A clinic for leprosy patients was opened at the Service hospital in San Francisco. A consultant in leprosy meets patients bi-monthly. X-ray, laboratory, and other services of the hospital are available to them. Their records are studied by the Carville staff by means of inter-hospital communications channels. The clinic also provides follow-up services for West-coast patients who have been discharged from Carville. At the request of the Secretary of the Interior, the Surgeon General sent a medical team to American Samoa in May 1960 to investigate leprosy. The epidemiologist from Carville and the consultant in leprosy at the San Francisco hospital spent three weeks investigating every known or suspected case of leprosy in American Samoa as well as selected groups of the general population. Tissue specimens and blood samples were still under laboratory analysis when the fiscal year ended. 124 Department of Health , Education , and Welfare , I960 More than 9,400 persons visited the Carville hospital during the year, including 582 physicians and 542 nurses. They came from 15 States and from Argentina, Brazil, Canada, China, Guatemala, India, Japan, Korea, Malaya, and Mexico. Twenty- four seminars were attended by a total of 586 persons. An outstanding example was the seminar for 29 missionaries of various Protestant denominations. MEDICARE The Dependents’ Medical Care Act of 1956 authorized the Divi¬ sion’s hospitals and clinics to admit active and retired members of the Federal uniformed services and their dependents and the depend¬ ents of deceased members of these services. This program, popularly called MEDICARE, has resulted in increased utilization of PHS facilities by these patients each succeeding year. In 1960, MEDI¬ CARE inpatient admissions in PHS hospitals increased 6 percent to 15,247 ; meanwhile their average daily census rose 2.4 percent, to 636. Outpatient MEDICARE visits numbered 413,393, an increase of 8.4 percent. The daily census of PHS patients in hospitals of the Depart¬ ment of Defense averaged 124, while the number of Defense Depart¬ ment beneficiaries in Public Health Service hospitals averaged 268. TRAINING MEDICAL CARE PERSONNEL Nearly 300 physicians, dentists, pharmacists, and dietitians took internship or residency training in Public Health Service hospitals in 1960. Ten of the hospitals are approved for postgraduate 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 American Dental Association approval for internships in dentistry. In Seattle, the hospital lias a residency in prosthodontia ; on Staten Island, a resi¬ dency in oral surgery; in New York City, the outpatient clinic has an approved rotating dental residency. The Staten Island hospital provides residency training each year for one graduate student from the Columbia University School of Public Health and Administrative Medicine. This institution is visited annually by students in Co¬ lumbia’s course in hospital administration as the representative Fed¬ eral hospital in the New York metropolitan area. Four nurses responsible for inservice training of nurses at Public Health Sendee hospitals conducted a two-months pilot course in cardiovascular research methods and techniques, at the Clinical Center of the National Institutes of Health. The experience gained was studied to establish guidelines for future programs of research train¬ ing for nurses in other clinical specialties. Through the hospitals’ various affiliations with colleges and tech¬ nical schools, more than 100 undergraduates obtained practical ex- Public Health Service 125 perience and clinical instruction in physical therapy, occupational therapy, vocational therapy, social service, medical technology, and dental hygiene. The hospital on Staten Island continued to provide the clinical nursing portion of the training course for hospital corps- men given by the U.S. Coast Guard. CLINICAL INVESTIGATIONS Clinical and basic research conducted in Public Health Service hospitals includes both individual projects and inter-hospital inves¬ tigations. A number of studies are associated with research activi¬ ties of outstanding medical institutions, such as the Tulane University and Stanford University medical schools. Staten Island, New Orleans, and San Francisco Public Health Serv¬ ice Hospitals have full-time directors of research, trained in leading university laboratories. Four other Service officers received similar training in 1960. The 1960 appropriation act for the Department of Health, Educa¬ tion, and Welfare authorized Public Health Service hospitals to ob¬ tain research grants from the National Institutes of Health on the same basis as non-Federal institutions. The Baltimore, Norfolk, New Orleans, San Francisco, and Staten Island hospitals are cooperating in a three-year study of effectiveness of various drugs in treating essential hypertension. NIH grants totaling $154,000 have been approved for this research. PROGRESS IN ADMINISTRATION Management appraisal surveys were conducted at the hospitals in Galveston and on Staten Island. These included observation and evaluation of current operating methods. On the grounds of the Carville hospital ten new cottages for mar¬ ried patients were built, and two dormitories were converted to apart¬ ments. Ten new staff quarters were also completed, and extensive renovations were made to the gate house and the administration build¬ ing. FEDERAL EMPLOYEE HEALTH PROGRAM The Federal Employee Health Program aims to promote and main¬ tain health and well-being among Federal employees. It plans and conducts activities encompassing public health, preventive medicine, and emergency medical care. Health units are operated on a reim- bursible basis, for Federal agencies requesting this . service. The medical care activities of the program are carried on in cooperation with employees’ private physicians. In 1960 three new health units were added, bringing the total to 32 ; these serve more than 53,000 employees located in 128 Federal agency programs. The number of physicians in the health units was in- 126 Department of Health , Education , and Welfare, 1960 creased from 10 to 17. There were 1,753 physical examinations given Federal employees over the age of 40, as compared with 348 in 1959. All employees served by the 32 health units may receive poliomyelitis and influenza immunizations at minimum cost without leaving their offices for more than a few minutes. From January through June 1960, approximately 20,000 polio immunizations were given 11,000 individuals. In the same period, almost 3,000 influenza immuniza¬ tions were given. More than 2,000 immunizations for Kocky Moun¬ tain Spotted Fever were given in endemic areas, also 250 tetanus im¬ munizations in places where there was unusual hazard. Vision tests and glaucoma tests were offered through all health units. Plans were completed to offer diabetes detection tests in 1961. FREEDMEN’S HOSPITAL In addition to operating the Public Health Service hospitals, clinics, and outpatient offices, the Division of Hospitals also supervises the administration of Freedmen’s Hospital, a general medical and surgical hospital in Washington, D.C. There were 13,945 patients admitted to F reedmen’s Hospital in 1960, slightly more than in 1959. The average daily inpatient census de¬ clined from 362.4 to 352.9, reflecting a small decrease in the average stay. Outpatient department visits declined from 97,298 to 95,414. The number of long-term patients was fewer than in previous years. Nevertheless the hospital experienced serious crowding at several periods of the year, especially in the medical and obstetrical depart¬ ments. All training accreditations were maintained. The hospital served as the clinical teaching center for juniors and seniors of Howard University’s College of Medicine. It also gave approved internship and residency training, and conducted approved teaching programs in nursing and X-ray technology. A total of 47 residents received advanced training in the depart¬ ments of medicine, surgery, neuropsychiatry, obstetrics and gyne¬ cology, and pediatrics. There were 7 medical interns, 2 dental in¬ terns, and 9 research fellows. Twenty-seven students were graduated from the Freedmen’s Hos¬ pital School of Nursing, bringing the total number of graduates to 1,401. Ten dietetic interns, two pharmacy interns, and eight students of X-ray technology completed training. More than 50 clinical research projects were in progress at the hospital, and some 40 scientific articles by staff members were pub¬ lished or were in preparation. The hospital’s pressing need for better facilities grows more acute as time goes by. It has become increasingly difficult to give medical Public Health Service 127 care and to conduct teaching programs acceptably in facilities no longer equal to the demand for modern services. Foreign Quarantine So long as significant outbreaks of infectious diseases are still occurring in other parts of the world, our Nation cannot be com¬ placent about its freedom from outbreaks of quarantinable diseases. The speed and volume of traffic to the United States from abroad is constantly increasing. There is always a chance, therefore, that cases of contagious disease may enter the country. To prevent this, personnel of the Division of Foreign Quarantine stand vigilantly on guard at all ports of entry. The last outbreak of quarantinable disease in this country known to have originated in international traffic was the smallpox outbreak in New York City in 1947. Since then, a few persons infected with this disease have been intercepted at the ports by F oreign Quarantine personnel. Smallpox continued to challenge international quarantine control in 1960. It occurred in about 60 international airport and seaport cities of 21 countries. The most serious outbreak was in Moscow where 11 cases were reported including one brought in from the Far East. The disease was confined to the city by means of a mass vacci¬ nation program and the requirement that all persons entering Moscow have recent vaccination. Explosive outbreaks of smallpox occurred also in newly established countries of Africa, particularly in port areas. Epidemics were reported by several countries of central Africa. The disease remained endemic in countries of the F ar East and a few countries of South America. A few cases were reported aboard ships. Yellow fever reappeared in the Sudan for the first time in several years; more than 100 cases were reported. The disease also spread into adjacent provinces of Ethiopia and the Belgian Congo. Another major outbreak of yellow fever occurred in a new agricultural area of La Paz Department, Bolivia. Sporadic cases occurred in Ghana, Nigeria, Brazil, Colombia, Peru, and Venezuela. Cholera epidemics continued to be confined to countries of the Far East. Fewer cases were reported than in previous years. Most recently cholera reappeared in Akyab, Burma. An epidemic in Thai¬ land lasted 17 months, ending in October 1959. The international seaports and airports of the world remained free of plague. The disease was still present in rats and other rodents in some areas of the Americas, Africa, and Asia, and spread to the human population in several instances. Outbreaks of human plague 128 Department of Health, Education , and Welfare, 1960 were reported by Indonesia, Southern India, Vietnam, Ecuador, and Peru. Countries of Africa reported sporadic cases. In the United States, five cases of plague were reported. One, lab¬ oratory-acquired, was in Maryland; four were in the West and South¬ west. None was significant to international traffic. Immediate field investigations in an affected area in New Mexico revealed an epizootic that first decimated the wood rats and then spread to rabbits and pos¬ sibly other hosts. Further field investigations are being made. The increase in cases during the year and the growth and movement of population in the United States suggest the need for comprehensive field studies of syl vatic plague. Sporadic cases of louse-borne typhus were reported in several ports of Africa, Asia, and South America. The disease was present also in Mexico. Louse-borne relapsing fever is endemic in Ethiopia. More than 8,000 cases were reported in calendar year 1959, nearly double the number reported in 1958. Single cases were reported in Tunisia, the Belgian Congo, Nigeria, Somaliland Protectorate, Bolivia, Peru, Cyprus, Turkey, and Afghanistan. NONQUARANTINABLE DISEASES The Public Health Service, the U.S. Department of Agriculture, and State and local health authorities in Texas were concerned with protecting against introduction of anthrax from Mexico. A signifi¬ cant outbreak of anthrax occurred in cattle in Matamoros, Mexico. Five human cases were reported there; the infections were mild, re¬ sponding to antibiotics. A problem was presented by the fact that residents of Brownsville, Texas, often buy meat in Matamoros. The Service was informed that anthrax had also occurred in 1959 in a herd of cattle brought into Brownsville from Matamoros, and that four persons contracted anthrax from direct contact with the infected cattle. These cases were successfully treated. An outbreak of Japanese B encephalitis in Korea subsided in Oc¬ tober 1959, primarily because of cooler weather. Ten provinces re¬ ported 1,886 cases and 521 deaths from July 30 to October 7. Nigeria reported a major epidemic of meningitis (meningococcal) — the first in a decade ; up to April 24, 1960, there were 33,470 cases and 2,320 deaths reported. About 35 to 40 percent of the cases were in children. The disease was controlled through treatment and isolation of patients by mobile health teams under direction of four physicians. INTERNATIONAL TRAFFIC In calendar year 1959 more than 7 million persons from the United States traveled in other countries. The risk of introduction of dis¬ ease by this moving population is reduced by vaccination of travelers Public Health Service 129 before they leave home. Vaccinations required and recommended for international travelers are stated in the Public Health Service booklet “Immunization Information for International Travel.” In the 1960 fiscal year inspections of aircraft for quarantine or immigration-medical purposes continued in about the same volume as in the preceding year — 70,383 in 1960 compared with 70,607 in 1959. The increased use of jet aircraft, with greater passenger capacity, was evidenced by a 16.4 percent increase in quarantine inspections of per¬ sons arriving by air, from 1,859,843 in 1959 to 2,165,664 in 1960. In¬ spections of ships decreased slightly, from 33,271 in 1959 to 33,180 in 1960. Quarantine inspections of persons arriving by ship increased from 1,955,760 to 1,967,997. Travelers subject to quarantine inspection arriving in the United States by all modes of travel, including land entry from the interior of Mexico, decreased slightly, from 5,264,354 in 1959 to 5,186,789 in 1960. This change was accounted for by a decrease in inspections of persons arriving by land from the interior of Mexico from 1,448,751 to 1,053,128. It was necessary to detain only 37 persons in isolation in 1960, compared with 607 in 1959. The number of persons who were allowed to continue to their destinations in the United States, but were subject to medical supervision for a time, was 54,459 compared with 117,310 in 1959. MEDICAL EXAMINATIONS General 'program. — The downward trend during 1958 and 1959 in number of aliens examined by medical officers abroad was reversed in 1960. The number of alien applicants for visas who were examined increased from 155,068 in 1959 to 173,402 in 1960. Those examined were, as before, mostly immigrants. Aliens examined on arrival at United States ports increased 10.3 percent, from 2,669,768 in 1959 to 2,945,264 in 1960. Of the aliens examined abroad, 1,602 were found to have diseases or conditions excludable under the immigration law. Among those examined at ports in this country 2,331 were found to have excludable diseases or defects; many had been so diagnosed abroad, but were admitted under special provisions of the immigra¬ tion law. At the close of 1960, Korean orphans immigrating to the United States under the sponsorship of a prominent agent were arriving properly attended and in good condition. Earlier, many Korean orphans arrived here in a poor condition of health, suffering from malnutrition, enteritis, pneumonitis, scabies, impetigo, or other ill¬ ness; in a few instances, they died on their way to this country or soon after they arrived. This situation has been corrected, as the result of conferences of division personnel with the State Depart¬ ment and with a physician representing the sponsoring agent, and 130 Department of Health , Education, and Welfare, 1960 by field visits of the division’s medical examiner from Hong Kong. Immigration of aliens with tuberculosis. — The immigration of cer¬ tain aliens who have tuberculosis continued for the third year under Public Law 86-253 (amending Public Law 85-316). Under this law, quarantine officers abroad examined 400 aliens with confirmed or suspected tuberculosis during the year, compared with 1,073 in 1959; 794 aliens were placed under health controls after arrival in the U.S., compared with 1,445 in 1959. Migratory farm labor. — In the program of recruiting agricultural workers from Mexico, 431,631 laborers were examined, with 7,033 rejections, at three migratory centers in Mexico; 477,710 examina¬ tions were made, with 5,114 rejections, at five border reception centers in the United States. At the reception centers 438,493 serologic tests for syphilis were made (an increase of 29.3 percent over 1959), and 21,776 positive reactors were detected. The rate of detection of positive reactors decreased from 61 per thousand laborers tested in 1959 to 49.7 per thousand in 1960, indicating the result of treatment given in the program. YELLOW FEVER RECEPTIVE AREAS American Samoa, the Trust Territory of the Pacific Islands, and the Ryukyu Islands were added to the yellow fever receptive area in territories for which the United States is responsible. Action was begun to remove the following from the yellow fever receptive area : Arizona, New Mexico, Oklahoma, and the part of Texas west of a line from Del Rio to Wichita Falls; this decision was based on the fact that no Aedes aegypti mosquitoes — which can carry the disease — have been found in these areas in recent years. ENTOMOLOGY PROGRAM The program for controlling the yellow fever mosquito ( Aedes aegypti) was carried into nearly 150 international traffic areas in the South, along the Mexican border, and in Puerto Rico and the Virgin Islands. Results were favorable. Insecticide resistance studies were undertaken at Miami and New Orleans, using laboratory-reared Aedes aegypti larvae. The Miami studies showed evidence of slight tolerance to DDT. Other insecticides are used in the control program. Many species of mosquitoes and other insects of medical importance on aircraft and on ships arriving in this country were intercepted by quarantine personnel. Insecticides were applied to a large number of these conveyances. OTHER QUARANTINE ACTIVITIES Standard aircraft quarantine procedures were instituted, providing for simplification of inspections at airports. Emphasis was placed on Public Health Service 131 measures affording greatest protection against bringing in disease, with minimum interruption of international traffic. The Air Trans¬ port Association of America commented : “Your new procedures will enable the United States to demonstrate an effective quarantine facili¬ tation program essentially based on efficient management practices.” Effective June 10, 1960, the Surgeon General added J amaica to the quarantine-exempt areas. This action was based on a study by per¬ sonnel of the Division of Foreign Quarantine and the Communicable Disease Center. Measures were taken to have adequate immunity maintained by per¬ sons working in airport and seaport areas whose occupation brings them in contact with traffic from abroad. Quarantine officers asked the cooperation of local health authorities in emphasizing the im¬ portance of current immunization. Among those for whom small¬ pox vaccination every 3 years was recommended are personnel of Federal inspectional services, airline employees, taxi drivers serving airports and seaports, and personnel of hotels and hospitals in cities where international airports or seaports are located. Yellow fever vaccination every 6 years was recommended for persons who may deal with planes or ships arriving from a yellow fever infected area. Quarantine service on the Mexican border was strengthened by ex¬ tension of inspection coverage from 922 to 2,110 hours per week. Higher standards were adopted for appointment of inspectors, and an intensive staff training program -was begun. The position of epidemiologist for the European area was estab¬ lished, and the Public Health Service medical officer stationed at the U.S. Embassy in London was given this additional duty. The pur¬ pose is to effect liaison with foreign health authorities on problems concerning unusual occurrence of communicable disease, and to assist in a sound approach to related quarantine measures in this country. Principal Domestic Field Offices were established in El Paso (cen¬ tralizing responsibility for activities along the entire Mexican border) and in New York (centralizing responsibility for activities from Chi¬ cago to Norfolk) . Progress in Indian Health The first Public Health Service hospital for Indians was dedicated on May 21, 1960, at Shiprock, New Mexico. Shiprock Hospital signalizes the constantly improving health serv¬ ices given Indians and Alaska Natives by the Public Health Service as wrell as the increasing effort of American Indians to improve their own health and living conditions. 132 Department of Health, Education, and Welfare, 1960 Major emphasis in the Indian health program in 1960 was placed on improving the quality of health services available to the Indian people. Medical care and preventive health services were provided in hundreds of facilities located as close as practicable to the homes of the widely scattered peoples. To meet the needs of about 342,500 Indians and 37,500 Alaska Na¬ tives (Aleuts, Indians and Eskimos) the Division of Indian Health operates a far-reaching health program. This program provides es¬ sential services through its 52 hospitals, 23 health centers, 20 school health centers, and field clinics at almost 300 locations. In addition, hospital and medical services through community sources are financed by the division by means of contracts with private physicians, den¬ tists, non-Federal hospitals, and State and local agencies. The year 1960 was the fifth since the transfer of the Indian health program from the Bureau of Indian Affairs to the Public Health Service. The following accomplishments are noteworthy. The passage of Public Law 86-121, Indian Sanitation Facilities Act, in July 1959 and the authorization of $200,000 to put it into effect, made possible the initiation of 39 emergen cy community environ¬ mental sanitation projects. Twenty-nine of these were completed within eight months. A village clinic program was begun in Alaska. For the first time, medical officers, accompanied by public health nurses or technicians conducted regular monthly one-to-three-day clinics in 18 villages. They also visited many other villages enroute, thereby making medi¬ cal care available to about 10,000 Alaska Natives in all. In this way the division was able to increase preventive health services, intensify case-finding, and provide treatment for acute medical problems, in isolated areas hitherto seldom visited. Two custom-made dental trailers, completely equipped and entirely mobile “offices on wheels,” were placed in operation in the Albuquer¬ que and Phoenix areas, to extend the horizon of dental health services, particularly to children. The ever-increasing understanding and acceptance of modern health and medical care by Indians themselves was evident during the year. GENERATIONS OF NEGLECT A backlog of disease and disability accumulated through genera¬ tions of neglect poses formidable problems for the staff of the Division of Indian Health. The majority of Indians still live in isolated cir¬ cumstances. Most of the reservations and villages are remote, sparsely settled, and hard to reach. Health resources and services taken for granted by most of the U.S. population are not readily available to Indians. Public Health Service 133 Death rates from such preventable diseases as gastroenteritis, in¬ fluenza, pneumonia, and tuberculosis run up to eight times higher than in the general population. Water supplies, which are often polluted and generally are inadequate for domestic needs, frequently must be hauled for long distances. Infant deaths have always been excessive: deaths occur among Indian infants during the first year of life at twice the rate of that for other babies born in the United States. Accidents in and around the household take considerable toll. Over-crowded, substandard housing, dietary deficiencies, lack of op¬ portunity to learn or practice the simplest basics of personal hygiene or community health protection — all contribute to poor health and the high death rate. IMPROVED THERAPEUTIC SERVICES Perhaps the most impressive health success story of recent time among Indians concerns tuberculosis. Once the principal cause of death, tuberculosis now ranks eighth. There has been a continuous decline in the number of deaths and a reduction in morbidity. During 1960, the average daily census of tuberculosis patients in Indian hos¬ pitals fell almost 20 percent. The upwrard trend in general patient admissions continued, with an increase of nearly 5 percent over 1959. The total of almost 77,000 hospital admissions set another all-time high. Births in Indian hospitals increased more than 500 over 1959, to a total of 8,330. Increasing numbers of Indian mothers now seek modern medical and hospital care. A greater quantity and a higher quality of direct pharmacy serv¬ ices were provided by 41 pharmacists assigned to 31 Indian hospitals and 2 health centers. Well over 80 percent of the inpatients and more than half of the outpatients served by Public Health Service Indian health facilities benefited from this improved function. Though the number of nurses available in 1960 was still too small to meet all the nursing needs, improvement w7as made. There was a gain of 102 professional nurses. Eighty-eight wTere assigned to hospi¬ tals, 2 to public health field stations, and 12 to clinics, outpatient serv¬ ices, and schools. The social workers of the division devoted the greatest proportion of their time to children’s problems and to assisting the handicapped and chronically ill. Increased emphasis was placed on broader par¬ ticipation in community programs and on cooperative planning with public and private social agencies. Bearing directly on improvement in quality of services was the training given to young Indian people who are interested in partici¬ pating as workers in the health program. In 1960 the two schools of 134 Department of Health , Education , and Welfare , 1960 practical nursing, at Albuquerque, New Mexico, and Mount Edge- cumbe, Alaska, graduated 74 students, who were assigned to positions to Indian health facilities. Inservice dental assistant training at Mount Edgecumbe and the Intermountain School, Utah, was given to 20 young Indians. Two dental assistants received training at Owy¬ hee, Nevada. Nineteen sanitarian aides were graduated from the basic inservice course offered at Phoenix, Arizona; 9 received refresher training at Fairbanks, Alaska; and 14 completed advanced training at Window Rock, Arizona. IMPROVED PREVENTIVE HEALTH SERVICES A continuing cooperative research project with the National Insti¬ tutes of Health is expected to provide long-needed information about the nutritional status and dietary intakes of children. Plans were made for additional research of this nature in 1961. Much remains to be done in the field of mental health. The mental health demonstration project of the Division of Indian Health and the Bureau of Indian Affairs at the Flandreau Indian Vocational High School in South Dakota, in which the National Institute of Mental Health also participates, developed two major efforts during the year. Primary effort was directed toward maintaining and ex¬ panding individual and group services to emotionally disturbed stu¬ dents. The second effort centered on providing basic data for a continuing study of mental health problems at the school. Notable progress has been made against trachoma, an eye disease that can cause blindness. Under the direction of an internationally recognized trachoma expert, the virus has been isolated and grown. Since trachoma is rarely seen in medical centers, every physician entering the Indian health program was given help in recognizing trachoma in its early stages so that cases could be found and treated before irreversible changes in the eyes took place. Division per¬ sonnel in the Southwest reported that treatment of trachoma victims was resulting in a cure rate of 85 to 90 percent. The Trachoma Manual and Atlas, published by the division in 1958, was revised in 1960 because of worldwide interest in the subject. Closely coordinated liaison among Federal, State, and local health agencies was responsible for improved use of community health re¬ sources to serve Indians. Activities to assure continued construction of community hospitals, under terms of Public Law 85-151, for joint use by Indians and other patients, were strengthened. Under this law, the Public Health Service is authorized to participate financially in construction of such community facilities. Because of the declining number of tuberculosis patients, hospital services were discontinued at the PHS Sanatorium in Tacoma, Wash¬ ington. The few remaining patients from Washington, Alaska, Public Health Service 135 Montana, Oregon, Idaho, and other States were returned to hospitals closer to their homes. Inpatient care at the Cheyenne Agency in South Dakota was suspended because of the flooding of all homes, buildings and roads in the area by Army engineers developing the Missouri River Basin project. The health facility that had been there was replaced by a new 30-bed hospital at Eagle Butte, built by the Corps of Engineers. DENTAL SERVICES Major attention in 1960 was directed toward dental services for the children of school age and younger. The goal is to prevent or mini¬ mize the accumulation of dental defects and infections such as is now present in the adult Indian population as the result of years of neglect. Contract dental care was expanded to provide better dental services where direct service is less practicable. Two hundred private dentists under contract in 1960 provided treatment for 5,180 patients. Cor¬ rective dental health services were given to 72,000 persons at 78 regu¬ lar clinic locations and more than 200 temporary locations. The division’s dental staffs handled nearly 160,000 visits. The dental trailers put into use in the Albuquerque and Phoenix areas made it possible to bring dental services into localities where the Indian children have never had the benefits of examination and treatment. In Alaska, dental service was greatly improved. Thirty-three vil¬ lages wTere visited by dental staff teams, who stayed from a few days to a month. Again the greater part of the service was directed toward children ; emergency care was given for all ages. Dental health con¬ ditions in villages visited were found to be deplorable. There is acute need for further expansion of dental health services for Natives in the Alaska villages. ENVIRONMENTAL SANITATION On July 31, 1959, the President approved Public Law 86-121, the Indian Sanitation Facilities Act, which clarified and extended the authority of the Surgeon General of the Public Health Service with regard to aid to Indian tribes and Alaska Natives for construction of domestic and community sanitation facilities. An appropriation of $200,000 was made in the fall of 1959. The Division of Indian Health immediately programmed 27 projects to overcome emergency water supply problems in Indian communities in ten States. Additional emergency projects were undertaken later. Of the 39 projects started, 29 were completed by June 30, 1960. This work was accomplished with the full cooperation of the Indian people, who contributed many hours of volunteer labor and agreed to take responsibility for operat¬ ing and maintaining the completed projects. 136 Department of Health , Education , amZ Welfare , I960 The Indian Tribes cooperated more fully than ever before in the activities of sanitarian aides. Indians trained in the basic elements of sanitation and educational techniques, through visits, demonstrations, and technical assistance, helped with the education of their own people in health and sanitation practices in the home and community. The aides received professional guidance from engineers and sanitarians. In Alaska, this program was carried out in 25 Native villages under contract with the Alaska Department of Health and Welfare. The division supported special studies, at the PHS Arctic Health Research Center in Anchorage, Alaska, on practicable facilities for water supply and waste disposal in Native villages and on improving methods of curing fish and protecting food. PROGRESS TOWARD NEW AND IMPROVED HEALTH FACILITIES New hospitals were opened at Shiprock, New Mexico, and Eagle Butte, South Dakota. The Shiprock hospital, dedicated in May 1960, is a modern 75 -bed health facility. Built at a cost of nearly $1.7 million, it integrates inpatient and outpatient services with all phases of public health activities. The Eagle Butte hospital with 30 beds, replaced an outmoded structure. It was built by the Army engineers and opened for patients in March 1960. Construction of a new 200-bed regional hospital and medical center at Gallup, New Mexico, and a new 50-bed health facility at Sells, Arizona, neared completion. The procurement of equipment and the selection and assignment of staffs were beginning as the fiscal year ended. Construction was started on new hospitals at Kotzebue, Alaska, and Kearns Canyon, Arizona. Major modernizations of the hospitals at Rosebud and Pine Ridge, South Dakota; Browning, Montana; and Whiteriver, Arizona, were nearing completion. Alterations and additions were completed at several hospitals including those at Santa Fe, New Mexico; Sacaton, Arizona ; and Fort Belknap, Harlem, Montana. The critical shortage of housing for the physicians, nurses, and other members of the staffs was being alleviated by the construction of 88 new permanent housing units, from fiscal 1960 funds totaling $2.5 million. COOPERATION WITH STATES AND COMMUNITIES Joint planning with State agencies was consistently the method used to stimulate the fullest possible participation of Indians in State and community life. Ten major meetings resulted in working agree¬ ments with the departments of health concerned. It will soon be possible for American Indians and Alaskan Natives to obtain con¬ veniently located and markedly improved health services throughout their immediate and adjacent areas. Public Health Service 137 Hospital and Medical Facilities Out of the recent appraisal of the Hospital and Medical Facilities construction program — now in its 13th year — has come abundant evidence of the need for long-range, community-wide, as well as State and National planning. Hospitals and other health facilities are built to serve generations of patients. Structural durability is essential. Structural adapt¬ ability is even more important. Today, when a community, or a group of public-spirited citizens, plans a general hospital, they must consider the changing requirements of modern medicine ; for example, possible treatment in the general hospital for patients with tuber¬ culosis or mental illness; increasing preventive medical services for persons of all ages. In addition, consideration must be given to co¬ ordination of hospitals with other community health service, sucli as welfare agencies, rehabilitation and home care services. Tn recognition of these factors, the Division of Hospital and Medi¬ cal Facilities was instrumental in establishing several special plan¬ ning committees. The guidelines and principles they lay down are expected to (a) stimulate more accurate planning and coordination of health facilities, and (b) provide increased national leadership in planning. The committees are concerned both with medical facility planning and with hospital research. Some are sponsored in collaboration with other agencies and professional associations. They are at work on such problems as planning coordinated areawide health facilities and determining the facility needs of the mentally ill and the tuberculous. In addition, a number of studies and surveys were conducted by the Division covering a wide range of subjects — investigations of various aspects of “Progressive Patient Care,” a study of representative medical schools in connection with developing architectural guide material, an examination of modernization needs of the Nation’s health facilities, an analysis of national goals for health facility con¬ struction, a study relating to the collection of uniform hospital data, and studies leading to the development of a hospital prototype that will give maximum protection from fall-out. PROGRESSIVE PATIENT CARE In ever-increasing numbers, hospitals are adopting one or more of the elements of “Progressive Patient Care” — a concept whereby pa¬ tients are grouped according to the degree of their illness rather than type of illness. Studies have been initiated to determine: (a) The number of beds which should be allotted to intensive care, intermediate care, and self-care units in hospitals; (b) the costs in the various units; (c) the differing organizational patterns in teaching hospitals, 573826—61 - 10 138 Department of Health , Education , and Welfare, 1960 fulltime staff hospitals, and departmentalized hospitals; (d) the pa¬ tient’s acceptance of the pattern of care given in intensive care units ; and (e) the effect of intensive care on the incidence of complications in certain diseases. MEDICAL SCHOOL STUDY In collaboration with the Division of Public Health Methods, the division began a study of medical school facilities, as requested by a committee appointed by the Association of American Medical Col¬ leges. Public Health Service representatives surveyed typical medi¬ cal school facilities throughout the Nation. Findings will be used as a basis for guide material on requirements for medical school facilities. MODERNIZATION NEEDS OF HOSPITALS ' A nationwide survey by the division showed that $3.6 billion would be required for needed modernization and replacement of general hospitals, public health centers, and State-owned mental hospitals. FALLOUT-PROTECTED HOSPITAL Under a contract with the Office of Civil and Defense Mobilization, the division developed a 150-bed model hospital which will offer structural protection against fallout in case of nuclear attack. An exhibit and a publication were prepared to show the details. CHANGING NEEDS AND EMPHASIS OF PROGRAM Considerable progress has been made in the construction of general hospital beds and facilities. State agencies report that 79 percent of the need for general hospitals was met in 1960 as compared with 77 percent during the previous year and 59 percent in 1948 when State records first became available. On the other hand, there is still a great shortage in long-term care facilities. The lack of chronic disease hospitals continues to be the Nation’s greatest gap in health facilities. Only 15 percent of the need has been met. The second greatest need is the nursing home. Only 40 percent of the Nation’s requirements for nursing homes has been met. According to State plans on January 1, 1960, 845,000 additional beds in all types of hospitals were still needed. In addition, 257,000 additional beds in nursing homes were needed for skilled nursing care. Population growth, the increased need for medical and nursing care of the aging and chronically ill, the increased demand for hos¬ pitalization from all age groups, and the obsolescence rate of hospitals tend to offset the progress of new construction in narrowing the gap between beds available and beds needed. Public Health Service 139 SCALE OF OPERATIONS As of June 30, 1960, some 5,200 Hill-Burton projects had been approved for Federal assistance. The total cost was estimated at $4.4 billion, of which the Federal contribution was $1.3 billion. There were 3,564 projects, providing 149,898 beds, complete and in operation ; and 1,350 projects, to provide 56,882 beds, under construction. The remaining 285 projects were in the preconstruction stage; these will provide 12,480 beds. A grand total of 219,260 hospital beds and 1,453 health units for outpatient care will be available as a result of these projects. The majority of applications approved in this program are for general hospitals. As of June 30, 1960, 62 percent of the projects were general hospitals adding 173,213 beds; 3 percent were mental hos¬ pitals adding 15,558 beds; 1 percent, tuberculosis hospitals adding 7,404 beds; 3 percent, chronic disease facilities adding 10,031 beds; 5 percent, nursing homes adding 13,054 beds; and 16 percent were public health centers and State health laboratories; 7 percent, diag¬ nostic centers ; and 3 percent, rehabilitation centers. Dental Resources The continuing decline in the number of dentists in relation to popu¬ lation is a serious challenge to the Nation’s health. If the dental care which the population of the future will demand is to be provided, it will be necessary to halt this decline and develop an adequate num¬ ber of dentists to meet the demand. National leadership in efforts to solve the dental manpower prob¬ lem has been the responsibility of the Division of Dental Resources, and all its activities have been directed toward that goal. Statistical studies have estimated future manpower requirements. Research and experimentation in dental education and technology have been con¬ ducted to find ways to improve the dental student’s training and increase his skills and productivity as a practitioner. Advisory and information services have encouraged the development of voluntary dental prepayment plans that enable more people to purchase regular dental care. ASSESSING MANPOWER REQUIREMENTS Knowledge of the active dental force, its size and distribution is essential in manpower planning. A series of regional surveys pub¬ lished by the division to provide long-term analyses of trends in manpower requirements and supply have stimulated programs of dental school expansion and construction. 140 Department of Health, Education, and Welfare, 1960 “The Dental Profession in the Midwest,” the fifth regional study, was prepared for publication in 1960. A survey of the Middle Atlantic States, which will complete the series, was initiated. The regional surveys form the basis for a project that will estimate national dental manpower needs through 1980. INCREASING UTILIZATION OF AUXILIARY PERSONNEL An announcement that the American Dental Association and the American Association of Dental Schools would sponsor a conference on utilization and training of dental assistants in the fall of 1960 brought national recognition to the division’s experimental work in dental education. Employment of auxiliary dental personnel, such as the chairside assistant, is an effective method of expanding available dental services, because it enables the dentist to treat more patients. The chairside assistant project instituted by the division in six dental schools in 1956 seeks the most effective method of teaching dental students to work with assistants. At an evaluation conference in January 1960, representatives of these schools unanimously recommended that the training be given to every dental student. Related projects undertaken during the year were directed toward increasing the supply of qualified dental assistants. Production was begun on a motion picture which will be used in recruitment of dental assistants. Experimental programs designed to establish a standard training course for chairside assistants were planned, under agree¬ ments signed with four educational institutions: University of New Mexico; Boise (Idaho) Junior College; Montgomery Junior College, Takoma Park, Md. ; and Kirkman Technical High School, Chatta¬ nooga, Tenn. FINANCING DENTAL CARE Establishment of voluntary prepaid dental care programs and budget payment plans is effectively lowering the cost barrier that pre¬ vents potential patients from obtaining the care they need. To en¬ courage development of such programs, and the resulting increased use of dental services, the division has served as an advisory and in¬ formation center on dental care economics. In 1960 the division published studies describing the history, operat¬ ing methods, and extent of utilization of three plans: (1) A program of dental care for public assistance beneficiaries offered by the Wash¬ ington Dental Service Corporation; (2) a budget payment plan de¬ veloped by the Kanawha Valley, West Virginia, Dental Society; and (3) the dental care program of the St. Louis Labor Health Institute of the International Brotherhood of Teamsters. In addition, a glos¬ sary. of terms used in dental prepayment was compiled and widely distributed. Public Health Service 141 Continuing projects included the collection of data on utilization of services in a privately operated dental clinic and in a dental mainte¬ nance care program developed by a union. TECHNOLOGICAL ACTIVITIES Dentists of the division continued to conduct dental examinations for the National Health Survey. The index for measuring dental malocclusion which the division developed was among the epidemio¬ logical examination procedures tested in a research project in Idaho. A committee of representatives of the American Dental Association and the American Association of Dental Schools was established to work with the division in a study of space and equipment require¬ ments of dental schools. Nursing Resources In the fall of 1959 and the spring of 1960, 13 Pennsylvania hospitals completed studies of their nursing personnel at work. Meanwhile in the Middle West, three hospitals in Indianapolis concluded similar studies of their nurses’ activities. At about the same time on the West Coast, plans began for 10 hospitals in San Francisco to study nurse utilization in their day-to-day operations. Several hospitals halfway round the world in Delhi, India, made the initial move toward conducting the first nursing activity studies in their country. For each of these studies, a consultant of the Division of Nursing Resources played a leading role by teaching the method of studying nursing activities which the division has developed. Staff members of the participating hospitals learned how to observe, record, and analyze what professional nurses, practical nurses, and nursing aides actually do in their specific hospital settings. A division consultant spent three months in India under auspices of the International Cooperation Administration, assigned to assist the Indian Nurses Association in a survey of the nation’s nurse supply. By invitation of the association, she also spent part of her time teach¬ ing the study method to the staffs of several hospitals in Delhi. The division’s study method continued to show its worth in dollars saved and in increased time spent by nurses in direct care of patients. Repeatedly, studies of this kind have clearly revealed that numerical shortages of nurses, although still great for the Nation as a whole, are more apparent than real in some situations. When nurses are relieved of non-nursing duties, often there actually are enough nurses with time enough to meet the needs of all their patients. SCOPE OF DIVISION ACTIVITIES To improve further and increase the kind and amount of nursing that patients receive, the division provides consultation to States, 142 Department of Health , Education, and Welfare, 1960 hospitals, professional organizations, and other agencies and groups working to meet community health needs. The division’s staff con¬ sultants carry out studies of major problem areas in nursing. Con¬ siderable effort is devoted to stimulating extramural research of importance to nursing, and to motivating capable nurses and other professional people to pursue careers in nursing research. The pro¬ fessional nurse traineeship program has been extended and expanded. Consequently, the number of nurses adequately trained for positions of leadership has thus been increased. A nurse consultant of the division served on the faculty of the Second International Seminar on Nursing Kesearch sponsored by the International Council of Nurses in Delhi, India, in the spring of 1960. ASSESSMENT OF NURSING NEEDS During the year Kansas completed a survey of its nurse supply, thus joining a long list of other States that have made such surveys with the assistance of the division. Mississippi received consultation in a resurvey of nurse supply. Massachusetts was completing a survey. In Kansas, the present deficit was estimated at about 1,800 profes¬ sional nurses. Further, it found that an inordinately large propor¬ tion of nurses holding leadership positions — ranging from 42 to 100 percent in all categories of nursing — were not adequately prepared for their jobs. In all, more than 200 large hospitals have now received assistance to conduct nursing activity studies. A I6mm sound filmograph, “How to Observe Nursing Activities,” developed in 1959, has been helpful in extending the use of the activity study technique. Efforts were continued to determine how this technique can be more effective in hospitals of less than 50 beds. The division attempted to provide all possible assistance with a relatively small staff of nurse consultants. A major need is to pro¬ vide more follow-up consultation on activity studies. Only by follow¬ up can the assistance be provided that hospitals need in order to act on their study findings and insure the use of professional nursing skills at the patient’s bedside. So far, it has not been possible to meet fully all requests for initial assistance and for follow-up consultation. PART-TIME NURSES In cooperation with the American Hospital Association, the divi¬ sion began a study to find answers to the following questions : How much nursing is done by professional nurses employed part-time? Do they continue working part-time in the same hospital for many months or years? Or do they serve part-time in first one hospital Public Health Service 143 and then in another? How much of a contribution do they make? The division first sought information on part-time staff nurses from several hundred general hospitals throughout the Nation. It then planned to obtain directly from nurses who are employed part- time more detailed information by questionnaire. EMOTIONAL NEEDS OF EXPECTANT MOTHERS Public health nurses on the staffs of local health departments rou¬ tinely work with young married women expecting their first babies ; they see the expectant mothers either in the health department’s pre¬ natal clinics or during regular home visits. How sensitive are these nurses to the emotional needs of young expectant mothers ? Are the nurses enough aware of the symptoms that augur present or future emotional problems requiring specialized help ? A nurse consultant in mental health assigned to the division has been directing an exploratory study designed to answer these ques¬ tions. The study is also intended to determine whether a relation¬ ship exists between the public health nurse’s sensitivity to emotional symptoms and selected personal characteristics of the nurse herself. OTHER STUDIES IN PROGRESS A study was being developed to find out the nursing needs of small hospitals. The number of small hospitals throughout the Nation has steadily increased; they differ from large hospitals in various ways. The study is planned to be primarily descriptive in nature. It is expected to provide valuable information for future work with small hospitals and their staffs. Progress was made on a study of the characteristics of nursing supervisors. Another deals with the career goals of high school students. Work was completed on a study designed to measure the change of attitude among nurses toward their profession. Comparative data were obtained on a small group of nurses during their senior year as students and later during their active practice of nursing. RESEARCH GRANTS AND FELLOWSHIPS The division continued to stimulate research having importance for nursing, as part of its programming responsibilities for extramural nursing research projects and fellowships. Increasing emphasis was placed on research in clinical nursing. Efforts were directed toward stimulating the kind of training researchers need to conduct clinical nursing studies. Research projects approved in 1960 are concerned with various aspects of nursing care; the changing role of nurses as scientific and technologic advances are applied to patient care; adequacy of nursing education for the nurse’s changing role; and other allied subjects. 144 Department of Health, Education, and Welfare, 1960 Forty-one research grants were awarded, compared with 37 in 1959. These represented investments of $1,208,300 and $976,300, respectively, in the improvement of nursing service. Expansion of the research fellowship program was even greater, making it possible for more nurses to prepare for careers in research. Full-time fellowship awards were made to 43 nurses in the amount of $197,700, compared with 16 fellowships totaling $70,000 in 1959. Awards for part-time study wTere made to 36 nurses, the same number as in 1959. PROFESSIONAL NURSE TRAINEESHIPS Congress in 1959 approved legislation extending the professional nurse traineeship program for an additional 5 years until June 30, 1964. The legislation also provided for the use of traineeship funds for short-term training courses for nurses. Both 5-year extension and short-term training were recommended in August 1958 by the national conference for evaluation of the traineeship program. In the 4 years since it was begun, the professional nurse trainee- ship program has been of aid in meeting the need for nurses with leadership and teaching talents. Several thousand nurses have re¬ ceived advanced training in administration, supervision, and teaching ; the amount awarded in the traineeships was about $16.9 million. The number of participating schools of nursing and schools of pub¬ lic health sponsoring advanced programs of study has risen to 87. In 1960 they received grant awards totaling more than $5 million to provide traineeships to nurses. Policies were developed to guide the award of traineeship grants for short-term training. These intensive courses give nurses the oppor¬ tunity to update their skills in nursing administration, supervision, and teaching. Before the year ended, 37 grants had been awarded to sponsors of a total of 75 short-term courses; the sponsors included the Western Interstate Commission on Higher Education, universi¬ ties, general hospitals, State health departments, and State profes¬ sional nursing organizations. Medical Services for Federal Agencies The medical care programs of the Coast Guard, the F ederal Bureau of Prisons, the Maritime Administration, and the Bureau of Em¬ ployees’ Compensation were carried on by Public Health Service offi¬ cers who are assigned to these agencies on a reimbursable basis. UNITED STATES COAST GUARD, TREASURY DEPARTMENT Health and medical services of the U.S. Coast Guard were given by 97 Public Health Service officers, including 47 dentists- 34 physi- Public Health Service 145 cians, and 12 nurses. Medical officers served aboard vessels engaged in operations of ocean weather station VICTOR in the Pacific and sta¬ tions BRAVO and COCA in the Atlantic, and with other cruise ships as needed. Doctors and dentists served aboard the vessel making the annual Bering Sea Patrol and the icebreaker used in operation DEEP FREEZE V. PHS officers were assigned to Washington headquarters of the Coast Guard; to the Coast Guard Academy, New London, Connecti¬ cut; to various shore stations; and to the vessel COURIER stationed in the Mediterranean broadcasting Voice of America programs. The physicians aboard the cutter on the Bering Sea Patrol, from Seattle to Point Barrow, Alaska, and return, examined and treated Alaska Native families gathered at health clinics in the schoolhouses of some 25 villages visited. The dental officer gave treatments and X-ray examinations, performed extractions, and put in fillings. BUREAU OF PRISONS, DEPARTMENT OF JUSTICE For the thirtieth year, the Public Health Service provided medical, psychiatric, psychological, dental, nursing, and related health services for Federal prisoners. There were 22 hospitals and 8 infirmaries to provide care for the 23,000 prisoners. Psychiatric services were strengthened by the assignment to operat¬ ing programs of three psychiatrists who were trained at the Menninger Clinic under sponsorship of the Bureau of Prisons and the National Institute of Mental Health. This helped to keep up with the in¬ creasing demands for psychiatric diagnostic and treatment services, which are required under the provisions of the Youth Corrections Act, the New Sentencing Act, and the Act providing for the care and custody of insane persons charged with or convicted of offenses against the United States. The staff at the reformatory for youthful offenders at Lompoc, Cal., which serves as a diagnostic center for the West Coast area, completed 87 psychiatric evaluations for Federal courts. Similar re¬ quests were made of medical staffs of several other institutions. Medical staffs made some increase in the psychiatric services given prisoners. Treatment included use of the newer psychopharmacologic agents. The number of narcotic addict offenders committed with long sen¬ tences has substantially increased. In 1960 the medical staff at the New York City Detention Headquarters treated 326 offenders for acute symptoms of withdrawal from drugs; most of them required hospital treatment. The medical staff at the Leavenworth penitentiary in Kansas began a special study of addict offenders to obtain informa¬ tion needed to develop future programs for the care of this group. 146 Department of Health , Education, and Welfare, I960 New forms of group therapy were initiated because the use of group techniques enables staffs to extend their services with increased effi¬ ciency. At the National Training School for Boys, Washington, D.C., the psychologists held regular group meetings with an entire cottage of TO to 90 boys. This proved a valuable means of relieving emotional and personality disturbances which often occur in newly committed youths. At 7 institutions, group programs were in progress to facilitate the training of personnel in the handling of emotionally disturbed offenders. The medical officer at the Federal Correctional Institution, Tallahassee, Florida, established a group program for treatment of diabetic prisoners. Group techniques are used in teaching proper diet and hygiene and in treating the psychosomatic compli¬ cations of diabetes. At five institutions, special clinics have been set up for treatment of acne. Observation of young prisoners with scarred and blemished skin has shown indications of causal relationships between the in¬ dividual’s inadequate personality pattern and his skin condition. Pioneering efforts in research continued. The staff at Ashland, Ky., has undertaken a project to determine effectiveness of group counseling in a correctional institution. The psychologist at the Medical Center for Federal Prisoners in Springfield, Mo., continued work on a multiple- approach personality inventory test. The staff at Atlanta, Ga., cooperated with Emory University in studying effects of various drugs in causing mental symptoms. As an out¬ growth of this project, a large sample of the Atlanta prison popula¬ tion is being studied to determine the incidence of symptoms of personality and character disorders. Requests for prisoner volunteers to participate in medical research projects increased. Cooperation in significant research continued to be a major concern of the prison medical service. Preliminary studies were made, with the assistance of the Na¬ tional Institute of Mental Health, looking toward the construction of a new 600-bed psychiatric facility, which is badly needed because of overcrowding at the Medical Center in Springfield. Among con¬ struction projects completed during the year was the modernization and renovation of the hospital at the Federal Reformatory in Chilli- cothe, Ohio. Installation of modern dental equipment was completed in all the institutions. The prison hospitals provided a total of 407,709 hospital relief days. Medical staffs performed 843 major operations and 5,849 minor operations. Outpatient departments gave 914,700 treatments. Physicians gave 31,498 physical examinations. The two institutions for women reported 30 births. Deaths in all institutions totaled 52. Public Health Service 147 MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE Medical and dental care for the cadet midshipmen, faculty, and staff members of the U.S. Merchant Marine Academy, Kings Point, New York, was provided by a medical officer and two dental officers of the Public Health Service assigned to the Maritime Administra¬ tion. The medical officer in charge of the Public Health Service hos¬ pital on Staten Island acted in an advisory capacity to the academy in connection with the health program. There were 485 admissions to the academy’s Patten Hospital. Emergency medical care was available at the North Shore Hospital, a general community hospital in Manhasset, 12 miles away, where cooperation of the staff was excellent. Outpatient treatments and services, including physical examinations and inoculations of cadets, totaled 10,233. Dental visits numbered 3,304. In Washington, the Public Health Service physician serving as Chief Medical Officer for the Maritime Administration provided pro¬ fessional counsel to the insurance department and to the local Office of Seamen’s Services in preparation of clinical abstracts. BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR Medical officers of the Public Health Service assigned to the Bureau of Employees’ Compensation, U.S. Department of Labor, administer the medical care program for the Federal Employees’ Compensation Act and other compensation acts. Medical care, including treatment for injuries and physical and vocational rehabilitation services, is pro¬ vided by medical officers and facilities of the Public Health Service, by other Federal medical establishments and by private physicians. Medical services are provided for traumatic injuries and for all diseases that have work-connected causes. Increased attention was given during 1960 to the physical and vo¬ cational rehabilitation of injured Federal employees with emphasis on aiding those having a minor physical impairment and a major mental or psychoneurotic involvement. Special services for ionizing radiation injuries, hospital staphylococcus infections, and forest fire injuries were also provided. Bureau of State Services The major function of this Bureau is to encourage the rapid and widespread application of health knowledge. New environmental health hazards, resulting from industrial and population growth, and the chronic diseases, which are mounting as the communicable diseases 148 Department of Health , Education , and Welfare , 1960 decline, have received special emphasis in Bureau programs. This emphasis has been given without diminishing efforts in the control of those communicable diseases which continue to be constant threats to the health of the American people. The Divisions operated by the Bureau of State Services in fiscal year 1960 were: General Health Services, Special Health Services, Public Health Nursing, Dental Public Health, International Health, Communicable Disease Center, Engineering Services, Radiological Health, Health Mobilization, and Water Supply and Pollution Control. Division of General Health Services The programs administered by the Division of General Health Services include the Arctic Health Research Center, the National Office of Vital Statistics, program development, public health educa¬ tion, State grants, and professional training and traineeships. In¬ ternational education and exchange activities were transferred to the Division during the year (November 1, 1959) . STATE GRANTS For fiscal year 1960, a total of $269,475,000 was available for grants- in-aid to States and territories to conduct public health programs and to build hospitals and other health facilities. This total reflects an increase over the preceding year of $2 million divided equally between heart disease control and mental health programs. The amounts of actual payment and the purposes for which they were made are as follows : General health services - $14, 985, 422. 00 Venereal disease special projects _ 1 2, 371, 491. 73 Tuberculosis control _ 3, 993, 078. 00 Mental health activities _ 4, 911, 490. 00 Cancer control _ _ 2, 190, 090. 00 Heart disease control _ 2, 904, 661. 00 Hospital and medical facilities construction _ 143, 432, 545. 87 Waste treatment works construction _ 40, 295, 227. 03 Water pollution control _ 2 2, 900, 827. 00 1 Includes $634,086.73 supplies and services furnished in lieu of cash. 2 Includes $242,255.00 paid to interstate agencies. Other funds used to help strengthen State and local health pro¬ grams were: $1,904,224.48 for traineeships for professional public health workers; $122,465.27 for training and demonstration projects in air pollution control; $952,497.99 for grants to schools of public health in the provision of public health training; and $225,239.66 for cancer demonstration projects, which includes $13,132.66 for personal services furnished in lieu of cash. Public Health Service 149 ARCTIC HEALTH RESEARCH CENTER The Arctic Health Research Center is the only research unit of the United States which is concerned exclusively and comprehensively with the health problems associated with life in low temperature areas. Although the installation is small and progress is hampered by the absence of basic data long available for other parts of the world, the range of research projects is extensive. The 58 papers prepared by 18 Center scientists during the year for professional groups and journals, national and international, is indicative of substantial progress. In epidemiological studies, emphasis is placed on field and labora¬ tory investigations of disease outbreaks and endemic diseases in Alaska. Serology as a tool of epidemiology is being used increasingly, with assistance from the Rocky Mountain (Montana) Laboratory. Serologic evidence of tularemia has been found to be widespread among Eskimo and Indian men from all over interior Alaska. Bru¬ cellosis is known to occur among caribou-eating groups. Also in collaboration with the Rocky Mountain Laboratory, a search has been started for Arbor viruses in Alaska. Specimens of tissue and sera from various migratory birds will be obtained and examined for antibodies against equine encephalitides and psittacosis. Further study of the adaptation of man to cold environments has been implemented through arrangements with the University of Alaska to use electronic equipment and trained assistants in assessing degree of adaptation through training and repeated exposure to mod¬ erately cold temperatures. Recent reports from the Center have established that hereditary methemoglobinemia is an enzymatic defect. A test for the enzymatic deficiency has also been developed that is a relatively easy and practical laboratory procedure. In connection with cystic hydatid and alveolar hydatid diseases, all suspects are now given a battery of serologic tests through coopera¬ tive arrangements with Public Health Service hospitals in Alaska. A serological test has been worked out which promises to be specific for alveolar hydatid disease. This year marked the first successful winter-long operation of an air lock system developed to prevent freezing of water supply lines during intervals between pumping periods. Other studies in environ¬ mental sanitation involve a windmill- driven generator to provide heat for thawing, ground water reconnaissance in 15 villages, sewage stabi¬ lization lagoons, experimental recirculating waste treatment units, and inventories of food fishes and their parasites. NATIONAL OFFICE OF VITAL STATISTICS National vital statistics are based on reports of births, deaths, fetal deaths, marriages, divorces, and notifiable diseases that are collected 150 Department of Health , Education , and Welfare , I960 by non-F ederal registration officials. They are used to plan programs in public health, medical and demographic research, education, social welfare, business, and government. The National Office of Vital Statistics is engaged in a continuing program to increase the completeness and accuracy of vital data and to make them more comparable by coordinating the registration and statistical practices of the States and other gathering jurisdictions. As part of this effort, the eighth national biennial meeting of the Public Health Conference on Records and Statistics was held in June 1960. The Conference is an organization of study groups on problems of interest to producers and consumers of vital statistics, inside the Public Health Service and the Department, and elsewhere. In addition to publishing basic annual data, the National Office of Vital Statistics originates and supports research designed to improve statistical methods, increase the exactitude of vital data, deepen and extend interpretive techniques, and broaden the use of statistics as a meaningful source of insight into the measurable values of society. As an example of its support of important research in vital sta¬ tistics, the National Office in January 1960 began serial publication of new fundamental studies in birth statistics developed by the Scripps Foundation for Population Research. These studies will give a more exact and detailed picture of the fertility experience of American families based on annual birth rates for mothers by their exact years of age for first, second, and succeeding birth orders. After the initial presentation has been completed, the National Office of Vital Statistics will carry on similar researches. In addition to giving a more precise perspective on birth rates, this approach will identify any changes that may be occurring in the most fertile ages for childbearing. PROGRAM DEVELOPMENT Within the Program Development Branch, there is clear evidence that research in public health practice is receiving increasing attention and support among health departments, voluntary agencies, and schools of public health. Requests for information on research grants in this field, and for liaison, workshop, and consultation services have steadily mounted during the year. The Branch also conducts intramural studies to define community health needs and resources, health attitudes, and survey techniques. Final reports on two such studies are nearly complete : one study was carried out in a Great Plains county that lacked local health services ; the other explored the nature of anxieties relating to illness. The Branch is the focal point in the Public Health Service for the development of school health and rural and migrant health programs. A major aim is to coordinate the interests and resources of agencies Public Health Service 151 and groups involved in each activity. To this end, staff members par¬ ticipated in many working conferences at national, State, and local levels. A national institute was held for professors of health educa¬ tion in schools of education, in co-sponsorship with the National Edu¬ cation Association. A study was initiated on the health beliefs and behavior of East Coast migrants and the intermediaries to whom they turn for health assistance. New program aids and data were prepared for field and interagency use. PUBLIC HEALTH EDUCATION Through consultation, research, and training activities, the Public Health Education Branch assisted States and local health depart¬ ments, units of the Public Health Service, educational institutions, and other organizations in developing health education programs that will influence health habits of the general public and special groups. Full-time health education consultants are serving in 6 of the 8 Ke- gional Offices. The Branch concentrated on stimulating badly needed research in health education, particularly by official and voluntary health agencies. Several regional seminars were held, designed to sensitize organiza¬ tions to the importance of such research as well as to develop research competence. By the end of the fiscal year, several research projects had been initiated in the field. TRAINING The public health traineeship program was extended by The Con¬ gress for an additional 5 years, through June 30, 1964. During 1960, traineeships were awarded to support the graduate or specialized public health training of 622 physicians, nurses, engineers, sani¬ tarians, dentists, health educators, and other professional personnel needed in modern public health practice. The annual appropriation for grants to accredited schools of public health for the provision of comprehensive professional training was increased to $1 million for fiscal year 1960, as against $450,000 for 1959. INTERNATIONAL EDUCATION AND EXCHANGE BRANCH Programs of study and observation were arranged and supervised for 640 international health students and visitors representing 89 countries during 1960. A total of 126 training facilities were utilized including schools of public health, medicine, and nursing; clinical institutions; and 16 Public Health Service installations. Division of Health Mobilization The Division of Health Mobilization has responsibility for coordi¬ nating Public Health Service activities conducted under assignment 152 Department of Health, Education, and Welfare, 1960 by the Office of Civil and Defense Mobilization, to ensure health serv¬ ices for the civilian population in the event of disaster. The health mobilization program encompasses the preparation of national emergency plans and the development of preparedness pro¬ grams covering (1) health services; (2) development, utilization, and emergency management of health manpower ; (3) availability of essen¬ tial health resources through such activities as stockpiling of scarce items and materials and stimulating increased commercial inventories ; (4) community water supplies; (5) a program of guidance and con¬ sultation to public and private health services regarding disaster pre¬ paredness measures; and (6) individual self-help measures. Priority is being given to the development of an Emergency Health Service to function during a national emergency. This organization will provide for the coordination of personnel of the Public Health Service, Food and Drug Administration, Office of Vocational Reha¬ bilitation, medical personnel from the Children’s Bureau, and per¬ sonnel from the Veterans Administration and other Federal agencies with health capabilities. As part of the vital function of training, three nationwide courses were given during the year in basic concepts of health mobilization for civil defense. Approximately 300 members of medical and health- related professions attended. Several thousands more received mobi¬ lization information through special briefing sessions and various education media. Research efforts were directed to the development of (1) a scale model Civil Defense Emergency Hospital for training purposes; (2) a self-help procedures manual; (3) standardized medical treatment procedures for use with austere resources ; (4) efficient methods for the emergency management of health manpower. Region III, DHEW, was selected as a pilot area to develop and test procedures for regional and State operations. Fifty PHS reserve officers were recruited and trained to serve in their local communities to assist in the implementation of emergency operational survival plans. Health Mobilization Program Representatives were recruited and assigned to each PHS regional office, each OCDM regional office and to nine States. Division of Public Health Nursing The Division of Public Health Nursing has been active this past year in four broad areas: 1) the extension of health department serv¬ ices to the care of the sick at home, 2) the improvement of manage¬ ment practice in public health nursing, 3) new developments in public Public Health Service 153 health nursing education, and 4) research in public health nursing practice. Consultation has been given at national, State and local levels on the first three of these subjects. Plans have been developed to examine various methods of providing comprehensive nursing services and to stimulate nursing care programs in every State. Substantial progress has been made in the improvement of nursing administrative practices and is well demonstrated by the number of agencies instituting work measurement procedures. Since 1953 when this program was begun in one large county health department, 32 local health departments have established these procedures and are utilizing the resulting data to plan and analyze their programs. The method of documenting changes in the health status of patients has been refined and is ready for more extensive trials. Through the use of this method in one agency it was learned that the nurses pro¬ vided service for 158 public health nursing problems found among the 89 patients studied. Within three months, over 70% of these problems showed definite improvement or were entirely eliminated. The twentieth census of nurses employed for public health work in the United States and its territories has been completed. This census showed a relatively small increase, 16 percent, since 1950 in the number of nurses employed by local official and other agencies. A sharp in¬ crease of 89 percent in the number of nurses employed by boards of education was also shown. Division of Special Health Services The Division of Special Health Services is responsible for the pro¬ grams directed toward specific health problems or particular popula¬ tion groups. Emphasis is placed on such major health problems as chronic illness control and the health of the aged. Division programs are: medical aspects of air pollution, accident prevention, occupa¬ tional health, cancer, and control of tuberculosis, heart disease, and other chronic diseases. CANCER CONTROL PROGRAM Forty-nine Community Cancer Demonstration Projects were sup¬ ported from funds appropriated by Congress for the first time this fiscal year. Public health agencies and nonprofit organizations and educational institutions were recipients of about $1,400,000 in project grants administered by the Cancer Control Program. The purpose of - these grants is to aid in demonstrating ways in which confirmed tech¬ niques in cancer control can be applied widely in communities with a resultant reduction in the cancer death rate. Major emphasis was placed on projects involving cytologic examinations. The break- 573826—61 - 11 154 Department of Health , Education , and Welfare , I960 through in cytology, as an aid in finding early cases of cancer, promises to reduce substantially the death rate from cervical cancer. Project grant funds supplement the $2,250,000 which was granted to help support State health department programs. The Program, with assistance from the National Cancer Institute, prepared a position statement on smoking and lung cancer for the Surgeon General. The article, which concluded that “the weight of evidence at present implicates smoking as the principal etiological factor in the increased incidence of lung cancer,” was published in the November 28, 1959, issue of the Journal of the American Medical Association. Two exhibits on the subject were displayed at national and regional medical meetings. In six regional meetings, the status of national, State, and local public health efforts in cancer control was explored, and plans were made by which technical assistance can be furthered. Two regional meetings were also held with private practitioners to discuss potentials in cancer control and their ideas for applying existing knowledge. The Program’s efforts to increase cytological examinations for cervical cancer among women who are Federal beneficiaries of public medical care resulted in the examination of more than 40,000 women in 12 different projects. HEART DISEASE CONTROL PROGRAM The Heart Disease Control Program supports and promotes wide¬ spread use of the products of research in cardiovascular disease. It stimulates joint activities among Federal, State, and local health agencies and the health professions to reduce heart disease occurrence, disability, and death. The work of 64 medical and other professional officers assigned to States on request covers the broad spectrum of heart disease control — clinical work, applied research, and public health activities. On October 29, 1959, Secretary Flemming announced the valida¬ tion of the fluorescent antibody technique for the rapid identification of Group A beta hemolytic streptococci in human throat smears. Since that time, the Program has sponsored training in the technique for health department laboratory technicians of 27 States and Puerto Rico and has contracted with each of the participating agencies for validating data and other information. Full participation from the States and territories is expected by January 1961, thus bringing the prevention of first attacks of rheumatic fever and glomerulonephritis a step closer to reality. Community studies were planned which will help provide a scien¬ tific basis for deciding whether the lives of moderate hypertensives can be prolonged by early treatment. A test of a heart sounds recorder for use in finding heart abnormalities among school children was Public. Health Service 155 continued in Chicago, under sponsorship of three local groups and the Public Health Service. To develop a rational basis for primary prevention of coronary heart disease, the Program supported many projects seeking to identify and measure factors associated with the disease in different population groups ; diet, obesity, stress, and ethnic factors are currently being investigated by epidemiological techniques. To demonstrate ways of making the latest measures in stroke rehabili¬ tation services available to communities, the Program participated in projects with eleven State and local health departments. In these projects, knowledge is being applied to restore stroke patients to activities of daily living. The program worked with cooperating groups to develop and test new electrical and electronic aids for physicians in diagnosing heart disease. Means by which electronic computers and observer instru¬ ments can be related are being studied. The long-range goal is to make it possible for each physician to have, at his patient’s bedside, the equivalent of diagnostic services that are now available only in large medical centers. CHRONIC DISEASE CONTROL PROGRAM Health departments in increasing numbers are being assisted by the Chronic Disease Program in developing effective measures for early detection and prevention of long-term disability and improve¬ ment of care for the chronically ill and the aged. Program Services Continuous diabetes detection programs are gaining wider accept¬ ance by small health departments and clinics with low budgets and small volume screening goals. This is the result of practical pro¬ cedures worked out and recommended by the Program in the use of inexpensive, hand-operated blood testing equipment developed a year ago. Mobile testing equipment is being used in multiple screening pro¬ grams for detecting diabetes, glaucoma, brucellosis, obesity, and heart abnormalities. These programs are bringing detection services to widely scattered rural population centers. Strike Back at Arthritis, a booklet produced in collaboration with the Arthritis and Rheumatism Foundation, provides physicians and health agencies with a tool for preventing or minimizing the crip¬ pling effects of the disease. A similar Public Health Service book¬ let, produced two years ago, dealing with the crippling results of stroke is widely used by medical and ancillary professional groups in professional training and in disability control programs. Programs to improve care given in nursing homes have been en¬ hanced by a joint agreement with the American Red Cross and Amer- 156 Department of Health, Education, and Welfare, 1960 ican Nursing Home Association to use authorized Red Cross Nurse instructors to train nursing home aides. The Red Cross has already trained 3,000 nursing home aides in 33 States and the District of Columbia in care techniques developed by the Public Health Service. An inventory of existing home care programs in the United States, being made in conjunction with the American Medical Association, will be valuable to communities intending to or carry¬ ing out such programs. Operational Research Validation of diabetes detection tests continues. Screening of 22,000 expectant mothers during a six-year study of the effects of abnormal carbohydrate metabolism in pregnancy has been completed. Preliminary data indicate that pregnant women with ab¬ normal glucose tolerance are more likely to develop diabetes, and that there is a greater than expected incidence of diabetes among their children. Screening and diagnostic tests for glaucoma are being evaluated in collaborative studies under way at four universities. These stud¬ ies, supported by 5 -year grants from the Public Health Service, will help standardize early detection procedures. TUBERCULOSIS CONTROL PROGRAM The most significant event for the Tuberculosis Program in fiscal 1960 was the Arden House Conference on Tuberculosis, held Novem¬ ber 29 to December 2, 1960, and co-sponsored with the National Tuber¬ culosis Association. The Conference was called to discuss ways of putting existing control techniques to most effective use in speeding the consistent decline of tuberculosis as a major hazard to the public health. The 18 conferees, men and women of national eminence in public health and related fields, made 12 recommendations for the improvement of tuberculosis control in the United States. The major recommendation was for the widespread application of chemotherapy as a public health measure. This means aggressive effort to treat — with proper combinations of drugs over a sufficient period of time — all persons with tuberculosis who are sources of in¬ fection in the community. In many communities, treatment of tuber¬ culosis patients is obstructed by insufficient or poorly utilized re¬ sources. Although there may be enough hospital beds, outpatient facilities as well as coordinated hospital and outpatient care are often inadequate. There is a shortage of physicians trained in treating tuberculosis, and frequently the services of those available are not advantageously utilized. Laboratory and X-ray services in many areas need to be expanded. In some areas, many clinic patients must Public Health Service 157 pay for drugs— a requirement tliat too often either inhibits their seek¬ ing care or interrupts its course, to the patient’s damage. The major recommendation, which indicates community action against these problems, together with the other 11 recommendations are now guides for the Tuberculosis Program’s continuing technical assistance to the States, and have been the subject of State and Re¬ gional conferences. In research, the Program has reported on findings in the fields of atypical mycobacterial infections, tuberculin sensitivity, and chemo¬ therapy evaluation. A concentrated effort was made to call to the attention of the medical profession the results of a Program study which demonstrated that the drug, isoniazid, will prevent practically all the serious extrapulmonary complications of primary tuberculosis in infants and young children. Research is also continuing on other prophylactic applications of this drug. OCCUPATIONAL HEALTH PROGRAM In protecting the health of American workers, Occupational Health Program personnel studied numerous operations, ranging from celery growing to uranium mining. Through combined on-the-site studies and laboratory research, Program dermatologists pinpointed the cause of a troublesome skin disease among celery workers. The ura¬ nium mining study, now in its 11th year, involves health hazards with a long latent period. Although lung cancer findings are not yet con¬ clusive, a vigorous educational program is underway which may ultimately result in the adoption of recommended measures to control exposures to radiation in the mines. Other continuing major studies included the effects of industrial noise on hearing loss and silicosis among metal miners. In addition, extensive laboratory research probed into how ever- multiplying toxic agents and conditions affect the worker’s health, how their effects may be detected early before irreversible damage occurs, and how they may be effectively controlled. It has been shown that the tolerance developed by the lung tissue of animals repeatedly exposed to ozone is increased by prior exposure to lower doses of certain other irritating substances such as nitrogen peroxide, thiols, and oil mists. Also of significance are animal studies which indicate that a high- salt diet may reduce nervous system injury from carbon disulfide, a chemical used largely in the manufacture of viscose rayon and cellophane. Developments in environmental evaluation techniques include com¬ prehensive experimentation with an electronic dust counter, direct reading devices for toxic gases, and ion exchange separation proce- 158 Department of Health, Education, and Welfare, 1960 dures. These devices are being utilized in habitability studies aboard nuclear submarines and in industrial hygiene investigations. Consultation was provided to official agencies, industry, and labor in solving baffling cases of worker illness and in developing and strengthening occupational health programs. Training activities to increase technical competence in official agencies were intensified. In addition, a prototype training course in occupational health for local health officers was presented to indicate how health department staffs can contribute to this field of health. The Occupational Health Program was designated the national center responsible for obtaining abstracts of United States literature in the occupational health field as part of a new world- wide abstract¬ ing service established by the International Labor Organization. AIR POLLUTION MEDICAL PROGRAM In furtherance of its three-fold objective — to determine the adverse effects of air pollution on human health, to develop methods of mini¬ mizing such effects, and to help health authorities in applying these findings — the Program benefited during FY-1960 by its 1959 reor¬ ganization. Two new sections, Laboratory Investigations and Com¬ munity Investigations, and several specialized research units con¬ cerned with auto exhaust, eye irritation, and pulmonary function were engaged in the conduct or direction of research activities, which now utilize about 95 percent of the Program’s resources and staff. The number of research projects under way has risen from 7 in 1956 to 44, as of July 1, 1960, and the projects completed from zero to 13. In addition the Program maintains technical cognizance over an addi¬ tional 30 research grant projects. Highlights of the Year’s Progress FY-1960 marked the first published results of long-term studies which combined air measurements and other engineering techniques with statistical, epidemiological, and animal laboratory studies . . . also the first published results of studies of the relationship of specific air pollutants to a specific disease. The Program rendered assistance to the State of California in set¬ ting up the first legal standards for motor vehicle exhaust fumes and for air pollutants in general. It also intensified sharply its research on the chronic biologic effects of long-term exposures of plants, ani¬ mals, and human beings to air pollution containing irradiated auto exhaust components. The Program’s progress was accomplished in close collaboration with the Air Pollution Engineering Program. By year’s end, plans were well advanced for the integration of these two Programs into a New Air Pollution Division. Public Health Service 159 ACCIDENT PREVENTION PROGRAM The Accident Prevention Program continued to identify major problem areas through research and to develop programs of preven¬ tion. Program Activities A research project to determine the relationship of health and physi¬ cal status of drivers to motor vehicle accident experience was inaugu¬ rated in cooperation with the State of Connecticut. During the next year approximately 10,000 drivers in this State will receive multiple screening examinations in a mobile unit. The screening results and diagnosis of each driver will be related to his automobile accident ex¬ perience since 1952 and his traffic violation experience since 1959. An intensive nationwide effort was undertaken to trace and locate 2,000 small house trailers equipped with a gas heater produced by one manufacturer which was found to be defective. Every means of mass communication was used to warn trailer owners about the heater and through the combined efforts of State and local public health depart¬ ments and the manufacturer most of the trailers and heaters were located and the owners warned of the hazard. A total of sixteen deaths from carbon monoxide poisoning occurred as a result of the use of this heater. Utilizing the information obtained from the epidemiologic study , of fires and explosions in Mississippi County, Arkansas, a prevention program was developed. The most frequent causes of fires were found to be defective electrical equipment or wiring and defective petroleum heating or cooking stoves. Preliminary tabulations indicate that accident injury cases treated in physicians’ offices and hospitals in the five-county area surrounding Harrisonburg, Virginia, have decreased significantly since the demon¬ stration project began in 1958. This project was developed to demon¬ strate the effect of a broad, intensive educational program upon the incidence of accidental injuries in a community. In cooperation with the American Medical Association and the Na¬ tional Safety Council a nationwide campaign to encourage the installa¬ tion and use of automobile seat belts is being conducted. Seat belt manufacturers report a 300-percent increase in sales over last year. State and Local Developments An increasing public health interest in accident prevention through¬ out the country is apparent. There are now 365 local poison control centers in 52 of the States and territories. Twenty-eight individuals are now working full time on various accident prevention activities in State or local public health agencies in 17 different States. 160 Department of Health , Education, and Welfare, 1960 Division of Radiological Health In its second year, the Division of Radiological Health made good progress in all phases of its primary mission, which is to help develop a nationwide Federal-State structure of radiological health programs and facilities commensurate with the needs of the general population. Underlying that mission is the rapid and continuing expansion in usage of various forms of ionizing radiation sources in the healing arts, in vitally important research, in industry, agriculture and trans¬ portation, and in national defense. Broad public and official support of the Division’s mission and pro¬ gram was evidenced by the increased funds authorized by the Con¬ gress — $622,688 in fiscal year 1959 ; $2,844,900 in fiscal year 1960 — and by the cooperation received from other F ederal agencies, State govern¬ ments, educational, research and professional organizations, and the public press. Of particular significance were these closely related developments : creation of the Federal Radiation Council by Presidential Executive Order with a mandate to advise the President and provide guidance to Federal agencies; a presidential order that the Department of Health, Education, and Welfare intensify its radiological health efforts and assume primary responsibility within the Executive De¬ partment for collation, analysis, and interpretation of environmental radiation levels ; the naming of the Secretary of the Department as the first Chairman of the Federal Radiation Council; and the delegation by the Secretary to the Public Health Service of the principal ele¬ ments of these efforts and responsibilities. Attainment of a coordinated nationwide environmental radiation surveillance network neared reality in fiscal year 1960, aided by the opening of two new regional laboratories at Montgomery, Alabama, and Las Yegas, Nevada, and the expansion of the milk sampling net¬ work from 12 to 59 stations. Construction was begun on a third laboratory, at Rockville, Maryland, to specialize in X-ray protection studies and training. When fully operational, these new facilities will greatly enhance research and training activities as well as surveillance. The Service’s Sanitary Engineering Center at Cincinnati continued as the principal resource for research in methodology for the radio¬ chemical analysis of air, water, milk and food samples, and for short¬ term technical training. The ability of the Division to render technical assistance to State health agencies is steadily increasing. During the year, full-time radiological health specialists were on assignment to 4 regional offices and 13 States ; inventories of 40 State programs were completed ; and numerous medical or dental X-ray surveys initiated — all these activi- Public Health Service 161 ties being pointed toward development of State capabilities in radio¬ logical health. Significant progress was made toward closing the gap in our knowl¬ edge of the effects on specific population groups of chronic, low-level radiation exposure from various sources and in various localities. The bulk of the Division’s rapidly expanding research program — both direct and supported — is designed for this purpose, 17 additional studies having been initiated during the year. Implementing the presidential directive, a comprehensive data col¬ lation, analysis, and publication program was begun, and numerous other activities either initiated or expanded. These include: a pro¬ gram of public education and information; training in radiological health techniques of 961 personnel from public health and allied pro¬ fessions; and designation of 49 PUS personnel to receive specialized university instruction. Technical advice and liaison wTas provided to Federal agencies, universities, and professional and industrial groups with an interest in radiological health. Division of Engineering Services The Division of Sanitary Engineering Services provides training, technical assistance and consultation to State and local health de¬ partments, industry and other groups on the engineering aspects of environmental health problems. Division programs are: air pollu¬ tion engineering, milk and food sanitation, general engineering, and engineering resources and training. The research center for these programs is the Robert A. Taft Sanitary Engineering Center in Cin¬ cinnati. This Center also carries out research for the Divisions of Radiological Health and Water Supply and Pollution Control. ROBERT A. TAFT SANITARY ENGINEERING CENTER The Robert A. Taft Sanitary Engineering Center combines in a single installat ion research, training, and technical assistance on engi¬ neering aspects of environmental public health problems. The Cen¬ ter serves the environmental health divisions of the Public Health Service through its facilities for research in air pollution, milk and food sanitation, radiological health, and water supply and pollution control. Its research staffs also provide technical consultation and assistance to other Federal and State governmental units and indus¬ trial groups. A special training program conducts professional level intensive short-term courses for scientists, engineers, and public health workers from State agencies, industry, universities, and other Federal agencies. ENGINEERING RESOURCES AND TRAINING The development, training, and improved professional status of sanitary engineers both in and out of the Public Health Service 162 Department of Health , Education , and Welfare , 1966 was fostered during the year through the medium of traineeships, in- service training, research grants and fellowships, research training grants, and cooperation with universities, professional, and technical organizations. The 1960 roster of sanitary engineers was begun in cooperation with the National Science Foundation. Arrangements for a survey of future manpower needs in sanitary engineering are underway. GENERAL ENGINEERING PROGRAM Special Citations and Letters of Commendation for excellence in sanitation were awarded to 9 railroads and 24 vessel companies. Two of the vessel companies won Special Citations for the fifth consecu¬ tive year. A higher level of surveillance was reflected by a 10-percent increase in operational inspections on railroads and a 15-percent in¬ crease on vessels engaged in interstate travel. The program was ex¬ panded to handle sanitation problems related to food service and to servicing areas for jet aircraft on commercial airlines. More than 200 new aircraft and vessels were issued Certificates of Sanitary Con¬ struction. An interdepartmental Committee on Sewage and Waste Disposal from Vessels was formed to investigate and recommend treatment and disposal methods. Initial steps were taken to formu¬ late standards on vessel sanitation for the World Health Organiza¬ tion similar to those now in use on airport sanitation. Final revisions to technical manuals dealing with sewage disposal, school sanitation, and mobile home parks were prepared for publica¬ tion. In cooperation with the American Public Works Association, work began on a new supplement to the refuse disposal practices manual. Joint activities with industry and other agencies led to the preparation of a supplement to the “Handbook on Sanitation of Air¬ lines.” Final drafts of the revised National Plumbing Code were submitted for committee review. Field testing of a new guide for evaluation of community environmental health facilities and services was conducted in six metropolitan areas. Three research projects in water supply were begun including one to investigate the relationships of turbidity to incidence of infectious hepatitis. A comprehensive nation-wide inventory of interstate car¬ rier water supplies was completed. A program for surveying approx¬ imately one-third of these supplies annually was established. The “List of Accepted Equipment” was increased by 1,373 new items, some 324 of which required modification prior to acceptance. MILK AND FOOD SANITATION PROGRAM Continued growth, through increasing State and local participa¬ tion in the State-Public Health Service voluntary program for the certification of interstate milk shippers, was shown during the year by Public Health Service 163 the certification of 80 additional shippers, making a total of 700 in 36 States, receiving milk supplies from more than 100,000 dairy farms. In shellfish control, approximately 1,400 shippers were certified. Im¬ provements in the certification program were effected through meet¬ ings and seminars held in shellfish producing areas. All of the coastal States, except Alaska, have currently endorsed State- Public Health Service shellfish programs. Close operating contacts are being main¬ tained with Canadian authorities under the terms of a bilateral agreement. Research at the Sanitary Engineering Center shows that the strontium-90 and cesium- 137 levels in milk decreased substantially since the cessation of nuclear weapons testing late in 1958. Short half-lived fallout is no longer detectable in milk. More than 50 State agencies are cooperating in a national program for standardiza¬ tion of milk laboratory procedures. Recently developed assay pro¬ cedures for shellfish poisons have been evaluated, standardized, and applied to the public health control of shellfish growing areas. Im¬ proved methods for the bacteriological examination of shellfish have been developed. The ordinance and code part of a proposed new Food Service Manual to replace the 1943 Ordinance and Code Regulating Eating and Drink¬ ing Establishments is expected to be published by July 1961. Par¬ ticipation with national public health and sanitation organizations and industry in the development of sanitary standards for milk and food equipment resulted in the completion of 12 such standards. More than 130 seminars and training courses attended by over 6,000 indi¬ viduals were sponsored or participated in by the Program. AIR POLLUTION ENGINEERING PROGRAM During fiscal year 1960, the Ad Hoc Committee on National Goals in Air Pollution Research — established by the Program at Secretary Flemming’s request after the National Conference on Air Pollution in late 1958 — completed its intensive study in preparation for a final report. This report recommends desirable national levels of support during the next 10 years for air pollution research and delineates the proper research responsibilities, and suggested expenditures, of the Federal Government, States, communities, and industry. Research continued to dominate Program activities, with major emphasis on the auto exhaust problem; the research facility at the Sanitary Engineering Center — one of the most comprehensive of its kind in the country — has begun to produce findings of real signifi¬ cance : on the relationships among fuel composition, engine operating cycles, and exhaust gas composition; and on biological effects (in cooperation with the Air Pollution Medical Program). 164 Department of Health , Education, and Welfare, 1960 Other Highlights of the Year’s Progress In collaboration with the Weather Bureau, the Program worked out an experimental plan for forecasting air pollution potential in the eastern half of the United States. Extensive studies were initiated on the possible hazard to public health from air pollution as a result of increasing the content of tetraethyl and tetramethyl lead in motor fuel. The National Air Sampling Network was further expanded and a good start made, with improved instruments, on sampling of gaseous air pollutants. Late in fiscal year 1960, P.L. 86-493 was passed. It provides for intensive PHS study (and report to Congress) on motor vehicle exhausts. This will enlarge the scope of the Program’s work. Division of Water Supply and Pollution Control The increasing importance of water to an expanding population and industry focused national attention on water quality manage¬ ment. The growing stature of the Federal water pollution program, raised in 1959 to Divisional status, is reflected in expanding activities and increased services to the States. To determine reliable pollution trends, the National Water Quality Network of stream sampling stations was enlarged to 75. Continuing data have been collected, analyzed and published on water and waste treatment facilities and needs. Economic evaluations of water pollu¬ tion continue. Public Health Service research at the Sanitary Engineering Center and through grants to universities has been intensified, especially in water and waste treatment and water quality effects of pesticides, ra¬ dioactive and petro-chemical wastes. An intensive study in the Arkansas-Red River Basin to develop plans to control brine pollution is now in its fourth year and is reach¬ ing usable conclusions. Groundwork has been laid for an inventory of Federal establishments to determine the extent of and remedial measures for pollution coming from these installations. Incentive grants under P.L. 660 for municipal sewage treatment plant construction reached $180 million at the end of fiscal year 1960. Of 2,156 projects approved under the grant authority, 1,031 were com¬ pleted and 682 under construction. Over 90 percent of the grant funds has gone to communities of under 100,000 population. Continued assistance to States through the enforcement provision of P.L. 660 is resulting in measurable benefits. Thirteen actions, af¬ fecting some 4,000 miles of interstate streams, have been taken. Con¬ tinuing files are maintained on 2,000 problem areas. Involved in fis- Public Health Service 165 cal year 1960 actions were : the Missouri River, St. Joseph and Kansas City municipal areas involving the States of Kansas and Missouri; the Animas River, Colorado-New Mexico; the Columbia, Washing- ton-Oregon; Bear River, Idaho-Wyoming-Utah ; North Fork of the Holston River, Tennessee-Virginia. Also the largest comprehensive water pollution cleanup yet undertaken was launched in the Colorado River Basin, involving seven States. Determination of water supply requirements in conjunction with U.S. Army Corps of Engineer impoundments continued. A water use survey of the Delaware River Basin was concluded. Special reports were compiled for the Senate Select Committee on National Water Resources. Communicable Disease Center The Communicable Disease Center, Atlanta, Ga., is the national resource for the prevention and control of infectious diseases. It conducts epidemiological, field, and laboratory studies and provides various types of technical assistance to the States. Because infectious diseases are a universal problem, many are the target of international health efforts. CDC cooperates with the World Health Organization through representation on expert advisory panels and committees and as a laboratory diagnostic and study center. It also provides technical support and personnel as needed for the health programs of our own country’s International Cooperation Administration. At year’s end, CDC took possession of its new headquarters facilities adjacent to the Emory University campus in suburban Atlanta. The Center will continue to study certain diseases at strategically placed field stations throughout the country. EPIDEMIC AND DISASTER AID CDC gave epidemic aid in 41 instances, most commonly in connec¬ tion with outbreaks of infectious hepatitis, poliomyelitis, staphylo¬ coccal infections, aseptic meningitis, encephalitis, and acute gastro¬ enteritis. It also conducted several hundred field investigations of epidemic outbreaks and individual case problems involving a wide variety of diseases. Disaster aid was furnished to 5 States. REPRESENTATIVE FIELD AND LABORATORY STUDIES Venereal diseases. — The incidence of venereal diseases continued to mount throughout the country during the year, with infectious syphi¬ lis and gonorrhea up 52.7 percent and 4 percent respectively over the 1959 figures. Eleven States and the District of Columbia recorded in¬ creases ranging from 60 percent to 325 percent for infectious syphilis. 166 Department of Health, Education, and Welfare, 1960 Slightly more than one-half of the reported 369,554 cases of venereal disease were found in 51 of the largest cities. A Public Advisory Committee on Venereal Disease Control was established to study the current situation and suggest ways of im¬ proving the technology and administrative pattern of VD control. CDC supported epidemiologic and casefinding services in 43 States and Territories through 85 project grants totalling $2,619,309 of Fed¬ eral funds and the assignment of 226 medical and paramedical per¬ sonnel to health departments. Laboratory personnel visited 19 State, 3 PHS, and 5 Latin American laboratories and held syphilis serology workshops in 13 States for 489 participants from 261 laboratories. All States and Territories and 5 foreign countries participated in the serologic evaluation study. Excellent agreement of results was obtained in a large-scale com¬ parison of the Rapid Reagin diagnostic test with unheated serum and the VDRL slide test. The Rapid Reagin test is more economical of time, space, and personnel, and the New York City laboratory plans to use it in screening tests, following reactives with confirmatory tests. For the first time, a rapid, cheap, effective method is within reach for detecting gonorrhea in the female. The delayed fluorescent anti¬ body method gives results equal to those of the best culture methods, both in the infected and carrier states. There is no evidence of increased sensitization of syphilitic patients to penicillin administered in conventional dosages. This drug appears to be less bactericidal to gonococci than formerly thought, and other antibiotics are being tried in vitro. Poliomyelitis and aseptic meningitis. — Polio epidemics occurred characteristically in urban slum areas among unvaccinated preschool children, although one, in Seattle, Wash., affected un vaccinated adult males also. The national total of 5,200 cases of polio with 60-day residual paralysis was 50 percent above 1958 and double the 1957 figures. In Massachusetts and several other areas, Type III outbreaks were disturbing, but the most severe epidemic, in Des Moines, Iowa, was caused by Type I poliovirus. A study was started on the susceptibility of newborn infants to liv¬ ing, attenuated poliovirus strains which might confer immunity to the natural, virulent strains. Clear differentiation of polio and aseptic meningitis caused by ECHO and Coxsackie viruses is essential to measuring the effectiveness of polio control programs. A surveillance program was undertaken in several large cities to record variations in incidence of the polio and other enteroviruses and to evaluate the long-range effect of living poliovirus vaccines. Public Health Service 167 Infectious hepatitis. — Infectious hepatitis, a disease that recurs in long-term cycles, increased sharply, with epidemics reported and studied in all parts of the country. Even higher incidence is antici¬ pated for the coming year. Respiratory infections. — Asian influenza epidemics reappeared with sharp increases in influenza-pneumonia mortality and total mortality particularly among older age groups in all geographic areas. A na¬ tional influenza program is being developed to encourage annual in¬ fluenza immunization of older persons and those with chronic illness. In the second year of study of respiratory illnesses among CDC laboratory personnel and their dependents, the Myxovirus parain¬ fluenza viruses were the most important cause of illness both in adults and children. Previously these agents have been associated primarily with respiratory diseases in children. Their contribution to disease in the population at large is still uncertain. Hospital- acquired infections. — Requests from States for epidemic aid, consultation, phage typing, and diagnostic reagents, together with observations made during research studies in hospitals, testify to the continued importance of the problem of staphylococcal and other hos¬ pital-acquired infections. CDC is investigating the role of environmental factors in the spread of these infections and the efficacy of germicides. A comprehensive monograph on microbiological air sampling was published, covering a decade’s work by both the Communicable Disease Center and the Army Chemical Corps. Laboratory studies have shown that in vitro conversion of phage types dccurs among certain epidemic strains of staphylococci. Long¬ term epidemiologic evidence seems to support the hypothesis that these changes also occur in nature as a result of action of phages within the strains themselves. Encephalitis ( arthropod-home ). — In an outbreak of eastern en¬ cephalitis in southeastern New Jersey, 21 of 33 human cases died. The causative virus was isolated from birds, horses, human cases, and, for the first time, from the mosquito, Culex restuans. CDC continued its studies on the ecology of arthropod-borne viruses throughout the country. Brucellosis. — An outbreak of 117 cases of brucellosis among em¬ ployees of a swine slaughtering plant in Iowa was the largest epi¬ demic of this disease recognized and investigated in a packing plant in this country. For the first time, Brucella organisms were isolated from the air ; contact is generally considered to be the mode of trans¬ mission. Recent trends indicate that brucellosis is becoming a prob¬ lem mainly among swine packing-plant workers. 168 Department of Health , Education , and Welfare , I960 Leptospirosis. — The largest outbreak of leptospirosis recognized so far involved more than 80 cases in Iowa. Exposure apparently oc¬ curred in swimming holes near a river. The causative organism iso¬ lated from human cases was also found to be prevalent in cattle that had access to these streams. VECTOR CONTROL Thirty-four community vector control programs in Oklahoma and IT in adjoining States have developed as satellites to the original demonstration project begun by CDC in Oklahoma. A similar intra¬ state expansion is occurring around a demonstration in Pennsylvania. The discovery last year that vapors from closed bags of DDVP could kill malaria mosquitoes in ventilated huts stimulated studies * on the residual fumigation technique. A formulation of DDVP in an inert carrier has been developed which will release insect-killing vapors from a small cartridge for a period up to three months. A relatively low-cost rubber orifice disk has been developed which reduces both the amount of insecticides needed and the exposure of spraymen to compounds used in the control of disease-carrying insects. Two critically ill patients with parathion poisoning recovered within 30 minutes after a new experimental chemical, 2-PAM, was administered. LABORATORY SERVICES AND NEW TECHNIQUES More than 64,000 specimens were referred to the CDC laboratories by State and local health departments, Federal agencies, research groups, and foreign countries. The Center produced and distributed, in addition to the amounts required in its own programs, some 50,000 ml. of diagnostic reagents, 905 shipment-lots of tissue culture media, 4 mammalian cell-line seed cultures, and other diagnostic materials. The fluorescent antibody (FA) technique, which reduces the time and effort required for specific identification of disease organisms, successfully passed field tests for gonorrhea, streptococcal disease, and rabies. It is now ready for practical application on the Brucella or¬ ganisms and work is proceeding on other potential BW agents. It appears to be as sensitive as conventional methods for the detection of enteropathogenic coli. Cells of the fungus, Histoplasma capsula- tum , have been detected in tissue smears of experimentally infected animals and in soil samples from this country, Tanganyika, and Vene¬ zuela. The soil tests were accomplished in a few hours and the re¬ sults were confirmed by mouse technique — a method requiring 3 months. Studies are underway to determine the permissible ranges of variation in technical application of the FA techniques and to dis¬ cover and define optimal conditions for carrying out each important Public Health Service 169 step, so that the method can be readied for routine application to problems in public health laboratories generally. Development of a chromatographic adsorption technique for the purification of fluores¬ cein-labeled globulin permits staining of the plague organism in im¬ pression smears of body fluids and tissues of infected laboratory and wild rodents, without nonspecific staining. INTERNATIONAL COOPERATION Studies have been undertaken in collaboration with the World Health Organization on the standardization and evaluation of sero¬ logic and immunologic methods for the diagnosis of schistosomiasis. In Puerto Pico, results obtained with the skin test were comparable to those obtained by stool examination. CDC continued to operate as the International Influenza Center for the Americas. During the year, 8(5 influenza virus strains were submitted to the Center for antigenic analysis. At the request of the Pan American Sanitary Bureau, a team from CDC studied the epidemiologic, entomologic, and operational data on malaria in El Salvador, Nicaragua, and Costa Pica. TRAINING More than 3,700 persons from State and local health departments, Federal agencies, academic institutions, industry, and numerous or¬ ganizations received organized training from CDC in various aspects of communicable disease control. An additional 229 persons from other countries also received training. Division of Dental Public Health The Nation’s dental health problem was attacked along a broad front through studies of fluoridation, dental care for the chronically ill and aged, utilization of dental assistants, defluoridation of water to prevent fluorosis, intraoral cytological testing for the early detection of oral cancer, and the nature and cause of periodontal disease. The Division assisted health departments in promoting fluorida¬ tion, administering dental health programs, planning and conducting field studies, and recruiting personnel. FLUORIDATION About one out of every three persons using central water supplies, or 37.1 million in 1,922 communities, was drinking water containing fluoride added through controlled fluoridation. In fiscal year 1959, 35.6 million persons in 1,814 places drank fluoridated water. In addi¬ tion, about 7 million persons in 1,903 communities used water con¬ taining enough fluoride naturally to reduce tooth decay. 573826—61 - 12 170 Department of Health, Education , and Welfare , 1960 STUDIES Dental examinations at Bartlett, Texas, and Britton, South Dakota, where the water has been defluoridated for about 8 years, showed de¬ fluoridation was effective in preventing fluorosis. A contract was negotiated for designing and testing radically new defluoridation equipment which is expected to reduce costs and pre¬ vent cyclic fluctuation of fluoride levels. A study was begun to determine some of the factors influencing community acceptance or rejection of water fluoridation. Another study was begun in Minnesota to determine the value of intraoral cytological testing for the early detection of oral cancer. Of major interest are the usefulness of the intraoral smear as an earlier indication of cases for biopsy, correlation of biopsy and smear findings, and the acceptance and use of this technique by the dental and medical professions. As a part of the Kansas City study of dental care for institution¬ alized homebound chronically ill patients, begun last year, a program was instituted for training senior dental and dental hygiene students in caring for the chronically ill. Another study was begun on the nature and cause of periodontal disease. DEMONSTRATIONS A pilot demonstration of the utilization of trained chairside dental assistants was begun in Knoxville, Tennessee. Two fluoridation demonstrations were initiated, one in Will County, Illinois, the other in Allegheny County, Pennsylvania. These proj¬ ects will demonstrate the operation and servicing of fluoride feeders designed for individual homes. Half will be in rural homes and half in Suburban areas. Division of International Health The Public Health Service, through the Division of International Health, represents the United States in international health organiza¬ tions; provides program and policy guidance to the Department of State on international health matters; and provides technical aid to the International Cooperation Administration and its overseas missions. Until November 1, 1959, when the Division was transferred from the Bureau of State Services to the Office of the Surgeon General, it was responsible for planning and supervising training programs in the U.S. for foreign health and medical personnel. With the re¬ organization, the training function was transferred to the Division of General Health Services in the Bureau of State Services. Public Health Service 171 During the year, Service personnel served on official U.S. delega¬ tions to major international meetings, including conferences of the World Health Organization, the Pan American Health Organiza¬ tion, and the South Pacific Commission. The Surgeon General was Chairman of the U.S. Delegation to the 13th World Health Assembly in Geneva in May. The Division assisted the State Department in developing official U.S. policy on questions which came before these and other international organizations with health-related programs, including United Nations Children’s Fund, Food and Agriculture Organization, and International Labor Organization. Public Health Service personnel served international organizations in their personal technical capacities during the year, either as mem¬ bers of WHO expert panels or as short-term consultants to WHO and PAHO. Service officers also participated in international non¬ governmental meetings in their fields of specialty. About 130 Serv¬ ice officers were assigned to International Coooperation Administra¬ tion overseas missions during the year. The Division played an increasingly active role in the U.S.-U.S.S.K. medical exchange program, arranging for U.S. missions in pathology and radiobiology to go to the Soviet Union and for Soviet missions in microbiology, radiobiology, and metabolic diseases to visit the U.S. In November a new exchange agreement was signed, providing for di¬ rect negotiation between the Public Health Service and the Soviet Ministry of Health for future exchanges. (Medical exchanges under a previous agreement were negotiated by the Department of State with the assistance of the Public Health Service.) The new 2-year agreement provides for exchange of 5 technical missions, exchange of 20 individual scientists for periods of from 3 months to a year and joint sponsorship of 3 scientific conferences: in poliomyelitis, heart diseases, and cancer. Two of these conferences were held during the year under review : A conference on polio was held in Moscow, May 12-16, with 13 U.S. and 15 Soviet scientists participating, and a con¬ ference on heart diseases was held in Washington, D.C., May 9-18, with 4 Russian and 9 U.S. scientists participating. The Division completed studies of health conditions and resources in Mexico, Nigeria, Republic of the Congo (formerly Belgian Congo), Morocco, and Colombia, bringing to 21 the number of studies com¬ pleted in the International Epidemiological Series. 172 Department of Health , Education , and Welfare , 2960 Table 1. — Statement of appropriations , authorizations, and obligations, fiscal year 1960 [In thousands] Funds available for obligation Appropriations Appro¬ priations and authori¬ zations Net transfers between appro¬ priations Repay¬ ments for services Prior year un¬ obligated balances Total funds available Amounts obligated Total. $840, 853 Appropriations, PHS. 840, 734 Control of tuberculosis _ Control of venereal diseases - Assistance to states, general - Communicable disease activities _ Sanitary engineering activities _ Foreign quarantine activities _ Construction, mental health facilities, Territory of Alaska _ Equipment, communi cable disease cen¬ ter. 6, 452 5,400 24, 497 8,158 15, 720 4, 686 Hospitals and medical care _ Salaries and expenses, hospital construc¬ tion services _ _ _ Indian health activities _ Construction of Indian health facilities... Grants for hospital construction (1960-61). Grants for hospital construction (1959—60) . General research and services, National Institutes of Health _ National Cancer Institute _ Mental health activities _ _ _ National Heart Institute _ Dental health activities _ Arthritis and metabolic disease activities. Allergy and infectious disease activities.. Neurology and blindness activities _ Operations, National Library of Medi¬ cine. _ _ _ _ Research facilities construction and site acquisition _ _ Construction of library facilities _ Grants for waste treatment works con¬ struction (1960-61) _ Grants for waste treatment works con¬ struction (1959-60) _ Grants for waste treatment works con¬ struction (1957-60) _ Construction of animal quarters, Hamil¬ ton, Montana _ _ _ _ Construction of Biologies Standards Laboratory Building _ _ Construction of surgical facilities _ Construction of Dental Research Build¬ ing - - - - Grants for construction of health research facilities _ _ _ Construction of animal quarters _ General office building _ _ Retired pay of commissioned officers _ Salaries and expenses _ National Institutes of Health Manage¬ ment Fund _ Consolidated Working Fund, HEW, Grants for Research _ 51,600 1,650 45, 245 4, 946 186, 200 45, 994 91,257 68, 090 62, 237 10,019 46, 862 34,054 41, 487 1,566 150 45, 000 1,816 150 30,000 3 1, 682 5, 816 Appropriations, special project funds made available by other agencies _ Salaries and expenses, Bureau of Prisons, (transfer to HEW, PHS) _ American Sections, International Com¬ missions, State, (transfer to HEW, PHS) . . . . . $34, 349 $129, 496 $1,013,640 34, 349 129, 322 1,004, 405 20 405 548 1, 192 6,500 792 5, 750 ”’739' 1455 2 3,207 95, 726 1 40 7 3 438 12 2,241 8, 442 657 74 1,193 40 154 9, 553 55 24, 679 71 6, 472 5, 400 24, 902 8, 706 16, 912 4,992 6, 500 792 57, 350 1,650 46,439 8, 153 186,200 95, 726 45, 994 91.258 68, 130 62, 244 10, 022 47, 300 34,062 41.488 1,578 150 2,241 45, 000 10.258 657 150 128 308 1, 193 30,040 154 9, 553 1,682 5, 871 24, 679 71 8, 942 2,071 74 1 Liquidation of contract authorization obligated in fiscal year 1959. 2 Does not include amount of $159,412.60 which was reappropriated. * Does not include $43,147.75 to be deappropriated. $857,256 848,993 6,444 5,337 24,728 8, 683 16, 746 4,968 6,500 792 57, 156 1, 612 45, 686 4, 364 59, 140 95,313 45, 789 85,031 67, 583 61, 572 9,971 46, 620 34,034 40,249 1,549 147 314 39,723 8, 442 657 150 92 100 887 30,039 7,332 1,682 5,736 24,476 8, 055 2,070 73 Public Health Service 173 Table 1. — Statement of appropriations , authorizations, and obligations, fiscal year 1960 — Continued [In thousands] Funds available for obligation Appropriations Appro¬ priations and authori¬ zations Net transfers between appro¬ priations Repay¬ ments for services Prior year un¬ obligated balances Total funds available Amounts obligated Salaries and expenses, Office of Civil and Defense Mobilization (transfer to HEW, PIIS) _ _ _ $179 $179 147 Research and development, Office of Civil and Defense Mobilization (trans¬ fer to HEW, PHS) _ 236 Farm labor supply revolving fund, Bu¬ reau of Employment Security, (trans¬ fer to HEW, PHS) _ 585 549 General Administrative expenses, Sec¬ tion 411, Mutual Security Act, execu¬ tive, (transfer to HEW) _ 35 33 Technical cooperation, general executive, (transfer to HEW) (annual).. _ 1,964 2, 296 206 1,951 1,586 184 Technical cooperation, general executive, (transfer to HEW) (no year)... Defense support, general executive, (transfer to HEW) _ _ _ Special assistance, general, executive, (transfer to HEW) _ _ _ 246 233 President’s Contingency Fund, execu¬ tive, (transfer to HEW) _ 27 27 Salaries and expenses, Office of Civil and Defense Mobilization, (transfer to HEW, Office of Secretary) _ 1,023 1,023 Gift funds donated for general and specific purposes $118.7 $174. 0 292.7 208.3 Patients’ benefit fund, Public Health Service hospitals. _ _ _ 39.0 20.5 59.5 35.3 Public Health Service unconditional gift fund... .. .. . .. _ _ 28.7 57.8 86.5 74. 6 Special Statistical Work, Vital Statistics. Public Health Service conditional gift fund . 10.0 10.0 0.5 41.0 95. 7 136.7 97.9 Table 2. — Commissioned officers and civil service personnel as of June 30, 1960 174 Department of Health, Education, and Welfare, 1960 >> ■iS-a c3 n •g-aS S-SS 05 H CO 05 CO lO (N 00 C >CO3-1 ® O a 2 d ^isMs^ga o §d gg u, S-S-dSd^ O^^PhPh^ 53 <5 j§ o oo o o£ 2 d d d d dO •d o o o o .o m 2 ’w ’w ’53 ‘w "m v> > JjqgSSSo s: .S'd JO as ,o2 > g'g , ^ cd cd o^1 Sl^wS- g § § 8 g-g^ OfiSwwS^' d^_v-.— 5 ° o o o,§ o o Q «« d d d d ® d d " °.2.2.2.2 £23 ® ‘55 ‘55 ’w 'mhj'ln' oSSSS Sap s«g CO t-. tj CD "go ^ o O M g 60 d-2 d ^ O o I co^ go TPh >f "2 ptt ®.2 g>. g S S-22 h ^ rn j ® ® d os ® d QOfuKKHm? oooooooo §.2 “ 2 S 2 2 i2 M {S'E'H'E'E'E'E 'E OPPPPPPPP Public Health Service 175 ; II S 5 25 24 4 6 3 34 6 37 1 9 4 1 O* § i j i ; II 8 Hfr3e3C3*0 ICO CO OH • ' • i 00 lO 1 1 Is js^sssas is'"" s01 i i I CO i H 1 1 i j Is i j |a r |s | j | | j 1,035 617 3 isss j 1° j j i r j 1C o • 6, 510 sgisiaigsssis 1 IS ! ** ! 7, 011 II3sI=s§sSSIs a 227 216 18 1 1,271 844 18 016 'L §§l2ISilssIIs ja E O O o 1 I £ o E V I Traineeships Amount $3, 051, 862 13 i 18 i ; • -a ! ! ! S i ; f | Number § sg j ; i j§ 8 Training grants $73, 744, 160 3, 550, 578 5, 904, 838 5, 878, 406 1,125, 216 13, 292, 994 8, 869, 542 27,810, 927 1 1 O | Number 1 of SSg-isisi s i Research fellowships Part-time Amount $817, 112 j < is slgg iS SS* h D 1 D i § i Number s j! ji 5? i Full-time Amount $14,023, 560 1,064, 748 436, 906 2, 030, 354 395, 932 5, 013, 787 2, 608, 566 1,996, 889 o ! o j Number 1 of 8*9*S»’ § i Construction grants Amount § s i is si i§ Number g j I j ig Research grants Amount $198, 719, 397 21,056,625 30, 729, 199 34, 370, 440 4, 508, 299 26, 018, 186 35, 947, 109 22, 808, 798 s i 1 i i j Number g 1,508 2,083 1,793 372 1,361 2, 064 1,182 I j Program 1 £ 1 1 Arthritis and metabolic diseases . caiiuci - Dental research _ _ _ | j j) Jlf 3ii! I iji 111] fill jl 3 li S'13 S 176 Department of Health, Education, and Welfare , 1960 Waste treatment. works construction $40, 295 I S§83§&Ss5 :|iS||lSS|S|g|S|Sg||Slg|||||| ~ci r-t j r* rt ,-T rH~ rH *-T Hospital and medical facilities construction $143, 433 4,623 !lS!S§lSi§sis8sssslg5S!Il6lilslsIS!!lg -*«0 HH mTi> CNHNH Water pollution control 3 $2, 659 Heart disease control i u Cancer control 061 *Z$ Mental health $4,911 General health $14, 985 SsSa8SS**SS*s8Si*gS8aa8aS5S*3»*S31S*S8S8» Tubercu¬ losis control 1 1 s S5SSS|§SSl5«-SaS|5:^3B|g8SS§SSSS§;aS|g|S5SgSS|8 Ill! g 3 ssgsssssg j*°| is-388 is Public Health Service 177 Office of Education I. Responsibility for Public Education The local school district, the State, and the Federal Government each have an important part to play in the growth of American pub¬ lic education. The role each assumes today in carrying forward this enterprise is linked to the history of the Nation from colonial times onward. THE ROLE OF LOCAL COMMUNITIES In the days of the early settlers, schools were maintained by vari¬ ous church congregations or were established in towns by action of the town councils. Before the middle of the 17th century, Massa¬ chusetts colonists began setting aside certain tracts of land for the support of local schools. This practice later developed into a fairly uniform policy throughout the New England colonies and was fol¬ lowed to some extent in the other colonies. Since the birth of the Nation the States, while possessing legal authorization for the establishment and administration of their pub¬ lic schools have, nevertheless, delegated to local communities con¬ siderable responsibility, especially for the operational management of elementary and secondary schools and community colleges. In fis¬ cal 1960 local agencies assumed about 56 percent of the cost of oper¬ ating these schools. THE STATE ROLE In 1785, about 3 years before the ratification of the Constitution, the Second Continental Congress enacted the basic land ordinance, which regulated the disposition of public lands in the western terri¬ tory and “reserved the lot No. 16, of every township, for the main¬ tenance of public schools within the said township.” In 1787 the same Congress, in one of its last acts, established the Northwest 179 180 Department of Health , Education , and Welfare , 1960 Ordinance which declared that “schools and the means of educa¬ tion shall forever be encouraged” in the new areas. In fulfillment of this directive, the people within each State have through their elected representatives determined the structure, the scope, and the means for meeting the educational aspirations of the citizens. These representatives have provided for a State depart¬ ment of education to be the chief educational agency at the State level to discharge in various degrees its major functions — leader¬ ship, regulatory, and operational — for the common school system. For higher education, there is yet no comparable agency at the State level in most States. At the present time about 40 percent of the total funds for the operation of public elementary and secondary schools are derived from State sources. THE FEDERAL ROLE The pattern of the Federal Government’s concern for education which had been set in the acts of 1785 and 1787 was further established when Congress passed the Morrill Land-Grant Act of 1862. By this act, additional public lands, or their equivalent, were given to the States for the support of public higher education within the States. Since that time, numerous Congressional acts have assisted and sup¬ ported our educational structure, always operating within the well- established policy of primary State responsibility. The most prominent development during recent years in the field of financing public education has been a growing conviction on the part of a number of nationwide educational associations and organi¬ zations and of a large segment of the public, that the Nation must improve public education by increasing the school revenues. In 1955 the White House Conference on Education recommended a substantial increase in funds for public education. Similar recom¬ mendations were urged by the President’s Committee on Education Beyond the High School in 1957, in the Rockefeller Report on Edu¬ cation in 1958, by the Problems and Policies Committee of the Ameri¬ can Council on Education in the same year, by the President’s Science Advisory Committee in 1959, by the Educational Policies Commission of the National Education Association and the American Association of School Administrators in 1959, and by the White House Conference on Children and Youth in 1960. THE UNITED STATES OFFICE OF EDUCATION Established in 1867, the U.S. Office of Education continues to be the only Federal agency whose total concern is education. During the past few years as the problems of education have become more complex and solutions to them have increasingly involved the mate¬ rial and manpower resources of the Nation, the responsibilities and activities of the Office of Education have greatly enlarged. Office of Education 181 This growth was the result primarily of a need to examine through research and study the whole educational process in order to discover new goals, new approaches, new applications, new measurements, in line with the demands of the times, and to administer additional legislative provisions and conduct the programs which grew out of these laws.1 More recently, it became apparent that there were needs in educa¬ tion and needs to be met through education which could be supplied only through a nationwide pooling of resources, coordination of efforts, and exchange of experience and research findings. As a means toward this end, the Office of Education during this fiscal year in¬ creased its field staff to facilitate carrying on the basic functions of the Office. Limited decentralization of certain Office activities in assigned areas had taken place as early as 1940. , In implementing the provisions of the Lanham Act, the Office of Education provided professional con¬ sultative services to the Federal Works Agency in the program of school construction in housing areas developed for workers in national emergency efforts. These services required that specialists be available in an assigned geographic area on a continuous schedule. Legislation passed in 1950, providing financial assistance for school construction and for current school expenditures in federally affected areas, re¬ quired the placing of 40 Office of Education specialists in regional areas to assist in administering the provisions of that legislation. Administration of the National Defense Education Act of 1958 (except title IX) required the appointment of 14 regional staff members — 9 in the interest of higher education programs and 5 in the interest of programs administered through the States. With the expansion of field services through the nine regional offices of the Department of Health, Education, and Welfare during fiscal 1960, the Office of Education made its basic services more imme¬ diately available to help meet educational needs and problems where- ever they occur. The Commissioner appointed a regional representative — an educa¬ tional generalist with the background of an outstanding career and demonstrated ability in public education, administration, and higher education — to each of these nine offices. The regional representative acts for the Commissioner in providing information within his geo- 1 The U.S. Office of Education was established by Congress for the purpose of collecting and disseminating statistics and facts, and promoting the cause of education. The Office had approximately 1165 employees at the end of fiscal year 1960. Its budget for salaries and expenses was $9,600,000. Federally appropriated amounts were administered by the Office for the following Federal programs : Vocational education, $40,863,393 ; land-grant colleges, $5,051,500 ; school assistance to federally affected areas, $247,435,000 ; coopera¬ tive research, $3,200,000 ; library services, $6,131,000 ; and defense education activities, $159,700,000 ; expansion of teaching in education of the mentally retarded, $1,000,000. 182 Department of Health , Education , and Welfare , 1960 graphic region. These services, like all those offered by the Office, are conducted in harmony with the principle of rendering assistance with¬ out interference. This administrative extension of the Office of Education makes pos¬ sible a much more intimate appraisal of the problems and needs of an area or specific locality and reduces the response interval between field and Office to a minimum. It makes available to the Commissioner the services of nine field representatives through which he keeps abreast of educational needs and developments throughout the Nation. In supplying information and counsel for the conduct of conferences, workshops, and demonstrations, this arrangement permits better coor¬ dination of effort between Department of Health, Education, and Welfare and regional offices, State educational agencies, and private institutions. The Future Role of the Office of Education. — A number of develop¬ ments for the improvement and extension of Office services are on the horizon. In order to plan properly for the schools of tomorrow, there must be a continuing supply of comparable, complete, accurate, and up-to-date information about the conditions and progress of edu¬ cational and cultural institutions and activities in our own Nation and in other countries of the world as well. Development in cooperation with the States of a modern nationwide intercommunicating system for providing needed information about education is a matter of major importance. It is necessary first of all to obtain agreement on stand¬ ard definitions of needed items of information and their universal application. Competencies in educational accounting, high-speed machine and electronic technology for recording, storing, retrieving, and analyzing are essential elements of such an intercommunicating system of educational information. Thus, a truly modern Office of Education data center, serving the needs of the Nation in cooperation with State and local data centers, would provide a sound basis for decision making about education. Research and experimentation for the improvement of educational practices must be accelerated, and the Office must stimulate ways to bring about prompt and comprehensive extension of newly discovered, adequately tested and improved methods and media of instruction. Research must also probe the foundations of education in an endeavor to discover the motivations of human behavior and the processes of learning. The leadership role of the Office of Education is a major function. As coordinator of the Nation’s educational interests, the Office can, through the experience and specialized training of its professional staff members, identify important emerging educational issues and problems of concern. It can stimulate study, deliberation, and plans Office of Education 183 for conferences, and provide demonstrations through which it can alert the profession and the people concerning these issues and prob¬ lems, and it can encourage consensus in ways to deal with them. It can diagnose incipient educational ills or weaknesses and help to solve those problems before they become critical. Finally, it can identify imbalance and recommend action necessary to restore a sound balance in the total educational structure. Only thus can educational oppor¬ tunity be genuinely available to every person in the Nation. Fiscal year 1960 was a year for stock-taking. Great issues, na¬ tional and worldwide, were focused in this year. In the status of each of these issues education, or the lack of it, had its part, and in the outcome of each issue education will play a much larger and more crucial part. Whatever the goals may be, education today is a para¬ mount concern of every nation. Never before has education been so linked with the personal destiny of every citizen and with the destiny of the free world. The past decade has witnessed the greatest revival of popular in¬ terest in education in the United States since the land-grant college movement placed the specific benefits of higher education within the reach of more of the people. The great debate of the past 10 years has surged around every feature of our educational structure — edu¬ cational philosophy and goals; organization, administration, and finance; housing and facilities; curriculum and methods. Nothing has escaped the scrutiny of both educator and layman. The problems which face education today, however broad and di¬ verse, may be summarized in five simple questions: (1) What are our educational goals? (2) How shall we provide physical facilities and equipment? (3) How shall we provide teachers and how shall they be trained? (4) What shall we teach to insure full development of the potential of each student? (5) How shall we teach — what com¬ munications media shall be used ? These problems are the result, in general, of five underlying causes, conditions, or forces present in our society today. They are: (1) the population explosion and changing population structure, (2) the expansion of knowledge, (3) the urge for quality or excellence in education, (4) the national emergency — the threat of communism, and (5) the need for international educational cooperation and assistance. As we have become increasingly aware of these basic causes, the im¬ portance and urgency of the problems engendered by them have likewise increased. Throughout the body of this report these problems and their causes will be discussed, not by answering directly the questions enumerated or in probing the causes listed, but by showing, wherever appropriate, the relationship of Office activities to them. 184 Department of Health , Education, and Welfare, 1960 In this report, these are treated in a discussion first of elementary, secondary, and adult education; second, of higher education; third, of research and experimentation; fourth, of educational statistics and information; and fifth, of international educational relations. II. Elementary , Secondary 9 and Adult Education THE ROLE OF STATE DEPARTMENTS OF EDUCATION The emerging position of State education agencies, as primary leaders in the accelerating improvement of American education, is one of the most significant phenomena of recent years. This expanding State role may well be the key to providing education adequate to the Nation’s increasing responsibilities, while preserving our traditional and valuable decentralization of responsibility in education. State leadership, which was originally limited primarily to col¬ lecting and reporting information, and the support of minimal stand¬ ards through teacher certification, has expanded in uneven stages, in response to public realization of increasing educational needs. Vast economic, social, and technological changes and the enormous growth of public education in the 20th century made new demands upon our decentralized system of education. As public education grew in size and complexity, people came to demand a more comprehensive reali¬ zation of the democratic ideal of equality of educational opportunity, an essential feature of a free society. This demand could not be met when local school units existed in isolation. Wide differences in ability among local communities to support educational programs, and the inadequate programs offered in some localities, came to be looked upon as matters affecting the wel¬ fare of all people in the State and all people in the Nation. In recent years, new patterns of State support in financing of edu¬ cation to guarantee every child in the State a foundation educational program have been adopted in many States. With statewide mini- mums set, the State agencies then assisted and encouraged local units to exceed the minimums and to diffuse good practices. In meeting the demands for more and better services required by a rapidly expanding public education enterprise, the State departments have been elevated to a leadership position. To administer effectively their expanded programs, more suitable structures were required in the State departments of education. Par¬ ticular attention has been given recently to better methods of selection, composition, and tenure of State boards of education. The boards have been given more authority and responsibility over the tothl State educational program. There has been special concern to find more suitable methods for selecting the chief State school officer and his Office of Education 185 staff. The position of chief State school officer continued to gain in prestige and importance during the past few years as persons of out¬ standing competence and ability were selected to administer expanded programs. In the 1950’s every State department of education was reorganized in some manner to promote structural unification or functional co¬ ordination. Laws were passed in eight States to give the State board of education the power to appoint the chief State school officer. Twenty-two States now do this. All States enacted legislation in the 1950’s to promote functional coordination of State department of edu¬ cation operations. This was accomplished mainly through a more precise delineation of the duties and responsibilities of State boards of education and chief State school officers. The trend has been toward increasing the authority of the State board of education to determine the broad policy and direction of the State public educational enter¬ prise ; concurrently, the chief State school officers have been given more authority as professional leaders and administrators. With State and local educational goals set at higher levels, the peo¬ ple in the States want to see tangible results that justify the increased expenditures. They want to know what kind of educational pro¬ grams they should have, how they can get good teachers, how instruc¬ tion can be improved. The State departments are, therefore, increas¬ ingly emphasizing quality factors in their leadership and research programs. An outstanding recent example is the progress made by the States in providing leadership services to enable local schools to improve their science, mathematics, and foreign language instruction. In this they were aided by provisions of title III of the National Defense Edu¬ cation Act. Two years ago there were only 33 State specialists in the fields of science, mathematics, and foreign language; now there are 194. The significance of this increase is indicated by the activities of these specialists. These supervisors are developing State standards for equipment and minor remodeling of classrooms, assisting in de¬ termining teacher qualifications, conducting local and regional work¬ shops for teachers working on local curricular projects, demonstrating equipment and effective teaching techniques, undertaking research in the fields concerned, and developing curriculum guides. Aided by title V(A) of the NDEA, State departments of education increased the number of their guidance and counseling personnel from 76 to 177 during the past 2 fiscal years. The State educational agency can give better leadership and service when it has the facilities, personnel, and know-how to assess the status of the educational program within the State at any given time. States have been making substantial progress toward a more rapid 573826 61 13 186 Department of Health , Education, and Welfare , 1960 and uniform system of gathering, analyzing, interpreting, and dis¬ seminating information about education. Federal financial assistance authorized in title X of the NDEA has greatly intensified and ampli¬ fied activities for providing more adequate information about educa¬ tion. Working closely with the local educational agencies and the Office of Education, State educational agencies are improving record¬ keeping procedures and are adopting standard educational termi¬ nology and units of measure. During the year, the Office of Educa¬ tion published handbooks with standardized definitions on financial accounting for school activities and on property accounting for State and local school systems. These handbooks supplement two others recently developed, one on basic items of educational information at the State level and the other on financial accounting. Timely and reliable facts and figures will further advance the in¬ creasingly important research function of the State departments of education. This research function promises to become central to all departmental activities. State leadership is being directed toward the full and best use of all available resources, including the findings of research. It has fostered improvements through the development of local initiative and experimentation. Though State departments have been strengthened with more money and with more power and authority, they are exert¬ ing their greatest influence by the increasing excellence of their leadership. QUALITY EDUCATION FOR ALL Identifying talents of all children and youth and providing quality education for all are recognized to be increasingly important in a rapidly changing and highly interdependent, complex world. Pro¬ viding educational opportunities that will help each individual become as effective and as productive as his ability permits is essential, not only for his own well-being, but for the good of the whole society, because quality education for each fosters the continuous improve¬ ment of democracy for the benefit of all. IDENTIFYING TALENT OF ALL YOUTH By 1975, according to U.S. Department of Labor estimates, this country will have need for more than twice as many scientists, en¬ gineering workers, technicians, and college workers as it now has. The number of teachers needed in elementary and secondary schools is expected to increase by approximately 25 percent, and a rise of 30 percent is expected in the number of physicians. Job opportunities for skilled wmrkers and clerical workers will increase by about 25 percent — while little or no growth is expected in the number of needed unskilled workers. Office of Education 187 National manpower needs in the years ahead call for the full utili¬ zation of the talents of all citizens. Modern society requires the special skills of the scientist, the physician, the linguist, the teacher, the technician, the creative artist, and the operator of complex machinery. It is, therefore, imperative for the Nation and the in¬ dividual that every youngster have the education appropriate for his special talents and needs. During the past year many school systems throughout the United States took steps to insure the full development of all children. To identify the strengths of children, educators used a variety of meth¬ ods and techniques. In particular, guidance and testing programs during the past year received added attention as a means of finding, conserving, and developing all types of talent. The underachiever, the school dropout, the student following a course of study not suited to his abilities and aptitudes, the slow learner, the culturally deprived youngster — all represent an incalculable loss to themselves and to the Nation. A trained guidance counselor, working in cooperation with teachers and parents, can assist the student in understanding himself, his environment, and his educational and vocational opportunities and requirements. The counselor thus helps the student to achieve self- motivation — one of the prime objectives of the guidance process. Organized programs for the identification of abilities, aptitudes, and skills of secondary school students are now available to about 75 per¬ cent of the Nation’s public and nonpublic secondary schools. Although an equivalent of 15,800 full-time guidance counselors were employed in 1959, there was still need for an estimated 20,000 additional secondary school counselors to raise the existing ratio of 1 counselor for every 600 students to the desired ratio of 1 for every 300 students. Qualification standards for counselors vary, but there is a definite trend to require a master’s degree, or the equivalent with a guidance major for full-time counselors. The importance of early identification of a child’s potential is now generally recognized. However, the methods and techniques used in working with elementary school children must be adapted to their age and level of maturity. Attempts are now being made to define the problems of training specialists on this level. As yet, only a few colleges are offering adequate training programs for elementary school guidance workers. Essentially the elementary school teacher should serve as counselor with appropriate assistance from guidance specialists. Academic abilities and aptitudes on both elementary and secondary levels can be measured with more confidence than those in the social and esthetic areas. However, abilities in music, art, creative writing, the dance, and social participation can be identified by teachers through 188 Department of Health, Education, and Welfare, 1960 records and observation of present performance. Evaluation based on these records and observations can be used to some degree in coun¬ seling the students. The passage of the National Defense Education Act of 1958, which made special provisions for State-administered programs of counsel¬ ing, guidance, and testing, has contributed not only to the identifica¬ tion of talent in mathematics, science, and foreign languages (areas initially receiving the greatest attention), but also to the discovery of students talented in other areas. QUALITY EDUCATION AND SCHOOL LIBRARIES School administrators, in working toward quality education, are concerned with the improvement of school library services. Decent publications of various national educational organizations reflect re¬ newed interest in the potentialities of the school library for strength¬ ening elementary and secondary schools. Elementary School Build¬ ings — Designs for Learning , published in 1959 by the Department of Elementary School Principals, NEA, in a discussion of functional design, states on page 146 : “Elementary school libraries will soon be conceived as teaching materials centers rather than static book col¬ lections. Expanding elementary school library services will soon re¬ quire suites of rooms to accommodate not only book collections and reading tables but also larger informal reading and browsing areas, librarian work offices, inactive material storage space, professional teacher libraries, student typing and writing cubicles, recording and listening tables, and science equipment areas.” In the November 1959 issue of The Bulletin of the National Association of Secondary School Principals , Paul E. Elicker, then executive secretary of the Associa¬ tion, states, “Today the school library is an essential part of the teach¬ ing-learning situation in ail effective secondary-school programs.” Standards for School Library Programs published in March 1960, by the American Library Association was prepared by the American Association of School Librarians in cooperation with 19 national edu¬ cational and lay organizations and is based on research in school li¬ braries of superior schools. These standards reflect, therefore, two strong trends in school library service — cooperation of school libra¬ rians with other educators, and research for school library develop¬ ment. However, a post card statistical survey of centralized school libraries and librarians for 1958-59 in all school districts of 150 or more pupils, recently completed by the U.S. Office of Education, showed wide gaps between averages for the schools in the survey and the new national standards of the American Library Association for school libraries. Only 34 percent of elementary schools in the survey had centralized school libraries, and only 65 percent of the school librarians serving Office of Education 189 public schools met minimum standards for professional education. In 1958-59, there were over 10 million pupils enrolled in elementary schools without libraries, and over 600,000 pupils enrolled in second¬ ary schools and combined elementary-secondary schools without li¬ braries. The average expenditure during 1958-59 for books even in schools with centralized libraries was only $1.60 per pupil, whereas the national A.L.A. standard is $4 to $6 per pupil. The average num¬ ber of volumes per pupil in total centralized school libraries was 5.3 ; the new standards recommend 10 books per student. These statistics give evidence of the need for augmented developmental services and research in problem areas for the school library field. Several major research studies of national scope concerned with school libraries have been undertaken. Under the Cooperative Re- search Program of the U.S. Office of Education, phase I of a study was made by Rutgers University, to develop instruments to measure the effectiveness of elementary school libraries, and determine the relationship of scores on these instruments to other factors in the school and community situation. In phase II, not yet undertaken, these instruments will be applied in a large and representative group of elementary schools. State Department of Education Responsibili¬ ties for School Libraries , a survey conducted by the U.S. Office of Education, at the request of the Council of Chief State School Officers, was published in J une 1960. It is a status study of State department of education services to school libraries in the 50 States of the United States. The Study Commission of the Council of Chief State School Officers is developing a policy statement on State department of edu¬ cation responsibilities for school libraries, based on this status study. The project is an example of cooperative endeavor by administrators and school library supervisors to improve the quality and scope of school service through State department of education leadership. BALANCE IN THE CURRICULUM Concurrent with the attention being paid to the identification of the abilities of all youth is an insistence upon curricular balance. For three years prior to 1959-60, the education of the academically talented student received particular emphasis and the curriculum was shaped to some extent to his needs. This emphasis continues, but during the past year additional efforts were made to secure a balance in the curriculum through increased attention to the talents of all youth. The trend toward curricular balance can be discerned in efforts to improve instruction for each pupil through experimentation, inservice education of teachers, and research in curricular organization and content. In many schools the process of identifying the pupil’s abilities and needs begins as early as the first grade and continues until the pupil 190 Department of Health , Education , and Welfare , 1960 leaves school. Cumulative record cards which show a pupil’s mental and achievement test scores, his grades, personal interests, hobbies, and various personal characteristics are being used by more and more teachers as a resource to improve the quality of instruction and to achieve a balanced education for each pupil. These cumulative rec¬ ords are usually maintained by teachers and guidance counselors who may gather additional information about a student’s home and school problems and activities. The trend toward a more balanced curriculum is evident also in the general improvement of instructional offerings in the various subject matter areas. A better balance in the areas of science, mathe¬ matics, and modern foreign languages is being achieved through the use of up-to-date laboratory equipment, made possible under the pro¬ visions of title III of the National Defense Education Act. By ex¬ tending the teaching of these subjects to the full range of elementary and secondary grades, a greater number of our youth are receiving balanced, quality instruction in these areas of knowledge. In the English language arts, the teachers are currently concerned with each pupil’s special aptitudes and problems in speaking, writing, and literary appreciation; his strengths and weaknesses in reading and in the use of oral and written language ; his reading interests and level of literary appreciation ; and the works of literature read by the pupil as well as his reaction to each selection. Through such means as these, a highly individualized program of English language arts is being made available to the pupil. In the social studies area greater emphasis is also being placed on citizenship education for its exercise in our own Nation and for world understanding. Through the study of geography and associated information concerning the background and customs of the peoples of other lands, through international exchange correspondence and proj¬ ects, and through the study of a wider range of modern foreign lan¬ guages (now begun in the elementary grades more frequently than in the past) , students are becoming better equipped for social and politi¬ cal responsibility in today’s world. From kindergarten and ele¬ mentary grades through secondary school levels, social studies pro¬ grams are giving priority to citizenship education. The Office of Education assisted in the promotion of efforts to make health and safety teaching more effective than ever before, with the idea of helping all youth, academically talented and otherwise, to profit fully from their program of studies. Many educators now believe that the different forms of creativity whether they occur in scientific invention, industrial design, business management, astronomy, mathematics, education, housekeeping, art, music, drama, and dance, or the dynamics of personal relationships, are all facets of the same basic phenomenon of creativity. Office of Education 191 The promotion of arts experiences in the curriculum is one way to help educate for creativity. Realizing that the arts as well as the sciences can be explored as parts of the same reality, study of the various arts is important in balancing the curriculum experiences in our schools. Teachers must help children and young people appraise their abili¬ ties, search out their talents, and know of the opportunities available to them in our technological society. Industrial arts enable students to express themselves concretely, think in special relationships, manip¬ ulate materials toward definite goals, control tools and machinery, develop pride in personal work. To be liberally educated in today’s world, the individual needs technical understanding. The trend toward better curricular balance is but one indication of the effort now being made in schools throughout the Nation to assure a quality education for every individual. This abiding concern for the individual was reflected in the theme of the Golden Anniversary White House Conference on Children and Youth held in fiscal 1960 — “a creative life in freedom and dignity.” The 7,600 conference par¬ ticipants, representing all age groups and all walks of life, recognized the vital importance of making special educational efforts for the individual in the decade ahead. Additional evidence of this concern is the emphasis now being placed on vocational education and special education for exceptional children and youth. The achievement of balance in the curriculum is a difficult and con¬ tinuing problem. If schools are to maintain the wholesomeness of experience, all aspects of learning must be adequately represented. A curriculum has to be so designed that general needs of all are met at the same time that special needs of the talented are provided for. The single most significant development of our aerospace age is the increased rate of change . Schools keep this fact in mind as they strive for a balanced curriculum for American children and youth. MEETING VOCATIONAL EDUCATION NEEDS Many youth desire to prepare for various occupations by pursuing secondary school courses which are designed to fit persons for useful employment. This vocational preparation is a Federal-State pro¬ gram of cooperation which has, from its beginning in 1917, been based upon the fundamental idea that vocational education is essential to the national welfare. Although its curriculum is designed to pro¬ duce well-rounded citizens, its special purpose is to provide education to prepare workers for occupations in the fields of agriculture, dis¬ tribution, home making, trades and industry, practical nursing, and for occupations requiring highly skilled technicians. In recent years vocational education programs have been directed toward a larger segment of the secondary school enrollment. F or ex- 192 Department of Health, Education, and Welfare , 1960 ample, home-making teachers, school administrators, and supervisors, working toward the goal of strengthening family life, have sought to redirect their programs to reach more high school students — the col¬ lege bound, those who marry soon after graduation, and those who go immediately into a wage-earning occupation. The Office of Education has recently stimulated action and aided the States in the development of research, especially through coordi¬ nating cooperative research projects, to provide sound bases for im¬ proving and revising secondary school programs for serving a larger number of students in vocational education fields. Many well-prepared teachers of home economics are needed to meet the growing needs. The States have made an effort to recruit and prepare more teachers and to evaluate teacher preparation programs to meet present-day needs. Foremost is the teacher’s need for a liberal education and a professional education that will best fit her for broad responsibilities. Enrollments in trade and industrial education for high school youth have increased annually for more than a decade. It is expected that enrollments will grow steadily as the need for additional skilled workers increases, as programs are organized in areas not now being served and as additional States encourage the establishment of larger units of school administration. Industry continues to decentralize, moving to expanding population areas. Because trade and industrial education is generally offered in the more populous centers, many youth living in rural areas have had no opportunity to pursue courses in this field which lead to useful em¬ ployment. Investigations are being made to determine ways by which youth in rural areas can acquire learning experiences which will pre¬ pare them for work in industry. Recent technological innovations have caused great changes in job requirements of industry. Schools are recognizing the increasing need for curriculum review and revision to assure up-to-date course offer¬ ings for students who would seek employment in industry. Conducted as a part of the program of trade and industrial educa¬ tion are an increasing number of courses in practical nurse education. Hospitals and other health agencies have cooperated in the develop¬ ment of new programs which provide, under professional supervision, both inschool instruction and hospital clinical experience. Improved teaching practices and curriculum materials have resulted from the combined effort of the States and local school authorities and the pro¬ fessional groups concerned with nursing and nurse education. While the number of people engaged in farming is decreasing, the agricultural product today is constantly increasing. This fact, com¬ bined with the rapid increase in population and the increasing need Office of Education 193 for able individuals with farm experience backgrounds, constitutes a vital problem for those who are responsible for vocational agriculture programs for farm youth. The successful farmer of today must con¬ tinually keep up to date technically and mechanically; he must be able to make correct managerial decisions and successful business transactions. In this period of rapid social, economic, and techno¬ logical change, some adjustment of the curriculum, therefore, will no doubt be necessary. The need for well-qualified teachers of vocational agriculture continues. Distributive education in the secondary schools is a cooperative part- time inschool program and at- work experience to provide young per¬ sons interested in distribution with the required skills and knowledge. The curriculum has been strengthened to include a study of distribu¬ tive organizations; of marketing, including wholesaling, retailing, buying, selling, and pricing; of factors affecting marketing, including advertising, display locations, and lay-out; and of the consumer in the marketing process. The Area Vocational Education program, providing for the train¬ ing of highly skilled technicians under authority granted by title VIII of the National Defense Education Act, has now been in operation for two years. In fiscal 1960, every State participated in the pro¬ gram. Preparatory courses were available to secondary school stu¬ dents in the upper levels of their classes, to high school graduates who wished to pursue technical training in their thirteenth and fourteenth years of schooling, and to adults of any age who were able to meet admission qualifications. Rigorous preparatory training programs, usually 2 years in length, were organized for a number of technician occupations, including electronics, mechanical drafting and design, instrumentation, engi¬ neering aids, industrial chemistry, data programing, and metallurgy. Short extension training courses involving the applications of science and mathematics were offered in the fields of communications, data processing, electronic drafting and design, industrial planning, in¬ strument control, power operation and distribution, jet and rocket propulsion, and airframe structure. Large enrollments continued in the various xVrea Vocational Edu¬ cation programs during 1960. Thus, the Area Vocational Education program is providing new opportunities for the training of many youth and adults who were previously unable to obtain training be¬ cause they did not live in or near a center where training was available. Vocational Education for Adults. — Vocational education for adults plays an essential role in maintaining America’s high rate of produc¬ tion and consumption and, as a consequence, its high standard of living. Adult workers in any field, through training in skills and 194 Department of Health , Education , and Welfare , 1960 knowledge related to their occupations, can adapt themselves to tech¬ nological changes and other developments in their occupations, become more productive, prepare themselves for advancement, and increase their earning capacity. Vocational education programs provide in¬ struction for out-of-school youth and adults both employed and tem¬ porarily unemployed in part-time schools and extension classes con¬ ducted at hours of the day or evening when they are free to attend. More than half of all persons enrolled in programs of vocational education are adults or youth who have left the full-time school. The needs of special groups are more and more recognized — mobile families, aging family members, young homemakers, and handicapped homemakers. The general character of several occupations is changing. The need for related technical knowledge by workers in many occupations is reflected by a continuing demand for trade extension training and the reevaluation of course content in several programs. Evening trade extension programs have expanded to accommodate employed workers who need skills and related knowledge to retain their present jobs or to prepare themselves for promotional opportunities. The nature of the instruction is flexible so as to adapt to the changing tech¬ nological needs of the employed worker. Distributive education focuses directly on distributive personnel within the framework of their careers. About 88 percent of the total enrollment in distributive education is accounted for by extension classes, which encompass training for broad or specialized career objectives and for problem solving at high levels of distributive businesses. The States have recently devoted considerable attention to the prob¬ lems of young men who are striving to become established in the busi¬ ness of farming. The pressure of continuing to remain on the farm in the face of progressive narrowing of the margin of profit derived from farm products is great. In view of these problems and pres¬ sures, there has been a substantial increase in the number of students who have enrolled in vocational agricultural education classes during the past few years. Adults who are. established in farming have attended classes in relatively large numbers. In Area Vocational Education programs in fiscal 1960 the number of short unit extension courses (on-the-job training courses) for work¬ ers employed in technical pursuits was larger than the number attend¬ ing preparatory (inschool) courses. Some unique courses such as electronic data programing, and vacuum tube technology were organized to meet the specific employment needs of students who had left the full-time school. Office of Education 195 Industry, distribution, and agriculture require men and women with a high degree of manipulative skill, technical knowledge, and adapt¬ ability. The percentage of unskilled workers in our labor force is steadily declining; the percentage of semiskilled and skilled operatives is increasing. Technological advances will continue to increase the demand for highly skilled technical workers. Vocational education programs, which serve both youth and adults, will therefore be of increasing importance to our social and economic life in the years ahead. MEETING SPECIAL EDUCATION NEEDS Special education, within the framework of American education, is dedicated to providing suitable educational opportunity to every ex¬ ceptional child who can benefit. Included are those who have marked physical handicaps, severe mental limitations, serious social and emo¬ tional problems, as well as those with remarkable gifts and talents. To open the doors of opportunity the school systems must make many adjustments and add special features to the usual school program. Some children and youth can progress best in special schools, others in special classes in regular schools. Some need only part-time special education services. For other children, the school must go to the hos¬ pital, the institution, the convalescent home, or under certain condi¬ tions to the child’s own home. A comprehensive program includes careful evaluation and place¬ ment of children, adjustments in curriculum, specially prepared teach¬ ers, adapted school housing and equipment, and coordination with other related professional services. Few American communities have reached this ideal for all of their exceptional children, but it is a goal toward which the Nation as a whole is moving at an accelerated pace. A quarter of a century ago, only about 750 local public school sys¬ tems reported enrollments of exceptional children and youth in special education programs. By 1948, that number had doubled, and 10 years later it had reached a total of nearly 3,700. The 1958 survey revealed that many of these school systems were located in less populated sec¬ tions of the country and that some draw into their programs handi¬ capped or gifted children from as many as 10 or 20 of the neighboring towns and villages. Another indication of progress in this segment of American educa¬ tion is the rapid rise in the number of handicapped and gifted chil¬ dren in various types of special education programs. Enrollments in special schools and classes of the public day schools alone increased about 130 percent in the decade 1948-58. This is more than three times the rate at which the total public elementary and secondary school enrollments increased during the same 10-year period. 196 Department of Health, Education, and Welfare, 1960 The special education enrollments for each area of exceptionality for 1958 as reported by the local public school systems in 48 States are given below: Number Area of Exceptionality of Pupils Total _ 860,814 Blind _ 2, 742 Partially seeing - 8, 266 Deaf _ 6, 162 Hard of hearing _ 13, 037 Speech impaired - 474, 643 Crippled _ 28, 355 Special health problems _ 21, 714 Socially and emotionally maladjusted - 27, 447 Gifted _ 52, 005 Mentally retarded (upper range) _ 196,785 Mentally retarded (middle range) - 16,617 Other 1 _ 13, 041 1 “Other” includes the following pupils reported in combined categories of exception¬ ality : Blind and partially seeing, 119 ; deaf and hard of hearing, 1,993 ; speech impaired and hard of hearing, 4,493 ; crippled and special health problems, 4,686 ; special health problem and socially maladjusted, 22 ; upper and middle range mentally retarded, 1,403 ; and multi-handicapped, 325. When public and private residential school enrollments (based on preliminary tabulations of the 1958 survey) and estimates of private day school enrollments are added, the total number of handicapped and gifted pupils receiving special education may well reach a million and a quarter. Nevertheless, special education programs are lagging far behind actual needs. While the arrears vary somewhat from one type of exceptionality to another, it is estimated that at present over the total program, not more than 1 child in 4 is receiving specialized education suitable to his needs. In the field of mental retardation, for example, of the estimated number of more than 1 million children of school age needing special educational services, approximately 243,000 were reported in special classes in both day and residential schools in 1958. Although there are many reasons for this lag — for example, the fact that many exceptional children live in areas which are remote from centers where programs of special education have been de¬ veloped — the principal deterrent to growth at present is lack of quali¬ fied personnel. In recognition of this need, the Office of Education, in collaboration with leaders throughout the Nation, has conducted a nationwide study and published a series of reports on the compe¬ tencies which are desirable for teachers and other special educators in the various areas of exceptionality. State departments of educa¬ tion are continuing to develop and improve certification standards for teachers in the specialized areas. Office of Education 197 To assist in relieving the critical shortage in qualified personnel, a graduate fellowship program has been developed in one of the areas of exceptionality under the provisions of Public Law 85-926. Grants for fellowships are allocated to colleges and universities for the prepa¬ ration of college instructors to conduct programs for the training of teachers of the mentally retarded. Grants for fellowships are also made available to State educational agencies for the preparation of leadership personnel to direct and supervise educational programs for the mentally retarded. A third aspect of the program being developed under provisions of Public Law 85-926 will be initiated in fiscal year 1961. Grants will then become available to stimulate the development of graduate pro¬ grams in the education of the mentally retarded in those parts of the Nation where opportunity for professional preparation in this field is either nonexistent or inadequate. During 1960, which was the first year of this program, grants were made for 1771/2 fellowships, at an average individual cost of about $5,600 and a total cost of about $994,800. Of these, 84% Avere used by 19 institutions of higher learning (under sec. 1), and 93% were used by State educational agencies (under sec. 2). All but 7 States par¬ ticipated in the first year of the program. As these figures indicate, there has been a vigorous response from all parts of the Nation to this opportunity for advanced study in the field of education of the men¬ tally retarded. Experience indicates that not only will the demand for these fellowships continue, but that in the years ahead there will be keen competition for the fellowships. Progress toward the goal of securing sufficient numbers of qualified special educators has, in recent years, gone hand in hand with progress in attaining new knowledge and new insight into some of the crucial problems confronting educators of the various types of exceptional children. The contribution of the Federal Government, particularly through the cooperative research program of the Office of Education, has been a significant one. From the inception of this program in J uly 1956 to the present time, contracts have been drawn with colleges, universities, and State education agencies for somewhat more than 100 research projects in the field of special education. Nearly two-thirds of these studies focus on the education of men¬ tally retarded children. The remaining one-third center around cru¬ cial problems in the education of children who are blind, deaf, hard of hearing, speech impaired, socially maladjusted, or gifted. Find¬ ings from a large number of these research projects are already avail¬ able for use in making improvements of existing programs or as a basis for planning new programs for handicapped and gifted children. 198 Department of Health , Education , and Welfare, 1960 Chief among the byproducts of this relatively new nationwide focus on research in the education of exceptional children has been an intensified interest among teachers in the findings of experimental studies. With this activated interest, supported by continued inter¬ pretation and communication of findings, it is anticipated that to¬ day’s research will be effectively translated into tomorrow’s educa¬ tional programs for exceptional children and youth. MEETING LIFELONG-LEARNING NEEDS Lifelong learning is rapidly becoming a recognized and legitimate concept in American education. The rapidity of technological de¬ velopment and the complexity of present-day social, economic, and international problems has made it necessary for education to become a process of lifelong learning to enable each citizen to function ef¬ ficiently as an individual and to contribute effectively as a citizen. During the past year a leading educational periodical, The Over¬ view , cited statistics which indicated there were more adults in the United States engaged in formal programs of education than there were students enrolled in schools from kindergarten through graduate school. The Bureau of the Census in the October 1957 Current Population Purvey estimated that about 9 million adults were at¬ tending formal classes which met three or more times. Additional millions are attending educational programs of an informal nature. Organized lifelong learning is encouraged, sponsored and operated by many types of institutions, agencies and organizations. Among these are our public school districts, public and private community or junior colleges, public and private colleges and universities, private schools specializing in programs such as trade or business oriented enterprises, labor organizations, businesses and industrial establish¬ ments, public and school libraries, the Agricultural Extension Serv¬ ice, hospitals, museums, various government agencies, and the many clubs, associations, and voluntary groups which provide a planned educational program for their members or for the general public. The various programs of adult education are as numerous as are the bodies of knowledge known to man. These programs include civic and public affairs, general education (including most of the common areas of study), home and family living, Americanization or training for future citizenship, technical education for the development of occupational or business skills, agriculturally oriented training pro¬ grams, education for the worthy use of leisure time, personal and group relationship training, remedial education, health and safety education, religious training, depth education in professional or man¬ agerial skills, and competencies and training oriented to the func¬ tions of our armed forces. Office of Education 199 Methodological approaches to the education of adults are quite different from those used on other levels of education. Studies may be carried on through formal classes, discussion groups, forums, tele¬ vision and radio education, correspondence or home study, conferences and institutes. Technical education for adults has been stimulated through grants and leadership provided under title VIII of the National Defense Education Act. In the past year, four State departments of educa¬ tion have added personnel who are responsible for adult education programs. Because adult education programs have a variety of sponsors and because the importance of lifelong learning has only recently been recognized, there is great need for the cooperative development of standardized terminology and definitions through the creation of a handbook of basic items on adult education. Until this is done, it will be impossible to describe satisfactorily the magnitude and status of adult education or to collect adequate and consistent data. The Office of Education has proposed that such a document be developed. The demand for leadership personnel educated specifically for adult education roles has been increasing. Heretofore, many of the adminis¬ trators and teachers in adult education, of necessity have had to obtain their training and experience outside the field. Today, however, 15 universities provide graduate education through the doctorate in the field, and many others offer one or more courses at the graduate level. Many universities are now studying the development and/or expansion of their graduate training programs in adult education. The Office of Education has provided consultative leadership to the Commission of Professors of Adult Education in an effort to clarify and systematize graduate education programs. Under title IV of the NDEA (Na¬ tional Defense Fellowships), the Commissioner of Education has ap¬ proved at one university a graduate program of study in adult educa¬ tion for the training of doctoral candidates and has awarded five fellowships for study in this field. There is urgent need to establish a clearinghouse for the nationwide collection and dissemination of information on all aspects of adult education, including a bibliography of published and unpublished re¬ search studies. During fiscal 1960 a committee representing all national-level organizations serving adult education met to develop a plan for such a facility, including the coordination of services from organizations now serving as clearinghouses in specific areas of adult education. An expanded program of research relating to adult education is being stimulated by the Office of Education. A Cooperative Research project, entitled “Attitudes Toward Adult Education by Social Class” 200 Department of Health , Education , and Welfare, 1960 is currently being conducted at the University of California at Berke¬ ley. An exploratory conference of persons engaged in adult educa¬ tion research was held during this year to discuss, among other topics, research completed, in progress, or projected. During the past year, one issue of the Review of Educational Research was devoted to adult education. The education of the migrant is another area of particular concern to those in adult education. Adult educators and other citizens are working vigorously to solve the problems related to cultural depriva¬ tion, lack of occupational training, and apathy toward citizenship responsibilities. Adult educators are also concerned with the education of older citi¬ zens. The forthcoming White House Conference on Aging has stimu- lated interest in education for older citizens. In addition, every State is conducting research in this area ; and, on the local level, many public school systems are experimenting with programs for aging citizens. Adult education is concerned with individuals’ needs, and many of these needs are of a highly specialized nature. The growing awareness and acceptance of the principle of lifelong learning indicate the neces¬ sity of a greater allocation of America’s educational resources to this task. Of the total enrollment in programs of vocational education for which grant funds were used, about 50 percent were persons who had left the full-time day school. Most of them were employed workers. Discussion of these programs may be found on pages 193-195. Lifelong Learning and the Public Library. — Opportunities for con¬ tinuing education beyond formal schooling represent a fast growing need in these rapidly changing times. Throughout the Nation, the American public library is helping to meet this educational and cultural need of the community it serves. In its individualized services, the public library recognizes no age or educational barrier, but provides resources and guidance alike to the business executive, the professional man, the farmer, the mechanic, the senior citizen, the teenager, the housewife, the immigrant, the schoolchild, the college student, and to the citizen studying local, na¬ tional, and world problems. To all, the public library is a continuing source of aid in self-education, in cultural appreciation, in increased vocational competence, and in the constructive use of leisure time — truly a “university of the people.” Basic to the fulfillment of these and related responsibilities is the public library’s collection, a collection which today goes beyond books to include other informational media such as films, slides, pictures and prints, maps, recordings, documents, newspapers and magazines. These materials are selected and classified not only according to subject areas covered but also according to reading levels. Readers’ advisory Office of Education 201 services are provided to direct those who wish assistance in pursuing their studies. In addition to this very personalized service to the individual, the public library also initiates, supports and participates in educational, civic, and cultural activities of the community. Program-planning guidance is provided to a variety of civic, service, cultural, and pro¬ fessional groups and organizations. Discussion programs, lectures, forums, exhibits, and film programs are sponsored. Many public libraries are engaged in radio and television activities such as book talks, story hours, and a presentation of highlights of the library’s many resources and services. Through a network of central libraries and neighboring branches, public libraries extend their resources throughout their area of service. Where branch libraries or stations cannot be established, bookmobiles provide public library service — in housing centers, recreation camps, at the village crossroads, at farm meetings, at nursing and convalescent homes, and at shopping centers. The Library Services Act (Public Law 597, 84th Congress) author¬ izes an appropriation of $7.5 million annually for 5 years for grants to States for the extension of public library service to rural areas without such service or with inadequate service. Since this act was passed in 1956, significant developments have taken place throughout the Nation.2 Some of these developments, after 3 years, are listed below : Thirty million rural people enjoy new or improved public library services. State funds for the development of rural public library service have increased 54 percent, and local appropriations for rural public libraries have increased 45 percent. County and regional library developments have brought public library service for the first time to over 1 million rural children and adults and substantially improved service to 7.6 million more. Over 65 rural counties and an equal number of New England towns formerly without any public libraries are now receiving library service. Approximately 200 new bookmobiles have been placed in operation in rural areas. More than 5 million books and other informational materials have been added to the resources of rural communities. Over 400 counties and 645 New England towns are participating in the demon¬ stration and development of county and regional library systems by either intro¬ ducing library service where it has never been available or by improving inade¬ quate book and information services. The library needs of rural areas are great. At the close of fiscal 1960 there were still approximately 25 million people in rural areas 2 The Library Services Act was extended by President Eisenhower’s signing of Public Law 86-679 on August 31, 1960, thereby extending the act for 5 years beyond June 30, 1961. 573826—61 14 202 Department oj Health , Education , and Welfare, 1960 without public library services. There were about 21 million more who had not benefited by cooperative State-local-Federal library de¬ velopment projects under the Library Services Act. There were roughly 250 counties in the United States still with no public library services within their borders. ORGANIZATION AND ADMINISTRATION The upsurge of interest in improving and upgrading the public schools has led to an acute realization that quality education for every boy and girl is dependent upon sound local school system organiza¬ tion and administration. Efficiently organized school districts and more effective utilization of staff personnel are essential if the public schools are to be strengthened. SCHOOL DISTRICT REORGANIZATION In the American pattern of administering public education, good schools are dependent upon soundly organized local school systems. Experience has shown that small school districts usually have limited financial resources and, therefore, cannot provide a varied curriculum, adequate school facilities, comprehensive pupil personnel services, and competent teaching and staff personnel. Of the Nation’s 42,000 school districts (including nonoperating dis¬ tricts) , 7 out of 8 have fewer than 1,200 pupils ; only 3 States have no school systems enrolling fewer than 1,200 pupils. In addition, school districts with fewer than 1,200 pupils average nearly 1 more teacher per 100 pupils than districts with more than 1,200 ; and districts with fewer than 300 pupils average nearly 2 more. These figures suggest the poor use of manpower by small districts, a waste which the Nation, faced with a continuing teacher shortage, can ill afford. The number of school districts has been reduced from 95,000 in 1948 to 53,000 in 1957 and 42,000 in 1960. Most of the decrease since 1957 took place among districts enrolling fewer than 1,200 pupils. The decrease was most pronounced in systems enrolling fewer than 150 pupils. However, despite this trend, nearly half of all school systems still have fewer than 50 pupils. The Office of Education through the consultative services offered by its specialists has aided State and local school officials and local plan¬ ning groups in stimulating efforts toward reorganization of inefficient and inadequate school districts. The need for studies in local school system organization and administration becomes more urgent in the face of rising school enrollments, shortage of teaching staff, and in¬ creasing strain on local school finance sources. In carrying out these broad purposes, three exploratory studies relating to organizational characteristics of medium- to large-size school systems were completed in 1960. Office of Education 203 STAFFING America’s program to provide a system of free public education for some 36 million children is founded upon the teacher as the basic unit of instruction. It is through this basic teacher unit that all other efforts in education — administration, housing, instructional services — are directed. It is only through the continued interest in and support of programs directed at improving the quality of teacher performance that organizations external to the classroom can influence significantly the educational program received by America’s youth. The growth in the school population has created a marked increase in the demands for teacher personnel. Furthermore, the changing nature of our society has, with new demands and expectations for the schools, created the need for certain specialized personnel offering supporting services to the classroom teacher. During fiscal 1960, the Office studied the need for an increasing number of professionally qualified and competent teachers for Amer¬ ica’s public elementary and secondary schools. Delated problems of improved staff salaries, teacher selection procedures, and of preservice and inservice teacher education were also explored. These studies will be of great benefit to those who plan and administer the programs in our public schools during the coming years. Several factors have contributed to the development of programs directed at improving the quality of the instructional program. One, of course, is the combination of a great national interest in our schools and the increased lay involvement in school policy development. An additional stimulation has come from national groups, either privately or publicly supported, concerned with special areas of the curriculum. Changes in methods of instruction, utilizing technologi¬ cal aids, and changes in organization for learning, such as team teach¬ ing, have profound implications for staff selection and assignment as well as for staff preservice and inservice programs. Parallel to this concern for improving the quality of the instruc¬ tional program is the need to attract a sufficient number of competent individuals into the teaching profession. Current estimates indicate a need for approximately 50,000 teachers annually merely to meet the projected increase in pupil enrollment. The past year has seen con¬ siderable interest, and acceptance, of the use of teacher aids, theme readers, and other paraprofessionals. However, even by making the most optimistic evaluation possible of such programs, there is every indication that education will be short in available staff, and at a salary disadvantage when competing with other professions for staff selection. In order to fulfill the urgent needs in strengthening local school sys¬ tems, the Office of Education plans to intensify its efforts in conduct- 204 Department of Health, Education, and Welfare, 1960 ing studies on school board organization and practices; the external relationships existing between school and community ; procedures and practices for attracting, developing, and holding competent staff per¬ sonnel; and procedures involved in establishing soundly organized school districts. HOUSING AND FACILITIES It is generally recognized and often asserted that both teachers and pupils need proper tools if pupils are to be given an opportunity to develop their abilities — whether abstract, artistic, mechanical, or so¬ cial — to a maximum level. The school plant, one of the tools essential to education, includes all physical facilities and equipment required for implementing an instructional program that will make this de¬ velopment possible. The significance of this concept is illustrated by the fact that, during the 10-year period from 1949-50 through 1958-59, the people of the United States approved the construction of approxi¬ mately 565,000 public elementary and secondary classrooms for their children. Nevertheless, there was a reported shortage of 132,400 class¬ rooms in the fall of 1959. In an effort to reduce this shortage, local school districts reported plans for the construction of 62,700 additional rooms during 1959-60. Current trends and predictions indicate that, for the decade from 1959-60 through 1968-69, there will be a need for 607,600 classrooms and related facilities, of which 416,600 will be required during the first half of the decade (1959-60 through 1963-64). Assuming that the construction schedule for 1959-60 is met, the need would then be 544.900 classrooms for the remaining 9 years in the decade, of which 353.900 would be required for the first 4 years. If this schedule is met, it seems probable that, for the 5-year period from 1964-65 through 1968-69, a total of 191,000 additional classrooms will meet the anticipated requirements. The amount of all capital-outlay expenditures for public education currently exceeds $3 billion per year. Now at an all-time high, these expenditures will need to rise sharply during the next 10 years. Pres¬ ent capital-outlay expenditures, plus interest payments, account for nearly one-fourth of the total annual expenditure for public educa¬ tion. Other school plant services account for about 10 percent of the total annual expenditure — 3 percent for maintenance and 7 percent for school plant operation. The size of current annual expenditures for public education plus the fact that about one-fourtli of the country’s population spend their working days in schools, either as pupils or as employees, make public education the Nation’s largest enterprise. Those who are responsible for planning, constructing, equipping, and operating our schools must have information, equated to dollai s-and-cents costs, that will enable Office of Education 205 them to make wise decisions concerning the health, safety, intellectual development, and physical welfare of pupils as well as others who use school facilities. The Office of Education has a responsibility at the national level for collecting and disseminating accurate information on all phases and aspects of the school facilities program. Traditionally, it has provided this information through consultative services and through published reports to State and local school officials and other organized regional groups. These services should be expanded and continued, but the total effort should not stop here. Recognizing the importance of research and experimentation relat¬ ing to school sites, buildings, and equipment, the Office of Education recently initiated a project which could make it the center of informa¬ tion on research and related material on school facilities. Beginning on a small scale, the Office has undertaken, among other things, to collect and disseminate information regarding (1) existing research and related materials, (2) topics which represent problem areas in this field, (3) sources of information about such research, and (4) or¬ ganizations which are or may be engaged in research or studies in this field. A number of recent technological studies and experiments may influence decisions regarding school facilities. The adoption of a standard module for school construction, for example, could cut school construction costs and at the same time permit greater flexibility by allowing a building to be put together in any number of different and appropriate architectural arrangements. Coordination of the devel¬ opment of new construction materials and experiments with new con¬ struction techniques may reduce both the construction cost and the amount of time required for construction. Cost studies of various types of heating, ventilating, and cooling systems may influence de¬ sign patterns, improve health conditions, and remove certain safety hazards. Results of studies on the physical characteristics of children have already brought about improvements in design, fabrication, and flexibility of school furniture and equipment. Data produced by studies on the interrelationship of light and color may produce sig¬ nificant changes for the improvement of visual conditions in class¬ rooms. There are other factors and emerging concepts which influence the planning of school facilities. The concept that gifted children require special learning experience has definite implications for both space arrangement and types of equipment. A wider use of special pro¬ visions for children with mental, emotional, and physical handicaps creates a need for special equipment and diversified types and arrange¬ ments of space. Expanded school offerings have become important 206 Department of Health, Education, and Welfare, 1960 factors in planning school facilities. The enrichment of science, math¬ ematics, and language programs under the provisions of the National Defense Education Act has stimulated interest in the design of in¬ structional rooms and in the quantity and types of instructional equipment used for these subject areas. Experiments with reading groups indicate that a revision in room sizes is needed. Expansion of the educational program to include summer sessions, extracur¬ ricular seminars, before- and after-school sessions, and Saturday classes must be considered when new facilities are planned. Newer instructional methods may also influence school plant needs. Special space arrangements are required for the satisfactory use of mechanical and electronic teaching aids. Large-group . instruction, now deemed feasible for some subject areas, requires more space than the conventional type class. F acilities for closed-circuit television, a recent innovation in instructional method, must be planned with spe¬ cial care. Another trend which influences school facility planning is the in¬ creasing use of school facilities by community groups. In this in¬ stance, decisions must be made with respect to frequency of use, group sizes to be served, and types of equipment which will be required by these groups. In addition to providing leadership and consultative services in the areas of long-range planning, functional planning, school plant ad¬ ministration, building technology, and school equipment, the Office of Education provides similar services in the area of property man¬ agement. With an estimated current investment of $30 billion in public school property — sites, buildings, and equipment — increasing emphasis is being given to its management. Adequate training, super¬ vision, and work standards for maintenance personnel is now consid¬ ered essential to a properly functioning educational program. The services performed by them can prevent undue depreciation of school property; protect it against misuse, vandalism, and other damaging activities; eliminate numerous fire hazards and prevent others from developing ; contribute to the health and safety of pupils and school employees ; and create an environment that is conducive to educational efficiency. III. Higher Education in the United States Higher education in the United States began with the establishment in the American Colonies, primarily under religious auspices, of nine colleges patterned after the British colleges of Oxford and Cambridge Universities, but without university organization relating the colleges to each other. In all, 182 permanent colleges were founded in the United States before the Civil War. The 1959-60 Education Direc - Office of Education 207 tory (Part 3: Higher Education ) lists 2,011 institutions of higher education. ANALYSIS OF INSTITUTIONS Several factors have combined to make education beyond the high school in the United States a veritable patch- work quilt of institutions differing widely in size, in quality, and in kind. First, the educational pyramid tapers very slowly, as a direct result of the Nation’s commit¬ ment to the ideal that every American boy and girl shall be not only permitted but encouraged to develop individual capacities to the full¬ est. Of each 1,000 pupils who entered the fifth grade in the fall of 1950, 885 entered high school (9th grade) in the fall of 1954; 584 graduated from high school in the spring of 1958; and 308 (or more than half those completing high school) entered college during the academic year 1958-59. The second factor in the diversity of the Nation’s institutions of higher education is their disparate origins — most were initiated under various private or religious auspices and still reflect a correspondingly varied assortment of objectives, methods, and policies. A third factor in institutional diversity is the fact that the tax- supported institutions, which accommodate 59 percent of the students, are themselves supported and controlled by different agencies and groups. The 50 States, and in many cases the counties within these, the local school districts, and even individual municipalities have their own colleges for which they or their constituted officials select boards of control. Of the 2,011 institutions of higher education listed in the Directory , 1,313 operate under private or denominational control, and 686 under State, county, district, or municipal control. Twelve are under the control of the Federal Government. Enrollments of degree-credit students in 1,952 of the 2,011 institu¬ tions totaled 3,402,297 in the fall of 1959, a 4.4-percent increase over the preceding year. In addition to the degree- credit students were an estimated 250,000 in college-level terminal-occupational curricula. Of the total degree-credit enrollment, 41.1 percent was in private or church-controlled institutions, and 58.9 percent in tax-supported insti¬ tutions. More than 460,000 degrees were awarded by the Nation’s in¬ stitutions of higher education during 1958-59 : 9,360 at the doctoral level, 69,497 at the second level (master’s except first professional), and 385,151 at the bachelor’s and first-professional degree level. For the Nation’s colleges and universities the 1959-60 academic year was marked by an awareness of the broadening dimensions of impending problems, and a deepening sense of urgency regarding them. In large measure this was due to anticipation of the effects of the tidal wave of enrollments which has moved slowly through the elementary schools during the last decade and has now en- 208 Department of Health, Education , and Welfare , 1960 gulfed the high schools as well. Every area of planning for higher education — organization, facilities, staffing, curriculum, finances — was dominated during 1960 by the sober realization that there re¬ mained little more time in which to prepare for the rise in en¬ rollments which has just begun to make itself felt in the colleges. Enrollments will probably achieve maximum rate of rise about 1965, but will probably not reach their crest before 1968 or even later. Chart 1 shows for comparison, the total degree-credit enroll¬ ments of the Nation's colleges and the population aged 18-21 years, as recorded for 1939 and 1946-59, and as projected for 1960-70. Chart 1. — TOTAL DEGREE-CREDIT ENROLLMENT IN RELATION TO POPULATION AGED 18-21: CONTIGUOUS UNITED STATES, FALL 1939 AND FALL 1946 THROUGH FALL 1959, WITH PROJECTIONS TO FALL 1970 Millions (ratio scale) Source : U.S. Department of Health, Education, and Welfare ; Office of Education. Opening Fall Enrollment in Higher Education, 1959: Analytic Report. In the fall of 1959 the Nation’s 512 2-year colleges enrolled a total of 411,495 degree-credit students, a 6.5 percent increase over the pre¬ ceding year, and accommodated in addition nearly 500,000 students in organized occupational curricula, adult education, extension and other special categories. Not included in these junior college totals are the enrollments of approximately one hundred separately organized 2- year units of university systems, which should be considered in any assessment of the junior college movement as a whole. The most dramatic development in the 2-year college movement in the United States continues to be the rapid increase in the number of public junior colleges, particularly in the eastern part of the coun¬ try. Florida, Maryland, New York, and Virginia are moving ahead Office of Education 209 rapidly in organizing new 2-year colleges. Evidence of an awakened interest in this type of institution is also seen in New Jersey, Rhode Island, and Massachusetts. Massachusetts established its first State supported junior college in 1960, and Rhode Island enacted legislation to launch a system of 2-year colleges beginning in 1962. There is thus considerable evidence that the movement toward establishment of 2-year colleges in communities anticipating large increases in student population, as was recommended by the President’s Committee on Education Beyond the High School in 1957, will be a significant factor in the Nation’s efforts to accommodate increasing enrollments in higher education. During 1960 the Office moved rapidly to sketch in bold outlines the crisis that will confront the Nation’s colleges and universities in the middle and late 60’s. In 1959 it had published the first of five parts of the comprehensive national survey of higher education facil¬ ities, Part 1 : Cost and Financing of College and University Building , 1951-1955. In 1960 it completed Part 2: Planning for College and University Physical Expansion, and proceeded with Part 3: Inven¬ tory of College and University Physical Facilities. Utilizing both the completed and ongoing portions of this survey, the Office projected during 1960 a realistic and challenging estimate of the physical plant needs for the decade just beginning, as follows : (1) $2.1 billion for replacement and rehabilitation of buildings which are now, or will become during the decade, unsatisfactory, unsafe, or obsolete ; (2) $13.7 billion for expansion of facilities to accommodate increased en¬ rollments ; and (3) $3.3 billion for increased and improved facilities for research and pro¬ fessional training. The total facilities requirements, as projected year by year for the next decade, are shown in chart 2. Chart 2. — ANNUAL NEED FOR PHYSICAL PLANT EXPENDITURES FOR HIGHER EDUCATION, BY FUNCTION, 1960-70 I960 ‘61 ‘62 '63 '64 ‘65 '66 '67 '68 '69 1970 210 Department of Health, Education, and Welfare, 1960 On the basis of its survey of institutional plans for construction of new facilities (and rehabilitation of those in existence), the Office compared the projected facilities needs and the projected institutional expenditures for 1960-70, year by year, as shown in chart 3. In chart 4 the cumulative projected expenditures are compared with cumulative total need, showing that by 1965 a cumulative gap of $2.9 billion, and by 1970 a gap of $5.2 billion, will have widened between expenditures for facilities and actual need, unless ways are found to increase expenditures beyond present institutional plans. Identified as far more serious than the need of $19 billion in ten years for facilities is the anticipated necessary increase of annual expenditures for current operation of institutions of higher education, from $5 billion in 1960 to at least $12*4 billion in 1970. For the bene- Chart 3.— ANNUAL NEED FOR PHYSICAL PLANT EXPENDITURES COMPARED WITH PROJECTED INSTITUTIONAL EXPENDITURES, 1960-70 LEGEND- BffW total ANNUAL need I960 '61 '62 '63 ‘64 ’65 ‘66 '67 '66 '69 1970 Chart 4.— CUMULATIVE NEED FOR PHYSICAL PLANT, HIGHER EDUCATION, 1960-70 BILLIONS $20- - * - — - Office of Education 211 fit of those who will have to deal with this problem at institutional, State, and national levels, the Office published in 1960 detailed analyses of institutional income and expenses for current operations, in its Biennial /Survey of Education , and in other reports. Timing its efforts to coincide with a significant upsurge in higher education planning at State, regional and institutional levels, the Office accelerated and expanded its services to those engaged in planning activities. Materials published in this effort included the annual Review of State Legislation Relating to Higher Education , the survey and analysis of State Boards Responsible for Higher Education , and the annual compilation, Higher Education Planning and Management Data. The Office assisted in the development of coordinating mech¬ anisms within both public and private agencies for higher education, prepared for publication a report on Criteria for the Establishment of Two-Year Colleges , and provided extensive consultive services to institutions, boards of control, and State and other higher education officials. The Office’s goal in all this effort was to promote the quality and efficiency of higher education in general through the establishment of patterns for collective action within the bounds of freedom and flexi¬ bility. In conducting surveys such as Higher Education in the Tide¬ water Area of Virginia (completed in 1960), and Higher Education in South Dakota (in progress during 1960), the Office has provided sig¬ nificant service in interpreting, to those responsible for higher educa¬ tion planning, the needs and potentialities of institutions and areas. In particular, the Office has found itself in a position to ease the stress between institutional and organizational leaders and the representa¬ tives of public agencies in matters affecting budget and program planning. STAFFING AND UPGRADING OF PERSONNEL Having experienced increasing difficulty in the recruitment of pro¬ fessional staff, college and university administrators became aware during 1960 that the staffing of the Nation’s colleges will become at least as serious a problem as the provision of facilities in the decade just begun. The Office’s most recent report on Faculty and Other Professional Staff in Institutions of Higher Education indicates that in 1957-58 the Nation’s institutions of higher education employed ap¬ proximately 335,000 professional staff members in teaching (of degree-credit courses), administration, and research, full-time and part-time — the total constituting the equivalent of approximately 250,000 full-time professional staff members. From the report and existing trends, plus the enrollments projected for the decade, it is anticipated that full-time equivalent professional staff will rise from 212 Department of Health , Education , and Welfare , 1960 approximately 280,000 in 1960 to 400,000 in 1970. When to the yearly increments required by increasing enrollment are added the numbers necessary to replace those lost by death, retirement, or change of pro¬ fession, it is estimated that during the decade it will be necessary to employ about 336,000 new professional staff members for the Nation’s colleges. The qualitative aspects of this need for new professional staff mem¬ bers are as serious as its magnitude. Assuming that half the yearly supply of doctorates take positions in higher education (at the present rate of production of 9,360 per year), only about 46,800 of the 336,000 new professional staff members, or 13.9 percent, will have doctor’s degrees at the time they enter the profession. The extent to which doctoral production must be increased in order to maintain even the present quality of entering staff can be judged by comparing the figure of 13.9 percent with corresponding ones of 31.4 percent (with doctor’s degrees) for entering teachers in 1953-54, 26.7 percent for 1955-56, and 23.8 percent for 1958-59. In the brief period of time since the conclusion of World War II, the Nation’s universities have become a major research enterprise. In 1957-58 approximately 30,000, or about 13 percent, of all full-time- equivalent professional staff in the Nation’s colleges and universities were engaged full time in the pursuit of organized (or separately budgeted) research; by 1959-60, the estimated full-time-equivalent had advanced to approximately 40,000, or about 15 percent of the total. The projection of total professional staff to 1970 given above assumes that the full-time-equivalent total of personnel engaged in research will increase from 40,000 in 1959-60 to 80,000 in 1970. Annual expenditures for organized research in colleges and univer¬ sities are now close to the $1 billion mark. During fiscal 1960 the Office also analyzed and interpreted the problems relating to staffing the Nation’s colleges and began the diffi¬ cult task of establishing guidelines and goals in the production of needed members of new professional staff. These services will be especially valuable to those responsible for planning expansion of graduate programs, the administration of financial aid to graduate students, and the expansion and maintenance of professional staff for undergraduate programs. In addition the Office reported exten¬ sively on the slow rise of faculty and staff salaries in the Nation’s institutions, calling attention to the fact that unless the salaries were increased more rapidly than those in other occupations (to offset a trend in the reverse direction over several decades), the problem of recruiting higher education staff from among the persons who become suitably qualified in the next decade will be increasingly difficult. From the 1930’s to 1956-57, the pay, in stable dollars, of a full pro¬ fessor at Yale, Columbia, Johns Hopkins or Harvard decreased about Office of Education 213 20 percent; in the same period the salary of an average member of the labor market rose 50 percent in stable dollars.3 Average salaries for full-time faculty members in all 4-year under¬ graduate colleges rose from $6,160 in 1957-58 to $6,810 in 1959-60, an increase of 10.6 percent in two years. This is far less than sufficient to produce doubled faculty salaries in the decade which began in 1957, as recommended by the President’s Committee on Education Beyond the High School. Average salaries in private institutions ($6,510 for 1959-60), which are lower than in public institutions ($7,040), showed the larger increase, 14.2 percent in two years, com¬ pared with 8.8 percent in public institutions. MANPOWER— GRADUATE AND PROFESSIONAL EDUCATION The staff requirements of institutions of higher education in the present decade constitute one of several factors which will greatly increase the load on the Nation’s graduate and professional schools. There can be no doubt about the imminent upsurge in college enroll¬ ments at the undergraduate level. The implications for graduate and professional education, though not quite so obvious, are equally certain when viewed in the light of the unfolding pattern of American manpower. The Department of Labor has called attention to three factors which will alter the distribution and character of American manpower during the 1960’s. First, a larger number of people will be seeking work in the labor market. Second, there will be a continuation of the trend toward white collar occupations. Third, there will be a rise in training and educational requirements of jobs of almost all kinds.4 During the 1960’s the number of workers in the country will rise by about 14 million, an increase of nearly 20 percent. The number of professional, technical and kindred workers for whom special train¬ ing is required, however, is expected to increase almost 60 percent be¬ tween 1957 and 1970. But according to the projections there will be a slight decline in the total number of workers in the 35-44 age group, as a result of the low birth rates of the 1930’s. For all these reasons it is urgent that every effort be made to increase the number of young people who equip themselves, academically and professionally, for the many types of jobs that will require more education and more training than ever before.5 Recognizing this need, the Office has pre¬ pared periodic reports on enrollments in organized occupational cur- riculums, on professional and graduate education and other subjects relating to the problem of trained manpower. Looking to the future, the Office in 1960 included in a reexamination of its program of educa- 3 Financing Higher Education , 1960-70 , McGraw-Hill Book Company, 1959. 4 Higher Education, December 1959. 5 Newell Brown, “Manpower and Higher Education in the 60’s,” Higher Education, December 1959. 214 Department of Health , Education , and Welfare , 1960 tional data-gathering a consideration for a comprehensive analysis of the oncoming manpower supply as it moves through the educational system. In connection with its NDEA Counseling and Guidance In¬ stitutes, the Office also began to develop a long range approach to the problem of guidance of American youth in a way consistent with the national pattern of opportunity and manpower needs. Likewise, in view of the anticipated load on the Nation’s graduate and professional schools in the middle and late 1960’s, the Office accelerated its study of graduate and professional programs, giving particular attention to their capacities and potential for expansion. STUDENT ASSISTANCE The rapid rise of tuition and fees in the Nation’s colleges and uni¬ versities during the last few years has become a matter of increasing concern — and of debate. Many educators and business leaders, citing the American ideal of equal opportunity and the evidence that higher education has become a social and economic necessity for able youth, hold that tuition, fees, and other costs should be kept low, particu¬ larly in the public colleges and universities. Others argue that costs of attending college have increased less rapidly than has disposable income over the last two decades, and that the families of students can afford to pay a substantial share of the cost of higher education. A few persons have gone so far as to say that the colleges should charge the student the full cost of his education — that he should borrow what his family and he cannot pay at the time. A study of 196 representative institutions of higher education, 1939- 58, 6 shows that between 1939 and 1949 tuition and fees rose 44 percent in public institutions and 50 percent in private institutions. During 1949-58, these charges rose 60 percent in public and 75 percent in private institutions. The cost of living index rose 71 percent from 1939 to 1949, but only 21 percent from 1949 to 1958. In contrast, median family income in families with heads 35 to 54 years of age rose 132 percent from 1939 to 1949, and 64 percent from 1949 to 1957. Despite disagreement on what proportion of the income of institu¬ tions of higher education should be derived from charges to the stu¬ dents, there seems to be almost universal agreement on the desirability of scholarships and other forms of aid to college students. The pat¬ tern of such aid has altered significantly in the last few years. The number of scholarships and fellowships awarded by individuals, foun¬ dations and corporations has increased. The institutions have greatly increased the number of their scholarship grants, both funded and un¬ funded. The most significant developments in the student assistance area, however, have been the Student Loan and Graduate Fellowship programs set up under the NDEA, and the rapid increase in State 9 Lanora Lewis, College and University Business , December 1959. Office of Education 215 scholarship and loan guarantee programs. The preliminary report of a 1960 Office study of State programs of financial assistance for college and university students discloses 148 such programs in 44 States. Data obtained on 73, or fewer than half of these, list 42,791 students benefited by a total expenditure of nearly $16 million. IV. Research and Experimentation in Education THE SETTING OF RESEARCH IN EDUCATION The complexities of modern-day life have led to the development of educational needs which the pioneers in this field could scarcely have anticipated. Problems associated with the increase in population, the expanding amount of knowledge, and the movement of hitherto un¬ known nations into world prominence, all combine to make the tasks of today’s educators the most challenging in world history. If educa¬ tion is to face the challenge, master the difficulties, and assume the role of leadership, the increased performance and utilization of re¬ search and experimentation is essential. Educators have long sought for better ways to use existing knowl¬ edge. They have also sought new knowledge in subject matter fields and in the realm of pedagogy itself. Yet, not until recent decades has the field of research in education begun to approach the stature which it must attain. During those years, research in education has moved from man's attempt to solve his problems by merely rearrang¬ ing old knowledge into new thought patterns, to the intensive descrip¬ tion, systematic analysis, and experimentation which results in strengthening the substantive areas of knowledge and improving the processes of instruction, organization, guidance, and administration in our schools. Measured in terms of employment, annual expenditures, rate of expansion, capital facilities, and clientele, education is one of the Nation’s largest “growth industries.” Many successful American industries spend from 3 percent to as much as 9 percent of their sales dollar in research and development. Nevertheless, despite the expan¬ sion and growth potential of education, it has been one of the slowest “industries” to profit by research, experimentation, and development, especially when a change involved abandoning of old methods, old processes, and old products to which people had become attached. SUPPORT OF RESEARCH AND EXPERIMENTATION IN EDUCATION On the other hand, it is encouraging to see that increased expendi¬ tures for research in education are being used by many sources as a tool for improving education. Private philanthropic foundations, voluntary health and welfare agencies, academies of science, scientific and professional agencies, local and national research institutes, private business and industry, and the Federal Government are pro- 216 Department of Health , Education , and Welfare , 1960 viding an ever-increasing flow of funds, varying from a few thousand to millions of dollars, for educational research and experimentation. Some organizations provide support for research on basic issues only, others support only the applications of research, and still others support programs between these two extremes. Some agencies support research in any field of education, while others limit their support to chosen areas. During the last decade Federal contributions to research in edu¬ cational institutions have been increasing rapidly. During the fiscal year of 1951, Federal contributions for research in all educational in¬ stitutions totalled $64 million. While the exact figures are not yet available for the fiscal year covered by this report, the figure for fiscal year 1959 was $223 million. The size of the increase in this last decade is certainly a strong indication of the growing concern for and support of research in educational institutions. However, pro¬ viding funds for the support of research in educational institutions is not necessarily the same as providing funds for research in education. An important way to improve education is through the expenditure of funds for research in education as a field of study itself. The Office of Education is now engaged in supporting this type of activity. Cer¬ tain phases of research in education are being furthered by the staff specialists who conduct various types of status and information studies. However, research activities administered but not performed by the Office of Education are supported through the National Defense Education Act of 1958, and the Cooperative Kesearch Program, au¬ thorized by Congress in 1954. Under the provisions of the National Defense Education Act of 1958, a number of educational research programs have been carried on during the past 2 years. Under title VI, the Office of Education ap¬ proved 115 projects involving research, experimentation, development of specialized instructional materials, and studies and surveys relating to the improvement of modern foreign language teaching. One hun¬ dred twenty-three contracts were negotiated in support of these pro¬ jects. During the first 2 years of the act, a total of $6,455,086 was designated for research and studies contracts. For fiscal years 1961 and 1962, continuation costs for some of these contracts total $2,035,355. Title VI authorizes a contract program only, with no provision for grants-in-aid. In the development of this research program the Office of Education sought the advice and counsel of more than 250 leading scholars and specialists. Additional individuals and groups have worked under contract to carry out a broad range of studies and surveys such as evaluation of language institutes, inventory of resources and prac¬ tices at language and area centers, development of archives dealing Office of Education 217 with all the languages of the world, and collection of statistics on the status and trends of language study. Entire new experimental courses of study are being developed for the secondary schools. Covering 6-year sequences and oriented to the audiolingual approach, the first-year materials in Spanish, French, German, Russian, and Italian are receiving field trials in more than 100 school field centers in 1960-61. More than a dozen colleges are under contract to experiment with new methods and programs for training more proficient future language teachers. Other research deals with the use of special equipment and devices such as films, film¬ strips, language laboratories, and teaching machines. The ability of American education to teach effectively many of the so-called neglected but significant languages of the world depends upon the availability of adequate instructional materials. To fill this need, a vast materials-development program has been initiated in 78 languages not commonly taught in the United States, from major world languages such as Hindi, Arabic, and Chinese to lesser but strategic tongues such as Swahili, Tibetan, and Thai. This program will go a long way toward filling the present gaps in instructional manuals, grammars, dictionaries, readers, and other teaching materials. Under title VII of the NDEA the Office of Education is assisting and fostering through grants or contracts, research and experimenta¬ tion in the uses of new educational media such as motion pictures, radio, and television; and is disseminating information, directly or through contracts, concerning the educational uses of these media. During fiscal years 1959 and 1960 the Advisory Committee on New Educational Media approved 116 project proposals for grants totaling $7.5 million to bring the projects to completion. Research projects funded under title VII are being carried on pri¬ marily in colleges and universities. The research relates to every instructional level from kindergarten to university, and concerns all of the broad content areas of learning. These projects reflect especially the emerging interest in the possibilities of television for large-group instruction and of teaching machines for individualized learning. Over half of the grants awarded to date focus upon these two methods of instruction. The Cooperative Research Program of the Office of Education was developed with the purpose of seeking new knowledge and new appli¬ cations for existing knowledge in the field of education. Therefore, no limits have been established on the nature or topic of the studies which can be supported under this program. Rather than establishing rigidly limiting categories under which all research proposals must be subsumed, the Cooperative Research Program receives all proposals 573826- -61 - 15 218 Department of Health , Education, and Welfare, 1960 which relate to the field of education, and evaluates them for approval on the basis of their significance to education, the quality of research design, the quality and promise of the staff and facilities at the insti¬ tution proposing the study, and the economic efficiency of the proposed research. From the time the program began operation on July 1, 1956, through June '30, 1960, the Research Advisory Committee of this pro¬ gram has recommended a total of 373 projects out of a total of 1,091 received. For these 373 approved projects, the total estimated Fed¬ eral obligations, including those contracts for which negotiation was yet pending at the close of fiscal 1960, will reach $15.8 million. Again, the success of this program in encouraging colleges, universities, and State departments of education to increase the scope of their research activities indicates a realization that research is the key to tomorrow’s growth, that the future of education depends on learning new facts about education and better ways to utilize the knowledge we already possess. THE POTENTIAL OF RESEARCH IN EDUCATION Research in education as a key to tomorrow can be demonstrated in many ways. However, one of the most graphic methods is a rather simple statement of questions which now concern educators, and for which research is now seeking the answers. An analysis of the 46 re¬ search proposals recommended by the Cooperative Research Pro gram’s Advisory Committee in May 1960 reveals some of the questions for which answers are currently being sought. Illustrative areas of study and questions follow : Creativity and Giftedness : How can the identification of gifted students be improved? Education of the Handicapped Child : Can the comprehension level and knowledge of blind children be increased through the use of recordings to supplement their Braille reading? How should this material be presented so as to achieve maximum learning? Elementary Education : To what extent are pupils in the primary grades capable of learning the basic abstract mathematical concepts? Vocational Education : How are talent and giftedness being identified among students in voca¬ tional schools? Higher Education : How do the academic and student subcultures on a campus — for example, fraternities, academic clubs, dormitories — influence pupil achievement in college? School Administration : Can persons who have potential abilities to serve effectively as public school administrators be identified systematically ? Guidance and Counseling : What are the causes of indecision in career decision-making and how can they be alleviated? Office of Education 219 School Finance : What are the relationships and the implications of the relationships be¬ tween tax payments and benefits received in school districts? International Education : Can, and is, education being used in other countries to contribute to the achievement of national development goals? These are some of the key questions which should be answered if educational programs and emphases are to be wisely planned, and if a satisfactory measure of success in our educational efforts is to be realized. Yet even if all of these questions are answered through the research and experimentation now in progress, we will have inves¬ tigated only a few of many problems which continue to face our educational leaders and the citizens whose future depends on education. The United States of America has long been recognized as a leader in the field of education as well as other fields of human activity. Today, that leadership is being challenged. We must no longer pro¬ crastinate in developing educational programs which will assure the continuation of our leadership. In developing these programs, re¬ search and experimentation must light the way to the progress that is necessary. V. Educational Statistics and Information For many years, various groups have sought to identify the types of educational information needed by government agencies at the national, State, and local levels; by the general public; and by the educational community. The U.S. Commissioner of Education has from time to time appointed advisory groups of national leaders to examine the Office’s program of statistics and other information on education. The most recent of these groups, the Advisory Committee of Users of Educational Statistics, which has met periodically for the last 2 years to review the program of the Office, completed its final report in May of 1960. Groups of professional statisticians also have examined the procedures and program of the Office in this area several times in the last few years. There is general agreement among all qualified individuals who have reviewed the Office’s informational program that several major shortcomings currently exist: (1) lack of information on many ques¬ tions bearing on national educational policy, (2) limited dependability and compatibility of present educational data from different sources, (3) lack of currency in the information available, (4) the high unit cost of available items of national information, and (5) incomplete dissemination of existing knowledge. For some time the Office of Education has been actively engaged in effecting improvements in its statistical and other informational 220 Department of Health, Education, and Welfare, 1960 services. Through the joint efforts of its management staff, subject matter specialists, and statistical personnel, a new procedure for the unification of survey planning has been initiated. This coordinated planning should result in earlier identification of gaps in knowledge, in elimination of overlap in projects undertaken, in a more effective schedule of operations, and in the improvement of statistical standards. Important progress has been made in several areas within the last year. First, a study of the feasibility of use by the Office of different and more speedy types of statistical processing equipment has been completed. Investigation of the capabilities of recently developed electronic data processing equipment leads to the conclusion that the availability of such equipment lias implications for the statistical program of the Office. Second, under the authority of title X of the National Defense Education Act, the Office made steady progress during fiscal 1960 in developing cooperative relationships with State education agencies, and in improving statistical procedures in State education offices. Communication between the Office and the field is increasing and is becoming constantly more efficient. Progress was also made in the assembly of information on the use of Office-sponsored handbooks for setting up records in and making reports by local school dis¬ tricts, and in gathering information on the extent of use of machine processing procedures in local school districts and institutions of higher learning. Standard terminology and definitions of items of educational in¬ formation, contained in such Office of Education handbooks and manuals as the Common Core of State Educational Information , Fi¬ nancial Accounting for Local and State School Systems , and Account¬ ing for School Activity Funds , were adopted by additional States as a result of this program. Many States began a systematic collec¬ tion of basic items of information and indicated a desire to share such information with the Office. Preparation by the Office of a handbook on school personnel was underway during the year. Although not under title X authority, similar cooperative activi¬ ties are being carried on with higher education leaders in institutions and professional organizations. During the fiscal year, the Office took a more active leadership role in working with such institutions toward the development of a cooperative program of information about higher education. Third, a procedure has been initiated whereby the Office’s statistical program is being unified so as to prevent duplication of effort, over¬ lapping of surveys, and obtaining the same items of information on more than one questionnaire. An important accompanying activity was the development of item analyses of all Office periodic survey forms so that an authoritative Office of Education 221 list of such items will be available for use by those who need to know what items are now being collected or have been collected in the past. The basic items needed to produce the derived items now obtained are also being ascertained so as to eliminate as far as possible the con¬ tinued collection of derived items on the traditional type of question¬ naire. During the closing months of fiscal year 1960 a special Office- wide task force began the work of investigating the need for and the feasi¬ bility of developing a nationwide cooperative system of educational information. The work of this task force was supported by the services of consultants with expert knowledge of the educational sys¬ tem of the Nation and of recent technological advances in information storage and retrieval. VI. International Education INTERNATIONAL EDUCATION AND NATIONAL POLICY There is a growing belief that the future of mankind may depend upon the outcome of a race between the accomplishments and goals of education in the free world and in the totalitarian states, and that if education for a free society does not win, the world may experience a disaster, the nature and extent of which are unknown. In one year, thirteen new nations in Africa, all critically lacking in trained man¬ power, are achieving independence. The success or failure of any one of these nations, or of similar emerging nations in Asia, or Latin America, may have repercussions involving the whole world. The great need of the new nations is to develop their human re¬ sources to enable them to make use of their natural wealth, to establish stable and effective governments, and to take their place as equals in the community of nations. The development of human resources is a function of education. Thus education becomes a major instrument of international as well as national policy. It is national policy among the developing nations, who comprise about half of humanity, to give education a top priority as a tool to develop among their people the capacity to survive and to build a good life. It is national policy for many of the older nations to offer edu¬ cational assistance to the younger peoples. The Soviet Union is offering educational assistance as a manifestation of communist policy, and the free world is providing educational assistance as a demonstra¬ tion of democratic principle. Thus the classroom in Africa, parts of Latin America, and of Asia, becomes a battleground of ideas. Here the nature of man’s future may be determined by the contest between democratic and totalitarian concepts. American education has today major responsibilities not known a few years ago. In a time of increasing scarcity of competent teachers. 222 Department of Health , Education, and Welfare , 1960 we must share many of our best teachers with those whose need is greater. At a time when plans for the future education of American children tax anticipated fiscal and academic resources, we must also plan for the growing needs of our friends among the new nations. American education is no longer only American ; as an instrument for the creation of a free world, American education is also international education. These developments have placed serious new responsibil¬ ities on the Office of Education. There is a growing need for research in educational trends and developments abroad, both behind the curtains and in the free world. Each year the publications of the Office in the international area grow in quality and numbers. Since 1955 the Office has published more than 400 titles in comparative and international education. But the largest international responsibility of the Office is to help Americans. The Office provides a variety of traditional services, by collecting and disseminating information on foreign education, by coordinating American educational representation with international organizations, and by analyzing foreign academic credentials. The Office also helps States and communities to broaden the foundations of American education by including in our schools information about the non- Western world. There is a keen and growing awareness that if Americans are to win in the educational race, and are to give the help needed by the new nations, Americans must be better, more intensively, and more broadly educated than ever before. Americans have felt for some time that if they are to give maximum educational and technical assistance to the peoples of other countries and if they are to possess maximum understanding of these peoples, they must in greater numbers be familiar with the languages and cultural backgrounds of the countries in which they are serving either as official representatives of the United States or in a private capacity. The Language Development Program, authorized under title VI of the NDEA, came into being because of this need. Under this pro¬ gram, language proficiencies, teaching materials, and materials con¬ cerning historical and cultural backgrounds of the areas where the languages are used, are being developed in many languages not com¬ monly taught in the United States. These languages range from major languages of the world to many of the lesser but strategic tongues. A fuller account of this program is given on pages 216-217. INTERNATIONAL EDUCATIONAL EXCHANGE The Office continued to conduct three major programs under agree¬ ments with the Office of Educational Exchange (formerly the Interna¬ tional Educational Exchange Service) and the International Co¬ operation Administration of the Department of State: the Teacher Exchange Program, the Teacher Development Program, and the Tech¬ nical Assistance Training Program in Education. The total number Office of Education 223 of participants in the three major programs was 1,998. In addition, it provided extensive services to other visitors. The Teacher Exchange Program . — The Teacher Exchange Program continued to expand, both in the number of participants and in the number of participating geographic areas. In 1959-60, the total num¬ ber of participants was 619, distributed as follows: teacher inter¬ changes, 150 pairs (300 teachers) ; other United States teachers assigned abroad, 133; other foreign teachers assigned in the United States, 31 ; seminars abroad for United States teachers and adminis¬ trators, 155. Because of the great interest in the seminar for school administra¬ tors, first initiated in 1959 when over 500 applications were received for 20 vacancies, two seminars were offered in 1960, each one accommo¬ dating 20 participants. One was held in France and Finland, the other in Norway and Italy. A new summer seminar was introduced in Brazil for teachers of the history and geography of the Americas and teachers of Portuguese. The International Teacher Development Program. — Programs were conducted for 486 visiting educators from 65 countries. Of these, 310 participated in the regular six-month program. Seventy-nine at¬ tended two workshops arranged by the Office at the University of Puerto Rico. The remainder participated in summer programs or in individualized special projects. The seminar in Puerto Rico, initiated in 1956 to provide study op¬ portunities for Latin Americans wTho do not have an adequate knowl¬ edge of English to participate in the regular program in the United States, has become so popular that two seminars were offered for the first time. Participants in the second seminar were brought to the mainland for brief visits to New York, Philadelphia, and Washington. The University phase of the regular six-month program was con¬ ducted at 11 institutions in 9 States. In January and February, these participants spent six weeks in intensive observation of school systems in 23 States. The combined number of visits to different communities by participants in the total program reached 1,040. The Technical Assistance Training Program. — The number of par¬ ticipants in this program increased from 647 in 1958-59 to 893 in 1959-60. Especially noteworthy was the sharp increase in the Near East and Africa area, from 182 to 330. A substantial increase was also shown in the Far East, from 274 to 338. Countries with 50 or more participants included Indonesia, the Philippines, Thailand, Viet¬ nam, The United Arab Republic, Iraq, and Turkey. A total of 50 countries were represented. Training was provided in approximately 60 different fields at almost 150 training centers. In addition, par¬ ticipants visited many other educational institutions and industries for brief periods. 224 Department of Health , Education , and Welfare, 1960 Services to “ Secondary ” and “ Nonprogram ” Visitors. — Inherent in its position as the agency which represents education in the Federal Government, the Office has a responsibility to provide services in its field to visitors not assigned to the three budgeted programs described above. ‘Secondary” visitors are grantees under United States Gov¬ ernment-sponsored exchange programs who are assigned to other agencies for training, but who come to the Office for brief periods; “nonprogram” visitors are those not on United States Government- sponsored programs who receive assistance from the Office in planning and conducting their educational activities in the United States. In 1959-60, the number of “secondary” and “nonprogram” visitors reached 418, an increase of 138 over the previous year. Services to these visitors were provided primarily by staff assigned full-time to other programs. Exchange of Materials. — Materials pertaining to the international and comparative study of education are collected from many sources, and are placed on exhibition in the Educational Materials Laboratory at the U.S. Office of Education. They are intended for use by inter¬ ested specialists and visitors. Office publications are also sent to other countries in accordance with official arrangements. As Office specialists visit other countries they (1) bring back ex¬ amples of educational materials used in schools abroad, official pub¬ lications, programs of study, and university and school catalogs ; and (2) arrange for direct exchange of informational and service publica¬ tions with materials centers in other countries. Credential Evaluation. — The Office of Education provides an advisory service for evaluating foreign academic credentials in terms of approximate equivalent levels of education in the United States. The purpose of this service is mainly to assist educational officials in American schools, colleges, universities, State education agencies, and other institutions and organizations in making creden¬ tial evaluations. About 4,437 sets of foreign academic credentials were handled in fiscal 1960. Several types of publications helpful to persons dealing with such credentials are regularly developed by the Office. AMERICAN SPECIALISTS ABROAD The United States Government endeavors to share our vast human and professional resources with less fortunate peoples of the world. Education is an essential aspect of the technical assistance made avail¬ able by the United States in most of the countries of South America, the Near East and Africa, the Middle East, and the Far East. This program and a similar but largely complementary technical assistance program of the United Nations require approximately 900 direct-hire educational technicians. There are also a number of foundations in the United States which conduct educational programs in foreign countries. Office of Education 225 The Office of Education has responsibility for recruiting educa¬ tional specialists for the technical assistance programs of the Inter¬ national Cooperation Administration and UNESCO. Approximately 100 technicians are recommended to ICA each year. Two or more candidates are recommended to UNESCO for each vacancy, since American educators must compete for selection with candidates from other countries. INTERNATIONAL BUREAU OF EDUCATION The admission of the United States into membership in the Inter¬ national Bureau of Education in July 1958 was the culmination of more than 20 years of United States cooperation with this oldest international educational organization. Following are a few per¬ tinent facts concerning this organization. History. — The International Bureau of Education whose headquarters are in Geneva was first established as a private organization in 1925. Its purpose was to serve as a center for the exchange of information on educational matters. After operating for 3 years on a private basis, it was reestablished in 1929 as an organization to which governments might belong directly or through their min¬ istries of education. Organization. — The IBE is governed by a council which meets annually in July, and by a smaller executive committee which meets in February. The President of the council is traditionally from France, and customarily the chairman of the Executive Committee is from Switzerland. The IBE Secretariat is dedicated to furthering IBE’s purpose as a “centre of information and research in connec¬ tion with all matters concerning education.” International Conference. — In 1932 and 1933, the Bureau invited nonmember governments to send observers to the Council’s annual meeting. The interest thus aroused among educators in various parts of the world led to the establish¬ ment of an annual International Conference on Public Education. Between 50 and 60 countries prepare reports on the status of education in these countries, and on educational topics selected for discussion at the Conference. IBE and UNESCO have jointly sponsored the Conference since 1947. Membership. — In 1960, 44 nations from all parts of the world were members of the IBE. The United States, which joined in July 1958, was the first English- speaking country to assume membership. Increasingly English is being used by participants in the Conference although simultaneous interpretation in French, Spanish, Russian, and English is regularly provided. Other Activities. — IBE has served since its inception as a clearing house of in¬ formation on education. It maintains a library of over 100,000 volumes on education, and possesses a unique collection of materials on school legislation, approximately 15,000 textbooks, and more than 14,000 volumes of children's literature from many parts of the world. The Bureau has published more than 200 volumes. These publications include the International Yearbook of Education which contains a world survey of edu¬ cational developments in 60 or more countries. A quarterly Bulletin, issued by the IBE alone, contains information on education in various parts of the world and reviews of recent educational publications. Function of the Office of Education. — The Office of Education serves as secre¬ tariat for United States membership to the International Bureau of Education and assumes responsibility each year for preparing the yearly reports. It also designs an exhibit interpreting aspects of education in this country. In the 226 Department of Health, Education, and Welfare, 1960 selection of delegates to attend the conference and in the coordination of United States efforts both in the United States and in Geneva, the Office provides serv¬ ices of its own specialists and enlists the cooperation of persons and agencies both within and outside government. OFFICE RELATIONS WITH OTHER INTERNATIONAL ORGANIZATIONS Increased activity and interest regarding international organiza¬ tions marked the work of the Office during the year. Among the major efforts in this area were the following : The Commissioner of Education attended the Seventh National Conference of the United States National Commission for UNESCO. He was also chairman of the United States delegation and a working member of a regional seminar on education held in Brisbane, Aus¬ tralia, by the South Pacific Commission. The Office nominated United States educators to participate in a number of international meetings. Among these were a training course on Over- All Educational Planning, held by the Organization of American States in Bogota, Colombia, and a seminar on educational materials sponsored by the New Zealand Commission for UNESCO. Major projects completed during fiscal 1960 included the United States Chapter for the UNESCO World Survey of Education , Vol. Ill , Secondary and V ocational Education; material for a report to UNESCO on international programs in Education, Science, and Cul¬ ture; and a chapter on education for the United Nations Economic and Social Council to be included in the Report of Experience in the Field of Social Development of Potential Assistance to Under- Developed Countries . COMPARATIVE EDUCATION The perspective gained from examining the educational systems of other countries has always been important and is especially so at the present time as the United States marshals its resources to maintain its position of world leadership. Basic research in the field of com¬ parative education has been carried on for many years by the Office of Education, and with increasing vigor in the last few years as addi¬ tional funds and staff have been devoted to this purpose. The Office in recent years has sent a growing number of people to various countries to study foreign educational systems, and has held conferences on various aspects of foreign education. Comparative education, involving as it does comparisons between countries, must be conducted with a great deal of care. An educa¬ tional system has meaning chiefly when considered within the cultural setting of a particular country. A comparative education study brings us a greater understanding of a foreign educational system and a glimpse of the essential character of the country itself. Most im¬ portant of all, comparative education gives us insight into the work¬ ings of our own education system and the goals and aspirations of Office of Education 227 our society. It opens our eyes to new possibilities, to the universality of certain basic educational problems, and to the close relationship of education and the forces at work in a society. In the fiscal year 1960 the Office published major bulletins on teacher training in the Netherlands, Belgium, and Luxembourg, and on educa¬ tion in Brazil, Haiti, and the Soviet Zone of East Germany. There were, moreover, less comprehensive publications on education in 13 of the West European countries, 9 of the countries of the Near East and North Africa, and 2 countries of East Europe. Publications concern¬ ing various aspects of education in the Soviet Union and Communist China totaled 4. A general bibliography on education in most of the major countries of the world and more detailed bibliographies on education in Poland and the Soviet Union were also published. Comparative education specialists were sent to Africa (9 countries) , to the Far East (Japan, Taiwan, Hong Kong), and to Afghanistan and Iran for the purpose of gathering materials for future publica¬ tions on education in these areas. In conjunction with the East-West contacts program, the Office of Education sponsored two visits to the Soviet Union by teams of American specialists, one for the teaching of foreign languages and the other to study educational research procedures used in the Soviet Union. Two major conferences wTere sponsored by the Office during the year, one on education in England and the other on how American education is interpreted abroad. Comparative education specialists presented papers or served as panelists for meetings relating to foreign edu¬ cation sponsored by the Organization of Arab Students in the United States, the University of Florida’s Annual Conference on the Carib¬ bean, the Ibero-American Institute, a special subcommittee of the Organization of American States, the Institute of International Edu¬ cation, the National Association of Foreign Student Advisers, the American Association of Collegiate Registrars, and the Council on Evaluation of F oreign Student Credentials. This year the Office also embarked on a project of systematic analysis of the educational system in Communist China. The pre¬ viously mentioned trip to the Far East is part of this endeavor as is a forthcoming conference on Chinese Communist education (August 1960). More detailed reports of activities for fiscal 1960 will be published separately for the following Federal programs administered by the U.S. Office of Education : 1. Financial Assistance for Areas Affected by Federal Activities, and School Construction in Areas Affected by Federal Activities 2. National Defense Education Act of 1958 3. Cooperative Research 4. Vocational Education (including Practical Nurse Training) 228 Department of Health , Education, and Welfare, 1960 Table 1. — Enrollment in 50 States and District of Columbia, 1958—59 and 1959-60 [Office of Education estimates] Grade level and type of school 1958-59 1959-60 Kindergarten through grade 8: Public school system (regular full-time) _ _ __ _ _ 26, 700,000 5, 000, 000 180,000 27, 800, 000 5, 400, 000 180, 000 Nonpublic schools (regular full-time) - _ _ _ Other schools L_ _ __ __ ... _ Total, kindergarten through grade 8 _ _ .. 31,880, 000 33, 380, 000 Grades 9 through 12: Public school system (regular full-time) _ __ _ 8, 300, 000 1, 000, 000 90,000 8, 400, 000 1,100,000 90, 000 Nonpublic schools (regular full-time) _ Other schools 1 _ _ _ Total, grades 9 through 12 _ _ 9,390,000 9, 590,000 Kindergarten through grade 12: Public school system (regular full-time) _ _ 35,000, 000 6,000, 000 270,000 36,200,000 6, 500,000 270, 000 Nonpublic schools (regular full-time) _ __ _ Other schools 1 _ _ _ _ _ . Total, kindergarten through grade 12 _ 41,270,000 3, 600,000 42, 970, 000 3,750,000 Higher education: Universities, colleges, professional schools, junior col¬ leges, normal schools, and teachers colleges (degree-credit enrollment) Total, elementary, secondary, and higher education _ _ _ 44, 870,000 46, 720, 000 1 Includes Federal schools for Indians, federally operated elementary-secondary schools on posts, model and practice schools in teacher training institutions, subcollegiate departments of colleges, and residential schools for exceptional children. Table 2. — Supply and demand for elementary and secondary public and non¬ public school teachers: Continental United States ( excluding Alaska ), 1959-60 [Office of Education estimates] Item Elemen¬ tary and secondary Item Elemen¬ tary and secondary S upply Demand Total classroom teachers 1958-59 _ 1, 493, 000 Total classroom teachers 1958-59 1, 493, 000 70, 000 Less teachers with substandard creden¬ tials in public schools preceding year (Fall 1958) Total classroom teachers needed to meet enrollment increases in 1959-60 . . 92, 300 Qualified classroom teachers, preceding year _ 1, 400, 700 1 viol LldoMUULLl IcaLllcIo IlvcUDu lyoy CU-- Less qualified teachers from regular sources in classroom service, 1959-60-.. l, Quo, UUU 1, 368, 000 Less qualified teachers not returning to classroom service in 1959-60 1 152, 700 Supply needed from other sources, 1959-60 195, 000 Qualified teachers of the preceding year returning to classroom service in 1959-60 _ 1, 248, 000 97, 000 To be met by the re-entrance of former teachers into the profession, employ¬ ment of teachers with substandard Newly trained teachers entering class¬ room service 2__ _ _ _ credentials, further overcrowding of classes, or curtailment of curriculum. Teachers with substandard credentials becoming fully certificated 3 _ 23, 000 (The corresponding figure for 1958-59, using the same dropout rate, is 182,- 000 i). Total qualified teachers from regular sources in classroom service, 1959-60. 1, 368, 000 1 This figure for the number of qualified teachers not returning to classrooms is estimated on the basis of a 10.9 percent dropout rate. The total is approximately 50,000 higher than would be obtained by using the dropout rate of 7.5 percent employed in previous years. The advisability of using the new rate was indicated by the results of a survey conducted by the Office of Education. 2 Derived from The 1959 Teacher Supply and Demand Deport, National Education Association, Research Division. Computed as 83.3 percent of newly certificated inexperienced elementary teachers, and 67.8 percent for high school teachers. 3 One-quarter of the teachers with substandard credentials the preceding year, probably a generous estimate. No data available. Office of Education 229 Table 3. — Grants and other financial assistance to States , Office of Education , for fiscal year 1960 1 2 3 States and outlying parts of the United States Total 2 _ Alabama _ Alaska _ Arizona _ Arkansas - California - - Colorado _ Connecticut _ Delaware _ District of Columbia. Florida _ Georgia - - Hawaii _ Idaho _ Illinois - - Indiana _ Iowa _ Kansas _ Kentucky _ Louisiana _ Maine - - Maryland _ Massachusetts - Michigan _ Minnesota _ Mississippi - Missouri _ Montana _ Nebraska _ Nevada _ New Hampshire . New Jersey _ New Mexico . . New York _ North Carolina _ North Dakota _ Ohio _ Oklahoma _ Oregon _ Pennsylvania _ Rhode Island _ South Carolina _ South Dakota _ Tennessee _ Texas _ Utah _ Vermont _ Virginia _ Washington _ West Virginia _ Wisconsin _ Wyoming _ Guam _ Puerto Rico _ Virgin Islands _ Colleges for agri¬ culture and the mechanic arts Coopera¬ tive vocational education Mainte¬ nance and operation of schools (Public Law 874) School construc¬ tion (Public Law 815) library services Defense educational activities Men¬ tally retarded Total 5, 051, 500 39, 140, 434 3166,660,734 70, 553, 170 7,036,729 < 68, 506, 824 71, 327 357, 020, 719 100, 541 1, 063, 459 4, 134, 169 1, 178, 556 207, 576 1, 924, 249 8, 608, 552 71, 283 85, 978 4, 937, 070 2. 273, 264 46, 657 78. 720 7, 492, 973 77, 477 204, 863 3, 910, 640 3. 360, 417 72, 485 139. 691 7, 765, 576 89, 047 780, 559 953, 655 660, 185 164, 544 883, 240 3, 531. 233 175, 599 2, 083, 982 26, 023, 090 12,396,011 239. 322 1, 869, 372 2, 033 42, 789, 412 83, 218 340, 791 4, 657, 958 1, 482, 603 88, 084 1,162,940 8, 132 7, 823, 726 90, 022 352, 160 1, 504, 810 360, 626 67. 807 317, 107 2, 692. 535 73, 172 185, 836 641, 028 48, 391 109, 059 1, 057, 488 117, 625 230, 289 347. 914 97, 644 641, 558 4, 765, 332 1, 577,909 146, 259 2, 025, 014 9. 000 9, 262, 718 104, 360 1,094. 212 4, 650, 651 1.364, 942 223, 578 820, 728 8, 258. 473 74, 985 180, 891 958,511 2, 330, 961 55. 087 283. 933 3, 884, 370 75, 871 231, 670 1, 313, 116 602, 442 85, 934 587, 751 2, 896, 786 156, 905 1,682, 459 2,911,440 1, 072, 962 230, 178 1, 186, 055 3,650 7, 243, 650 109, 244 963, 233 862, 161 1.438,320 1, 945, 686 5,318, 646 96, 145 849, 945 597, 624 318, 876 213, 719 957, 220 3,033, 531 89, 005 577. 369 4. 527, 154 1, 467, 086 76, 570 486, 667 7, 223, 854 99, 374 1, 065, 690 1.113, 299 205, 963 221, 203 1, 054, 541 3, 760, 073 96,768 871, 379 849, 597 268. 053 158, 010 1, 978, 294 4, 222, 102 79, 115 231, 634 1, 400, 588 367, 808 61, 052 322, 391 2, 450 2, 465, 039 93, 371 447, 163 5, 487, 449 4, 250. 791 72,000 484, 574 10. 835. 350 116, 788 733, 176 4, 768, 743 573, 097 80. 000 1, 050, 448 _ 7, 322, 254 133. 559 1, 358, 365 920, 041 2. 800. 457 221, 976 2, 950, 174 8, 384, 574 99, 750 935, 247 413, 809 246, 113 172. 203 1, 678, 280 2, 166 3, 547, 570 91, 735 961, 493 1, 348, 521 684, 269 193, 061 2, 068,017 5, 347,097 109, 448 1, 084, 681 2, 050. 041 931, 751 198, 893 1, 641,219 6, 016, 035 75, 895 205, 305 1. 414, 747 1. 520, 194 72, 427 356, 026 3, 644, 596 83, 222 441, 703 1. 557, 295 485. 835 108, 519 512, 256 3, 188, 832 71, 596 179, 589 1, 226, 881 124, 835 68,141 84, 499 1, 755, 543 75, 319 173, 264 1,034,802 62, 015 331, 118 1, 676, 519 118, 233 767, 848 3, 079, 175 963, 315 97,403 1, 756, 621 5.500 6, 788, 096 76, 794 235, 333 4, 036, 614 4, 429, 888 73, 042 663, 376 9, 515. 050 217, 933 2, 482, 102 3, 416, 560 1, 586, 921 249, 152 4, 761, 827 3,050 12, 717. 547 110, 518 1, 500, 204 2, 011, 507 703, 359 302, 331 3, 223, 393 1,633 7, 852, 948 76, 180 288, 687 336, 233 845, 927 42, 146 422, 098 9,800 2. 021, 072 149, 269 1, 670, 421 4, 139. 409 1,048,253 270, 635 1, 952, 603 7, 331 9, 237, 922 92. 278 736, 475 6, 615, 389 3, 066, 253 99. 815 1, 345, 086 11,955, 297 85, 175 389, 785 851. 685 266, 000 89, 514 848, 936 2. 531, 096 174, 719 2, 118, 946 5, 166, 227 6, 096 250, 486 4, 662, 760 12. 379, 235 77, 899 173, 149 1, 607, 652 242, 489 59, 305 352, 195 2, 512, 690 91, 117 732, 732 2, 890, 143 525, 502 127, 918 567, 630 2,650 4, 937, 694 76, 511 287, 001 1. 698, 838 958, 222 82, 462 268, 828 3, 371, 863 102, 835 1, 123, 383 1, 891. 600 226, 395 219, 097 1. 751. 043 3,532 5, 317, 888 146, 920 1, 993, 378 11,099, 365 4, 575, 261 288, 142 6, 591, 644 3,050 24, 697, 762 76, 871 189, 731 1, 645, 421 689, 843 74, 658 363, 868 3. 040, 395 73, 768 187, 365 64,664 63, 385 218. 507 607. 690 103, 104 987, 317 13. 007, 273 4, 003, 652 211, 253 2, 607, 408 20, 920, 009 93, 730 542, 274 7. 100. 291 1, 353, 152 125. 287 1, 588, 351 _ 10, 803. 087 90, 005 628, 224 115, 532 167, 674 1, 788, 849 2, 790, 286 104, 260 960, 903 555, 663 190, 468 2, 328, 611 7, 350 4, 147, 257 72, 898 170, 986 660,542 198. 800 50. 291 303, 293 1, 456, 812 64, 069 711, 730 519, 500 15, 495 65, 058 1, 375, 852 50, 000 742. 086 2, 949, 537 220,000 509. 802 4, 471, 426 42,730 75. 439 11, 079 45, 449 174, 697 1 On a checks-issued basis. Does not necessarily agree with allotments or expenditures for a given year. 2 Inasmuch as the cents have been dropped from this table, a totaling of any column may or may not equal the total given for that column. 3 Does not include payments made to Army, $5,274,916.85; Navy, $1,367,808.36; Air Force, $1,482,562.09. * Does not include amounts paid for loans and repayable advances or amounts paid to institutions under the National Defense Education Act, $60,264,003.12. Food and Drug Administration The food and Ding Administration is in a period of transition, of growth from a small organization to one adequate to meet the heavy responsibilities recognized by a committee of distinguished citizens appointed in 1955 to appraise its operations. Laws enacted since then for better public protection have required substantial additional per¬ sonnel and facilities. A management consultant firm employed to review field operations, in a report issued early in 1960, recognized the growing demands being made upon FDA by the development of new products and manufac¬ turing processes. It affirmed the recommendations for additional manpower made in 1955 by the Citizens Advisory Committee. The report recommended continuing the present system of FDA Districts, and increasing the number and staff of Resident Inspection Posts. It also called for additional measurements of workload and work accom¬ plishment to ascertain how well the consumer is being protected. Program planning is being conducted on a long-range basis. The groundwork is being laid for systematic reporting of statistical data that can be used for program formulation, direction, and evaluation. Plans for the coming year include securing more information concern¬ ing the firms wdiose operations are subject to the Food, Drug, and Cosmetic Act, and their products. Plans also call for increasing from 77 to 130 the number of carefully designed regulatory programs that will be given major emphasis. Further planning is directed toward setting the goals of industry compliance to be sought from year to year in view of increased enforce¬ ment and educational facilities available. To accomplish this, and the other program-planning activities, advanced data-processing tech¬ niques must be employed. Training programs during the year were largely devoted to the field force. Supervisory personnel have a serious responsibility in training 231 232 Department of Health , Education , and Welfare , 1960 the new inspectors and chemists in the specialized techniques required for modern regulatory work. They must also keep experienced mem¬ bers of the staff informed on new developments in microanalysis, radiological instrumentation, and new chemical and bacteriological methods required in pesticide, food additive, and antibiotic detection and measurement. A series of newsworthy events about FDA programs and activities during the year caused a flood of inquiries concerning the safety of the food supply, and of lipsticks. Each development is covered in more detail later in this report. The largest food sampling and testing pro¬ gram in FDA history began in November 1959 when shipments of cranberries were found to be contaminated by a weedkiller known to cause cancer in test animals. The public needed assurance that the testing and labeling practices put into effect for the entire crop would make it safe to serve the traditional holiday menu. Not long afterwards, findings that a hormone (stilbestrol) , to capon - ize poultry artificially, remained in some parts of the treated birds required negotiation and announcement of industry agreements to discontinue such treatments and withdraw treated birds from the market. Concern likewise arose about the safety of lipsticks after proposals were published to ban most of the coal-tar colors that could be certi¬ fied for use in them. This was necessary because the law, subsequently amended, prohibited certification of such colors as safe and suitable for use if they were harmful in any quantity, without regard to the concentration normally used. Accurate press reports about these regulatory and administrative actions had to compete with sensational magazine articles and books charging that poisons are rampant in the Nation’s food supply. Some consumers were alarmed, others became aware for the first time of the complex problems involved in the use of chemicals to produce, process, package, and transport food crops. Thousands of consumer inquiries came to the Division of Public Information, each letter call¬ ing for an answer as to FDA’s views, and assurance that every possible precaution is being taken to protect public welfare. A Consumer Inquiries Branch was established in the Division to answer such correspondence informatively and more efficiently. New publications were developed covering major topics of interest. A booklet, “What Consumers Should Know About Food Additives” and a circular, “Food Facts vs. Food Fallacies” were reprinted by industry organizations and widely distributed to libraries, schools, and other educational institutions. Millions of growers and processors also received FDA educational material through organizations that could reach specific groups. Efforts were made particularly to reach growers who do not ship Food and Drug Administration 233 their products directly in interstate commerce, but whose products eventually move interstate. Agricultural teachers received copies of “Grain Sanitation,” “Clean Corn,” “Milk and Cream — How to Comply with the Federal Food, Drug, and Cosmetic Act,” and “Protecting Crops and Consumers,” and requested thousands of copies for use in their classes. Milk and dairy associations distributed over a million copies of a message to farmers entitled “Keep Residues of Drugs and Pesticides Out of Milk.” The first million was used so quickly that an immediate reorder was required. This was the first time FDA had ever attempted to place an official notice about the law into the hands of every member of such a large industry group. The program of interpretive releases for the trade and public press has been expanded in order to explain the many new regulations and policy statements that have been issued, and to promote better public understanding of complex issues. The Consumer Consultant program was reactivated bv appointing a Consumer Programming Officer to plan and coordinate the activi¬ ties of 20 consumer consultants located in the Districts. The function of the consultants is to provide planning personnel with information needed to appraise the effectiveness of consumer protection. The con¬ sultants also help to disseminate FDA information to consumer groups through talks and meetings and by radio and television appearances, to the end that informed public opinion will be the basis of recom¬ mendations for better protection. The basic 1961 fiscal year appropriation is $16.8 million, a $3 million increase over that for 1960. In addition, $100,000 was appropriated for preliminary planning of an animal research facility. A supple¬ mentary appropriation of $1.2 million was enacted to implement new laws signed July 12, 1960 — the Color Additive Amendments and the Hazardous Substances Labeling Act. The 1961 appropriation provides for 2,199 positions in FDA, in¬ cluding* 451 in programs resulting from legislation enacted after the Citizens Advisory Committee study was made in 1955. On the basis of a projected 15-percent annual increase from the 1956 total of 877, the Citizens Committee goal for 1961 is 1,763, or 15 positions more than the 1,748 actually provided for work covered by their recommenda¬ tions, and not counting personnel provided for the new programs. Seventy-five percent of the increase in basic funds is budgeted for improved field operations, including an increase in inspectors which will permit inspecting plants at a rate of once in 41/2 years in com¬ parison with about once in 5i/£ years in fiscal 1960. The 1961 budget provides funds for the continuation of a planned program of reno¬ vating FDA’s District office facilities, on a 2-year schedule. Funds are requested for fixed equipment during the first year, and for special items of portable scientific and administrative equipment 573826—61 - 16 234 Department of Health , Education , and Welfare, 1960 during the second year. The 1961 budget provides funds to complete Los Angeles and Buffalo District offices begun in 1960, to begin the first-year renovation of Boston, Cincinnati, Kansas City, and Min¬ neapolis Districts, and for the partial financing of first -year costs to renovate New York District. With a new building for Detroit opened a year ago, new quarters for Atlanta dedicated in June 1960, and the new Dallas District to be opened in January 1961, 10 of the 18 Districts will be modernly and efficiently housed by 1962. Congress appropriated $15.1 million for construction of an FDA headquarters in Washington. This will alleviate the acute shortage of laboratory and office space which the Citizens Advisory Committee had pointed to in 1955. The expansion program it recommended, and which won the support of the Administration, Congress, and the public at large, has now made headquarters space even more inadequate. The staff has been dispersed into scattered locations at the expense of efficiency. Existing antiquated facilities are not suitable for the advanced experimentation required today to keep up with the tech¬ nological advances of the regulated industries. Therefore, the fa¬ cilities planned, both in Washington and the field, are not luxuries, but are necessities to meet the demands of increasing responsibilities, numerical growth, and scientific progress. An adequate animal research facility is imperative. Experimental animals have been required for decades in conducting drug bioassays for compliance with U.S. Pharmacopeia standards. By 1935, phar¬ macology had become so important to FDA evaluations of safety that a new Division was formed and staffed with experts. The 1938 Act, with its provisions for control of safety of new drugs before market¬ ing, materially added to the responsibilities of this Division and required an increase in the number of experimental animals to be housed. Antibiotics certification tests further expanded the animal colony. The Pesticides Chemicals Amendment of 1954, and, more extensively, the Food Additives Amendment of 1958, made the housing problem for necessary research animals even more acute. Every effort is being exerted to provide better housing for the animals. The 25-percent increase for headquarters operations will be utilized to improve basic and applied research on food additives and pesti¬ cides, to obtain the results of experience with new drugs after they are in widespread use, and to give increased attention to food standards. Funds are also provided for the study of radiological contamination of foods, drugs, and cosmetics. Specific problems that also will be studied will include bacterial contamination of frozen foods, the possibility of carcinogens finding their way into foods, and toxic prop¬ erties of fatty acids, all of which are under intensive investigation by industry scientists. Food and Drug Administration 235 Efforts to improve public understanding of regulatory programs and thereby promote voluntary compliance will also be stepped up under the provisions of the 1961 budget. Food, Drug, and Cosmetic Act ON THE FOOD FRONT One of the major disasters of the year in its effect on interstate sup¬ plies of foods and drugs was the explosion in the downtown area of Rosenberg, Oreg., of a truck loaded with 2 tons of dynamite and 4 y2 tons of ammonium nitrate. Two grain elevators, a soft-drink bottling plant, some drugstores, and a drive-in ice cream establishment were among the establishments wrecked with glass particles contaminating the foods and drugs. FDA assisted State and local health and food officials in segregating contaminated lots, which were destroyed under the supervision of these officials. The Montana earthquake in August caused great injury to vacation¬ ers but there were few food and drug establishments in the disaster area requiring attention. Potential Health Hazards Radiation and Civil Defense . — In August the President established the Radiation Health Council and designated the Secretary of Health, Education, and Welfare as its chairman. Under this program FDA has been given the responsibility for determining, establishing, and enforcing permissible levels of radioactivity in foods, drugs, and cosmetics; monitoring such products to determine levels of radio¬ activity; conducting research for identification and evaluation of radioactivity in foods, drugs, and cosmetics, and decontamination techniques for affected products, and for the training of Federal, State, and local food and drug officers and professional and technical em¬ ployees of regulated industries in such methodology and techniques; approving radioactive drugs used in diagnosis and treatment ; conduct¬ ing regulatory work to combat “radioactive” quackery; and for disseminating information about these activities. Twenty-six persons were assigned to the radiological program for this fiscal year 1960; it wfill be augmented in 1961 with a budgeted staff of 116. The 11 civil defense positions are financed by funds appropriated for the Office of Civil and Defense Mobilization. During the year a number of reports were made of samples col¬ lected from various parts of the country and tested for total beta radiation, as a check on fallout contamination. This program covered about 6,000 samples of 50 different foods, including some imported articles. Although tabulations have not been completed, there appears to be a general decline in total radioactivity except for tea, alfalfa, and 236 Department of Health, Education, and Welfare, 1960 spinach. Brewing of the tea and processing of the spinach significantly reduced the levels of radioactivity in those commodities as consumed. With the cessation of large-scale nuclear weapons testing in October 1958 the shorter-lived isotopes from fallout apparently have decreased considerably and new methods to isolate individual isotopes must replace the “total beta” measurements which have been used for fall¬ out comparisons. Tests were begun for Strontium 90 in wheat, cabbage, and potatoes grown in 12 States and soybeans from one of them. Examination of individual samples showed levels within the limits recommended by the National Committee on Radiation Protection as permissible for lifetime exposure. The FDA Civil Defense Training Program for Federal, State, and local food and drug officials, designed to help them safeguard the food and drug supplies of the Nation in case of enemy attack, was reactivated in 1960. Basic changes were made in the original course to conform to new developments in chemical, biological, and radio¬ logical weapons since 1957. More time was given to practical exercises and less to the more technical aspects of the course. The revised train¬ ing courses held at 10 field Districts and in Washington, D.C., were attended by 337 people, including new FDA employees, State and local food and drug officials, and members of regulated industries. The remaining Districts will be covered in 1961. The course presented the effects of theoretical chemical, biological, and radiological attacks on food and drugs, procedures for testing exposed food and drugs, and the decontamination or destruction of contaminated food and drugs. The Biological Warfare Research Program was limited to building an organization necessary to perform the research operations, and acquiring a thorough understanding of the problem. A Biological Warfare Research Branch has been created. The program being de¬ veloped is designed to study the vulnerability of wholesale packages of foods and drugs to bacteriological agents introduced during overt or covert attacks, and to develop simple procedures that will be crit¬ ically needed following any enemy attack for decontamination of affected products. It is hoped that this program may be expanded by similar studies of products in retail containers and by the deter¬ mination of the longevity of potential agents in various foods held under usual storage conditions. Food additives . — Regulations promulgated under the Food Addi¬ tives Amendment to the Act are discussed under “Changes in the Law and Regulations.” Some industry groups were at first surprised to learn that the term “food additives” covers much more than the mere deliberate addition of substances to foods in the process of manufac- Food and Drug Administration 237 ture, where the manufacturer knows exactly what he is putting in, how much is involved, and whether or not its safety has been established. Illustrations of such possibilities and problems include compounds formed by chemical reaction during the process of manufacture ; resi¬ dues of insecticides and cleaning materials used in food plants and processing equipment; compounds to prevent corrosion in boilers, which may be carried by steam into the food ; substances which migrate to the food from packaging materials, printing ink, and mold inhibi¬ tors used on fruit containers ; and drugs added to animal feeds either to treat disease or promote growth. FDA staff members gave talks to industry associations throughout the year to promote better understanding of the specialized problems confronting them. In contrast to the food industry which had long experience in operating under the Food, Drug, and Cosmetic Act, many of these groups were facing Federal regulatory procedures for the first time, some with apprehension. The use of stilbestrol for the artificial caponizing of poultry was authorized in 1947, after a 2-year study of new-drug applications showing that no significant residues of the drug wTould remain in the edible tissues of treated birds. Since it wTas known that this hor¬ mone could cause cancer in experimental animals, a policy statement was issued in May 1959 that under the Food Additives Amendment provisions, no further new-drug applications could be made effective for such substances and that all sanctions then in effect would be reviewed. An extensive reexamination of the use of stilbestrol in the raising of beef cattle, sheep, and poultry showed no detectable residues in meat from treated animals but small residues were found in the skins, livers, and kidneys of treated poultry. Authorized manufacturers were requested to suspend production of stilbestrol for use in poultry immediately, and representatives of the poultry industry and the retail food industry were requested to arrange for the immediate discontinuance of the sale of treated birds to consumers. Their agreements to do so were announced on December 10, 1959. Approximately 1 percent of the poultry crop was involved. (See also “New Drugs.”) Consumers, too, need to know more about food additives. Writers of sensational articles and books are frightening many people with false conclusions about the safety of the food supply, as mentioned in the introductory chapter. FDA published a booklet in January entitled “What Consumers Should Know About Food Additives” to explain to the public that food additives are an integral part of the tremendous progress being made in modern food technology and that the new law establishes safeguards to prevent the use of new, untested substances. 238 Department of Health , Education} and Welfare , I960 The Food Additives Amendment became fully effective on March 6, 1960. Attention was given to food additives during 3,700 factory inspections, with referral to FDA headquarters of any findings re¬ quiring administrative or scientific review. Pesticides.- — The enforcement of the 1954 Pesticide Chemicals Amendment is one of FDA’s major problems. Approximately 2 million growers are using several hundred million pounds of pesticides yearly in the production of our foods. Approximately 23 percent more field time was spent on this project than in the previous year in surveillance of pesticide practices of growers, the collection and examination of samples, educational work, and the development and improvement of analytical methods. Sixty seizures totaling 1,377 tons were made during the year of raw agricultural commodities containing unpermitted pesticide chemicals or residues in excess of established tolerances, and processed foods having unpermitted pesticide chemical residues. In volume, the largest seizures involved 738 tons of apple pomace stored in farm silos. This pomace consists largely of the skin and extracted pulp of apples, the byproduct of the manufacture of vinegar, cider, apple¬ sauce, and other apple products. It contains a concentrate of pesti¬ cide residues much greater than the apples from which it is derived. FDA investigations showed that when cattle were fed apple pomace DDT appeared in the milk and meat, and a policy statement was issued that articles containing such residues were in violation of the F ood, Drug, and Cosmetic Act. Most of the apple-processing plants arranged to have the pomace hauled to dumps but some of it found its way into the silos of dairy farmers. After the seizures were adjudicated, the pomace was taken from the silos, spread on the fields, and plowed under. In its impact on the public as well as the industry, the action taken involving cranberries containing aminotriazole by far dominated all of the other enforcement work. Although the tonnage destroyed after seizure was approximately one fifth of that of the apple pomace, more than 3 million pounds of the 1957 crop, which had been held until the residue status was cleared, were in the process of being destroyed voluntarily when contamination was discovered in the 1959 crop going to market. The use of aminotriazole as a weed killer on cranberry bogs began in the 1957 growing season before it was registered with the U.S. De¬ partment of Agriculture on a no-residue basis, with directions calling for use not later than 7 to 10 days after harvest. These directions were widely disseminated after the registration in January 1958, and a large volume of the 1957 crop known to have had application of the weed killer during the growing season was set aside in freezer storage pend¬ ing an expected establishment of a residue tolerance. Petitions for Food and Drug Administration 239 such a tolerance were withdrawn when evidence developed that amino- triazole caused thyroid tumors in experimental animals. When there were rumors that the chemical was being misused, FDA chemists be¬ gan working to perfect methods to detect it in the cranberries. When the method was finally available in the fall of 1959, samples of cran¬ berries were examined for aminotriazole and interstate shipments found contaminated were seized and the facts were announced to the public. Because of the approaching holiday season, FDA launched into the most extensive sampling and testing program it had ever undertaken for a single commodity. Press, radio, and television kept the public informed of day -by-clay progress on the clearance program — some pa¬ pers even going into detail as to the procedures of the time-consuming tests and the elaborate equipment required. Agreement was reached with the industry on a plan for labeling cranberries tested and found free of aminotriazole so that the buying public could identify these cranberries and buy them with confidence. In October 1959 it was announced at a milk industry meeting that FDA was starting to sample milk with a view to regulatory action on shipments containing residues of antibiotics and pesticides. This fol¬ lowed a 5-year period of FDA investigational surveys and an educa¬ tional program in which agricultural and industry groups had participated. After this announcement schools were set up to teach the methods involved in detecting and measuring drug and pesticide residues. State and local officials attended 12 antibiotics and 13 pesti¬ cide methods schools, and there was also participation by key industry technologists who could train other industry control people in their use. State and local agencies examined more than 50,000 samples for antibiotic residues, issued warnings when they were found, and in some cases refused to permit deliveries until the milk was found free of contamination. They were also active in tracing sources of con¬ tamination in the eight shipments of dairy products that were seized by Federal action because of pesticide residues. These consisted of six lots of evaporated milk, one of condensed milk, and one of butter. Eight carloads (346 tons) of mercury-treated grain diverted from seed use to food channels were seized. Other pesticide residue seizures included celery to which Parathion was applied in many times the recommended amounts, Bibb lettuce, spinach, and dried beans. The lettuce was produced in greenhouses where it was protected from out¬ door conditions and a fungicide (PCNB) which was registered on a “no-residue” basis was applied. The firm, when notified by FDA that the lettuce contained an unpermitted residue, persisted in shipping it and advised dealers not to hold it pending Government analysis. The Department of Agriculture then issued a notice that the labeling of 240 Department of Healthy Education , and Welfare , 1960 pesticides is approved only for normal outdoor use, and should not be followed for greenhouse growing unless specific directions appear on the label for such use. Food 'poisoning . — Forty-live outbreaks of suspected food poisoning involving approximately 3,600 persons were investigated by FDA dur¬ ing the year. Insanitary handling or prolonged holding under in¬ adequate refrigeration continued to be the underlying cause of a majority of the outbreaks. In two outbreaks, foods in interstate commerce appeared to be in¬ volved, one of these was associated with a product in an apparently defective container. Investigation revealed that the remainder of the lot was satisfactory. Whipped oleomargarine held without re¬ frigeration in retail stores was responsible for the illness of 36 per¬ sons. Investigation revealed the presence of enterotoxic Staphy¬ lococci in samples of the product. Lots involved were not of recent production and no outstanding lots were found on the market. Botulinus in home-canned foods was responsible for 4 outbreaks involving 10 persons with 3 deaths. To Keep Food Clean Although first attention must be given to keeping potentially dan¬ gerous food from reaching consumers, 75 percent of the food seizures were based on filth and decomposition. A total of 6,898 tons were seized in 571 actions. Of these, 336 seizures involved merchandise that became unfit after interstate shipment. As the result of FDA inspections disclosing merchandise that would be subject to seizure if shipped, owners voluntarily destroyed an additional 6,913 tons of unfit food in 1,133 actions. They also reported 251 plant improvements costing nearly 3 million dollars in structural changes, repairs, new equipment to contribute to sanitary operations, and hiring of new sanitarians. Many other firms are continuously improving their plants and operations without reporting- details and costs to inspectors, or suggestions being required. In either case, such actions provide long-range consumer protection. One of the largest voluntary recalls and destructions followed na¬ tional press publicity given to seizure in Hawaii of a small lot of spaghetti in tomato sauce following a factory inspection indicating that the spaghetti used had been prepared and held under insanitary conditions permitting insect contamination. The home office in the East sent top management representatives to the California branch to correct the situation. The manager was relieved and the plant shut down for cleaning. About $100,000 worth of the product was recalled from the market and destroyed, and approximately 120,000 Food and Drug Administration 241 pounds of spaghetti ingredients that had been held under insanitary conditions were converted to animal feed. In general, warehouse conditions have improved as a result of con¬ stant pressure and legal actions. Inspections made at food-storage warehouses, including wholesale grocers, chainstore warehouses, cold- storage warehouses, and other establishments where food is stored for subsequent distribution, totaled 3,653, a slight increase over the 3,218 warehouse inspections made in 1959. Seizures were made of 146 lots found contaminated with filth, 13 prosecution actions were filed, and 3 injunctions were requested to pre¬ vent the distribution of food that had become contaminated while held for sale. In two of these cases improper use of a toxic rodenticide was also a factor. In another case where injunction was under considera¬ tion the firm and the building owner made extensive repairs of the warehouse, destroyed rodent-contaminated and insect-infested mer¬ chandise, and thoroughly cleaned the premises, thus attaining the ob¬ jectives of an injunction without formal action. The largest warehouse seizure involved a million pounds of rodent- contaminated sugar in the spring of 1960. A few months earlier a relatively small portion of this large lot was found contaminated and seized but the owner did not take the necessary steps to keep rodents from defiling the remainder of the lot. A warehouse owner fined $3,000 for insanitary storage conditions resulting in the contamination of cereals and ready-mixes had been convicted on the same charges within a year. The Federal judge, at sentencing, said he would be fully justified in imposing a prison sen- Table 1. — Actions on foods during the fiscal year 1960 Projects Seizures Criminal Prosecutions instituted Injunction petitions Total... . . . . . . . 757 61 10 Beverages and beverage materials _ _ _ 13 0 Bakery, ready to eat cereal, and macaroni products _ 9 12 Cereals and grain products: Human use _ _ 101 2 4 Animal use _ . ... . .. _ _ . 2 Chocolates, sugars, and related products _ 26 4 1 Dairy products: Butter and churning cream _ _ _ _ _ ... .. 19 5 Cheese and other dairy products _ 12 0 Eggs and egg products.. _ ..... ... 21 4 1 Flavors, spices and condiments . . 16 3 1 Fruits and fruit products . . . . . . . . 63 1 Meat products and poultry _ . 9 0 Nuts and nut products . _ . .. . . . . .. 91 4 Oils, fats, and oleomargarine _ . . . 1 Seafood. .. _ _ _ 65 2 1 Vegetables and vegetable products _ _ _ _ _ _ _ 102 8 1 Miscellaneous foods (mixed lots) . . ... 5 0 Warehouse foods.. _ .. _ ... _ ... .. 147 13 3 Food for special dietary uses 1 _ . .. . 38 0 Food adjuncts . . 1 0 1 Includes vitamin products intended as food supplements. 242 Department of Health , Education, and Welfare , 1960 tence, and warned the defendant that he must choose between keeping his warehouse clean or getting out of the food business. During the educational campaign to keep pesticides and antibiotics out of the milk supply the message of clean milk and cream was con¬ tinued. A trend from farm-separated to creamery-separated cream, with collections in bulk tank trucks is creating a problem for the milk station in identifying the farmers who are not following recommended practices of protecting milk from filth and decomposition. In deliv¬ eries in cans from individual farms the collecting stations could deter¬ mine objectionable lots by sediment tests and reject them. Shrinkage in the volume of production, consolidation to larger manufacturers with better quality control concepts, and a marked switch from sour to sweet cream for butter making have resulted in a decrease in regula¬ tory actions, from 18 seizures of filthy butter and churning cream in 1959 to 8 in 1960. One firm that had continued the manufacture of sour cream butter was prosecuted for the shipment of adulterated cream and with its officers, was fined $9,000, the heaviest fine of the year, and the heaviest meted out to a creamery in recent years. The firm has announced that it will discontinue manufacturing sour cream butter. The clean grain program was continued through talks at meetings and discussions with many members of the trade, participation in grain association schools, distribution of sanitation leaflets, and inspections of elevators and bulk shipments. The program was furthered by inspectors of the Commodity Stabilization Service who followed up on FDA’s reports of violative elevators storing CSS grain, and issued warnings that licenses would be suspended for elevators that did not protect the grain from rodents and insects. Their actions stimulated repairs and diversion of contaminated grain to feed use before it could contaminate incoming clean grain. Four injunction petitions were forwarded to the Department of Justice to prevent the shipment for human consumption of adulterated wheat held under insanitary conditions. Seizures of bulk lots of grain contaminated by rodents were made in 27 actions involving 1,895 tons. Continued sanitary improvement was noted in most processing plants, but one large candy factory was enjoined from shipping con¬ taminated products from a factory heavily infested by insects and rodents. Two large lots of contaminated cocoa beans had been seized at this factory, and factory inspections in October, December, and January disclosed intensive infestation of the plant’s equipment as well as in raw materials and finished chocolate products, despite previ¬ ous warnings. The injunction restrained the firm from shipping ap¬ proximately 300,000 pounds of products manufactured under these insanitary conditions. Food and Drug Administration 243 Improved sanitary conditions were found in the crab-picking plants of the Chesapeake Bay area. A South Carolina crabmeat packer was fined $500, given a 1-year suspended sentence, and placed on probation by a judge who commented that crabmeat, usually consumed without further cooking, should be produced under the very best conditions. Rodents, insects, and insanitary personal habits are intolerable, he added, and those who cannot produce crabmeat under the best of con¬ ditions should get out of the business. The problem of diversion of incubator reject eggs to human food channels by an organized group of bootleg-type racketeers has been discussed in previous reports. In the Southeast, a permanent in¬ junction was granted to prevent the interstate shipment of lots lo¬ cated last year, fines were levied against another firm and its operator, and additional seizures were made. At Nashville, three key individu¬ als in the racket were sentenced to 4-month prison terms for shipping frozen candling rejects for food use. They had been involved in Federal jurisdictions elsewhere and had had their cases transferred to the Federal court at Nashville, expecting lighter penalties. A convicted principal in the East Coast diversion of rotten incubator reject eggs into foods, pleaded guilty to violating terms of a 5-year probationary sentence and was sentenced in November 1959 to 3 months in jail, for shipping reject eggs from Connecticut to New York for breaking out and packing in 30-pound cans to be frozen and dis¬ tributed to New York and New Jersey food processors. Fines were also imposed against operators in Florida and Texas. The ringleaders of this group apparently have diverted their activities to other enterprises, but such a profitable racket is difficult to suppress and others will continue to attempt it. For example, a new bootleg incubator reject enterprise was uncovered as a result of information received from Michigan authorities that some hatcheries were making shipments from that State. Surveillance was established and a truckload of more than 600 cases was seized while in transit in northern Indiana. This type of en¬ forcement requires extensive time, unusual hours, and coordinated efforts of Federal, State, and local officials. Pocketbook Protection The 1959 report described a nationwide check of the net weight of packaged foods and announced the initiation of a seizure program when significant shortages are encountered and attention to net con¬ tents practices of food packers as a part of each food-plant inspection. Products seized for short weight or volume during the fiscal year included popcorn, candy, spices, frozen strawberries, stuffed olives, nuts and nut products, cooking oil, canned peppers, tomato sauce, and soup mix. 244 Department of Health , Education , and Welfare, 1960 Among the products seized for failure to comply with official stand¬ ards were various “chocolate” items made with cocoa, and others low in chocolate, cocoa containing cocoa shell, enriched flour deficient in enrichment and failing to bear mandatory labeling information as to its vitamin and mineral properties, low- fat butter, cheese made from unpasteurized milk and not held the required 60 days, tuna failing to meet fill-of-container standards, canned peaches containing mixed pieces of irregular size, jams low in fruit content, margarine masquerading as butter and other margarine failing to bear manda¬ tory labeling, canned beans with excessive fiber, and canned peas not labeled to show that they had been prepared from dried peas. Another type of violation affecting the family food budget is failure of unstandardized items to meet the ingredient statements on their labels — through substitution of cheaper ingredients than the pur¬ chaser is led to expect. Seizures for such violations included coffee with dextrose and undeclared artificial flavoring, cream pies without the whipped cream they were declared to contain, fish fillets unlabeled as to species or packer, shrimp with broken pieces substituted for whole, whiting not fully dressed as labeled, vanilla containing artificial vanilla, monosodium glutaminate “extended” with salt, choke cherry preserves with artificial coloring, imitation lemon juice, watered orange juice, poultry falsely labeled “pheasants and guinea hens,” blended oils low in or without the olive oil claimed, and unlabeled pizza sauce. Among the deceptive animal feeds seized were meat scraps containing bristle, horn, hoof, and other non-edible animal parts, and cottonseed meal low in declared protein. DRUGS AND DEVICES Recalls. — -Thirty-five defective or misbranded drugs were recalled by manufacturers during the year, 11 at the request of FDA. Eighteen were defective in composition because of low potency, deterioration, lack of sterility, etc. Six were recalled because they caused injuries — three earwax removers that caused inflammation in some users, an arthritis ointment that caused burns, and two veterinary preparations that were toxic to pigs. Another recall was made by an importer of an injection drug when studies in England indicated that large doses caused cancer in experimental animals. Nine of the recalls were made to correct labeling — five were labeled with the names of other drugs, three required changes in ingredient statements, and one was labeled for over-the-counter sale, whereas it was limited to prescription dispensing by the terms of its new-drug application. Illegal Sales of Prescription Drugs A tragic episode in Arizona just before Christmas dramatized anew that drivers using amphetamines endanger our highways — a cattle Food and Drug Administration 245 truck speeding down the wrrong side of the highway collided with a bus, killing 9 people, injuring 31, and causing more than $100,000 worth of property damage. Amphetamine tablets were found in the demolished cab of the truck and the drug was found in the blood of the dead driver, who had been on the road 48 hours without sleep. A step-up in enforcement against illegal sales of amphetamines and barbiturates by persons unlicensed to dispense prescription drugs and untrained in the responsibilities attendant to such sales, is reflected in the fact that more court prosecution cases involved unauthorized sources than licensed pharmacists and drug stores, 82 and 80, respectively. Although many cases were brought against truckstops, cafes, small peddlers, etc., the primary objective was to uncover their suppliers. Large quantities of amphetamines were seized after arrests of whole¬ sale peddlers wdio had agreed to deliver the drugs to FDA inspectors they believed to be middlemen for truckstops. In volume the largest case involved more than 786,000 tablets seized from the dwelling and car of partners who have been charged with conspiracy to violate the F ood, Drug, and Cosmetic Act. Such whole¬ sale operators are the keymen in the situation; many of them have criminal records for other underground activities. Five cases were brought against medical practitioners, frequently tied up with truck-driver peddlers, on the charge of dispensing drugs without the physician-patient relationship so essential to good medical practice. Of 187 criminal actions charging drug violations 167 were based on illegal sales. Individuals and firms involved totaled 276. Adulterated and Misbranded Drugs andrDevices A serious threat to the production of prescription drugs of standard purity and potency was an independent testing laboratory which was giving faked data on the drugs it tested for small drug manufacturers. The firm offered complete drug analytical work, including chemical, bacteriological, and animal testing. FDA investigators found that the firm lacked the facilities to per¬ form the work. FDA laboratory scientists prepared samples for anal¬ ysis known to have different purity and composition than those de¬ clared on the label ; the testing firm reported that they complied with the label statements. The fictitious information the firm supplied its customers included data for establishing the safety of a new drug. Prosecution resulted in fines, a 1-year suspended jail sentence for the president of the firm, and a 3-year probation under strict supervision by FDA. Of equal danger to public health is the apparently widespread coun¬ terfeiting and repacking of potent drugs by bootleg-type operators who do not hold effective new-drug applications or have adequate con- 246 Department of Health , Education, and Welfare, 1960 trol systems. Just as the fiscal year ended, FDA Districts were work¬ ing with State drug officials and private investigators in developing evidence of large-scale distribution of counterfeits of trademarked new drugs, including some still in the stage of clinical investigation by the originators. The 1959 report described two cases based on counterfeits of well- known brands of tranquilizers. The head of one firm then under in¬ dictment received a 6-month suspended jail sentence and is now work¬ ing as a salaried employee of another drug firm; his former firm is out of business and his associate in the venture, who received a fine, has abandoned the drug business. Inadequate manufacturing controls were found in a number of cases, resulting in nonsterile injection drugs or drugs below or above their labeled potency. In one prosecution case in which the firm and its president were fined $3,500 a prescription drug was 2 y2 times its labeled strength. The firm had a long history of failure to control the potency of its products, and had been previously fined for sub¬ potency of vitamins. Charges were filed in 20 drug and device and 4 vitamin seizures that the items involved failed to meet standards set forth in official standards or their own labeling. False and misleading claims were charged in 158 seizures of drugs, vitamin and dietary items, and therapeutic devices. Thirty-six of these were based principally on unfounded claims of weight reduc¬ tion, and in many of the 38 vitamin and food supplement seizures such claims were prominent. Many of the purported reducers de¬ pended upon the supposed benefits of appetite depressants whose effectiveness has been disproved by controlled clinical tests conducted by a research group which included an FDA physician. In April a circuit court, in rejecting an injunction appeal by the distributors of a widely advertised product of this type, accepted the affidavits of medical experts that this drug (phenylpropanolamine) does not possess significant appetite-depressing properties as claimed. Another “appetite suppressant” offered for weight reduction was tartaric acid in cigarettes promoted by such slogans as “puff your pounds away” and “watch your weight go up in smoke.” A Federal court affirmed the Government’s view that these cigarettes were not effective for weight reduction, and upheld the seizure in November 1959. Other so-called weight reducers seized were supplements to low- caloric diets which would alone, if followed, result in weight reduction. The devices seized because of unfounded claims for weight reduc¬ tion were largely mechanical vibrators and massagers, usually promis¬ ing “spot reduction.” Among the purported cancer “cures” each also offered for various other serious conditions were colored lamps sold as do-it-yourself Food and Drug Administration 247 assembly kits, consisting of a lamp base, electrical fixtures and wiring, and five colored plastic slides. In addition to claims for cancer, this lamp was promoted in accompanying literature for glaucoma, arthri¬ tis, tuberculosis, scarlet fever, measles, influenza, and among others, “all diseases which may afflict the body of man.” On June 7 a Fed¬ eral court in Los Angeles issued a condemnation order for the seized lamp units and a permanent injunction against further distribution. Another “cancer cure” consisted of tape-recorded organ music of “Smoke Gets In Your Eyes” priced at $500, including a “sound thera¬ peutic vibrator” that could be made from widely available parts for $35. The patient could get the “message” and “treatment” by listen¬ ing to the music with earphones and through electrical energy supplied by two wire-connected pads, with current pulses varying in voltage with loud or soft music. It was offered not only for cancer, but for diagnosing and treating pathological conditions of the head, lungs, heart, stomach, gall bladder, spleen, appendix, spine, cataracts of the eyes, and germ diseases. Another device that was seized and distribution of which was halted provided two to three times the amount of radioactivity in a radium watch dial contained in eight quartz tubes imbedded in a plastic barrel. Another quartz tube containing blood taken from the patient was placed in the barrel, refrigerated for 24 hours, and reinjected into the patient in order “to establish the normal chemistry” of the body. It was recommended for cancer, diabetes, arthritis, anemia, and bone ailments and w^as used extensively in the treatment of mentally re¬ tarded children. At the end of the year it was under a temporary restraining order. Most of the devices seized wrere innocuous apart from claims that turned people away from competent medical treatment, but danger to health was charged in seizures of nine shipments of a breast developer with a mechanical pump suction, best described as a modified milking machine, and in an injunction case involving a gynecological device. False representations are still being made that vitamins, minerals, organically grown items, and various nutritional supplements are required to prevent or cure diseases caused by diets alleged to be universally deficient in nutritive value. FDA has continued its cam¬ paign to educate the public in the true value of nutritional advance¬ ments on the one hand, and the falsity of certain types of claims on the other. Typical are claims that the average American has a severe dietary problem because foods grown on depleted soil, or proc¬ essed in accordance with our modem custom, lack essential nutrients that must be supplemented to prevent, cure, and alleviate many disease conditions. A press conference by the Secretary of Health, Education, and Welfare, calling public attention to such misrepresentation, brought 248 Department of Health, Education, and Welfare , 1960 one firm nationwide attention by release of a series of correspondence between the firm and the Secretary. When the prosecution case against the firm was tried there was no contest and a $1,500 fine was assessed. Five other actions were brought for illegal sales promotion of nutritional items with unfounded medical claims. Another firm and its officers, enjoined in 1950 from making claims through literature or house-to-house salesmen, for its vitamin-mineral preparation in violation of the Federal Food, Drug, and Cosmetic Act, were ordered by the Federal Trade Commission to cease and desist from making false claims, including: That the decree of injunction amounted to an endorsement of their product by the U.S. district court and the Food and Drug Administration; that the allowable claims listed in the injunction applied only to the product and to no competitive product ; and that no other seller of vitamin and mineral products has the right to submit its promotional literature to the F ood and Drug Administration for inspection and comment. In a policy statement published in December, FDA warned that any claim, direct or implied, in the labeling of fatty substances offered to the general public that they will prevent, mitigate, or cure diseases of the heart or arteries is false aiid misleading, and will cause such sub¬ stances to be misbranded. Many firms had been attempting to capi¬ talize on the widespread interest in the possible relationship between blood cholesterol levels and heart and artery diseases. Legitimate research and clinical evaluation of unsaturated fats is under way, but the present data are incomplete and contradictory and promotion based on them is misleading. A number of seizures were based on false claims that the articles would lower blood cholesterol. A best seller on folk medicine by a New England physician, was given wide publicity in popular magazines. In it he attributed miraculous curative powers to a combination of honey and vinegar. A local woman devised a “recipe” for the mixture and it was pur¬ chased by a national distributor of miscellaneous household products other than foods. A big publicity campaign was launched, with a tie-in to the book. Seizures were made as soon as interstate shipments began. The manufacturer is now attempting to devise labeling that will not misbrand the product. Other products seized for false and misleading claims were not con¬ centrated in any specific category, but included tonics, ointments, herbs, and other products with misleading claims for lay treatment of arthritis, respiratory troubles, canker sores, sexual maladjustments, and “that tired feeling.” /Veit? Drugs During the fiscal year 480 new drug applications were received, 112 of which were for veterinary drugs. Within the same period 268 Food and Drug Administration 249 applications became effective, which includes 46 for veterinary drugs. Eight hundred and nineteen supplements, providing for changes in effective applications, and including 115 for veterinary drugs, were given favorable action. Two effective applications were suspended without contest, and notice of hearing with respect to refusal of an application was given in one instance which resulted in its voluntary withdrawal. Requests for the voluntary suspension of 10 applications providing for the use of diethylstilbestrol as implants or injections in poultry were made to the respective firms. Notices of hearing issued to three of these firms which did not consent to suspension. Among the new products introduced during the year were three antibiotics, one administered orally for fungus infections of the skin, scalp and nails, one for amoebic and bacillary dysentery and one for fungus infections of the vagina; a new anticancer agent; seven diuretics for the treatment of edema ; a new anti-inflammatory cortico¬ steroid and three steroids for enhancing the building-up processes of the body; a progesteronelike steroid, as an oral contraceptive agent; seven agents useful in the therapy of psychiatric conditions, five of which have a tranquilizing action and two of which are essentially stimulating. The list of new drugs for the year also includes a muscle relaxant, an antiepileptic, three products for the treatment of Park¬ inson’s disease, two antihistamines, one narcotic for the control of pain, a barbiturate for general anesthesia by intravenous injection, a local anesthetic, a drug for lowering blood cholesterol, one for decreas¬ ing blood coagulation, an anticholine-sterase for the treatment of glaucoma, an enzyme to assist in the surgical removal of cataracts, an appetite depressant, a drug for the treatment of pinworms, three drugs to decrease nasal congestion, and an antiseptic gargle. One of the drugs introduced for veterinary medicine was a tranquilizer for use in chicken and turkey feed to combat “stressful environmental con¬ ditions” and aortic rupture in turkeys. COSMETICS AND COLORS xl recall of a home-permanent kit was made by a cosmetic manu¬ facturer when injury complaints were received of painful irritation when the neutralizer it contained inadvertently got into the eyes of some users. The firm notified retailers to stop selling the home- permanent kit and set it aside until the neutralizer solution was replaced. A product labeled “Oil of Bergamot Synthetic” wTas seized because it consisted of imitation oil of bergamot and olive oil. A second cos¬ metic was misbranded by claims in an accompanying leaflet in vio¬ lation of the drug provisions of the law. It was falsely represented to improve the hair and skin, help build blood, curb the appetite and 573S26 — 61 - 17 250 Department of Health , Education , and Welfare, 1960 aid in losing weight, and to contain the amino acid necessary for tissue growth. No court actions were taken against violative colors. CERTIFICATION SERVICES Coal-tar colors. — All coal-tar colors used in foods, drugs, and cos¬ metics (except hair dyes) must be from batches certified by FDA as harmless. In 1960, 5,588 batches representing 7,806,139 pounds were certified, and 40 batches representing 38,812 pounds, rejected. Insulin. — All batches of insulin must be tested and certified before distribution. Examination of 350 samples resulted in the certification of 285 batches of 7 insulin drugs and 58 batches of materials for use in making insulin-containing drugs. Antibiotics— The predistribution testing and certification of certain antibiotics is also provided by amendments to the act. Examinations were made of 16,601 batches of penicillin, chlortetracycline, bacitracin, chloramphenicol, streptomycin, dihydrostreptomycin, tetracycline, neomycin, nystatin, novobiocin, erythromicin, polymyxin B, oleando¬ mycin, and amphotericin B during the fiscal year. The last seven antibiotics are not included in the certification amendments, but are tested when they are mixed with those requiring certification. Seventy batches were found to be unsatisfactory by either FDA or the manu¬ facturer for failing to meet the following standards: Potency (43), sterility (10), streptomycin content (5), pharmaceutical attractive¬ ness (4), moisture (4), pyrogens (2), and solubility (2). Enforcement of Other Acts A total of 114,174,657 pounds of tea was examined under the Tea Importation Act. Rejections for failure to measure up to the stand¬ ards set by the U.S. Board of Tea Experts totaled 222,736 pounds, or less than 0.2 percent. Five rejections were appealed to the U.S. Board of Tea Appeals, which upheld the decision of the FDA exam¬ iner in four cases and sustained the appeal in one. A bowl cleaner was seized for failure to bear the word “poison” as required by the Caustic Poison Act. No permits were issued for importations of milk from foreign coun¬ tries, nor were any actions instituted under the Filled Milk Act. New Court Interpretations Two petitions for certiorari were filed with the Supreme Court dur¬ ing the fiscal year. The Supreme Court denied the petition for review of a color case, thus upholding the Secretary’s order delisting yellow colors No. 3 and No. 4 for use in foods. Food and Drug Administration 251 Following their convictions for selling amphetamine drugs in viola¬ tion of the Durham-Humphrey Amendment, which had been upheld by the Circuit Court of Appeals, a medical doctor and his wife filed petitions with the Supreme Court requesting review of their convic¬ tions. Certiorari was denied and the defendants are now serving their sentences. A district court found for the Government in a case involving a manufacturer’s request for a declaratory judgment that sodium nitrite and sodium nitrate at 200 p.p.m. or less in fish is generally recognized as safe. The court declined to substitute its scientific judgment for that of the F ood and Drug Administration and held that the declara¬ tory judgment procedure is not the proper way to handle questions under the Food Additive Amendment to the Federal Food, Drug, and Cosmetic Act but rather they should be handled under the Adminis¬ trative Procedures Act. In a seizure against chocolate mint candy alleged to be deceptively packaged, the district court found against the Government on the grounds that the package label bore an accurate statement of the quantity of contents and the type of package used was necessary to protect the mints during shipment. The Government has appealed. A part-time pharmacist and drug salesman was convicted and sen¬ tenced under the Food, Drug, and Cosmetic Act to 8 years for the unauthorized sale of prescription drugs, including narcotics, without prescription. He appealed the conviction on the grounds that the Food and Drug Inspectors to whom he sold the drugs had used unfair means to induce the sales or, in other wrords, had entrapped him. Since the conduct of the inspectors was well within the permissible limits spelled out in the decisions covering the law of entrapment, the Court of Appeals for the 8th Circuit upheld the district court. The U.S. Court of Appeals for the 5th Circuit upheld FDA’s ballistic-type evidence proving the shipment of prescription drugs from an out-of-State manufacturer on the basis of their identity. A microanalyst identified them by means of punchmarks and other microscopic findings. A district court ruled in a case involving seizure of cigarettes in¬ tended for reducing body weight that the product was a drug within the meaning of the act, and that it was misbranded with false and misleading claims. The Government charged in part that the product was a new drug and since there were conflicting views among the experts as to the safety of the product, the court upheld the Govern¬ ment’s new-drug charge. A district court dismissed a seizure case involving a device which in its assembled form had not moved in interstate commerce, but whose component parts had been received in interstate commerce, prior to their assembly, holding that the device was not within the 252 Department of Health , Education , and Welfare , 1960 jurisdictional purview of tlie act. This decision did not follow the reasoning of other courts in earlier cases of a similar nature. Changes in the Law and Regulations Public Law 86-139, signed August 7, 1959, declares nematodes, plant regulators, defoliants, and desiccants economic poisons for the purposes of the Insecticide, Fungicide, and Rodenticide Act. This makes them subject to the tolerance procedures of the Pesticides Amendment when registered for use on raw agricultural commodi¬ ties. It became effective on March 6, 1960, for substances in use prior to January 1, 1958, with 1-year extensions permitted for specific products, where there is no undue risk to the public health. Public Law 86-537, signed June 29, 1960, amended the Food, Drug, and Cosmetic Act by requiring raw agricultural commodities which are products of the soil to bear labeling on shipping containers de¬ claring the presence of preservative chemicals added after harvest, but exempts them from such declaration after they have been removed from such containers and are on display for retail sale. Public Law 86-546, also signed June 29, provides for the centrali¬ zation of food additives appeals on a single issue in one circuit court. Two bills under active consideration during the year were not signed until July 12, 1960, but are included in this report because they require immediate regulation-making programs. The Color Additive Amendments to the Food, Drug, and Cosmetic Act will replace original provisions of the act regulating coal-tar colors for use in foods, drugs, and cosmetics. Before the amendment, the law called for certification of such colors where it could be shown that they were harmless, but had no provisions for limiting the amount used. This made it necessary to ban the use of certain colors even though they were found injurious only in much greater amounts than customarily employed. There had been incidents where too much color had been used and illnesses had resulted. The new amendment deals with all colors, whether or not derived from coal-tar, provides for batch certification where necessary, and authorizes tolerances where necessary to ensure safe use of colors. It will also require the retesting of. all previously permitted colors where there is any doubt as to safety. It contains a cancer clause, similar to that of the Food Additives Amendment prohibiting the establishment of any tolerance for an additive shown by suitable tests to induce cancer. The amendment became effective on its enactment, but an interim period of 2 y2 years is provided, during which commercially estab¬ lished colors may be provisionally listed while testing is carried on with a view to securing permanent status. Food and Drug Administration 253 The Federal Hazardous Substances Labeling Act is not an amend¬ ment of the Food, Drug, and Cosmetic Act but largely a replacement of the Caustic Poison Act of 1927, which was outdated and limited in coverage to 12 specific caustics and corrosives. The new law applies to household substances which are toxic, corrosive, irritant, strong sensitizers, flammable, radioactive (if named by regulation), or pres¬ sure generators, if such articles may cause injury or illness from customary or reasonably foreseeable use, including ingestion by children. Labeling requirements include the signal word “DANGER” on sub¬ stances which are flammable, corrosive, or highly toxic, as defined in the act, and “WARNING” or “CAUTION” on all other hazardous substances. Affirmative statements, such as “Causes Burns” or “Vapor Harmful” or similar wording descriptive of the hazard are required, as well as “POISON” if the product is highly toxic. Instructions are required for first-aid treatment when appropriate and for han¬ dling and storage of packages which need special precautions. Penalties include fines up to $500, imprisonment up to 90 days, or where there is intent to defraud and mislead $3,000 and 1 year, respectively. The law also provides for injunctions. It is similar to the Food, Drug, and Cosmetic Act in its provisions for factory inspection, sample collection, publicity, and coverage of imports. It becomes effective immediately, but no seizure or criminal penalty may be enforced until February 1961, with provision for extension up to 1 additional year for specific products. Early in June at a Senate hearing on drugs, the Secretary of Health, Education, and Welfare made a number of recommendations to strengthen the drug provisions of the Food, Drug, and Cosmetic Act. On July 2, 1960, the Chairman of the Labor and Welfare Committee of the Senate introduced S. 3815, entitled “A Bill to protect the public health by amending the Federal Food, Drug, and Cosmetic Act so as to clarify and strengthen existing inspection authority thereunder; require manufacturers of new drugs to keep records of, and make re¬ ports on, clinical experience and other relevant data bearing on the permissibility of such drugs ; require that drugs be prepared or packed under adequate controls to insure proper identity, strength, purity, and quality, and otherwise insure their compliance with the Act; and extend to all antibiotics the certification provisions of the Act now limited to certain antibiotics.” Congress did not hold hearings on this bill nor did it complete action on the following bills which had been introduced earlier: Regulation of habit-forming barbiturate and amphetamine drugs, premarketing testing of cosmetics for safety, and making assault on FDA inspectors a Federal offense. 573826 61 - 18 254 Department of Health , Education, and Welfare , 1960 REGULATIONS Di^ugs. — An interpretive statement was published in the Federal Register of March 25, 1960, bringing together in part 131 of the regu¬ lations warning statements on drugs and devices which had previously appeared in the act and published regulations and recommendations by FDA in trade correspondence. This is intended to help the trade in designing labeling in compliance with the requirements of the law that drugs and devices for over-the-counter sale must bear adequate warning statements for safe use. Three drugs previously limited by their new-drug applications to prescription use were exempted from this requirement by regulation, on the basis of evidence submitted by their manufacturers that they were safe for over-the-counter sale under proposed labeling. Two were for oral use in the temporary relief of the symptoms of hay fever or other minor conditions. The third is a broncho-dilator for oral use in the temporary relief of cough due to minor conditions. Section 130.9 of the new-drug regulations was amended to provide that a supplemental new-drug application is not required for a minor change which is not significant from the standpoint of safety. The applicant must, however, submit full details of the change and will be notified by FDA whether a supplemental application is required. A proposal under study at the close of the fiscal year and published on July 22 would require manufacturers to make complete and re¬ liable information for the use of prescription drugs available to physicians, and would also prevent the marketing of a new drug until the adequacy of the methods, facilities, and controls employed in its production were verified by establishment inspections when deemed necessary. Forty-one new monographs and 1,431 amendments were added to the antibiotic regulations. Food additives. — The 1958 Food Additives Amendment became ef¬ fective on March 6, 1960, with provisions for 1-year extensions for specific substances when there was need for such extensions and no undue risk to public health would incur. More than 900 requests for such extensions were received and about 800 were granted before June 30, 1960. Most of them concerned substances for use in the manufacture of food packaging, processing, and storage materials. Publication was also made proposing or concluding that approxi¬ mately 700 substances be generally recognized as safe for use in food, and therefore exempt from food additive controls. One-hundred and seventy-six food additives petitions were re¬ ceived since the amendment was enacted, of which 27 did not require regulations. Eighteen regulations establishing tolerances were is¬ sued, 63 petitions were withheld from filing pending receipt of fur- Food and Drug Administration 255 ther data from the petitioner or were voluntarily withdrawn. The remainder were in process at the end of the year. A group specializing in the administrative handling of these peti¬ tions was established in the Office of the Commissioner to process the petitions and coordinate scientific advice from staff Bureaus. A new branch was also established in the Division of Food to review petitions and to confer with members of the industry concerning de¬ velopment of the required information, and with the field Districts concerning testing of proposed analytical methods. Accelerated pro¬ grams of toxicity testing were put into effect in the Division of Phar¬ macology. Coal-tar colors . — An October 21 proposal to withdraw FDA’s out¬ standing certificates of harmlessness and suitability for use of seven coal-tar colors primarily used in food met industry requests for a hearing. On January 8 the hearing was denied, on the basis that the objections filed present legal questions that could not be resolved by a public hearing, and would have to be decided by the courts. One objection was not legally valid because a previous FDA action in the removal of two colors from the list of permitted colors had already been reviewed and upheld by the Court of Appeals for the Eighth Circuit. The colors involved are FD&C Orange Nos. 1, 3, and 4, and all batches of FD&C Red No. 1 that do not comply with specifi¬ cations for that color established July 16, 1959. The effective date of the order was extended to April 6, 1960. On October 6, 1959, action banning the use of 17 coal-tar colors used primarily in lipsticks was proposed and scheduled to become effective on J anuary 6, 1960. On the filing of industry objections and a request for a public hearing, the effective date of the order was postponed. The hearing began on February 17 and lasted 11 days. The delisting of 3 of the colors (D & C Red Nos. 11, 12, and 13) was canceled after concluding that they should receive further study. On June 15 on the basis of evidence presented at the hearing, a tentative decision was announced to remove the other 14 colors from the list for certification for unrestricted use in foods, drugs, and cosmetics, and allow their use for external drug and cosmetic use only. (This excludes use in lipsticks, wherein the article is partly ingested.) The colors involved are D & C Orange Nos. 5, 6, 7, and 17; D & C Red Nos. 8, 9, 10, 19, 20, 33, and 37; and D & C Yellow Nos. 7, 8, and 9. The Color Additive Amendments, which were subsequently enacted before the delisting action became final, pave the way for establish¬ ment of safe tolerances for these colors whenever scientific evidence of their safety can be established. Pesticides. — Ninety-six pesticide tolerances or exemptions were established for raw agricultural commodities, involving 15 pesticides. 256 Department of Health , Education , and Welfare, 1960 In addition, tolerance levels were changed for 2 pesticides involving 43 commodities, and temporary tolerances were established for 2 pesticides involving 15 commodities. Since the enactment of the Pesticide Chemicals Amendment, 2,166 tolerances or exemptions have been established for 112 pesticide chemicals. It was necessary to rescind the tolerance of 0.1 part per million for heptachlor when it was discovered that the pesticide undergoes a chemical change after it is sprayed on plants resulting in conversion into a new compound, heptachlor epoxide. Residues of the epoxide carry through in milk and meat from forage, on which heptachlor was widely used for controlling the alfalfa weevil. When the original tolerance was established, it was on the basis that the residues would consist of heptachlor and that such residues would not deposit in the milk of cows consuming treated grain or forage. Exemption from the requirement of a tolerance for residues of the microbial pesticide bacillus Thuringiensis Berliner on certain food crops was established on the basis of evidence that the micro-organism would not be pathogenic to man or other warmblooded animals, though lethal to certain species of insects. Food standards. — New standards were established for canned prunes, seedless grapes, berries, and plums. An order was published setting standards for orange juice and orange juice products, but objections were filed requiring a public hearing and the standards were stayed. A number of amendments were made in existing standards. Pepsin or papain enzymes were permitted in enriched farina to facilitate quicker cooking. Butylated hydroxytoluene was permitted in par¬ boiled enriched rice to retard flavor deterioration. Edible oils were permitted to be rubbed on the rind of blue and Gorgonzola cheese to improve adherence of foil wrappers. Sorbic acid was permitted in consumer-size packages of spiced, club, and cold-pack cheese to retard mold development. Methylcellulose was added to the list of permitted emulsifiers of French and salad dressings. Spices, natural flavorings, and vinegar were added to permitted optional ingredients of canned pineapple. Additional vegetable seasoning ingredients were permitted in canned peas. Calcium salts were permitted for firming canned peppers. The designation of optional forms for label declaration of canned sweet potatoes was enlarged to provide for the names “halves,” “halved,” and “cuts.” Tomato puree was permitted to be labeled as “concentrated tomato juice” when produced from whole tomatoes and concentrated to 21-25 percent solids. Standards for artificially sweetened fruit jams and jellies for people on sugar-restricted diets were stayed on going into effect on J anuary 28 because of objections requiring a formal hearing. Food and Drug Administration 257 Two industry proposals — to permit flavoring fruit preserves with cherry liqueur and rum, and to permit adding citric acid to canned tomatoes — were denied without hearings. Scientific Investigations Constant research is necessary if FDA scientists are to keep abreast of the problems and responsibilities of food law enforcement. New problems of analysis, nutrition, toxicology, bacteriology, and pharma¬ cology continually arise. Fortunately, new analytical tools and tech¬ niques have also become available. The seven Divisions which com¬ prise the Bureau of Biological and Physical Sciences have made good use of many of them and have displayed considerable ingenuity in adapting them to the problems at hand. Increasing use is being made of paper and gas chromatography, polarography, mass spectrometry, spectrophotometry, bioassay, and radiochemistry. The use of many of the newer techniques requires special training and it has often been necessary to conduct special training programs and seminars. During fiscal 1960 the Bureau was strengthened by the addition of 75 scientific personnel, technical assistants, and clerks. Fifteen projects relating to the development of new methods or improvement of present methods for the assay of antibiotics were completed. Among them were development of tests for the new semi¬ synthetic potassium penicillin 152, and methods for assaying dairy products (cheese, butter, ice cream, powdered milk, etc.) for anti¬ biotic residues. Twelve clinical studies in man, relating to the testing, action, and mode of administration of antibiotics, were concluded. A new powder for oral suspension, containing penicillin G plus triple sulfonamides, was tested; also a mechanical device, “hypospray,” used to inject antibiotics. Five miscellaneous antibiotic research projects were completed. Ninety-one regulatory samples of cosmetics were collected and analyzed, most of them as a result of consumer complaints. New methods of analysis were developed for certain cosmetic preparations. A manual of cosmetic analysis was prepared and awaits publication. Work continues on the chemical structure and occurrence of intermediates of certifiable coal-tar colors. Specifications for mineral oil, proposed as a food additive for many purposes, have been devised to ensure the absence of carcinogenic hydrocarbons. Development and improvement of methods for the detection and determination of pesticides and food additives are im¬ portant continuing projects. A method which allows the analysis of milk for residues of DDT within 1 day’s time was developed. Paper chromatographic methods for the detection of residues of six of 258 Department of Health , Education , and Welfare , 1960 the more common pesticides were perfected and are in routine field use. For some years FDA scientists have worked to replace the slow and costly chick bioassay for vitamin D with simpler methods. Chemical methods employing infrared spectrophotometry or fluores¬ cence have now been developed. An official method for determining vitamin A in oleomargarine has been adopted. A tissue culture labora¬ tory has been established ; this technique allows the growth and repro¬ duction of human and animal cells in artificial media. The effect on growth of suspect chemicals (additives, etc.) can then be studied in what is essentially a test tube manner. Sometimes effects too subtle to be observed in the intact animal can be noted. Efforts to isolate and identify the toxic agent, associated with by¬ product fats, which causes edema and death in poultry have been continued. Results of bacteriological examination of some 3,000 samples of frozen precooked foods, representing 81 separate items, were compiled during the year. As reflected by bacterial content, there is no doubt that sanitary practices of many frozen precooked food plants could be improved. Surveillance of the industry will be continued with major emphasis at the plant level. Living staphylococci were found in 12 percent of 314 market milk samples. The organisms are now being typed and their resistance to various antibiotics is being checked. The concern is whether or not potentially dangerous antibiotics-resistant strains of staphylococcus are developing in milk and dairy products as a result of treating cows for mastitis with antibiotic preparations. Development of methods for the detection of filth and decomposi¬ tion in foods continues, with emphasis on fish, cocoa, cheese, fig paste, frozen strawberries, canned tomatoes, coffee, and grape products. Application of starch gel zone electrophoresis has been used in the species identification of fish and red meats. Revisions of the U.S. Pharmacopeia and the National Formulary have appeared and their standards for drugs will become official on October 1, 1960. The Food, Drug, and Cosmetic Act designates the methods and standards of these compendia as official. FDA chemists have assisted in these revisions and have contributed new methods. Work continues on the stability of insulin, digitalis, thyroid, and posterior pituitary preparations. Toxicity and cumulation studies were conducted on a number of pesticides. Various materials sus¬ pected of being carcinogenic were investigated. Studies, both bio¬ logical and chemical, of the persistence and distribution of stilbestrol in the tissues of treated poultry, were conducted. Various additives and coal-tar colors are being checked for toxicity by means of long- Food and Drug Administration 259 term feeding tests with animals, and gross and microscopic pathology of affected organs is being studied. The pilot program for reporting unusual or adverse reactions to drugs was expanded, on a contract basis, to include more, but still a limited number of, hospitals representing a cross section of medical specialties. It is an outgrowth of a 4-year voluntary pilot study designed to develop information promptly on the untoward effects of the newer drugs. The information will be used in the resolution of medical problems associated with the safety of new drugs. Although such drugs have had most careful clinical tests in controlled experi¬ mental use, wide use in general medical practice sometimes brings to light effects not anticipated from the investigational studies. Such disclosures prompt measures for better public health protection, such as label changes as to dosage, warnings to physicians, formula changes, or, in extreme cases, withdrawal of the product from the market. Veterinary medical research studies, some conducted on contract with State universities, included investigations of antibiotics in milk, efficacy of injectable iron products for swine, efficacy of drugs used in the treatment of poultry diseases, milk-level studies of sulfonamides in dairy cattle, and residues of stilbestrol in eggs from broody hens. The one objective criterion in the oyster standard limits the amount of drained liquid or free liquor to 5 percent when tested in a specified manner within 15 minutes after packing. This has proved unenforce¬ able through results obtained after interstate shipment. In its search for tests to correlate packing practices with examinations of shipped lots, the Government Industry Cooperative Research Project has de¬ veloped 18 methods of which 3 in combination have given promising results with oysters produced in Chesapeake Bay. They must be tested with oysters produced on the Gulf Coast and West Coast before they can be considered in the formulation of new standards. Enforcement Statistics FDA inspections during the year consisted of 20,513 of inventoried factory and warehouse establishments, 2,098 of pesticide practices, 3,700 of food additives being employed, 3,594 of public eating places to check on the notification of the serving of oleomargarine, and 183 involving illegal sales of drugs. Of 32,788 domestic samples collected, 22,744 represented foods, 9,697 drugs and devices, 259 cosmetics and colors, and 259 miscellaneous. In the 237 criminal actions terminated (or terminated for some defendants) in the Federal courts during 1960, fines assessed totaled $186,004. Jail sentences ranging from 1 hour to 2 years were imposed in 48 cases involving 56 defendants. Twenty-three individuals were 260 Department of Health , Education , and Welfare , I960 required to serve imposed sentences, averaging 8 months; they were suspended for 33 on condition that violative practices be discontinued. Records of actions terminated in the courts were published in 1,755 notices of judgment. Table 2. — Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1960 Item Total Criminal prosecu¬ tions instituted Seizures accom¬ plished Injunctions Violative samples Actions Violative samples 1 Actions Violative samples Actions requested Total. . 2,893 1,274 1,279 248 1,614 1,002 24 Foods _ 1, 443 1,442 5 828 251 61 1, 192 757 10 Drugs and Devices _ 443 1,028 187 414 242 14 Cosmoties At colors 2 5 2 Caustic poisons _ 3 1 3 1 i The number of samples on which the actions are based always exceeds the number of actions; in seizures a variety of articles may be contained in a single shipment, while in criminal actions each sample usually represents a single shipment which forms one count of action. Table 3. — Import samples collected , examinations made , and lots detained during the fiscal year 1960 Item Samples collected Examina¬ tions made Lots detained Total _ 13, 217 15, 475 4, 784 Foods 10,045 2, 754 418 14, 683 584 208 2, 613 1,951 220 Drugs and devices _ Cosmetics, colors, miscellaneous _ Office of Vocational Rehabilitation Advances in Research, Training, Centers, and Workshops Give Program New Incentives In the fiscal year that ended June 30, I960,1 the number of dis¬ abled persons who were helped to overcome their handicaps and find employment through the State-Federal program of vocational re¬ habilitation reached a new high of 88,275. In addition to removing the prospect of dependency for this number of handicapped persons, there was substantial progress during the year toward new objectives that have come with expansion of the public program of vocational rehabilitation under provisions of Public Law 565, enacted in 1954. There was a tremendous upswing in rehabilitation research during 1960. A considerably greater number of new projects seeking new knowledge or to test the validity of an idea or method were initiated than in any previous year. And there was continuing emphasis on the rehabilitation of those with severe disabilities, which produced a substantial increase in the number of special demonstration projects, as compared with 1955, to help those handicapped by mental illness, mental retardation, deafness, hearing loss and speech defects, cardiac diseases, epilepsy, blindness and visual handicaps, and orthopedic handicaps. The training of workers in various aspects of rehabilitation received new impetus because more funds were available to expand support for training of professional personnel in all fields related to rehabilitation, 1 Unless otherwise indicated, all subsequent reference to 1960 will be to the fiscal year, that is to say, the period between July 1, 1959 and June 30, 1960. Data on charac¬ teristics of those rehabilitated in fiscal year 1960 are estimated. 261 262 Department of Health , Education , and Welfare, 1960 but especially in medicine, counseling, speech pathology and audiol¬ ogy, and prosthetics and ortliotics. Creation and operation of rehabilitation centers, workshops, and other facilities received noteworthy attention in communities and States in response to the demand for an increasing variety of settings in which intensive or specialized services can be adminstered. There was an increasing trend toward operation of rehabilitation facilities by State rehabilitation agencies. The number of rehabilitation facili¬ ties approved for construction under provisions of Hill-Burton legis¬ lation during the year was 41 — seven more than in the previous year, and more than twice the number approved in 1958. And the increased importance of centers and workshops to the program is inherent in the total of 46 research and demonstration projects that are concerned with rehabilitation in these kinds of establishments. REHABILITATIONS IN 1960 The new record in the number of persons rehabilitated into employ¬ ment was nine percent more than in the previous year. Gains were made in all of the States but six, and in the District of Columbia, Puerto Rico, Guam and the Virgin Islands. The preponderance of disability referrals continued to be among those with orthopedic disabilities — amputations and other crippling conditions. About 41 percent (36,000) referrals arose out of these conditions, and, of these, about three-fifths resulted from accidental injuries, about one-fifth were from poliomyelitis, osteomyelitis, or arthritis, and the remainder from other orthopedic impairments. Referrals came from many sources, but the largest proportion (34 percent) came from physicians, health agencies, or hospitals. Another 14 percent was referred by public welfare agencies, and 7 per¬ cent by State employment service offices. About 12 percent applied for services on their own initiative. The remainder came from such sources as educational institutions, employers, and unions. Nearly half of the rehabilitants had dependents, and 63 percent were male. The occupations in which rehabilitants of 1960 wTere placed in¬ cluded nearly all types of work, including more than 4 percent who went into such short supply professions as teaching, engineering, and medicine. The proportions employed in other major occupational groups remain similar to those in previous years — skilled and semi¬ skilled, 26 percent; clerical and sales, 17 percent; service workers, 19 percent; family workers and housewives, 14 percent; profes¬ sional, semi-professional, and managerial, 8 percent; agriculture, 9 percent ; and unskilled, 7 percent. At the close of the fiscal year, 180,000 other disabled people were receiving services from State rehabilitation agencies, against a total of 171,000 in 1959. Chart 1. — DISABILITIES AND MAJOR OCCUPATIONAL GROUPS Percent of rehabilitants, by types of disability at acceptance and by major occupational group at closure, fiscal year I960 DISABILITIES MAJOR OCCUPATIONS Office of Vocational Rehabilitation 263 M°h 11% 264 Department of Health , Education, and Welfare, 1960 ECONOMIC VALUE OF THE PROGRAM The extent to which the public vocational rehabilitation program can improve the economic status of handicapped persons, increase the Nation’s productive potential, and relieve some of the dependency upon public assistance was strikingly shown in 1960. About 66,000 of the 88,275 handicapped persons prepared for and placed in employment during 1960 were unemployed when their re¬ habilitation began. The group that had been working at the time they wTere accepted for service were earning at a rate of about $61 million a year and generally were employed in unsafe, unsuitable, or part-time work. In the first full year of employment for the entire group after rehabilitation, it is estimated that they will have earnings at the rate of $171 million. Nearly 18,000 of those who were rehabilitated received public assist¬ ance at some time during the process, at the estimated rate of $17 million a year. The estimated total cost of the rehabilitation of these persons was about $16 million, a one time outlay. It is estimated further that those who were established or placed in employment through the public rehabilitation program will pay, during the remainder of their working lives, from seven to ten dol¬ lars in Federal income taxes for every Federal dollar invested in their rehabilitation, so that the conversion of so many persons from tax consumers to taxpayers is of pronounced economic benefit to the Nation. Research Projects Set New Record One hundred and one new projects for research and demonstration in vocational rehabilitation were approved during 1960, the largest number of awards made in any year since they were inaugurated in 1955. Eighty of the grants were for research and demonstration purposes. Twenty-one were selected demonstrations, in which knowl¬ edge and techniques emerging from research are applied in appro¬ priate settings over wide geographical areas, to attain the widest and most rapid benefits for those persons within several categories of severe disability. The 1960 grants amounted to $2,911,482. With $3,478,026 granted for continuance of 134 projects approved in previous years, expendi¬ tures for the year were $6,389,508. There were 344 projects com¬ pleted, in operation, or approved in the first six years of the research program, and the total expenditures for all projects were just over $18 million at the end of the fiscal year. Grants for projects are made to a wide variety of public and private nonprofit groups including universities, colleges, medical schools, Office of Vocational Rehabilitation 265 hospitals, rehabilitation centers, State vocational rehabilitation agen¬ cies, sheltered workshops and homebound programs, and many types of voluntary-private organizations. In general, these projects have as their objectives one or more of the following: a) Development of new techniques for treating, evaluating, training and vocational place¬ ment of disabled persons not previously helped because of lack of per¬ tinent knowledge; b) Sharpening the effectiveness of existing methods by further study and testing of results derived from their application ; c) Increasing the effectiveness of existing public and private programs by establishing special facilities and services to overcome inadequa¬ cies in vocational rehabilitation services which prevail on a regional basis; and d) Creating new job opportunities for demonstrating the capacity of disabled individuals to perform under competitive condi¬ tions in jobs previously closed to those with certain disabilities. A National Advisory Council on Vocational Rehabilitation — a statutory body — reviews all project applications and makes recom¬ mendations to the Director of the Office of Vocational Rehabilitation in making grant awards. The Council is composed of twelve mem¬ bers appointed by the Secretary. They are leaders in the scientific, educational, or public affairs fields which contribute to the vocational rehabilitation of disabled individuals. Miss Mary E. Switzer, Di¬ rector, Office of Vocational Rehabilitation, is Chairman of the Council. Within the year there was a sharp increase in the number of se¬ lected demonstration projects. In 1959, there were 42 such projects in 29 States, but at the end of 1960 there were 64 projects in 37 States. Selected Demonstrations in 1960 Occupational centers for mentally retarded _ 21 Work classification and evaluation centers for cerebral palsied _ 7 Work adjustment centers for disabled persons with emotional problems _ 6 Occupational adjustment services for epileptics _ 2 Services for the homebound : Industrial homework _ 3 Vocational adjustment in a community home-care program _ 1 Blind and visually handicapped : Optical aids clinics _ 15 Work evaluation of older disabled workers _ 4 Rehabilitation of the chronically ill _ 2 Services to blind farmers _ 1 Rehabilitation of the mentally ill _ 2 Total _ 64 To the categories existent in 1959, three new ones were added during 1960. One was “halfway houses” for persons newly discharged from mental hospitals (based on State experience in this field) to provide group living for selected patients and so ease their transition back to the community. The second was based on experience gained in a project for demonstration of methods of evaluation, training and 266 Department of Health , Education, and Welfare, 1960 placement of a group of men and women whose median age was 64 years. The third type of project was one for the training of blind persons in agricultural practices to prepare them for farm ownership or tenant operation. MENTAL RETARDATION A new national pattern of specific services to the mentally retarded is emerging from studies of this disability. A great deal of new knowledge is coming out of research projects supported by OVR grants, and is being applied through occupational training centers for the retarded that now number 21 in 18 States, with seven new ones that were added in 1960. These centers are highly important in the rehabilitation of those who are mentally retarded. The approximately 3,000 such persons per 100,000 of our population is a high proportion compared to other severe disabilities. No medical treatment is known that reduces the severity of intellectual deficit in a person, so that this disability is lifelong. The greatest benefit to be expected for a retarded person is within social and vocational training, followed by carefully selected placement in highly selective jobs. For these reasons the new pattern of services for the mentally retarded is highly important. Some of the projects that are expected to fill in this pattern are studies in such peripheral areas as evaluating the effectiveness of speci¬ fic training in different lines of work and the value of varying the length of stay in training to fit individual needs; development of a standardized scale to assess individual training potential, and assess¬ ment of needs of certain States and appropriate services to meet them. The total number of grants related to mental retardation reached 36 by the end of the year. MENTAL AND PERSONALITY DISORDERS The nationwide attack on mental illness, spurred by the knowledge that on any given day about 600,000 mentally ill persons are in hospi¬ tals, has led to increased activity in research pertaining to their voca¬ tional rehabilitation. Eleven new projects — including “halfway houses” for the adjustment of discharged mental patients to commu¬ nity living — were approved during the year, to research and demon¬ strate several aspects of rehabilitation for the mentally ill. Some of the projects are investigating the rehabilitation of alco¬ holics. Others are looking into methods of employability prediction, developing new patterns of psychiatric and vocational services for emotionally disturbed young people, or for clinical treatment and home economics training for homemakers recovering from mental illness. Office of Vocational Rehabilitation 267 Most of the projects are aimed at the growing concept of organiza¬ tion of the mental hospital as a therapeutic community, in which all of the personnel are trained and conditioned to the special problems met in working with the mentally ill, to foster and sustain delicately balanced relationships that are created. CHRONIC ILLNESS Five new projects were approved in the areas of chronic illness or aging during 1960. It is difficult to estimate the number of chronically ill, aged-disabled, or long term patients in this country. Current estimates indicate that there may be more than 5 million persons in the United States between 45 and 64 years of age who have been disabled by serious illness or impairing conditions. Of these, this Office has estimated that 1.5 million are feasible for vocational re¬ habilitation. The remaining 3.5 million persons include many who could be returned to some degree of self-care and independence through appropriate services. Other estimates show that there are also about 5 million persons with consequential chronic diseases in the age group over 65. New and previously approved projects in these areas have demon¬ strated that with proper evaluation, training and other rehabilitation services many of the chronically ill may be returned to work or may achieve greater independence. One project serving older disabled clients during the two-year period ending in 1960 placed 224 persons with a median age of 64. Another project approved in 1960 has found a relatively high degree of rehabilitation potential among severely disabled homebound persons as compared to other groups such as those cared for in nursing homes. The total number of projects approved in this area is now in excess of 30. The impact of these projects on reorientation of hospitals, nursing homes, and other institutions engaged in rehabilitation, and the creation of services in the community for post-institutional care and employment continues to increase throughout the Nation. BLINDNESS Thirteen new projects in areas relating to the rehabilitation of blind persons were approved during 1960. Seven were research projects — investigation of auditory cues used by blind persons during travel; development of methods to train blind persons as piano tuners ; a pilot training project in a medical center for ophthalmologists working on rehabilitation of the blind; collection and exchange of information on technical devices and aids for blind persons ; training of blind per¬ sons as language translators; identification of problems inherent in rehabilitation of the rural blind ; and a grant to the American Founda- 268 Department of Health , Education , and Welfare , I960 tion for the Blind for development of a nationwide program to attract qualified persons for work in the rehabilitation of blind persons. One of the six selected demonstration projects was concerned with correlation of public and private services for blind farmers to help them to become owners or operators of farms. The rest were for estab¬ lishment of optical aids clinics for persons with low visual acuity. There are now 15 such clinics in 14 States. The disabled persons who use these optical centers not only have new occupational opportunities open to them by removal of their classification as legally blind persons, but there is also frequent removal of barriers to education and other activities that are part of a normal life. In one clinic situated in a university medical school, 148 of the first 180 patients examined had aids or glasses prescribed. Only 18 were beyond help of the clinic, and 14 more did not need or could not adjust to optical devices. CEREBRAL PALSY Two additional selected demonstrations providing work classifica¬ tion and evaluation services for persons disabled by cerebral palsy were approved in 1960. There are now eight of these projects. More project activity is anticipated in this area in which it is esti¬ mated that there are between one-half and three-fourths of a million disabled, with an annual increase of approximately 10,000 births. NEW VISTAS IN RESEARCH Advances in the medical sciences have brought new demands for research, not only to keep pace with current developments, but to meet new challenges. Notable examples are the rehabilitation prospects for persons with such widely separated disabilities as hemophilia and spinal bifida. Both of these disabilities are so susceptible to treat¬ ment that persons with these conditions may now make plans for their future vocational life. Accordingly, research grants have been made for systematic exploration of the educational, social, and medical prob¬ lems associated with both disabilities. There are 40,000 persons in the country known to have hemophilia, so that this disability alone is of considerable concern in future plans for vocational rehabilitation. Advancements in modern engineering have produced a storehouse of miniaturized electronic, pneumatic and hydraulic mechanisms that may be adaptable through research to functional and sensory needs of the severely amputated or paralyzed. Two projects concerned with the application of external power in bracing were approved during the year and grants were awarded to five additional projects in the area of orthopedics. New job opportunities are emerging for the handicapped, through research. For example, a project conducted by Georgetown Uni- Office of Vocational Rehabilitation 269 versity will develop methods for training blind students, selected nationally, to become Russian language translators to meet a growing national need for simultaneous translation services in research and intelligence fields. Another project is studying the interplay of deafness and emotional disturbance, to learn how each affects the other, and to find the best procedure of dealing with both problems in the same patient. Pre¬ viously the needs of emotionally disturbed deaf people have often been completely ignored in terms of their mental health because of their more obvious problems in communication which often completely masked the much more destroying effects of their psychic illness. On the basis of findings from this project it is expected that additional clinical demonstrations will be established to train professional work¬ ers in better ways to serve those patients. Training Expanded to Cover Specialists in Several Fields The sixth year of operation of the training program reflected con¬ tinued progress in alleviating the serious deficiency of personnel trained in the various aspects of vocational rehabilitation. An increase of 22 percent in available funds, from $4,800,000 in 1959 to $6,200,000 in 1960, made possible an expansion of support for training personnel in fields to which the highest priority had been assigned — medicine, rehabilitation counseling, speech pathology and audiology, and prosthetics and ortliotics. There was also continued support of training in other professions with severe manpower short¬ ages, especially physical therapy, occupational therapy, nursing, social work, and psychology. Gains were made in new programs for the training of specialists in rehabilitation of the deaf and the blind; and, as most of the medically related professions were represented, it was possible to continue several inter-disciplinary projects. The number of teaching grants to educational institutions for basic or advanced professional training increased from 143 in 1959 to 186 in 1960. The amount granted for teaching was slightly in excess of the amount granted for traineeships, a reversal of a previous trend. This may be attributed to new teaching grants for programs designed primarily to strengthen and improve curricula in the area of rehabili¬ tation concepts and techniques, a necessary first step before students can be trained effectively. Teaching grants are made to educational institutions to enlarge and strengthen these curricula with a bearing upon rehabilitation and, where necessary, to employ additional faculty for classroom teaching 573826—61 - 19 270 Department of Health , Education, and Welfare, 1960 or supervision of clinical practice. Traineeships are granted to further the expressed interests of students in careers in rehabilitation. MEDICINE Programs for the training of undergraduate medical students in rehabilitation medicine have been established in 35 of the 86 ap¬ proved schools of medicine and osteopathic medicine, as compared with 25 in 1959. Since physical restoration is frequently a prerequisite for effective vocational rehabilitation and the number of specialists in physical medicine and rehabilitation is far below that needed to meet the demands by medical schools, teaching hospitals, and rehabilitation centers, physicians are receiving traineeships for study during their residency training. On June 30, 1960, there were 127 physicians with OVR stipends enrolled in residency training programs, an increase of 20 percent over the enrollment at the end of 1959, when 105 physicians were re¬ ceiving traineeships. In order to stimulate interest in rehabilitation and to encourage their future specialization, fellowships were granted to about 60 undergraduate medical students for research or for clinical service in rehabilitation during their vacation period. REHABILITATION COUNSELING Rehabilitation counseling courses continued to receive a large pro¬ portion of funds allotted for training. A minimum of 600 trained counselors per year is required to meet the growing need in State voca¬ tional rehabilitation agencies and community rehabilitation programs. The number of universities with rehabilitation counselor training programs in actual operation has grown from 11 in 1955 to 29 in 1960. Two others initiated active planning in 1960 with a view to admitting the first students in the 1960-1 school year. Full-time enrollment in the 29 programs numbered about 535. The number of students ranged from five to 45, with 17 as the median. Rehabilitation counselor training programs have graduated about 875 since 1955. Intensive work has been started on curriculum content in the rehabilitation counselor training programs, the majority of which are two-year courses leading to a master’s degree or to an advanced cer¬ tificate in rehabilitation counseling. SPEECH PATHOLOGY AND AUDIOLOGY The critical shortage of speech and hearing therapists qualified to provide services to the approximately 6,000,000 persons above school age with significant speech and hearing problems, prompted grants to 22 of the approximately 70 universities with graduate training pro¬ grams in speech pathology and audiology, as compared with 12 in Office of Vocational Rehabilitation 271 1959; and traineeships were granted for 90 students in 1960, more chan double the amount in 1959. Although the 400 students currently enrolled is producing far less than a recognized need of 1,500 graduates a year, O VR grants are making it possible for more training programs to include specific content on rehabilitation of adults with communica¬ tion disorders and for more students to secure essential graduate training. PROSTHETICS AND ORTHOTICS Since 1957, OVR has provided support to three university training centers, one in California, one in New York and one in the midwest, for short-term courses for physicians, therapists, prosthetists, ortho- tists and rehabilitation counselors in various aspects of the fabrication, fitting and training in the use of prosthetic and orthotic devices. In 1960 such courses reached over 1,300 persons, the largest number since initiation of the program. OTHER PROFESSIONAL FIELDS An insufficient supply of teachers for schools of occupational ther¬ apy and of physical therapy has for years delayed their expansion. Grants for traineeships for graduate study have made it possible for a small number of experienced therapists to secure advanced prepara¬ tion, and so improve the quality of teaching. In 1958-9, fifteen physical therapists did graduate work under OYR traineeships which enabled five of them to be employed in 1960 as physical therapy instructors. Three of these five are in new schools established in geographical areas which had great need for them. The shortage of personnel, qualified by training and interest, to work with the 200,000 to 300,000 deaf persons in the United States brought establishment of an ad hoc committee of leaders of the deaf in February 1960, to plan for the training of personnel involved in rehabilitation of deaf persons. Short-term courses were held to orient personnel to the social and vocational aspects of deafness, on the development of rehabilitation facilities for the deaf, and on psy¬ chological assessment of deaf persons. REHABILITATION OF THE BLIND Courses for rehabilitation counselors on placement of blind persons in competitive occupations have been continued and now have reached about one-half of the 200 rehabilitation counselors in State agencies who carry responsibility for placement of blind persons. A new training program for mobility instructors of the blind, peripatology, has been established and has enrolled eight students interested in a career of teaching blind persons physical orientation and independent 272 Department of Health , Education , and Welfare , 1960 travel. This is the first such course under university auspices and leads to a master’s degree in peripatology. MENTALLY ILL AND THE MENTALLY RETARDED Ten institutes of workshops specifically related to training courses for rehabilitation counselors and others concerned with the mentally ill or retarded were in operation during the year. Emphasis is on the hospitalized patient and his return to the community, including job placements in the face of prejudicial attitudes on the part of pros¬ pective employers, and on mental retardates for whom there is a more optimistic outlook. Remunerative employment possibilities are now being discovered for the mentally retarded through sheltered workshops, properly planned training programs and increased under¬ standing of their needs, educability and other potentials. EPILEPSY The first national institute on the Total Rehabilitation of Epi¬ leptics wTas held during the year. An OYR grant enabled 50 leaders in rehabilitation of epileptics to meet as a pilot project for regional, State, and local workshops where counselors and selective placement specialists can be trained in the unique vocational needs of epileptic persons. Surveys show that new methods of treatment and new medi¬ cines provide ways for at least 80 percent of epileptic adults, when properly placed, to become capable of productive employment in a broad category of jobs. Specialized Facilities in Demand for Treatment of Severely Disabled Rehabilitation facilities in increasing variety are needed as the attack on disability widens and deepens. The principal types of facilities are rehabilitation centers and rehabilitation workshops, but there is increasing demand for specialized facilities for those who are mentally retarded, deaf, blind, or emotionally disturbed. Integrated planning for the development and use of facilities is based upon the Vocational Rehabilitation Act and provisions of the Medical Facilities Survey and Construction Act of 1954 (Hill-Burton) authorizing Federal assistance in construction of rehabilitation facilities. ESTABLISHMENT OF FACILITIES In fiscal year 1960, 29 States spent funds for establishing rehabili¬ tation facilities and workshops under basic support and the exten¬ sion and improvement provisions of the 1954 amendments. Sixty- five State agencies now include provisions in their State plans per- Office of Vocational Rehabilitation 273 mitting them to establish either rehabilitation facilities or workshops. In fiscal year 1960, these State rehabilitation agencies expended for rehabilitation facilities and workshops from State and Federal funds a total of $2,400,000 — approximately the same amount as in 1959 — with the Federal share amounting to $1,600,00. Forty-one new facilities under the Medical Facilities Survey and Construction Act of 1954 were jointly approved in 1960 by the Surgeon General of the Public Health Service and the Director of the Office of Vocational Rehabilitation. Their total cost was $21,026,096, of which the Federal share was $7,569,971. Expenditures under this Act for rehabilitation facilities since its enactment in 1954 amount to $100,742,783, of which sum the Federal share was $28,716,686. Assist¬ ance was given to 147 different rehabilitation facilities in 46 States. Federal allotments to the other four States were transferred to adjoin¬ ing States where citizens of the transferring States could be served. Most of these facilities are medically oriented but legislation is pend¬ ing in the Congress to provide additional authority for Federal assistance in constructing vocationally oriented facilities as well, to permit establishment under the Hill-Burton act of less than compre¬ hensive medical rehabilitation facilities of the physical medicine type in hospitals. OPERATION AND USE OF FACILITIES At the close of fiscal year 1959 1,480 disabled clients of State agencies were employed in sheltered workshops, 75.4 percent more than in 1954. In the 1960 fiscal year, State vocational rehabilitation agencies purchased services from rehabilitation facilities for 10,700 clients, as compared with 2,400 in fiscal year 1955. The State agencies expended $4,800,000 for these services in 1960 as compared with $900,000 in fiscal year 1955. ENCOURAGING NEW METHODS AND TECHNIQUES The operators of rehabilitation facilities and those who purchased their services were aided extensively in 1960 through research and demonstrations and short-term intensive training programs. A total of 46 research and demonstration projects have been ap¬ proved which are immediately related to rehabilitation in a facility. In addition, 39 special demonstrations are underway, all but one in a workshop setting. An authoritative guide for architectural design of rehabilitation centers, developed cooperatively by the Conference of Rehabilitation Centers and Facilities, the American Institute of Architects, and the Pennsylvania State University School of Architecture, has been made available, and is receiving wide acceptance. 274 Department of Health , Education , and Welfare , 1960 There is ever-increasing interest in activities concerned with the evaluation phase of the work potential of the disabled. A relatively new service in rehabilitation facilities is pre-vocational evaluation to determine the potential of handicapped people receiving service in re¬ habilitation centers and workshops. Under sponsorship of the State University of Iowa, widespread current research and experimentation along those lines was summarized in 1960 and made available to all centers. As the number of facilities increase and as more insurance com¬ panies, State rehabilitation agencies, and others purchase service from them for handicapped people, there is more demand for recognized standards for such facilities by which all who use them may judge the quality of the services they offer. Major efforts are underway, with financial assistance from the Office of Vocational Rehabilitation, to develop such standards. A National Institute on Workshop Standards is the vehicle es¬ tablished to carry out the purposes of a grant made through the Office to the National Rehabilitation Association and the National Associa¬ tion of Sheltered Workshops and Homebound Programs for strength¬ ening standards of workshop practices. Educational Opportunities for Mentally Retarded Accelerated A new viewpoint on mental retardation within recent years has brought accelerated action toward improving educational opportuni¬ ties for this group, and new research into the causes and prevention of this disability. Activities of the National Association for Re¬ tarded Children have helped greatly to focus national attention on mental retardation, and to combat a prevalent attitude that a mentally retarded person has little hope for the future. In keeping with a public awakening to this disability, and a noted tendency of families to seek services for these handicapped persons (rather than keeping them in the background) the demands for vocational services have increased markedly. In attempting to train retardates for industry and to place them, both the Office and State vocational rehabilitation agencies recognized the need to greatly augment the number of vocational training fa¬ cilities. It was also readily apparent that greater consideration should be given to the skills which might be acquired at various levels of retardation and the extent of social adaptation which might be expected through a training experience. The number of research and demonstration projects relating to mental retardation was increased by 14 during 1960, making a total of 36 that have inquired into this aspect of vocational rehabilitation since Office of Vocational Rehabilitation 275 the advent of rehabilitation research. Seven of the new projects were special demonstrations, supported in part by the OVR to put to practical use over a broad geographical area, the knowledge gained through research. The other seven projects were in new areas of re¬ search and demonstration. Most of the States now assign vocational rehabilitation counselors to work with the State training schools. Many schools, in addition to their special education programs, provide opportunities for voca¬ tional training. Since only five percent of the estimated three and one-half million mentally retarded persons in this country are insti¬ tutionalized, and many of them will never be able to care for them¬ selves, a much greater problem lies in locating and providing appro¬ priate services for those outside of institutions. Toward this end State vocational rehabilitation agencies are increasing efforts to pro¬ vide special counselors to work with the public school system. In this way early counseling and guidance is available for the retarded youth who might otherwise become lost in the community upon comple¬ tion of his required schooling, or for those who drop out of school. With this increasing emphasis on work with the retarded it has be¬ come evident that counselors carrying these caseloads are in need of some special preparation. Last spring the Office of Vocational Re¬ habilitation called together a group of experts in this field to assist the planning of a long-range program for intensive short-term train¬ ing of personnel concerned with mental retardation. Plans are now under way in several regions for workshops based in universities and utilizing faculty particularly knowledgeable in this area of disability. During the past year training grants were made to four universities for such workshops. MENTAL ILLNESS Opportunities for rehabilitation of the mentally ill have greatly increased in recent years, through more effective use of established facilities and the addition of new ones, in which more precise and more productive rehabilitation procedures emerge from research. Ten research projects relating to mental illness have been completed since initiation of rehabilitation research, several of which have been incorporated in State programs. Eighteen projects are currently ac¬ tive. Grants have been made to three States for operation of “half¬ way houses,” modeled after the three established earlier by one State agency. Several other State agencies are operating facilities in State mental hospitals to provide pre- vocational and vocational training. Several States have increased staffs assigned to work with the men¬ tally ill. Training grants were made during 1960 to two educational institutions for short term training of workers with the mentally ill. 276 Department of Health , Education , and Welfare, 1960 Several regionwide workshops during the year — some with univer¬ sities and the National Institute of Mental Health as co-sponsors — helped to orient community and State agency staff in new aspects of helping the mentally handicapped, and it is to be noted that out of such workshops has come inspiration for several research projects in mental health. Services Expanded for Those With Communicative Disorders The nationwide emphasis on improvement of vocational rehabilita¬ tion services for persons who are deaf or who are hard of hearing was marked by two significant trends in 1960, both with considerable promise for the future. There was an awakening of interest in the rehabilitation of deaf persons on the part of professional workers in disciplines other than those concerned primarily with the field of deaf¬ ness. There was also greater participation in this phase of vocational rehabilitation by persons who are deaf and engaged in professional pursuits, who bring fresh viewpoints on the ways that vocational re¬ habilitation services can be made more effective to meet the needs of this handicapped group. A noteworthy step was taken in April 1960 when staff from the OVR participated in the annual meeting of the Conference of Execu¬ tives of American Schools for the Deaf. The OVR group brought into sharper focus some concepts and needs of deaf people which are not always appreciated, but are basic to their success in rehabilitation. After stating the prime need for effective communication leading to the full exchange of thought, the symposium concluded that there should be emphasis on the concept of persons with communicative dis¬ orders as individuals rather than a labeling of them as “the deaf,” a categorical designation which often hampers their employment op¬ portunities and social acceptance. It was also held that there should be the same standards of performance for deaf persons as for persons with normal hearing, to eradicate existing patterns of paternalism. It was also stressed that deaf people should have opportunity to receive special services, as required, in rehabilitation facilities staffed with personnel trained in work with deaf people and with programs de¬ signed to meet their special needs. A conference of outstanding research workers at Gallaudet College in June 1960, identified some important researchable problems on vocational rehabilitation of the deaf and indicated their relative priorities, to call these needs to the attention of research workers in many disciplines. Office of Vocational Rehabilitation 277 In July 1960, a demonstration rehabilitation counseling center was established at Gallaudet College, aided by a grant from OVR. This center, staffed by psychologists interested in working with the deaf, is designed to serve as a model for others over this Nation, and to become a source for research in the counseling and guidance of the deaf. Services to the Blind Some of the more imperative needs of blind people and of those with impaired vision came closer to fulfillment during the year through the training of persons in key professions and specialties. A study of the doctor-patient relationship when blindness occurs was initiated through a grant to support a seminar on blindness for ophthalmologists in the Georgetown University Medical School. This is the first course of this kind ever given by an institution of higher learning. Another course activated for the first time in a graduate school, and made possible by a grant, is a training course for sighted instructors of the blind in mobility. This gives fourteen months training depth not merely of physical problems of blindness, but of associated mo¬ tivational ones. The placement of blind persons in industry requires special knowl¬ edge of the problems involved. A training grant to Southern Illinois University is supporting a project for development of new techniques in finding suitable employment and in placing blind people in various kinds of jobs. Further advancement in the rehabilitation of blind persons into agricultural pursuits was made with the completion of a project by the Alabama Institute for Deaf and Blind, with respect to the needs of the blind farmer. The project was supplemented with a film and a brochure, to be used for explanation of the project’s results to other State agencies and organizations. An educational experiment for the blind was initiated with a re¬ search grant to Georgetown University to support an effort to teach aural Russian to blind persons, with the ultimate purpose of training them as Russian-English translators. VENDING STANDS FOR THE BLIND New records were made in the vending stand program in 1960. At the end of the fiscal year a total of 2,078 stands operated by blind persons for the full or for part-time periods had been reached. Ap¬ proximately a third of them were on Federal property, and the rest on State, local, or private property. Some, operated in such places as national parks, were seasonal. The stands had a gross business of $38,219,340, or ten percent more than the year before ; they returned 278 Department of Health , Education, and Welfare, 1960 $7,541,304 in net profits to 2,216 operators,* and the average profit for all operators — full and part time — was $3,688. Services for Elderly Disabled Expanded The steady growth in the number of persons of 45 years or more in the population is accompanied by a growing number of rehabilitations of the disabled among them. This is a reflection of increased attention to this group, growing research into methods and techniques for serving older persons, and the expenditure of more available State funds for their rehabilitation. In 10 years the percentage of rehabilitations of disabled persons of 45 years or more, as a part of the total number for the year, grew from 24 percent in 1950 to an estimated 30 percent in 1960, more than 28,000 of the total of 88,275. State expenditures have swung upward steadily for rehabilitation services to the aging. In 1955, about $9 million, or close to a quarter of total expenditures of State agencies for the year, were for disabled persons of 45 years or more. In 1959, this figure was an estimated $20 million, and rose to an estimated $24 million in 1960, or approxi¬ mately 30 percent of total expenditures. Research into problems of rehabilitation for the aging was expanded during the year to about 30 projects. One of the demonstration proj¬ ects completed during the year was among aged persons confined to a county institution. One accomplishment of the project was the case of a 72-year-old woman who hadn’t walked in years, and became ambulatory after appropriate services. Another was that of a man 77 years old, believed to be incurably deaf, who regained power of communication. The methods developed in this project are now being used in similar demonstrations in other parts of the country. Medical Aspects of Program ArefExpanded There was intensification of the medical aspects of vocational re¬ habilitation during the year. Appointment of an Assistant Director for Health and Medical Activities and an additional medical officer, and establishment of a Medical Advisory Committee for the program were in response to indicated needs for widening of the medical phases of vocational rehabilitation. A principal objective of these actions was the greater provision of medical consultative services for State rehabilitation counselors, so that better evaluations could be made of disabilities and work poten¬ tialities of persons referred to the State agencies, and for the planning of realistic vocational goals. Four more regions are receiving medical Office of Vocational Rehabilitation 279 consultation through services provided by Public Health Service medical officers servicing both OVR and PHS programs at the regional level. Through efforts of the Central Office, States are being stimu¬ lated to use medical consultation on a person-to-person basis between physicians and counselors for the discussion of individual cases. The huge need for physicians trained in physical medicine and re¬ habilitation is urgent and continuous. An advisory panel for the medical training program was named during the year to establish training criteria and to plan the enlargement of the medical training activities. Small Business State agencies are intensifying efforts to find rehabilitation oppor¬ tunities for the disabled through self-employment, small business, industrial subcontracting, and the manufacture of products by the handicapped, including homebound. About 10 percent of the 88,275 disabled persons rehabilitated through the State-Federal vocational rehabilitation program in 1960 became self-employed, with the aid of their State agencies. In addi¬ tion, about 1 percent of all rehabilitants were employed in a State agency-managed business enterprise. Additional opportunities are expected from a new program entered cooperatively by the Office of Vocational Rehabilitation, several State agencies and the Office of Education to determine how educational programs in distribution services can be utilized for small business enterprises. Expenditures for State Programs Funds available to State rehabilitation agencies for their basic programs have more than doubled since 1954. States and the Con¬ gress both have increased available funds by more than 100 percent in that period. The total of Federal funds that was granted to States in 1960 for support of their basic programs was $49,072,022, about eight percent more than in 1959. Nineteen States — Alabama, Arizona, Arkansas, Connecticut, Delaware, Georgia, Iowa, Kentucky, Massachusetts, Nevada, New York, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Vermont, Washington, West Virginia, with the District of Columbia, Guam and the Virgin Islands — acquired all of the Federal allotments available to them by making available sufficient matching amounts. Five States acquired more than 95 percent but less than 100 percent; two States, 90 to 95 percent; six States, 80 to 280 Department of Health, Education , and Welfare, 1960 90 percent; seven States and an island possession, 70 to 80 percent; six States, 60 to 70 percent; three States, 50 to 60 percent; and two States, less than 50 percent. Eight States, the District of Columbia and Guam spent more of their own money on rehabilitation objectives in 1960 than was required to gain their full allotments, making an aggregate additional expendi¬ ture of more than $1 million for rehabilitation objectives. Extension and Improvement Grants A total of 99 projects were initiated by 57 rehabilitation agencies in 43 States during 1960, aided by Federal funds granted under exten¬ sion and improvement provisions of the Vocational Rehabilitation Act. These grants were used for establishment of rehabilitation facil¬ ities or workshops, improvement of specialized services to disability groups, or improvement of program and administration. Federal funds for these purposes totaled $987,171 in 1960. State Plans State rehabilitation agencies are in greater degree making use of the provisions of the Vocational Rehabilitation Act under which they may establish facilities or workshops. Each State agency — they total 54 general agencies and 36 serving only the blind — must have plans outlining their administrative and program courses. Fifty-eight of the 90 agencies — 40 general and 18 for the blind — now have in their plans provisions for establishment of rehabilitation facilities. Fifty- four agencies — 35 general and 19 for the blind — have provisions for workshops. Since 1955, provisions for facilities have been added to the Plans for 31 agencies, and those for workshops have been added to 21 Plans. The States have spent $10,500,000 for establishing facilities and workshops under these provisions. OASI Disability Determinations All persons applying to the Bureau of Old Age and Survivors Insurance for disability insurance benefits under 1956 amendments to the Social Security Act are, as a matter of government policy, con¬ sidered for possible rehabilitation services. During 1960, State rehabilitation agencies made approximately 300,000 initial determinations of disability among these applicants, screened about 350,000 applicants for rehabilitation potential, and accepted 35,000 of them for services. Three research and demonstration projects have been initiated that Office of Vocational Rehabilitation 281 relate to the improvement of methods for determining disability among these applicants and for assessing their rehabilitation potential. REHABILITATION AND LABOR HEALTH SERVICES Increasing opportunities have arisen in recent years for collabora¬ tive effort among OVR and many groups with interests in rehabilita¬ tion. Organized labor, for instance, is represented on the National Advisory Council for Vocational Rehabilitation, and AFL-CIO com¬ munity councils are active over the country in projects for improve¬ ment and extension of rehabilitation services. In furtherance of this activity, an institute was held in December 1959, with the help of an OVR grant, in which representatives of labor, health, and rehabilitation services participated. Out of the institute came guidelines of particular usefulness to State rehabilita¬ tion agencies and counselors in developing statewide working relation¬ ships with labor and similar groups for more effective rehabilitation measures. Additional State and local meetings have been planned for the coming year. International Activities Research into rehabilitation is to be extended to or expanded in nine countries through the use of counterpart funds which have accumu¬ lated to the credit of the United States in those countries in recent years. During the year the Congress was requested, and acceded, to appropriate a total of $930,000 for the purchase of foreign curren¬ cies in Brazil, Burma, India, Indonesia, Israel, Pakistan, Poland, UAR-Egypt, and Yugoslavia, for rehabilitation research, with the required expenditures within these countries. The International Unit has assembled a considerable volume of ma¬ terials describing the possible areas of research in each of the nine countries, and discussed them with the State Department, along with the general policies of administration that will govern the programs. Additional opportunities for international research will become available with activation of the principles to be initiated under the International Health Research Act passed by the Congress and signed into law during the year. FOREIGN TRAINEES Visitors from 39 foreign countries came to the United States during the year for study and observation of rehabilitation practices. Of the 104 who came, 31 were long-term trainees for whom detailed pro¬ grams of study in universities and agencies were prepared. Seventy- three short term trainees were referred to OVR by voluntary agencies, universities, departments of the Federal government and international organizations for whom visits to installations and courses of observa¬ tion were arranged. 282 Department of Health, Education, and Welfare, 1960 Table 1. — IS umber of referrals and cases, by agency, fiscal year 1960 Referrals Cases During fiscal year During fiscal year Agency 1 Re¬ Closed from active load Re¬ Total Accept¬ ed for serv¬ ices Not accept¬ ed for serv¬ ices 2 main¬ ing at end of year 3 Total active load (receiv¬ ing serv¬ ices) Reha¬ bilita¬ ted After reha¬ bilita¬ tion plan initi¬ ated « Before reha¬ bilita¬ tion plan initi¬ ated * main¬ ing at end of Tyear 6 United States, total _ 379,650 126, 839 130, 637 122, 174 297,950 88,275 10, 396 18, 791 180,488 Alabama - - 8,342 3,827 1,622 2,893 9,324 2,563 338 481 5,942 Alaska . ... . . 526 164 290 72 417 54 57 108 198 Arizona: General.. - 1, 564 578 553 433 1,295 455 65 72 703 Blind _ _ - 117 54 37 26 172 30 12 7 123 Arkansas - - 7,873 2,944 3,337 1,592 5, 456 2,368 184 161 2,743 California - 24,358 6; 166 13, 536 4. 656 15, 111 2, 382 827 2,687 9, 215 Colorado - 4, 201 1,740 821 1,640 3,173 908 163 114 1, 988 Connecticut: General... - 2,542 1, 538 407 597 4,023 1, 014 209 331 2,469 Blind _ 199 94 57 48 207 63 14 0 130 Delaware: General _ 1, 419 669 500 250 1,349 504 10 116 719 Blind _ 58 28 21 9 47 19 6 4 18 District of Columbia. . 4, 269 884 2,656 729 2,081 488 92 234 1, 267 Florida: General _ 14, 329 4,698 6,263 3,368 9,609 3,382 452 572 5,203 Blind _ 3,672 404 2,059 1, 209 1,053 280 56 47 670 Georgia _ _ 21,084 6,676 6,453 7,955 12, 614 5,914 310 441 5,949 Guam _ _ _ 171 32 14 125 82 4 3 0 75 Hawaii: General - 1,406 328 476 602 688 220 45 12 411 Blind _ 30 13 4 13 67 17 9 0 41 Idaho: General - - 1,958 393 868 697 958 356 33 25 544 Blind _ 34 14 10 10 45 10 1 3 31 Illinois _ 13, 337 6,097 4,453 2,787 14, 537 4,219 444 1,172 8,702 Indiana: General - 2,989 1,620 720 649 4,025 1, 232 83 202 2,508 Blind _ 188 86 57 45 230 40 16 22 152 Iowa: General _ 5,200 1,535 1, 558 2,107 3,747 1, 219 156 189 2,183 Blind _ 280 93 121 66 192 40 5 13 134 Kansas: General _ 3,788 1, 413 1,017 1, 358 3,051 889 91 146 1,925 Blind . 331 93 76 162 251 60 6 8 177 Kentucky _ _ 6,564 1, 643 2,525 2,396 3,907 1, 313 157 249 2,188 Louisiana: General . . 5,034 3,015 978 1,041 7,722 1, 814 307 499 5,102 Blind . . . 849 203 213 433 659 115 17 19 508 Maine: General _ 1, 936 547 517 872 1, 334 375 64 123 772 Blind _ _ 167 76 54 37 151 32 9 19 91 Maryland.. - 5,370 2,201 1, 351 1, 818 5,743 1, 413 136 573 3,621 Massachusetts: General _ 6,608 2,250 1, 663 2,695 5,115 1,656 131 279 3,049 Blind _ 364 150 93 121 424 81 33 37 273 Michigan: General - 9,232 3,785 1, 998 3,449 10, 000 3,216 503 191 6.090 Blind _ 385 218 87 80 484 106 41 49 288 Minnesota: General _ _ 7,185 1,741 2,466 2,978 5,051 1,251 226 99 3, 475 Blind _ 959 140 349 470 438 86 11 23 318 Mississippi: General _ 3,194 1, 656 514 1,024 3, 426 1,284 72 142 1,928 Blind _ 925 352 387 186 923 287 27 19 590 Missouri: General . . . 7,634 2,263 3,110 2,261 4,776 1,544 214 221 2,797 Blind _ 718 175 242 301 539 174 19 23 323 Montana: General . . . 1, 902 474 624 804 1, 371 385 32 31 923 Blind . . . . 356 19 295 42 56 18 4 3 31 Nebraska: General - 1,588 727 255 606 2,205 536 46 78 1, 545 Blind . . . 199 48 91 60 143 61 0 3 79 See footnotes attend o* table. Office of Vocational Rehabilitation 283 Table 1. — IS umber of referrals and. cases , by agency , fiscal year 1960 — Con. Referrals Cases During fiscal year During fiscal year Agency 1 2 Re¬ Closed from active load Re¬ Total Accept¬ ed for serv¬ ices Not accept¬ ed for serv¬ ices 3 main¬ ing at end of year * Total active load (receiv¬ ing serv¬ ices) Reha¬ bilita¬ ted After reha¬ bilita¬ tion plan initi¬ ated * Before reha¬ bilita¬ tion plan initi¬ ated « main¬ ing at end of year « Nevada: General _ _ 1,069 199 778 92 346 116 31 15 184 Blind _ 34 9 5 20 40 6 0 2 32 New Hampshire: General . . 878 241 632 5 769 185 89 14 481 Blind . - . - 36 19 8 9 73 13 3 8 49 New Jersey: General - - 5,665 1,972 1, 972 1,721 4, 488 1,362 261 404 2,461 Blind _ 873 228 283 362 525 177 24 9 315 New Mexico: General - 1, 574 391 822 361 636 271 24 10 331 Blind _ _ - 203 40 51 112 97 26 7 2 62 New York: General . . 28,745 9, 143 10, 920 8,682 19, 251 6,294 559 1,180 11, 218 Blind _ _ 1, 194 492 252 450 1, 003 271 32 89 611 North Carolina: General - 10, 546 5,914 3, 479 1, 153 13,544 4,821 393 573 7,757 Blind.... . 1, 411 553 605 253 1,518 403 35 106 974 North Dakota - 1, 910 520 536 854 1, 236 366 36 43 791 Ohio: General . . 7,678 2,789 1,991 2,898 5. 738 1,624 151 244 3,719 Blind— . . 1, 188 274 716 198 822 160 45 43 574 Oklahoma . - 4, 971 2,830 1,201 940 8,019 1,680 226 699 5, 414 Oregon: 2,875 General . . . 6,072 1, 022 2,175 2,722 759 112 185 1,666 Blind— . . 234 49 82 103 158 41 5 2 110 Pennsylvania: General— . — - 25, 669 8,538 7,499 9,632 20, 297 5,764 960 1,474 12,099 Blind-. . . 1, 573 332 600 641 1,052 250 66 102 634 Puerto Rico - - 8,317 1,756 1,370 5,191 4, 932 1,023 79 224 3,606 Rhode Island: General _ 2,281 981 346 954 2,253 721 111 8 1, 413 Blind . - 110 94 1 15 252 51 10 10 181 South Carolina: General . 7,028 2,119 2, 262 2,647 5,172 1,589 137 157 3,289 Blind . . - 340 140 145 55 321 103 6 23 189 South Dakota: General . - 1, 216 351 340 525 1,007 253 31 0 723 Blind _ _ 343 32 179 132 107 30 4 1 72 Tennessee: General _ 10, 241 3,084 3,869 3,288 7,039 2,509 219 347 3, 964 Blind . — 1,232 305 307 620 841 238 14 38 551 Texas: General . . 12,885 3,778 3,558 5, 549 10, 986 2, 478 166 692 7,650 Blind . 1, 127 413 381 333 820 371 10 21 418 Utah.. . . . . 2,205 891 727 587 1, 916 517 59 43 1,297 Vermont: General _ 1,005 260 286 459 768 182 69 41 476 Blind - 58 19 30 9 62 21 5 2 34 Virginia: 4,663 General _ 15, 197 4,324 7,193 3,680 8,779 3,217 216 683 Blind . . . 447 84 106 257 243 67 18 4 154 Virgin Islands _ 110 46 2 62 99 42 3 0 54 Washington: 2,513 General - - 4,533 1, 554 1,463 1, 516 4,079 990 163 413 Blind— . — . 227 89 79 59 217 61 12 7 137 West Virginia _ 15, 948 4, 849 4, 135 6,964 11, 157 3,023 96 926 7,112 Wisconsin: 80 3,948 General . . 7,024 1, 997 2,484 2,543 5,647 1, 481 138 Blind . . 129 74 23 32 216 65 11 11 129 Wyoming . . — 690 180 246 264 432 177 24 9 222 1 In States with 2 agencies, the State division of vocational rehabilitation is designated as “general,” and the agency under the State commission or other agency for the blind is designated as “blind.” 2 Services declined, services not needed, individual not eligible, individual needing services other than vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc. 2 Eligibility for rehabilitation not yet determined. < Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 8 Closed prior to initiation of rehabilitation plan because of indifference of individual, increase in degree of disability, loss of contact, etc. « In process of rehabilitation on June 30, 1960. 284 Department of Health , Education , and Welfare , 1960 Table 2. — Vocational rehabilitation grants , 1960, State divisions of vocational rehabilitation Total Alabama.. . Alaska _ Arizona _ Arkansas. - California.. Colorado... Extension State or territory Support and im- grants provement grants Total $43,501,816 $898,760 $44,400,576 1,982,496 113, 510 337,288 1,262, 873 2, 774, 359 554, 794 188 5,000 7, 643 14,805 120, 190 14,343 1,982,684 118, 510 344,931 1,277,678 2,894,549 569, 137 Connecticut _ Delaware _ District of Columbia. Florida . . Georgia . . Guam . . . 328,369 139,486 232,887 1, 319, 128 2, 264, 996 48, 575 15, 532 5,000 32,007 5,000 343, 901 144, 486 232, 887 1,319, 128 2, 297,003 53, 575 Hawaii. Idaho... Illinois.. Indiana. Iowa _ Kansas. 184,246 164, 162 1,973,074 463, 831 671, 221 460, 196 3,083 49,041 22, 669 19, 172 13, 659 187, 329 164, 162 2,022,115 486, 500 690,393 473,855 Kentucky _ Louisiana . . Maine _ Maryland - Massachusetts. Michigan . . 490, 888 1,036,904 222, 704 606, 650 712,097 1,268,388 25,820 7,981 32, 178 65, 943 516,708 1,036,904 230, 685 606, 650 744,275 1,334, 331 Minnesota. Mississippi. Missouri... Montana.. Nebraska.. Nevada.... 895, 842 596, 358 652,209 171, 663 273, 179 45, 653 23,755 25, 182 5, 768 8, 142 5,000 919, 597 596,358 677, 391 177,431 281,321 50, 653 New Hampshire. New Jersey . . New Mexico _ New York _ North Carolina.. North Dakota. .. 84, 184 952,350 39, 795 190, 066 7, 059 2, 840, 544 50,408 1, 636, 128 10, 594 307, 840 5,449 84, 184 992, 145 197, 125 2, 890, 952 1, 646, 722 313, 289 Ohio. . Oklahoma _ Oregon . Pennsylvania. Puerto Rico.. Rhode Island. 797,736 1, 172,382 514, 138 3, 351,742 716, 667 252,460 58, 773 19, 156 5,536 47, 385 7,335 856, 509 1, 191, 538 519, 674 3, 399, 127 716,667 259, 795 South Carolina. South Dakota.. Tennessee _ Texas _ Utah . Vermont _ 768, 856 218,668 1,265, 183 1,422, 180 301, 373 152,777 9,000 4,688 32,063 7,251 ' 777,856 223,356 1,265,183 1,454,243 308, 624 152,777 Virginia . Virgin Islands. Washington.. West Virginia. Wisconsin _ Wyoming _ 1,193,475 19, 429 804, 954 1, 126, 152 1,066,450 98,056 23, 160 16, 507 22,500 5,000 1,193,475 19,429 828, 114 1, 142, 659 1,088, 950 103,056 285 Office of Vocational Rehabilitation Table 3. — Vocational rehabilitation grants , I960, State commissions or agencies for the blind Total . Arizona _ Connecticut. Delaware. ._ Florida . Hawaii _ Idaho . State or Territory Support Extension grants and improve¬ ment grants Total $5, 570,206 $88, 411 $5, 658, 617 84,454 41, 950 36, 380 439,000 30, 230 14, 724 1,914 3,840 2,056 86,368 45, 790 36, 380 439, 000 32, 286 14, 724 Indiana . . Iowa _ _ Kansas _ Louisiana _ Maine . Massachusetts. 55, 545 294, 129 133, 095 171, 979 74, 062 171,060 4,486 3, 668 8,508 55, 545 298, 615 136, 763 171, 979 74,062 179, 568 Michigan.. Minnesota. Mississippi. Missouri... Mon tana. . Nebraska. . 118, 229 154, 722 304, 603 239, 004 47,418 77, 289 4,071 118,229 154, 722 304, 603 239, 004 47, 418 81,360 Nevada _ New Hampshire. New Jersey . . New Mexico _ New York _ North Carolina.. 12, 448 24,215 204, 075 54, 547 410, 738 481, 170 1,250 8,400 20, 131 12,448 25, 465 212, 475 54, 547 430, 869 481, 170 Ohio . Oregon _ Pennsylvania.. Rhode Island.. South Carolina. South Dakota . 327, 495 87, 177 389, 990 52, 544 60, 511 56,213 6,893 8, 816 1, 172 334, 388 87, 177 398, 806 52, 544 60, 511 57,385 Tennessee. . Texas . Vermont.... Virginia _ Washington Wisconsin.. 330, 546 286, 792 31, 450 86,880 87, 724 97, 818 10, 206 3, 000 330, 546 296, 998 31, 450 86,880 87, 724 100,818 573826- 61—20 Saint Elizabeths Hospital During the year just closed, problems of understaffing and over¬ crowding have persisted, the admission rate has increased substan¬ tially, and a number of vacancies have existed on the medical staff. Nevertheless, thanks to the devotion and industry of the entire person¬ nel of the hospital, the care of the patients has continued to be satisfactory, and the various activities of the hospital have been carried on to the best of everyone’s ability. Every attempt has been made to achieve the high standard of care to which the hospital is dedicated. The so-called tranquilizing drugs which are coming on the market in ever-increasing numbers have been utilized to a very sub¬ stantial extent and have proved themselves valuable in the institu¬ tional care of mental patients. The program of open wards and patient self-government has been extended and the results have been decidedly beneficial in accomplishing the aim of resocializing and rehabilitating the patients. The load of aged and infirm patients, however, continues to increase, and raises ever-new problems as to the role of the mental hospital in caring for this particular group. In the last annual report comment was made upon the growing competition of the States for psychiatric personnel. Many of the States offer far greater inducements to trained personnel than does the Federal Government, not only in the line of salaries but of what may be termed “fringe benefits,” such as housing, food, and protection 'from suits for malpractice. During a large part of the year there have been as many as ten vacant medical staff positions, so it is encouraging to report that the prospects for the coming year are brightening. Nearly all of the third-year residents have elected to remain on the staff, and several other well-trained physicians have been recruited. It is our hope that this situation indicates a possible change in the tide. 287 288 Department of Health , Education, and Welfare, 1960 One of the risks of prediction appears in the statement of last year’s annual report, “It appears that some stability of discharges and ad¬ missions is being achieved.” At the time that statement was made the statistics justified it. However, during the past year, although the number of discharges to the community showed a very slight in¬ crease, the number of admissions increased startlingly to 1,894. This represented an increase of 287, and was the largest number of ad¬ missions in a single year since 1945. Of these admissions, 540 or 20.8 percent had previously been patients in Saint Elizabeths Hospital or similar institutions. During the past few years an increase in the readmission rate has been noted, but it is not clear that this represents the total reason for the tremendous rise in admissions. We have mentioned previously what appears to be an abuse of the writ of habeas corpus. In fiscal year 1959, for example, there were 133 cases in which the hospital either had to show cause why a writ should not be issued or produce the patient in court. During the year just closed this number has more than doubled. One hundred and fifty-three orders to show cause were issued and 121 writs, a total of 274. The fact that the vast bulk of these petitions was unfounded is suggested by the fact that only three patients were discharged and two conditionally released. The amount of time involved by the physicians and employees who are required to accompany the patient to court or to testify is inordinate, and constitutes a great burden on the hospital. During the month of June 1960, for example, the three physicians in the John Howard Pavilion spent 119 hours in court, that is an average of one work- week each. It is a pleasure to report that in September 1959 the new John Howard Pavilion, the maximum security section of the hospital, was put into operation. The move of the prisoner patients from the old Howard Hall was accomplished without incident, with the great assistance of the United States Marshal’s Office and the District of Columbia Department of Corrections. Eleven of the wards have been put into operation since the opening of the building, and the last one will be opened shortly after the first of July. This has relieved entirely, at least for the moment, the necessity of establishing a waiting list. The existence of this waiting list has been a source of great concern to the hospital and to the courts of the District and the latter have been most understanding and tolerant of the demands of our lack of space. One cannot predict how long the happy state of prompt admission will last, as the number of prisoner patients being sent to the hospital either for observation, found incompetent for trial, or found not guilty by reason of insanity seems to be showing a steady rise. Various other agencies of the Government, notably the Health De¬ partment, the Public Welfare Department, and the Rehabilitation Saint Elizabeths Hospital 289 Division of the District have been most helpful, as have the Veterans Administration and the Department of Justice. Further plans for even closer cooperation are being worked out. During the year a great deal of time and energy have been consumed by attempting to carry out the demand of the Bureau of the Budget that more patients be transferred from Saint Elizabeths Hospital to other agencies, notably D.C. Village and Glenn Dale of the District of Columbia, the Public Health Service and the Veterans Administration. The policy of the hospital for years has been to transfer to the D.C. Village those patients who are willing to go and who show a reasonable pros¬ pect of conforming to the various requirements of that institution. There have been numerous conferences and visits to the respective institutions already mentioned, but numerous obstacles have been encountered, so that in spite of the labors of the mountain hardly more than a mouse has so far been produced. The work will continue, but it should be borne in mind that human values as well as mere statistical logistics enter into consideration in a problem of this sort. During the year visitors from no less than 24 foreign countries honored the hospital. Such visits are always a source of stimulation and gratification to the staff. Throughout its history the hospital has been acutely aware of the fact that although the care of the patient must always come first, the institution has an obligation as well in the lines of education, both of personnel and of the community, and of research. These programs have been prosecuted vigorously during the year. In the field of psy¬ chiatry the George Washington University and Howard University Medical Schools have utilized the facilities of the hospital for the training of their medical students. The hospital is likewise approved for a three-year residency in psychiatry. In the field of general medi¬ cine the institution is the only public mental hospital in the country which is approved for rotating internship. It is likewise fully ac¬ credited by the Joint Commission on the Accreditation of Hospitals. Training proceeds in general medicine, surgery, pathology, and ra¬ diology. There are also internships, residencies, and planned field work in psychology, social work, occupational therapy, and clinical pastoral work. Instruction in nursing is carried on, on both the un¬ dergraduate (by affiliation with training schools) and graduate levels. In the field of research the hospital is happy to report progress in the work of the Joint National Institute of Mental Health — Saint Elizabeths Hospital Clinical Neuropharmacology Center. A large exhibit of the work done in this Center was shown at the meeting of the American Psychiatric Association in Atlantic City in May. Un¬ der the auspices and advice of the Hospital Research Committee, 20 projects were commenced during the year. 290 Department of Health, Education , and Welfare , 1960 Division of Clinical Services CLINICAL BRANCHES The general care and treatment of the patients is carried on by three clinical branches, each of them subdivided into services. In addition a Medical and Surgical Branch is charged with the acute medical and surgical treatment of all patients and emergency attention to employees. There are three admission services. Civilian patients under 64 years of age are admitted directly to the Dix Pavilion. Those over 64 are admitted directly to the Geriatric Building. Sex psychopaths and male prisoners under charges or sentence, or found not guilty by reason of insanity are admitted directly to the John Howard Pavilion. There is a steady increase in the number of elderly and infirm patients, and there seems to be no reason to expect this to diminish unless other suitable facilities of a non-psychiatric nature can be found in the community. With the transfer of the patients from the old Howard Hall to the new John Howard Pavilion, the West Side Service was abolished, at least temporarily, with the other wards being assigned between the West Lodge and Detached Services. As a result those two services are altogether too large, and as soon as possible the West Side Service will be reinstituted. The number of voluntary admissions continues without much change — 191 during the year just closed. It is unfortunate that this provision of law is not used more, as the present laws relating to the commitment of mental patients are unduly cumbersome and unfair to the patient. During the year, indeed, a decision of the Court of Appeals has made the procedure even more complicated by providing that every patient whose commitment is contemplated may appear in court to contest his commitment. This is in addition to the right of jury trial and the use of habeas corpus proceedings. It is to be hoped that some time in the future the District of Columbia may have commitment laws which are at least as humane as those of most of the other States. The tranquilizing drugs have been used copiously. It is almost impossible to contemplate a reversion to the “good old days” before tranquilizers were known. In addition, some of the so-called psychic energizer drugs have been utilized, but as yet there is much to be desired in the drug treatment of the depressions. Electro-shock continues to be used sparingly. Group therapy is used widely and individual psycho¬ therapy wherever possible in selected cases. The requirements of time obviously limit the use of this latter modality. As a result of the increased admissions the number of patients actually in the hospital showed an increase at the end of the fiscal year of 97, the total being 7,120. A large number of volunteer groups have been very faithful in visiting the wards and providing entertainment for the patients there as well as at the Red Cross House and Hitchcock Hall. There has Saint Elizabeths Hospital 291 been increasing cooperation with the various community agencies in this regard. MEDICAL AND SURGICAL BRANCH The work of this Branch as in the past continues to be unusually varied and of high efficiency. The neurological service has been ex¬ panded, and it is expected that in the near future the employee health service will materialize through contract with the Public Health Serv¬ ice. During the year a total of 2,377 patients were treated in the Medical and Surgical Service, with a total of 85,578 hospital days. In addition over 55,000 clinic visits were recorded. A radiation officer and a sanitary engineering officer have been appointed. NURSING BRANCH This Branch, in spite of shortages, notably in the graduate nurse field, has rendered yeoman service to the care of patients. An active program of in-service training in all types of ward personnel is carried on, and 13 schools of nursing and the Navy Hospital Corps affiliate with the Hospital. Training on a postgraduate level is provided for graduate students from Catholic University. The general shortage of graduate nurses throughout the country is reflected in the figures of the hospital, but the number has held steady since last year, gradu¬ ate nurses totaling 252. No male graduate nurses have been available for employment since 1956. It is to be hoped that this shortage may be remedied before long. PSYCHOTHERAPY BRANCH This Branch embraces individual and group psychotherapy, psycho¬ drama, dance and art therapy. The Director of this Branch is also the coordinator of professional training. The various types of pro¬ fessional training have been expanded during the year, and the work has brought a closer relationship among the various professional groups. PSYCHOLOGY BRANCH Four research projects are under way. During the year one doctors’ thesis was completed under the supervision of the Branch. Speech therapy has been added to the armamentarium of the Psychology Branch. There were 111 teaching sessions, and 3,777 tests were given by the Branch during the year. RECREATIONAL THERAPY BRANCH The program of this Branch continues to be very active, providing ward parties and entertainments, the latter being held on the wards, in the Ked Cross Building, and in Hitchcock Hall. Patients have been given the courtesy of using the swimming pool at Bolling Air 292 Department of Health , Education , and Welfare , I960 Force Base. The Branch has recently been assigned the duty of un¬ dertaking coordination of ward parties in order to avoid unnecessary duplication. Community participation in the whole program has j been most gratifying. OCCUPATIONAL THERAPY BRANCH The expansion and organization of this Branch have continued and widened. An educational program for patients carried on by volun¬ teers is a notable activity. In addition, pre-vocational testing and pre-industrial therapy have been developed and carried out. All of these forms of therapy are conducted by the referral of physicians. Thirteen student interns were under instruction during the year. VOLUNTEER SERVICES BRANCH Four hundred and fifty-seven volunteers per month contributed a total of 21,687 hours of service during the fiscal year — a most astonish¬ ing record, and a gratifying testimonial to the interest which the com¬ munity exhibits in the welfare of the patients at the hospital. The variety of groups and individuals is too wide to enumerate. The American Red Cross, various church groups, and community service groups have been most generous in their attendance and in their interest in the patients. The hospital is deeply appreciative of what they have done. SOCIAL SERVICE BRANCH Considerable expansion of the Branch has taken place during the year. One thousand four hundred and seventy-eight patients were served, and a total of over 21,000 interviews were held by the social workers. A nursing follow-up project of the D.C. Health Depart¬ ment is being conducted under a grant from the National Institute of Mental Health, and 47 patients have been referred. The Voca¬ tional Rehabilitation Division of the District of Columbia Govern¬ ment is planning to increase to six its total number of rehabilitation counsellors, who work in close cooperation with the Social Service Branch. One aspect of the work of sending patients to the District of Columbia Welfare and Health Departments has been emphasized during the year, namely, the need of the District for a larger number of available foster and nursing homes especially for older patients and for adequate support of such patients as may be placed there. CHAPLAIN SERVICE BRANCH This Branch, under Jewish, Protestant, and Roman Catholic chap¬ lains, carries out religious ministry to the patients, both in chapel serv¬ ices and on the wards. New patients are visited, and such other pa¬ tients as request the services of the chaplains of their faith. Training Saint Elizabeths Hospital 293 is carried on both for Protestant and Roman Catholic clergy and for theological students. The community clergy have been most helpful in participating in special services. The Director of Protestant Chap¬ lain activities during the year served as the Chairman of the Mental Health Week Committee early in May. During that week probably at least 5,000 or more persons visited the hospital, thus increasing their understanding of the aims and activities of the institution and of mental illness in general. MEDICAL RECORDS BRANCH No hospital is complete without adequate records. Indeed, some of the more cynical are inclined to think that the accrediting bodies are more interested in records than they are in the care of the pa¬ tients. The Branch has functioned efficiently and during the year installed open-shelf filing with terminal digit numbering. LIBRARY SERVICES The Medical Library provides library service to the medical staff, both by making accessible volumes in the hospital library and obtain¬ ing others through inter-library loan. The library gained 1,363 ac¬ cessions during the year, the total number of accessioned volumes now amounting to 21,000, besides over 18,000 pamphlets. Some com¬ ment was made last year about the amount of “red tape” involved in obtaining inter-library loans. Particular thanks, however, are due to the Veterans Administration for their very generous and continuing cooperation. It is expected that eventually the proposed wings to be added to the Administration Building will provide further space, even though that too may not be entirely adequate. The Patients’ Circulating Library now has over 64,000 volumes and gained nearly 4,000 during the year, largely by donations. In addition there are numerous classes in bookbinding, typing, shorthand, and languages. LABORATORY BRANCH This Branch continues to grow in activity and efficiency. An isotope unit is now being installed, and much new equipment has been ob¬ tained, much of it on Government surplus. Over 180,000 tests were carried out during the year, an increase of 10,000 from 1959. Autop¬ sies continue at a reasonable rate, the rate during 1960 being 40.8 per¬ cent, that is 201 autopsies. Division of Administratioji It would be gratifying if space permitted an enumeration of the various accomplishments of the branches and sections in this Division, such as financial, personnel, construction, engineering, grounds, 294 Department of Health , Education, and Welfare, 1960 laundry, dietary, and maintenance. With the increasing number of patients and with the increasing complexity of governmental opera¬ tions all of these sections have been more than busy. They have, at the same time, been highly efficient in their accomplishments. Much is involved in the day-to-day maintenance of an institution of this size, but in addition various improvements have been carried out and some reconstruction. Detailed plans have been developed for the proposed Continued Treatment Building No. 9 and a very considerable amount of preliminary work has been done for the development of the Re¬ habilitation Building which is contemplated. Needs of the Hospital Some of the buildings are old and replacements are needed. Whether eventually the increasing demands of the patient load will demand an expansion of the hospital is at the moment an open ques¬ tion. Even more important, however, than buildings is the need of revising the salary scale and the perquisites for professional personnel. This is essential if the Federal Government is to approach meeting the competition of the various States. The support of the Secretary has been deeply appreciated in securing further recognition of the vital Federal role of the hospital. Table 1. — Movement of patient population, fiscal year 1960 Total Male Female White Colored Total White Colored Total Total number under care and treat¬ ment, fiscal year I960... . . . 9,451 2,621 2,098 4,719 2,713 2,019 4,732 Remaining on rolls, June 30, 1959 . . . 7, 557 2,114 1, 699 3, 713 2,205 1,639 3,844 Admitted during fiscal year 1960 . 1,894 507 499 1,006 508 380 888 Total discharged and died . 1,605 491 337 828 477 300 777 Discharged... . 1, 101 330 246 576 316 209 525 Conditions on discharge: Recovered . . . 72 15 24 39 13 20 33 Social recovery . . . 352 60 54 114 128 110 238 Improved . . . 452 161 96 257 132 63 195 "Unimproved . 181 78 48 126 42 13 55 Worse . . . 0 0 0 0 0 0 0 No mental disorder . . . . . 42 14 24 38 1 3 4 Unknown. . 2 2 0 2 0 0 0 Died . 504 161 91 252 161 91 252 Remaining on rolls, June 30, 1960... . 7, 846 2,130 1,761 3,891 2,236 1,719 3, 955 Change in sex and color . 0 +4 -1 +3 -2 -1 -3 Adjusted on rolls, June 30, 1960 . . Absent on visit or elopement . . 7,846 2, 134 1,760 3, 894 2,234 1,718 3, 952 726 114 132 246 263 217 480 In hospital, June 30, 1960 _ _ 7,120 2,020 1,628 3, 648 1, 971 1,501 3,472 Table 2. — Consolidated statement of movement of patients , by classification , fiscal year 1960 Saint Elizabeths Hospital 295 spuBjsj mSjtA OOhOWNO CO 1-H (M 05 1 05 05 C* 1 N CO i aaiAiag onqnj; NtNHHOOO CO CO 00 1 00 05 CO ICO CO 1 sjauosud "S'll CO - o 05 rH 00 ^ CO cO l— sdJOQ auiJBjv ooohhon !>• 1 t>- 00 t suaqB paujajuj - i j i i- aoiAjag uSiaioj OJ O CO T-H OJ 05 rp 00 0*0 c* suopBAjasaj [BJapaj CO O* O CO CO 05 »— 1 00 t^rH o (NNO lO CO | CO CO 05 sjuapisajuou ,3,d 241 1 241 13 228 1 +274 275 33 242 242 pJBUQ ?SBOQ lO 1 1 1 l tO till to I to to auoz [bub 3 1 1 1 1 O i i i i o 1 cO 1(0 (O 3UBSUT UBtpBUB3 g°NHH2 53 1 52 55 sauioH [buoijbnj jo UBaona MOhhON (N ! o ^ to sjiBgv uBipuj jo uBajng HOCOCOOOO • 00 1 00 T-H CO lO • O i to o [Bjo^qng 6, 108 1,460 1,082 458 624 6, 486 -266 6,220 634 5, 586 7, 568 7, 557 1,894 1,605 504 1,101 7,846 0 7, 846 726 7, 120 9, 451 :§« - a i 05 05 05 H i-H fcO - ^ ©§5 MflO- h’S’0£Bh’,1- aSSt# S » g s o o a i& ;sf8 •2 gS -73 iSo a CT3 fl«5g Ug^ii-ag . a,ca^ «•-» o *— • OHraJLOQH O American Printing House for the Blind As the official schoolbook printery for the blind in the United States, one of the principal functions of the American Printing House for the Blind, in Louisville, Kentucky, is the provision of special educa¬ tional books and supplies for the blind school children throughout the country through the Federal Act “To Promote the Education of the Blind.” This act, originally passed in 1879, authorizes an annual appropriation to the Printing House for this purpose. Allocations of books and materials are made on a per capita basis. Only those pupils may be registered whose vision comes within the accepted definition of blindness as follows: “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20 degrees.” The Printing House maintains large catalogs of Braille books, Talking Books, recorded tapes, Braille music publications, large- type texts, and tangible apparatus. A rich collection of educational ma¬ terial is thereby provided for the kindergarten through the high school grades. A total of 6,656 blind pupils was enrolled in the residential schools for the blind and 6,835 in public schools — a total of 13,491 blind pupils being served by the Printing House — for the fiscal year ending June 30, 1960. During the 1960 fiscal year, Braille books, educational periodicals, and music made up approximately 42.5 percent of the materials re¬ quired by the schools ; Braille slates, Braillewriters, maps, and other mechanical devices about 22 percent; Talking Books about 3.5 per¬ cent ; recorded educational tapes about 1 percent ; and large-type books about 28 percent. Approximately 7 percent was used for miscella¬ neous items. 297 Gallaudet College Gallaudet College is devoted to the education of deaf persons who because of their handicap would have difficulty in schools and colleges for hearing students. The college, located in Washington, I).C., is the world’s only college for the deaf. It was accredited in May 1957 by the Middle States Association of Colleges and Secondary Schools. In addition to education, it conducts research into the educational problems of deafness. It consists of the Kendall School and the college proper. KENDALL SCHOOL Primary and secondary schooling is provided for deaf children in the Kendall School, which also serves as a laboratory school for teach¬ ers training in the college. The oral method of instruction is used for all pupils except those who make no progress under it. Enroll¬ ment last year was 90 of which 60 came from the District of Columbia. GALLAUDET COLLEGE The college, established in 1864 by act of Congress, offers the asso¬ ciate’s degree after 2 years of study, and a bachelor’s degree in the liberal arts and sciences. The Preparatory Department provides the senior year of high school for students who are unable to obtain it in the State schools for the deaf. The Graduate Department of Educa¬ tion offers a master’s degree and a professional diploma in the educa¬ tion of the deaf to students with normal hearing, and offers a 4- week training course to vocational counselors who wish to acquire a deeper understanding of deaf persons. Total enrollment in the college last year was 385, with students from 45 States, the District of Columbia, and 6 foreign countries. In addition, there were in attendance throughout a part of the school year 73 students enrolled in (a) sum¬ mer school graduate courses, and (b) courses in “orientation to the deaf” for vocational rehabilitation counselors, welfare workers, etc. 299 Howard University Howard University, located in the District of Columbia, was char¬ tered by act of Congress on March 2, 1867. The university offers programs of higher education on the undergraduate, graduate, and professional levels. Undergraduate students are registered in the college of liberal arts; graduate students seeking the master’s and doctor of philosophy degrees are registered in the graduate school; professional students are registered in the colleges of medicine, den¬ tistry, pharmacy, and the schools of engineering and architecture, music, social work, law, and religion. (The school of religion receives no support from Federal funds.) The educational program of Howard University is conducted in keeping with the democratic purposes of the land-grant colleges and State universities with the low tuition fees and living costs which characterize these State institutions and with an educational program resting upon and permeated by the content and spirit of a general or liberal education. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and undertakes to discharge a special responsibility for the admission and training of Negro students. In June 1960 President Mordecai W. Johnson retired after 34 years as President of the University. The Board of Trustees elected as his successor Dr. James M. Nabrit, Jr., Dean of the Law School and Secretary of the University. Dr. Nabrit had been a member of the faculty at Howard University for 24 years. ENROLLMENT OF STUDENTS During the school year 1959-60, the university served a total of 7,402 students as follows : 5,653 during the regular academic year and 1,749 in the summer session of 1959. The total net enrollment, ex¬ cluding all duplicates, was 6,507, distributed in the 10 schools and 301 573826 — 61 - 21 302 Department of Health , Education, and Welfare, 1960 colleges as follows: liberal arts, 3,122; graduate school, 726; engi¬ neering and architecture, 898 ; music, 309 ; social work, 129 ; dentistry, 644 ; medicine, 355 ; pharmacy, 161 ; law, 106 ; and religion, 57. This enrollment included a larger body of Negro professional students than in all universities of public support in all the Southern States combined. GEOGRAPHICAL DISTRIBUTION OF STUDENTS Of a total of 6,003 students seeking degrees, 5,142 or 85.6 percent came from 45 States and the District of Columbia, while 861 students or 14.4 percent came from outside the continental United States including 2 possessions of the United States, 48 foreign countries and 17 island possessions of the British, French, and Dutch West Indies. The 5,142 students from the United States were distributed as follows: New England States, 82; Middle Atlantic States, 825; East North Central States, 294; West North Central States, 88; South Atlantic States, 3,122; East South Central States, 384; West South Central States, 291 ; Mountain States, 14 ; and Pacific States, 41. The 861 students from outside the continental United States came from 48 foreign countries, including Canada, 2 countries in the West Indies, 3 countries in Central America, 2 countries in South America, 10 countries in Europe, 14 countries in Africa, 16 countries in Asia, and 17 island possessions of the British, French, and Dutch West Indies. VETERANS There were 633 veterans enrolled at the University during the 1959-60 school year. They were distributed among the 10 schools and colleges as follows : 221 in liberal arts, 50 in the graduate school, 8 in music, 123 in engineering and architecture, 25 in pharmacy, 96 in medicine, 62 in dentistry, 13 in social work, 30 in law, and 5 in religion. ARMY AND AIR FORCE ROTC Army ROTC — There were 440 students enrolled in Army ROTC during the school year 1959-60. Of this number, 202 were in the first year course, 142 were in the second year, 61 were in the third year, and 35 were in the fourth year. During the year, 31 students were commissioned as reserve officers in the Army. Air Force ROTC — There were 388 students enrolled in Air Force ROTC. Of this number, 215 were in the first year course, 142 were in the second year, 12 were in the third year, and 18 were in the fourth year. During the year, 9 students received commissions as reserve officers in the Air Force. In addition, seven students who Howard University 303 were enrolled in five-year academic programs, completed all of their ROTC work and were scheduled to be commissioned upon graduation. THE FACULTY During the 1959-60 school year, a total of 653 teachers served the university. Of this number, there were 374 full-time teachers and 279 part-time teachers. The full-time equivalent of the teaching staff was 443.80. Of this number, 390.85 were teaching in the rank of instructor and above. From its establishment in 1867, the university has had on its faculty learned and able men and women, selected on the basis of their competence and character, without regard to sex, race, creed, color, or national origin. It was a major purpose of the founders of the university, however, to employ Negro teachers, among others, on every faculty. The Negro members of these faculties constitute a larger group of professional teachers than all the Negroes so employed in all other American universities combined. Many of the outstand¬ ing Negroes in the public life of America have served in the past on faculties of the university. Such persons include the founder and operator of the first blood plasma bank, the first Negro governor of an American possession, the first Negro in the Secretariat of the United Nations, and the first Negro member of the United States Court of Appeals. THE BUILDING PROGRAM Construction was continued on the new auditorium-fine arts build¬ ing, which was scheduled to be completed during the fall of 1960 and put into operation at the beginning of the second semester in the 1960-61 school year. This building will provide an auditorium for 1,500 persons, a laboratory little theater having a capacity of 320 per¬ sons, classrooms, and other facilities for the entire school of music, the department of art, and the department of drama. Plans were completed for the construction of the home economics building, preparatory to beginning construction during the 1960-61 school year. GRADUATES During the 1959-60 school year, there were 680 graduates from the ten schools and colleges of the university. These graduates came from 31 States, the District of Columbia, the Virgin Islands, Puerto Rico, 22 foreign countries, and 12 island possessions of the British and Dutch West Indies. These 22 foreign countries included Canada, Panama, British Guiana, Cuba, 7 countries in Africa, 6 countries in Asia, and 5 countries in Europe. 304 Department of Health , Education , and Welfare , I960 The 680 graduates were distributed among the 10 schools and col¬ leges as follows : liberal arts, 329 ; engineering and architecture, 61 ; music, 19; the graduate school, 50; social work, 48; medicine, 69; den¬ tistry, 49 ; dental hygiene, 7 ; pharmacy, 17 ; law, 26 ; and religion, 5. Three honorary degrees were also conferred. Since its establishment in 1867, Howard University has graduated 21,770 persons. The large majority by far of these graduates have been Negroes. Their number includes a larger body of graduates in medicine, dentistry, pharmacy, engineering, music, law, and social work than the entire output of Negro professional graduates in all the publicly supported colleges and universities in the South. The largest number of graduates have entered the field of teaching, primarily in the Southern States. Three thousand and eighty-four have entered the practice of medicine ; 2,426 have entered the practice of dentistry and dental hygiene ; 2,409 have entered the field of law ; 797 have entered the ministry ; 875 have entered the field of pharmacy ; 784 have gone into engineering and architecture ; and 479 have entered the field of social work. A large but undetermined number is engaged in government activities. SERVICE IN FOREIGN COUNTRIES Teachers and students from Howard University continued to render distinguished service in foreign countries. The countries where they have gone include Burma, Brazil, Ceylon, Egypt, Ethiopia, West Ger¬ many, India, Indonesia, Israel, Iraq, Italy, Kenya, Liberia, British Guiana, the Sudan, Japan, and Vietnam. Fulbright scholars from Howard University have served in Egypt, Ghana, Iraq, Japan, Nor¬ way, Sweden, Denmark, Italy, France, Greece, England, and India. Government officials both in the United States and in foreign coun¬ tries have frequently indicated that they found the services of mem¬ bers of the faculties and students to be of great value to their country and its interests abroad. During the 1959-60 year a number of members of the staff served in various capacities. A member of the staff of the Department of Gov¬ ernment was engaged in a research mission on Communist infiltration for the Southeast Asia Treaty Organization. The head of the Depart¬ ment of Home Economics was a delegate to the United Nations Con¬ ference on Human Eights in Geneva. A member of the staff of the Department of Architecture served on the staff of the United States Operations Mission to the Sudan. The Dean of the School of Law, for the second successive year, was a member of the United States delegation to the International Labor Organization Conference in Switzerland. With regard to Dr. Nabrit’s services there, the Assistant Secretary of Labor wrote as follows: “He represented the United States on the substantive com- Howard University 305 mittee of the Conference concerned with the question of Consultation and Cooperation Between Public Authorities and Employers and Workers Organizations at the Industrial and National Levels. Dr. Nabrit did an outstanding job in this committee, where he was most effective in presenting and explaining the United States viewpoint. In addition, he made a very favorable impression on his colleagues, and all of this redounded to the credit of the delegation as a whole.” It is also to be noted that at the invitation of the Department of State, the Howard University Choir, in June 1960, began an 80-day tour of 18 Latin American nations, under the auspices of the Interna¬ tional Cultural Exchange Service. These technical and professional services not only contribute spe¬ cifically to the success of programs of our Government in foreign lands, but the spiritual and good-will effects of these representatives from Howard are major assets in our relationships with Asian and African peoples. They serve the cause of democracy around the world. ■ : _ Detailed Contents OFFICE OF THE SECRETARY Office of Assistant Secretary (Security, Civil Defense, Interna- Page tional Activities) _ 2 Office of Assistant Secretary (for Legislation) _ 3 Office of General Counsel _ 3 Special Assistant to the Secretary (Health and Medical Affairs). 4 Office of Assistant to the Secretary (for Program Analysis) _ 5 Office of Administration _ 5 Office of Field Administration _ 6 Special Staff on Aging _ 7 Assistant to the Secretary (for Public Affairs) _ _ _ 7 Office of Public Information _ 8 Table 1. — Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1960 _ 9 SOCIAL SECURITY ADMINISTRATION SOCIAL SECURITY IN 1960 . . . - . . 11 Hearings and Appeals _ 16 International Activities _ 16 OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE . 18 What the Program Is Doing _ 19 Administering the Program _ 23 Legislative Developments During the Year _ 29 Provisions of the 1960 Amendments _ 29 Special Study Requested by the Congress _ 33 Surveys of the Status of Beneficiaries Under the Old-Age, Survivors, and Disability Insurance Programs _ 34 Program Simplification _ 35 Financing the Program _ 35 PUBLIC ASSISTANCE _ 36 A Quarter Century in Retrospect _ 36 Legislative Changes _ 37 Increasing Acceptance of Public Welfare Measures _ 38 Areas Identified as Needing Further Consideration _ 40 Considerations for the Future _ 43 Developments in 1960 _ 47 New Legislation _ 47 Trends in Caseloads and Expenditures _ 48 Program and Administrative Developments _ 50 CHILDREN’S BUREAU _ 56 Some Facts and Figures About Parents and Children - 56 Major Trends _ 57 Legislative Developments During the Year _ 58 1960 White House Conference on Children and Youth - 59 Federal Interdepartmental Committee on Children and Youth — 61 Programs of the Bureau _ 61 307 308 Department of Health , Education , and Welfare , I960 Research in Child Life _ Maternal and Child Health Services - Crippled Children’s Services _ Child Welfare Services - Juvenile Delinquency Service _ International Cooperation _ FEDERAL CREDIT UNIONS _ Table 1. — Social Security Administration: Funds available and obliga¬ tions incurred, fiscal years 1960 and 1959 _ Table 2. — Financing social insurance under the Social Security Act: Con¬ tributions collected and trust fund operations, fiscal years 1958-60 _ Table 3. — Old-age, survivors, and disability insurance: Number of fam¬ ilies and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of December 1959 and November 1958 _ Table 4. — Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1960 and amount of benefit payments in fiscal year 1960, by State _ Table 5. — Old-age, survivors, and disability insurance: Selected data on employers, taxable earnings, and contributions, by State, for specified periods _ Table 6. — Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1958-60 _ Table 7. — Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average pay¬ ment, June 1960, and total payments to recipients, by program and State, fiscal year 1960 _ Table 8. — Special types of public assistance under plans approved by the Social Security Administration: Federal grants to States and total ex¬ penditures and percent from Federal funds, by program and State, fiscal year 1960 _ 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 1960 _ Table 10. — Federal credit unions: Assets and liabilities, Dec. 31, 1959, and Dec. 31, 1958 _ _ _ Table 11. — Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding, Dec. 31, 1934-59. - Page 61 62 65 67 72 74 77 79 80 81 82 84 85 86 88 90 91 91 PUBLIC HEALTH SERVICE HEALTH OF THE NATION _ _ 93 Health Record _ 94 Births, Marriages, and Divorces _ 95 Funds and Personnel _ 95 National Library of Medicine _ 96 Board of Regents _ 96 The New Building _ 96 Indexing Services _ 96 Organizational Changes _ 96 Inter-Library Loans _ 97 Detailed Contents 309 Pag© Program Statistics _ 97 Public Health Methods _ 97 Future Needs for Physicians - 97 National Health Survey - 98 Environmental Health Study _ 98 Homemaker Services _ 98 Studies and Reports _ 98 Work in Progress _ 99 THE NATIONAL INSTITUTES OF HEALTH _ 99 Division of Biologics Standards _ 101 Division of General Medical Sciences _ 102 Center for Aging Research _ 104 Division of Research Grants _ 104 Division of Research Services _ 105 Clinical Center _ 105 Institute of Allergy and Infectious Diseases _ 106 Grant-Supported Research _ 107 Institute of Arthritis and Metabolic Diseases _ 107 Arthritic Diseases _ 108 Diabetes _ 108 Other Metabolic Diseases, Basic Research _ 109 Cancer Institute _ 109 Grant-Supported Research _ 111 Institute of Dental Research _ 112 Grants and Awards _ 113 Heart Institute _ 113 Grant-Supported Research _ 114 Institute of Mental Health _ 115 Support of Research _ _ 116 Basic Research _ 116 Clinical Investigations _ 117 Community Services _ 118 Training _ 118 Institute of Neurological Diseases and Blindness _ 118 Grant-Supported Research _ 120 BUREAU OF MEDICAL SERVICES _ 120 Hospitals and Outpatient facilities _ 121 Volume of Services _ 121 General Hospitals _ 122 Narcotic Addiction _ 122 Leprosy _ 123 Medicare _ 124 Training Medical Care Personnel _ 124 Clinical Investigations _ 125 Progress in Administration _ 125 Federal Employee Health Program _ 125 Freedmen’s Hospital _ 126 Foreign Quarantine _ 127 Nonquarantinable Diseases _ 128 International Traffic _ 128 Medical Examinations _ 129 Yellow Fever Receptive Areas _ 130 Entomology Program _ 130 310 Department of Health, Education , and Welfare , 1960 Page Other Quarantine Activities _ 130 Progress in Indian Health _ 131 Generations of Neglect _ 132 Improved Therapeutic Services _ 133 Improved Preventive Health Services - 134 Dental Services _ 135 Environmental Sanitation _ 135 Progress Toward New and Improved Health Facilities _ 136 Cooperation With States and Communities _ 136 Hospital and Medical Facilities _ 137 Progressive Patient Care _ 137 Medical School Study _ 138 Modernization Needs of Hospitals _ 138 Fallout-Protected Hospital _ 138 Changing Needs and Emphasis of Program _ 138 Scale of Operations _ 139 Dental Resources _ 139 Assessing Manpower Requirements _ 139 Increasing Utilization of Auxiliary Personnel _ 140 Financing Dental Care _ . _ 140 Technological Activities _ _ 141 Nursing Resources _ 141 Scope of Division Activities _ . _ 141 Assessment of Nursing Needs _ 142 Part-Time Nurses _ 142 Emotional Needs of Expectant Mothers _ „ _ 143 Other Studies in Progress _ 143 Research Grants and Fellowships _ 143 Professional Nurse Traineeships _ 144 Medical Services for Federal Agencies _ 144 United States Coast Guard, Treasury Department _ 144 Bureau of Prisons, Department of Justice _ 145 Maritime Administration, Department of Commerce _ 147 Bureau of Employees’ Compensation, Department of Labor _ 147 BUREAU OF STATE SERVICES _ 147 Division of General Health Services _ 148 State Grants _ 148 Arctic Health Research Center _ 149 National Office of Vital Statistics _ 149 Program Development., _ _ _ 150 Public Health Education _ 151 Training _ 151 International Education and Exchange Branch _ 151 Division of Health Mobilization _ 151 Division of Public Health Nursing _ 152 Division of Special Health Services _ 153 Cancer Control Program _ 153 Heart Disease Control Program _ 154 Chronic Disease Control Program _ 155 Program Services _ 155 Operational Research _ 156 Tuberculosis Control Program _ _ _ 156 Occupational Health Program _ _ _ 157 Detailed Contents 311 Page Air Pollution Medical Program _ 158 Highlights of the Year’s Progress _ 158 Accident Prevention Program _ 159 Program Activities _ 159 State and Local Developments _ 159 Division of Radiological Health _ 160 Division of Engineering Services _ 161 Robert A. Taft Sanitary Engineering Center - 161 Engineering Resources and Training _ 161 General Engineering Program _ 162 Milk and Food Sanitation Program - 162 Air Pollution Engineering Program - 163 Other Highlights of the Year’s Progress _ 164 Division of Water Supply and Pollution Control _ 164 Communicable Disease Center _ 165 Epidemic and Disaster Aid _ 165 Representative Field and Laboratory Studies _ 165 Vector Control _ 168 Laboratory Services and New Techniques _ 168 International Cooperation _ 169 Training _ 169 Division of Dental Public Health _ 169 Fluoridation _ 169 Studies _ 170 Demonstrations _ 170 Division of International Health _ 170 Table 1. — Statement of appropriations, authorizations, and obligations, fiscal year 1960 _ 172 Table 2. — Commissioned officers and civil service personnel as of June 30, 1960 _ 174 Table 3. — Research grants and awards, fiscal year 1960 _ 175 Table 4. — Payments to States, fiscal year 1960 _ 176 OFFICE OF EDUCATION Responsibility for Public Education _ 179 The Role of Local Communities _ 179 The State Role _ 179 The Federal Role _ 180 The United States Office of Education _ 180 Elementary, Secondary, and Adult Education _ 184 The Role of State Departments of Education _ 184 Quality Education for All _ 186 Identifying Talent of All Youth _ 186 Quality Education and School Libraries _ 188 Balance in the Curriculum _ 189 Meeting Vocational Education Needs _ 191 Meeting Special Education Needs _ 195 Meeting Lifelong-Learning Needs _ 198 Organization and Administration _ 202 School District Reorganization _ 202 Staffing _ 203 Housing and Facilities _ 204 312 Department of Health, Education, and Welfare, 1960 Page Higher Education in the United States _ 206 Analysis of Institutions _ 207 Staffing and Upgrading of Personnel _ 211 Manpower — Graduate and Professional Education _ 213 Student Assistance _ 214 Research and Experimentation in Education _ 215 The Setting of Research in Education _ 215 Support of Research and Experimentation in Education _ 215 The Potential of Research in Education _ 218 Educational Statistics and Information _ 219 International Education _ 221 International Education and National Policy _ 221 International Educational Exchange _ 222 American Specialists Abroad - 224 International Bureau of Education _ 225 Office Relations With Other International Organizations _ 226 Comparative Education _ • _ 226 Table 1. — Enrollment in 50 States and District of Columbia, 1958-59 and 1959-60 _ 228 Table 2. — Supply and demand for elementary and secondary public and nonpublic school teachers: Continental United States (excluding Alaska) 1959-60 _ 228 Table 3. — Grants and other financial assistance to States, Office of Edu¬ cation, for fiscal year 1960 _ 229 Chart 1. Total degree-credit enrollment in relation to population aged 18—21 : Contiguous United States, fall 1939 and fall 1946 through fall 1959, with projections to fall 1970 _ 208 Chart 2. — Annual need for physical plant expenditures for higher educa¬ tion, by function, 1960-70 _ 209 Chart 3. — Annual need for physical plant expenditures compared with projected institutional expenditures, 1960-70 _ 210 Chart 4. — Cumulative need for physical plant, higher education, 1960-70. 210 FOOD AND DRUG ADMINISTRATION Food, Drug, and Cosmetic Act _ 235 On the Food Front _ 235 Potential Health Hazards _ 235 To Keep Food Clean _ 240 Pocketbook Protection _ 243 Drugs and Devices _ 244 Illegal Sales of Prescription Drugs _ 244 Adulterated and Misbranded Drugs and Devices _ 245 New Drugs _ 248 Cosmetics and Colors _ 249 Certification Services _ 250 Enforcement of Other Acts _ 250 New Court Interpretations _ 250 Changes in the Law and Regulations _ 252 Regulations _ 254 Scientific Investigations _ 257 Enforcement Statistics _ 259 Table 1. — -Actions on foods during the fiscal year 1960 _ 241 Detailed Contents 313 Page Table 2. — Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1960 _ 260 Table 3. — Import samples collected, examinations made, and lots detained during the fiscal year 1960 _ 260 OFFICE OF VOCATIONAL REHABILITATION Advances in Research, Training, Centers, and Workshops Give Program New Incentives _ 261 Rehabilitations in 1960 _ 262 Economic Value of the Program _ 264 Research Projects Set New Record _ 264 Selected Demonstrations in 1960 _ 265 Mental Retardation _ 266 Mental and Personality Disorders - 266 Chronic Illness _ 267 Blindness _ 267 Cerebral Palsy _ 268 New Vistas in Research _ 268 Training Expanded To Cover Specialists in Several Fields _ 269 Medicine _ 270 Rehabilitation Counseling _ 270 Speech Pathology and Audiology _ 270 Prosthetics and Orthotics _ 271 Other Professional Fields _ 271 Rehabilitation of the Blind _ 271 Mentally Ill and the Mentally Retarded _ 272 Epilepsy _ 272 Specialized Facilities in Demand for Treatment of Severely Dis¬ abled _ 272 Establishment of Facilities _ 272 Operation and Use of Facilities _ 273 Encouraging New Methods and Techniques _ 273 Educational Opportunities for Mentally Retarded Accelerated. 274 Mental Illness _ 275 Services Expanded for Those With Communicative Disorders _ 276 Services to the Blind _ 277 Vending Stands for the Blind _ 277 Services for Elderly Disabled Expanded _ 278 Medical Aspects of Program are Expanded _ 278 | Small Business _ 279 Expenditures for State Programs _ 279 Extension and Improvement Grants _ 280 State Plans _ 280 OASI Disability Determinations _ 280 Rehabilitation and Labor Health Service _ 281 International Activities _ 281 Foreign Trainees _ 281 Table 1. — Number of referrals and cases, by agency, fiscal year 1960 _ 282 Table 2. — Vocational rehabilitation grants, 1960, State divisions of voca¬ tional rehabilitation _ 284 314 Department of Health, Education , and Welfare , 1960 Page Table 3. — Vocational rehabilitation grants, 1960, State commissions or agencies for the blind _ 285 Chart 1. — Disabilities and major occupational groups _ 263 SAINT ELIZABETHS HOSPITAL Division of Clinical Services _ 290 Clinical Branches _ 290 Medical and Surgical Branch _ _ _ 291 Nursing Branch _ 291 Psychotherapy Branch _ 291 Psychology Branch _ 291 Recreational Therapy Branch _ 291 Occupational Therapy Branch _ 292 Volunteer Services Branch _ 292 Social Service Branch _ 292 Chaplain Service Branch _ 292 Medical Records Branch _ 293 Library Services _ 293 Laboratory Branch _ 293 Division of Administration _ 293 Needs of the Hospital _ 294 Table 1. — Movement of patient population, fiscal year 1960 _ 294 Table 2. — Consolidated statement of movement of patients, by classifica¬ tion, fiscal year 1960 _ 295 AMERICAN PRINTING HOUSE FOR THE BLIND Services to Schools and Classes for the Blind _ 297 GALLAUDET COLLEGE Kendall School _ 299 Gallaudet College _ 299 HOWARDJUNIVERSITY Enrollment of Students _ 301 Geographical Distribution of Students _ 302 Veterans _ 302 Army and Air Force ROTC _ _ _ 302 The Faculty _ 303 The Building Program _ 303 Graduates _ 303 Service in Foreign Countries _ 304 U.S. GOVERNMENT PRINTING OFFICE: I960 Department of Health, Education, and Welfare Annual Report DEPARTMENT CF HEALTH, EDUCATION AND WELFA.v JUN ' ~ 1962 LIBRARY 1961 US. L Department of Health, Education, and Welfare Annual Report DEPARTMENT CF HEALTH, EDUCATION AND WELFAP. U.S. GOVERNMENT PRINTING OFFICE WASHINGTON : 1962 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington 25, D.C. - Price $1.25 (Paper Cover) U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1961 Abraham Ribicoff, Secretary Ivan A. Nestingen, Under Secretary OFFICE OF THE SECRETARY Wilbur J. Cohen . Philip H. Des Marais . James M. Quigley . Lisle C. Carter, Jr . Rufus E. Miles, Jr . James F. Kelly . , Assistant Secretary {-for Legislation) . , Deputy Assistant Secretary. , Assistant Secretary. , Deputy Assistant Secretary. , Administrative Assistant Secretary. , Deputy Administrative Assistant Secretary and Comptroller. Boisfeulllet Jones . . Special Assistant to the Secretary {Health and Medical Affairs). Donald P. Kent1 . Lloyd E. Ohlin . . Special Assistant for Aging. , Special Assistant to the Secretary {Juvenile Delinquency) . Jim G. Akin . Jon O. Newman . Wallace Turner . . Alan son W. Willcox . Chester B. Lund . Harvey A. Bush . Frederick H. Schmidt . James W. Greenwood, Jr . Dale S. Thompson . James C. O’Brien . Dean Snyder . Robert A. Kevan . , Congressional Liaison Officer. . Assistant to the Secretary. , Assistant to the Secretary {for Public Affairs). , General Counsel. , Director of Field Administration. . Director of Public Information. Director of Security. , Directory of Management Policy. Director of General Services. , Director of Personnel. , Defense Coordinator. , Departmental Coordinator for International Affairs. SOCIAL SECURITY ADMINISTRATION William L. Mitchell . Joseph H. Meyers . Victor Christgau . , Commissioner of Social Security. Deputy Commissioner of Social Security. , Director, Bureau of Old-Age and Survivors Insurance. Kathryn D. Goodwin . . . J. Deane Gannon . Katherine B. Oettinger . , Director, Bureau of Public Assistance. Director, Bureau of Federal Credit Unions. , Chief, Children's Bureau. 1 Appointed after June 30. iii PUBLIC HEALTH SERVICE Luther L. Terry . Surgeon General. John D. Porterfield . Deputy Surgeon General. James V. Lowry . Chief , Bureau of Medical Services. Charles E. Burbridge . . . Superintendent , Freedmen's Hospital. Theodore J. Bauer . Chief , Bureau of State Services. James A. Shannon . Director , National Institutes of Health. Forest E. Linder . Director , National Center for Health Statistics. Frank B. Rogers . Director , National Library of Medicine. OFFICE OF EDUCATION Sterling M. McMurrin . Commissioner of Education. Wayne O. Reed . Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION George P. Larrick . Commissioner of Food and Drugs. John L. Harvey . Deputy Commissioner of Food and Drugs. OFFICE OF VOCATIONAL REHABILITATION Mary E. Switzer . Director of Vocational Rehabilitation. E. Emory Ferebee . Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL Winfred Overholser . Superintendent. Dale C. Cameron . Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Finis Davis . Superintendent, American Printing House for the Blind. Leonard M. Elstad . President , Gallaudet College. James M. Nabrit, Jr . President, Howard University. REGIONAL DIRECTORS Lawrence J. Bresnahan .... Region I, Boston, Mass. Joseph B. O’Connor . Region II, New York, N.Y. Edmund W. Baxter . Region III, Charlottesville, Va. Richard H. Lyle . Region IV, Atlanta, Ga. Melville H. Hosch . Region V, Chicago, III. James W. Doarn . Region VI, Kansas City, Mo. James H. Bond . Region VII, Dallas, Tex. Albert H. Rosenthal . Region VIII, Denver, Colo. Fay W. Hunter . Region IX, San Francisco, Calif. IV Letter of Transmittal Department of Health, Education, and Welfare, Washington , D.C. , December i, 1961. Dear Mr. President: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1961. Respectfully, The President, The White House, Washington , D.C. Secretary. VI Contents Page The Secretary's Report . 1 Social Security Administration . 19 Public Health Service . 131 Office of Education . 241 Food and Drug Administration . 313 Office of Vocational Rehabilitation . 357 Saint Elizabeths Hospital . 385 American Printing House for the Blind . 397 Gallaudet College . 399 Howard University . 401 {A detailed listing of the contents of this report, byl topic headings, will be found on pages 407—418./ vii In the middle of fiscal year 1961, a new administration came into office. There came to the Department a new Secretary and with him a new direction for the Department. The body of this report, in which the operating agencies of the Department present specific accounts of their work, covers the entire fiscal year (July 1, 1960, through June 30, 1961). This, the Secre¬ tary’s portion of the report, however, deals principally with the second half of the fiscal year — the first months of steward¬ ship — and beyond into the continuing plans for the Department in 1962. The Secretary’s Report A beginning is a time for clarity, for reexamination, and under¬ standing. When I came into the Department, I knew it was a complicated and sometimes controversial organization — a busy department with over 100 different programs — but a department of great interest to me and to the American people because its activities concern the human everyday problems of men, women, and children. As Governor of Connecticut, I was familiar with the pattern of Federal-State cooperation by which this Department has played such a helpful role. Now that it had become my responsibility, it was necessary to see exactly what was being done, what should continue, and in what direction. I wanted to look at the Department’s past commitments, at its problems and priorities, and at its traditional solutions — to measure past answers against today’s problems. We Take Inventory The primary interests of the Department of Health, Education, and Welfare are implicit in its name — the health, the education, and the welfare of all the people. It is the department of everyday concerns. The programs of its five major operating agencies — the Public Health Service, the Office of Education, the Social Security Administration, the Food and Drug Administration, and the Office of Vocational Rehabilitation — are con¬ cerned with the home, the school, the hospital, the community, the air around us, the water in the tap, the food on the shelf, the drugs in the medicine chest, the lipstick in the purse, the bank account, and the hope for tomorrow. Taken together, these things add up to the happiness or unhappiness, the meaning of the future for men, women, and children. There can be little welfare without health, and the deprivations and frustrations of unsatisfactory environment or insecure economic posi¬ tion can lead to physical ailments, mental illness, and delinquency. Inadequate education is often the reason for the financial problem — lack of training leading to unemployment or failure to advance. 2 Department of Health , Education , and Welfare , 1961 The Department administers programs of its own and supports — with money and advice — promising projects and research of others. Nearly 90 percent of its appropriation went out as grants-in-aid to the States, non-Federal institutions, and individuals in 1961. They serve greatly to strengthen State departments of health, of education, and of public welfare. In addition to the direct aid they afford these activities, the grants have considerable impact upon the economy through the dollars channeled into many communities and the protec¬ tion and restoration of productivity of the individuals kept in health, returned to self-support, or advanced in learning. The policy of the Department in these grant programs — as laid down by the Congress and the Executive and endorsed and enforced by tradition — is not to dictate, control, or interfere but to provide means and inspiration, guidelines, and stimulation for the greatest possible range of ingenuity and enterprise in improving the conditions of the people. Before we began our inventory, we had decided that we would not be satisfied with generalities. We were — and are — interested in the specifics of action; not rigid, arbitrary specifics, but feasible and developing ways of moving for¬ ward on many fronts toward long-time gains. The specifics of action are always simple in the past tense — what we did, how we did it. The specifics of the future are more difficult. What do we want to ac¬ complish? What is important for us, in this contemporary world, to accomplish ? How can we accomplish it ? What We Seek We believe the Department should be idealistic in philosophy and in program goals, practical in program operations. Our objective remains the same — helping to improve the conditions and prospects of man. The means change because the problems change. We cannot afford to be bound by tradition that makes fine history but no current progress. As to the meaning of our words — when we say “aid” to education, we mean exactly that — help for education, not control. Control re¬ mains with the States and localities as it always has in the long Federal-State partnership in education. When we say “welfare,” we do not mean only financial assistance. Welfare should not be just relief money spent each month and needed again the next. To us, welfare should mean a return to self-help, self-reliance — wherever possible — through training, retraining, and rehabilitation for young people, for old people, for middle-aged people, for handicapped people — in short wherever needed. Until this past session of Congress, for example, aid was not available to a family The Secretary’s Report 3 with dependent children if the father were present in the household — even if he were unemployed. If the father deserted, however, his family could become eligible. If he stayed and tried desperately to cope with family problems, he and the rest of the family were penal¬ ized for his presence. This just does not make sense. We want to hold families together, not drive them apart. For the truth is that the social welfare or the security of an indi¬ vidual depends upon many factors other than money. For almost everyone, there is little security possible without a sense of having a place in the world. For the child, that usually means a place in a family. For the elderly, it can mean a place in the familiar surround¬ ings of the home community and the continuation of some activity or responsibility to give meaning to living. For the adolescent, both family and community relationships are important in this transition period of life. The Department seeks to help people — child, youth, or adult — find or maintain their place in the world. Point of Vantage The Department enjoys a perspective for viewing — beyond its own activities and programs — all interests engaged in the search for solu¬ tions to problems of health, education, and welfare. Such a point of vantage should make it possible to see things whole — the achieve¬ ments and the gaps, the possibilities and the difficulties. This could be an exciting view to have, a stimulating, prodding summary — moving citizens, professions, and government to action. The Department has long been a collector and reporter of informa¬ tion on what others are doing in the fields of its interest, but too often this has seemed a mere statistical delivery service, without adequate assessment of the information and its significance to the national interest. It seems to us that the Department of Health, Education, and Wel¬ fare, as policy adviser to the President and as a resource for the Congress and the people, should be more creative, more critical, take more initiative, and seek to stimulate a ferment of ideas. It should make available reports of progress and problems encountered in spe¬ cific operating projects in certain communities to help other commun¬ ities and organizations know what is being done and thought and found to work elsewhere. Citizens should know what the national situation is in health, education, and welfare. They should look at the problems and recognize the needs. Programs of Prevention Wherever possible we seek preventive measures — preventive medi¬ cine, preventive education, preventive welfare. The first, preventive 4 Department of Health , Education, and Welfare, 1961 medicine, is a fairly familiar phrase covering quarantine activities, sanitation, safety campaigns, inoculations, annual checkups, and other medical care in health as well as in sickness. The other two are per¬ haps strange to the eye and ear but not to our planning. What is preventive education? Education can obviously prevent ignorance and illiteracy. In addition, education of quality and train¬ ing keyed to the needs of the individual student can help prevent the economic distress suffered by the untrained person who cannot find employment or cannot advance. Education and training can help prevent delinquency arising out of resulting frustrations and despair. They can prevent the waste of talents needed by the Nation and aban¬ donment of hope by the retarded and handicapped, cruelly and mis¬ takenly termed “uneducable.” Preventive welfare is a strange and — to the ear — rather contradic¬ tory phrase. Perhaps it would be better expressed as anticipatory welfare. It means social services — not necessarily money and cer¬ tainly not money alone — given in time, before a family breaks up or a person breaks down from accumulated distresses and crises — services designed to prevent ultimate dependency. It means also services designed to prevent continuing, lifetime dependency by providing rehabilitation and training to dependent persons already on public assistance rolls to restore them to self-support, self-care, and self¬ esteem. Eestoration services should not be limited to persons capable of returning to gainful employment ; they should be available to any¬ one able to reach a goal of even partial self-care. The dollar value of the prevention of anything is impossible to estimate, for it is difficult to prove just what has been prevented or the degree to which a problem has been retarded. But we have seen enough notations of school dropouts and of broken homes on the rec¬ ords of juvenile delinquents to know that these things can lead to delinquency and are worth trying to prevent. The lack of education revealed by the chronically unemployed and the inability of the professions and the Nation to obtain well-trained people show us the need for preventive education. It is too costly to do without. To prevent scarring and wasting of lives — by improving health, increasing educational opportunity, and advancing economic secu¬ rity — seems a noble and rewarding mission to us. A Time of Change It is not surprising to us that many parts of our program must change, that new things must be tried, for we live in a time of accel¬ erating change. The Secretary’s Report 5 The texture of society is different, the design for living so altered in the last few years that even the stages of the change have been obliterated. It is as though the patterns were destroyed and new ones were made from different materials by different beings for dif¬ ferent beings. We have faced changes century to century before, and generation to generation, but these were usually gradual changes in which traces of the origins remained. The shadow of each day’s change grew a little wider but did not suddenly blot out the past beyond remembrance. This is no longer true today. Space is wholly new as far as ordinary human understanding and “occupancy” are concerned. Automation is new beyond any previous technology. Radioactive fallout from man-made weapons is new. The dimensions of time and space have changed. And so it is not entirely a criticism of the past operations in the Department that we seek so many new approaches in our programs today. The necessity for some could not be anticipated, and many are very difficult to achieve. A few of our new problems are caused by evils or by failures or by neglect and callous disregard for human needs, but most are ac¬ tually the products of our successes. In the field of food and drugs we are faced with continuing change growing out of the progress of technology — new methods of growing, processing, and packaging foods for our convenience, new discoveries in drugs which save lives, but which also can have dangerous side effects. The sales of medicinal chemicals and of cosmetics more than doubled between 1948 and 1958. Chemical additives are used in proc¬ essing and packaging food. Farmers use pesticides on their crops. If they didn’t, we would not have our present abundance of food; but, if food were not checked and pesticides regulated for safety, abundance could well be a serious health hazard for us. Environmental health problems change because of developments and improvements in manufacturing, which give us essential products but which also necessitate disposal of waste products, chemicals, and gases. The crowding of population into “convenient” urban centers multiplies the problems of disposal of human waste materials. Radi¬ ation hazards exist not only from weapons testing but also from our greatly increased use of nuclear energy in medicine, industry, and else¬ where. The automobile adds exhaust fumes to the “fresh air” of our cities. Stephen Vincent Benet said of the early days of this con¬ tinent, “There was ... in the air ... a medicinal quality that brought health to those who breathed it.” Even allowing for poetic license, this is no longer true. Education faces not only pressure of numbers but necessity for constantly updating its information and adding new subject matter. 6 Department of Health , Education , and Welfare, 1961 Here, too, it is man’s progress — our fantastically successful conquest of time and distance — that causes problems. As the world contracts and once faraway, strange places are no longer far in time and must not be allowed to remain strange in understanding, the need for new language studies expands. The new sciences and the world of space require whole new curriculums of studies and teachers qualified and equipped to teach them. Medical advance often brings change upon itself. The lengthening of the lifespan has brought a higher proportion of elderly persons in the population. This in turn has brought additional problems in the treatment of chronic diseases and ailments of the aging, and a conse¬ quent need for better home care, nursing homes, and methods of care outside of already crowded hospitals. Improvements in therapy for the mentally ill make it possible for many to return to their home communities. There they and their families need access to guidance, assistance in adjustment, employment help, and frequently the services of day hospitals or outpatient mental health clinics. Thus every time we solve a problem, we seem to pose another — and sometimes several. We never quite catch up, because, before we get where we are going, the destination changes. The various agencies of the Department came into existence because of change and problems. They pioneered ; almost everything they did was “a first.” They are finding stimulation in pioneering again. Forward Movement — 1961 Our new appraisal and our new plans are bearing fruit. Within these few short months a number of concrete results are apparent. ★ A new and more comprehensive program providing greatly strengthened aid to communities in the development and improvement of health services outside the hospital got underway. Designed to increase the availability, scope, and quality of health facilities and services — nursing homes and halfway houses, visiting nurses and homemakers — the program has particular significance for the aged and the chronically ill. All too often such “patients” must remain in a hospital or institution whose intensive services they do not need, which they cannot afford, and where they take up room needed by others, only because they have no other place or way to obtain the simple services they do require. The new community services program cannot, of course, suddenly put an end to such problems but it can stimulate a real examination and attack, community by community and State by State. It can re¬ sult in better care for more people and serve the additional purpose of freeing needed hospital beds for the acutely ill. The Secretary’s Report 7 ★ Environmental health problems — particularly the dangers of wa¬ ter and air pollution — came under stepped-up attack in coordinated programs covering whole regions and industries. Under the new water pollution act signed by President Kennedy in July 1961, the most far-reaching approach in history is being made to stream pollution abatement. The new law strengthens the long exist¬ ing Federal-State partnership making it possible for communities to receive greater Federal aid in building waste-treatment works and — because of an extension of Federal enforcement powers — affording them an opportunity for more effective action to control pollution reaching their community from upstream neighbors. Regional research facilities are being established in recognition of the fact that, although water pollution is a national problem, its spe¬ cifics differ greatly from one part of the country to another and re¬ quire different scientific knowledge and engineering application. The concept of air as a limited resource is vital. As air pollution threatens 90 percent of our urban communities, the Department is seeking wider application of all known methods of control and ad¬ ditional research into better methods and instruments for abating it. Negotiations with the automotive industry in 1961 resulted in an agreement for factory installation in all new automobiles, beginning with 1963 models, of a device to reduce the amount of motor fumes re¬ leased into the atmosphere. ★ In education — although the major fight for Federal aid is still to be won — there was a new concentration on the search for excellence at all levels, elementary through college, and in vocational as well as academic instruction. Two-year extensions of the National Defense Education Act and of aid to federally impacted areas were enacted by Congress. In vocational education, a special panel of outstanding men and women was appointed to work with the Department in an effort to update the character and quality of this field of education. As the country moves into an age of advanced technology and increased industrialization and automation its young people must be prepared and its manpower needs must be satisfied. ★ For the first time since the depression days of the thirties, a re¬ examination of the policies and structure of public welfare has been made, focused upon the causes of dependency rather than on its symptoms. Ten administrative changes were made in the Department’s public welfare program in December 1961 to provide a substantial start toward a reorientation of the Federal-State public assistance pro¬ gram. Emphasis will be upon the rehabilitation and restoration to self-support of persons on public assistance wherever possible. For 8 Department of Health , Education, and Welfare, 1961 those who will continue to need assistance, an approach more realistic and less restrictive than the present categorical division of aid will be sought. Family services will be added to money aid. Incentives will be provided for young people receiving aid as dependent children to help secure their own future through earnings without jeopardiz¬ ing necessary current assistance to their families. Indicative of this new focus, the Bureau of Public Assistance has been renamed the Bureau of Family Services. Within the Bureau a new major unit, the Division of Welfare Services, has been estab¬ lished to give special attention to States’ activities designed to reduce dependency, provide family counseling and services, and remove any abuses of trust which may exist on assistance rolls. ★ For the first time since the public assistance program began a quarter of a century ago, the Federal Government provided aid to dependent children whose parents are the victims of unemployment. This is a significant breakthrough in the welfare field. Proposals in one form or another to fill this gap in public assistance coverage have been before Congress for the past 10 years. The new law is effective only until July 1, 1962, but it is hoped that before that time the general revision of welfare programs will provide for continuing assistance to such families. ★ A number of strengthening social security measures filled gaps in the old-age, survivors, and disability insurance program. Requirements for insurance benefit eligibility were relaxed, making it possible for approximately 160,000 previously ineligible persons to qualify for benefits in the first 12 months following passage of the legislation. The retirement age for men was lowered from 65 to 62. Minimum insurance benefits paid to retired workers and to aged widows were increased. Additional incentive was provided for re¬ tired workers to increase their own earnings on jobs, without losing so much of their social security payments. ★ A more comprehensive approach to juvenile delinquency has been made possible by new legislation in which the Congress gives recog¬ nition to the national nature of the problem. The Department is seeking cooperation not only from law-enforce¬ ment agencies but also from citizens and organizations in the com¬ munities who can give employment or encourage further schooling — the real preventives in this area of waste and tragedy. Demonstration projects designed to show how communities can take coordinated and effective action to aid youth are being supported. Funds are being provided to train additional personnel in this field. ★ For the aging, the Department has moved with enterprise and dispatch, acting as spokesman and advocate of the interests of elderly persons wherever support is needed or possible — in health, in employ¬ ment opportunities, in education, and in welfare. The Secretary9 s Report 9 In seeking employment opportunities, the interest of the Peace Corps has been enlisted in balancing some of its youth with the experi¬ ence and maturity of older men and women, particularly in the teach¬ ing field. In welfare, preparation of a series of “case histories” of successful community projects and social services for the aging was begun for distribution as a guide for other communities. Social services are being sought for those elderly persons able to pay for them as well as for those in financial need. Interagency cooperation has offered unexpected opportunities and advances. For example, the Housing and Home Finance Agency, constructing and financing housing for the aged, ran into problems of management concerned with the social and welfare needs of its ten¬ ants. The Agency sought help from the Department, and the Depart¬ ment is now helping to train project managers for such housing developments. ★ A new concentration in vocational rehabilitation on fundamental aspects of disability and rehabilitation can be reported. The Department’s program includes psychological aspects of dis¬ ability, the attitudes of communities toward disabled people and those of employers toward hiring them, the adaptation of electronics and powered devices to artificial limbs and sensory aids, special rehabilita¬ tion needs of older disabled persons, disabled mothers with dependent children, and severely disabled persons whose rehabilitation may be beyond the means or facilities of their State agencies. ★ Strengthened regulations will permit the Food and Drug Admin¬ istration to provide more complete protection to the public against hazards of unsafe foods and drugs and the economic losses occasioned by quack remedies, false labeling, and deceptive packaging. Regulations have been issued requiring that labeling and promo¬ tional literature accompanying new drugs will provide the physician with full information about the hazards as well as the potential benefits of the drugs. Preliminary work is underway to establish a badly needed national repository of drug-reaction information. The new Hazardous Substances Labeling Act requires safety infor¬ mation in the labeling of chemical products used in the home. A Special Program for Survival The same coordination of many parts and many activities of the Department, and the same community wide focus in planning which we seek in our programs concerned with everyday, normal events, are also valuable to us in planning to meet that most abnormal eventuality — a thermonuclear attack upon this country. 626936—62 - 2 10 Department of Health , Education, and Welfare, 1961 Every discussion of both the possibility of such an attack and the advisability of having fallout shelters comes around eventually to a third point. If we survive the attack, how do we go about the daily business of living when we come out of our shelters? To a certain extent the answer to that question must come from the Department of Health, Education, and Welfare, and the Department has been moving in the past months to provide it. The Department’s Bureau of Family Services and Children’s Bu¬ reau have been developing guidance materials for the States on emer¬ gency feeding, emergency lodging, emergency clothing, emergency registration and inquiry (designed to locate separated members of families) , and emergency social services, including financial assistance. These services would be required in postattack situations wherever there are persons in need. At the end of the fiscal year, the first of the emergency welfare publications was being reviewed by the 50 State welfare departments. Since then, three additional volumes have been completed- — as review and working drafts — and two more are now in process. The Department’s Division of Health Mobilization has stockpiled 1,930 complete emergency hospitals and $200 million worth of medical supplies and equipment, ranging from bandages to blood derivatives and surgical instruments, throughout the country. It has, within the past fiscal year, completed a publication, “Family Guide — Emergency Health Care,” designed to tell all citizens clearly and simply how to care for themselves and their families in fallout shelters or in emer¬ gency situations beyond the reach of medical help. A complete course has been prepared for use in training American families in the basic principles of medical self-help. These health and welfare publications are guidelines to survival, concerned with the basic and essential minimums — trying hard to assay realistically what it would be like and how such new problems could be met. The programs they suggest will require the cooperation of all levels of government and of private organizations and indi¬ viduals. Today: The National Situation As we put our first months behind us, what is the national situation in health, education, and welfare ? What do we see from our national vantage point ? Health The American people are — in general — in good health, but to main¬ tain and raise this level of health we need more doctors, nurses, hospi¬ tal facilities, community health services. The Secretary’s Report 11 We are in some difficulty at both extremes of life. The United States has slipped to 10th place among nations in prevention of infant mortality. And for all our good start in many important things necessary to the health progress of the American people, we are still sadly lacking an effective method by which older people can purchase essential health care. We know more than we ever have about the nature of disease and how to save lives. Many of the old scourges have been defeated or controlled throughout the Nation, but new dangers, such as accidents and environmental pollution, have been spawned by our urban indus¬ trial civilization. In medical research, we are on the brink of important discoveries in cancer, respiratory diseases, mental illness. Yet we have not been able to apply, as widely as we should, many long-known and thoroughly proved results of earlier research. Dramatic results have been reported during the year in the use of cancer chemotherapy in the treatment of certain types of malignancies. New therapies in mental illness continue to reduce the number of pa¬ tients in public mental hospitals. Demonstration projects show that the majority of stroke patients can be restored to self-care. Thirty- five to 40 percent of all known diabetics now safely substitute oral medication for the tyranny of the daily insulin injection. Yet against these research advances we must place certain gaps in the Nation’s use of its medical knowledge. In the seventh year of fhe effective Salk vaccine, nearly 80 million people under 40 still have not completed the recommended course of injections. Every year nearly 13,000 die of cervical cancer, a disease which can almost infallibly be detected in its curable stages by a simple test. Twenty thousand American lives are taken each year by rheumatic fever and rheumatic heart disease — a disease caused by a chain reaction which can be broken at the beginning and in the middle. Many are blind whose sight could have been saved. It is not enough to discover and develop through research new reme¬ dies unless they can be brought within the reach of the people — all the people. If false remedies and quack devices reach the market, the ends of research and legitimate medicine are defeated. In rehabilitation, we are moving into a period of fulfillment. In 1962, after more than 40 years of growth, the public program of voca¬ tional rehabilitation will reach a significant milestone — the rehabilita¬ tion of more than 100,000 disabled people in a single year. Voluntary rehabilitation agencies are growing in size and effective¬ ness. Dozens of new rehabilitation centers and sheltered workshops are now in operation. 12 Department of Health , Education , and Welfare , 1961 New legislation will make possible help in training teachers of the deaf and in providing more funds for the work of the American Printing House for the Blind so that blind children may have the Braille books and other educational supplies they need. Although a number of projects designed to aid the mentally retarded are in operation, we still need to do more and to know more about what can be done to help in this special field. Education In education, ours is a time of reckoning. We have suddenly been brought up short and made to realize that we have actually been losing a race, not just against Russia but against ourselves. It has been shocking to wake to the fact that having our hearts in the right place and meaning well will not automatically keep us champion. A first look is perhaps deceiving. We have more boys and girls in school than ever before — and more go on to college than ever before in any country. More go beyond a first degree to graduate study. We expect to have T million students in our colleges in 1970. We have fine educational institutions, many dedicated educators, and at least a vocal commitment to education by the great majority of our citizenry. New classrooms have been built, new teachers have entered the profes¬ sion — but not enough of either. There is no guarantee that all our bright boys and girls will be able to get inside the doors when they come in 1970, or that, if they do, they will find the trained teachers they need waiting to receive them. And in spite of the zooming enrollment figures, we lose many of our finest students before college because of lack of funds or motivation to continue their schooling. We are losing also the potential talents of thousands of boys and girls, some to delinquency, because we do not have the kind of vocational education to equip them to compete in the marketplace. We have an appalling record of school dropouts in every State. Of the 10,800,000 students enrolled in high school grades 9 through 12 in the Nation’s public and nonpublic schools in 1961-62, 2 y2 million will drop out before graduation. This is a tragic way to prevent further crowding of classrooms. There are not enough teachers today to teach our children in the first grades, the high schools, or in the universities. But even more serious is the fact that many of those we do have are not properly qualified. It is this quality of teaching that is our basic educational problem. It has much to do with the dropouts and with the lack of motivation for going on to college. It has much to do with the defi¬ ciencies which even earnest and talented students take with them to The Secretary’s Report 13 higher grades and into professions and careers. It is the good teacher who catches a child up in the excitement of learning, who makes the borderline case a student, who inspires the talented and creative to work against all odds to become “educated.” We do not have enough good teachers. It is not wholly a matter of inadequate salaries that has affected the quality of our teaching, though this has certainly been one cause of failure to attract outstanding students to the teaching profession or to hold them in it. We have — under pressure of need for numbers — failed to set and maintain high enough standards for teachers — both for entrance to the profession and in classroom performance. Nor have we been effective everywhere in teaching teachers how to teach. It is easy to say we need better education. It is harder to decide what better education is — how we get it — what should be spent in dollars, in hours, in creativity, and effort to get it. It is apparently hard for even the educational community to make a commitment to education as a whole. The institutions of higher learning are not really much interested in the problems of the elementary and secondary schools, although that is where their students come from. The aca¬ demic specialists do not concern themselves with the needs of voca¬ tional schools, although both are necessary for a balanced community. Many who oppose Federal aid for all schools as Federal control sup¬ port Federal aid for the schools of their own districts — the so-called federally impacted areas. In truth, the total Nation is impacted when it comes to education. Welfare In our national program of social insurance, we are doing well. Beginning its second quarter century, social security, as it is com¬ monly known, provides a floor of economic support to 15,624,182 men, women, and children. Nine out of 10 employed persons in the Nation, and their dependents, are protected under old-age, survivors, and dis¬ ability insurance. Eighty-five percent of the people now becoming 65 years of age are eligible for retirement benefits under the program, and in the future this proportion will rise to 95 percent or more. Yet a most serious gap still exists — the failure to provide health insurance for the aged under the program. A beginning to progress against juvenile delinquency can be seen. The waste of youth, growing out of unbearable home environments and lack of community care which make crime seem a boy’s or girl’s best opportunity, is too expensive for the Nation to bear. The Con¬ gress has recognized it as a national problem, and forward-looking programs are getting underway. 14 Department of Health , Education , and Welfare , 1961 Improvement in protection for children in adoptive situations, in the courts, in communities, and within families is enlisting, and needs, much effort. New ideas and increasing resources are being brought to bear upon various facets of the needs of older citizens — in health, in housing, in employment, in social services. But these are only beginnings. The speed and effectiveness with which Federal, State, and local public and voluntary welfare organizations have cooperated in aiding refugees from Cuba during the past year provide heartening proof of the ability of our welfare structure to meet serious emergency sit¬ uations, yet everywhere it is undermanned and undertrained. In the field of public assistance — “relief” — there is serious trouble. Here, the most encouraging thing to report is that a reassessment has been made, a searching look taken at the national situation and plans made for changes. It could not be otherwise. The cynicism and pub¬ licity overtones of the Newburgh “plan,” the District of Columbia cut¬ backs in aid to large families, and other welfare “cases” all combine to endorse our belief that we have been supporting a social welfare structure in need of major revision rather than further patching. Public assistance programs are concerned with the needs of depend¬ ent persons not covered under social insurance or those whose minimum needs exceed their insurance benefits. These are the needy aged, blind, and disabled, and dependent children in families broken by death, incapacity, or absence of a parent, and more recently in fami¬ lies hard pressed because of unemployment. Assistance has, to date, consisted largely of pouring out money — private and public, local, State, and Federal — tremendous in total but tragically inadequate in individual cases. The 6.2 million persons on public assistance rolls in 1961 were largely frozen there, sustained at a minimal level of decency by monthly relief payments but with little hope or opportunity for guid¬ ance or rehabilitation services which might eventually return many of them to self-support. Social work staff — inadequate in number and training (1 caseworker with full professional training to every 23,000 public assistance re¬ cipients) — has been unable to make the home visits and provide coun¬ seling and other family services needed as much as the monthly money payments. The new Federal-State program, proposed to the States, seeks to meet the actual needs of families — whether this means their retention on the rolls or help in getting off. It will require a major effort in recruitment and training of profes¬ sional staff. It could be greatly aided by coordination of public and private voluntary welfare agency activities within each community. The Secretary’s Report 15 Tomorrow This then is our national situation today, in health, in education, and in welfare. Tomorrow we must do better — each tomorrow we must do better. The gap between acquiring knowledge and putting it into action for people must be narrowed. The Department seeks to publicize developments in medicine, in education, and in welfare. It tries to advance the use of new findings in these fields through pilot projects and demonstration programs. It is incredible that the citizens most in need of medical care should be denied it. People 65 years of age and over have medical costs twice those of younger people, yet their annual income, on the average, is only half as large. During any year they can expect to spend be¬ tween 2 and 3 times as many days in the hospital as a younger person. They need protection against the high cost of hospitalization and other health services and they want it, not as a gift but as a right earned and established during their productive years. The program we propose is simply a means of paying for hospital costs and related health services, not a means of providing these serv¬ ices. It is not a program of socialized medicine but a program pro¬ viding for prepayment of health costs with freedom of choice of doc¬ tor and hospital. Arrangements for paying for the services would be much the same as those now used under private hospitalization in¬ surance plans. No other method is as feasible or as fair to everyone. We are fully aware that virtually all responsibility for the conduct of American education rests outside the Federal Government. This is as it should be, but the Federal Government would be derelict in its duty to its citizens and to the Nation if it did not do all in its power to aid American education, which is in trouble generally. We cannot be satisfied with any educational endeavor that is not genuinely com¬ mitted to the highest standards of which we are capable. We have sought, and we will continue to seek, to strengthen our schools in facilities, curriculum, counseling, and the quality and sal¬ aries of our teachers. We will stress the arts and humanities as well as science, for both are essential. We hope to broaden the improvement of language teaching under the National Defense Education Act by providing assistance to teachers of English as well as teachers of foreign languages. Many of our young people enter college unable to speak, write, spell, punctu¬ ate, or understand their own language properly. This failure in a single subject hampers and holds them back in all subjects. We are interested in education of all kinds, for there must be op¬ portunity for instruction and achievement in all fields. We hope to obtain revisions and extensions in vocational education which will 16 Department of Health , Education , and Welfare , 1961 place it in proper relationship to general education and will provide the necessary flexibility to meet shifting employment patterns. We will seek other legislation from Congress, with one of our first concerns the necessary measures to extend and complete the general reorientation of our welfare program which we have begun through administrative changes. We are seeking congressional authority to establish a new position, that of Assistant Secretary for International Affairs, to coordinate our growing responsibilities and opportunities in the international field. The exchange of ideas, experimental methods, research findings, and personal skills between nations is beneficial to health, education, and welfare everywhere and contributes beyond its immediate results to human understanding. The President has proposed the establishment of an Institute for Child Health and Human Development at the National Institutes of Health. The new Institute would concentrate on problems of birth defects, infant mortality, mental retardation, and maternal factors in¬ fluencing child health and development. It would study the process of aging as part of the program of human development. The Department also looks hopefully to the Congress for final passage of two bills designed to provide educational and health serv¬ ices to migratory workers and their children. They would make possible some lifting of the burden of neglect, ostracism, and hope¬ lessness long suffered by these people. We will advocate and support legislation to extend and strengthen the consumer-protection activities of the Food and Drug Administra¬ tion. We will seek legislation to aid the health professions in training urgently needed manpower through construction of educational fa¬ cilities and provision of scholarships and educational grants. The expenditure of money by itself will not automatically bring progress in health research, in education, or in welfare. If it did, we could simply buy an end to cancer, to heart disease, to mental ill¬ ness — indeed, to disappointments and dependency. We could pur¬ chase wisdom and security over the counter. It is, however, the talent and quality of people, the direction, pur¬ pose, and focus of research and community projects, and the ex¬ cellence of facilities that make the money count. So we will support the projects which will stimulate creativity in others, the education and training that will produce more educators and leaders, the dem¬ onstrations that will be so clear and well thought through that many can follow their paths. We can reorient our welfare objectives, but it is the States which make the final plan and administer the program and ultimately the caseworker in the home who must find answers for the distressed. The Secretary9 s Report 17 We can sponsor educational improvements, but it is the States and the local school boards and, in the end, the teacher who make them work. We can support and prod on matters of health, but it is in the doctor’s office, the research laboratory, and the home community that lives are saved and services rendered. All citizens are needed in this new world of our time. And yet the sick man, the hopeless man is lost. The frightened or insecure man has no strength to lend his Nation. The juvenile delinquent destroys all the years of his youth which might have offered most, in time, in courage, and in daring. The neglected aged waste their bonus hours. The Department of Health, Education, and Welfare is looking for new answers and seeking new knowledge with a particular urgency : The realization that some of the new answers and new knowledge it seeks could mean the difference between life and death for many men, women, and children ; the difference between full realization of their gifts by the talented and a mere plodding existence of little interest to themselves or others; the difference between a grim waiting out of empty years by older men and women isolated in their last days and a happy, successful living of longer life in familiar and beloved surroundings. To have value, beginnings must stretch into continuity. So, for tomorrow, we plan to continue what we have started in our search for human successes. 18 Department of Health, Education, and Welfare, 1961 Table 1. — Grants to States: Total grants under all Department of Health, Edu¬ cation, and Welfare programs, fiscal year 1961 [On checks-issued basis] States, Territories, and possessions Total . . Alabama . . Alaska . Arizona . . Arkansas _ _ California _ Colorado _ Connecticut _ Delaware _ District of Columbia . Florida . Georgia . . Hawaii _ Idaho _ Illinois _ _ Indiana... . . Iowa _ _ _ Kansas _ _ _ Kentucky . . Louisiana _ Maine . . Maryland _ Massachusetts _ Michigan _ Minnesota _ Mississippi _ Missouri _ _ Montana _ Nebraska _ _ Nevada _ New Hampshire _ New Jersey _ New Mexico _ New York _ North Carolina _ North Dakota . . Ohio . . . Oklahoma _ Oregon _ Pennsylvania _ Rhode Island _ South Carolina . South Dakota _ Tennessee _ Texas . Utah _ Vermont . . Virginia _ _ Washington . . West Virginia _ Wisconsin _ Wyoming _ Canal Zone . Guam . . Puerto Rico.. . . Virgin Islands . Wake Island _ Undistributed . Total Social Secu¬ rity Admin¬ istration Public Health Service 1 Office of Education Office of Vocational Rehabili- tation White House Confer¬ ence on Aging Ameri¬ can Print¬ ing House for the Blind* $2, 890. 122, 796 $2, 218, 508, 079 $244,206,612 $372, 075, 573 $54,932,040 — $9, 508 $410, 000 80, 181, 949 63, 342, 607 6, 726, 484 7, 937, 737 2, 167, 428 7, 693 12, 461,873 2, 177, 1 15 2, 800, 982 7, 370, 278 113, 498 27, 566, 565 17, 649, 662 2, 403, 688 6, 995, 770 513, 862 3, 583 46, 631,209 36, 098, 243 4, 950, 459 3, 829, 659 1,747, 960 4, 888 314, 532, 595 244, 798, 381 11, 502, 139 55, 260, 093 2, 935, 542 36, 440 49, 784, 413 40, 630, 284 2, 443, 570 6,015, 792 690, 767 4, 000 23, 173, 735 16, 444, 188 1, 753, 959 4, 545, 596 419,910 10, 082 4, 882, 258 2, 665, 364 884, 681 1, 154, 775 176, 133 1,305 10, 532, 184 9, 263, 390 797, 773 221,021 248, 750 1,250 74, 853, 263 59,064, 653 5, 822, 137 8, 135,079 1, 823, 606 -3, 599 11, 387 89, 711,932 69, 027, 133 7, 788,325 10, 153, 324 2,731,790 11,360 16, 960, 200 3, 733, 490 2,801,146 10, 058, 623 365, 330 1,611 12, 229, 220 8, 132, 615 1, 424, 890 2, 482, 959 187, 978 778 117, 897, 881 98, 349, 905 8, 382, 234 9, 009, 484 2,136, 414 -14 19, 858 35, 410, 788 27, 174, 410 4, 451, 419 3, 249, 452 528,064 7,443 40, 877, 599 33, 541,235 3, 676, 317 2, 676, 750 978, 992 4, 305 39, 94i, 956 28,167, 364 3, 872, 651 7, 187, 912 709, 363 4, 665 60, 078, 589 49, 575,061 6, 385,085 3, 474, 802 638, 753 4, 888 117,526, 663 107, 759, 606 5, 596, 679 2, 828, 481 1,334,815 7,082 18, 629, 937 14, 010, 042 1, 239, 837 3, 038, 766 340, 348 944 39, 437, 703 19, 625, 134 3, 806, 624 15, 378, 851 618, 179 8, 915 91,836, 179 76, 268, 236 4, 761,422 9, 682, 464 1, 105, 782 18, 275 84, 752, 224 68, 133, 709 6, 252, 611 8, 822, 904 1,524, 586 18,414 50, 832, 699 41.574, 468 4, 710, 334 3, 399, 704 1, 140, 166 8,027 53, 378, 331 42, 451, 699 5, 976, 238 3, 695, 090 1,251.383 -273 4,194 102, 421, 196 90, 435, 603 5,710,314 5,419, 460 848, 432 -112 7, 499 11,916, 063 6, 476, 636 1, 705, 845, 3,516, 680 216, 87S -1, 504 1,528 21, 157, 719 13,312, 540 3, 085, 972 4, 402, 395 354, 396 2,416 6, 194, 453 3, 038, 161 1, 132, 335 1,941,413 82,151 -301 694 8,108, 632 4, 801, 418 1, 346, 538 1, 855, 087 104, 561 1,028 44, 733, 826 32, 037,151 3, 918,077 7, 699, 940 1, 062, 910 15, 748 30, 346,148 18, 243, 213 2, 746, 337 9, 123,015 230, 556 3,027 175, 305, 025 143, 948, 724 13, 694, 413 13, 851, 347 3, 769, 963 40, 578 75, 798, 347 54, 709, 152 11, 668, 426 6,911,656 2, 496, 642 12, 471 11,548,866 8, 051, 763 1,401,229 1, 754, 510 340, 581 -50 833 111,772,798 88, 955, 939 9, 918, 069 11,511, 160 1, 365, 994 21,636 99, 507, 864 83, 757, 740 3, 608, 514 10, 721, 173 1,417, 548 2, 889 24, 849, 175; 19, 469, 234 2, 678, 261 2, 139, 283 557, 351 -787 5, 833 123, 810, 882 95, 774, 766 13, 267, 049 10, 371,733 4, 367, 838 29, 496 14, 005, 143 9, 867, 406 1, 116, 622 2, 694, 084 325, 948 1, 083 34, 854, 198 23, 238, 987 5,114,728 5, 327, 170 1, 169, 256 -26 4,083 13, 909, 776 8, 948, 483 1,206, 992 3, 448, 831 304, 192 1,278 59, 763, 588 45, 047, 583 8, 374, 836 4, 692, 804 1, 640, 366 7, 999 158,749, 693 127, 094, 594 11,857, 107 18, 072, 492 1, 710, 030 15, 470 15, 695, 221 10, 590, 887 1,955, 992 2, 836, 649 309, 999 1,694 7, 474, 725 5, 821,468 1,451,330 204, 352 -2, 842 417 49, 182, 395 2i, 860, J 99 7,315, 764 18, 663, 639 1,334, 600 8, 193 60, 024, 859 45, 260, 646 3, 157, 675 10, 576, 918 1, 021, 982 7, 638 39, 273, 878 30, 634, 857 5, 777, 242 1,503, 295 1, 353, 485 4, 999 42, 794, 627 33, 256, 990 4, 936, 879 3, 607, 971 985, 621 7,166 5, 326, 786 3, 222, 008 691, 981 1, 316, 429 95, 785 583 28 28 1,316, 184 231 711 48, 465 973, 972 62, 036 16, 584, 132 10, 154’, 532 3, 927, 365 1,763, 164 736, 766 2,305 1, 020, 365 607, 694 180, 571 199, 678 32, 422 105 401 105 401 8, 468* 858 8, 468] 858 1 Includes permanent annual appropriation of $10,000. 3 Excludes $248,844 paid to water pollution interstate agencies. Social Security Administration Social Security in 1961 The year 1961 saw a new determination to move the social security programs forward in helping to build the Nation’s social and economic strength. On June 30, President Kennedy signed into law the Social Security Amendments of 1961. On that occasion the President emphasized the part that social security plays in providing for families, children and older persons in time of stress. The amendments, he noted, rep¬ resent an additional step toward eliminating many of the hardships resulting from old-age, disability, or death of the family wage-earner. Provisions of the 1961 amendments liberalizing old-age, survivors, and disability insurance will especially help some groups in the popu¬ lation who have the smallest incomes and other resources aside from their benefits to fall back on. Minimum benefits were raised from $33 to $40, aged widows’ benefits were increased 10 percent, old-age benefits were made payable to men at age 62 on an actuarially reduced basis, the quarters of coverage required for insured status for people at or near retirement age were reduced, and the retirement test was liberalized. It was expected that in the first 12 months in which the amendments were effective about 4,770,000 people would receive $815 million in new or increased benefits. The changes will be financed by additional income from increased contribution rates. The 1961 amendments also provided for an increase in Federal participation in public assistance payments by the States to recipients of old-age assistance, aid to the blind, and aid to the permanently and totally disabled for the period October 1, 1961, through June 30, 1962. A decrease in the need for public assistance in some instances, however, was expected to result from the more liberal old-age, sur¬ vivors, and disability insurance benefits provided in the amendments and reduction of the insured-status requirement. The Social Security Amendments of 1960, which became law shortly after the beginning of the fiscal year, reflected growing 19 20 Department of Health , Education, and Welfare, 1961 national concern with economic problems associated with health and medical care. To provide improved protection against economic loss caused by disability, the age-50 requirement for eligibility to disability benefits under old-age, survivors, and disability insurance was elimi¬ nated. Further to assist the States in meeting the health-care costs of the needy aged, Federal sharing in State payments to suppliers of medical care to old-age assistance recipients was increased. Also a new Federal-State program of medical assistance for the aged was authorized for older people who can meet living expenses but cannot afford the medical care they need. By the end of August 1961, 14 States had new medical assistance for the aged programs, 4 States had completed plans for new pro¬ grams, and 15 States were in the process of developing program plans. The medical assistance for the aged measure, President Kennedy declared in his February 9, 1961, health program message to Congress, recognized the problem of those needy aged requiring public assist¬ ance to meet their medical costs. But, the President indicated, the main problem — that of preventing dependency arising from the costs of health care in old age — must now be met by using the old-age, survivors, and disability insurance system, called by his task force on health and social security ‘The only sound and practical way of meeting the health needs of most older people.” By providing pro¬ tection against the costs of medical care through the basic national system of contributory social insurance, “it will be possible for our older people to get the vital hospital services they need without ex¬ hausting their resources or turning to public assistance,” the President said. Benefits under the health insurance program recommended by the President would be available to all persons 65 and over who are eligible for old-age, survivors, and disability insurance or railroad retirement benefits. The program would provide payment, within certain limits, for the cost of inpatient hospital care (after a deduct¬ ible), skilled nursing-home care after hospitalization, hospital out¬ patient diagnostic services (after a deductible), and visiting-nurse and related home-health services. Congressional hearings on the benefit, financing, and administra¬ tive features of the program worked out by the administration, which the President stressed was “a very modest proposal cut to meet abso¬ lutely essential needs,” were held after the close of the fiscal year. The recession confronting the Nation as the new administration took office focused attention on another aspect of the economic security of the worker and his family — the protection afforded by the Federal- State unemployment insurance system. The Temporary Extended Unemployment Compensation Act, one of the first antirecession meas- Social Security Administration 21 ures proposed by the administration, was passed by Congress on March 24, 1961. The law provided additional benefits up to 13 weeks for workers who exhaust their regular unemployment benefits under existing State and Federal programs after June 30, 1960, and before April 1, 1962. Up to the end of June 1961, about 1,155,000 individuals had qualified for the extended benefits. Other administration proposals advanced as recession turned to recovery stressed the need for long-range measures to improve and strengthen the unemployment insurance system. The proposals in¬ clude a permanent standby Federal program of extended benefits for technologically displaced workers, benefits equal to at least one-half of an individual’s average weekly wage (subject to maximums related to statewide averages) to bring benefit levels more nearly into line with those originally intended, and extension of the system’s coverage in recognition of the fact that the risk of lost wages due to unemploy¬ ment is common to all wage and salary workers. Another proposal, passed by Congress in May 1961, made new Federal funds available to States that extend their child aid programs to help needy children in families in which a parent is unemployed. Inclusion of unemployment as an eligibility factor in Federal-State aid to dependent children will work toward the Nation’s goal of ena¬ bling children to grow up in normal, secure homes. It will help meet need in many families, such as those for example where the bread¬ winner is not covered by the unemployment insurance program or has exhausted his benefits. Temporary action was taken pending ■ completion of study by the Administration looking toward permanent changes in present laws. The measure expires June 30, 1962. Twelve States had adopted this measure at the end of August 1961. The amendments and proposals sketched here and detailed along with others in subsequent sections of this report were designed to put the Nation in a position to deal more effectively with longstand¬ ing or emerging problems. Recognized as still urgently needed, how¬ ever, was wider application of present knowledge and development of new. A new approach toward finding better ways to help people to help themselves by searching out the causes of dependency was made in March 1961, when the first grants under a program of cooperative research and demonstration projects were announced by the Social Security Administration. The cooperative research and demonstra¬ tion grant program was authorized by Congress to add to existing knowledge or devise and evaluate new methods of applying knowl¬ edge with regard to such problems as the prevention and reduction of dependency, coordination and planning between private and public 22 Department of Health, Education, and Welfare, 1961 welfare agencies, or improvement in the administration and effective¬ ness of programs carried on in relation to the Social Security Act. Sixteen grants totaling about $350,000 were awarded, with the advice of an outstanding group of experts, to educational and nonprofit institutions. The Social Security Administration also conducted an intensive review of its own research and statistical activities. As part of the review, Commissioner of Social Security William L. Mitchell invited a distinguished group of experts from the social science research community outside Government to advise him concerning the future scope and objectives of the research program. “After 25 years,” Mr. Mitchell told the advisory group, “the social security programs have reached a degree of maturity, and new or unsolved social problems are pressing upon the Nation with a degree of urgency that makes it highly desirable for us to reassess our responsibilities for research and research planning.” The advisory group was in unanimous agreement that a continuing program of long-range research in addition to basic statistical activ¬ ities and current program-related research is needed if the Social Security Administration is to make further significant contributions to the understanding and solution of persistent human problems and of new problems that lie ahead. The basic recommendation con¬ tained in the report of the group to the Commissioner was that the Social Security Administration “accept responsibility for carrying out, stimulating, and supporting long-range research in the broad field of human resources and social welfare.” Indicative of a widely shared, constructive concern of the American people with questions of income security, health security, and the social needs of older persons was the White House Conference on Aging. After 2 years of preparation, involving hundreds of groups through¬ out the Nation and probably more than a quarter-million individuals, the Conference was held January 9-12, 1961, in Washington, D.C. It was attended by 2,565 official delegates. The purpose of the deliberations, as summarized by the Chairman of the National Advisory Committee for the Conference, was to reach agreements and make recommendations on four basic problems: (1) the older person’s economic situation; (2) his health and medical problems; (3) his pattern of living; and (4) the mobilization of re¬ sources, public and private, to improve the three preceding situations. The “pluralistic approach” to providing for the security of older persons and to the problem of financing medical care was strongly advocated by the interested delegates. It was the consensus that the proper approach to the medical care problem was through a combi- Social Security Administration 23 nation of patient payments, private health insurance plans, and Fed¬ eral and State government participation. One of the most specific conference developments was the majority recommendation of the income-maintenance section that the old-age, survivors, and disability insurance mechanism should be the basic means of financing health care for the aged. At the end of fiscal year 1961, total payments under social security and related programs were made at an annual rate of more than $31 billion. The payments represented 7.5 percent of total personal in¬ come in June, compared with 6.4 percent a year earlier. Rising old-age, survivors, and disability insurance benefits and larger un¬ employment insurance payments accounted for the major part of the increase. Under old-age, survivors, and disability insurance, the number of beneficiaries in current payment status increased by 1,362,000 from June of the previous year to 15,624,000. The number of disability insurance beneficiaries and their dependents rose 376,000, the largest annual increase since disability benefits became payable in 1956, pri¬ marily because benefits were extended to disabled workers under age 50 and their dependents beginning November 1960. The number of beneficiaries 65 and over increased by 799,000 to 11,323,000. Total benefits paid out during June 1961 amounted to more than $1 billion. In federally aided assistance for persons 65 and over, 2.3 million were receiving old-age assistance and 46,000 received medical assist¬ ance for the aged in June 1961. Nearly 3.4 million children and their adult caretakers received aid to dependent children — including 112,000 recipients in the newly added unemployed-parent group — 106,000 received aid to the blind, and 384,000 received aid to the permanently and totally disabled. In addition, more than a million persons re¬ ceived general assistance financed from State and local funds. Pay¬ ments for all types of assistance for the month were $337 million. Federal grants to States for maternal and child health and welfare programs under the Social Security Act for fiscal year 1961 were $18,113.9 million for maternal and child health services, $19,797.4 million for crippled children’s services, and $13,613.1 million for child welfare services. The 1960 report of Federal credit union operations noted that in 1960 Federal credit unions made 4^ million loans totaling nearly $3 billion. During fiscal year 1961, 626 new credit unions were chartered. The Social Security Administration had 32,100 employees on duty at the end of the fiscal year. The great majority of the employees were in district offices and other offices of the Bureau of Old-Age and Survivors Insurance. 24 Department of Health , Education , and Welfare , 1961 Hearings and Appeals Old-age, survivors, and disability insurance claimants are guaran¬ teed the right to hearing and review. The number of hearings con¬ tinued to increase in 1961. During the fiscal year, 14,105 requests for hearings were received — a 6-percent increase over the previous year. Requests for hearings on disability cases, however, climbed 29 percent in the last 4 months of the fiscal year. The increase was attributable in large part to the Social Security Amendments of 1960. The upward trend was ex¬ pected to continue since the full impact of the amendments had not yet been realized. Because of the accelerated tempo of requests for hearings, 17 percent more cases were pending on July 1, 1961, than on that date a year earlier. Thirty-four hearing examiners were added to the Office of Hearings and Appeals staff to handle the increased workload. Requests for Appeals Council review of hearing examiners’ de¬ cisions declined from 7,300 in fiscal year 1960 to 5,210 in fiscal year 1961. The number of cases pending at the end of the year was reduced 36 percent. However, the impact on the council’s workload of the upward trend in hearings was anticipated for early fiscal year 1962. The Appeals Council issued decisions on 224 cases remanded by the courts. Although 163 new cases were remanded during the year, the number of cases pending was reduced from 219 to 158. A substantive survey of the operations of the Office of Hearings and Appeals was conducted by private legal consultants at the request of the Department. The purpose of the survey was to assure that the administrative processes of the office provide fair and impartial hearings. International Activities The Social Security Administration International Service planned training programs or conducted training sessions for 932 persons from 81 countries during fiscal year 1961. Requests for the training came through the International Cooperation Administration, the United Nations, the World Health Organization, the Organization of Ameri¬ can States, numerous embassies, and a variety of voluntary agencies, foundations, and universities. Referrals of foreign leaders and spe¬ cialists through the Department of State continued to increase with the growth of the cultural exchange program and its extension to newly developing countries. Of the nations represented by the trainees, 21 were Asian or Middle Eastern countries, 15 were African, 19 were European, and 19 were Social Security Administration 25 Latin American. Six — all newly developing countries — were repre¬ sented for the first time: Afghanistan, Cyprus, Nepal, Nigeria, Sene¬ gal, and Somalia. The Palau Islands of the Trust Territory were also represented. In addition to training, the Social Security Administration engaged in a broad spectrum of international cooperative activity related to its fields of interest. The Commissioner participated in the Eleventh Meeting of the Bureau Executive Committee of the International So¬ cial Security Association in Leningrad, and other officials represented the Social Security Administration at the association’s working group meeting on old-age insurance and on the American Regional Com¬ mittee of Social Security Actuaries and Statisticians. The Tenth Session of the International Conference of Social Work in Rome, in which Social Security Administration officials also participated, at¬ tracted social workers from 60 countries, many from the newly in¬ dependent nations in Africa attending for the first time. Cooperation with the Department of State in connection with ses¬ sions of the United Nations Economic and Social Council, the Social Commission, and UNICEF contributed to increased recognition for social development in United Nations’ programs. Emphasis on social development in the new Act of Bogota program was a basis for in¬ creased cooperation with the Organization of American States. A recommendation of the Social Security Administration was influen¬ tial in the creation of a separate department of social affairs within the organization. The Social Security Administration also carried on a number of activities in connection with the International Labor Organization, including furnishing advisors to U.S. delegations to conferences in Buenos Aires and Geneva. The Division of Program Research con¬ tinued to participate, on behalf of the Department, in the regular work of the Interdepartmental Committee on International Labor Policy. Cooperation with voluntary agencies interested in international social welfare included participation in the National Social Welfare Assembly’s Washington workshop on international affairs and in the session of the International Committee of the Council of Social Work Education in New York. A consultant served with the Com¬ mittee on International Social Welfare of the National Association of Social Workers. As in past years, the Social Security Administration cooperated with the International Cooperation Administration in recruiting so¬ cial welfare and maternal and child health experts. Twelve experts were assigned to ICA overseas missions for some period during the year. The experts served in seven countries. The Social Security Administration undertook to advance a co¬ operative research program on social welfare questions through a re- 626936—62 - 3 26 Department of Health , Education , and Welfare , 1961 quest for foreign currency under the activities authorized by the Agricultural Trade Development and Assistance Act of 1954, as amended. Funds were requested for fiscal year 1962 in seven coun¬ tries. The studies proposed encompass such questions as urban social problems, social services and social security, medical care for the aged, juvenile delinquency, community development, and training of social welfare personnel. Old-Age, Survivors, and Disability Insurance The old-age, survivors, and disability insurance program provides continuing income for workers and their families as a partial replace¬ ment of earnings lost when the family earner retires in old age, becomes permanently and totally disabled, or dies. It does this in a way that enhances the dignity of the individual, fosters self-reliance, and helps to prevent dependency. The program is supported by the contributions of covered workers and their employers and covered self-employed people. Benefits are earned through work and are related to past earnings. Payments under the program serve as a base to which the individual may add savings and income from private insurance, private pension plans, and other sources. Thus the worker is encouraged to supplement the basic protection afforded by his social insurance benefit with what¬ ever additional protection he can afford to buy. In the 26 years since the original Social Security Act was enacted the old-age, survivors, and disability insurance program has become firmly established as by far the largest program for assuring income to individuals and families who suffer a loss of earnings when the worker retires, becomes disabled, or dies. More than 9 out of 10 mothers and children are protected against the loss of income result¬ ing from the death of the family breadwinner. Nearly 86 million people in the Nation have worked long enough to be insured for retirement and survivors benefits under the program ; more than half of these have worked long enough to meet the requirements for dis¬ ability protection and this number will increase rapidly each year. Eighty-five percent of the people now becoming 65 are eligible for retirement benefits and in the future this proportion will rise to 95 percent or more. At the end of June 1961, benefit checks were being sent out each month to over 15.6 million beneficiaries. It is clear that the program as now constituted is playing a major role in assuring that people who have been self-supporting during Social Security Administration 27 their working years will be able to remain independent when they no longer have income from work. Nevertheless there are gaps in the protection afforded by the program that need attention. Health insurance for older people would fill the most serious of these gaps. The benefits provided under old-age, survivors, and dis¬ ability insurance, even when supplemented by other income and sav¬ ings, do not and cannot afford protection against the large and unpredictable costs of major illness for most people. The high health costs and low incomes of the aged as a group preclude a satisfactory solution of the problem through private insurance, and the Nation has long since decided to use social insurance as the basic approach in meeting economic problems that affect the majority of the people. The President has proposed that the social insurance method be used to help finance the health needs of the aged. Providing health insurance for the aged under old-age, survivors, and disability insur¬ ance would enable people to contribute during their working years toward protection against certain major health costs in old age, just as they now build protection against other major risks. Another area that will need attention is how to keep the benefit structure in line with changes in the economy. Most people now coming on the benefit rolls have their benefit amounts based on recent years of work. Over the long run, though, under present law, benefit amounts will be based on a lifetime average of the person’s earnings in covered work. If there is no provision for benefit change as earn¬ ings go up, the average earnings on which benefit amounts are based will more and more reflect the lower wages paid a person in his earlier years of work. Even if the benefit structure were changed so that a benefit was up-to-date when it was first awarded, there would still be a need to revise benefit levels periodically so that beneficiaries can share in the higher levels of living that active workers enjoy. Basic to any consideration of the problem of keeping the program in line with the changing economy is the matter of adjusting the ceiling on the amount of earnings that can be taxed and credited toward benefits. Adjustments in the earnings ceiling to correspond with rises in earnings are important from the standpoint not only of keeping benefits up to date but also of keeping the financial base of the program from shrinking. While the program now affords effective protection for workers of all ages and their families against the risk of severe, long-term dis¬ ability, there is still a significant gap in this protection. Under present law, a worker who has been totally disabled throughout an extended period of time is not eligible for benefits unless his condition will be of long-continued and indefinite duration. Disabled workers and their families however have great need for benefit income during an extended period of total disability even though the worker may be 28 Department of Health , Education , and Welfare , 1961 expected to recover, and they should be afforded protection under the program. Increasing attention should be given to the vocational rehabilitation of disabled beneficiaries. The restoration of such beneficiaries to pro¬ ductive work is clearly in the best interest of the individual and the economy, and results in savings to the social security trust funds. To this end, legislation should be enacted to permit limited expenditures from the trust funds to reimburse the States for rehabilitation services for disabled beneficiaries. Making available a certain amount of full Federal financing for rehabilitation of social security disability beneficiaries would encourage the States to extend services to a greater number of such beneficiaries than is practicable under the financial limitations of the present matching fund programs, with consequent advantage to the beneficiaries and little if any cost to the social security trust funds. Another gap in the protection of the program occurs because there is no provision in present law for the payment of benefits to a child who is dependent on a worker who is not the child’s parent. As a result there are cases where a child who has been living with and being supported by an insured worker cannot get benefits on the worker’s record when deprived of his support as a result of the worker’s re¬ tirement, disability or death. Consideration will need to be given to the possibility of paying child’s insurance benefits to a dependent child based on the earnings record of the worker who supported him even though the parent-child relationship now required by law does not exist. The coverage of the old-age, survivors, and disability insurance program, broad as it is, still leaves unprotected some gainfully em¬ ployed people and their families. Extension of coverage under the program to essentially everyone employed would provide assurance to all workers that the protection of the program would follow them from one job to another. Especially important is the extension of coverage to the approximately 2 million civilian employees of the Federal Government who are under staff retirement plans — the largest group still lacking social security protection. This protection can be provided without undue cost to employees or the Government, in a way that assures that every employee affected will have combined protection under social security and a staff retirement system that is at least as good as — and, in most instances, much better than — his present protection under only a staff retirement system. The inde¬ pendence of the staff retirement systems need in no way be impaired. The plan could also provide that present employees would have the opportunity to choose to continue their existing coverage under a staff retirement system without change, or to come under social security coverage and adjusted staff retirement provisions. Social Security Administration 29 A large group of workers whose employment is covered under the program nevertheless has inadequate protection under the program because a large part of their earnings is in the form of tips, which are not counted as wages for social security purposes. Because much of their income is not counted their benefits have little relation to their true level of earnings. The Department of Health, Education, and Welfare and the Department of the Treasury have recommended to the Congress that tips received by an employee in the course of his employment for an employer be treated like wages paid directly by the employer insofar as possible and have suggested a plan for securing reports and collecting taxes on tips. The old-age, survivors, and disability insurance program has now become firmly established as the basic program in the Nation for pro¬ tecting American families against economic dependency arising from loss of income as a result of retirement in old-age, disability, or death of the family breadwinner. The past year brought unusually heavy legislative activity. Enactment of the Social Security Amendments of 1960 at the beginning of the fiscal year and the 1961 amendments at the end of the year resulted in needed improvements in the pro¬ gram, broadening its scope and increasing its effectiveness and flexibility. The Bureau of Old-Age and Survivors Insurance moved ahead during the year to put into effect the new provisions of the 1960 amendments as well as changes which studies have indicated will im¬ prove its administrative effectiveness, while maintaining a high quality of service to the public. Meantime, the Bureau is continuing to study and evaluate the program and its administration. What the Program Is Doing BENEFICIARIES AND BENEFIT AMOUNTS Old-age, survivors, and disability insurance benefit payments in the fiscal year ended June 30, 1961, totaled $11,889 million, 10 percent more than the amount paid during the preceding fiscal year. Benefit payments under the disability insurance part of the program were one- third larger than in fiscal year 1959-60 and totaled $704 million. Old-age and survivors insurance monthly benefits rose 9 percent to $11,018 million and lump-sum death payments amounted to $167 million, about $1 million higher. The number and amount of monthly benefits in current-payment status increased sharply. In June 1961, 15.6 million beneficiaries were receiving benefits at a monthly rate of $992.0 million — increases from June 1960 of 1.4 million in number of beneficiaries and $102.2 million in amount of monthly benefits. The increase in number was 10 per- CHART 1.— OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE BENEFIT PAYMENTS AND BENEFICIARIES 30 Department of Health , Education, and Welfare, 1961 o 2° i/i O' ‘Includes about 3% lump turn awards. Social Security Administration 31 cent, and the rise in the monthly amount almost 12 percent. The in¬ crease in the monthly rate resulted from (1) the growth in the total number of beneficiaries, (2) the rising proportion of benefits based on recent higher earnings with as many as 5 years of lowest earnings and periods of total disability omitted from the benefit calculation, and (3) the 19G0 legislation increasing the benefit for each child of a deceased worker to three-fourths of the primary insurance amount. Men aged 65 or over and women aged 62 or over made up 12.3 million (79 percent) of the beneficiaries — 8.4 million of them were retired workers and 3.9 million were the wives and dependent hus¬ bands of retired or disabled workers and the widows, dependent widowers, and dependent parents of workers who had died. Of the remaining 3.3 million (21 percent), 2.1 million were children, about 616,000 were mothers, and 558,000 were disabled workers under age 65. About 2.6 million monthly benefits were awarded in fiscal year 1961, 364,000 more than the number awarded in the preceding year. A record number of 540,000 monthly benefits were awarded to disabled workers under age 65 and their wives, husbands, and children. About 121,000 of these benefits were awarded to disabled workers under age 50 (first eligible in November 1960) and about 137,000 to their de¬ pendents. New highs were also reached for mother’s benefits (96,000) and for benefits awarded to children of deceased or retired workers (331,000) . About 122,000 monthly benefits attributable to the liberal¬ ized insured-status provision in the 1960 amendments were included in the year’s awards. Old-age (retired-worker) benefits accounted for about three- fourths of the awards under this provision ; the aver¬ age monthly amount was $39.35 compared with $83.85 for awards under the earlier provision. Lump-sum death payments during fiscal year 1961 numbered 825,000, about 5,000 more than the previous high established in fiscal year 1960; this was the 11th consecutive year in which a new record for lump-sum awards was set. About 794,000 deceased workers were represented in these awards. The average lump-sum amount per worker was $210.36, about the same as in the preceding year. In June 1961, the average old-age insurance benefit paid to a retired worker who had no dependents also receiving benefits was $70.40 a month. When the worker and his wife both received benefits, the average family benefit was $124.90. Families consisting of a widowed mother and two children received on the average $190.70. Among beneficiaries on the rolls at the end of June 1961 whose benefits are based on earnings after 1950 the average for a retired worker with no dependents receiving benefits was about $78.90, for an aged couple about $133.90, and for a widowed mother and two children about $214.20. 32 Department of Health , Education , ami Welfare , 1961 DISABILITY PROVISIONS During the fiscal year, a period of disability was established for about 220,000 workers, 30,000 more than in the preceding fiscal year and about 13,000 more than the previous record number in 1957-58. About 22,000 disabled persons aged 18 or over who had applied for child’s monthly benefits were found to have a disability that began before they had reached age 18 ; the number was about 6,000 smaller than in 1959-60. Since the beginning of the program in 1955, about 1,185,000 workers and dependent children have been found to be severely disabled and to meet the other requirements for a period of disability. The number of disabled workers receiving monthly benefits rose 50 percent in the fiscal year and totaled 558,000 at the end of June. About 340,000 benefits were being paid to the wives, husbands, and children of these beneficiaries — a 125 percent increase. (As men¬ tioned earlier, benefits were first payable to disabled workers under age 50 and their dependents for November 1960.) By the end of June 1961 child’s monthly benefits were being paid at a monthly rate of $5.0 million to 113,000 disabled persons aged 18 or over — depend¬ ent sons and daughters of deceased, disabled, or retired insured workers — whose disability began before age 18. About 15,000 women — who would not otherwise be eligible for benefits — were re¬ ceiving wife’s or mother’s benefits as the mothers of disabled persons receiving child’s benefits. During the fiscal year, there has been a growing volume of litiga¬ tion in connection with the disability program, with a resulting troublesome proportion of reversed decisions. The Bureau is study¬ ing the situation carefully in the hope that with improved procedures, both the volume of litigation and the number of reversals may be decreased. By the end of 1960, the latest date for which this information is available, about 94,800 persons were receiving old-age benefits in¬ creased by an average $8.40 a month because their social security rec¬ ords were frozen for periods while they were disabled before reach¬ ing retirement age. About 32,800 wives, husbands, and children of retired workers and about 45,300 widows, widowers, children, and parents of workers who had their social security records frozen before death were also receiving larger monthly benefits because of the freeze. For the same reason, lump-sum death payments in 1960 based on the earnings records of 18,850 deceased workers were increased by an average of $23.36 per worker. Social Security Administration 33 THE PROTECTION PROVIDED Of the population under age 65, an estimated 77 million were insured at the beginning of the calendar year 1961. Some 38 million of these people were permanently insured — that is, whether or not they con¬ tinue to work in covered jobs, they will be eligible for benefits when they reach retirement age, and their families are protected if they die. (Included in this total were about 900,000 women aged 62-64 who were already eligible for old-age benefits but on a reduced basis.) The remaining 39 million were insured but must continue in covered work for an additional period to be insured permanently. If the father should die, the mother and young children in 9 out of 10 families in the Nation can count on receiving monthly survivors insurance benefits. An estimated 48 million of the insured persons under age 65 also met the insured status requirements for protection against the risk of long-term and severe disability. Of the 17.0 million people aged 65 or over in the United States at the beginning of 1961, 73 percent were eligible for benefits under the program. Sixty-four percent were actually receiving benefits, and 9 percent were not receiving benefits because they or their husbands were receiving substantial income from work. Taking into account the liberalization in the requirement for fully insured status provided by the 1961 amendments, the percentage of aged persons who will be eligible for benefits at the beginning of 1962 is estimated to be 76. This percentage is expected to rise to 83 by the beginning of 1966. THE COVERAGE OF THE PROGRAM An estimated 73 million persons worked under old-age, survivors, and disability insurance during the calendar year 1960. In addition, about 1 million persons employed in the railroad industry had, in effect, joint coverage under the railroad retirement and old-age, sur¬ vivors, and disability insurance programs. Altogether, including em¬ ployees of State and local governments and nonprofit organizations 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 United States were covered or eligible for coverage under the program. Of workers not covered and not eligible for coverage during a typical week, about one-third were covered by Federal, State, or local " retirement systems. The remaining two-thirds — 7 percent of the ' Nation’s paid employment — consisted generally of persons who are not regular workers and are for the most part self-employed persons and domestic and farm workers who did not meet certain requirements of the law as to the amount of their earnings or the length of time worked. 34 Department of Health , Education , and Welfare , 1961 INCOME AND DISBURSEMENTS Expenditures from the Federal Old-Age and Survivors Insurance Trust Fund during the fiscal year totaled $11,743 million, of which $11,185 million was for benefit payments, $322 million for transfers to the railroad retirement account and $236 million, including Treas¬ ury Department costs, for administrative expenses. Total receipts were $11,814 million including $11,293 million in net contributions and $522 million in interest on investments. Receipts exceeded disburse¬ ments by $72 million, the amount of the increase in the trust fund during the year. At the end of June 1961 this fund totaled $20.9 billion. Total assets of the old-age and survivors insurance trust fund, except for $1,377 million held in cash, were invested in United States Govern¬ ment securities as required by law ; $3.4 billion were invested in public issues (identical to Treasury securities owned by private investors), and $16.2 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 2.7 4 percent. Expenditures from the Federal Disability Insurance Trust Fund during fiscal year 1961 totaled $745 million, of which $704 million was for benefit payments, $5 million for transfers to the railroad retire¬ ment account, and the remainder — some $36 million — for administra¬ tive expenses. Total receipts were $1,082 million, including $1,022 million in net contributions and $60 million in net interest on invest¬ ments. Receipts exceeded disbursements by $337 million, the amount of increase in the fund during the year. At the end of June 1961, the fund totaled $2,504 million. (Contributions to this fund first became payable in January 1957 and benefit disbursements began in August of that year.) Assets of the disability insurance trust fund consisted of $2,386 million in United States Government securities and a cash balance of $119 million. The invested assets consisted of $87 million in public issues and $2,299 million 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 2.85 percent. Administering the Program The Bureau entered fiscal year 1961 with normal workload backlogs, the amount of work pending at various work stations being generally no more than necessary to keep work flow current. With a relatively stable workload situation and more favorable workload-to-staff rela- Social Security Administration 35 tionship than had existed for several years, the Bureau appeared to be in a good position to put into effect improvements in operations which had been successfully tested and would make for improved adminis¬ tration and a higher quality of public service. This highly favorable situation was altered, however, with enactment of amendments to the old-age, survivors, and disability insurance program in September 1960. Once again the Bureau was faced with a heavy influx of addi¬ tional workloads and had to make preparations to recruit and train the necessary additional staff. At the same time, plans were being put into effect to proceed with further study and implementation of the long-range integrated data processing and electronic data process¬ ing programs to which the Bureau was committed. The 1960 amend¬ ment provisions which resulted in immediate, substantial workload increases were those which changed the retirement test, eliminated the age-50 requirement for disability insurance benefits, and liberalized insured status requirements. The additional workloads resulting from the amendments necessi¬ tated substantial staff increases and made it imperative that the Bureau recruit and train new personnel as rapidly as feasible. Addi¬ tional personnel requirements were measured against expected work¬ load increases, recruitment potential, Bureau capacity to effectively train and absorb into regular operations the added staff, and pro¬ jected requirements after fiscal year 1961. Employees on duty at the end of the fiscal year totaled 31,391. This end-of-the-year staffing total reflects not only the increase due to 1960 amendment workloads, but also normal program growth, some scheduled advanced recruitment to secure the best college graduates available, and a stepped-up recruitment activity carried out in antici¬ pation of the latest amendments to the program enacted on June 30, 1961. In addition to the staffing indicated above, the Bureau also used 2,129 man-years of overtime during the fiscal year. In addition to workload impacts, the 1960 amendments also pre¬ sented a number of administrative problems that had to be resolved promptly, to ensure effective implementation of the changes made in the law. Priority was given to training on the amendment provisions, essential for both experienced and newly recruited personnel. The Bureau was also faced with the task of issuing and coordinating a considerable volume of instructional material and forms essential for the implementation of the amendments. Initial emphasis was given to those areas in which the amendments had immediate effect. A com¬ prehensive informational campaign on the amendments to inform the public of the changes in the law was conducted. A few key workload figures best illustrate the magnitude of the operating task faced by the Bureau during the year. Approximately 36 Department of Health, Education, and Welfare, 1961 2, GOO, 000 claims for old-age and survivors insurance benefits and about 935,000 for disability insurance benefits were received. New social security accounts were established for 3,451,000 persons and duplicate account number cards were issued to 3,039,000 people. Approxi¬ mately 273,800,000 earnings items were received for posting to indi¬ vidual accounts and more than 2,650,000 requests for changes in personal record data were processed. About 2,300,000 statements of earnings accounts were issued to individuals who inquired about the status of their earnings records. On January 1, 1961, a new Division, designated as the Division of Management, became operative. In this new organizational entity, the management functions formerly performed by the Division of Administrative Management and the Division of Public Information and Personnel Management, with the exception of the Office of Infor¬ mation, were consolidated. The Office of Information now reports directly to the Office of the Director. The new Division serves as the staff arm of the Director for man¬ agement analysis and appraisal, financial management, personnel management, training, employee health and communications, procure¬ ment, and general management services. Consolidation of these func¬ tions in one Division permits greater coordination of the management activities involved, places them under the control of one Assistant Director, and makes possible a unified and more effective leadership in top-level Bureau management functions. For the past few years, the Bureau has been exploring the use of electronic equipment to handle its rapidly increasing workloads with¬ out increasing staff at a proportionate rate. By 1955, electronic equipment had been developed to the point where installations were made in the Division of Accounting Operations for the maintenance of earnings records and making initial benefit computations. Sub¬ sequently, in 1958, computers located in the Division of Accounting Operations were used to convert old-age, survivors, and disability insurance benefits to the new rates resulting from amendments to the law and, in 1959, to facilitate the recertification of benefit payments for the Baltimore Payment Center. Based on this earlier experience with electronic computers, the Bureau launched a long-range program of developing an integrated data processing system in its claims operations to provide better serv¬ ice to the public through increased speed and accuracy, plus reduced costs. The broad concept envisioned a claims operation in which in¬ formation and decisions would be recorded in machine language at early points in the process, transmitted automatically with maximum speed and accuracy, and translated electronically into final products. A thorough investigation of the many types of data processing equip- Social Security Administration 37 ment was conducted and notable progress was achieved in the imple¬ mentation of the long-range integrated data processing system. Full development is expected by 1964. During the year, computers and related equipment were put into operation at the various payment centers. Computers were installed in the Philadelphia, Chicago, Kansas City, and Birmingham Payment Centers. Peripheral equipment was installed in the New York and San Francisco Payment Centers. The Philadelphia Payment Center provides computer service to New York, and the Kansas City Payment Center services San Francisco. The Baltimore Payment Center is serviced by the computer in the Division of Accounting Operations. During the year, the entire accounting records for the Bureau’s old-age, survivors, and disability insurance beneficiary rolls, representing some 15 million items, were converted to magnetic tape. Electronic data processing systems and programs were placed in regular operation to create media for issuing initial benefit checks, mechanically prepare award certificates, prepare checkwriting media for recurring payments, and mechanically update beneficiary records by additions, deletions, and changes of address. These techniques now make it unnecessary for the Treasury Disbursing Offices to estab¬ lish and manually maintain records on new additions to the beneficiary rolls. The creation of master record tapes will permit the recording of monthly payment history. In addition, it will permit the introduc¬ tion of methods for mechanically processing beneficiaries’ annual re¬ ports of earnings, suspensions and reinstatements of benefits, terminations of entitlement, and change of address items. Testing of high-speed wire communications between Kansas City and San Francisco, designed to transmit data from magnetic tape to magnetic tape, has been completed. This was a venture into a rela¬ tively uncharted area of transmitting data over telephone lines from one tape station to another tape station over 1,800 miles away. The tests were conclusively successful and the system was put into opera¬ tion. Recording on magnetic tape of payment histories for all beneficiaries was started in January 1961, and included actions taken in December 1960. All benefit actions are now added to the tape records on a daily basis through the regular daily updating operations. This provides current benefit, payee, address, and payment history data for all in¬ cluded beneficiaries. At the same time that it was investigating and planning for com¬ puter applications to the claims process, the Bureau conducted a Data Transmission Pilot test in 1960. The Pilot installation, involving 26 district offices, 2 relay centers, 3 payment centers, 2 regional offices, 38 Department of Health , Education , and Welfare , 1961 and the Central Office in Baltimore was observed and thoroughly tested during fiscal year 1961. Based on the results of this study, the Bureau decided to proceed with the establishment of the entire Na¬ tional Data Transmission System which will include all Regional and district offices, payment centers and Bureau Headquarters in Balti¬ more. In June 1961, contracts were let for the special equipment needed for the Baltimore Transmission Terminal, 6 Communications Control Centers, and 48 relay centers to be established as key elements in the National System. One Communications Control Center will be located in the Social Security Building in Baltimore and the others will be located in the payment centers at Chicago, Philadelphia, Bir¬ mingham, Kansas City, and San Francisco. Schedules for the orderly linking of all the Bureau’s processing points during fiscal year 1962 have been drawn up and additions to the system are being made on a regular basis. Late in the fiscal year, a Telecommunications Man¬ agement Branch was established in the Division of Management to provide unified control and management of the National Data Trans¬ mission System. In connection with studies concerning the use of electronic equip¬ ment and data transmission systems, the Bureau is also studying other aspects of the claims process. For example, a contract was made with The Johns Hopkins University in Baltimore for a 3-month explora¬ tory Operations Research Study to determine whether operations research techniques could be profitably applied to processing and organizational problems in the long-range aspect of the Bureau’s work. The study, conducted by a research team from the University, was started in November 1960 and completed in February 1961. A comprehensive report of findings and recommendations was published in April and reviewed by the top staff of the Bureau to determine whether and how operations research might be used most advanta¬ geously in decision-making processes. As a result, a decision was made to develop a Bureau operations research capability. Outside profes¬ sional assistance will be utilized to augment and complement available Bureau skills in the development of this program. The Bureau continued its activity in studying proposals to provide health insurance for beneficiaries aged 65 and over. Issues and prob¬ lem areas involved in the administration of such a program are being studied to permit development of possible solutions and alternative courses of action. In January 1961, a small group of Bureau per¬ sonnel was detailed to study and develop plans for the administration of a health insurance program. This staff is working in coordination with other organizations within the Department of Health, Educa¬ tion, and Welfare and other government agencies. Discussions were also held with representatives of other national organizations in the Social Security Administration 39 health field concerning various alternatives and problems presented by the proposed legislation. The large variety of complex questions and problem areas encountered by this group during its investigations in the last 6 months indicate a need to continue these studies, so that the Bureau will be properly prepared to provide advice on the admin¬ istrative feasibility of proposals and to step into actual administration if health insurance for the aged is enacted. In the last few years, the administration of the old-age, survivors, and disability insurance program in foreign countries has been the subject of considerable review and study. Surveys have been con¬ ducted in Europe and the Far East to identify problem areas and to explore wTays and means of facilitating the claims process and ex¬ pediting service to claimants. In fiscal year 1959, an agreement was negotiated with the Veterans Administration, whereby Veterans Ad¬ ministration staff and facilities in the Philippines are utilized on a re¬ imbursable basis for services in connection with old-age, survivors and disability insurance affairs originating in that area. Another step was taken last year to accomplish additional improvements in this area of Bureau operations. A decision was reached to bring together in one central office location as many as possible of the diverse activi¬ ties related to the administration of this phase of the program. In May 1961 establishment of a new Branch in the Division of Claims Control wTas approved to provide overall responsibility for old-age, survivors, and disability insurance program administration in foreign countries. During the past year, the Bureau has been engaged in the process of settling down in the new Social Security Building on the outskirts of Baltimore and working out the many necessary adjustments. As of the end of the year, one unresolved problem was that of space require¬ ments — the new building is filled to capacity and certain segments of the Bureau are still located in downtown Baltimore. A series of amendments, with the resulting growth of staff, has made it difficult to keep pace with the demands for space. Construction of an Annex to the Social Security Building to house those segments of the Bureau still downtown has proceeded according to plan. It appears that there will be no difficulty in meeting the contract completion date of June 1962 for this addition to the building. As of the end of June 1961, work was proceeding ahead of schedule. Increasing space needs have led to a recommendation for expan¬ sion of the Annex to provide sufficient space for all of the disability and Baltimore Payment Center functions. Accordingly, an appro¬ priation request has been submitted to Congress to obtain funds to provide additional space in the Annex. 40 Department of Health , Education , and Welfare, 1961 At the end of fiscal year 1961, 30 large employers, with about 4 million employees, were either reporting employees’ earnings on mag¬ netic tape, or had plans to report by this method in the near future. There are savings to both the employers and to the Government in this system. The employer is able to eliminate the time-consuming listing of lengthy wage reports, often running as high as 1,000 pages per employer, along with the transcription errors which are costly to correct — both for the employer and for the Government. The taped wage reports, prepared automatically from the employer’s payroll records, also eliminate steps in the Government’s processing of the reports, such as punching cards for each employee reported. At present, 253 employers having 10,000 or more employees are submitting reports of their employees’ earnings directly to the Social Security Administration rather than through the Internal Revenue Service. The direct submittal of these reports permits the earnings records of the nearly 7 million employees affected to be processed and updated about 15 days earlier than under conventional methods. An additional 39 employers with approximately 1 million employees are considering the adoption of this plan. During the year, the Bureau continued to work with the Internal Revenue Service to obtain more complete and accurate earnings re¬ porting, particularly in the areas of migrant farm laborers and domestic service workers and self-employed persons and to secure more prompt processing and forwarding of earnings reports to the Bureau. As a result of the negotiations conducted during the past year, previous agreements were firmed up and agreement was reached on a program for increased Internal Revenue Service audit and compliance activ¬ ities. The details of this program will be worked out in fiscal year 1962. A significant recent accomplishment was the inauguration of a formal accounting procedure by which certain representative payees are required to submit annual reports as to the stewardship of the funds they have received on behalf of minor children and adults found to be unable to handle such funds. This development grows out of extended Bureau experience in this area. The accountability procedure augments but does not supplant personal interviews with certain representative payees at stated intervals. The significance of the annual accounting is that it requires a representative payee, under a system of administrative guardianship, to make appropriate report¬ ing’s of his use of the funds received on behalf of beneficiaries in a trust relationship. All necessary forms, internal instructions, and formal regulations have been developed, and district office personnel are now engaged in interviewing, interpreting, and implementing this procedure with Social Security Administration 41 accountable payees. Further administrative refinements are contem¬ plated, particularly in the early years of the activity when careful policy review and control will be required. Legislative Developments During the Year The Social Security Amendments of 1961, P.L. 87-64, mark still another step forward in providing American workers and their fam¬ ilies with basic protection against the hardships that can result from loss of earnings when the breadwinner retires, becomes disabled or dies. This legislation was enacted June 30, 1961. PROVISIONS OF THE 1961 AMENDMENTS Reduction in the minimum eligibility age for retirement benefits for men. — The age at which men are first eligible for old-age and sur¬ vivors insurance benefits is lowered from 65 to 62, with benefits for those who claim them before age 65 reduced to take account of the longer period over which they will get their benefits. It is estimated that benefits amounting to $440 million will be paid during the next 12 months to about 560,000 people who would not have been eligible for insurance benefits if it were not for this change. Under the new provision, the insurance benefits for a man worker are reduced at the same rate as now applies for a woman worker (% of 1 percent for each month before age 65 for which a benefit is payable) ; husband’s insurance benefits are reduced at the same rate as now applies to wife’s insurance benefits (2%6 of a percent for each month before age 65 for which a benefit is payable) ; and widower’s and surviving father’s insurance benefits are payable in full as widow’s and surviving mother’s insurance benefits now are. A man who be¬ gins getting old-age insurance benefits in the month in which he reaches age 62 will get a benefit amounting to 80 percent of the amount he would get if he stopped working then but waited until his 65th birthday before applying for benefits ; a man getting husband’s insur¬ ance benefits at age 62 will get 75 percent of what he would have gotten at age 65. As is now true for women, the percentage reduction in the insurance benefit payable before age 65 will continue to apply after 65, except that if the person works and earns enough before he reaches 65 to cause any of his benefits to be withheld the reduction in his benefit will be refigured at 65 to reflect the fact that benefits were not paid for as many months before 65 as was contemplated when the original computation was made. As originally proposed, the provision to lower the minimum eligi¬ bility age for insurance benefits for men would have involved some 626936—62 - 4 42 Department of Health , Education , and Welfare , 1961 additional cost (estimated at 0.10 percent of payroll on a level- premium basis) . This additional cost would have arisen because the computation of both fully insured status and the average monthly wage (from which benefit amounts are figured) would have been liberalized for men as they were for women when insurance benefits were made available to them at age 62. The measuring period for determining the number of quarters of coverage required to be fully insured for benefits and for determining the number of years to be included in the computation of the average monthly wage would have been based on the period ending with the beginning of the year of attainment of age 62 instead of age 65 — a 3-year-shorter period than under present law. Using a smaller number of years in the computa¬ tion permits the dropping of more years of low earnings and thus may have given a higher average monthly wage and a higher benefit amount even where the person works right up to age 65. In the amendments as adopted, an increase in the cost of the program is avoided by continuing to use age 65 as the ending point for deter¬ mining insured status and computing the average monthly wage for a man. Because the period for computing the average monthly wage for men extends to age 65 even though men may claim benefits before that age, in some cases where coverage was very recent as many as 3 years without earnings may have to be included in the computation. Where the man works after entitlement to reduced benefits, therefore, the new law provides for a special automatic recomputation without an application at age 65, or death before age 65, to pick up such earn¬ ings and, in death cases, to shorten the period used. The minimum benefit increased . — The minimum insurance benefit payable to a retired insured worker who begins to get benefits at or after age 65 or to a disabled insured worker, and to the sole survivor of a deceased insured worker, is increased from $33 to $40 per month (the minimum primary insurance amount), with corresponding in¬ creases for people getting other types of insurance benefits — for example, wives and children — based on primary insurance amounts of less than $40. This provision will put an additional $170 million in the hands of 2,175,000 people in the first 12 months of its operation. The provision for increase in minimum benefits makes an improve¬ ment in the old-age, survivors, and disability insurance program that is much needed at the present time. People coming on the benefit rolls in the future will generally get benefits above the minimum level because they will have had a chance to work in covered employment during their best working years. Right now, though, many of the people on the rolls are getting benefits at or near the minimum level not because they had a low level of lifetime earnings but because they Social Security Administration 43 were already old when their jobs were covered and their earnings under the program were lower than their average earnings over their lifetime. The increase in the minimum makes the protection of the program more effective for these people. Insured status requirements changed. — The insured status require¬ ment — the proportion of time that a person must work under social security to be eligible for old-age, survivors, and disability insurance benefits — is changed from 1 quarter of covered work for each 3 calendar quarters elapsing after 1950 to 1 quarter for each calendar year (equivalent to 1 for each 4 calendar quarters) up to the year in which he reaches age 65 (age 62 for women) . This change makes the insured status requirements for people who are now old comparable to that which will apply in the long run for people who will attain retire¬ ment age in the future. These latter will be fully insured if they are in covered work for the equivalent of 10 years out of an adult work¬ ing lifetime of about 40 years. This change will help many people who are uninsured because the work they did during their working years was not covered and by the time their jobs were covered they were already so old that they could not work regularly enough to meet the insured status requirements then in the law. About $65 million will be paid during the first 12 months to 160,000 people who would not otherwise have qualified for insurance benefits. The aged widow’s benefit increased. — The insurance benefit payable to an aged widow of a deceased insured worker is increased by 10 percent, from 75 percent of the worker’s primary insurance amount (the basic amount on which all old-age, survivors, and disability insurance benefit amounts are based) to 82% percent. (A similar increase is made in the insurance benefit payable to a widower and to a surviving dependent parent where only one parent is entitled to benefits.) This change will result in $105 million in additional bene¬ fits being paid to 1,525,000 older people during the first 12 months of operation. Under the law in effect up to this time, when a man died his widow had to get along with one-half of the benefit income that the family had while the man was living. If the retirement benefit for a man bears a reasonable and adequate relationship to his previous earn¬ ings, as it is intended to, then % of that benefit is not adequate for his widow in terms of the man’s earnings. The increase provided in the legislation will produce a more reasonable relationship between the widow’s benefit and her deceased husband’s earnings. The retirement test liberalized. — The provision for withholding benefits from beneficiaries whose earnings exceed $1,200 a year (gen¬ erally referred to as the retirement test) is changed so that $1 in 44 Department of Health , Education , anrf Welfare , 1961 benefits will be withheld for each $2 of earnings between $1,200 and $1,700, rather than between $1,200 and $1,500 as under previous law. (One dollar in benefits will be withheld for each $1 earned over $1,700.) Expanding the area over which the $l-for-$2 adjustment applies means that older people have a positive incentive to increase the part-time work they do up to the $1,700 point. There is thus a substantial improvement in the effect of the program on incentives for older people to contribute their skills and energy to the economy and to improve their own economic status through such current work as they are able to obtain and perform. Under the new test, about 350,000 people will start to get insurance benefits or will get more benefits for 1961 than they would get if the law had not been changed. Extension of the time for filing fully retroactive applications for establishing disability periods. — The legislation extends for 1 year — through June 30, 1962 — the time within which insured workers with long-standing disabilities may file applications for disability protec¬ tion on the basis of which the beginning of a period of disability can be established as early as the actual onset of disablement (as far back as October 1941). Many of those benefited by this provision are per¬ sons who only recently — through the 1960 amendment that provided cash disability benefits for disabled workers under age 50 — were af¬ forded the opportunity to become eligible for monthly disability benefits. Some of these new eligibles only now are learning of their rights to disability benefits. In some instances these rights would have been lost if the time for filing fully retroactive applications had not been extended. As in the previous law, where an application is filed after the deadline (now June 30, 1962), a period of disability can be established no earlier than 18 months before the date of filing application even if the applicant stopped working because of his dis¬ ability much earlier than that 18th month. Employees of State and local governments. — The 1961 amendments afforded employees of the States and localities additional time to elect social security coverage under the provision permitting specified States to cover only those retirement system members who desire coverage, with all future members being covered compulsorily. The amend¬ ments also added New Mexico to the list of States to which the pro¬ vision applies ; it now applies to 17 States. Giving survivors of certain ministers opportunity to elect cover¬ age. — The 1961 amendments extended the provision of the 1960 amendments which permits ministers to elect coverage before April 16, 1962, to the survivors of certain ministers. Survivors of ministers (or Christian Science practitioners) who die on or after the date of enactment of the 1960 amendments (September 13, 1960) and before April 16, 1962, without having elected coverage, may file certificates of election before April 16, 1962. Social Security Administration 45 Contribution rates increased. — The social security contribution rates payable by employers and employees are increased by % of 1 percent each, and the contribution rate for self-employed people is increased by %6 of 1 percent and rounded to the nearest tenth of 1 percent, beginning with 1962. In addition, the tax increase scheduled for 1969 will be moved up to 1968. Since the amendments would increase the level-premium cost of the program by 0.27 percent of payroll, and since these changes in the social security contribution rate schedule provide for additional income to the trust funds which is also esti¬ mated at 0.27 percent of payroll, the legislation does not change the actuarial balance of the insurance program and the insurance system will remain on a sound financial basis. The changes in the contribution schedule are shown below : Calendar years Employers and employees, each Self-employed Old New Old New 1962 . . . . . . Percent 3 3^ 4 4 4J4 Percent 3H m 4H Percent 4H 5M 6 6 6 x Percent 4.7 5.4 6.2 6.9 6.9 1963-65 _ _ _ _ _ _ _ 1966-67 _ 1968 . . . . . . . . 1969 and after _ Research Activities A major survey research project conducted during the fiscal year 1961 was a survey of the characteristics and resources of 3,400 dis¬ ability insurance beneficiaries and disabled persons in the eight largest metropolitan areas whose social security records were frozen to pro¬ tect their benefit rights. The findings of this survey are now being tabulated. Other studies of disability beneficiaries were begun during the year, utilizing nonsurvey data; these studies concern the charac¬ teristics of persons who have been denied a period of disability, and the characteristics of disabled persons who were rehabilitated by State agencies in the 1957-58 period. Reports were issued during the year on data collected in a 1957 survey of aged beneficiaries and mother-child groups. These reports analyzed the impact of hospitalization costs on the aged, as well as the sources of income, employment status, and living arrangements of retired beneficiaries. In the coming fiscal year, the Bureau plans to begin a study of a sample of aged beneficiaries who will be revisited over a period of years in order to determine how their situation changes as they grow older and the kind of adjustments they make to such changes. The Bureau conducted a survey of State and local retirement sys¬ tems, and began preparation of a report on the benefit-contribution 46 Department of Health , Education, and Welfare, 1961 characteristics of such systems before and after old-age, survivors, and disability insurance coverage was obtained. Several pretests were made in a survey of reasons why persons apply for old-age benefits ; the survey questionnaire was revised in the light of the pretest results, and plans were made for full-scale quarterly surveys in fiscal 1962. A number of other socio-economic research studies were completed during the year, utilizing nonsurvey techniques. Reports were issued on the characteristics of persons separating and withdrawing contri¬ butions from the Federal Civil Service Retirement System; the re¬ habilitation implications of activity limitations among disabled workers ; and the employment of women under the program. Program Simplification Progress continues to be made by the Bureau in its efforts to make the old-age, survivors, and disability insurance program easier to un¬ derstand, accept, and administer. Many of the proposals for sim¬ plifying the program that were developed over the last few years were included in the Social Security Amendments of 1960. During the last year, the Bureau completed studies and developed recommenda¬ tions for simplifying the insured status requirements for benefits and the provisions for paying reduced benefits before age 65. Some of these proposals, along with others of the same nature developed by the Chief Actuary of the Social Security Administration, were in¬ corporated in the amendments of 1961. Further progress along these lines was made in the area of paying reduced benefits before age 65 as a result of a major redrafting effort by the Legislative Counsel’s Office of the House of Representatives. Late in fiscal 1961, the Bureau got underway a long-term simplifica¬ tion project to reorganize and rewrite title II of the Social Security Act. The objectives of this project are to : (1) improve the organiza¬ tion and format of the statute; (2) eliminate unnecessary verbiage; and (3) eliminate minor inequities and inconsistencies. Although the Bureau took the initiative in setting up this project, the new title will be prepared in cooperation with the staffs of the Legislative Counsel’s Office and the Committee on Ways and Means of the House of Representatives. Financing the Program The old-age, survivors, and disability insurance system, as modified by P -L. 87-64, has an estimated benefit cost that is very closely in bal¬ ance with contribution income. In enacting the 1961 amendments Congress again made clear its intent that the program be self-support- Social Security Administration 47 ing from contributions of covered workers and employers. Careful review was given to intermediate-range and long-range actuarial cost estimates prepared for use of the congressional committees in their legislative considerations. The program as amended continues to be financed on an actuarially sound basis, both for the next 15 to 20 years and for the distant future. The difficulties involved in making exact predictions of the actuarial status of a program that reaches into the distant future are widely recognized. If different assumptions as to, say, interest, mortality, retirement, disability, or earnings had been used, different results would have been obtained. Accordingly, no one set of estimates should be looked upon as final, in view of the fact that future ex¬ perience may vary from the actuarial cost estimates. Nonetheless, the intent that the system be actuarially sound can be expressed in law by a contribution schedule that, according to the intermediate-cost schedule, results in the system being substantially in balance. OLD-AGE AND SURVIVORS INSURANCE BENEFITS The level-premium cost of old-age and survivors insurance benefits after 1961, on an intermediate basis, assuming interest of 3.02 percent and earnings at about the levels that prevailed during 1959, is esti¬ mated at 8.79 percent of payroll (after adjustments to allow for ad¬ ministrative expenses and interest earnings on the existing trust fund) . The level contribution rate, equivalent to the graduated rates in the law, is estimated at 8.55 percent of payroll, leaving a small actuarial insufficiency of 0.24 percent of payroll. In view of the very long range over which these projections are made, and the many variable factors included, the insufficiency is so small that the system may be considered in 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 insurance benefits. The estimated level-premium cost of the disability benefits (adjusted to allow for administrative expenses and interest) on an intermediate basis is 0.56 percent of payroll. Contribution income has been specifically allo¬ cated to finance these benefits; this income is equivalent to 0.50 per¬ cent of payroll, leaving a small actuarial insufficiency of 0.06 percent of payroll. F uture experience with this program will be studied care¬ fully to determine whether the actuarial cost factors used are appro¬ priate or if the financing basis needs to be modified. The use of slightly less conservative cost factors would result in cost estimates showing the disability insurance system in complete actuarial balance. 48 Department of Health, Education, and Welfare, 1961 Summary and Conclusion In the years since the adoption of the Social Security Act the Ameri¬ can people have moved a long way toward attainment of the goal of freedom from want. Establishment of the old-age and survivors in¬ surance program and improvements that have been made in it through¬ out the years have contributed in large measure to the progress that has been made. Because under this social insurance system the right to benefits is earned through work and paid for in part by contribu¬ tions from the worker’s earnings, the system goes hand-in-hand with our American traditions. The social insurance program that has proved so successful thus far can and should be improved so as to meet the challenge of changing conditions and applied to emerging problems, so that in the future it will continue to make a major con¬ tribution to the welfare of the American people. Public Assistance Public assistance, complementary to social insurance, attempts to meet minimum essential needs of individuals and families when, for various reasons, they are unable to do so themselves. It is the basic underpinning program in the social security system of the Nation, dealing with unmet individual needs that generally are not insurable because of their unpredictability, or are beyond the scope or level of benefits considered actuarially sound under social insurance. This dual attack on unmet basic human needs — social insurance and public assistance — was bom out of the stark realization that the process of industrialization and urbanization which, within less than a century, had transformed a major part of our farms and countryside into factories and cities, had also created social problems with which individuals could no longer deal within the family or local community. Industrialization brought greater productivity, higher standards of living, better nutrition, improved medical care, and many other comforts and luxuries for those who had the money to buy them. But economic progress also brought social changes in addition to increases in population. There were disproportionate increases in the de¬ pendent age groups — the aged and children — and a shrinking pro¬ portion of wage earners to support them. Family responsibility, of necessity, also lessened as the large farm family was replaced by the smaller parent-children unit in the cities dependent largely on in¬ come from wages. Mass unemployment in the early 1930’s left millions without the means of buying the basic necessities of life. Federal governmental Social Security Administration 49 aid, first designed to meet immediate emergency financial need due to unemployment, was later channeled into long-range preventive meas¬ ures — social insurance against the risks of unemployment, old age, de¬ pendency of children because of the death of the wage earner, and disability. Legislative changes in the Federal old-age, survivors, and disability insurance program have extended its coverage until today 9 out of 10 persons in the working population come within this broad umbrella of economic protection. Role of PA Programs It is with the needs of dependent persons not covered under social insurance or whose minimum needs exceed insurance benefits that public assistance programs are concerned. Less than 4 percent of the population received public assistance in June 1961, and despite the increased dollar cost of public assistance over the years, expendi¬ tures for this purpose in fiscal 1961 represented less than a cent per dollar of total personal income in the Nation during 1960. (See chart 2.) Assistance to sustain and strengthen individual and family life are vital to those who need it. The provision for financial assistance, medical care, and other social services under federally aided public assistance programs available in most of the local communities of the United States has assured the minimum essentials of living to the needy aged, blind, disabled, and children in families broken by death, incapacity, or absence of a parent, and more recently, in families hard-pressed because of unemployment. (See chart 3.) It has also contributed much to strengthening family ties that might otherwise have been irreparably scarred by anxiety and poverty or broken by separation of children from their home and parents. The basis on which Federal-State public assistance programs are administered is also significant in sustaining principles fundamental to our democracy. Initial provisions of the public assistance titles of the Social Security Act reflect respect for the dignity of the indi¬ vidual and recognition of his rights as well as of his responsibilities. The definition of assistance as a money payment leaves with the needy person responsibility, like that of others in the community, for decid¬ ing how best to use his income. Provision for a hearing before the State agency protects individual rights when a needy person has been denied aid or is dissatisfied with the amount of his assistance payment, or when his application has not been acted upon with reasonable promptness. His privacy is safeguarded by preventing disclosure by the agency of personal information that would subject him to indignity or embarrassment. CHART 2.— PUBLIC ASSISTANCE HIGHLIGHTS, 1961* 50 Department of Health , Education , and Welfare , 1961 Includes general assistance under State and local progi Social Security Administration 51 CHART 3.— MAJOR CAUSES OF DEPENDENCY OF PUBLIC ASSISTANCE RECIPIENTS,* JUNE 1961 6.2 Million * Excludes general assistance recipients under State and local programs. The availability of Federal funds to the States and the placement of responsibility for the program with a single State agency has served as an impetus in establishing or strengthening State depart¬ ments of public welfare throughout the country. The flexibility inherent in the public assistance program has also permitted its adaptation to meet some of the changing needs of the American people. Through subsequent legislative changes, the scope and coverage of the public assistance programs were broadened to include the per¬ manently and totally disabled ; the aged, the blind or disabled recipi¬ ents who are patients in public medical institutions; the costs of medical care or other remedial care paid directly to doctors, hospitals, and other suppliers of such services ; needy adults responsible for the care of dependent children ; children aged 16 and 17, without regard to school attendance; and children living with first cousins, nieces, and nephews (in addition to previously specified relatives). 52 Department of Health , Education , and Welfare , 1961 The amount of Federal financial aid to States has been increased on several occasions through various devices to make it possible for assistance payments to keep pace with rising costs of living. Meas¬ ures were added to improve medical care provisions for the needy. Clarification was also made of the availability of Federal financial participation in the costs of providing staff services to help needy persons find and use their own strengths and available resources to develop their potential for more satisfying and independent living. New Legislation Although the public assistance titles of the Social Security Act were amended by almost every Congress since 1935, an unprecedented amount of legislation was passed during the closing days of the 86th Congress and the first session of the 87th Congress. The legislation passed in fiscal 1961, outlined below, continued to strengthen existing provisions, but also charted paths new to the public assistance program. Public Law 86—571, July 1960 The Department of Health, Education, and Welfare was authorized for the first time to provide reception service and hospitalization at Saint Elizabeths Hospital, or elsewhere, for certain repatriated mentally ill nationals of the United States. Public Law 86—778, September 1960 A new program of medical assistance for the aged was established. Federal funds were made available to enable the States to help those older persons not receiving old-age assistance who are able to meet normal expenses but do not have sufficient income or resources to meet the costs of necessary medical services. Increased Federal financial participation was made available to States that made payments to suppliers of medical care in behalf of recipients of old-age assistance. In addition to the usual share in assistance payments up to a monthly maximum of $65 per aged recipient, additional Federal sharing was provided based on expenditures for payments to suppliers of medical care up to a monthly maximum of $12 per recipient. Federal financial participation was permitted for the first time in State vendor medical care payments (under both the new medical care program and the old-age assistance program) in behalf of patients in a medical institution as a result of a diagnosis of tuberculosis or psychosis for 42 days after such diagnosis. Dollar limitations on the total annual amount of Federal funds for Puerto Rico, the Virgin Islands, and Guam were increased for medical care payments made in behalf of recipients of old-age assistance. Effective July 1, 1962, a State agency, in determining need for blind assistance, must disregard the first $85 of earned income per month plus one-half of earned income in excess of $85. Until then, beginning October 1, 1960, a State is per- Social Security Administration 53 mitted to disregard the first $85 per month and one-half of the excess or to continue to apply the $50 per month exemption as under the old law. Special legislation providing for the approval of the Missouri and Pennsylvania blind assistance plans, due to expire June 30, 1961, was extended to June 30, 1964. Public Law 87-31 , May 1961 The aid to dependent children program was temporarily broadened to provide assistance to needy children in families where the breadwinning parent is unemployed. (From May 1, 1961, through June 30, 1962.) Federal financial participation was permitted in the State’s expenditures for foster care for a child receiving aid to dependent children who, as a result of a judicial determination is removed from his own home because he lacked proper care and protection, and placed in an approved family home; and for whose placement and care the agency administering the State plan for aid to dependent children is responsible. (From May 1, 1961, through June 30, 1962.) September 1, 1962, was set as the date after which Federal funds will be withheld from a State whose plan, as required by State legislation, provides for denying assistance to a needy child living in a home considered by the State to be detrimental to his well-being. (Date postponed from June 30, 1961.) Training grants for public welfare personnel authorized by amendments in 1956, effective July 1, 1957, for 5 years, were extended through June 30, 1963; and the Federal share of State expenditures for training purposes was raised from 80 percent, as authorized in 1956, to 100 percent, effective for allotments through June 30, 1963. (No appropriation was made for this purpose for fiscal 1962.) The average amount of vendor medical payments in which there is additional Federal participation for old-age assistance was raised from an average monthly expenditure per recipient of $12, as provided under the 1960 amendments, to $15. Public Law 87-64 , June 1961 The Federal share of assistance payments under programs of old-age assistance, aid to the blind, and aid to the permanently and totally disabled was tempo¬ rarily increased. The first $30 per recipient per month, in which Federal partici¬ pation is 80 percent, was raised to $31, and the maximum average payment in which the Federal Government will participate (exclusive of the special pro¬ vision for additional Federal participation in vendor medical payments in old-age assistance) was raised from $65 to $66. (From October 1, 1961, through June 30, 1962.) Dollar limitations on the total annual amount of Federal funds for Puerto Rico, the Virgin Islands, and Guam were increased to facilitate their imple¬ menting liberalizations authorized by the new legislation. Assistance was provided for United States citizens and their dependents repatriated from a foreign country because of personal misfortune or inter¬ national crisis, who are in need of temporary assistance after reaching a port of entry in the United States. Trends in Caseloads and Expenditures In June 1961 assistance was available in all 54 jurisdictions of the country (including the District of Columbia, Guam, Puerto Rico, and 54 Department of Health, Education, and Welfare, 1961 the Virgin Islands) under the federally aided programs of old-age assistance, aid to the blind, and aid to dependent children (6 juris¬ dictions administering aid to dependent children also made payments to unemployed-parent families, and 1 jurisdiction made payments for the foster care of children). Federally aided programs for the permanently and totally disabled were administered by 50 jurisdic¬ tions, and 9 States made payments under the new program of medical assistance for the aged. General assistance (wholly State and/or locally financed), in some form for some persons, was available in all 54 jurisdictions. A total of 7.2 million persons received aid in June 1961 under the six public assistance programs (including general assistance). The increase of 442,000 persons over the number aided in June 1960 largely reflects the impact of the 1960-61 recession. The year’s greatest changes in number of recipients were increases of 360,000 in the Federal-State aid to dependent children program and 80,000 in State- local general assistance — the two programs most sensitive to changes in economic conditions. The size of the aid to dependent children program is undoubtedly also affected by the continuing rise in child population; by July 1961, there were 67,063,000 children — more than a third of the total population in the 54 jurisdictions of the country — under 18 years of age. In aid to dependent children, the 3,383,000 recipients, including 2,613,000 children in 878,000 families, assisted in June 1961 repre¬ sented an increase from June 1960 of 11.9 percent. Part of this increase was due to the addition of 112,000 recipients in unemployed- parent families, the majority of whom had been transferred from general assistance programs. The 1,049,000 persons, in 406,000 cases, receiving State and/or locally financed general assistance in June 1961 represented an 8.2- percent increase, over June 1960. Beginning in April, however, there was a sharp decline in the number receiving general assistance, which continued steadily through the end of the fiscal year (from 1,607,000 persons in 525,000 cases in March to 1,049,000 persons in 406,000 cases in June). The number in unemployed-parent families transferred from general assistance to the extended aid to dependent children program accounted for less than a fifth of this decline. The number of recipients of aid to the permanently and totally disabled also rose, from 363,000 in June 1960 to 384,000 in June 1961, an increase of 5.8 percent. By June the new program of medical assistance for the aged was aiding 46,000 persons, most of whom had formerly received care in medical institutions or nursing homes under old-age assistance programs. The other federally aided programs showed decreases ; old-age assistance, from 2,359,000 to 2,296,000 per- Social Security Administration 55 sons — a drop of 2.6 percent; and aid to the blind, from 108,000 to 106,000 persons — a drop of 2.2 percent. Total assistance expenditures, including vendor payments for medi¬ cal care, for all six programs for the fiscal year 1961 were $3,944 million — a 5.7-percent increase over expenditures in 1960. Total pay¬ ments rose $97 million or 9.5 percent in aid to dependent children; $29 million or 10.7 percent in aid to the permanently and totally dis¬ abled; $12 million or 0.6 percent in old-age assistance; and $2 million or 1.7 percent in aid to the blind. In the State and/or locally financed programs of general assistance, total payments (excluding vendor payments for medical care) increased $28 million or 8.3 percent. Pay¬ ments under the new program of medical assistance for the aged totaled $40 million in fiscal 1961. Although the national average assistance payment did not increase in all programs, higher total expenditures reflect in part other efforts to offset the continuing rise in living costs, with the medical care component showing the greatest relative increase. For example, cost standards were raised in one or more programs in about a third of the States; in old-age assistance, 7 States raised their maximum on individual monthly payments, and a smaller number liber alized maxi- mums in each of the other programs; several States broadened the scope of medical care provided through vendor payments; and a few States made their first medical care vendor payments in behalf of old- age assistance recipients. In aid to dependent children, the national average payment was $30.30 per recipient in June 1961, compared with $29.11 a year earlier. Average payments ranged from $9.32 in Alabama (except for $3.82 in Puerto Rico) to $51.61 in Connecticut. In old-age assistance, the average payment was $67.85 per recipient in June 1961, compared with $68.01 in June 1960. Average payments ranged from $35.40 in Mississippi (except for $8.30 in Puerto Rico) to $96.51 in Colorado. In medical assistance for the aged, the aver¬ age medical cost paid per recipient in the 9 States making payments in June 1961 was $200.59. For all States, the median medical care vendor payment under old-age assistance increased from $7.54 per recipient in June 1960 to $11.32 in June 1961. In aid to the permanently and totally disabled, the average payment per recipient was $68.19 in June 1961, compared with $65.96 a year earlier. Average payments ranged from $34.85 in Mississippi (except for $8.70 in Puerto Rico) to $132.90 in Massachusetts. In aid to the blind, the average payment per recipient was $73.36 in June 1961, compared with $72.85 a year earlier. Average payments ranged from $38.43 in Mississippi (except for $8.27 in Puerto Rico) to $126.45 in Massachusetts. 56 Department of Health , Education , and Welfare , 1961 For the 53 jurisdictions reporting on State and/or locally financed general assistance programs, excluding medical care vendor payments, the average payment per case was $65.13 in June 1961, compared with $67.44 in June 1960 (46 percent of all cases were family cases, includ¬ ing an average of 4.4 persons per family) . Average payments ranged from $12.89 per case in Alabama (except for $7.27 in Puerto Rico) to $110.76 per case in New Jersey. The number of persons receiving both old-age, survivors, and dis¬ ability insurance benefits and old-age assistance payments continued to increase. In February 1961, about 715,400 old-age assistance re¬ cipients, or 31 percent (compared with 28.5 percent in 1960 and 19.2 percent in 1955) were receiving assistance because their insurance benefits and other resources were insufficient to meet their basic and/or special needs, such as medical care. The percentage of re¬ cipients of other types of public assistance who also received old-age, survivors, and disability insurance benefits was considerably smaller — 18.1 percent of those receiving aid to the blind, 8.6 percent of those receiving aid to the permanently and totally disabled, and 5.4 percent of the families receiving aid to dependent children. SOURCE OF FUNDS FOR PUBLIC ASSISTANCE PAYMENTS Of $3,939 million expended for the six public assistance programs in fiscal 1961, about 52 percent, or a little over $2,049 million, came from Federal funds; 35.9 percent, or $1,413 million, from the States; and 12.1 percent, or $477 million, from the localities (of which $209 million was spent for general assistance) . For the five special types of public assistance, the Federal share of total costs was 59 percent; the State share, 33.3 percent; and the local share, 7.7 percent. Assistance payments during 1961 repre¬ sented about 0.9 of a cent per dollar of total personal income in the Nation during 1960. Program Developments Major program changes resulted from legislation passed during fiscal 1961. Significant developments also occurred in other areas. INCREASED PROVISIONS FOR MEDICAL CARE Federal funds were made available for the first time to help States meet the cost of medical care needs unrelated to the need for main¬ tenance through the establishment of a new program of medical assist¬ ance for the aged. Additional Federal funds (beyond the usual share in assistance payments) were also made available to States that make vendor medical payments in behalf of old-age assistance recipients. Social Security Administration 57 PROVISIONS OF THE NEW MAA PROGRAM The new program of medical assistance for the aged authorized by legislation passed in September 1960 provided Federal funds to enable the States to help pay for medical care for the older persons not receiv¬ ing old-age assistance who are able to meet regular living expenses but cannot meet the costs of unusual medical services. Federal par¬ ticipation under the new program, limited to expenditures paid in behalf of eligible recipients to suppliers of medical or remedial care, ranges from 50 to 80 percent, depending upon the relationship between the per capita income in the State and the national per capita income. No maximum is set on the amount of the payment made by a State with Federal participation. The States are given considerable lati¬ tude in determining the scope of the program, including both the con¬ ditions of eligibility and the kinds and extent of services for which costs will be assumed. However, among conditions imposed by the Federal act were the inclusion of both institutional and noninstitu- tional care and services; and several 'prohibitions including: a dura¬ tional residence requirement; the placing of a lien against the property of any individual prior to his death on account of medical assistance properly paid in his behalf or recovery of such assistance from his estate until after the death of the surviving spouse, if any ; and any charge, such as an enrollment fee or premium, as a con¬ dition of eligibility. Congress also directed the Department of Health, Education, and Welfare to develop guides and standards on the level, content, and quality of medical care and services for States to use in evaluating and improving their medical care programs ; and to evaluate the effec¬ tiveness of the new legislation and make recommendations for improv¬ ing State medical care programs. ADDITIONAL PROVISION FOR OAA RECIPIENTS In September 1960 increased Federal funds also were made avail¬ able to States that make vendor medical payments in behalf of old- age assistance recipients to provide an additional amount (beyond the usual share in assistance payments) based on expenditures for these payments up to a monthly maximum of $12 per recipient. In May 1961 this maximum was increased to $15. The establishment of a medical care program for the aged not re¬ ceiving assistance, plus the provision of additional money specifically for medical care for old-age assistance recipients, greatly augmented the amount of medical care available previously under federally aided public assistance programs. Although most of the Nation’s juris¬ dictions (44 out of 54 in June 1960) had some provision in their 626936—62 - 5 58 Department of Health , Education , and Welfare , 1961 public assistance programs for costs of medical care through the vendor payment, and some of the jurisdictions provided for some items of medical care in the money payment to the recipient (including 6 of the 10 that did not use the vendor payment), the majority of the States provided for only limited medical care, financing one or more services, but not the broad scope of services needed by most sick people. IMPLEMENTING THE MEDICAL CARE LEGISLATION The early effective date of the medical care legislation (passed in September 1960 and effective October 1, 1960) spurred action by Federal and State agencies. The day the President signed the 1960 amendments, a group of State representatives met with Bureau staff to advise on the medical care provisions. Representatives of the American Medical Associa¬ tion, the American Hospital Association, and the Bureau also held special meetings in Washington on the new program. The American Medical Association, which gave full support to the 1960 legislation, encouraged their State organizations to urge action in their respective States, and the American Hospital Association ap¬ pointed a committee to work with the Bureau in relation to the new program. Many inquiries came from State welfare agencies and medical societies asking for consultation on various aspects of medical care under consideration in State planning, and for interpretation of the clause in the amendment requiring “reasonable standards” of financial need. A new Division of Medical Care Standards was established in the Bureau, and a group of 16 physicians and specialists in paramedical areas was appointed to advise on medical matters. Consideration of major policy issues, development of instructional material for State use, and issuance of interpretive materials on the new provisions were given high priority. Policy and administrative questions were dis¬ cussed with departmental, regional, and State agency staff and with other interested agencies and groups. Broad national policies were developed against which States could prepare their plans, and pro¬ cedures were shortcut wherever feasible. Consultation was provided to State agencies on the development of necessary State legislation and plans to put the new medical care provisions into effect. State officials met with Bureau staff in Wash¬ ington to consider specific State situations, and special legislative sessions were held in several States to obtain a legal base and appro¬ priations for initiating new, or modifying existing, programs. Within a month after the effective date of the legislation, 12 States started action to put the new program into effect. In March 1961, when close to 50 State legislatures were in session, some 20 States Social Security Administration 59 considered measures to establish programs of medical assistance for the aged. By the end of August 1961 legislation establishing such programs had been passed or was in process in 33 States — 14 States had new programs in operation, 4 States had completed plans for new programs, 8 States had enacted legislation but had not yet completed their plans, 4 States were still working on legislation to provide a legal base or appropriation for the program, and 3 States had obtained legal authority but no appropriation. Data obtained by the Bureau from the 14 States with programs of medical assistance for the aged on August 31, 1961, revealed that all but 4 began on a conservative basis; 10 set a maximum on the amount of income recipients may receive, ranging from a low of $1,140 for a single recipient with no dependents, to a high of $3,000, with varying allowances for dependents; and 11 States placed major limi¬ tations on the care for which they would pay. All 14 States exempt real property used as a home but take into account the resource value of other real estate in determining the value of assets, although most do not require its liquidation. Most exempt a life insurance policy with a small cash surrender value, but consider as assets medical in¬ surance policies and similar resources designed to meet medical costs. A reserve of cash or “resources convertible to cash,” ranging from $300 to $5,000, is permitted in 9 States. The hospital stay to be paid for ranges from 10 days per year in 1 State to as many as are neces¬ sary in others. Hospital care is limited by 7 States to acute, life- endangering, or traumatic conditions requiring hospital care; and 7 others provide hospital care as recommended by the physician. The cost of nursing home care is included by 8 States, but 4 of these re¬ strict it to post-hospital or convalescent care. In 11 States, the noninstitutional-care provisions include physicians’ services in the home and office ; some of these States limit the services to acute conditions or to treatment necessary to prevent hospitaliza¬ tion. The most frequently covered services, in addition to those of the physician, are dental services to relieve pain or treat acute infections, and prescribed drugs, which in some States are limited to drugs needed for acute or life-endangering conditions. In five States costs are assumed for the four basic medical care needs (hospital care, nursing home care, physicians’ services, and prescribed drugs) ; in nine States, one or more of these services is not included. The additional Federal funds made available for medical care costs of old-age assistance recipients was used by 23 States to improve the content or coverage of medical care provisions in their old-age assist¬ ance programs, and 1 planned to do so by January 1962. Of the 11 States with no previous provision for medical care vendor payments, 8 either added such provision, or planned to do so by January 1962. 60 Department of Health, Education, and Welfare, 1961 In some of the 18 States that did not add or improve vendor medical care provisions in their old-age assistance programs, the additional Federal funds made it possible to avoid cuts in provision for medical services by preventing or eliminating deficits in State funds, or en¬ abled an increase in grants to recipients of other public assistance by the release of State funds. The content of medical care service for which costs are assumed for recipients of old-age assistance is considered comprehensive or rela¬ tively so in 26 States. These States provide for hospitalization, nurs¬ ing home care, and physicians’ services without significant limitations as to the nature of the patient’s illness, unit cost of care, number of days of care, or number of visits to or from a doctor. While several of these States have some limitations, most of them meet the cost of practically any needed and available care. The 21 States with more limited provisions most frequently pay only for hospitalization and nursing home care. In some of these States, responsibility for the cost of hospitalization is further restricted to cases of acute illness and emergencies. PROVISIONS FOR NEEDY CHILDREN EXTENDED The number of children dependent on public aid is at an all-time high. However, even with a 37-percent increase in total child popu¬ lation, and with extensions in the aid to dependent children program that include additional needy children, there was only a slight in¬ crease — from 3.5 to 3.7 percent — in the proportion of children receiv¬ ing aid in June 1961 compared with a decade ago.1 In the 50th anniversary year of the initiation of the first State mother’s aid pro¬ gram, legislation passed in 1961 contributed several major, although limited, extensions in the Nation’s provisions for these needy children. Extension of ADC to Unemployed-Parent Families As part of national planning to stimulate recovery from recession, the aid to dependent children program was temporarily extended to children in families where the breadwinning parent was unemployed. This was the first time since 1935 that Federal funds were made avail¬ able through public assistance to help children in families hard- pressed because of unemployment. Provision was also made for co¬ operative arrangements with State employment and vocational educa¬ tion agencies to help the unemployed parent secure employment and to have more training if he needs it, as well as for denial of aid when a bona fide job offer is declined without good cause. The ADC legislation enacted in May and effective May 1, 1961, (through June 30, 1962) required early administrative action to help 1 Percentages are related to the 51 jurisdictions for which comparable data are available for 1901 and 1950. Social Security Administration 61 States implement its provisions, as well as development of national policy and establishment of new program relationships. Bills had been prepared by some States to permit temporary extension of ADC to needy children of unemployed parents in anticipation of passage of this proposal while it was still before Congress, and a few States passed such extension bills contingent upon Federal action. By the end of August 1961, 12 States had made provision for aid to children of unemployed parents in their ADC programs, 3 States planned to do so in the near future, and legislation was still in process in 1 State. The implementation of this provision in several States raised ques¬ tions about the use of Federal funds for work relief projects. In re¬ sponse to expressions of public concern about providing assistance to employable persons, a departmental policy was publicized in June 1961 stating that, if a local community wants to require the unem¬ ployed parent to work on a public project for assistance given him, it may do so. However, Federal funds may not be used to pay any part of the individual’s wages, since the Social Security Act does not authorize the use of Federal funds to match amounts paid by States as work relief; but Federal funds may be used to pay a share of the payment that covers the difference between the parent’s earnings on the project and the family’s need as determined under the State’s assist¬ ance standard. (This is similar to the provision for Federal partici¬ pation in assistance payments which supplements wages from private employment insufficient to meet a family’s need.) Provision for Foster-Family Care The ADC program was also extended in May 1961 to provide foster¬ family care for a child receiving aid to dependent children who, as a result of a judicial determination, is removed from his own home be¬ cause he lacks proper care and protection and is placed in a State- approved or licensed family home, and for whose placement and care the agency administering the State plan for aid to dependent children is responsible. Under the new foster- family care legislation, the State must provide for developing a plan for each child to assure proper care while he remains with a foster family (including periodic review of the neces¬ sity for continuing in foster care) ; the provision of services to im¬ prove the conditions in the home from which he has been removed, or to arrange for his placement in the home of another close relative; and the use of public child welfare services staff to the maximum extent practicable in the placement of the child. To help States implement this temporary extension of ADC (from May 1, 1961, through June 30, 1962) a joint Bureau of Public Assist¬ ance and Children’s Bureau committee immediately began work on 62 Department of Health , Education, and Welfare, 1961 developing national policies and procedures, and exploring ways in which the two Bureaus could work cooperatively with the States. Draft materials were reviewed in joint meetings of regional and central office staff. By the end of August 1961, the foster-family care provision was incorporated by 10 States in their aid to dependent children programs, 7 States planned to do so in the next few months, 12 States that did not expect to need legislation to implement the provision were still considering it, and in 6 States, legislatures con¬ sidered but did not adopt the provision. Relation of foster -family care legislation to State action around “ unsuitable homes? — The foster- family care legislation was precipi¬ tated by the denial of aid by several States to needy children living in so-called “unsuitable homes.” Although 24 State ADC plans carry some reference to “suitable homes,” most of them include provisions to enable public welfare agencies to help make plans for the child’s best interests, and continue assistance until the plan has been carried out. Eight State plans, however, denied assistance without assurance that an arrangement suitable for the child’s upbringing is worked out. In these States, if the child’s home was found to be “unsuitable” the child could be left in the home, deprived of needed support. The plan provisions in these States raised grave question as to whether they were consistent with the intent of the aid to dependent children and child welfare provisions of the Social Security Act. The issue was brought to a head in July 1960 when one State (Louisiana) enacted legislation under which the State terminated aid to about 23,000 needy children — ostensibly because they lived in “un¬ suitable homes.” In this instance, State legislation denied assistance to children if the adult caretaker was living with, but not legally married to, a mate ; or if the mother had had an illegitimate child at any time since first receiving assistance, unless she could prove to a parish welfare board that she had ceased illicit relationships and was maintaining a suitable home for her children. Public reaction to the withdrawal of assistance from such a large group of needy children resulted in widespread public protest. A large number of national welfare agencies and citizens’ groups urged the Department to take appropriate action to protect needy children against such hardships. Many individuals and agencies expressed indignation over the injustice of denying children aid because of the conduct of their parents, and concern about the effect of deprivation on the children as well as its long-run harmful effect on the Nation. The Commissioner of Social Security held a hearing on the State’s action in the fall of 1960 in order to determine whether the State?s ADC plan was being administered substantially in accordance with the requirements of the Social Security Act. A large number of na- Social Security Administration 63 tional welfare and church organizations united in expressing their concern ; many adopted resolutions or prepared statements expressing their opinions and philosophy in relation to the issue; and several presented briefs as “amicus curiae” in connection with the hearing. Some also expressed concern about other needy children in the State in the event of withdrawal of Federal funds. Following the hearing, the State revised its plan, eliminating its more serious program defects and providing for skilled protective services to be available to the children affected by the suitability pro¬ vision. In the absence of any Federal requirement prohibiting States’ use of “suitable home” as an eligibility factor, and with acceptable revisions in the State plan, the Commissioner in January 1961 ruled that the State plan for aid to dependent children provided a basis for continued receipt of Federal payments. Subsequently, the Secretary of the Department concluded that “. . . when a needy child who otherwise fits within the ADC pro¬ gram of the State is denied the funds that are admittedly needed to provide the basic essentials of life itself because of the behavior of his parent or other relative, the State plan imposes a condition of eligi¬ bility that bears no just relationship to the ADC program . . . [and] that eligibility conditions with the effect described above are not compatible with entitlement for continued Federal grants.” The Commissioner of Social Security subsequently approved the following requirement issued by the Bureau effective July 1, 1961 : A State plan for aid to dependent children may not impose an eligibility condition that would deny assistance with respect to a needy child on the basis that the home conditions in which the child lives are unsuitable, while the child continues to reside in the home. Assistance will therefore be continued during the time efforts are being made either to improve the home conditions or to make arrangements for the child elsewhere. The foster- family care legislation passed in May 1961 confirmed and supported this departmental policy, but postponed its effective date from July 1, 1961, to September 1, 1962, to allow additional time for any State that required legislative action to make necessary plan changes. Five of the 8 States were able to amend their plans to con¬ tinue assistance until children in homes found “unsuitable” were re¬ moved from their homes. Three States (Louisiana, Michigan, and Mississippi) were unable to meet the requirement under their existing legislation, and qualified for the extension of time. Other Developments in ADC During the year, the school attendance requirement for children 16 and 17 years old was eliminated in Illinois and South Dakota; and Nevada raised the eligibility age limit from 16 to 18, with the provi- 64 Department of Health, Education , and Welfare , 1961 sion that the child between 16 and 18 be regularly attending school and receiving passing grades. There are now only 2 States in which as¬ sistance is not continued to age 18, at least for children attending school — Georgia has an age limit of 16 years, regardless of school attendance, and Texas limits assistance to children under 14. How¬ ever, all but 10 States still have a durational residence requirement; 11 States still do not include children living with first cousins, nephews, or nieces; and 1 State (Texas) excludes a child who is not a United States citizen. WELFARE SERVICES STRENGTHENED Consultation to States and preparation of informational, interpre¬ tive, and in-service training materials continued on various ways of providing services to persons dependent on public assistance. Coop¬ erative relationships were maintained with various national public and voluntary agencies concerned with families and children, the aging, homemaker services, or community planning, with participa¬ tion on various committees of these organizations in joint effort to develop new methods of providing help to those in need. Primary emphasis was given to strengthening welfare services appropriate to social and economic problems of families and older persons. In relation to families, activities centered around services to strengthen family life, and to deal with special problems such as illegitimacy, neglect of children, inadequate home management, and care of children. A pamphlet, Unmarried Parents — A Guide for the Development of Services in Public Welfare , was prepared jointly by the Children’s Bureau and the Bureau of Public Assistance to provide guidelines for public welfare agencies in developing or improving services to unmarried parents. Similarly, an addendum to the 1958 Directory of Homemakers published in the Homemaker Service Newsletter was prepared jointly with the Children’s Bureau and the Public Health Service. Work also was initiated on a project to teach ADC mothers housekeeping skills. States generally are concerned about the need for earlier recognition of conditions detrimental to children or disruptive of family life. Some States are instituting experimental or demonstration projects to help families improve their situation and increase their capacity for self-care, more independent living, or self-support. To assist States in these developments, consultation was provided on family-centered services, with emphasis on preventive measures such as adequate care and guidance of children, and planning with parents to assure the health and education of their children. Materials were also developed illustrative of the role of the public welfare worker in providing specific, concrete services to improve the home and strengthen family life. States were also given help in evaluating their efforts. Social Security Administration 65 Attention to the problems and needs of the aging was accentuated by the White House Conference on Aging. Bureau staff participated in the Conference held in January 1961 by serving as technical di¬ rectors for the sections on Social Services, and Family Life, and in taking active roles in sections on Medical Care, Income Maintenance, Community Planning, and the Pole and Training of Personnel. They also assisted in the preparation and distribution of Background Papers on Family Life and Social Services ; in providing statistical and other background material used by the delegates; and in drafting some of the Conference reports. Pertinent Conference recommendations were summarized and made available to the States; their implications were also considered in Bureau work planning. Technical assistance was provided to the American Public Welfare Association’s Project on Aging, including the planning and con¬ ducting of institutes on public welfare program planning and staff development in behalf of older persons. The Bureau joined with the APWA, National Committee on Aging, and Family Service Associa¬ tion of America in sponsoring a Seminar on Casework Services for Older People at Arden House in the fall of 1960 for selected staff from public and voluntary agencies. The summary of the Conference has had wide distribution. Bureau staff also continued to serve on committees of the APWA’s Committee on Aging, and the National Council on Aging (formerly the National Committee on Aging). Other efforts in strengthening welfare services included participa¬ tion in planning for a national structure to promote homemaker serv¬ ices, working with a State in preparing a publication on its home¬ maker services in small or rural areas; drafting a document on the public assistance caseworker’s role in services to the ill and disabled; and developing guides for use in the administrative review of State welfare services. Also a listing was made of the location of special studies and numerous experimentations on improving case services and their results, and assistance was provided to several States on adminis¬ trative considerations in establishing specialized casework units and other organizational arrangements for staff providing direct services to individuals. EFFORTS TO IMPROVE STANDARDS OF ASSISTANCE Pamphlets were issued on Establishing Money Amounts for Fuel for Heating , discussing factors to be considered in applying the fuel formula developed by the U.S. Weather Bureau; and State Methods for Determining Need in the Aid to Dependent Children Program , describing how States’ standards and income policies govern need determination in the eligibility process. Both reports were prepared as part of Bureau follow-up on recommendations made in 1960 by 66 Department of Health, Education, and Welfare, 1961 the Advisory Council on Public Assistance. Technical assistance was also provided on request to the Department of Agriculture in their planning for the food stamp plan. Administrative Developments Legislation passed in fiscal 1961 added broad responsibilities to Bureau activities and substantially increased its workload. In addi¬ tion to providing assistance to States in administrative and fiscal changes involved in implementing the new legislation, statistical, financial, and other reporting systems were initiated for operational purposes and for keeping the Secretary, the Commissioner, Congress, and the public informed as to program developments. Federal review of State practice under the new provisions was undertaken to assure that it was in keeping with congressional intent and used methods re¬ quired for proper and efficient administration. The Bureau’s limited resources were stretched to prepare interpre¬ tive materials and correspondence in response to public interest heightened by the controversial nature of some of the social issues emerging in the implementation of the new legislation, and to co¬ operate with other groups, as requested, on special projects. For example, the Department was asked by the Senate Special Committee on Aging to cooperate in a special inquiry addressed to all State agen¬ cies on plans and accomplishments to date in their programs of medical care for the aged and provisions for medical care under old- age assistance.2 Effort was also made to obtain data about the effectiveness of the new legislation. For example, Selected Characteristics , covering financial eligibility and the scope of medical services provided, initially developed for the States with such plans in operation, was kept current as additional States revised or added new programs; and information is being obtained for a more comprehensive publica¬ tion on the characteristics of medical and remedial care provisions of State public assistance plans. Planning was also initiated for evalu¬ ating the experience gained in administering the new provisions as a basis for recommending future improvements. Other assistance was provided to the States on methods of issuing and accounting for payments to suppliers of medical care in behalf of assistance recipients, administration of urban agencies, manual and records management systems, field services, and methods of super¬ vision. To meet increasing interest of States, efforts were intensified in developing caseload standards, including evaluation of work done 2 The Staff Report to the Senate Committee on Agin?, State Action To Implement Medi¬ cal Programs for the Aged, based on their inquiry in March, was issued in June 1961. Social Security Administration 67 in other fields and its applicability to public assistance operations, and preparation of guides for use of States. A management conference was held in San Francisco in November 1900 focused both on im¬ proving services to urban agencies and on methods of organ izat ion and administration. PUBLIC ASSISTANCE STAFF TRAINING The preliminary report, 1960 Survey of Salaries and Working Conditions of Social Welfare Manpower , based on a study made by the Bureau of Labor Statistics, in cooperation with the National Social Welfare Assembly and the Department of Health, Education, and Welfare, reveals the following pertinent data about State and local public assistance personnel : 34,500 persons in executive and social work positions in State and local public welfare agencies primarily on public assistance (a 15-percent increase from 1950 to 1960) ; 13 percent of the supervisory group (an increase from 10 percent in 1950), and slightly more than 1 percent of the casework group (a decrease from 2 percent in 1950), had full professional social work training ; nearly two-fifths of the supervisory group had some graduate social work training , as did 10 percent of the casework group (a decrease from 17 percent in 1950) ; 65 percent of the casework group had an undergraduate degree (an increase from 60 percent in 1950) ; and the 1960 median supervisor’s salary was $5,797 a year, and the median case¬ workers’ salary was $4,338. Salary increases ranged from 60 to 75 percent over the 10-year period with 23 percent reflecting rising living costs. The situation in 1960 represents a slight gain since the first welfare manpower survey was made in 1950, but it also reveals the inadequate preparation of the majority working in social work positions in the public assistance programs : Slightly more than a third have not completed college ; 89 percent of the caseworkers have had no study in any graduate school of social work; 19 out of 20 have not completed graduate professional training (99 percent of the caseworkers and 87 percent of the supervisory staff) ; and there is only 1 caseworker with full professional training for every 23,000 assistance recipients. The limited number of professionally qualified staff administering the public assistance programs is considered by many groups a major obstacle in the provision of more effective services that could help lessen dependency, prevent further deterioration, and mitigate the effect of need on individuals, families, and communities. 68 Department of Health , Education , and Welfare , 1961 With Federal funds paying half the cost, some in-service training is provided by most State agencies, and during the past year about 550 public assistance workers in 39 jurisdictions were on educational leave (4 out of 5 were receiving some Federal or State money to help pay for their training). An Educational Standards Project was established by the Bureau to determine more clearly the scope and level of performance which can reasonably be expected of the worker with a bachelor’s degree. Work undertaken toward this objective has included (1) identifying specif¬ ically the variety of functions which make up the public assistance caseworker’s job, and (2) determining which of these functions a worker with a bachelor’s degree can perform acceptably. Profes¬ sional judgment is being utilized in making tentative decisions, and research designs are being developed to test these judgments. While concentrating first on the job of the caseworker, such determinations will be made subsequently for other jobs. The preparation of a textbook to serve as a guide for in-service training of new public assistance workers was initiated, and plans made for developing appropriate teaching materials on casework con¬ cepts for staff without professional education. Work continued on developing and testing of in-service training materials to help staff improve services provided to the aging. As part of its plan initiated in 1960 to provide short-term training seminars for State agency staff, the second session for State welfare field representatives was held in October and November 1960. In collaboration with the Children’s Bureau, a Handbook of Staff De¬ velopment is being prepared containing suggested standards and guides for State welfare agencies. Wyoming’s training plan for po¬ tential county directors was published in the Bureau’s “How They Do It” series and distributed to State agencies. States were encouraged to extend opportunities for academic train¬ ing under the 50-50 Federal matching provisions for the costs of administration, to develop other methods of improving staff compe¬ tence, and to make more effective utilization of professionally trained staff. Consultation and other resources were also provided to schools of social work and others, as requested, including participation on various committees of the Council on Social Work Education, and on the American Public Welfare Association’s Committee on Social Work Education and Personnel. Cooperative activity was also under¬ taken with other units within the Department on training aspects of areas of mutual concern. The Bureau’s training plans for its Federal employees were both long-range, in relation to program needs; and short-term, in relation to training opportunities appropriate to job duties provided under the Government Employees Training Act. Long-range planning in- Social Security Administration 69 volved full-time outside training of selected staff members to achieve objectives in knowledge essential to program development; short-term planning brought special seminars to Bureau staff, and provided training opportunities for 8 employees in government-sponsored train¬ ing activities, and for 34 employees in non-government facilities. Related Program Activities INCREASED RESPONSIBILITY FOR CIVIL DEFENSE EMERGENCY WELFARE SERVICE PROGRAMS The Emergency Preparedness Order No. 5 signed by the Director of the Office of Civil and Defense Mobilization on January 10, 1961, assigned certain civil defense mobilization functions concerning edu¬ cation and welfare to the Secretary of Health, Education, and Welfare.3 These functions were delegated by the Secretary to the Commissioner of Social Security, and are carried out by the Bureau of Public Assistance, working with the Children’s Bureau. Emphasis during the past year was focused on organization, re¬ cruitment, orientation to emergency welfare services responsibilities, and preparation of national guidance materials to help State welfare departments in developing State-local emergency welfare service pro¬ grams, including training activities. Progress was made in establish¬ ing working relationships with constitutent units in the Department of Health, Education, and Welfare, the Office of Civil and Defense Mobilization, and other Federal departments and agencies having competencies related to emergency welfare services. Arrangements were made for participation of national voluntary welfare and related agencies to facilitate participation by local vol¬ untary agencies in Emergency Welfare Service activities. “Memo¬ randa of Understanding” were completed with 12 national voluntary and related agencies 4 incorporating their role in support of the Government in pre-attack planning and post-attack operations. Negotiations continue with other such agencies. Copies of the com¬ pleted “Memoranda of Understanding” have been distributed through voluntary and public channels. Work was also initiated on a nationwide inventory of welfare man¬ power and other basic welfare resources. Information about these resources will be stored on punchcards or magnetic tape for use by 3 The Order was not rescinded by Executive Order 10952 (dated July 20, 1961) assigning certain civil defense responsibility to the Secretary of the Department of Defense. * American National Red Cross, Child Welfare League of America, Council of Jewish Federations and Welfare Funds, Council on Social Work Education, Family Service Asso¬ ciation of America, National Association of Social Workers, National Catholic Welfare Conference, National Conference of Catholic Charities, National Council of the Churches of Christ in the United States of America, National Travelers Aid Association, The Sal¬ vation Army, and United Community Funds and Councils of America. 70 Department of Health , Education , and Welfare, 1961 the Office of Emergency Planning’s National Resource Evaluation Center in identifying and locating resources still existing after an attack, and in developing estimates of casualties. Identification of the location and number of State and local public assistance offices and personnel has already been completed. The Bureau was also assigned responsibility for developing information about requirements for items relating to body protection and household operations needed for survival. This information also will be used to determine where shortages or surpluses now exist. Progress was made on the development of guidance materials. A document, Emergency Welfare Service — Guidelines and Structure , was released in draft form in March for review and preliminary testing to State and local public welfare agencies, national voluntary agencies, and to State civil defense directors. Fiscal Policies and F ederal- State Agreements , which was issued in April, includes model forms by which States could amend or supersede their 1956 agree¬ ments to accept responsibilities under the expanded emergency welfare service program assigned to D/HEW. (Several States have signed these new agreements to strengthen and support the Emergency Welfare Service programs.) States were encouraged to undertake Emergency Welfare Service training of State and local welfare staff as part of their regular staff development activities. Outline Plan for Development of Emergency Welfare Service Training Materials , a syllabus of source material for training persons who will carry emergency social service respon¬ sibility in local welfare centers, was drafted to facilitate such training. Federal civil defense informational materials also were made available to States, and a bibliography of materials pertinent to training in emergency welfare services was initiated. Plans were developed with OCDM 5 for a coordinated and compre¬ hensive training plan with their Office of Training and Education under which EWS was given responsibility for providing the emer¬ gency welfare services content for courses given at OCD-DOD college and instructor training centers. An orientation document for key individuals in civil defense was developed for use in conjunction with regular and specialized courses. Work is underway on uhow-to-do-it” materials on emergency lodging, emergency feeding, emergency clothing, emergency social services, and emergency welfare registration and inquiry. A hand¬ book, Civil Defense Emergency Planning in Welfare Institutions , is being prepared for the guidance of superintendents of welfare institu¬ tions. Those aspects of emergency social services which deal with the 5 On August 1, 1961, the training and education function was transferred to the new Office of Civil Defense, Department of Defense (OCD-DOD). Social Security Administration 71 care of children, especially those separated from their parents, are being prepared by the Children’s Bureau representative and the emer¬ gency welfare services staff. Staff was assigned to five D/HEW regional offices to facilitate communication between the central office and the States, with plans to staff the remaining regions in 1962. Two regional and three bi- regional meetings were held during the year with representatives of State public welfare agencies; highlights of the guidance materials were presented and discussion was held on the responsibility of public welfare in providing technical leadership in developing and carrying out essential welfare service functions in time of emergency. Policy material was prepared on the use of Federal matching funds by State and local welfare departments for civil defense purposes, and merit system examinations were prepared for State emergency welfare services personnel. An exhibit on emergency welfare serv¬ ices was prepared for use at the National Conference on Social Welfare held in Minneapolis in May. A pilot project on natural disaster training was conducted by the American National Red Cross Disaster Services for emergency welfare services staff to assist in evaluating the adaptability of the course content and its method for training pur¬ poses for a war emergency. EWS staff also participated in the first phase of the 1961 “Operations Alert” exercise. ASSISTANCE PROVIDED TO CUBAN REFUGEES The break in diplomatic relations between Cuba and the United States led to a heavy influx of Cuban refugees in the United States. Although many of the refugees were professionally or technically trained, a large proportion needed assistance of one kind or another — financial aid, employment counseling, retraining, or help in resettle¬ ment and adjustment to American customs. Until February, a large part of the burden of providing care, maintenance, and shelter in the greater Miami area was borne by voluntary agencies and individuals. Recognizing that the problem was one affecting not only Florida but the entire Nation, President Kennedy, in January 1961, assigned responsibility to the Department of Health, Education, and Welfare for coordinating, intensifying, and expediting governmental and private aid to Cuban refugees. Federal funds from the Mutual Security Program were authorized for this activity. With responsibility for developing and administering the program assigned to the Secretary, a 9-point program of assistance was formu¬ lated within 3 weeks, setting a precedent in speed. Working closely with the office of the Commissioner of Social Security, Bureau staff served on the survey team which made the initial reconnaissance visit 72 Department of Health , Education , and Welfare , 1961 to Miami in late January. They also were members of the Depart¬ ment’s task force which developed the basic data for a comprehensive Federal program of health, education, employment, welfare, and re¬ settlement services for needy Cuban refugees. Assistance standards similar to those established for local residents by the Florida State Department of Public Welfare were used in the provision of the basic necessities of life, hospital care, and child welfare services. Surplus food commodities also were made available. To help relieve the Miami area of the impact of its refugee concentration, contracts were made with voluntary agencies for resettlement of refugees in other parts of the country, including help in obtaining jobs and in adjusting to new locations. In February, the Bureau was assigned operating responsibility for temporary financial assistance, hospital care, and related social and welfare services to Cuban refugees. Policies and procedures were developed for use of State welfare agencies in administering this phase of the program as representatives of the Federal Government. Regional and central office staff worked closely in its implementation, and in making plans for the distribution of surplus commodities. Agreements were initiated with the Florida State Department of Public Welfare. In less than a week of intensive planning and re¬ cruiting of a bilingual staff, the State agency was prepared to accept immediate transfer of cases of needy refugees from voluntary agencies in Miami and from the long list of applicants registered at the Cuban Refugee Emergency Center. First payments were made on February 27. A week later some 2,800 adults and 840 children were receiving financial aid. By the end of March, about 3,800 cases in the Miami area had received financial aid ; about 42 percent of them were single-person cases. The average family payment was around $85 a month. Resettlement of refugees through voluntary agencies under contract with the Federal Government averaged about 250 families a month; from November through June, 4,672 refugees were resettled. The cooperation of other States was enlisted to provide help for relocated families who, for various reasons, were unable to maintain themselves. By the end of June approximately 8,700 cases had received assistance under the program in the Miami area. Of the $2,275,000 allotted the Bureau between February 27 and June 30 for assisting Cuban ref¬ ugees, all but $5,000 was used in Florida.6 The speed and effectiveness of the cooperative effort of Federal, State, and local public and voluntary welfare agencies in aiding needy 8 The total amount allotted to the Bureau of Public Assistance included $440,000 for the care of unaccompanied children but, except for fiscal aspects, responsibility for this segment of the program was assigned to the Children’s Bureau. Social Security Administration 73 Cuban refugees is both a tribute and a true test of the strength of the American social welfare structure and its ability to adapt its resources to meet serious emergency problems affecting the well-being of people. ASSISTANCE TO U.S. NATIONALS REPATRIATED FROM OTHER COUNTRIES The Bureau has continued to assist the Department of State in ar¬ ranging for the reception and care of those American nationals and their dependents repatriated from other countries who need special help upon arrival in this country. During the past year, assistance was requested by the Department of State in behalf of 120 cases in¬ cluding 231 individuals from 32 countries. Thirty-nine of these cases involved mental illness. Through the cooperation and help given by public and private welfare agencies, primarily in New York, arrange¬ ments were made for emergency reception service, transportation, hospitalization, and other needed services. Assistance was also provided to needy United States citizens and their dependents who fled to this country from Cuba. Many were without cash resources because they were prevented from taking money out of Cuba. Some had resided there for many years and had lost contact with relatives or friends in this country. With a special au¬ thorization of $30,000 from the President’s Emergency Fund, assist¬ ance was provided to help these repatriates return to the place where they formerly lived, or to join relatives who could assist them in re¬ establishing themselves in the United States. In July 1961 about 140 American families repatriated from Cuba were helped ; about $29,000 of the $30,000 authorized for this purpose was used by Florida, and most of the remaining $1,000 by other States. During the year, the Bureau also developed plans for implementing legislation passed in July 1960, 'when funds are appropriated, to pro¬ vide for reception and hospitalization at Saint Elizabeths Hospital, or elsewhere, of certain repatriated mentally ill United States citizens. The legislation, passed in June 1961, amended title XI of the Social Security Act to provide temporary assistance (through June 30, 1962) to other repatriated U.S. citizens who need help upon arrival in this country. This amendment is an outgrowth of a long period of pro¬ gram development and interdepartmental consideration. INTERNATIONAL ACTIVITIES Cooperative work with the SSA Office of International Activities during the past year included central office planning for and con¬ sultation to foreign visitors, and interpretation of U.S. social welfare programs to individuals and international groups referred by various Government agencies. Bureau regional staff also provided consulta- 626936-62- 6 74 Department of Health, Education, and Welfare, 1961 tion and planned or arranged observation programs in cooperation with State and local public and voluntary welfare agencies for visitors from other countries. Comments were prepared on United Nations’ documents, and suggestions made for social welfare projects to be included in the program financed through the purchase of foreign currencies excess to the normal requirements of the United States in accordance with Public Law 83-480, the Agricultural Trade De¬ velopment and Assistance Act of 1954, as amended. Bureau staff also participated in the annual Seminar for Foreign Service Officers of the Department of State, and in the 10th International Conference of Social Work held in Rome. A Look Ahead Public assistance has played an important role in the social security system in assuring needy people the right to live at a level of minimal decency. To the extent the need for this kind of assurance is con¬ sidered a consequence of a healthy, growing industrial society will the full potential of public welfare measures be utilized in achieving the balanced social and economic development essential to a strong democracy. Although significant gains have been made in the relatively short history of the Federal-State public assistance programs, tremendous forward strides could be made under a fuller utilization of existing legislative provisions. Other gaps in program provisions require legislative change. ASSISTANCE PAYMENTS NOT MEETING “NEED” Although Federal, State, and local governments have substantially increased their expenditures, with rising costs and the shrinking value of the dollar, public assistance payments are not meeting “need” in many instances. Fewer than half the States are fully meeting “need,” judged by standards they themselves have set. (Need is defined here as the gap in income between the total cost of living essentials set by the State and the individual’s resources to meet that cost.) The other States either impose maximums on the monthly amount of assistance any individual or family may receive or meet only a specified proportion of need. In some States, the standards themselves are inadequate. As indicated in chart 4, although the average assistance payment has increased in dollar terms, the increased cost of public assistance in the past 25 years has been due more to monetary inflation than to expansion in the purchasing power of the assistance payment. Social Security Administration 75 CHART 4.— PURCHASING POWER OF AVERAGE OLD-AGE ASSISTANCE PAYMENT. DOLLAR AMOUNTS ARE ADJUSTED FOR CHANGES IN THE BUREAU OF LABOR STATISTICS CONSUMER PRICE INDEX. $67.85 INADEQUATE PROVISION TO MEET MEDICAL CARE COSTS Although recent Federal legislation increased provisions for costs of medical care, and significant gains have already been made in some States, the majority still provide for only limited medical care, and not the broad scope of services needed by most sick people. 76 Department of Health 3 Education , and Welfare , 1961 NEEDY CHILDREN ARE BEING “SHORT-CHANGED” Provisions for needy children are not keeping pace with the in¬ creased child population. As indicated in Chart 2, about the same proportion of the child population received assistance in 1961 as in 1950; program changes during this period have not resulted in a significant relative increase in the proportion of children receiving aid to dependent children. Inequities between provisions for the needy aged and those for dependent children also highlight the restrictive effect of the attitudes of many toward certain causes of dependency of children such as the socially unacceptable behavior of parents. These inequities also compound the damaging effects on children of serious social problems — dependency, family breakdown, illegitimacy, ill health, and disability. Chart 5 highlights facts concerning widespread fallacies as to the impact of illegitimacy on the aid to dependent children program. Only about y2 of 1 'percent of the total child population are illegiti¬ mate and receiving aid to dependent children , even though about 4% percent of the Nation’s child population are illegitimate. NEED FOR PREVENTIVE AND REHABILITATIVE SERVICES BY QUALIFIED STAFF Although the importance of providing other social services by qualified staff is recognized through legislative provisions, many fac¬ tors hinder their effective implementation. Because of staff limitations and heavy workloads (e.g., 1 caseworker with full professional training to every 23,000 assistance recipients — see other detailed information in chart 6), the States’ services plans, in general, realistically define their responsibility by limiting the problems for which services would be provided, limiting services to those required in the determination of eligibility for money payments, or limiting services to those that could be provided only during regu¬ lar contacts for eligibility determination. High caseloads and lack of staff skills also limit the quality of services that can be provided by most agencies, since this kind of help usually needs the knowledge and skill that comes from professional social work training. Provision is also needed for skilled staff services before eligibility for assistance is established, as well as for aiding those who can be helped to utilize their own resources and resources available elsewhere in the community, to prevent their ultimate need for public assistance. These are but some of the areas that could be strengthened if public assistance measures are to be used as a constructive force in dealing with the many social problems facing our productive and growing CHART 5. _ ILLEGITIMATE CHILDREN RECEIVING AID TO DEPENDENT CHILDREN EQUAL i/2 OF 1 PERCENT OF ALL CHIDREN Social Security Administration 77 CHART 6.— PUBLIC ASSISTANCE CASEWORKERS,* EARLY 1960 78 Department of Health , Education , and Welfare , 1961 SOURCE: i960 Survey of Salaries and Working Conditions of Social Welfare Manpower] U.S. Department of Health, Education, And Welfare; Social Security Administration; Bureau of Public Assistance - Chi Idren' svBureau, 1961 * Includes caseworkers working on general assistance under State and local programs. Social Security Administration 79 economy. The extent they are used for prevention and rehabilitation, as well as for sustaining life at a level of minimal decency, will deter¬ mine the degree to which the human resources of the present and future will be conserved. Measures to strengthen the individual and the family are sorely needed today, as never before, to add strength to a nation carrying grave responsibilities of leadership in a world seething with rapid economic and social change. Children’s Bureau By law and tradition, the Children’s Bureau serves the children of the United States and its current program reflects its concern for the well-being of all children. The legal base for its service is contained in two acts, and in dele¬ gations of responsibilities to the Bureau by the Secretary of Health, Education, and Welfare, and by the Commissioner of Social Security. Under its basic act of 1912, as amended, the Bureau is charged to investigate and report “upon all matters pertaining to the welfare of children and child life among all classes of our people.” Under title V of the Social Security Act, 1935, as amended, the Bureau, by delegation, assists the States through technical and finan¬ cial aid, in enhancing and protecting the well-being of many children through child health and welfare services. All of the Bureau’s activities are related and interwoven at many points. They reach out beyond the strict borders of social services and health services into many phases of child life that make for or interfere with the development and well-being and normal growth of children in their families, neighborhoods, and communities. Stemming from these two acts but interwoven into one program are the purposes of the Children’s Bureau today : to assemble facts that will keep the country informed about children and matters adversely affecting their well-being ; to recommend measures that will be effective in advancing the wholesome development of children, and in preventing and treating the ill effects of adverse conditions ; to give technical assistance to citizens and to voluntary and public agencies in improving the conditions of childhood ; and to administer the financial aid that the Federal Government appropriates each year to aid in building the child health and welfare services for children. Overall goals for the Nation’s children and youth were projected by the 1960 White House Conference on Children and Youth as the basis for national action, public and voluntary, Federal, State, and local for the next 10 years. 80 Department of Health , Education, and Welfare, 1961 The overall goal of the Children’s Bureau, reflecting society’s con¬ cern for its children, is that every child in our Nation have an op¬ portunity for healthy growth, for maximum development of his potentials, and for a productive and satisfying living experience. The Bureau’s focus on the whole child and the health and welfare services he requires for his well-being includes seeing him in his family and community setting and encourages the development of a whole gamut of essential services. The problems of children and youth with which our society is dealing make a multiprofessional ap¬ proach essential, as for example, in juvenile delinquency, mental re¬ tardation, adoption, illegitimacy, foster care, day care, homemaker service, and guides to parents on child rearing. Though directed to investigate all matters relating to child life, obviously a small agency such as the Children’s Bureau (at present its staff numbers less than 250) has to be selective. Over the years, children with disadvantages of many kinds have claimed the major attention of the Bureau. The social, environmental, and health haz¬ ards which affect the lives of children and prevent children from reaching their maximum potentials are constantly under review in the Bureau. Goals then must provide for meeting the needs of increased num¬ bers of children, for continuing the present trends toward better cover¬ age of their needs, dealing effectively with new needs as they arise, and for bringing to services for mothers and children the benefits from new developments in research. Changes taking place in patterns of family and community life are affecting lives of children profoundly. Among the most significant of these changes is the trend toward urbanization. Two-thirds of our population now live in metropoli¬ tan areas. At the same time, financially adequate families, especially those with children, are moving out of the central cities into the suburbs. In many instances, our sprawling metropolitan areas over¬ ride State and local governmental boundaries and essential services needed by children and families living in these outlying areas have not been developed. The core city, though having authority and structure, is left with reduced resources to deal with a population which has a high proportion of families presenting health and welfare problems. Family life may be expected to continue to be affected by mobility of our population, by employment changes resulting from automation and mechanization, by rising standards of living, and by a continuing trend toward employment of women outside the home. Admittedly there are still many gaps in the health and welfare services for children and many aspects of these programs require strengthening and improving. Social Security Administration 81 There are large geographic areas without special types of health and medical care that many mothers and children need and without child welfare workers to help children with family and other social problems. Great shortages exist in personnel especially trained for work with children. Too few young people are choosing careers in health and welfare services for children. To conserve children’s abilities and potentialities, the pool of skilled workers must be expanded substantially. Needs are pressing for more research into causes and treatment of children’s physical, emotional, and social problems. Research and demonstration programs are needed to advance the development of sound programs of service to children and their families. New patterns of community services for children are an urgent need in order to serve families and children more expeditiously without debasing quality of service. Many States lack adequate legal protections for children or fail to enforce what protections exist. During fiscal 1961, the attention of the Department, the Bureau, and State and local agencies was focused on the need to take stock and evaluate health and welfare programs for children. Much of the impetus for this reevaluation in State and local agen¬ cies comes from the 1960 White blouse Conference on Children and Youth. Present programs are being critically examined and plans are being made to expand the services to meet the needs of our in¬ creasing population of children who represent the wealth of our hu¬ man resources. The Children’s Bureau in common with these many agencies and organizations was analyzing its own functions and ac¬ tivities against the backdrop of the Conference. Another event lead¬ ing to reevaluation was the advent of the new administration which stimulated Government agencies and the country at large to reex¬ amine health and welfare programs generally. Some Facts and Figures About Parents and Children Births continue to be more than 4 million a year, but the crude birth rate and the rate per thousand women of child bearing age have dropped slightly since the peak of the 1950’s. The estimated number of children under 18 in the resident popula¬ tion of the United States — 50 States and the District of Columbia — in 1960 was 64.2 million, 35.8 percent of the total population. Provisional statistics indicate that the infant mortality rate for 1960, and the early months of 1961 (25.7 per 1,000 live births), has decreased appreciably from the high point of 27.1 per thousand live 82 Department of Health , Education , and Welfare, 1961 births in 1958. Death rates for babies less than 3 days old have changed very little in the past two decades. Nonwhite infants still have a higher mortality rate than white infants, and the excess is now greater than in 1950. Numbers, rates, and ratios of births out of wedlock continue to in¬ crease. The estimated number for 1959 was 221,000. The ratio per 1,000 live births increased over 1958 from 49.6 to 52 and the rate per 1,000 unmarried women age 15-44 years from 21.0 to 22.1. Forty percent of births out of wedlock in 1959 were to mothers under 20 years of age. In March 1960, there were 52.4 million married, divorced, and widowed women in the United States, of which almost one-third, or 17.1 million were in the labor force. Of those in the labor force, 5.1 million, or 42.5 percent, had children between the ages of 6 and 17; 2.9 million, or 20.2 percent, had children under 6. The number of working mothers with children under 18 years increased by about 500,000 since March 1958. In 1960, for the twelfth consecutive year, juvenile court delinquency cases increased over the previous year. The increase for 1960 was 6 percent when traffic cases are excluded. The rise exceeded the 2 percent estimated increase in the child population. Arrest data for 1960 reported by the Federal Bureau of Investigation for 1,614 cities show that the arrests of children under 18 years increased by 9 per¬ cent over 1959. Juvenile arrests in rural areas, tabulated by the Federal Bureau of Investigation for the first time in 1960, increased by 8 percent over 1959. Report to the Congress on Children in Migrant Families A report entitled Children m Migrant Families, prepared by the Children’s Bureau at the request of the Senate Appropriations Com¬ mittee, was transmitted to the Committee by Secretary Flemming on January 19, 1961. The report summarized information about the conditions, prob¬ lems, and unmet needs of children in migrant families. It gave particular attention to their needs for health services and for child welfare services, including day care. In preparing this report, the Bureau drew upon material and studies developed by a wide variety of groups. New information, elicited through a schedule submitted to national voluntary organizations and State public health and wel¬ fare agencies, was correlated with the Bureau’s own experience in working with public, voluntary, and civic agencies and organizations to promote the well-being of children in migrant families. Social Security Administration 83 Although admittedly a wide variety of provisions impinging on or affecting migrant children, such as education, child labor, housing, and sanitation are urgently needed, the recommendations in this report were focused on specific child welfare and child health measures that would contribute to alleviating the adverse conditions of children of migrant workers, especially children of working mothers. The Bu¬ reau recommended a program of immediate action, including: (1) Expansion of child welfare services and maternal and child health services so as to make these services readily available and accessible to migrant children and their families; (2) increased technical assist¬ ance to agencies and organizations engaged in helping migrant chil¬ dren; (3) increased encouragement of and assistance in research and demonstrations relating to new or improved measures for helping migrant children, in the fields of child welfare and child health; (4) increased investigating and reporting activities relating to the develop¬ ment of effective measures for improving the welfare and health of migrant children; and (5) a nationwide information-education cam¬ paign, to acquaint the public with the findings that result from these various activities. President’s Committee on Juvenile Delinquency and Youth Crime On May 11, 1961, President John F. Kennedy established by Execu¬ tive Order the President’s Committee on Juvenile Delinquency and Youth Crime. This Committee is composed of the Attorney General, the Secretary of Labor, and the Secretary of Health, Education, and Welfare. The Executive Order states, “The Committee (1) shall review, eval¬ uate and promote the coordination of the activities of the several departments and agencies of the Federal Government relating to juvenile delinquency and youth crime; (2) shall stimulate experi¬ mentation, innovation and improvement in Federal programs; (3) shall encourage cooperation and the sharing of information between Federal agencies and State, local and private organizations having similar responsibilities and interests; (4) shall make recommendations to the Federal departments and agencies on measures to make more effective the prevention, treatment, and control of juvenile delinquency and youth crime.” Also on the same date, the President announced the appointment of the Attorney General as chairman of the Committee, and the appoint¬ ment of David L. Hackett, a special assistant to the Attorney General, as Executive Director of the Committee. The Bureau cooperated with the Committee and provided a substantial amount of staff service to the Committee during the balance of the fiscal year. 84 Department of Health , Education , and Welfare , 1961 Juvenile Delinquency Legislation On May 11, 1961, President Kennedy transmitted to the Congress an administration proposal for a 5-year program of grants for demon¬ stration and evaluation projects and for training, and of technical assistance services, relating to the prevention and control of juvenile delinquency or youth offenses. As finally passed by both Houses, legislation — which was substantially in accord with the President’s recommendations — authorized appropriations for 3 years, beginning with the fiscal year 1962 for grants and technical assistance services. This legislation was approved by President Kennedy on September 22, 1961, and became P.L. 87-273. A supplemental appropriation bill was enacted which provided an appropriation of $8,200,000, thereby enabling immediate implementation of this new legislation. Appropriations The 1962 appropriation request of the Department provided for funds enabling the Bureau to implement two new programs which were authorized by 1960 legislation enacted in the early part of the 1961 fiscal year. The first piece of this legislation was the Inter¬ national Health Research Act. The second piece was contained in the 1960 amendments to the Social Security Act and was an authorization for a new program of grants for research or demonstration projects in the field of child welfare. As finally approved by the President on September 22, 1961, the 1961 Appropriation Act for the Department not only contained funds for these two new programs, but also contained increases of roughly $5 million apiece in each of the three programs of grants to the States which are administered by the Bureau. F or maternal and child health services and for crippled children’s services, respectively, the amount appropriated for the fiscal year 1962 was $25 million as compared with appropriations of $18,167,000 and $20,000,000, respectively, for the fiscal year 1961. These two appropriations for 1962 thereby reached the full amount authorized under the increased ceilings con¬ tained in the 1960 Amendments to the Social Security Act. With respect to child welfare services, the amount appropriated for grants to the States for 1962 was $18,750,000 as compared with $13,666,000 for 1961. Federal Interdepartmental Committee on Children and Youth The work of the Interdepartmental Committee on Children and Youth during fiscal 1961, its 13th year, featured followup on the 1960 White House Conference on Children and Youth. Member agencies Social Security Administration 85 of the Committee analyzed White House Conference recommendations related to their programs to determine those on which they could take action within the framework of their present authority, obligations, policies, and resources. They found that many of the recommenda¬ tions parallel their ongoing agency activities, and have expanded their services toward achievement of White House Conference objec¬ tives in a number of specific instances. These have included con¬ ferences and workshops sponsored by member agencies or participated in by such agencies, material developed, published, and disseminated, consultation service given, speeches made, and participation in a variety of activities related to White House Conference goals. In carrying forward the purposes of the Wliite House Conference, the Interdepartmental Committee on Children and Youth worked closely with the Special Unit for White House Conference Follow Up established in the Office of the Chief of the Children’s Bureau on November 1, 1960. With the assistance of staff of the Special Unit, the Interdepart¬ mental Committee on Children and Youth completed the revision of its publication, Programs of the Federal Government A ffeeting Chil¬ dren and Youth , originally published in 1951. Four subcommittees of the Interdepartmental Committee were ac¬ tive along the lines of White House Conference recommendations. The Subcommittee on Transition from School to Work developed a report, Outline for a Work and Service Program for Young Persons 16-21 Years of Age. This report has been widely used by various groups concerned with the development of programs to provide for youth opportunity for work, training and service. Many of the features of this report were incorporated in the Administration’s Youth Employment Opportunities Bill. The Subcommittee on Juvenile Delinquency stressed the need for more material in popular form to explain the multiple causes of de¬ linquency, for concrete action on preventive programs and for support of appropriations at all levels for basic programs for children. The Subcommittee on Families and Children of Agricultural Mi¬ grants devoted its attention to studying the proposals for legislation affecting migrant workers and their children under consideration in the Congress. A special subcommittee considered the White House Conference recommendation that a study be made of the effects of the draft law in peacetime on the youth of the Nation and on the Nation. This subcommittee recommended that although such a study was beyond the scope of the Interdepartmental Committee, the Committee might well consider ways of following up on youth rejected for physical and educational reasons. A subcommittee is now at work on proposals along this line. 86 Department of Health , Education , and Welfare , 1961 The Special Unit for White House Conference Follow Up The Special Unit, financed by a special Congressional appropriation for White House Conference follow up, operated until the end of the fiscal year, J une 30. The purpose of the Special Unit was two-fold : (1) to stimulate and reinforce activities by other agencies, organizations, and groups to achieve White House Conference objectives, and (2) to interweave White House Conference philosophy, materials, and forward view¬ point into ongoing substantive programs of the Federal agencies both at Washington headquarters and in regional offices. To carry forward tills purpose, the Special Unit worked along five major lines: (1) regional workshops; (2) consultation service to regional representa¬ tives of Federal agencies, and, upon request, to State Committees for Children and Youth and others; (3) preparation and dissemination of new material; (4) acquisition and distribution of material pre¬ pared by others ; (5) cooperative activities with the Interdepartmental Committee on Children and Youth and the National Committee for Children and Youth. Five special consultants, a principal consultant from the Washing¬ ton office, and four consultants assigned to regional offices in Boston, Dallas, New York, and San Francisco, devoted their major attention to developing methods of assisting State committees for children and youth and to open and broaden channels through which information and services can flow from various Federal agencies and national organizations in the regions to State committees. Partly as a result of this consultation service, several regional inter¬ departmental committees on children and youth may be established ; a meeting of the first one, in San Francisco, is scheduled for September. The National Workshop on Consultation to State Committees, spon¬ sored by the Children’s Bureau in October 1960, was followed in the spring of 1961 by four regional workshops in San Francisco, Chicago, Oklahoma City, and Boston. In cooperation with the Division of Reports, six new publications were projected — Youth Today — Tomorroiv's Adults , The Lebanon Story , and four pamphlets comprising the Headliner Series by Margaret Mead, Walt Kelly, Margaret Hickey, and Edgar Frieden- burg. Three of these were in the process of being printed at the close of the fiscal year. The Special Unit enabled 4 the Interdepartmental Committee on Children and Youth to expand greatly its continuing service in mail¬ ing selected publications to State Committees for Children and Youth. Social Security Administration 87 Some 450 pieces of material from Federal agencies, national organiza¬ tions, and State and local agencies and organizations were supplied to State committees. The Special Unit and the Interdepartmental Committee on Chil¬ dren and Youth also maintained close working relationships with the National Committee for Children and Youth. This included sharing of information, reports, and materials of mutual interest; participa¬ tion by the Executive Director of the National Committee for Chil¬ dren and Youth in the Interdepartmental Committee on Children and Youth meetings; and joint participation in various special conferences. The addition of a consultant for fiscal year 1962 for community planning will enable the Bureau with the assistance of its regional staff to give limited consultation services to State committees and to regional representatives of other Federal agencies in furthering objec¬ tives of the States for children and youth. Programs of the Bureau RESEARCH IN CHILD LIFE The Bureau’s research staff has a major responsibility for carrying out the legislative mandate “to investigate and report upon all matters pertaining to the welfare of children.” In addition to its own studies and cooperating in joint studies, the Bureau stimulates other agencies to undertake research in child life by formulating questions needing study, developing research methods, and providing technical assist¬ ance. Technical Research Some of the technical research studies conducted by the Bureau follow : 1. Cultural Studies of Youth The pilot anthropological study of American youth culture has com¬ pleted its first data-gathering stage in St. Louis. Material from inter¬ views, observation, and questionnaires has been brought back to Washington for analysis. Meanwhile plans are underway for drawing on the experience of the pilot study to design a number of larger studies in other centers. 2. Study of Cystic Fibrosis Studies directed toward determining the incidence and prevalence of cystic fibrosis, conducted in collaboration with the National Office of Vital Statistics and under contract with the Institute of Allergy and Infectious Diseases, continue. The first of these studies, initiated at the end of the calendar year 1958, provided national estimates of the number of hospitalized cases 88 Department of Health, Education, and Welfare, 1961 of cystic fibrosis, the number of discharges, and the number of deaths in hospitals resulting from the disease for each year, 1952 through 1957. A report of findings was published in the September 1, 1959, issue of Public Health Reports. A supplementary final report on demographic characteristics of patients hospitalized because of the disease in 1957 was published in the July 1961 issue of Pediatrics. In order to develop and test procedures for making a national study of the incidence and prevalence of the disease, a pilot survey of cases in Massachusetts, New Hampshire, and Vermont was made. A preliminary analysis of findings revealed that during the period 1952-58, inclusive, approximately 650 children residing in the pilot area were known to have cystic fibrosis. Based on cohorts of children born during each of those years, the incidence rate for the disease was estimated to be about 42 per 100,000 live births or 1 in 2,300. 3. Outcome of Independent Adoptions in Florida This study was conducted jointly by the Florida Department of Welfare and the Children’s Bureau and was financed by the Russell Sage Foundation. Findings concern the kind of homes found for the children, the way the children seem to be getting along, and the characteristics or conditions that seem to be associated with favorable or unfavorable adoption outcomes. The report will be published in book form by the Russell Sage Foundation in 1962. 4. Trends in Infant Mortality Studies on infant mortality trends in the United States since 1950 were carried forward. Three articles were published : “Recent Trends in Infant Mortality in the United States (1950-1957)” in the Feb¬ ruary 1961 issue of the American J ournal of Public Health; an account of current trends in the November-December 1960 issue of Children; and a study of current problems in perinatal and maternal mortality reported in the Bulletin of the National Association of Maternal and Infant Health. Infant mortality in 1960 and in the first quarter of 1961 continued to be elevated about 5 percent above the level expected on the basis of trends established during 1950-57. Currently the postneonatal mortality rate (1-11 months) is showing greater departure from expected levels in 1960 and 1961 than the neonatal rate (under 28 days) . 5. Children Who Receive Services from Public Child Welfare Agencies Published under the above title, this report (Children’s Bureau Publication No. 387) deals with the first study of the characteristics of these children made by the Children’s Bureau since 1945. This was a study of 220,812 children in 45 States. In addition to data on age, sex, color, marital status, and living arrangements, the study Social Security Administration 89 yielded some facts about agency practices and length of service to children. 6. National Survey of Social Welfare Manpower in 1960 A preliminary report has been issued jointly by the Children’s Bureau and the Bureau of Public Assistance on the National Survey of Social Welfare Manpower which the Department conducted in 1960 in cooperation with the National Social Welfare Assembly and the Bureau of Labor Statistics. The Department’s part of this sur¬ vey was planned by a working group set up by the Office of the Sec¬ retary, composed of representatives of the Children’s Bureau, Bureau of Public Assistance, the Office of Vocational Rehabilitation, and the Public Health Service. The Department’s survey covered all social welfare personnel in the Department and in State and local public welfare agencies administering programs for which the Department carries Federal responsibility, except those engaged in vocational rehabilitation. Statistical Reports During the year, the Bureau compiled and published current sta¬ tistical data received from State agencies administering the maternal and child health, crippled children’s and child welfare programs. It also published statistical data on children who receive services from public child welfare agencies, adoptions, the Cuban refugee program, licensed day-care facilities, juvenile court statistics, statistics from public institutions for delinquent children, staff losses in child welfare and family service agencies, recent trends in public child welfare personnel, distribution of personnel and expenditures, and organiza¬ tion for public child welfare services. A number of revisions of the Bureau’s statistical reporting were underway. Research Interpretation As part of its research interpretation, the Bureau completely rewrote and had in press at the end of the fiscal year two of its major publica¬ tions — Your Child from One to Six and Prenatal Care. Bulletins were printed and distributed by the Clearinghouse for Research in Child Life. Consultation and Conferences The research staff worked with or gave consultation requested by State health and welfare departments, national organizations, and universities on such subjects as evaluation of programs, delinquency statistics and studies, statistics and studies in child welfare, planning 626936—62 - 7 90 Department of Health, Education, and Welfare, 1961 health surveys, shortages of research manpower and what to do about it, parent education and family life. A number of conferences on various aspects of research was planned by or participated in by the Children’s Bureau research staff. Notable among these were the following : 1. Conference on Research in Child Welfare At the invitation of the Chief of the Children’s Bureau, 21 experts in research and practice in the field of child welfare met in Washing¬ ton on December 15 and 16, 1960, to discuss various aspects of the recent amendment to Title V of the Social Security Act authorizing grants for research or demonstration projects in child welfare. The discussion included the role of the Children’s Bureau, methods of regional participation, definitions of research and demonstration, grants for research planning and exploratory research, consultation on design, continuity of research, research in an operating agency, research personnel, and priorities in subject matter of research. A report of this conference has been published (Children’s Bureau Publication No. 389, Research in Child Welfare) . 2. Conference on State Research and Statistical Personnel The biennial conference of research and statistical personnel of State departments of public welfare sponsored jointly by the Bureau of Public Assistance and the Children’s Bureau was held in Denver, Colo., September 26-30, 1960. Representatives of 38 States attended. 3. Conference on Juvenile Delinquency Research The Division called a 1-day conference on delinquency research at which Professor D. H. Stott, Department of Psychology, University of Glasgow, presented findings from his research on the prediction of children’s social adjustment in general and of delinquency in j particular. MATERNAL AND CHILD HEALTH SERVICES All States, the District of Columbia, Puerto Rico, the Virgin Is¬ lands, and Guam received Federal funds to improve services for pro¬ moting the health of mothers and children. For the fiscal year 1961, the appropriation for maternal and child health increased to $18,167,000 with $1,000,000 earmarked for services to mentally retarded children. Because the great bulk of infant deaths now occur very early in the first year of life, more than one-third on the first day, approx¬ imately half in the first 3 days, 9 out of 10 in the first 5 months, and because nearly 3 times as many deaths are due to prenatal and natal causes as to postnatal causes, major efforts are being directed toward services to the mother before the birth of her child. Prenatal services I Social Security Administration 91 are being extended especially to population groups where great need for public services exists in both urban and rural communities. The problems of urban mothers and children receiving maternal and child health services are becoming analogous to those living in rural areas : the ratio of services to population is a decreasing one ; services are not always acceptable for cultural, financial, educational, geo¬ graphic, and, no doubt, other reasons. The increasing need for public prenatal services, the lack of progress in preventing prematurity and congenital anomalies, the question of why patients do not seek or accept prenatal care are being explored. Examples of such activities are : the medical-social project for unwed mothers and their babies in Hartford, Conn. ; the studies of deterrents to prenatal care particularly in the young unmarried mother in New York City; the Philadelphia Health Department study of deterrents to utilization of prenatal care services. Cooperative ventures in providing services locally involving health, welfare, and other agencies such as county hospitals are increasing in number. Striking examples are noted in Imperial, Madera, and San Mateo Counties in California, and Thurston County, Wash. Interestingly, in contrast to the prominence of large metropolitan area health problems but probably also part of the changing compo¬ sition of the population in our large cities, as well as the continuing rural and semirural health needs, is the interest in decentralization of services. For example, in Connecticut, plans are underway for small residential institutions for the mentally retarded to be located in various communities throughout the State. In California, local health department clinics for mentally retarded children are being established with consultation from a central clinic in a university center. In Pennsylvania, the first regional maternal and child health director has been appointed to carry out program administration and planning for the State health department’s regional office. The interest in the evaluation of program activities continues. For example, in Washington and California, studies are being designed to determine the effectiveness of children’s services. Oregon is ex¬ ploring methods of evaluating local health services in general. Ari¬ zona has a small study of maternal and child health services underway in one county concerned primarily with efficiency. The rapid increase in the school-age population in both elementary and secondary schools is causing educators and health personnel to review critically their current health programs. Service demands have multiplied not only in amount but in scope and in depth. Problems of emotionally disturbed children are receiving con¬ siderable attention in State maternal and child health programs. In Florida and South Carolina, maternal and child health directors are 92 Department of Health, Education, and Welfare, 1961 participating on committees whose objectives include development of services for these children. In connection with two medical schools, Emory and Vanderbilt Universities, new psychiatric facilities for children have recently been opened. In both, the primary objective is training of professional staff. Agencies are reporting increasing demands for maternal and child health and crippled children’s services in midwestern States because of greater unemployment, which is partly due to the shift of unskilled laborers from rural to urban areas, and also due to continued drought and crop failure. Several States as a result are receiving requests for additional well child conferences and prenatal clinics. Complete maternity care for medically indigent maternity patients in depressed areas of West Virginia has increased from two to seven areas. Two hundred and sixty patients were delivered without a fatality though the majority were considered a high-risk group. Public health nursing service, referrals of infants for well child super¬ vision, consultation by a district nutritionist and by a maternity nursing consultant have been part of the demonstration. The first national meeting on adolescent medicine was held in Denver in April. The 75 participants included pediatricians, inter¬ nists, psychiatrists, nurses, nutritionists, social workers, and psycholo¬ gists, who discussed the needs of the adolescent and how these can be met. The principal concern was the large proportion of youngsters who came to the clinics because of school failure, reading problems, psychosomatic complaints, and other indications of emotional mal- adaptation. During fiscal 1961 the special services rendered to mentally re¬ tarded children and their families by State health departments con¬ tinued to increase. A summary of the report of services provided by 38 States is as follows: Average per Item Number State Applications : Total handled this year _ 6, 485 171 New _ 8, 054 212 Carried over to next year _ 1, 646 43 Cases : Total admitted this year _ 5, 747 151 Total served _ 10, 644 280 Carried over to next year _ 6, 404 169 Age Distribution of I\eic Cases Item Age Group. Number Percent Total1’ _ 5,646 100.0 Under 1 year _ 138 2. 4 1-4 years _ 1, 787 31. 7 5-9 years _ 2, 432 43. 1 10-14 years _ 981 17.4 15-20 years _ — 308 5.4 * Excluded cases tor which age was not stated. Social Security Administration 93 This is a 32-percent increase in new applications and approximately a 20-percent increase in the total number of cases served. The number of children requiring continuing services showed an 80-percent in¬ crease over 1958. Efforts to reach more new cases and to spread the services and consultation available through these services are evident through such new developments as : 1. New mental retardation clinics have been established. — A new consultation and evaluation clinic in the Children’s Hospital of Louis¬ ville, Ky., despite rapid expansion, had 50 children on the waiting list by June. In April, a new mental retardation clinic opened for service in Columbia, S.C. 2. Greater geographic coverage has been achieved. — For example, in Georgia, the special project area had been expanded from three to six counties; in Alabama, the special project is offering consultation and some clinic services statewide. 3. Neio approaches are underway. — The California special project clinical team at Children’s Hospital, Los Angeles, is successfully training local health department staffs to carry out services inde¬ pendently. The Connecticut Community Program for Retarded Children has developed activities of diagnostic and counseling serv¬ ices for young children, community planning and education of pro¬ fessional and lay groups. 4. Critical evaluation of the program is underway in a number of States. — For example, the Maine mental retardation clinic has re¬ ported on its first 3 years of experience. Since the percentage of severely retarded declined each year, the possibility of habilitation is greater. 5. Training activities have been undertaken in many States. — For example, the Florida State Board of Health, through the Dade County Developmental Evaluation Clinic, was host to the first National Work¬ shop for Social Workers in Mental Retardation Projects held at Miami Beach, Fla., April 4r-7, 1961. Some 26 States have set up programs to detect and treat phenyl¬ ketonuria — an inherited metabolic disorder associated with mental retardation. More than 25 infants with this condition were detected the past year and placed under treatment for prevention of mental retardation. For example, Michigan has had a program of casefind¬ ing, diagnosis, and treatment of PKU. In Indiana, legislation has been passed which requires the State Board of Health to carry out an educational program for physicians, nurses, hospitals, and the public on phenylketonuria. To implement this legislation, 10,000 copies of the Children’s Bureau pamphlet Phenylketonuria have been purchased for distribution to all physicians and hospitals. In Region 94 Department of Health, Education, and Welfare, 1961 III, all States except North Carolina have adopted a test for the detection of phenylketonuria in the well-child and pediatric services. 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 programs. 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 surgi¬ cal treatment, and alleviation of unfavorable social and psychological influences which adversely affect the degree and duration of the dis¬ ability. The appropriation for crippled children’s services in fiscal 1961 was $20 million. State crippled children’s programs throughout the country provided care to 339,000 children in 1959 with many different impairments. For every 1,000 children under 21 years of age in the general population, 4.9 children were under care in crippled children’s programs. Children with other than orthopedic defects now constitute the largest group in the crippled children’s programs. Although the actual number of children with orthopedic defects has not declined, each year the States broaden their programs to include other handi¬ capping conditions such as cystic fibrosis, nephrosis, epilepsy, hearing, and certain neurological defects. A new pilot program designed to reduce the high mortality of in¬ fants born with congenital defects incompatible with life has been established at the Children’s Hospital in Philadelphia with special Children’s Bureau funds. The unit has highly trained staff and is patterned after a similar facility in Liverpool, England, which has proved the life-saving value of prompt, experienced surgical correc¬ tion and intensive pre- and post-surgical nursing and medical care. Among the nonorthopedic diagnoses reported by State agencies to the Children’s Bureau, congenital malformations of the circulatory system have shown a striking increase, attributable in large measure to the significant advances in heart surgery in recent years. From a little more than 2,200 children with congenital heart disease served in 1950, the number has grown to 14,450 by the close of the decade. Each year additional States develop their own facilities with spe¬ cially trained personnel for the care of their own children with congenital heart defects. For example, Hawaii engaged a team from the University of Minnesota to review the diagnostic and treatment services available for children with congenital heart disease. The team advised that the diagnostic services needed strengthening but that treatment, including open heart surgery, appeared to be satis- j factor^7. Washington has further developed its program. The Cali- Social Security Administration 95 fornia Regional Congenital Heart Project was adjusted during the year to permit acceptance of children from American Samoa. The trend toward developing services for the multiply handicapped and for children with various handicaps continues. The increasing acceptance of treatment of the child rather than his disorder, the large number of children in mental retardation clinics with additional handicaps, the shortage of trained personnel and funds to staff spe¬ cialized clinics, and the increasing knowledge about neurological disorders contribute to the consolidation of services and the application of multidisciplinary services. The trend is particularly evident in Pennsylvania, Kansas, New York, Maryland, Maine, and Connecticut. While States continue to expand their services in hearing conser¬ vation for the school-age population, there is an especially marked increase in interest in screening procedures for the infant and pre¬ school child. Institutes are being planned to instruct health per¬ sonnel in nonaudiometric screening techniques. Tape recorded tests have been devised to conduct screening at the ages of 3 and 4. For example, the Alaska study of prevention of hearing loss by control of chronic otitis media has been completed. The Alaska speech and hearing consultant has drafted a manual on hearing testing to be used primarily with nurses and will conduct training workshops for them. This is part of the effort to extend service to areas in the State beyond southeast where most of the program activity has been concentrated to date. Colorado and Oregon have produced films for both lay and pro¬ fessional viewers on their hearing conservation work. As part of a hearing conservation project in Hawaii, a study of etiology is under¬ way in Oahu. A statewide clinic for children who have a marked hearing impair¬ ment has been established in Atlanta, Ga., for children referred from the regular crippled children’s clinics; a team of otologist, speech therapist, audiologist, psychologist, and public health nurse partici¬ pate. The clinic is held at the Atlanta Speech School where various services are available on a fee basis. The program plans to develop similar diagnostic clinics in two centers as funds and clinical resources become available. Hearing aids are now being provided on a limited basis. Maryland has initiated a program of dental treatment for physi¬ cally handicapped and mentally retarded children at the Children’s Hospital in Baltimore. Diagnostic treatment, and follow-up services for children on an out-patient as well as in-patient basis are provided. Federal and State staff continue to participate in conferences, work¬ shops, and other forms of training. The following are examples: A biregional institute on Neurologically Handicapping Conditions in Children was sponsored by the University of California, School 96 Department of Health, Education, and Welfare , 1961 of Public Health and the California Department of Public Health, and financed by a special grant from the Children’s Bureau. The Children’s Bureau Division of Health Services, in cooperation with the Georgia Department of Public Health, sponsored a regional meeting of personnel working in crippled children’s programs. A variety of diagnostic and administrative problems was discussed in both general and group sessions. A regional conference on hearing conservation was held in Eliza¬ bethtown, Ky., to provide inservice training for public health nurses and health officers. A biregional conference of maternal and child health and crippled children’s staffs of the 10 States in Regions I and II was held to pro¬ mote professional communication among these geographically selected States. Four service areas were of particular interest : cystic fibrosis, phenylketonuria, multiple handicaps, and hospital consultation. CHILD WELFARE SERVICES Fiscal year 1961 brought new opportunities — and new7 challenges — to the Bureau in the field of child welfare. The authorization for these services was raised to a new high and in addition, new research and demonstration grants in child welfare were authorized by the 1960 amendments to Title V, Part 3. RESEARCH AND DEMONSTRATION PROJECTS IN CHILD WELFARE General plans for the administration of this program have been set up. The 1962 Departmental appropriation bill provides $350,000 for research and demonstration projects in child welfare. As a first step in implementing this program, 21 nationally known research and program consultants met with Children’s Bureau staff in December 1960 to consider areas of child welfare needing research and demonstration, methods of developing worthwhile projects, and priorities to be considered. Priorities were urged in such broad subject matter fields as removal of children from their homes, juvenile delinquency, administration and organization of child welfare services, information to strengthen direct services to children at the local level, and criteria for decision making in services for children. Participants indicated that great weight should be given to studies of the whole process of the “child removed from home.” The group stated its conviction that the Children’s Bureau has a strong role of leadership, stimulation, and coordination in this new program. Social Security Administration 97 FINANCING CHILD WELFARE PROGRAMS Major developments in the Federal grant-in-aid program for child welfare services during fiscal 1961 included : 1. An increase in the appropriation to $13,666,000 — $666,000 over the amount appropriated for the fiscal year 1960. 2. Only a minimum amount left as balance in the Federal Treasury (0.4 percent), with a record set in the amount paid out to the States of the total appropriation. This balance represents an all-time low. 3. The amount of $64,467 released by two States (Guam $52,467 and Idaho $12,000) and reallotted to 23 States on February 6, 1961. The amounts so reallotted ranged from $413.00 (Vermont) to $9,864 (New York). 4. Participation of Guam in the program the last quarter of fiscal 1961. Even though the beginning child welfare program is limited, a start has been made, with promise of future expansion. State legislatures in most areas of the country have provided some increases in appropriations for operating the child welfare program this past year. Most of these State funds continue to be absorbed in meeting the costs of the regular, on-going programs however. PERSONNEL The 1960 study on Salaries and Working Conditions of Social Wel¬ fare Manpower provides current information on the 116,000 workers in welfare, health, rehabilitation and recreation settings in govern¬ mental and voluntary agencies. Personnel in child welfare programs, in which large employment increases over 1950 were recorded, ac¬ counted for 21 percent of these workers. Over the 10-year period, child welfare employees in professional social work positions increased 74 percent. This represented a rise in numbers from 4,163 in 1950 to 7,264 in 1960. The number of employees with full professional education working primarily in public child welfare programs more than doubled in the decade — from 820 in 1950 to 1,881 in 1960. In 1960, 26 percent of all employees had full professional social work education as com¬ pared with 19.7 percent in 1950. But this increase by no means kept abreast of the increase in need for services with the result that the proportion of employees with no graduate education in social work rose to 46.2 percent as contrasted with 39.9 percent in 1950. Salaries rose 68 percent in the decade. In 1960, one caseworker in four received an annual salary of $5,200 or more. Professional social workers are still at a competitive disadvantage with other professional groups in the public services. The need for qualified personnel continues to be acute. Gains have been made in the proportion of trained staff in administrative, con- 98 Department of Health, Education, and Welfare, 1961 sultative, and supervisory positions; a smaller proportion of trained child welfare workers are found at the local level. Stipends for educational leave have been the chief means used by the States of increasing the proportion of supervisors with full pro¬ fessional training. Many States have not been able to provide enough stipends for educational leave to maintain a total staff of trained workers. Expansion of services and coverage in most areas of the country has only been possible through the addition of workers with¬ out training. States are taking steps to face this situation realistically through expanded educational leave and in-service training oppor¬ tunities and efforts to improve the existing bases for staff assignments. LEGISLATION The Children’s Bureau’s new legislative guides on termination of parental rights and responsibilities and the adoption of children were completed during this fiscal year. In preliminary form, copies were distributed to all State welfare departments and to a limited number of voluntary agencies. These guides are now at the Government Printing Office and printed copies will be available shortly. In addition to the September national ad hoc meeting on the new guide material, two legislative workshops were held. One in Atlanta with the six States participating together with representatives of the Office of General Counsel and the Children’s Bureau, the other in San Francisco and participants included representatives from eight States. State representatives included staff members from State attorney general offices. Many of the States and certain voluntary groups are already using these guides in studying, developing, and drafting proposals for improving present adoption laws; for consultation and advisory service to State and local officials, commissions and agency boards; and in developing and improving official State and local manuals in this important area. PROGRAM REVIEW AND ASSESSMENT A number of separate developments seem to forecast a critical “new look” at child welfare and welfare programs in general. These developments have many dimensions and stem from numerous sources. Some of them include : 1. The increasing costs of programs and the inadequacies of State and local public and voluntary financing. 2. No appreciable gain in closing the gap between mounting needs and resources. 3. Critical reappraisal of practices in certain areas which in turn j affect the structure for administering services. Social Security Administration 99 4. A resurgence of interest on the part of citizens in the needs of children, and how they are being met, attributable to the 1960 White House Conference on Children and Youth. 5. Increasing availability of research funds from foundation and governmental sources. 6. Steps to develop, refine, and adapt cost analysis and work meas¬ urement techniques to the social service field. 7. Continuous stimulation given by Bureau specialists and regional staff to attain more positive direction and leadership at the State level. The role of the national voluntary agencies should be recognized here also. Review of current practice this fiscal year has been directed pri¬ marily to foster care. State agencies are trying to improve adminis¬ trative policies and practices, after having some type of review of their children in foster care. CHILD WELFARE SERVICES IN SPECIAL AREAS The continued pressure for providing services to children in foster care and adoption, along with limited staff resources has continued to deter any marked development of basic services for children in their own homes. In those States which have initiated a “suitable home” provision in their ADC programs, child welfare staff have worked closely with the public assistance personnel to encourage policy which will reflect adequate protections for families and children. The relationship between the two programs has been thrown into sharp focus with passage of Federal legislation authorizing a limited program of foster care (effective May 1, 1961-June 30, 1962) for chil¬ dren receiving ADC who are removed from their own homes by a court of competent jurisdiction because they lacked proper care and protection. The amendment also provides that States choosing to come under this program shall use to the maximum extent practicable staff in the child welfare program. A joint Children’s Bureau-Public Assistance committee was ap¬ pointed to work on policies and procedures to implement the new amendment. The draft material was reviewed and discussed by a selected group of State administrators, public assistance and child welfare directors. Regional and central office staff of both Bureaus met together in Washington on June 27-28 to consider the draft ma¬ terial developed by the work group. The protection of children and their families was the paramount concern and interest of everyone participating in these two days of meetings. The plight of young children in families seeking divorce and a growing realization of the importance of strengthening and preserving 100 Department of Health , Education , and Welfare , 1961 family life have spurred greater interest in court counseling services. Both Colorado and Maine have expanded such services after successful demonstration project phases. Establishment of new homemaker programs under public aegis this year has also been primarily on a pilot basis. It is encouraging that where such services have been established, agencies have been success¬ ful in demonstrating their value. For example 25 homemakers are now employed under the public program in nine counties in Colorado. The Knox County, Tenn., homemaker service is looking forward to expansion and the Tennessee department plans to establish a similar service in Memphis. On the national level, the Advisory Committee to the National Com¬ mittee on Homemaker Service on which the Children’s Bureau has a representative, has developed a detailed plan for an ongoing national mechanism for promoting homemaker service. The National Health Council and the National Social Welfare Assembly are the agencies responsible for seeking foundation funds to support a new independent national homemaker organization. Three hundred and ninety thou¬ sand dollars is being requested for a 5-year experimentation period. It is expected that after two years, the amount needed from founda¬ tions will decrease as provision for member agency fees, individual fees, and the like is made. The report of the National Conference on Day Care for Children (November 17-18, 1960) is completed and will be distributed in the early fall of 1961. The report is a compilation of the speeches, discus¬ sion groups, content, and recommendations made by the Conference. All the regions report that much interest was generated “back home” by the Conference. A genuine awakening seems to be occurring in many communities as to the seriousness of the needs in this area. Lack of public financing to underpin the service remains one of the major blocks to any real establishment of day-care programs. “Children of Change,” the film on day care produced jointly by the Pennsylvania State Department of Public Welfare and the Children’s Bureau for the national conference, has been used effectively for com¬ munity group discussions. With few exceptions a regional roundup shows that major State activity this year was devoted to improving licensing functions rather than initiation of new day-care programs by way of facilities. The publication of Deterrents to Early Prenatal Care and Social Services Among Women Pregnant Out of Wedlock , a New York State Department of Social Welfare Study made with the use of Federal child welfare services funds in cooperation with the Com¬ munity Council of Greater New York, was an important development in the area of services to unmarried mothers. This survey is a first Social Security Administration 101 phase of a larger research demonstration project, with the second phase to deal with the development of “reaching out” techniques to overcome the obstacles to obtaining social services and early prenatal care. The major reason for failure for the unmarried mother to use avail¬ able social agencies for guidance and aid is that they see no need to do so. Only one-fifth seek help from a social agency in making plans for the baby. The majority of white mothers expect to place the babies for adoption, but 87 percent of Negro unmarried mothers and 94 percent of unmarried Puerto Rican mothers plan to keep their babies. This and other studies show that social, medical and legal resources for services to unmarried mothers remain inadequate. Although vol¬ untary and public welfare agencies indicate that services are available, they are often limited to community residents and to adoptive services for the baby. Funds are generally lacking for maternity home care, making it possible for individuals to arrange for hospital and medical care in return for adoptive placement of the child. An interesting trend seems to be developing with respect to the “demand” for children for adoption. For the last decade, the trend in the number of adoptions has been steadily upward. The estimated number of adoptions reached 102,000 in 1959. From opposite ends of the country, and from both public and voluntary agencies, information comes of a considerable decrease in the number of adoptive applicants. This decrease in adoptive applicants is being attributed variously to economic trends, world tensions, increased medical knowledge re¬ garding fertility, and public impatience with long waiting lists. One of the natural results of the decrease in applications and an increase in the number of children available for placement lias been a shortening of the waiting period. The improvement of specific adoption services, including adequate- legislation, is seen as an important goal by States. Many States seem to be unaware of the interrelatedness of one service area with other program areas, however, nor do they appear to recognize the im¬ portance of this element in planning for improved services. Very little work has been done, for example, in exploring the situations of children with families, who are given up for adoption. In the field of unprotected adoptions, the California State Depart¬ ment of Social Welfare study of black market operations with particular emphasis on interstate rings, lias driven home how far we are from correcting the root causes for this situation. Practices harm¬ ful to the welfare of children and against sound public policy were revealed, such as traffic in babies ; attorneys and doctors placing chil¬ dren in violation of State laws ; fees ranging from $3,000-$7,500 ; and 102 Department of Health , Education , and Welfare , 1961 advertising for mothers who would release their babies for adoption. Strengthened adoption legislation in at least one State is attributed to the California investigation which was partially financed through Federal child welfare services funds. Greater public awareness of the extent of the need for facilities for mentally retarded children (sparked by parental demands for im¬ proved services) has resulted in expanded residential facilities. In¬ formation available within the past year indicates that the number of State institutions in the United States has increased in the past three years from 99 to 111. The number of known private institutions has more than doubled — from 182 to nearly 400.6 Studies in various States indicate, however, that the addition of new facilities has not served to reduce the size of waiting lists, and that in many instances States have outstripped their fiscal capacity to build more institutions. These developments have focused attention on the need for more selective criteria in admissions, stepped up place¬ ment programs and expanded community services in foster family care, group day care, and other social services. A number of States are reexamining their standards and licensing procedures relative to residential and day-care facilities for retarded children. In the main, these resources are sponsored by commercial interests or parent associations. Many facilities are substandard or in some instances exempt from licensing. This has led to the for¬ mulation of new standards, in which the Bureau’s specialist in this area and some of the regional child welfare representatives have participated. The Bureau has continued to work with national organizations, State agencies, and schools of social work in regard to training and education in mental retardation. In line with the objective of enriching the curriculum of schools of social work with content on mental retardation, emphasis has been given to the development of case records and other teaching material. Immigration of Cuban citizens and unattached children has become a problem of huge proportions in Miami, Florida. At the end of June, there were 657 unaccompanied Cuban children in foster care; 198 in the Miami area and 459 in 33 communities in 19 States. The vast majority of the children were under care of Catholic agencies. The Florida State Department of Public Welfare agreed to be the agent for the Department of Health, Education, and Welfare in plan¬ ning for these children and in the use of Federal funds for their care. The administrative task is a very heavy one and the Florida State Department of Public Welfare has contributed an outstanding serv- Based on statistics collected by the National Institute of Mental Health (1959), and the 1960 American Association on Mental Deficiency Directory. Social Security Administration 103 ice to the Nation in arranging care for these Cuban children. The Children’s Bureau staff from both its central office and regional office has spent considerable time in consultation, both in the early plan¬ ning for the program and now with the States where the children are being placed. The Bureau has participated in the development of the Emergency Welfare Service Program by preparing guides and material on Care and Protection of Children as a part of the Emergency Social Serv¬ ices document. The report by Dunlap and Associates on Protection of Institutionalized Population Against Fall Out , which included five institutions for children, has been reviewed and changes recom¬ mended. Staff is also assisting in the development of a handbook for superintendents of welfare institutions, Civil Defense Emergency Planning in Welfare Institutions , related to the findings of the Dunlap Study. Five Emergency Welfare Services regional or biregional meetings were held ; one purpose of the meetings was to introduce to the States the basic document Emergency Welfare Services — Guidelines and Structure and its Supplement A: Fiscal Policies and Federal-State Agreements. JUVENILE DELINQUENCY SERVICE During the last half of the fiscal year, the Bureau’s staff spent a great deal of time meeting with officials of the President’s Committee on Juvenile Delinquency and Youth Crime, in securing and develop¬ ing information for use by this Committee, and in developing the Administration’s legislative program in the field of juvenile delinquency. Juvenile delinquency continues to be a subject of great public interest and concern. Both Congress and State Legislatures were active. State Legislation The trend to the “get tough” attitude continued. In at least three States, bills were introduced to lower the juvenile court age. In one, a bill was introduced to raise it from 16 years to 18 years. Apparently none of these bills were passed. In at least five States, bills were introduced which would have opened delinquency hearings to the public and permitted publica¬ tions of names ; in two of these jurisdictions, the bills were voted down, in three no action was taken. Legislation imposing a financial liability on parents for the delin¬ quent acts of children was introduced in at least six States; one law was passed but vetoed by the Governor, two laws were not passed, 104 Department of Health , Education , and Welfare , 1961 and as far as it is known, no action was taken on the rest. About one- third of the States have now passed such laws. As far as is known, none of them have been tested as to constitutionality even though serious questions have been raised as to their legality and social desirability. At least five States introduced legislation which would permit the establishment of camp programs ; in four the legislation passed, and in one it was defeated. In at least seven States, considerable activity has taken place with respect to the establishment of a family court. In at least nine juris¬ dictions, legislation was introduced amending the existing juvenile court statutes, some related to the strengthening of probation service and at least three to the improvement of detention facilities and proce¬ dures. Probably the most important State legislation in this area was that passed in California, which brings about major improvements in the juvenile court law. This was the result of a long, careful, well- documented study by the Governor’s Committee on Criminal Justice. The legislation incorporated many of the newer standards advo¬ cated by the Children’s Bureau in Standards for Specialized Courts Dealing with Children and the new revision of the Standard Juvenile Court Act. The Interstate Compact on Juveniles was passed in four more States. This brings the number of States that joined the Compact to 34. Consultation The volume of consultation was greater this fiscal year than in previous years. Consultation in the field, by correspondence, or office interviews was provided in response to 815 requests. All but 12 of the States received some type of consultation service during the year. Over 80 foreign visitors were provided program information and tech¬ nical assistance through office interviews. Program Trends Increased emphasis was evident on the community organization approach to achieve better planned and coordinated programs to re¬ duce juvenile delinquency and to strengthen these programs. The urgent need for coordination and the spread of community organiza¬ tion concepts to achieve this were given impetus by the 1960 White House Conference on Children and Youth. Interest and activity in planning and operating services and pro¬ grams designed wholly or in part to prevent delinquency is very much on the increase. The conviction seems to be growing around the coun¬ try that dollars and human resources channeled into sound preventive work are likely to yield more visible returns in checking the rise of juvenile delinquency. Social Security Administration 105 The problem posed by the mounting number of unemployed out-of¬ school youth was of widespread concern during the past year, par¬ ticularly in terms of the impact on the total delinquency problem. (The present unemployment rate is roughly 5 percent for all age brackets while unemployment among youth under 20 years of age is 20 percent or four times greater.) As the population of sprawling metropolitan areas continues to grow, communities are intensifying their effort to develop an effective planning and coordinating mechanism. Hopefully, this will bring about more interagency teamwork and clarify functions among the many public and private programs concerned with juvenile delinquency. The role of girl gang auxiliaries to hostile, aggressive boy gangs received attention in a number of urban areas. Recent newspaper stories calling attention to the existence of girl gangs have reminded the public that juvenile delinquency is not exclusively a male youth problem. The contribution of citizen leaders to the overall national effort to reduce delinquency is growing. The effectiveness of strong lay com¬ mittees having sound professional guidance in generating legislative and other action in behalf of children continues to be demonstrated in a large number of States and communities. The battle against juvenile delinquency continues to be fought with inadequate weapons. Too few personnel, most of whom are inade¬ quately prepared, have failed to stem the tide. Training courses on the local and State level, short courses at universities and colleges, stipends for students, graduate fellowships, curriculums for various kinds of police training — all represent major needs. Professional staff of juvenile institutions are eager to learn how to introduce group services and apply principles of group living to strengthen institutional treatment programs. There seems to be a tendency among institutional workers to regard group programs as treatment shortcuts to what individual counseling and casework seek to accomplish. Another tendency is to lump group counseling, group therapy, leisure time activities, and group living concepts together without understanding wherein each is different. Several States without a permanent statutory agency responsible for actively coordinating efforts in the youth field moved closer to this. These States are aware of the need for strengthened coordina¬ tion and communication among all agencies and groups working on behalf of children and youth. Significant progress was made toward consolidating the interest in delinquency prevention of official city, metropolitan (city -county) and State youth commissions throughout the country. Sustained consul¬ tation was given by the Bureau’s delinquency staff during the year 626936—62 - S 106 Department of Health , Education , and Welfare , 1961 to the Planning Committee established by these Commissions at their initial joint meeting in Washington in March 1960. This Committee was instructed to draft a statement of purpose together with recom¬ mendations for organization. The name “Conference of Public Youth Agencies” was adopted by the organization to enable youth commissions such as those in Chicago and Detroit with a concern for youth welfare generally as well as delinquency prevention to be active members. The publication Police Contacts with Juveniles: Perspectives and Guidelines is in draft form for reviewing purposes. It is being de¬ veloped in cooperation with the International Association of Chiefs of Police, International Juvenile Officers’ Association, International Association of Women Police, and the National Council on Crime and Delinquency. The trend to building camps continues as a means of providing group care for delinquent boys. Deducing the average length of stay in a training school is a technique employed by many States to cope with the increased size of their institutional populations. Eesearch con¬ tinues to be a growing enterprise in the institutional field. Group counseling and group psychotherapy command considerable attention in the field in spite of the lack of personnel to carry it out. Increasing concern is reflected by the States about the institutional treatment of the older more aggressive youth. Other areas of interest in institu¬ tional problems include the function of halfway houses, adequate staff patterns for various kinds of institutions, how to effect necessary changes in a traditional program without disrupting the complete program, the development of an adequate intake and orientation program, etc. A great number of courts, including judges and probation staff, continue to be concerned about the degree to which they are meeting their responsibilities. Difficulties are encountered in applying theo¬ retical concepts to daily practices because many of the intervening steps — between the theory and daily practice — have not been spelled out; poorly trained court staff; inadequate budget and, in some in¬ stances, a lack of court leadership. Although the clear statements of the definition of detention, the criteria of admission to detention, and the standards of good detention care (contained in the National Council on Crime and Delinquency’s Standards and Guides for Detention Care of Children and Youth) are “accepted” on the surface, practice continues to reflect a wide divergence of thought with respect to the nature of detention care, which children should be detained, and what detention should accom¬ plish. The number of detention homes continues to grow; unfortu¬ nately, the number of children held in jail does not seem to decrease. Social Security Administration 107 International Activities UNITED NATIONS INTERNATIONAL CHILDREN’S FUND This was the first year for the new cycle of meetings — a program session in December and a major policy and program session in June. At the mid- winter session (postponed from December to January because of the prolongation of the General Assembly) allocations were approved for $16 million to 122 projects bringing the total allocation for 1960 to $25,800,000. Increasing aid to Africa was emphasized. An emergency allocation of $286,000 was made to the Congo. The Chief of the Bureau headed the U.S. Delegation to this meeting and the Deputy Chief served as Special Adviser. The main Board session was held in June. From the standpoint of program orientation this meeting was one of the most important in UNICEF’s history. Major changes in policy were before the Board and were accepted in toto with strong support from the U.S. Delegation. Stated simply, instead of having a limited “line” of kinds of aid which countries may have, UNICEF will encourage countries to sur¬ vey their own needs, come up with their priorities for children, and request aid in these terms. The Board had before it surveys of chil¬ dren’s needs produced by the Specialized Agencies of the United Nations and some countries, which pointed up the wide range of prob¬ lems and the different priorities assigned to these in different parts of the world. This survey of needs was the basis for a policy change toward greater flexibility in programs with a wider spectrum from which a country might choose. On the basis of another survey — that of training in UNICEF- assisted projects — the policy of greater assistance to training, espe¬ cially for training facilities within countries was adopted. The kinds of aid UNICEF may extend to training projects have been expanded to include payment of salaries of instructors, stipends, and fellowships for trainees, as well as equipment and supplies. Continuing aid to malaria eradication with the current ceiling of $10 million per year was accepted, after considerable debate as to its appropriateness, as well as concern for the failures of some campaigns. At this session about $10 million was allocated to 83 projects in 51 countries and territories. The only unusual project was a program for the Congo (Leopold¬ ville) to initiate training for unemployed youth and to stimulate self- help at the village level. The Deputy Chief of the Bureau served as Special Adviser on the Delegation; Mr. Fred DelliQuadri, as U.S. Representative. 108 Department of Health , Education, and Welfare, 1961 On the invitation of the Mexican Government, the Program Com¬ mittee of UNICEF spent a week in Mexico preceding the Board meeting, to visit health programs. Seventeen representatives from as many countries spent a very profitable as well as pleasurable time seeing the “grass roots” of UNICEF aid. The Deputy Chief of the Bureau represented the United States. The group saw urban and rural health centers, visited training centers, village sanitation proj¬ ects, malaria eradication programs, hospitals, nurseries, and even homes. The malaria eradication program, assisted by UNICEF, provided opportunity for observation of house spraying in remote rural areas. Land once uninhabitable because of malaria is now free of the disease, and people are now living there. The group visited several of these projects — small communities of about 100 families. The group visited a number of health centers, which are being opened at the rate of one a day in Mexico. UNICEF provides equipment and assists with training of staff for these centers. MATERNAL AND CHILD CARE AND RELATED RESEARCH MISSION TO THE U.S.S.R. In mid-October the mission went to the Soviet Union for a 30-day study of research relating to the perinatal and early infancy periods of life. Sponsored by the National Institute of Neurological Diseases and Blindness, this mission was the first of five in the field of Public Health and the Medical Sciences for the 1960-61 period. The mission was composed of the Deputy Chief of the Bureau, Dr. Stewart Clifford, Chairman, of Children’s Hospital, Boston; Dr. Allan C. Barnes, Professor and Chairman of the Department of Obstetrics and Gynecology, Johns-Hopkins Hospital; Dr. Bernard G. Greenberg, of the University of North Carolina School of Public Health; Dr. Edith L. Potter, Professor of Pathology, University of Chicago; and Dr. Fred S. Rosen, Research Fellow in Medicine at Children’s Hospital in Boston. During their 4-week stay the mission visited about 30 institutions in the four cities of Moscow, Leningrad, Kiev, and Tbilisi. Hospitals, clinics, research institutes, creches, kindergartens, and a collective farm were seen and many research workers interviewed. INTERNATIONAL RESEARCH (FOREIGN CURRENCY PROGRAM) Under authority of sec. 104 (k) of P.L. 480 delegated to the De¬ partment of Health, Education, and Welfare and redelegated by the Secretary to the Commissioner of Social Security, the Children’s Bu¬ reau developed a program and budget proposals for 1962 for projects in its sphere of responsibility. Eight are in maternal and child health in six countries, two are for child welfare in four countries, and one Social Security Administration 109 project is for juvenile delinquency. The program is implemented through the use of excess foreign currencies. The International Health Research Act of 1960 (P.L. 610) which would have provided a somewhat broader program in child health research was not activated. CONSULTANT SERVICES Six professional people recruited by the Children’s Bureau worked abroad under the International Cooperation Administration during the year : three social workers, one physician, and two nurses. One of these nurses, in Guatemala, has participated in the planning of a nationwide maternal and child health program, for which the Chil¬ dren’s Bureau is at present training a doctor and a nurse from Guatemala. TRAINING During the year the Children’s Bureau planned and arranged train¬ ing programs for 64 specialists from 28 countries. Thirty-one of these were physicians, 1 was a dentist; there were 12 nurses, 10 social work¬ ers, 5 police officials, 1 judge, 2 lawyers, and a minister and iiis wife. The large majority of the physicians pursued a clinical specialty, 12 in obstetrics and gynecology and 9 in pediatrics. The others studied in the field of maternal and child health. Ten of the 12 nurses attended a college of nursing and followed a program which emphasized either pediatric or maternity nursing. Four of these are candidates for a degree — two for the B.S. and two for the M.S. Of the 11 trainees who had a primary interest in welfare services for children, 10 were social workers and 1, a lawyer, was an adminis¬ trative official in the French Ministry of Labor and Social Security. Five police officials, a judge, and one lawyer all came to the Bureau for program planning because their major interest was juvenile delinquency. The largest group of trainees (48) was sponsored by ICA and physicians accounted for the majority of these trainees. Both the number of professions represented by the students for whom programs are planned and implemented, and the type of sub¬ specialty training requested, demonstrate the need for continuing ex¬ ploration of academic and observation training resources. For example, two pediatricians wished further specialization — one in the study of tuberculosis in children and one in neurology. Several of the social workers requested that a major part of their observation experi¬ ence be devoted to the organized use of volunteers and programs for training volunteers. The administration of recreation programs not 110 Department of Health , Education , and Welfare , 1961 only in neighborhood houses, but those organized on a city- or county¬ wide basis was an important item for several of the child welfare students. Vietnam sent the largest number of students from a single country — eight, of whom six were physicians — followed by India and Thailand with seven each. Vietnam, Thailand, and India sent 14 of the 81 physicians. The concentration in these countries is probably a re¬ flection of their plan to upgrade the quality of medical schools and medical care. The fact that all three of the Iraqi physicians received degrees in public health in the maternal and child health sequence is indicative of Iraq’s interest in extending maternal and child health services throughout the country. Twenty-eight of the 64 students had programs which lasted 12 months, the most frequent time period, and the programs for 8 were from 6 to 12 months’ duration. Fifteen of the students, all of them sponsored by ICA, either completed or are still following programs of 18 months or longer. Of these, 10 are physicians, all in clinical specialties, 4 are nurses and 1 is a social worker. At the end of the fiscal year, 38 students were continuing their pro¬ grams into the new year. A number of these will return to their homelands in the early fall to be replaced by new students beginning training in the United States. International visitors come to the Bureau from a number of sources, governmental and private, and many come on their own. They are interested in learning about the function and programs of the Bureau or have a specific interest in one or more of the Bureau’s areas of responsibility. During the year, 170 different visitors came from 70 countries. Appointments programmed for visitors ranged from conferences of an hour or two to programs extending several days to nearly two weeks. They sometimes included observation in and around Wash¬ ington or in and around the locale of a regional office. The Bureau’s visitors represent a wide variety of professions, backgrounds and interests. Agencies such as the American Council on Education, the Govern¬ mental Affairs Institute and the National Social Welfare Assembly, which have contracts with the International Educational Exchange Service of the Department of State for training of foreign specialists, sometimes ask for guidance in selecting appropriate resources to which to send their visitors. CONSULTATION TO AMERICAN SPECIALISTS EN ROUTE TO FOREIGN ASSIGNMENTS While the number of American specialists who came to the Bureau for briefing before undertaking foreign assignments is small, it Social Security Administration 111 represents an interesting recognition of the Bureau’s international interests. For example, among these specialists was a social worker going to India to work in a child guidance clinic ; another was a psy¬ chiatric social worker going to Afghanistan, Pakistan and Iran under the auspices of the State Department; another, a USIA Women’s Ac¬ tivities Adviser who came to the Bureau for orientation. TRANSLATIONS Last year a social worker in El Salvador made a Spanish transla¬ tion of the Children’s Bureau pamphlet, Child Caring Institutions , by Martin Gula, but was unable to make arrangements to have it published. The Inter-American Children’s Institute took over the task of editing and publishing the translation titled Internados de Bienestar Infantil and has distributed it through tlie Spanish-speak¬ ing countries. The Instituto San Gabriel Arcangel, a school for mentally retarded children in Lima, Peru, is in the process of translating the Children’s Bureau pamphlet, T he Mentally Retarded Child at Home. OTHER ACTIVITIES Work was done on the development of material for the Peace Corps in relation to services in the fields of child welfare and maternal and child health that might be given abroad by members of the Corps. A publication, The International Activities of the Children) s Bu¬ reau, was written in cooperation with the Division of Reports. Summary Fiscal 1961 brought many new and challenging opportunities to the Children’s Bureau. These were expressed in amendments to title Y of the Social Security Act that raised the authorization of the three grant programs to a new high, authorized new research and demonstration project grants in child welfare, and provided that special project grants in the maternal and child health and crippled children’s programs could be made directly to institutions of higher learning. The recommendations of the 1960 White House Conference on Children and Youth were furnishing the impetus for many State and local agencies to reevaluate what they were doing to meet the needs of children and youth. In concert with these agencies the Children’s Bureau was analyzing its own functions in terms of 10-year goals. The advent of the new administration also was a potent force leading to the general reexamination of health and welfare programs. Fiscal 1961 was a year of steady progress and development for the Children’s Bureau and its programs. 112 Department of Health, Education, and Welfare, 1961 Federal Credit Unions The need for a Federal credit union program that existed in 1934 when the program was established still exists today. Established to provide a source of credit for persons of small means and to stimulate systematic savings, the program continues to promote sound credit and thrift practices among credit union members. The extent to which the program has strengthened family life, raised the standard of living of the members, and increased their self-reliance measures its effectiveness, but these are intangibles that are difficult, if not impossible, to measure. People were faced with financial problems in 1934, and they are faced with similar worries in 1961. An effective credit union program has helped to ameliorate these difficulties for its members in depression times and in times of economic prosperity. During 1960 alone, more than 4 y2 million loans amounting to nearly $3 billion were made to members of Federal credit unions, and the 6.1 million members had savings in their credit unions in excess of $2.3 billion as the year ended. Loans have been made for a vast variety of provident and produc¬ tive purposes. Members have financed a better education for them¬ selves or their children, paid for needed medical, hospital, or dental care, bought livestock and equipment to operate their farms, and used the proceeds of a loan for numerous other necessary or desirable purposes. Other members have used their savings to accomplish these purposes, making a loan unnecessary. Savings have been encouraged in amounts as small as 25 cents, and the bulk of the savings accumu¬ lated in credit unions has come from small amounts set aside regularly. Average savings in Federal credit unions amounted to nearly $400 per member at the end of 1960, and since these savings were accumu¬ lated in small amounts at a time, much of it would have been frittered away had it not been for the existence of a convenient place to save in the credit union. There are at the present time two major gaps in the program. While there are now more than 6 million families participating in the Federal credit union program, potential membership exceeds 11 million. Thus, only slightly more than half — 54 percent at the end of 1960 — of the potential members actually belong to their credit unions. Continuing educational programs are needed to accomplish wider participation in the program, although slow but steady im¬ provement has been noted. Where only 39 percent of the potential members were actually participating in the program at the end of 1950, the proportion grew to 46 percent by the end of 1955, and continued up to 54 percent on December 31, 1960. Credit union service to low income groups is the other area that can and should be expanded. Chartering has been predominantly in factories and other industrial establishments, among workers who Social Security Administration 113 have shifted out of the low income category since the depression days of the 1930’s. Federal credit unions today serve the middle-income group, for the most part. Means to accomplish successful operation of credit unions among low income groups are being explored, and an early solution is anticipated that will make possible the chartering of Federal credit unions for these groups. Moving forward to fill in the gaps already noted and further exten¬ sion of credit union service to millions of our citizens are challenges that will remain with the Bureau far into the future. Growth has been encouraging up to now — it behooves us to do all we can to accelerate that growth. Usurious money lenders continue to take a heavy toll of the worker’s income, and with the continually mount¬ ing pressure on consumers to go into debt, the need for consumer education in the wise use of credit becomes increasingly more impor¬ tant. The expansion in consumer credit has not lessened the need for savings, and continuing stimulation of systematic savings by the mem¬ bers will go far to allay their fears of financial insecurity. Realiza¬ tion of these objectives will aid in stabilizing the credit structure of the United States, and will provide a further market for securities of the United States. Issuance of the 10,000th active Federal credit union charter in March 1961 marked an important milestone in credit union history. In presenting the charter to employees of the Inter- American Develop¬ ment Bank, Secretary Ribicoff said, “This charter has special significance since your credit union now becomes the 10,000th active Federal credit union and a part of a program which since June 26, 1934, has effectively demonstrated that these free enterprise institu¬ tions owned, controlled and managed by their members do render a genuine thrift service to the people of America and other lands as well.” Some 6,300,000 members had accumulated $2V£ billion in savings (shares) in their Federal credit unions as fiscal year 1961 ended. Although savings in Federal credit unions represent only a small frac¬ tion — less than 1 percent — of the total investments of individuals in savings accounts, U.S. Government bonds, and life insurance reserves, an accumulation of this magnitude represents a significant achieve¬ ment in thrift among the members. These savings have been amassed slowly, often in amounts of a dollar or so at a time, and because of this, it is quite likely that very little of this amount would have been saved had credit union facilities not been available. Savings not only benefit the savers, but the borrowers as well, since these savings represent the bulk of the funds available to the credit unions for lending purposes. Stimulated by the 1959 amend¬ ments to the Federal Credit Union Act, borrowings are now at an all-time high. In 1960, Federal credit union lending approached the $3-billion level, and on December 31, 1960, loans outstanding topped the $2-billion mark for the first time. A stepped-up demand for loans, which has outpaced the growth in savings in the past 2 years, 114 Department of Health, Education, and Welfare, 1961 CHART 7. — AVERAGE MEMBERSHIP PER FEDERAL CREDIT UNION AND AVERAGE SHARE HOLDINGS PER MEMBER, DECEMBER 31, 1948-60 Average membership 700 Average shareholdings | Average membership Average shareholdings per member 400 300 - 200 1948 1930 1952 1954 1956 1958 1960 - $400 - $300 $200 $100 has resulted in increased borrowing by credit unions, liquidation of some of their investments, or both, in order to raise cash for lending purposes. Moving up 22 percent over the 1959 level, notes payable in Federal credit unions in 1960 represented 2.7 percent of their total liabilities, the largest proportion in 10 years. Total investments of Federal credit unions fell sharply in 1960, dropping not only below the 1959 level, but below the 1958 amount as well. This was the first year-to-year decline in investments since 1948. In the past 10 years, Federal credit unions have doubled in number, and resources have increased sixfold. Membership has tripled, and shareholdings are now some seven times the amount a decade ago. Communication between the Bureau and the Federal credit unions has been improved during the past year with publication of a new Bulletin. The first issue was sent to all Federal credit unions in March 1961, and numerous credit union officials have sent in favorable comments and many worthwhile suggestions for future issues. The Bulletin keeps officials currently informed on program developments. Social Security Administration 115 Two other major strides in improving communications with Federal credit unions were taken during the fiscal year with completion of a new Handbook for Federal Credit Unions and with the drafting of a new Supervisory Committee Manual. Both of these manuals are scheduled for distribution before the end of 1961. Recognition by the President of the value of self-help cooperatives and credit unions in helping to solve the social and economic problems of other countries gave impetus toward greater participation by the Bureau in international activities. The Bureau is working closely with the ICA Cooperative Review Committee, which is developing plans and policies to assist these self-help cooperatives in other countries of the free world. By continuously streamlining and improving procedures, the Bu¬ reau continues to meet its expenses of operation through fees paid by the Federal credit unions, and without appropriation of general funds. Increasing costs of operations, primarily resulting from periodic pay increases and other benefits for Bureau employees, have been absorbed without a corresponding increase in fees, and the fee schedule established in August 1958 remains unchanged as fiscal year 1961 ended. There were no amendments to the Federal Credit Union Act during the year. Table 1. — Social Security Administration: Funds available and obligations incurred , fiscal years 1961 and 1960 1 [In thousands, data as of June 30, 1961] Total . . __ . . . . . . Funds available 1 2 Obligations incurred 1961 1960 1961 1960 $2, 471, 014 $2, 274, 364 $2, 470, 676 $2, 268, 911 Grants to States . . . . 2, 228, 833 2, 177, 000 2, 084, 000 2, 037, 500 2, 231, 990 2, 180, 466 1, 211, 709 48, 517 704, 108 182, 625 33, 507 51, 524 18, 114 19, 797 13, 613 347 238, 339 659 228, 909 2,677 2, 486 146 3, 462 2, 079, 979 2, 033, 761 1, 157, 523 48, 824 660, 232 167, 182 Public assistance3 . . . . Old-age assistance _ Aid to the blind _ _ _ _ Aid to dependent children _ Aid to the permanently and totally disabled.. Medical assistance for the aged _ ... Maternal and child health and welfare services.. .. Maternal and child health services _ Services for crippled children.. . . . . Child welfare services _ ... Cooperative Research and Demonstration Projects _ Administrative expenses4 _ _ _ _ Office of the Commissioner5 6 _ _ _ _ Bureau of Old-Age and Survivors Insurance8 . . Bureau of Public Assistance _ 51, 833 18. 167 20, 000 13,666 350 241,831 669 232, 200 2, 727 2, 494 150 3, 591 46, 500 17, 500 16,000 13,000 190, 364 613 181, 600 2, 345 2, 300 200 3, 306 46, 218 17, 443 15, 873 12, 902 188, 932 602 180, 476 2,280 2, 278 198 3, 098 Children’s Bureau7.. _ . White House Conference on Children and Youth.. Bureau of Federal Credit Unions. . . . 1 Funds available and obligations reported by administrative agencies. 2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. 3 Includes $3,465,750 used from 1962 appropriation to complete 1961 requirements. 4 Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and all other objects of expenditure. 5 Appropriations by Congress from general revenues accounted for approximately 50 percent of the ad¬ ministrative expenses of the Office of the Commissioner in 1960 and 1961: balance from old-age and survivors insurance trust fund. 6 Administrative costs of the old-age, survivors, and disability insurance program which involved benefit payments of $10,798,000,000 in 1960 and $11,884,000,000 in 1961. Does not include construction costs of new buildings as follows: Funds available: 1960, $7,633,744; 1961, $5,179,585. Obligations incurred: 1960, $2,454,189 1961, $4,212,692. 7 Includes expenses for investigating and reporting on matters pertaining to the welfare of children au¬ thorized by the act of 1912, as well as expenses for administration of grants to States. 116 Department of Health, Education, and Welfare, 1961 Table 2. — Financing social insurance under the Social Security Act: Contri¬ butions collected and trust fund operations , fiscal years 1959—61 [In millions; independently rounded] Item Contributions collected under— Federal Insurance Contributions Act 18 . Federal Unemployment Tax Act1 2 3 4 . State unemployment insurance laws 45 . . Old-age and survivors insurance trust fund: Receipts, total . . . Net appropriations and deposits . Net interest and profits on investments . Expenditures, total _ _ _ Monthly benefits and lump-sum payments . . Transfers under financial interchange with railroad retire¬ ment account 2--_ . - . __ . . . Administration . . . . Assets, end of year . . . . . . Disability insurance trust fund: Receipts, total _ _ _ _ _ _ Net appropriations and deposits . . Transfers from railroad retirement account 8 . Net interest and profit . . . . Expenditures, total . . . Monthly benefits . . . Transfers to railroad retirement account 8 . . Administration . . . . . Assets, end of year.. . . . State accounts in unemployment trust fund: Receipts, total . . . . Deposits 5 * * . . . . . . Interest . . - . . . . . Withdrawals for benefit payments . . . . Assets, end of year... . . . . . 1961 $12, 315 345 2,361 11, 815 11, 293 522 11, 743 11, 185 322 236 20, 900 1,082 1, 022 60 746 704 5 36 2,504 2, 614 2,417 196 3, 558 5, 729 1960 $10, 830 341 2, 165 10, 342 9, 843 500 11,055 10, 270 583 202 20,829 1,061 987 26 48 560 528 32 2, 167 2,351 2,169 182 2, 366 6,673 1959 $8, 460 324 1,675 8, 105 7, 565 540 9, 377 9,049 121 206 21, 541 928 895 33 360 339 21 1, 667 2, 126 1, 946 179 2,797 6,688 1 Contributions on earnings up to and including $4,200 a year in 1958 and $4,800 a year beginning Jan. 1, 1959. Contribution rate paid by employers and employees: 2M percent each beginning Jan. 1, 1957; 2Vi percent each beginning Jan. 1, 1959; 3 percent each beginning Jan. 1, 1960. Contribution rate paid by self- employed: 3% percent beginning Jan. 1, 1957; 3% percent beginning Jan. 1, 1959; 4 14 percent beginning Jan. 1, 1960. Includes deposits by States under voluntary agreements for coverage of State and local employees. Includes deductions to adjust for reimbursements to general funds of the Treasury of the estimated amount of employee taxes subject to refund on wages in excess of wage base. 2 Includes old-age and survivors insurance and, beginning Jan. 1, 1957, disability insurance contributions. 3 Prior to 1957 tax could be paid in quarterly installments by employers of 8 or more; beginning Jan. 31, 1957, tax payable annually on preceding year’s wages by employers of 4 or more. Rate is 3 percent (be¬ ginning Jan. 1, 1961, 3.1 percent) on first $3,000 a year of wages paid to each employee by subject employer. Because of credit offset, permitted for contributions paid under State unemployment insurance laws (or for full contribution if reduced by State experience rating provisions), effective rate of 0.3 percent (beginning Jan. 1, 1961, 0.4 percent) of such wages. 4 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 5 Contributions and deposits by States usually differ slightly, because of time lag in making deposits. Deposits in the State accounts also include loans from the Federal unemployment account of the unemploy¬ ment trust fund and the distribution of Federal tax collections among the States under the Employment Security Administrative Financing Act of 1954. 8 Under the financial interchange with the railroad retirement account the two social security trust funds are to be placed in the financial position in which they would have been had railroad employment always been covered under the Social Security Act. Source: Compiled from Final Statement of Receipts and Expenditures of the United States Government, other Treasury reports, and State agency reports. Social Security Administration 117 Table 3. — Old-age , survivors , and disability insurance: Number of families and beneficiaries receiving benefits and average monthly benefit in current- payment status , by family group, end of December 1960 and December 1959 [In thousands, except for average benefit] Family classification of beneficiaries Dec. 31, 1960 Dec. 31, 1959 Number of families Number of benefici¬ aries Average monthly amount per family Number of families Number of benefici¬ aries Average monthly amount per family Total _ _ _ 10, 959. 6 14, 844. 6 10, 112. 8 13, 703. 9 8, 061. 5 10, 599. 0 7, 525. 6 9, 931. 6 Worker only _ 5, 741. 8 5, 741. 8 $69. 90 5, 320. 7 5, 320. 7 $68. 70 Male _ 2, 921.7 2, 921. 7 79.90 2, 755. 3 2, 755. 3 78.00 Female . . . ... .. . 2, 820. 2 2, 820. 2 59.60 2, 565. 4 2, 565. 4 58.70 Worker and aged wife . . 2, 122. 0 4, 243. 9 123.90 2, 029. 4 4, 058. 8 121.60 Worker and young wife 1 . . . 1.0 2.0 111.00 .8 1.6 118.60 Worker and aged dependent husband. 14.3 28.6 105.50 14.7 29.3 103.60 Worker and 1 or more children .. . 50.2 113.4 119.40 44.8 102.5 118.90 Worker, wife aged 65 or over, and 1 or more children _ _ 22.0 67.4 157.60 13.0 39.9 157. 30 Worker, young wife, and 1 or more children _ . . _ _ _ 109.9 401.2 152. 30 102.1 378.3 151. 70 Worker, husband, and 1 or more chil¬ dren . . . . . .2 .6 115. 70 .2 .5 123. 70 Survivor families _ 2, 442. 8 3, 558. 1 2, 252. 8 3, 312. 0 Aged widow . . „ 1, 527. 3 1, 527. 3 57.70 1, 380. 1 1, 380. 1 56.70 Aged widow and 1 or more children... 14.2 29.2 112. 90 11.4 23.6 111.20 Aged widow and 1 or 2 aged dependent parents . . . . - . .3 .6 131. 00 .1 .3 130.50 Aged dependent widower- . . . 2.0 2.0 54. 10 1.9 1.9 53. 40 Widower and 1 or more children - (J) .1 84. 40 (J) (a) 92.60 Widowed mother only 1 _ 1.4 1.4 64. 20 1.1 1.1 55. 40 Widowed mother1 and 1 aged depen¬ dent parent - - - (>) (J) 173. 70 0 0 0 Widowed mother and 1 child _ 171.9 343.9 131. 70 159.7 319.4 129. 70 Widowed mother and 2 children _ 113.4 340.1 188. 00 106.4 319.2 170. 70 Widowed mother and 3 or more children - - - 113.8 547.6 181. 70 108.2 520.1 178.60 Widowed mother, 1 or more children, and 1 or 2 aged dependent parents... .5 1.8 214. 70 .4 1.6 219. 40 Divorced wife and 1 or more children.. .4 1.0 163. 40 .3 .9 166.80 1 child only... . . . . 296.4 296.4 58.50 282.6 282.6 56.90 2 children . . . . . 106.6 213.2 122.50 110.4 220.8 101.30 3 children... . 38.3 115.0 155. 00 36.1 108.4 129.50 4 or more children _ _ 22.6 102.5 157. 20 21.6 97.1 148.00 1 or more children and 1 or 2 aged de¬ pendent parents . .7 1.5 137.60 .8 1.8 136. 80 1 aged dependent parent _ _ 31.6 31.6 60.90 29.8 29.8 59.60 2 aged dependent parents.. . 1.5 3.0 107. 90 1.7 3.3 104.80 Disabled-worker families _ _ 455.4 687.5 334.4 460.4 Worker only _ _ 356.8 356.8 87.90 275.3 275.3 87.90 Male _ _ 261.3 261.3 91.90 206.3 206.3 91.90 Female _ _ _ 95.5 95.5 76.90 69.0 69.0 76. 10 Worker and aged wife _ _ _ 21.7 43.5 135.60 17.4 34.8 135.90 Worker and young wife 1 _ . .2 .4 143.20 .2 .5 133. 20 Worker and aged dependent husband. .2 .4 120. 70 .2 .3 116.60 Worker and 1 or more children... . 22.0 55.8 154. 40 11.2 28.2 153.90 Worker, wife aged 65 or over, and 1 or more children . . . .1 .3 186. 20 (*) .1 204.00 Worker, young wife and 1 or more chil¬ dren . . . 54.4 230.3 189. 10 30.1 121.1 185. 60 1 Benefits to children were being withheld. * Less than 50. Table 4. — Old-age , survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1961 and amount of benefit payments in fiscal year 1961, by State [In thousands] 118 Department of Health, Education, and Welfare, 1961 Benefit payments in fiscal year 1961 2 Q $703, 995 iriillllllls IlisllllslISlEIs jo t-T eo t* of -f ef gj" i-tHffl t^t-Toco jfTfroTjHOootCtCeq t IS VO Lump-sum death payments $166, 993 2§ ISIIi»sl8"ilIIIlS2llIg3l§| T(N-H^r Monthly benefits $11,017,539 Ss-lsllSsl3l3sllsllsBsilllsll Total $11,888, 527 IS-sllsg§5S|sSll|211isi§g23|| S" s'sfsWlS Monthly benefits in current-payment status, June 30, 1961 s Monthly amount $60, 327 3&°83S9S33SS S3SgiS3S8358S8is -T V co'r-T rfrt -Tof Number 897.7 COCO T)((N(»CCHOHCI5 00 rHlOCOONNlOCC-^NMWNINCON © iISVO Monthly amount $931, 705 IS^SlslSSSS^gSSSlSSIiggggi 3g J-T ofefrn ef i-f co if ?o co rf of *o of eo eo oo rf eo Number 14, 726. 5 0 1-H O5^OHNCOON(NH(NW0OOH^OcOCO^HNOOO«eO r S3|S|S|gSg||gS3S © r-T Total Monthly amount $992, 032 Sg”SS83ia338‘,l313§ilSSS8S38§S of oodjHadjoofec eo co H ” § ^ 2 2 2 ® 2" 2 N" n" ” Number 15, 624. 2 CO-cf CO CO 00 CO OO »0 -H O — 1 r-H CO t~- CM CO OO rl Tj< 05 i-H Tf< o *o (N 05 o $*jm*p*u ^^isSig§si§iisi® © r-T Beneficiary’s State of residence Total . Alabama Alaska.. American Samoa Arizona . . Arkansas _ California . Colorado... . . . . Connecticut. . Delaware _ _ _ District of Columbia. . Florida . . \jreuigia _ Guam _ _ Hawaii. . . . . Idaho.. . . . Illinois . Indiana Iowa . . Kansas _ Kentucky _ _ _ Louisiana Maine . . . . Maryland . . . Massachusetts . . . . Michigan.... Minnesota . . . Mississippi _ Missouri . _ Montana . . . Social Security Administration 119 Sls§IIsllIiSsl§SIISis!S15a5 CO ^-ojCco '-i<^-4<5ff0e0C*5 Total $2, 344, 337, 197 1,604,012 3,742,937 18, 495, 989 42, 438, 769 97, 792, 789 291, 680, 900 362, 366, 707 453, 450, 816 461, 388, 778 383, 134, 100 228, 241, 400 26, 880, 245 6,629,688 27, 309, 095 6, 376, 714 340, 165, 288 2, 361, 782 32, 832, 508 102, 064, 238 5, 223, 762 78, 803, 086 64, 698, 488 27, 818, 811 65, 307, 576 10, 307, 772 46, 734, 185 83, 978, 903 1, 782, 917 22, 397, 549 8, 083, 297 48, 623, 252 19, 349, 593 Total assets $2, 669, 734, 298 1,713,912 4,194,748 20, 993, 286 48, 592, 228 112, 464, 860 333, 761, 414 412, 577, 052 519, 144, 400 526, 363, 850 433, 548, 983 256, 379, 565 30, 788, 166 7, 507, 577 31, 217, 909 7, 123, 484 383, 722, 926 2, 585, 430 37, 709, 973 113, 582, 449 5, 938, 789 90, 734, 509 74, 203, 248 31, 981, 594 73, 967, 059 11, 705, 887 52, 352, 457 94, 208, 433 1, 935, 433 25, 453, 328 9, 051, 573 55, 662, 764 22, 387, 155 Number of members 6,087,378 47, 729 60, 518 185, 352 257, 551 430, 184 949, 402 971, 414 1, 104, 305 989, 108 691, 347 400, 468 78, 137 20, 354 66, 604 22, 419 787, 450 9, 767 83, 875 210, 142 18, 262 216, 261 185, 509 94, 050 107, 153 26, 573 106, 532 186, 587 3, 616 54, 684 26, 171 135, 825 54, 873 Number of credit unions 9, 905 hOOOOJOJNlNOHH cDOiOlNiOCDCOOOOiOCO COiOWCOiOOHNWH ■^NNO^NNOOfflHHNCqiOMNCOOCOHO lONh«5H CT> CO CO CD <© »0 OS OONMO ,-1 O 1-HN HCO (M .-H Asset size and State All credit unions . . . Credit unions with assets of: Less than $5,000 . $5,000-$9,999 . $10,000-$24,999 . . . $25,000-$49,999 . $50,000-$99,999 . . . $100,000-$249,999 _ _ _ $250,000-$499,999 . . . $500,000-$999,999 . . . . . . . $1, 000, 000-$l ,999,999. . . . $2,000,000-$4,999,999 . . . . $5,000,000 and over . . Credit unions located in: Alabama . . . Alaska . . . . . . Arizona . . . . . . Arkansas . . . . California . . . . . . Canal Zone . . . . Colorado. . . . . . Connecticut . . . Delaware . . . . District of Columbia . Florida . . . . . . . Georgia. . . . Hawaii . . . . Idaho _ _ _ _ _ Illinois . . . . Indiana . . . . . . . Iowa _ _ _ _ _ _ Kansas. . . . . . Kentucky... _ _ Louisiana . . . . . Maine . . . . Social Security Administration 129 SSSsIlglglliSIlllllillsSIllliislI SSllfl§'glI5SSiIgllllISElSg|lSg'llS 3SK»2^3S2'-SS9'»”S'SfS'grf"»'rfS3S Si 22 » ISillllgglsSSsligglllSllIIHISllS IsIsllSIlllSlSgssSsSlgillllSgSSSi l?2f^3SSf3-SS‘|'»”Wg‘“>-SSS'§2' S £2 “• 83faagB39S3g3aSS3g8MgB3ggSSaS223 53ii§i3Sg33ggggSili§SiSSSg§gS23g3 Sf^‘S‘2222"'gS'g^»‘2SfS‘S'"^“2‘3g'2‘ a 32 * ISSIIlSiillllsSlISIlllsiiSlSiisii s2|''"2'3sa3”32|‘-rfsaa'|-'^'2223'2 g s‘s *' ISlsIlllsIlalSlsSSIlSlsIllsSillss SS'2aWs2S2|2|a2saS|3“328ES?"S-|§ s SR222!S|SSaS?!?S|3|§S23SSge"8''|3™S Public Health Service Health of the Nation The great problems of providing the best possible health services for all of America’s citizens continue to occupy the attention of the Public Health Service. As new knowledge is developed, its benefits must be made available to the people who need them. While the people of the United States have a high level of health, the higher levels which can be achieved as medical knowledge increases remain as a challenge and a hope for the Nation’s future. The Public Health Service is the Federal agency principally con¬ cerned with protecting and advancing the Nation’s health. In work¬ ing toward this goal, it cooperates with many other health interests, including private medicine and its allied disciplines, local and State public health authorities, voluntary agencies, colleges and universities, and research organizations. Great changes in the health needs of the Nation, since the establish¬ ment of the Public Health Service in 1798, have resulted chiefly from brilliant advances of medical science. These advances have taken place at an accelerating rate. Today, as we begin the decade of the 1960’s, health care of the highest possible quality for all the people of this Nation is no longer an unrealistic dream. From its earliest responsibility of providing medical care for merchant seamen, the Service has added responsibilities for foreign quarantine, the care of a number of groups including American In¬ dians and Alaskan Natives, and the administration of Federal hos¬ pitals for victims of narcotics addiction and leprosy. These programs comprise the Bureau of Medical Services, one of the three major subdivisions of the Public Health Service. Assistance to State and local health departments began with the infectious disease epidemics of the nineteenth and early twentieth centuries. These services have increased and diversified greatly over the years. Through its Bureau of State Services, the Service now administers extensive programs of grants-in-aid to States and communities for many purposes, including the construction of hospitals and other 131 1.— PUBLIC HEALTH SERVICE ORGANIZATION, 1961 132 Department of Health , Education , and Welfare , 1961 Public Health Service 133 health facilities, construction of municipal sewage treatment works, and direct support of State programs in the control of many diseases. Technical assistance, loans of personnel or training of professionals and technicians employed at the State and local level, and research and guidance in public health practices are other means used to aid in public health protection. The National Institutes of Health is the third component of the Public Health Service. Maintaining a wide variety of medical re¬ search projects in its own laboratories, the Institutes also support an extensive research effort in universities and other medical research institutions in this country and abroad. Federal and non-Federal scientists, in partnership, administer this massive attack on the re¬ maining problems of health and disease. The 1960’s hold great promise for the elimination or control of some of the great remaining health problems of man. The next great nationwide health efforts may be expected in two broad areas : the physical environment and comprehensive health care. During the present decade, 1960-70, major national efforts, comparable with the great expansions of medical research and hospitals in the 1950’s, will be required in each of these areas. The former will in¬ volve the development and application of new, more efficient tech¬ niques to measure, evaluate and control natural and artificial factors in the environment which affect health and safety. The latter will involve the development of adequate supplies of well-qualified person¬ nel, appropriate facilities, new and more efficient methods to render comprehensive health services to the American people. To meet these challenges of the immediate future, the Public Health Service has been carrying out a substantial reorganization during the past year, based on the recommendations of a Task Force appointed in 1960 to study the mission and organization of the Service. The most fundamental changes proposed are designed to make the Service’s programs more effective in the development of comprehensive health services, giving special attention to the chronic diseases, and the pro¬ tection of the public against environmental threats such as water pollution, air pollution and radiation. Details of the organizational changes are contained in the reports of the units and programs concerned. The Public Health Service had a change of leadership during 1961 when, on J anuary 30, Dr. Luther L. Terry was appointed by President Kennedy to succeed Dr. Leroy E. Burney as Surgeon General. Dr. Terry is the ninth Surgeon General since that office was created in 1871. 134 Department of Health , Education , and Welfare, 1961 HEALTH RECORD According to National Health Survey studies, the American people experience about 368 million acute health conditions — conditions last¬ ing less than 3 months which involve either medical attention or at least 1 day of restricted activity — in a year, or a little over 2 per person per year. About 47 million persons are injured in a year, or 280 per 1,000 population. In addition, about 72 million Americans (or 41 percent of the population) suffer from one or more chronic conditions. About 1 person in 14, or 13,500,000 in all, has a chronic limitation affecting his major activity; and about 1 in 200 is confined to the house. The average person has about 16 days of restricted activity per year due to illness or injury, of which about 6 days involve bed disability. Persons 17 years of age and over show 5.6 days of work loss per year for these reasons, while school-loss days among children 6-16 years of age average 5.3. In the first half of the past decade, 1951-55, 1 the downward trends of mortality which had generally characterized the preceding 50 years continued. Since 1956, however, death rates have not changed very much, except at ages 15-24 years, where the decline has continued, and at 65 years and over, where the death rate has increased. The infant death rate dropped 9 percent from 28.4 per 1,000 live births in 1951 to 26.0 in 1956, rose in the next two years, and was lower in 1959. The rate in 1960, 25.7 per 1,000 live births, was 1 percent below the 1956 rate. The maternal mortality rate has de¬ clined steadily throughout this period, from 7.5 per 10,000 live births in 1951 to 3.2 in 1960, a drop of 57 percent. The infectious diseases were once the chief causes of death among children. The principal communicable diseases of childhood — scarlet fever, diphtheria, whooping cough, and measles — for which the com¬ bined death rate had declined from about 243 per 100,000 population under 15 years of age in 1900 to 5 in 1950, accounted for 1 death per 100,000 population in this age group in 1960. The death rates for a number of infectious diseases which once affected mortality significantly at all ages have also dropped since 1951. Thus, the death rate for tuberculosis, which was 20.1 per 100,000 population in 1951, was 5.9 in 1960; and the death rate for syphilis, which began its rapid decline in 1939, at 15.0 per 100,000 population, dropped to 4.1 in 1951 and to 1.7 in 1960. The death rate for influenza and pneumonia in 1960 was 36.6 per 1 All vital data are for calendar years. Figures and rates for 1960 are provisional. Deaths per 100,000 population Public Health Service 135 CHART 2. — DEATH RATES, 1930-60 CHART 3. — DEATH RATES FOR THE 10 LEADING CAUSES OF DEATH, 1900 AND 1960 Vascuiar lesions of central nervous Chronic system nephritis All accidents Malignant neoplasms Certain diseases of early Infancy CHART 4. — DEATH RATES FROM CHRONIC DISEASES AND ACUTE INFECTIONS 136 Department of Health, Education, and Welfare, 1961 100,000 population, higher than in any of the previous 11 years. For the first quarter of the year, severe localized outbreaks of respiratory illness were reported throughout most of the country. As a result, the death rate for the first 3 months of 1960 was almost the same as for the first 3 months of 1958, when Asian influenza was prevalent. Mortality from the major chronic diseases has generally remained stable during the past 4 years, with death rates higher than those reported for the previous 5 years. The death rate for cardiovascular- renal diseases was 518.9 in 1960, compared with 513.0 in 1951. The 1960 cancer death rate was 147.4, about the same as the rate in 1956, but substantially higher than the 140.5 rate in 1951. Death rates for suicide have fluctuated within a narrow range since 1951, and rates for homicide have remained practically unchanged since 1955, slightly below the rates reported for 1951-54. The rate Year CHART 5.— POPULATION GROWTH BY AGE GROUPS, 1900 AND 1960 Millions of persons Under age 20 Percent increase 1900 34 I960 69 105 1900 I960 1900 I960 Age 20-64 Age 65 and over CHART 6.— POPULATION OF THE UNITED STATES 65 YEARS OF AGE AND OVER 25 Public Health Service 137 for suicide rises to ages 75-84 years, while the rate for homicide reaches its peak at 25-34 years. Mortality from accidents has de¬ clined since 1951. Death rates for this cause fall to a low in early childhood, and then rise with increasing age. The death rate for motor vehicle accidents was 24.1 per 100,000 population in 1951, and 20.6 in 1960. No clear trend is apparent, but the level of death rates for this cause has been lower in the past 5 years than from 1951 to 1955. The death rate for nonmotor vehicle accidents declined from 38.4 per 100,000 in 1951 to 31.2 in 1960. As the mortality data suggest, life expectancy increased more in the first half than in the last half of the decade 1950-60. The average length of life for the entire population was 68.4 years in 1951, 69.6 years in 1956, and 69.7 years in 1960 — a net gain of about 1.2 percent for the entire period. In 1959, life expectancy by color and sex was as follows: white females, 73.9 years (a 1.2 percent gain over 1951) ; white males, 67.3 years (a 1.0 percent gain) ; non white males 60.9 years (a 1.3 percent gain) ; and nonwhite females, 66.2 years (a 1.5 percent gain). Thus, average length of life increased at a faster rate for women than for men, and for the nonwhite than for the white population. BIRTHS, MARRIAGES, AND DIVORCES In 1960, about 4,247,000 live births were registered, virtually the same number as in 1959. Although the number of births in recent years has remained fairly constant, the crude birth rate — the number of births per 1,000 popula¬ tion — has declined somewhat. The 1960 rate of 23.6 represents a drop of 2.1 percent from the 24.1 rate for 1959, and of 3.7 percent from the 24.5 rate for 1951. All these rates, however, are above any that prevailed from the late 1920’s through 1945, even when the earlier figures are adjusted for underregistration. In 1960, about 1,527,000 marriages were performed, an increase of 2.2 percent over the 1959 figure of 1,494,000. The marriage rate, how¬ ever, remained constant for the 2 years at 8.5 per 1,000 population. The 1951 rate was 10.4. Divorces totaled 395,000 in 1959, as compared with 368,000 in 1958, for an increase of 7.3 percent. The divorce rate was 2.2 per 1,000 population in 1959, 2.1 in 1958, and 2.5 in 1951. Funds and Personnel The total funds available to the Public Health Service in fiscal year 1961 amounted to $1,233.5 million (see table 1, page 233) . Appropria¬ tions and authorizations accounted for about $1,039.6 million of this 626936—62 - 10 138 Department of Health , Education , and Welfare, 1961 amount. The balance was made up of repayments for services given to other agencies and of unobligated balances from previous years. Over 70 percent of the total funds available was allocated to others, in the form of grants to State and local agencies, private institutions, universities, hospitals, and individuals outside the Federal Govern¬ ment. The remainder was used to support the direct responsibilities of the Public Health Service, such as hospital and medical care for legally designated beneficiaries, foreign and interstate quarantine, and Indian health services. At the close of fiscal year 1961, the Public Health Service had a full-time staff of 28,630 (see table 2, page 235) . This number included 1,803 members of the Begular Commissioned Corps, 2,025 members of the Beserve Corps on active duty, 151 of the Commissioned Beserve on temporary training duty, and 24,651 full-time Civil Service per¬ sonnel. Part-time personnel totaled 1,364. National Center for Health Statistics The National Center for Health Statistics was established in August 1960 following the recommendations of the Task Force which studied the mission and organization of the Public Health Service. Objectives in setting up the Center were to bring together the major components of Public Health Service competence in the measurement of the Nation’s health status; to identify significant associations be¬ tween characteristics of the populations and health-related problems ; to stimulate optimal use of technical and methodologic innovations in the collection, processing and analysis of health statistics; to create a resource for technical assistance in statistical data processing; to associate closely the functions of collection, analysis, interpretation and dissemination; to permit expansion of health intelligence pro¬ grams to correlate and interpret data from various sources; and to give better visibility to the national and international leadership of the Public Health Service in vital and health statistics. The Centers contains two divisions: the National Health Survey Division, formerly located in the Division of Public Health Methods ; and the National Vital Statistics Division, formerly entitled the Na¬ tional Office of Vital Statistics, and located in the Bureau of State Services. In addition, the Center includes an Office of Electronic Sys¬ tems and an Office of Health Statistics Analysis. NATIONAL HEALTH SURVEY The National Health Survey is a continuing program which makes studies to determine the extent of illness and disability in the popu¬ lation of the United States and to gather related information. Public Health Service 139 During the year the National Health Survey began the development of its third major data-collection mechanism, the Health Records Survey. Much of the information gathered through this undertaking will come from the records of institutions which provide medical, nursing, or personal care. The first project is a survey of nursing homes and similar places to obtain an estimate of the older persons in these institutions, their demographic characteristics, and their health status. The Health Examination Survey — the first cycle of which consists of a special, standarized health examination given to a representative sample of the adult population — had conducted 15 of the 42 “stands” in its national sample of localities, as of the end of fiscal year 1961. With the acquisition of a second mobile examination center, this Sur¬ vey is moving through the sample localities at the rate of about 20 stands per year. The second cycle of the Survey, in which a sample of the population aged 6 through 17 years will be examined, is now being planned. The Health Interview Survey, now in its fifth year of data collec¬ tion, provided information for eight publications on topics not previ¬ ously reported on by the National Health Survey: arthritis and rheumatism ; diabetes ; hernias ; acute conditions by geographic distri¬ bution; seasonal variations of acute conditions; edentulous persons; health insurance; and distribution and use of hearing aids, wheel chairs, braces, and artificial limbs. Health interview data also became the basis for reports on selected health characteristics of older persons, and selected health characteristics of the population by geographic regions and urban-rural residence and by geographic divisions and large metropolitan areas. In line with its obligation to develop and test new or improved methods, the National Health Survey Division continued a number of methodological studies already underway and initiated several new projects. The latter included a study to develop a method of gathering information on personal health expenditures, and another to evaluate and refine the household interview collection of data on health in¬ surance coverage in the general population. NATIONAL VITAL STATISTICS DIVISION On July 1, 1961, the National Office of Vital Statistics became the National Vital Statistics Division. It collects, tabulates, analyzes, and publishes the official U.S. vital statistics of births, deaths (including fetal deaths) , marriages, and divorces on the basis of transcripts of certificates that are filed with non-Federal registration officials acting under State laws. This Division also constructs the official U.S. life tables and related actuarial tables ; conducts health and social-research 140 Department of Health , Education, and Welfare, 1961 studies based on vital records and on sampling surveys linked to rec¬ ords; conducts research and methodological studies in vital-statistics methods including the technical, administrative, and legal aspects of vital-records registration and administration; and maintains a con¬ tinuing program to improve the quality and usefulness of vital sta¬ tistics through technical assistance and professional training at the Federal, State, local and international levels. National vital data are used in medical, demographic and educa¬ tional research, in social welfare, business and government, and in planning programs in public health and other areas. During the year, the Division and the Bureau of the Census, in co¬ operation with the University of Chicago, began a study of socio¬ economic factors in mortality for 1960. With the approval of State vital statistics offices, the Division selected copies of certificates for deaths occurring from May to August 1960. These records will be matched to the Census of Population data taken as of April 1960 to analyze mortality by the characteristics enumerated for the decedents in the Census when they were still alive. Among surveys that were completed or started during the year were 2 phases of a study of the incidence of cystic fibrosis, a study of radiological exposures of mothers during pregnancy, and a cardio¬ vascular-renal mortality study. Technical help was given for a na¬ tional polio inoculation study. Plans were worked out and initiated so that national marriage and divorce statistics for 1960 will be based for the first time on nationwide samples of marriage and divorce records collected from State and local vital statistics offices. These samples will yield detailed marriage and divorce figures for the United States as a whole, the four regions of the United States, the Marriage Registration Area, and the Divorce Registration Area, as well as for States that participate in the two registration areas. In previous years, detailed marriage and divorce data were available only for reporting registration area States. At the close of the fiscal year, the Marriage Registration Area (es¬ tablished in 1957) contained 35 States and 4 other areas; the Divorce Registration Area (established in 1958) contained 20 States and 1 other area. The Model State Vital Statistics Act (1959 Revision) was enacted in six areas during the fiscal year, and has been adopted in part or is receiving consideration in a number of other areas. The Division cooperated with agencies of the Departments of State, Defense, and Justice, and representatives of State health officers and State vital registrars in arriving at a common ground for improving the birth registration of citizens bom abroad and of alien-adopted children. A committee of the Council of State Governments con- Public Health Service 141 sidered and endorsed the actions that were taken by the cooperating group, and recommended repeal of conflicting State laws. OFFICE OF ELECTRONIC SYSTEMS Established toward the close of the fiscal year, the Office of Elec¬ tronic Systems has been engaged in the planning, site preparation, staffing, training, and programming activities incident to installation of computer facilities. OFFICE OF HEALTH STATISTICS ANALYSIS This Office was also constituted during the latter part of the fiscal year. The Office will : study and interpret health and vital statistics to assess the health status of the population; develop measures and indexes of health; study problems in disease classification and coor¬ dinate national proposals for revision of the International Classifica¬ tion of Diseases; and act as secretariat for the U.S. National Com¬ mittee on Vital and Health Statistics in its program to promote technical developments in the field of vital and health statistics. National Library of Medicine The National Library of Medicine continues to provide service to the world medical community through published bibliographical guides, an extensive interlibrary loan program, reader services, and reference research assistance. Its conventional systems for the organ¬ ization, storage, retrieval, and dissemination of information are be¬ coming severely taxed with the acceleration of medical research and the resulting increasing amount of scientific publications. As a consequence, the Library has responded by developing two new pro¬ grams for the improvement of medical communication services. Work started in 1961 on a 2-year program for the design and testing of an electronic data processing system to improve the Library’s capacity to store, retrieve, and disseminate information useful to workers in medicine and public health. Termed MEDLARS (Medi¬ cal Literature Analysis and Retrieval System) , the new system should improve the Library’s responsiveness to the current and continuing needs of multiple research groups, reduce the duplicative effort now involved in literature screening, offer more prompt and more efficient literature reference services, and enlarge, improve, and speed publi¬ cation of the Index Medicus. In addition, plans were made for an extramural program utilizing grant and contract mechanisms. This program is designed to support traditional publication media, strengthen services and resources of medical libraries, and encourage research and development in new and improved medical communication systems. 142 Department of Health , Education , and Welfare , 1961 BOARD OF REGENTS The Board of Kegents met on November 5, 1960, and April 7, 1961. At the November meeting the Board received the Director’s report on the status of the Library, and discussed the development of extra¬ mural programs. At the April meeting the Medical Literature Analysis and Ketrieval System project and Library program and budget plans for fiscal year 1963 were presented and approved. NEW BUILDING The new building was 80 percent complete at the end of the year, and planning was underway for dedication ceremonies on December 14-15, 1961. In anticipation of increasingly heavy work loads in the reference and interlibrary loan area, plans were completed for rearrangement of the collections and the application of mobile micro¬ photographic equipment in the photoduplication process to facilitate user services when the new building is occupied. PROGRAM STATISTICS In fiscal year 1961 the Library acquired 16,951 books, 69,968 serial pieces, and added 1,336 new serial titles, increasing its collections to 1,066,068 items. The History of Medicine collection was increased by 288 old and rare volumes. The staff cataloged 27,186 titles, and 813 pictures were added to the art collection. There were 152,768 volumes circulated, and 10,090 reference questions were answered. Main entries published in the National Library of Medicine Catalog totaled 18,219. The Index Medicus published 130,000 items from 1,775 journal titles. Interlibrary loan requests increased to 109,258 from the prior year experience of 95,595. Microfilm production amounted to 2,775,552 pages of which 689,954 pages were for preserva¬ tion purposes and 2,085,598 pages for interlibrary loan. PUBLIC HEALTH METHODS The Division of Public Health Methods provides staff services to the Surgeon General, develops and conducts research studies of health and related problems in the population, and participates in planning public health activities to meet current and foreseeable needs. The Division edits and publishes Public Health Reports , the official journal of the Public Health Service in public health practice and administration. MANPOWER AND MEDICAL EDUCATION Guides for the planning and construction of new medical schools were developed in cooperation with the Division of Hospital and Medical Facilities and the Ad Hoc Committee on Medical School Public Health Service 143 Architecture of the Association of American Medical Colleges and the American Medical Association. One volume, “Medical School Facilities : Planning Considerations,” examines the role and responsi¬ bilities of the medical school and the composition of its faculty and curriculum, summarizes general architectural requirements, and pre¬ sents cost estimates and elements in planning. The companion vol¬ ume, “Medical School Facilities: Planning Considerations and Archi¬ tectural Guide,” presents the same background material, but deals technically in architectural and engineering terms with the amount and type of space needed for the various medical school activities. The eleventh in the series of health manpower source books, pub¬ lished during the year, presents basic data on medical school alumni as of mid-1959. The data include State of practice, type of practice, and full-time specialization for all graduates (living in 1959) of each of the 78 active 4-year medical schools in the United States, by year of graduation. Relationship between State of practice and State where medical school was attended is also shown. The baccalaureate origins of 1950-59 medical graduates were studied to find out which and what kinds of colleges have been im¬ portant in preparing medical students. The study, to appear shortly as Public Health Monograph No. 66 , shows the relationship between the proportion of graduates who became physicians and such characteristics of the undergraduate college as type of program, administrative control, tuition, and location. A survey of 1950 medical school graduates, conducted in cooperation with the Council on Medical Education and Hospitals of the American Medical Association, relates current data to earlier data to show trends in medical practice. Type and method of practice, location of practice, place of residence before medical school, and graduate training for this group of physicians are reported. A nationwide survey of social welfare manpower as of 1960 was conducted jointly with the Bureau of Labor Statistics of the Depart¬ ment of Labor, the National Social Welfare Assembly, and the Social Security Administration. Detailed analysis of employment characteristics, levels of education, and annual salaries for the 11,700 medical and psychiatric social workers included in the survey is underway. WORK IN OTHER FIELDS The editing of a comprehensive textbook on administration of community health services, sponsored by the International City Managers’ Association and prepared in consultation with a special advisory committee of the American Public Health Association, was completed for publication. The book consists of 26 chapters by 144 Department of Health , Education , and Welfare , 1961 authorities in various phases of community health services. It is intended to serve chief administrators and health officers in cities and counties as a guide to public health policies, problems, and administrative methods. Additional reports and studies published or scheduled for publica¬ tion during the year include the eighth listing of the Clearinghouse on Morbidity Projects; an article analyzing health needs of the aged and current proposals for meeting these needs ; a chapter on current meth¬ ods of financing hospital care for a book on hospital administration ; the first study for the United States on a national basis of work loss due to illness in selected occupations and industries; a study of the causes of death responsible for recent increases in sex mortality differ¬ entials in the United States; an epidemiological diet study in North Dakota ; an article on illness in the United States as estimated from the Monthly Report on the Labor Force; and a paper on death rates for coronary heart disease in metropolitan and other areas. In connection with a study of medical group practice in the United States, three preliminary papers and a directory of medical groups practicing in 1959 have been published. A comprehensive report on the study is in preparation. Other projects underway include a survey of medical and health resources in the Cleveland metropolitan area; analysis of factors affecting the use and effectiveness of medical care in the absence of major financial barriers to care ; a study of the undergraduates origins of 1950-59 medical graduates of individual medical schools; and preparation of a revised directory of homemaker services. The Division provided staff services for a committee on medical care of the National Advisory Health Council and other technical assistance and consultation to congressional committees and to State, regional, and professional organizations. Division of International Health The Division of International Health arranges for Public Health Service participation and official United States representation in in¬ ternational health organizations, particularly the World Health Organization (WHO) and the Pan American Health Organization (PAHO) ; provides program and policy guidance to the Department of State on international health matters ; gives technical advice to the International Cooperation Administration (ICA) and assigns tech¬ nical personnel to its overseas missions. It is the responsibility of the Division to negotiate with the Soviet Ministry of Health for exchanges of scientists under the U.S.-U.S.S.R. exchange agreement and, in cooperation with the National Institutes of Health and research Public Health Service 145 facilities outside the government, to plan itineraries of visiting Soviet delegations or individual scientists. The Division develops studies of health conditions and resources in various countries of the world and arranges for widespread circulation of technical publications of inter¬ national health organizations to interested groups in the United States. During the year, the Division arranged for the official United States Delegations to the 14th World Health Assembly in New Delhi in February 1961, the 12th Meeting of the Directing Council of the Pan American Health Organization, Washington, October 1960, and the 43d Meeting of that Organization’s Executive Committee in Washington in May 1961. The Division, in consultation with the Department of State, developed official United States policy on topics discussed at these meetings, including the global malaria eradication campaign, intensified international medical research program, public health aspects of ionizing radiation, and worldwide community water supply program. The Chief of the Division was appointed by the President of the United States to be the U.S. Member on the WHO Executive Board and the Assistant Chief was appointed U.S. Member on the PAHO Executive Committee. In addition, an officer of the Division served as Alternate United States Commissioner on the South Pacific Com¬ mission, a consultative body composed of representatives of the six metropolitan governments administering territories in the South Pacific area. The Commission’s purpose is to encourage and strengthen international cooperation in promoting the economic and social welfare and advancement of the South Pacific peoples. The Division also acted in an advisory capacity with respect to health-related matters which came before meetings of other interna¬ tional organizations, such as the Food and Agriculture Organization, United Nations Children’s Fund, and the International Labor Organization. Public Health Service officers also served international organiza¬ tions as members of WHO expert panels or as short-term consultants to WHO or PAHO. For example, approximately 80 service officers are members of WHO panels in 38 health specialties. The Division assisted the Office of Public Health, ICA, in preparing a series of 10-year health plans for Africa, including plans for the eradication of smallpox and malaria and for control of trachoma, yaws, and treponematosis. More than 100 Public Health Service officers served with ICA overseas missions during the year. The Division also worked with the U.S. Peace Corps in arranging for assignment of medical officers to serve either as medical advisors in the Peace Corps headquarters or to provide medical care for volun- 146 Department of Health, Education, and Welfare, 1961 teers at project sites. In this connection, four medical officers and three civil service employees from the Service were on duty at the Peace Corps in Washington during the latter half of the year and one of the medical officers made a trip to Tanganyika to survey health and medi¬ cal care facilities in preparation for a Peace Corps project in that country. Negotiations under the U.S.-U.S.S.B agreement resulted in the exchange of 3 delegations from each country for a period of 30 days. The U.S. delegations, comprising 17 scientists, were in the fields of metabolic diseases, maternal and child care, and infectious diseases. The three Soviet delegations, with a total of 15 scientists, were in industrial medicine and hygiene, cardiovascular diseases, and oncol¬ ogy. In addition to the exchange of missions, the program brought five Soviet cancer specialists to the United States for a cancer meeting; sent six U.S. heart specialists to a joint heart meeting in Moscow; and assigned a National Cancer Institute scientist to spend 6 months in research at the Institute of Experimental Pathology and Therapy of Cancer at the Academy of Science in Moscow. The Division assisted in preparation and staffing of an exhibit on health and medicine in the United States at the First International Health Exhibition, sponsored by the Government of Italy and held in Pome from November 10, 1960 to January 8, 1961. Studies of health conditions and resources in the Philippines, Venezuela, Egypt, Guatemala, and El Salvador were compiled from published material during the year, bringing to 26 the number of such studies completed by the Division. One function which has increased in scope in recent years is the extensive distribution of a variety of technical publications of the World Health Organization, Pan American Health Organization, and South Pacific Commission. During fiscal year 1961, the Division distributed more than 7,500 such publications on a complimentary basis throughout this country. Division of Health Mobilization The health mobilization program of the Public Health Service is intended to carry out Federal responsibilities for health services under the national plan for civil defense and defense mobilization. The objective is to meet the health needs of the civilian population in the event of a national emergency. In July 1960, the Division of Health Mobilization, which is responsible for administering this program, was transferred from the Bureau of State Services to the Office of the Surgeon General. During the year, work was continued on plans for an emergency health service which would serve as the health arm of the Federal Public Health Service 147 emergency civilian government in a national disaster. This service combines personnel of the Public Health Service, Food and Drug Ad¬ ministration, Office of Vocational Rehabilitation, medical personnel from the Children’s Bureau, and personnel from the Veterans Admin¬ istration and other Federal agencies with health responsibilities. De¬ lineation of organization and functions neared completion and key positions were staffed. Processes were continued to develop data on calculating potential bomb damage ; providing maximum facility protection ; computing re¬ quirements for community medical supplies and equipment ; analyzing the available resources ; inventorying holdings of survival items. Effective October 1, 1960, management of the national emergency medical stockpile was tranferred to the Public Health Service from the Office of Civil and Defense Mobilization. The stockpile includes some $169 million in equipment and supplies, including 1,930 civil defense emergency hospitals. Most of these hospitals are in strategic non-target locations throughout the country and the other inventories are stored at 34 different warehouse facilities. Four national training courses were prepared and presented on the health mobilization aspects of civil defense. Assistance was given to the presentation of 4 similar courses sponsored by the health depart¬ ments in 4 States. The division also aided the States in conducting training exercises in the setup and operation of civil defense emer¬ gency hospitals. Staff assigned to Public Health Service Regional Offices worked closely with State health organizations to aid in devel¬ oping community health capabilities for emergencies. A research project was completed under contract from the Office of Civil and Defense Mobilization on what a person needs to know to survive a national disaster and meet his own health needs if deprived of a physician’s services. Working in cooperation with the American Medical Association, a medical self-help training course including an instruction kit, was developed and tested ; and a reference manual for use by householders, Family Guide — Emergency Health Care , was completed. Other research completed includes development of (1) scale models of civil defense emergency hospitals; (2) plans for a prototype mutual aid water supply; (3) methods of mobilizing and managing health manpower in a national emergency; and surveys of (1) water utilities and sewage utilities; (2) medical supplies on drug racks in grocery stores and warehouses. Projects in progress but not completed during the fiscal year were (1) creation of an austere medical care procedures manual to be used as a guide in training all health personnel ; (2) survey of current avail¬ ability of medical survival items in private physicians’ offices. 148 Department of Health , Education, and Welfare, 1961 Bureau of State Services This Bureau was vitally affected by the decision to reorganize the Public Health Service so that greater emphasis could be put upon the two major health problems of today: how to build comprehensive health care programs and how to safeguard the environment against hazardous pollutants. Because the solution to both problems depends primarily upon State and local actions, the challenge to this Bureau was how to improve its services to States and community health agencies. As a first step in meeting this challenge, the Bureau has strengthened its own administrative and program staffs in both the environmental and the community health fields and has regrouped its Divisions to assure a tighter coordination of all activities in each of these two major areas. The Robert A. Taft Sanitary Engineering Center, formerly a unit of one of the divisions, was brought directly under Bureau adminis¬ tration. This center conducts research, gives technical training and assists States and communities with problems of water and air pol¬ lution, radiological health and milk and food sanitation. Its activi¬ ties are reported under the divisions it services. The reorganization of the Bureau program is described in the fol¬ lowing division reports. Division of Community Health Practice Established February 1, 1961, this new Division supersedes the former Division of General Health Services. The year’s activities included the coordination and management of $274 million appro¬ priated for grants-in-aid and $2 million for training professional public health personnel. Technical assistance and consultation were provided throughout the country on State and community health programs and field research, health programs for schools and migrant workers, health education, and planning for professional training, in¬ cluding the education programs scheduled in the United States for foreign students and visitors from 89 nations. The Arctic Health Research Center, which does basic research on health problems in low- temperature areas, was transferred at year’s end from this Division to the Bureau’s environmental health administration. A new activity was added: the administration of a special grant of $86,320, transferred from the President’s contingency fund, to en¬ able Florida and Dade County to set up comprehensive health services for 25,000 to 50,000 Cuban refugees. Included were diagnostic screen¬ ing, dental and medical care, hospitalization, and other needed services and clinics in which Cuban medical personnel assisted county health personnel. Public Health Service 149 GRANTS MANAGEMENT For fiscal year 1961, a total of $274,100,000 was available for grants- in-aid to States and territories to conduct public health programs and to build hospitals and other health facilities. This reflected an in¬ crease over the preceding year of $4,625,000 which was shared among four programs: $2 million for general health programs; $1,250,000 for cancer control ; $1 million for mental health activities ; and $375,000 for heart disease control. Actual payments from total available funds were distributed as follows : General health services _ $16, 755, 443 Venereal disease special projects _ 1 2, 379, 805 Tuberculosis control - 3, 982, 055 Mental health activities - 5, 941, 888 Cancer control _ _ _ 3, 313, 568 Heart disease control _ 3, 300, 482 Hospital and medical facilities construction - 157, 004, 031 Waste treatment works construction _ 44, 085, 200 Water pollution control _ 2 2, 891, 860 1 Includes $847,754 in supplies and services furnished in lieu of cash. 2 Includes $248,844 paid to interstate agencies. Other payments helped to strengthen public health training and build up the supply of qualified personnel needed in modern health programs. A total of $1,991,819 was distributed for traineeships for professional public health workers, and $6,099,858 for professional nurses preparing for administration, supervision, and teaching. For training and demonstration projects in air pollution control, payments totaled $122,287 ; grants for radiological health training, $134,559 ; grants to accredited schools of public health, $951,210; and project grants for expanding graduate and specialized curricula, $446,892. In addition, community cancer demonstration projects received $1,257,164 in funds and $48,970 in personal services furnished in lieu of cash. From the appropriation for construction of mental health facilities in Alaska, a total of $2,801,482 had been paid through June 30, 1961. PUBLIC HEALTH ADMINISTRATION The Public Health Administration Branch gave technical assist¬ ance and consultation to State and local health agencies on several major concerns assigned to the Division, such as metropolitan health problems, programs related to general health grants, the develop¬ ment of comprehensive community health services, and training and demonstration activities. Staff assistance was also provided for a number of interdepartmental committees. The Branch conducts intramural studies on community health needs and resources, health attitudes, and survey techniques. One such 150 Department of Health , Education , and Welfare , 1961 study was published: The Impact of Asian Influenza on Community Life. Another was prepared for publication: A Health Study in Kit Carson County , Colorado. A study of physicians’ attitudes and practices with respect to smok¬ ing was started. The findings will be used to develop an educational program for patients affected by heavy smoking. An investigation of the psychological effects of fear-arousing information was begun to help formulate better educational materials on diseases such as cancer. Other studies were underway on public acceptance of im¬ munization programs; penicillin prophylaxis among college students with rheumatic fever; health problems in economically depressed areas ; and medical care costs and administration. School health staff members participated in many working confer¬ ences with representatives of State and regional agencies and volun¬ tary groups. Two regional institutes, cosponsored with the American Association for Health, Physical Education, and Recreation, were held in Los Angeles and Seattle, with about 100 participants from 8 western States. The institutes were designed to bring together professors of health education in teacher-training institutions and key education and health officials; and to provide discussions on new developments in the health sciences. Additional regional institutes are being planned to meet requests from other areas. National attention to problems of agricultural migrant workers and families has accelerated State and regional interests in health pro¬ grams for migrants. At the request of the Association of State and Territorial Health Officers, a personal health form was designed for uniform recording of data important to physicians and agencies pro¬ viding medical services for migrant family members as they travel from place to place. Thirty-four States requested a supply of the forms shortly after they became available. Current studies deal with the health aspects of a social service program, the crew-leader’s role in migrant health, and a project linking community health services for migrants along one migratory route between Texas and Michigan. EXTRAMURAL RESEARCH DEVELOPMENT Community-based research to find more effective patterns for the de¬ livery of modern health services continued to gain support among pub¬ lic and private agencies and schools of public health. More than a dozen State health departments now have a director or coordinator specifically responsible for developing such research projects through¬ out their departments. To help meet increasing requests for consultative and liaison serv¬ ices, the Division recently established a separate Research Grants Branch. Its staff provides consultation for individual investigators, Public Health Service 151 and works closely with other research stall's and committees, both within and outside the Department, on matters of promotion, policy, and training related to research in public health practice. The Branch collects and disseminates nationwide data on com¬ munity-based research projects, resources, and needs. In one regional office a research development staff has been set up on an experimental basis to determine if consultation services to State and local health departments can be provided more effectively from a decentralized location. Other regional offices have been cosponsors for several con¬ ferences held for State and local health officials interested in research programs. PUBLIC HEALTH EDUCATION The Health Education and Information Branch completed com¬ prehensive reviews of health education programs in several State health departments; leadership training projects were organized; staff services to international organizations concerned with health education research were provided, as well as speakers and consultants for meetings of public health workers; and health educators were recruited for Public Health Service programs. To exchange ideas and coordinate efforts, joint planning confer ences were conducted with State directors of health education, pro¬ fessors of health education from schools of public health, and staffs of voluntary health agencies. Three Branch health educators were loaned to States : one to develop ! the educational phases of a state medical care program, another to obtain experience in a local health department, and the third to serve as State director of health education. TRAINING Traineeships were awarded to support the graduate and specialized public health training of 607 physicians, dentists, nurses, sanitary engineers, health educators, veterinarians, and many other categories of professional personnel essential to modern public health practice. In August 1960 the Congress authorized a new program of project grants designed to help eligible schools enlarge their capacity and improve curricula for training professional health workers. More than half of 138 eligible schools responded with 164 proposals that included stronger programs in sanitary chemistry and biology; im¬ proved field training ; preparation of teachers in public health nursing ; and curriculum expansion in medical care administration, rehabilita¬ tion, metropolitian planning, radiological health, and air hygiene and pollution. Out of the total proposals, 92 projects were approved and 63 could be supported from the $1,430,000 appropriated for the first year. 152 Department of Health , Education, and Welfare, 1961 INTERNATIONAL EDUCATION AND EXCHANGE A total of 605 international health students and visitors from 89 countries received program assistance for 3,109 months of study and observation in the United States. The program involved 136 training centers, of which 86 were academic institutions. Major support for these activities comes from the International Cooperation Adminis¬ tration, which sponsors the largest single group of students and visitors. Those sponsored by the United Nations and other agencies are also given advisory and technical assistance. Comparison of 1961 with 1960 showed that the number of foreign students training in our medical schools increased 50 percent, while those sent to schools of public health declined about 50 percent. By countries of origin, 199 came from 15 Far East countries; and 181 came from 26 Latin American countries, representing a sharp increase over 1960 as well as broader sponsorship. Twenty-nine countries in the Near East, Africa, and South Asia sent 146 students and visitors; 18 European countries sent 78 ; and Canada, 1. ARCTIC HEALTH RESEARCH CENTER The only research unit of its kind in the United States, the Arctic Health Kesearch Center is concerned with health problems related to life in low-temperature areas. Study fields include environmental sanitation, biochemistry and nutrition, entomology, epidemiology, physiology, and zoonotic disease. During the year several investigations dealt with epidemic out¬ breaks — principally hepatitis, trichinosis, and respiratory infections. A study was completed on an outbreak at Fort Yukon, where more than 40 percent of the populace was affected ; and influenza Type B was established as the cause. Bequests increased for consultation on small institutional-type waste disposal methods in remote areas, where central water distribution is not available. Water supply studies included testing for reservoir liner materials that will withstand ice and frost action; well jetting; experiments in air lock installations, and low-cost hypochlorite feeder systems. Other studies of the Center involved aquatic biology, entomologic identifications, nutrition surveys, social and educational observations, tuberculosis chemotherapy, brucellosis, tularemia, hydatid disease, and rabies. Studies on adaptation to cold were extended, with observa¬ tions of human subjects for determination of indiviual adaptation by age, sex, and occupation. Public Health Service 153 Division of Hospital and Medical Facilities Planning activities of the Hill-Burton Program were highlighted during fiscal 1961 by the completion of two significant reports : “Plan¬ ning of Facilities for Mental Health Services,” which presented find¬ ings of a special committee selected by the Surgeon General; and “Areawide Planning of Hospitals and Related Health Facilities,” which presents the conclusions of a joint committee of the American Hospital Association and the Public Health Service. A third report, “Medical School Facilities — Planning Considera¬ tions and Architectural Guide,” was nearing completion as the fiscal year ended. This publication was prepared in cooperation with the Division of Public Health Methods and the Ad Hoc Committee on Planning Medical School Architecture of the Association of American Medical Colleges and of the American Medical Association. Other problem areas were also explored by special committees, with assistance provided by the Division staff. These committees, which are continuing their work into next year, are concerned with such problems as long-term care, rehabilitation, and tuberculosis. The Division continued its program of providing construction and research grants, participating in surveys and studies, preparing and disseminating guide materials for hospitals and related health fa¬ cilities, and providing consultation to those involved in health facility planning, construction and administration. CONSTRUCTION PROGRAM Since the first allocation was made in 1947, some 5,688 Hill-Burton health facility projects have been approved for Federal assistance. This represents a total cost of $4.9 billion of which the Federal con¬ tribution was $1.6 billion. A total of 238,946 beds for inpatient care and 1,596 health units for outpatient care will be available as a result of these projects. Thus, earlier shortages, particularly in the area of general hospital beds, have been substantially reduced by the pro¬ gram. In addition to general hospitals, which represent 61.3 percent of all Hill-Burton projects to date, other types of facilities provided aid include: mental hospitals, 2.4 percent of the total projects; tu¬ berculosis facilities, 1.3 percent; chronic disease hospitals, 3.3 percent; nursing homes, 5.5 percent; public health centers and State health laboratories, 15.6 percent; diagnostic centers, 7.2 percent; and re¬ habilitation centers, 3.4 percent. Although sizable gains have been made in general hospital con¬ struction (79 percent of the need has been met compared with 59 percent in 1948), a number of health facility problems continue to confront many communities. New needs have been created by 626936—62 - 11 154 Department of Health , Education , and Welfare, 1961 scientific advances, new patterns of care, shifts in population, length¬ ening life span, and obsolescence of existing facilities, particularly in metropolitan areas. To meet these needs requires continued sound State planning with strong community support. The Nation’s greatest gap in health facilities is in the area of long¬ term care. There are great differences in the present level of availabil¬ ity of long-term care facilities among the States. The five States which currently have the highest ratio of nursing home beds per 1,000 elderly, proportionately have seven times more long-term beds than the five States with the lowest ratio. If the country as a whole were to be brought to the level of the five highest ranking States we would need a half -million more long-term beds. Another great need is the development of small community or regional facilities for the mentally ill which would eventually replace the large State-owned institutions which now primarily serve a custodial function. RESEARCH GRANTS Hospital research is a growing activity in the Hill-Burton program. During the past fiscal year funds were provided for 34 extramural research projects, 22 of which were begun prior to June 1960. The grants, totaling $1,015,690, were made to universities, associations, and other nonprofit organizations interested in investigating means for providing effective patient care by the most efficient means at the lowest possible cost. The grants were made in five general areas : (1) the development of more effective organizational patterns for pro¬ viding services; (2) better community planning and coordination of hospital facilities and operations; (3) studies of hospital admissions and utilization of hospital services; (4) architectural and equipment design; and (5) methods for improving and simplifying working procedures. In the area of intramural research, the primary focus continued on Progressive Patient Care. Preliminary reports were completed on three studies — “Estimating Bed Needs in a Progressive Patient Care Hospital,” “Progressive Patient Care Cost Methodology,” and “Personnel Evaluation, Training and Procedures in Progressive Patient Care.” In addition, several new studies were begun during the year. The Division has found through its surveys that a growing per¬ centage of hospitals throughout the Nation are incorporating one or more of the elements of progressive patient care into their organiza¬ tional and operational structure. The staff has, through orientation, guide material, exhibits, speeches and consultation, given widespread distribution to this concept of care which emphasizes “the tailoring of services to meet the patient’s needs.” Public Health Service 155 COOPERATIVE STUDIES Many studies have been undertaken by the Division — some in col¬ laboration with other agencies and organizations concerned with the same problems. For example, the Division has joined forces with the American Hospital Association and the State of Georgia Department of Health in a pilot study to develop a methodology for uniform joint reporting of basic hospital statistics. Such uniform reporting will be an aid in State licensure and planning, in the gathering and com¬ pilation of National statistics, and in Civil Defense planning. An¬ other example is the assistance provided to J ohn Hopkins University in its examination of physical plant and operating needs of 10 Penn¬ sylvania general hospitals which were built in former coal mining communities. Still another cooperative effort was the joint develop¬ ment with the American Nursing Home Association of a manual for expense accounting in nursing homes, based on experience gained in a study of nursing home costs conducted jointly at the invitation of the Pennsylvania Department of Public Welfare. Approximately 200 publications have been prepared by the Division over the past several years. During the past year alone, approxi¬ mately 200,000 requests for these publications were answered. A growing number of visitors from the U.S. and abroad come to the Division for advice and consultation. Foreign visitors during the past year included representatives from England, Scotland, Pakistan, Paraguay, Yugoslavia, Poland, Costa Rica, Japan, the Philippines, Australia, and Viet Nam. Division of Chronic Diseases Established February 1, 1961, the Division of Chronic Diseases has as its overall mission the prevention of the occurrence and progres¬ sion of chronic disability and dependency. The Cancer Control and Heart Disease Control Programs were transferred from the former Division of Special Health Services into the new Division without organizational change. The Chronic Disease Program of the Division of Special Health Services was expanded into three separate program branches within the new Division. These branches are : Arthritis and Diabetes, Vision and Hearing Conservation, and Health Services for Long Term Illness (including problems of the aged). HEART DISEASE CONTROL The Heart Disease Control Program supports and promotes the use of research products and new techniques to reduce the effects of cardio¬ vascular disease. One hundred twelve medical and other professional personnel — a 50-percent increase over last year — are assigned to States to further heart disease control programs. 156 Department of Health, Education, and Welfare, 1961 Heart Disease in Children Laboratory technicians from all 50 States, 4 territories, and 5 cities were trained at the Communicable Disease Center in the fluorescent antibody technique for the rapid identification of the organism associ¬ ated with the onset of rheumatic fever and rheumatic heart disease. Nine States conducted 12 in- State training courses for 210 tech¬ nicians, and equipment and training personnel are scheduled solidly through December 1962. A test utilizing tape-recorded heart sounds to screen 33,000 school children for heart disease was completed in Chicago, and is stimulat¬ ing other areas to initiate screening projects. Plans are under way to test inexpensive, portable equipment, and to develop electronic meth¬ ods for initial screening of the tapes. Heart Disease in Adults To identify and measure the role of various factors in coronary artery disease, epidemiologic, clinical and laboratory studies are in progress in 12 States. As background data, coronary death rates by counties and other geographic areas are being computed for the 10-year period 1950-59 for several States. Through a series of projects in several States, it has been demon¬ strated that most stroke patients can be restored to self-care ; restora¬ tive services for stroke patients are being improved and extended. A long-term community study in Mercer County, W. Va., is en¬ deavoring to provide a scientific basis for deciding whether treatment reduces morbidity and mortality of moderate hypertensives. Else¬ where, the effect of sodium in drinking water on the management of patients with congestive heart failure is being investigated. Institutes and workshops were held in many places to teach heart disease control to health and related personnel. For example, the Program was instrumental in stimulating a series of cooperative training workshops for health and welfare workers in New Jersey, Colorado, Massachusetts, Kentucky, and Puerto Rico. A laboratory unit to standardize procedures and tests used in heart disease studies has been established at the Communicable Disease Center in Atlanta. A computer program for automated electrocardiographic analysis has successfully classified electrocardiograms by statistical techniques. A test on a larger scale is planned. Preliminary studies in electro¬ cardiographic telemetry and in computer analysis of phonocardio- grams are in process. CANCER CONTROL For the first time in more than a decade, Federal assistance to State health departments for cancer control was increased this fiscal Public Health Service 157 year. Federal funds rose from $2.25 million to $3.5 million, with a $25,000 minimum per State. In those States able to budget the in¬ crease immediately, most of the additional funds were put to use for clinic and casefinding activities and for program development. Demonstration Projects Seventy-nine Community Cancer Demonstration Project Grants were awarded, totaling $1,781,153. These projects are hastening the application locally of current knowledge for controlling cancer. Six¬ teen projects planned to examine some 50,000 women for uterine cancer. To bolster programs such as these, the education of nearly 200 cytotechnicians was aided through grants to approved schools of cytotechnology. Other grants supported projects in professional and public education, collection and analysis of data to improve care, in rehabilitation, and in other activities. Both the Cancer Control Program and the Association of State and Territorial Health Officers encouraged and emphasized cancer examinations among the comparatively high risk group of women receiving medical care from public agencies. Cytologic smears are being processed by the Washington Cytology Unit, the Cancer Con¬ trol Program’s laboratory, to help other Federal agencies to increase the number of beneficiaries being examined for uterine cancer. “Shoptalk,” a technique to aid professional education, passed from an experimetal to an operation stage. Perfected with the cooperation of the American Academy of General Practice, this technique uses filmstrips and tape-recordings of family physicians and specialists discussing practical problems of cancer control. The Academy is using these films and tapes to promote further discussion among other groups of physicians on the problems and opportunities in their daily practice in applying cancer detection and diagnostic techniques. The Public Health Service position on smoking and lung cancer was presented to medical and public health groups, in national, regional, and local meetings, including the annual meeting of the American Medical Association. HEALTH SERVICES FOR LONG-TERM ILLNESS Some 25 contracts and agreements related to health services for the chronically ill had been approved as of June 30, 1961 with State and local health and welfare agencies and nonprofit organizations. They were mainly training, survey, and research projects planned to pre¬ pare the way for broad service programs. Major areas of interest are : Nursing Care of the Sick at Home. — Professional nurses and assist¬ ants from both official and voluntary health agencies render services 158 Department of Health, Education, and Welfare, 1961 to that major proportion of the chronically ill and aged not residing in institutions. Homemaker Services. — Home help is supplied when illness or dis¬ ability creates a family need for such service. Coordinated Home Care. — Selected patients at home receive physi¬ cian-directed medical, nursing, social, and related services through a plan based on coordination, evaluation, and follow-up. Information and Referral. — Information concerning community health and medical care resources is made available from a central source, and consultation and guidance are offered to patients, families, and professional personnel. Periodic Health Appraisal. — The detection of disease in apparently well persons, the determination of the individual’s health status, and the early prevention of disability are furthered by periodic appraisals that include health history, physical examination, and clinical and laboratory tests and procedures. Nursing Home Services. — Many chronically ill and aged persons not in need of hospital care are accommodated in facilities that are designed, staffed, and equipped to provide nursing care and related medical services under State license. Technical assistance was supplied in the formulation of State Plans regarding grant expenditures for community health activities and services. More than 10,000 nursing aides in nursing homes have been trained through coordinated training activities developed in cooperation with the American Red Cross. Projects supported in eight communities have provided hospital guidance and consultation services to nursing homes, and a docu¬ mentary film on this operation has been produced. Over 10,000 copies of the “Nursing Home Standards Guide” have been distributed to State and local public and private agencies. Staff assistance was contributed for planning and conducting the White House Conference on Aging. National and Regional Institutes and Seminars were sponsored for the study of home care, nursing homes, and coordinated home care. Nursing home personnel will be trained in accounting techniques at Regional Seminars organized by the Program. DIABETES AND ARTHRITIS The Diabetes and Arthritis Branch cooperates with the National Institute of Arthritis and Metabolic Diseases by applying new re¬ search developments in community programs as soon as feasible. Public Health Service 159 Diabetes Blood Testing Diabetes detection and field research activities have been advanced. A preliminary report of blood test screening projects shows that 59 health agencies in 16 States and one territory screened over 74,000 persons during the fiscal year 1961. Employees of 27 federal agencies were included in a diabetes detec¬ tion program conducted by the Federal Employee Health Program and the Diabetes and Arthritis Branch. Results of 20,000 tests made in the Washington, D.C., area are under study, and screening is continuing. A continuing study of abnormal carbohydrate metabolism in preg¬ nancy conducted by a field research staff in Boston has disclosed that there is a reduction in the frequency of births of large weight babies among women treated with insulin during pregnancy. Followup examinations of 307 pregnant women treated with insulin, 307 posi¬ tive controls, and 319 negative controls have resulted in the diagnosis of diabetes in 36 insulin treated women, 45 positive controls, and one negative control patient. Automated Diabetes Instruction Time consumed by busy physicians instructing diabetes patients in self-care may be reduced significantly by an automated instructional course in diabetes being developed in cooperation with manufac¬ turers of a self-instruction machine. The machine has been success¬ fully used in industrial and armed forces training. The automatic teaching device will be tested in several health department clinics during the next fiscal year. Arthritis Control Though early detection of arthritis has not yet progressed to the same degree as diabetes control activities, attention and study have been given to possible utilization of several promising uric acid screen¬ ing methods. A number of communities are being explored as possible sites for field research in screening for gout — a disease that can be controlled with the prophylactic use of certain drugs. VISION AND HEARING CONSERVATION The Vision and Hearing Conservation Branch works closely with official State and local health agencies, national voluntary agencies, and the National Institute of Neurological Diseases and Blindness to develop a nationwide program for the early detection and management of vision and hearing impairments. Increasing awareness of the effectiveness of early detection of glau¬ coma in preventing blindness or serious sight impairment has resulted 160 Department of Health , Education, and Welfare, 1961 in widespread adoption of glaucoma screening programs by State and local health departments. Nearly half of all the State and territorial health departments have glaucoma detection programs. Approxi¬ mately 100,000 persons were screened during the fiscal year. National Reporting System In cooperation with the National Society for the Prevention of Blindness, the Branch has developed a national reporting system to obtain definitive information on glaucoma screening methods being used in local programs. The reports will supply valuable data on prevalence of the disease nationally, the types of population most susceptible to glaucoma, and the most effective screening methods. Validation of various screening tests in predicting the development of definite simple glaucoma was continued in a Glaucoma Collabora¬ tive Study involving five university ophthalmologic centers. This 5-year study is supported by grants from the National Institute of Neurological Diseases and Blindness. About 600 patients already have been evaluated. The specificity and sensitivity of the Schi0tz type tonometer is being studied at the University of Tennessee School of Medicine. Tonometer Sheath Developed A disposable, latex-rubber sheath called a “tonofilm” that keeps the footplate of a tonometer sterile during glaucoma screening tests has been developed. The device shows promise of reducing the hazards of eye contamination in large-scale screening operations where instruments have to be used repeatedly and kept sterile. Conventional methods of sterilizing tonometers are not very effective. The “tono- film” is being evaluated at two clinics before production is permitted for general use. Hearing Conservation A committee of expert consultants in audiometry and audiology was formed to develop criteria for hearing measurements that can be used in programs. Studies are being planned to develop information on the extent to which hearing loss is preventable or remediable, the effect of the aging process on hearing loss, and the types of hearing tests and standards that can be applied to community screening programs. Communicable Disease Center The Communicable Disease Center, Atlanta, Ga., carries out Public Health Service programs in the control of infectious diseases. It Public Health Service 161 conducts epidemiological, field, and laboratory studies and provides various types of technical assistance to State health departments. Because of the global nature of infectious diseases, CDC also partici¬ pates in health efforts around the world. It provides technical sup¬ port and personnel for the health programs spearheaded by the Inter¬ national Cooperation Administration. It also cooperates with the World Health Organization through representation on expert ad¬ visory panels and committees and as a laboratory diagnostic and study center. This year, CDC brought all its central activities together in new headquarters buildings adjacent to Emory University, which were dedicated on September 8, 1960. The Southeastern Rabies Field Station was moved from Montgomery, Ala., to Chamblee, Ga., and established as a National Rabies Laboratory. In April, a new labora¬ tory building adjoining the University of Kansas Medical Center was dedicated to house the Kansas City Field Station. This installation conducts investigations of the systemic mycoses and respiratory and enteric viral infections. With the transfer of the tuberculosis program to CDC this year, control activities for all infectious diseases became centralized. In addition, responsibility for collecting and publishing morbidity and mortality reports of communicable diseases was transferred from the National Office of Vital Statistics to CDC on January 1, 1961. EPIDEMIC AND DISASTER AID Epidemic aid was extended in 38 instances to 23 States, and addi¬ tionally to West Berlin and American Samoa. Several other States, the District of Columbia, and Puerto Rico sought consultations in connection with epidemics. Infectious and serum hepatitis epidemics accounted for 11 calls for aid, poliomyelitis for 5. Other diseases included infantile diarrhea, diphtheria, encephalitis, staphylococcal infections, streptococcal infec¬ tions, rabies, trichinosis, erythema infectiosum, anthrax, and typhoid fever. A localized concentration of leukemia in Cook Co., Ill., was studied in conjunction with the National Cancer Institute. Disaster aid was furnished to eight States in nine instances, pri¬ marily in connection with emergency vector control. REPRESENTATIVE DISEASE STUDIES Quota Sample Surveys The “quota sample survey” developed at CDC in 1959 was im¬ proved and modified, and its use was extended to a number of com- 162 Department of Health , Education, and Welfare, 1961 municable diseases. Originally designed to assess polio immunization levels of different population groups within a community, it was used this year to study epidemiological patterns of polio and several other diseases and to investigate factors possibly related to a concentration of cases of leukemia. When broadly applied, this technique promises to be a useful adjunct to guiding and evaluating many types of local health programs. Venereal Diseases Infectious syphilis morbidity climbed to 18,781 reported cases during fiscal year 1961 — the greatest number recorded in any year since 1960. Increased incidence involved both sexes and all age and racial groups. Thirty-seven States reported an upswing in cases, both among clinic and private patient groups, with 10 large cities contributing 42.3 percent of the total number of infectious cases. In an effort to reverse the tide, the Venereal Disease Control Pro¬ gram supported epidemiologic and casefinding services in 45 States and Territories through 82 project grants and through assignment of 226 doctors, nurses, health program representatives, and public health advisors to health departments. In addition, 123 public health workers were hired under cooperative agreements between the Public Health Service and other agencies. In the States, programs to visit private physicians and stimulate them to report all syphilis cases and permit epidemiological follow-up were vigorously pursued. Nearly 75 percent of infectious cases re¬ ported by physicians last year were subjected to the same rapid and intensive investigation in regard to contacts that is applied to most clinic cases. Every infectious case is regarded as an emergency. Since one out of four patients reports out-of-State contacts, epidemiologic information is transmitted by long-distance telephone. In some in¬ stances, outbreaks stemming from a single source have been found to span the continent and even cross oceans. Ke-interviewing and cluster testing are used to locate, examine, and bring to treatment as many contacts as possible. A revealing study of the sexual and social behavior of 600 teenagers who came to New York City’s venereal disease clinics during a 2-year period was completed during 1961. This study was conducted by the American Social Health Association in cooperation with the New York City Department of Health and financed by the Public Health Service. A limited edition of “Teenagers and Venereal Disease: A Sociological Study,” the detailed report of these findings, has been published by CDC. Inability to diagnose gonorrhea in the female has been an obstacle to the development of effective gonorrhea control programs. The Public Health Service 163 fluorescent antibody test has been adapted to the identification of the organism and is now being evaluated in field trials. Nine State health departments are using the Fluorescent Treponemal Antibody test to differentiate between biologic false positive reactions and those gen¬ uinely indicative of syphilis. Evaluation of therapeutic agents indicates that penicillin is still effective in the treatment of syphilis. Some decrease in the suscepti¬ bility of the gonorrhea organism has been noted ; however, a number of alternate antibiotics have been evaluated and are available. Influenza Acting upon recommendations of the Public Health Service Ad¬ visory Committee on Influenza, CDC mounted a campaign to stimulate the annual vaccination of high-risk groups against this disease. The elderly, the chronically ill, and pregnant women consistently account for a major portion of the excess influenza-associated mortality during epidemic periods. The campaign was aimed at the medical profession and others re¬ sponsible for the care of high-risk individuals. Its success was evident in the increased demand for vaccine. CDC prepared and distributed nearly 40,000 copies of an Influenza Fact Sheet to Regional Medical Directors, medical specialty groups, medical journals, State health officers, pharmaceutical houses, and other interested groups. Poliomyelitis The changing trend in poliomyelitis incidence in the United States was brought more clearly into focus during 1960. Only two major epidemics occurred, one in metropolitan Providence, R.I., and the other in Puerto Rico. However, there were numerous moderate urban and rural outbreaks and several localized concentrations of cases throughout the country. After the severity of the 1959 polio season, the dramatic drop in number of cases was particularly gratifying. Out of 2,218 paralytic cases reported to CDC’s Poliomyelitis Surveillance Unit,2 57.6 per¬ cent were concentrated in totally unvaccinated individuals and only 7.4 percent occurred in fully vaccinated persons. The effectiveness of the Salk vaccine was thus reaffirmed. A reversion to the infantile form of polio was seen, with 43 percent of the cases occurring in preschool children, peaking among one- and two-year olds. Also notable was the increased incidence in the 20- to 35-year age group. 2 Best available count. 164 Department of Health , Education , and Welfare, 1961 The Surgeon General’s Polio Advisory Committee took these find¬ ings into consideration when it met at CDC in October and January. Prominent among the Committee’s comprehensive recommendations for polio control were the intensified use of Salk vaccine as an immedi¬ ate goal and of oral vaccine for use in curbing epidemics as soon as it should become available. The Committee endorsed the Public Health Service plan to encourage local community drives to reach lower socioeconomic and younger age groups through “Babies and Bread¬ winners” campaigns. The first demonstration of an all-out community immunization effort was staged in Columbus, Ga., in cooperation with the State and county health departments. Although a preliminary Quota Sample Survey showed that this city of 120,000 population had a better than average immunization level, approximately 80,000 doses of Salk vac¬ cine were given in three 1-week periods. As the program proceeded, it was documented step-by-step. The Columbus campaign served as a prototype for others throughout the country. Community groups, the Advertising Council, and other organizations on the local and national level contributed talent, pub¬ licity, and manpower to the Columbus campaign and to others that followed it. At the end of the fiscal year, when licensing of oral polio vaccine Type I appeared imminent, the President of the United States requested and Congress appropriated $1 million to purchase oral vac¬ cine as it was licensed. The supply is to be used to study the effec¬ tiveness of the vaccine in controlling epidemics. Encephalitis (Arthropod-Borne) Studies in Colorado have uncovered a link between warm spring temperatures and the transmission rate of St. Louis encephalitis (SLE) and between cool springs and western encephalitis. If these findings hold true elsewhere, a means may have been found for pre¬ dicting outbreaks of encephalitis and the probable type. An unsus¬ pected enzootic vector of western encephalitis may be spreading the virus in high altitudes. Chicken flocks, placed strategically to serve as sentinels of viral activity, have demonstrated a high rate of trans¬ mission of this virus even when the mosquito Culex tarsalis , the pre¬ sumed vector, was essentially absent. Tuberculosis Many communities are hard pressed to provide clinic and out¬ patient services to tuberculosis patients, the majority of whom receive part, and sometimes all, of their treatment at home. The Tuberculosis Program made a special effort this year to help States with high case Public Health Service 165 rates and inadequate funds. By assigning professional workers, it enabled a number of areas to expand and intensify their services. In demonstration projects, nurses’ aids and specially trained investigators relieved public health nurses of routine tasks, freeing them for more professional functions. In another project, home¬ makers were employed to see if this would encourage patients to continue treatment. A major research activity dealt with the identification of unclassi¬ fied mycobacteria, which cause clinical disease similar to tuberculosis but do not respond to present drugs. More than 500 strains have been collected; 64 of these were subjected to tests in guinea pigs. Eleven new mycobacterial antigens were prepared and used for studies of human population groups, and others are now being developed. New findings from studies of tuberculin sensitivity and chemotherapy evaluation were reported and the large-scale study to determine whether isoniazid is effective in preventing tuberculosis was continued. Plague A new technique, involving fluorescein labeling, was developed for use in the field to permit immediate checks of dead rodents for plague infection. Schistosomiasis Field studies in Puerto Rico demonstrated the effectiveness of the predator snail Marisa comuarietis as a biological control agent against the snail intermediate host of schistosomiasis, Australorbis glabratus. A chemical, acrolein, was found to be a good combined herbicide and molluscacide in Puerto Rico field tests. VECTOR CONTROL Aedes aegypti , the urban vector of yellow fever, is being eliminated initially in a 5-square-mile area of Pensacola, Florida, in a CDC project to determine the cost and feasibility of eradicating this species. Studies on the release of sexually-sterile adult male Ae. aegypti as an aid to eradication have been initiated. Improved formulations of solid spontaneous vaporizers for DDVP have been developed for use in the residual fumigation method of vector control. Field tests of this method of controlling malaria mosquitoes, together with studies on the toxicity of DDVP vapor to humans, have been initiated in Upper Volta, Africa. The use of DDVP vapor for disinfecting aircraft while in flight has been found to be biologically feasible in tests on commercial planes. Studies have been started to determine if the vapor, as used in the tests, has any adverse effect on human volunteers. 166 Department of Health , Education, and Welfare, 1961 LABORATORY SERVICES AND NEW TECHNIQUES Nearly 56,000 disease specimens were referred for identification to the CDC laboratories by State and local health departments, by various Branches of the Center, and by Federal agencies other than CDC, research groups and foreign countries. In addition to the amounts required in its own programs, the Center produced and distributed more than 155,000 ml. of diagnostic reagents, and over 12,000 shipment lots of tissue culture media to health departments here and abroad, to other Federal agencies, universities, hospitals, and research groups. These materials are not available commercially. Conjugates for the nine important serotypes of enteropathogenic Escherichia coli found in the United States have been prepared and fully evaluated. Sensitivity and specificity were so encouraging that a field study was undertaken in San Juan, Puerto Rico, where incidence of infantile diarrhea is high. Additional work indicated by the study has been completed and the method now shows great promise for rapid diagnosis needed in the control of this disease. Under an agreement with the Division of Chronic Diseases, a labora¬ tory has been established to work out procedures for standardization of tests used in heart disease research and control. The first program of the new laboratory is a cholesterol program to support lipid epidem¬ iologic research in public health laboratories. Fifty-two laboratories in the United States and Canada are participating in this continuing program which is designed so that others may join the program. INTERNATIONAL COOPERATION In collaboration with the World Health Organization, a refer¬ ence skin test antigen for the diagnosis of schistosomiasis was prepared and distributed to workers in Japan, Philippine Republic, Africa, Lebanon, and India for evaluation. A protocol for the standardiza¬ tion of the skin test and methods for analyzing the results of these trials was prepared for use by WHO. Under a cooperative agreement between the governments of Colom¬ bia, South America, and the Republic of Lebanon, with the Public Health Service, members of the Audiovisual Section of CDC surveyed and secured film footage on nutritional standards of the civilian and military population in those countries. TRAINING Nearly 6,000 persons from State and local health departments, Fed¬ eral agencies, academic institutions, industry, and organizations attended 373 CDC courses in communicable disease control presented throughout the United States and at CDC headquarters. Over 26,000 Public Health Service 167 audiovisual aids were loaned in response to requests, and more than 100,000 pieces of training literature were distributed. Two venereal disease control seminars were held which attracted an additional 1,300 persons. Thirty-seven training publications were prepared and 69 audiovisual productions were completed during the year. Division of Accident Prevention Accidents are the first cause of death from age 1 to 36 and fourth for all ages. The Division of Accident Prevention, established Febru¬ ary 1, 1961, supports a broad program of research to identify human factors in accident causation which can be modified or compensated for. Its recent and ongoing activities include : Cooperation with the Greater Cleveland Safety Council on a public action program over a full year beginning September 8, 1961, the first attempt of its kind in any metropolitan center. Participation in a national seat-belt campaign launched by the Advertising Council of America. Provision of seat-belt anchor points for at least two seat belts in all American 1962 cars, partly as a result of PHS activity. A study in five rural Virginia counties to try to reduce accident rates through community organization and strong publicity. The results are being published as a valuable guide for other rural areas. Participation in a program on fire deaths and injuries in Mississippi County, Ark. Injuries from fires dropped dramatically in 1 year. The State health department is extending the work on a statewide, permanent basis. Other activities included sponsorship of a Conference of State Motor Vehicle and Health Officers which led to permanent committees to foster close cooperation of their departments on driver licensing, driver examinations for intoxication or drug addiction, and related medico-legal problems. A conference on driver simulation projects brought together all interested disciplines and opened a campaign for a wide range of devices. A successful Conference on Alcohol and Traffic Safety was held to compile all known facts on this subject. The first textbook on accident prevention for physicians and health workers was published, with PHS cooperation, by the American Public Health Association. The National Clearinghouse for Poison Control Centers, with 460 centers affiliated as of July 1, started pilot studies on preventing child¬ hood poisoning. A “safe medicine chest,” developed in the Division, is being consid¬ ered for production by several manufacturers. 168 Department of Health , Education , and Welfare , 1961 Other interests include mouth-to-mouth resuscitation, emergency care of accident victims, accidents of aged persons, safety standards for home appliances, epidemiology of traffic deaths, and effective home inspection for fire prevention. Division of Nursing The Division of Nursing was established in September 1960 by com¬ bining the Division of Public Health Nursing with the Division of Nursing Resources. All major program goals and objectives of the two former divisions are being continued and expanded and new objectives will be added as new health programs develop. The Divi¬ sion is responsible for the continuing appraisal of nursing needs and available resources to meet these needs. It also stimulates the develop¬ ment of new resources and assists health agencies, hospitals and other institutions to make the most effective use of nursing services. This work is carried out through: (1) systematic collection and analysis of data on nursing needs and resources; (2) consultation to State health departments, and through them to local health agencies, on all aspects of nursing programs for which they are responsible; (3) consultation on the application of study methods, as requested, to health agencies, nursing organizations, hospitals, both voluntary and tax-supported, and others; (4) intramural studies to develop new methods of improving nursing practice; and (5) grant operations, both for advanced training and for research. The Surgeon General’s Consultant Group on Nursing, appointed this year and comprising 24 leaders from health professions, industry, and civic groups, is considering the Nation’s nursing needs in order to make recommendations on the appropriate role of Federal and local governments and private agencies in the provision of adequate nursing care. The Division has primary responsibility for the prep¬ aration of materials and other staff services for this Group. The Division also gave leadership in nursing and health through the Division Chief’s service as an official adviser for the U.S. dele¬ gation to the 1961 World Health Assembly; loan of one nursing con¬ sultant to the World Health Organization for 3 months to prepare a nurse staffing guide for public health agencies; and loan of two consultants to universities to teach courses in nursing research. SYSTEMATIC ANALYSIS OF NEEDS In addition to the recurring biennial estimates of total nurse supply and the census of public health nurses, the Division has underway a series of related surveys and analyses to obtain information needed to guide program development. For example, the latest estimates re- Public Health Service 169 ported employment of 80,000 part-time nurses, but there was no in¬ formation on the amount of time these nurses work annually. The Division is conducting a study to provide information on the work patterns of this important group. More than 6,000 questionnaires from a sample of these nurses were received and coded ; data analysis will be completed in 1962 and a report published. An estimated 200,000 professional nurses maintain a current li¬ cense to practice although they are not actually nursing. These nurses could form an important corps to augment the national supply. To determine the availability — readiness and willingness — of inac¬ tive registered nurses to return to nursing posts full- or part-time, the Division is undertaking an extensive survey of a sample of these nurses. To provide data for the 1963 evaluation of the Professional Nurse Traineeship Program and other training activities, work was begun on the development of a questionnaire for use in obtaining detailed information on the present educational level of professional nurses and their potential for and interest in further preparation. NURSING CARE OF THE SICK AT HOME The Division continued to promote and encourage local health agen¬ cies in the development of programs to provide nursing care to sick and disabled persons in their homes. Vast expansion of home nurs¬ ing services can be predicted as demands grow due to the increasing numbers of chronically ill who are best cared for in their own homes. Technical assistance from both regional nursing consultants and headquarters staff has been accelerated because of the urgent need to develop these services in States which passed legislation including home nursing care for the aged as permitted under the 1960 Social Security Act Amendments. Assistance was requested on a variety of problems, such as the conditions necessary for the initiation of such a program, ways and means of recruiting and training personnel, organizational patterns for the new service, and ideas for publicizing this additional community resource. One major administrative problem raised was the determination of costs of providing nursing care in the home as a basis for fee sched¬ ules. The Division assisted two States to develop workable cost procedures. With the assistance of the regional nursing consultants, the Divi¬ sion of Public Health Methods, and the Bureau of Public Assistance, a statement, “Medical Assistance for the Aged and Nursing Services in the Home,” was developed and distributed to both health and welfare agencies nationwide. It has proved to be helpful to health and welfare departments in the development of cooperative programs. 626936 — 62 — —12 170 Department of Health, Education , and Welfare, 1961 A countywide nursing care of the sick program including a hospital-health department referral system was launched by the Rockland County Health Department in New York. Funds to make this program possible were transferred to the Division by the Heart Program. Consultation for this program has been provided by per¬ sonnel from the State Health Department and the regional nursing consultant, with overall direction by the Division. Ten additional agencies were assisted with instituting work meas¬ urement procedures. In one State, procedures were adapted for application on a statewide basis. NURSING SERVICES IN OUTPATIENT DEPARTMENTS The hospital outpatient department has a significant position in total medical care programs. It plays a key role in early discharge from the hospital, in the expanding programs of home care, and in care of the ambulatory patient, often preventing hospitalization. The Division has developed a method for improving nursing in an outpatient department through several interlocking studies designed to give a comprehensive picture of nursing services. These studies also afford a means of analyzing some aspects of patient experience, for example, patient “waiting” time, continuity of care between clinic and home, and patient teaching, which are influenced by the nursing administration of the outpatient department. This year, arrangements were made to assist in making such studies at three university hospitals in the South which recognize the urgency of their own problems relating to outpatient care. STATEWIDE STUDIES OF HOSPITAL NURSING Studies of inpatient nursing units continue to be an effective tool for self-evaluation by demonstrating how hospital nurses can better spend their time in patient care. Approximately 200 hospitals have now studied nursing activities with consultation from the Division. Workshops to teach the study method were conducted in Indiana, California, and Pennsylvania, and consultation was given in Kansas and New Jersey. These last three States are planning studies on a statewide basis in cooperation with local hospital associations and other health organizations. NURSING RESOURCES SURVEYS Consultation was given six States during various stages of initial or reappraisal studies of their nursing resources. These were West Virginia, Montana, South Dakota, Louisiana, Kansas, and Mississippi. Mississippi’s reappraisal in 1959-60 pointed out that a contributing cause of their meager professional nurse supply might be the high Public Health Service 171 percentage of nursing students (more than 50 percent) who either withdrew or failed to pass the State licensing examination. The Division cooperated with representatives of the schools of nursing in conducting a study of over 1,000 students to determine the relation¬ ship between results on various pre-admission tests and the eventual success of students, both in school and in obtaining licenses. Findings were studied thoroughly by school representatives and the reappraisal committee in a three- day workshop and plans were made for better selection of students and other program improvements. This study underscored the value of using high school grades and performance on admission tests as predictors of a student’s success in a school of nursing. It also demonstrated the high cost of training poorly qualified students. INTRAMURAL RESEARCH Reports of two completed studies by staff members were published. These were A Study of Student Nurse Perception of Patient Attitudes and Behavior Patterns of Premature Infants. In cooperation with the Boston Public Health Service Hospital, an experimental study of the comparative costs, durability, and accept¬ ability of reusable and disposable surgical gloves showed that use of disposable gloves saved personnel time which could then be reassigned to activities more closely related to patient care. A patient progress study was undertaken, designed to develop a technique by which public health nurses might define the health needs of patients and then measure response to each service given in terms of the ultimate goal the patient is expected to attain. This year, data were obtained from four agencies in Ohio, Wisconsin, and New York. Where the methodology has been tested, agencies have been enthusi¬ astic about its usefulness in helping them focus on the patient’s progress in relation to his problems. It is also considered to be an effective supervisory and self-evaluation tool. An evaluation of the Children’s Bureau demonstration of health services for migrant laborers in Florida is to be based on this study method, as are several other evaluation projects. GRANTS FOR TRAINING AND RESEARCH The Professional Nurse Traineeship Program, between September and March, awarded grants to 1,421 trainees through 94 schools, for long-term preparation in teaching, administration, and supervision. In the short-term training program, started last year, 117 short courses were approved and grants awarded to course sponsors in the amount of $792,000. Over 4,200 trainees participated in these courses. 172 Department of Health , Education , and Welfare , 1961 The Division is also responsible for consultative services to the Di¬ vision of Community Health Services on nursing applications for public health traineeships and on project grants for graduate training in public health. Thirty project grant applications were approved for training nurses in public health; about 250 nursing applications for public health traineeships were reviewed and acted upon. Through the Research Grants and Fellowships Program, a total of $1,700,000 was awarded for 19 studies of importance to nursing and for 26 full-time predoctoral fellowships to as many nurses to prepare for independent research. Project applications reveal a significant trend toward studies in clinical nursing as exemplified by a grant to study the relationship of nursing care to pain patterns following heart surgery. Approved projects deal with both hospital and public health nursing; nursing education and student health ; nursing in other nations ; patient teach¬ ing and activity patterns ; maternal and child health ; and assessment of nursing home care. Division of Dental Public Health and Resources The Division of Dental Public Health and Resources was established on September 1, 1960. Previously, responsibility for dental health ac¬ tivities had been divided between the Division of Dental Public Health and the Division of Dental Resources. Dental diseases are the most prevalent of all disorders, but only 4 people in 10 receive dental care annually. Accumulated treatment needs alone are great enough to employ the dental force full-time for five years. To provide the needed care and direct programs of disease prevention, the nation must rely upon a dental force which has di¬ minished in proportion to population for a generation. RESEARCH AND TRAINING CENTER In a major effort to reduce the time lag between the discovery and utilization of knowledge of dental diseases and their control, the Division obtained facilities in San Francisco for a Dental Health Center. The Center will be the first national facility to conduct applied research programs in the prevention and control of dental diseases and to train public health workers in the use of research findings. CONTROLLING DENTAL DISEASES The incidence of dental caries can be substantially reduced by the increased utilization of available and already proven methods of prevention. Through informational services and technical assist¬ ance to health departments, the Division encouraged the adoption Public Health Service 173 of water fluoridation, the most effective caries preventive. As of June 30, 1961, some 38,864,000 people in 2,008 communities were served by controlled fluoridation. An additional 7,000,000 lived in the 1,903 communities where the water is naturally fluoridated. Preventive programs initiated included a study of the effective¬ ness of stannous fluoride dentifrices in preventing decay among school children and the field testing of fluoridators for use in homes utilizing individual wells. Continuing activities included projects for testing different concentrations of topical stannous fluoride solu¬ tions and studies of the practicality of fluoridating school water supplies in rural areas where central water systems are not used. REMOVING BARRIERS TO DENTAL CARE In any year 60 percent of the population do not receive dental care. The cost of dental services, physical conditions such as chronic, disabling illnesses which make it impossible for people to go for care, and psychological and sociological influences which make people fear or ignore the need for care are among the factors which bar people from needed services. Activities originated or supported by the Division are designed to eliminate these barriers. Financing Dental Services Privately sponsored prepaid dental care plans are effectively lowering the cost barrier and increasing the utilization of dental services. The Division encouraged the growth of prepayment by serving as an informational and consultative center for consumer groups and dental societies establishing prepayment programs. This year the revised “Digest of Prepaid Dental Care Plans 1960,” summarizing the benefits, eligibility requirements, and other perti¬ nent information on programs already in operation, was published. A collection of fee schedules used in various prepayment plans was prepared for publication. An outgrowth of interest in prepayment has been the development of dental service corporations, nonprofit agencies through which State dental societies administer prepaid care plans. Under a cooperative agreement with the Michigan State Dental Association, the Division participated in the organization and administration of the society’s service corporation, gaining practical experience which will be useful in assisting other dental societies. Services for Special Groups In most communities, facilities and programs to provide dental care for the chronically ill and aged, the mentally and the physically handicapped are nonexistent. 174 Department of Health , Education , and Welfare , 1961 Three pioneering projects completed on June 30 produced basic data on dental care needed by the mentally and chronically ill and the aged and developed techniques and equipment for use in providing care for them. Two of the projects, at the West Virginia State Hospital in Huntington, W. Va., and at the Beth Abraham nursing home in New York City, will continue the treatment phases of those programs. The third project, a 4-year study of dental care for the chronically ill and aged in Kansas City, brought dental services to both the homebound and nursing home patients. The prototype program demonstrated how community service programs can meet the dental treatment needs of a neglected group. One phase of the project, the training of dental students at the University of Kansas City School of Dentistry in the use of portable dental equipment and the special techniques of care for the aged and ill, will be continued by the dental school. In cooperation with the State health departments of Idaho and Illinois, the Division initiated projects designed to assess the dental care needed by handicapped children. These projects will provide needed care and collect data necessary to the establishment of State and local service programs. Indifference to the need for dental care and fear of treatment are reflected not only in the failure of individuals to utilize dental services but also in public apathy toward dental public health programs. Studies underway in the Division continued the attempt to ascertain why certain population groups make, or do not make, dental visits and why people join various financing programs. DEVELOPING DENTAL RESOURCES Activities aimed at increasing the utilization of dental services must be accompanied by the building of a dental force adequate to meet the greater demand for care. Within 30 years the national dentist-population ratio has declined from a high of 58 dentists per 100,000 persons to 46. Just to maintain the current ratio, the nation must double, within 15 years, its capacity to educate dentists. Greater numbers of dental auxiliary personnel must be recruited and trained, and ways to increase the productivity of the dentist developed and utilized. Division studies in the space requirements and space relationships of dental schools were designed to learn how these facilities can be planned and constructed more efficiently and economically. The preparation of dental school planning guides undertaken this year should assure that new schools are built not only in accordance with Public Health Service 175 the most modern teaching concepts but with enough flexibility to be adapted to future innovations in curriculum and technology. Educational Programs The use of chairside assistants is an effective method of stretching available dental services, for it enables the dentist to treat more pa¬ tients. An experimental program to teach dental students to work with chairside assistants, originally initiated mider cooperative agree¬ ments with six dental schools, culminated this year in a grants program available to all schools. Already 40 schools have indicated that they will participate in the grants programs, administered by the Division for the National Institute of Dental Research, in the coming academic year. Seven technicial and vocational high schools, junior colleges, and dental schools will participate in a continuing cooperative pro¬ gram, started in 1956, to establish standards for training chairside assistants. ASSISTING OTHER HEALTH AGENCIES Assistance to State and local health agencies in the planning of dental programs is a continuing activity. This year a comprehen¬ sive study of State dental health programs, covering administration, resources, and program content, was initiated. The survey will serve as a basis for formulating recommendations and establishing standards to be used in guiding the future growth of these programs. Division of Water Supply and Pollution Control Fiscal year 1961 was the 5th year of administration of the water supply and pollution control program under Public Law 660. At the end of the year Congress enacted major revisions to the Water Pollu¬ tion Control Act, strengthening the Federal role and providing addi¬ tional aid to State and local governments. Two events during the year also focused attention on the gravity of the water situation : the first National Conference on Water Pollution (December 1960) and the release in January 1961 of a report by the Senate Select Com¬ mittee on National Water Resources based on a comprehensive two- year study. The legislation amending Public Law 660 was signed by the Presi¬ dent on July 20, 1961. It provides for: (1) intensified research and establishment of field laboratories; (2) inclusion of storage for water quality control in new Federal reservoirs; (3) extended and increased grants to States for their control programs; (4) liberalized and in¬ creased grants to further stimulate construction of municipal waste treatment facilities; and (5) broadened Federal enforcement pro- 176 Department of Health, Education, and Welfare, 1961 cedures to abate pollution. The Act declares it to be the policy of Congress to “recognize, preserve and protect the primary responsibili¬ ties and rights of the States in preventing and controlling water pollu¬ tion,” pointing out that the Federal role is one of leadership and pro¬ viding “technical services and financial aid to State and interstate agencies and to municipalities.” CONSTRUCTION GRANTS During fiscal 1961 grants totaling $45 million were approved for 590 municipal sewage treatment construction projects. During the entire 5-year period ending June 30, 1961, grants totaling $225 mil¬ lion were made in support of construction totaling $1.3 billion. Of the 2,746 projects approved, 1,580 were completed and 710 under con¬ struction. These will serve a population of 27 million and abate municipal pollution in over 33,000 miles of streams. PROGRAM GRANTS Grants to State and interstate agencies to assist them in establish¬ ing and maintaining adequate water pollution control programs have encouraged the States to increase their appropriations from $4.2 million in 1956 to $6.7 million in 1960. BASIC DATA To determine pollution trends, the National Water Quality Network of stream sampling stations was enlarged from 79 to 91, with 300 as the ultimate goal. Continuing data are collected, analyzed, and pub¬ lished on water and waste treatment facilities and needs. A report¬ ing system on pollution-caused fish kills was initiated. An inventory of Federal establishments to determine the extent of, and remedial measures for, pollution coming from these installations is in progress and due for completion in July 1962. ENFORCEMENT The enforcement procedure has been invoked in 15 interstate water pollution situations under the 5-year program of the Federal Water Pollution Control Act. One new enforcement action during the 1961 fiscal year was initiated on the North Fork of the Holston River (Vir¬ ginia, Tennessee). Additional steps in the enforcement procedure were taken in the following pending cases: the Bear River (Idaho, Utah, Wyoming) ; the Colorado and all its tributaries (Colorado, Utah, Arizona, Nevada, California, New Mexico, Wyoming) ; and the Missouri River, St. Joseph, Missouri. Also, as the fiscal year ended, preparations were near completion to hold a conference involving the Public Health Service 177 Raritan Bay (New York, New Jersey). Continuing files are main¬ tained on some 2,000 additional pollution areas. Enforcement actions to date are effecting pollution abatement in more than 4,000 miles of streams. The resulting remedial measures agreed upon include waste treatment f acilites to cost in excess of $500 million. RESEARCH AND RESEARCH GRANTS Research continued at the Sanitary Engineering Center in problems of wastes origin, characterization, treatment and disposal, and in stream monitoring, water treatment, and the supplementation and conservation of water supplies. A major project in advanced waste treatment was undertaken to develop entirely new processes which will approach 100-percent purification of wastes. Direct responsibility was assumed for the support and administering of water supply and pollution control research grants formerly funded by the National Institutes of Health, and to support the training of urgently needed personnel through research fellowships and training and project grants. COMPREHENSIVE PROGRAMS The technical staff continued work in comprehensive river basin programming. New projects were initiated in the Columbia and Colo¬ rado River Basins and the Great Lakes-Illinois Waterway Basins. An earlier project continued in the Arkansas-Red Basin. INTERAGENCY COORDINATION Coordination of programs with water resources plans and projects of other agencies continued. Technical services under such inter¬ agency agreements represent a major and expanding activity. Thirty- eight evaluations of water supply requirements have been completed under the Water Supply Act of 1958 in conjunction with impound¬ ments planned by the U.S. Army Corps of Engineers, and 48 others are in progress or scheduled. The Division has also provided staff tech¬ nical services in support of the Department’s membership in the South¬ east River Basin Study Commission and the Texas River Basin Study Commission. ADVISORY BOARD Six meetings of the Presidentially appointed Water Pollution Control Advisory Board were held in fiscal 1961. In response to a request from the Surgeon General, the Board conducted a detailed study of existing program resources and projected future require¬ ments in water pollution control. 178 Department of Health , Education , and Welfare , 1961 Division of Air Pollution On September 1, 1960, in recognition of increasing public concern about air pollution, the existing air pollution medical and engineering programs were combined in a single Division of Air Pollution. Following the approval, late in fiscal year 1960, of Public Law 86- 493 — which directs the Public Health Service to make a thorough study and report to Congress by June, 1962 on the health effects of motor vehicle exhausts — the Division has sharply accelerated its research in this area. AUTO EXHAUST RESEARCH The research projects set up to implement P.L. 86-493 involved complex procedures and required painstaking advance planning. By close of fiscal year 1961, however, many major studies were underway. In one group of studies, colonies of experimental animals are being exposed in the laboratory to irradiated and nonirradiated motor vehicle exhaust and to concentrations of auto exhaust pollutants as they occur in the ambient air on city streets. In six large cities, arrangements were completed for continuous measurement of exhaust- related gaseous pollutants to determine their ranges of concentration. In three cities, lead in the ambient air, and lead levels in the blood and urine of selected population groups, are being measured for correlation with traffic density and other parameters. To help determine the pollutant contributions of gasoline- and diesel-powered trucks and buses, their operating modes are being surveyed in several cities. The particulate fraction of gasoline and diesel engine exhaust is also being analyzed for a variety of poly¬ nuclear hydrocarbons and oxygenates for correlation with analyses of potential carcinogens in emissions from other combustion sources. A cooperative survey is underway in Los Angeles to determine ex¬ haust concentrations of hydrocarbons, carbon monoxide, carbon di¬ oxide, and nitrogen oxides in a representative sample of registered motor vehicles under prescribed operating conditions. The Division is also supporting, through its intramural research program and its research grants program, a number of other projects which should further help to determine the effects of motor vehicle emissions on human health. OTHER RESEARCH ACTIVITIES In 50 stations of the National Air Sampling Network, gaseous pol¬ lutants such as sulfur dioxide and oxides of nitrogen are now being sampled. Formerly, only particulates were sampled. Public Health Service 179 Further advances were made in designing and improving instru¬ ments for sampling pollutants or assessing their effects, for example, a portable transistorized particle counter and size analyzer. For industrial-type installations, improved filter devices were developed. Chemical research was oriented toward analytic methods for aromatic and aliphatic hydrocarbons and inorganic gases. Special sampling for assay of potential cancer agents was conducted in six cities. The previously developed analytic technique for measuring certain potential carcinogens, particularly 3,4-benzpyrene, was applied to air samples of 103 cities and 28 nonurban sites; city levels averaged 16 times those found in nonurban areas. To further gauge the potential carcinogenicity of polluted atmosphere, the geo¬ graphic distribution of lung cancer according to the histological type of tumor is being studied to test the theory that the different cell types may result from different causative agents. The following are typical of many field studies of air pollution’s health effects. Tests in a large industrial firm indicated a relationship between absenteeism due to certain respiratory diseases and total sulfate pollution in the air. Further study of results of a survey previously done in Nashville, Tenn., disclosed a similar association between asthmatic attacks and airborne sulfates. In studies of two small towns, which differed only in the degree of air pollution preva¬ lent, preliminary analysis of data suggests corresponding differences in the residents’ lung function and breathing capacity. Laboratory studies on health effects were also expanded. In fur¬ ther animal studies, conjugated nitro-olefins were found to be potent irritants, with not only eyes and respiratory tracts affected but also circulatory and nervous systems. An especially significant study revealed that the resistance of mice to respiratory infection was markedly decreased after exposure to ozone, as demonstrated by in¬ creased mortality rate and lowered survival time. Pulmonary func¬ tion tests revealed that human beings exposed under laboratory conditions to certain inhaled substances experienced reactions similar to those described in animals. TECHNICAL ASSISTANCE AND TRAINING Statewide air pollution surveys were completed, in cooperation with the State health agency, in Florida, Pennsylvania, and Georgia. De¬ tailed reports were published on earlier surveys in Minnesota and North Carolina. Substantial assistance was also given in surveys conducted by State or local health departments in Hamilton, Ohio; Charleston, S.C.; Lynchburg, Ya. ; Washington, D.C. ; and Berlin, N.H. Equipment loans or consulting services were provided to many other areas. 180 Department of Health , Education , and Welfare , 1961 Intensive technical courses in air pollution were given at the Sani¬ tary Engineering Center to 180 trainees from 32 States and 3 foreign countries. Two field courses were presented 6 times to 289 trainees. Support was also continued for the graduate-level air pollution cur¬ ricula being developed at 10 universities. NATIONAL GOALS Late in calendar 1960, an important report was published: National Goals in Air Pollution Research. This report was prepared by a highly competent group of consultants outside the Federal Govern¬ ment, who were invited by the Surgeon General to identify goals for air pollution research over the next decade and to recommend a fair apportionment among the Federal Government, State, and local gov¬ ernments, and industry of the efforts necessary to reach these goals. The Division has set its sights accordingly. Division of Radiological Health The Division of Radiological Health is responsible for development and implementation of ways and means of controlling and, wherever possible, reducing radiation exposure. With the rapid multiplication of sources, applications, and users of radiation, it is imperative that the States assume increasing responsibilities for radiation protection and control. Therefore, particular attention is placed on providing technical assistance to bolster the radiological health competency of the States. Technical personnel from the Division are currently as¬ signed as radiological health consultants to the Regional Offices and additional personnel have been assigned directly to State health departments. A new mail survey technique (Sur-pak) has been developed for evaluating dental X-ray units used in private offices and clinics. The Division furnishes the State health departments with survey packets, which are then distributed to each individual dentist or organization in the survey area. After exposure of the film packets to the X-ray units, they are returned through the State Health Department to the newly developed Radiological Health Laboratory at Rockville, Md., for interpretation and report of findings back to cooperating offices. The new Rockville Laboratory was established for the primary purpose of developing methods for the effective control of radiation hazards from medical, dental and industrial X-ray units as well as providing training in radiological health. At the request of the Navy Department, the Division established a radiation monitoring station at the site of a proposed Navy Reactor Public Health Service 181 at McMurdo Sound, Antarctica. Public Health Service personnel as¬ signed there are collecting background data from air, water, and algae samples in order to assure other nations that treaty requirements and safety regulations against contamination of the environment in that area are being rigidly observed. RESEARCH Fundamental and developmental research is being augmented in an effort to close the gaps of knowledge on the effects of radiation on man. An example of this effort is the “San J uan Research Project,” where continuing studies are being made of selected families in that area, evaluating food and water relationships to ingestion and reten¬ tion of radionuclides. Radon breath trailers have been obtained and construction of a radon air removal system is almost completed. An¬ other project vital to a large segment of our population is the “Late Effects of Radioiodine Therapy Follow-up Study.” The purpose of this study is to investigate the late effects of treatment with radioactive iodine among patients with thyroid diseases. Contracts have been signed with 16 hospitals to help conduct this work. The extension of research activities through the medium of extra¬ mural grants by the Division was made possible for the first time during the 1961 fiscal year with a $918,000 budget. Requested appro¬ priations were $1,198,000 for the 1962 fiscal year. These grants make possible use of laboratory and research facilities of universities, in¬ dustrial organizations, and official and nonofficial agencies through¬ out the country. TRAINING Training grants were also made available for the first time in fiscal year 1961 by Congressional approval of an initial disbursement of $500,000 to colleges, universities, and other institutions of higher learning, to improve, expand, or establish radiation health specialist curricula. Fifteen universities were selected, from applicants re¬ questing almost $2 million, to receive grants for staff, equipment, and student assistance. During fiscal year 1961, short training courses in the health aspects of radiation exposure were attended by over 1,000 Federal, State, and local governmental officials, foreign students and representatives of industry and private agencies. A Symposium on “University Curricula in Radiological Health,” with more than 100 educators and public health officials in attendance, was held at Princeton, N. J., during the year under sponsorship of the Division. The symposium proceedings underscored the acute shortage of trained radiological health personnel at all levels of professional 182 Department of Health , Education , and Welfare , 1961 competence. Nationwide radiation specialist training activities were revealed and clarified by this opportunity for an exchange of ideas on future planning. SURVEILLANCE The environmental radiation surveillance programs of the Division have expanded with the support of the Sanitary Engineering Center at Cincinnati, Ohio, and the regional laboratories at Las Yegas, Nev., and Montgomery, Ala. These regional facilities analyze environ¬ mental and biological samples collected by Federal, State, and local health authorities. Comprehensive data on radiation levels present in the surrounding environment, including air, water, milk and other foods are then published each month in the Division’s “Radiological Health Data” periodical. A Radiation Intelligence Network has been established with the purpose of assessing all sources of ionizing radiation in the environ¬ ment. A computational group has been organized as part of this net¬ work. A pilot study of environmental radiation sources in Montgom¬ ery County, Md., is being conducted in cooperation with the county health department. Air sampling stations were installed in nine loca¬ tions in the county. Samples of drinking water from public and pri¬ vate wells were obtained, and information about food intake and X-ray exposure was secured through household interviews. The primary purpose of the survey is to develop methodology and check the validity of methods for obtaining accurate records of total radiation exposure of a population group. Division of Occupational Health An increase of over 100 percent in direct operating funds for the Division of Occupational Health in fiscal year 1961 gave new thrust to research, consultation, and training activities to help meet more adequately the pressing needs in this complex field. In the research area, this increase permitted expanded effort in the development of better techniques, materials, and equipment for use in the prevention, diagnosis, and treatment of occupational disease. Impetus was given to activity in toxicology and in related fields of clinical medicine, engineering, chemistry, and physics. Physiologic and psychologic factors in the work environment were also brought imder study. The Division also assumed responsibility for the administration of research grants in occupational health. To stimulate needed research, a conference was held to consider epidemiologic investigations that might profitably be developed in industry. Public Health Service 183 Field investigations conducted during the year ranged from sili¬ cosis among metal miners to the possible health effect of handling animal feeds containing a wide variety of additives. The findings of a recently completed study will aid in establishing standards for conditions under which men can be employed for their entire working lifetime without developing hearing impairment due to excessive noise. In the study of uranium miners, now in its 12th year, more conclu¬ sive evidence points to a lung cancer hazard. Among miners with more than 3 year’s underground experience, deaths are occurring in ex¬ cessive numbers due to this disease. As part of the triennial exami¬ nation of 1,700 uranium miners, cytologic analyses of the sputum were made to determine their value in the early detection of lung cancer. Contracts were also negotiated with the States of New Mexico and Colorado and with private research facilities to complement the clinical studies and control efforts. Further attention to the problem and the need for effective control measures have been directed by special meetings and training courses. Among these, a meeting called by the Secretary of Health, Education, and Welfare brought together the governors and other officials of the seven uranium-mining States. Heads of State mining associations and governmental agencies concerned also met to consider action. In addition, 3 courses for 200 uranium mine and mill operators and monitors were conducted by the Division, and over 10,000 copies of an educational pamphlet were distributed to mine personnel. Studies of the mechanism of toxic stress included a continuing evaluation of the long-term effects of toluene diisocyanate (TDI), a chemical responsible for strong immunologic reactions. Dermatitis studies of epoxy, polyester, and polyurethane resins have led to the development of nonirritating patch testing concentrations and diluents as a diagnostic aid in distinguishing between allergic and primary irritant dermatitis. As part of an intensified training program 15 separate courses were presented with a combined attendance of 435 persons. Basic 2-week, training courses for industrial hygiene engineers and chemists, for many years offered once anually, were presented four times. In addi¬ tion, four advanced courses in lead analysis, analysis and control of noise, analysis of free silica, and dust evaluation techniques were offered. Special courses were held for various groups, including governmental occupational health directors and local health officers. During the year, field consultations and technical services were provided on over 100 different occasions in 30 States. 184 Department of Health , Education, and Welfare, 1961 Division of Environmental Engineering and Food Protection This newly organized division takes over most of the functions performed by the former Division of Engineering Services. These include the milk, food, and shellfish sanitation programs; the water supply, food service, waste disposal and general sanitation problems of interstate carriers; metropolitan planning and development, solid waste (refuse) disposal; and a variety of general sanitary engineering activities. The division carries out and supports research, training, technical assistance, standards development, equipment review, pro¬ gram planning and promotion and regulatory functions under the Interstate Quarantine Regulations. ENGINEERING RESOURCES AND TRAINING The Public Health Service, because of its expansion of environmen¬ tal health programs, has been acutely affected by the manpower shortage in these fields. Consequently, major activities of this unit have involved the recruitment of qualified personnel for all divisions that are working on environmental health programs and the develop¬ ment of current staff through on-the-job training and through assign¬ ments for specialized studies in colleges and universities. To advance research on environmental health problems, assistance was given to the National Institutes of Health in evaluating and awarding grants for the construction of research facilities, particu¬ larly in schools of engineering. GENERAL ENGINEERING In carrying out PHS regulatory functions under the Interstate Quarantine Regulations, Special Citations and Letters of Commenda¬ tion for excellence in sanitation were awarded to 13 railroads and 43 vessel companies. Certificates of Sanitary Construction were issued to newly built aircraft, vessels, and railroad dining cars. The “List of Accepted Equipment” for Interstate Carrier use was increased by 503 new items. Modification prior to acceptance was required on 32. Studies of water pollution by vessels operating on the Great Lakes were intensified and areas were designated where vessels now are pro¬ hibited from discharging wastes. Technical assistance in metropolitan planning was given to Fort Wayne, Ind. ; Omaha, Nebr. ; and Lake County, Ill. A new techni¬ cal manual dealing with metropolitan planning for environmental health was published as were other manuals dealing with individual water supply systems, refuse sanitation, sewage disposal, school sani¬ tation and mobile home parks. The PHS-sponsored Committee on Public Health Service 185 Plumbing Standards completed proposed changes in the National Plumbing Code. Organic chemical analyses by PHS established for the first time the occurrence patterns of these chemicals in finished water with a view toward relating it to chronic disease incidence. Work was intensified on the role played by water supply in the spread of infectious hepatitis. MILK AND FOOD PROGRAM Participation by States in the Cooperative State-PHS Program for the Certification of Interstate Milk Shippers increased for the ninth consecutive year. The July 1961 list of milk shippers who were com¬ plying with PHS sanitation compliance ratings contained the names of 752 firms in 37 States and the District of Columbia. Over 1,400 shippers were certified by producing States as meeting the sanitary requirements for the interstate shipment of shellfish. During the year, some of the cases in two outbreaks of infectious hepatitis were associated with the consumption of raw oysters and clams harvested from sewage-polluted waters. The Service is assist¬ ing States to strengthen their shellfish sanitation control programs to prevent recurrences. Research at the Sanitary Engineering Center shows that the levels of strontium-90 and cesium-137 in raw milk continued to decline during fiscal 1961. A method has been devised for removing stron¬ tium-90 from milk by ion-exchange resins. A pilot project, cospon¬ sored by the Public Health Service, the Department of Agriculture and the Atomic Energy Commission has been established at Belts- ville, Md. Substantial progress has been made in the development, evaluation, and standardization of microbiological and biochemical methods for the examination of shellfish, milk, and other foods. Technical assistance was given to all States and to industry on interpretation and application of PHS ordinances and codes, planning and administration of milk and food programs, sanitary design of milk and food equipment, and training of State and local health officials. More than 120 seminars and training courses on milk, food and shellfish sanitation attended by over 6,000 individuals were spon¬ sored or participated in by PHS engineers. Bureau of Medical Services The hospitals, clinics, health centers, and other health services operated by the Bureau of Medical Services are in 250 locations on land and on the sea — in the Arctic and Antarctic, in the United 626936—62 - 13 186 Department of Health , Education , and Welfare , 1961 States and in foreign countries, on the Atlantic and the Pacific. Al¬ most 13,000 personnel are engaged in the operation of the activities of the Service that provide direct health services to a wide variety of Federal beneficiaries. The purpose in building marine hospitals many years ago was to care for merchant seamen who became ill or suffered injuries on their long voyages and could not go back to their homes and families on reaching port. Today, medical and hospital care for American seamen, and other direct health services to safeguard the Nation’s strength, are provided by the Bureau of Medical Services. Millions of travelers — U.S. citizens and people from other coun¬ tries — arrive here each year from foreign points ; through the foreign quarantine program, they are checked against any doubt of contagious disease. American Indians and natives of Alaska are given com¬ prehensive health care through the Indian health program because they are not yet ready to provide it for themselves. Protection of the health of the men of the Coast Guard and the Coast and Geo¬ detic Survey, and the cadets at the Coast Guard Academy, has long been a responsibility of the Bureau. Members and retired members of the armed forces and their fami¬ lies receive care at hospitals and clinics of the Bureau where more convenient than military hospitals; in turn, commissioned officers of the Public Health Service may receive care in military facilities. Medical and hospital care for civilian employees of the Govern¬ ment who are injured on duty or become ill from causes related to their jobs is administered by the Bureau. In another program, it operates health units for a number of F ederal departments and agen¬ cies that have requested this help in protecting the health of their employees. A special hospital is devoted to treatment of leprosy. Treatment for narcotic addiction is offered in two neuropsychiatric hospitals. The Bureau is responsible for medical and hospital care in all the Federal prisons and correctional institutions throughout the country. The Bureau conducts clinical research and carries on training programs for medical and health personnel. Public Health Service Hospitals and Clinics The Division of Hospitals provides medical care for American sea¬ men and other groups designated by Congress as beneficiaries of the Public Health Service. This nationwide program which now en¬ compasses treatment of patients, professional training, and clinical investigations, was begun in 1798 with legislation establishing the old Marine Hospital Service, forerunner of today’s Public Health Service. Public Health Service 187 About 375,000 persons qualify for health care benefits offered by the hospitals and outpatient facilities of the Division. Besides mer¬ chant seamen, the patients include officers and enlisted men of the U.S. Coast Guard, officers and crew members of the U.S. Coast and Geodetic Survey, commissioned officers of the Public Health Service, civilian employees of the Federal Government injured in the line of duty, active and retired members of the Federal uniformed services and their dependents, and several other groups. Persons with leprosy and narcotic drug addicts as defined by Federal law receive care in special hospitals. In 1961, the Division operated 15 hospitals and 25 outpatient clinics; also 113 outpatient offices operated on a part-time basis by community physicians under contract with the Public Health Service. VOLUME OF SERVICES Inpatient admissions to the 15 hospitals in 1961 totaled 49,571 — a decrease of 1.8 percent under 1960. There were 803 babies born in the two hospitals that have obstetric services. The average daily in¬ patient census declined 5.2 percent to 4,735. Outpatient visits rose slightly to a total of 1,194,486. GENERAL HOSPITALS Admissions to the 12 general hospitals totaled 45,147 — male and female patients of all ages with a variety of health problems. These hospitals offer general medical and surgical services, and each has an active outpatient section. They are located in major port cities: Boston, New York, Baltimore, Norfolk, Savannah, New Orleans, Galveston, Memphis, Chicago, Detroit, San Francisco, and Seattle. Among merchant seamen and coastguardsmen, who make up the larger part of the patient census, the five leading causes of admis¬ sion are diseases of the digestive system, accidents, diseases of the genito-urinary system, respiratory conditions, and diseases of the bones and organs of movement. The hospitals participate in mercy missions following local disasters. In October 1960, the Service Hospital in New Orleans in answer to a distress call mobilized its emergency resources and detailed a physician to the scene of the collision of the ALCOA CORSAIR and the LORENZO MARCELLUS in the Gulf of Mexico; nine persons were admitted in the hospital. The hospital on Staten Island, N. Y., minis¬ tered to victims of the airplane collision over lower New York City December 16, 1960. In December 1960, the Staten Island PHS Hospital demonstrated the installation and operation of the Civil Defense Emergency Hos¬ pital for 80 leading hospital administrators from all parts of the 188 Department of Health , Education, and Welfare, 1961 United States. This exercise took place in an essentially unoccupied building 15 miles away by road and ferry. The Civil Defense Emer¬ gency Hospital, one of 2,000 stockpiled throughout the country for use in emergencies, was uncrated and ready to admit cases in 35 minutes. Treatment was under way for “stand in” patients within 1 hour. Popularly called “Operation Life,” the demonstration was conducted in cooperation with the Division of Health Mobilization of PHS, the Office of Civil and Defense Mobilization, and the Ameri¬ can Hospital Association. NARCOTIC ADDICTION The U.S. Public Health Service hospitals in Lexington, Ky., and Fort Worth, Tex., are neuropsychiatric hospitals devoted primarily to the treatment of narcotic addiction as defined by Federal law. They also admit patients with mental illnesses who are entitled to care as beneficiaries of the Federal Government. In 1961, these hospitals admitted 4,424 patients — a 4 percent de¬ crease from the previous year. The number of narcotic addict pa¬ tients admitted was 3,939 — a decline of 5.4 percent. Admissions of other patients increased 9.2 percent. The average daily census of 1,907 was about the same as in 1960. Narcotic drug addicts are admitted for treatment as Federal prisoners, as Federal probationers, or as voluntary patients. In 1961 the 3,364 voluntary patients accounted for 74 percent of the total admissions but for only 28 percent of the average daily census. This comparison illustrates the inclination of addicts to stop treat¬ ment before they derive sufficient benefit from it. Staff members of both hospitals participated in conferences, work¬ shops, seminars, and meetings called by agencies in several States. The hospitals received several hundred visitors from the United States and foreign countries ; of these, about 50 physicians and public officials were given orientation and training for extended periods. LEPROSY The U.S. Public Health Service Hospital in Carville, La., an inter¬ nationally recognized center for treatment, training, and study con¬ cerned with leprosy and its many allied problems, admitted 103 patients in 1961 compared with 85 the year before. The average daily inpatient census rose from 281 to 285. The benefits of modern therapy, notably the sulfone drugs, for leprosy are most marked in patients in whom the disease is diagnosed early. To gain these advantages for the patient, the hospital recog¬ nizes the need to intensify epidemiological studies in various States. Public Health Service 189 A full-time physician lias been assigned to established and coordinate this service. Since the discovery and trials of the sulfone drugs for the treatment of leprosy at the Carville hospital, the prognosis is more optimistic in cases treated with them in the early stages. However, the sulfones are not 100- percent effective. Better drugs are needed, and large gaps exist in the scientific knowledge of leprosy. Research activities at Carville include clinical appraisal, biochemistry, bacteriology, thera¬ peutics, and histopathology studies. During the year nearly 10,000 persons visited Carville, 1,065 of whom were medical personnel. Twenty-three States were represented by 554 physicians and 404 nurses, and 107 professional visitors came from 19 foreign countries. Also, about 50 organizations and schools sent groups to the hospital for orientation, tours, and demonstrations. A hospital volunteer program was activated, and 17 persons from Baton Rouge and other nearby communities offered their services. Dr. Robert G. Cochran of London, Advisor in Leprosy to the Ministry of Health of England and one of the world’s outstanding leprologists, spent 2 months in Carville as consultant to the staff. During his stay, about 60 leading scientists and public health officials from the United States and other countries gathered at the hospital for a conference on research in leprosy. MEDICARE The Dependents’ Medical Care Act of 1956 authorized U.S. Public Health Service hospitals and outpatient clinics to admit active-duty and retired members of the Federal uniformed services and their de¬ pendents and the dependents of deceased members of these services. Admissions of these patients to Public Health Service hospitals totaled 15,771 in 1961 — an increase of 524 over 1960. The average daily cen¬ sus of these patients was 636, the same as the year before. They made 426,573 outpatient visits, a 3.2 percent increase. The daily census of PHS patients in hospitals of the Department o f Defense averaged 143, while the number of Defense Department ben¬ eficiaries in PHS hospitals averaged 275. TRAINING OF PERSONNEL Nearly 300 physicians, dentists, pharmacists, and dietitians re ceived internship or residency training in the hospitals in 1961. Ten hospitals are approved for graduate medical training by the American Medical Association, Council on Medical Education and Hospitals. Residency training is offered in 13 medical specialities — anesthesiology, dermatology and syphilology, general practice, gen¬ eral surgery, internal medicine, obstetrics and gynecology, ophthal- 190 Department of Health , Education , and Welfare , 1961 mology, orthopedic surgery, otolaryngology, pathology, psychiatry, radiology, and urology. Nine hospitals have American Dental Association approval for internships in dentistry. Residencies in prosthodontia and oral sur¬ gery are conducted at the Service hospitals in Seattle and on Staten Island, respectively. The outpatient clinic in New York City has an approved rotating dental residency. The chief of the medical service in the hospital in San Francisco was appointed assistant clinical professor of medicine at the University of California Medical Center. Six staff members of the hospital in Lexington were appointed to the voluntary faculty of the new medi¬ cal center at the University of Kentucky. About 50 medical and dental officers on Public Health Service hospital staffs also were teachers at nearby medical and dental schools. The approved 1-year course in medical record library science con¬ ducted at the Service hospital in Baltimore graduated 8 students, bringing to 66 the number trained in this course during 10 years of operation. Affiliations with colleges and technical schools afforded practical ex¬ perience and clinical instruction to more than 100 graduates in physi¬ cal therapy, occupational therapy, vocational therapy, social service, medical technology, and dental hygiene. The hospital on Staten Is¬ land provided the clinical nursing portion of the hospital corpsmen training given by the Coast Guard. CLINICAL INVESTIGATIONS Research in U.S. Public Health Service hospitals is predominantly clinical, closely linked to the total hospital program and the primary responsibility of providing good patient care. A number of investi¬ gations conducted at the hospitals are associated with research activi¬ ties of outstanding scientific institutions such as the medical schools of Tulane University, New Orleans, and the University of Washing¬ ton, Seattle. Studies in the special hospitals chiefly concern the various health and social aspects of narcotic addiction and leprosy. The Addiction Research Center of the National Institute of Mental Health, located at the Lexington hospital, is recognized as one of the best in the world and is visited by many scientists from many countries each year. Established research programs were under way in 1961 at seven general hospitals. More than 60 projects were in progress. Full¬ time directors of research were on duty at Staten Island, New Orleans, and San Francisco. Support for research comes from the operating funds of the Divi¬ sion of Hospitals, from NIH research grants, or through a cooperative Public Health Service 191 arrangement between a Service hospital and a medical school. An in¬ stance of the latter is the research on the dilated heart which is being conducted by the hospital in New Orleans and the Tulane medical school. The May 1961 Bulletin of Tulane University Medical Faculty was devoted almost entirely to the working relationship between re¬ search activities of the Public Health Service New Orleans Hospital and Tulane University Medical School. Research on essential hypertension, conducted in seven of the hos¬ pitals, is financed by an NIII grant. Plans were under way as the year ended for research in the San Francisco hospital by the hospital staff and the heart disease control program of the PITS Division of Chronic Diseases. FEDERAL EMPLOYEE HEALTH PROGRAM Health protection for Federal employees was first seen as a respon¬ sibility of management in 1914 when the Treasury Department es¬ tablished a “relief room” in the main Treasury building. Today, after passing through stages of “emergency rooms” and “first-aid stations,” an employee health service has been developed which in¬ cludes preventive health programs with professional responsibility vested in a physician in charge. The Federal Employee Health Pro¬ gram, a part of the Division of Hospitals, operates health units for Federal agencies that request this service; the work is done on a re¬ imbursable basis. In 1961 the program continued the growth and development which started 2 years before. Five new units were added, bringing the total to 37. These units serve more than 57,000 employees and are con¬ tracted for by 167 agencies. Medical officers, full-time or part-time, were on the staffs of 31 units. Health maintenance examinations for personnel age 40 and older were given to 3,832 employees, compared with 1,753 in 1960 and 348 in 1959. Nearly 61,000 immunizations were given, including 41,798 for in¬ fluenza and 13,857 for poliomyelitis. There were 16,971 tests made for diabetes, 3,818 tests for visual acuity, and 1,505 tonometric tests for glaucoma. There were 243,356 visits to the health units. More than two-thirds of the 57,000 employees covered visited the units, and their average number of visits was 6.6. One of every 12 visits to health units resulted in a referral to a private physician or dentist. More than 300,000 treatments were given employees at the units ; about 1 of every 5 treatments was pre¬ scribed by a private physician. 192 Department of Health , Education , and Welfare, 1961 FREEDMEN’S HOSPITAL During 1961, Freedmen’s Hospital provided care for 15,163 inpatients, a record high for its 96 years. A total of 3,379 live births also set a new record for the hospital, topping 1960 by 10 percent. The 14,809 inpatient admissions represent a 6 percent increase over 1960. Average daily patient census at 375 was up 22. Outpatient visits declined 626 to 94,788 due to severe local winter weather con¬ ditions which prevented many patients from coming to the clinics for their appointments. Inadequacies of the hospital’s physical facilities caused numerous operating problems in ministering to the increased volume of patients. Excessive crowding frequently occurred in the medical, obstetrical and newborn services. The attending and consulting staff of physicians and dentists totaled 213, an increase of 24. The courtesy staff consisted of 115, 8 more than the 1960 roster. All training accreditations of the hospital were maintained during the year. Freedmen’s Hospital serves as the clinical teaching resource for junior and senior students of Howard University, College of Medicine. It also offers approved medical, dental, pharmaceutical, and dietetic internships and residency training in 14 medical spe¬ cialties and in hospital administration. There are also a school of nursing and a school of X-ray technology. The 50 available residency appointments at Freedmen’s Hospital were filled during the year and involved participation by 18 grad¬ uates of foreign medical schools. There were also 22 medical interns, 2 dental interns, 2 pharmaceutical interns, 10 dietetic interns and 12 research fellows. The School of Nursing graduated two classes as a result of its curriculum being changed from 36 to 33 months. The combined num¬ ber of nurses completing training was 44, raising the grand total of the school’s graduates to 1,445. The School of X-ray Technology continued its efforts toward refin¬ ing its curriculum, clinical practice and other component activities. The 10 1961 graduates of this 2-year course bring the school’s total to 50. Over 35 clinical research projects were in progress at Freedmen’s Hospital during the year. More than 40 scientific articles by staff members had either been published or were in process of being published. Legislation authorizing the transfer of Freedmen’s Hospital to Howard University was pending in the 87th Congress at the end of the year. (This legislation was approved on September 21, 1961.) Public Health Service 193 Freedmen’s Hospital again benefited greatly from the many volun¬ tary organizations that have given long and faithful hours of service to the institution and also from the organizations and individuals who made tangible donations for the benefit of the patients. The hospital for the second consecutive year participated in the J unior Red Cross Volunteer Program for the summer months. Sixty young ladies and one young man gave a total of 4,495 hours. Division of Foreign Quarantine The United States experienced its 14th year of freedom from out¬ breaks of quarantinable disease known to have been introduced from abroad. QUARANTINABLE DISEASES In Europe, however, quarantinable disease was introduced into countries by international travelers. Smallpox infection was im¬ ported by airplane passengers into Moscow, into Ansbach in West Germany, and into Madrid. Only in Moscow was the infection ad¬ vanced far enough on arrival to permit prompt detection of the dis¬ ease and application of control measures. Fifty-two passengers were isolated in Moscow for 2 weeks; no secondary cases occurred. In Ansbach, a young man who had been in Calcutta came home and worked in a photography shop for a week before becoming ill. An¬ other week passed before he was hospitalized. The illness was cor¬ rectly diagnosed as smallpox after further study. The man recovered. His mother, father, and a physician contracted smallpox and the mother died. The father and the father’s physician recovered. In Madrid, there were 16 cases of smallpox with 3 deaths, including the infected young girl who had returned by plane from Bombay. These events stress the importance of a careful check on the health and immunity of persons arriving at U.S. ports. World travel by jet plane increases the chances that a person without adequate immu¬ nity may contract smallpox and enter the country before symptoms develop. There is need to strengthen secondary defenses against spread of infection by improving and maintaining the immunity status of the population to the greatest extent feasible, particularly among port and transportation personnel and medical personnel who are in the most danger of exposure. Also, the possibility of smallpox infection should be considered if symptoms that may indicate the disease appear in a person who has recently been in a foreign country. Worldwide, the total number of smallpox cases in the calendar year 1960 was about 62,115, which was fewer than in the previous year, 194 Department of Health , Education , and Welfare , 1961 but the disease continued to be endemic in countries of Asia and Africa and in a few countries of South America. For the first time in 2 years plague was reported in an international port — Rangoon, Burma — where two human cases and two infected rats were reported. This provided warning that rodent control on ships and in ports must not be neglected. Additional warning was fur¬ nished when two cargo ships operating between the Gulf coast and Puerto Rico were voluntarily fumigated; more than 800 rats were killed in one ship, and more than 400 in the other. Epidemics of human plague continued to occur in areas where infection was present in rodents ; the countries included Bolivia, Brazil, Ecuador, Peru, the Congo, and the Union of South Africa. One death from plague occurred as a result of infection from wild rodents in an isolated mountainous area of New Mexico. Epidemio¬ logical investigation and control measures were instituted. Until the past year cholera had been confined to India, East Pakistan, and Burma. In July 1960 it became explosive in West Pakistan, where it had not occurred since 1958. In August it spread to Afghanistan, which had not had a cholera outbreak in more than a decade. Several months elapsed before the outbreaks were brought under control. India experienced a major cholera epidemic in several states and in the ports of Calcutta and Lucknow. An epidemic occurred in Burma. The disease was reported in Nepal. Yellow fever, which had been quiescent for a few years in former endemic areas, was believed to have become explosive in a southwest province of Ethiopia ; 3,000 deaths from a disease believed to be yellow fever were reported there in April 1961. Peru had a yellow fever epidemic early in 1961. Sporadic cases were reported by Bolivia, Brazil, Colombia, Venezuela, and the Congo. OTHER COMMUNICABLE DISEASES There was a recrudescence of meningitis (cerebrospinal) in Nigeria. It spread to Niger, Chad, and the Sudan. Several thousand cases were reported. Pilgrimage traffic in temperatures as high as 117° F. contributed to spread of infection. Influenza epidemics occurred in England, Wales, Ireland, Japan, American Samoa, and the Philippines. The A-2 virus was isolated in England and Wales, and the B virus in Japan. Psittacosis was found in a parrot from a shipment of 12 psittacine birds imported by a zoo in New Orleans. Several persons who had contact with the birds after they arrived in this country were notified. The other birds in the shipment were destroyed. Public Health Service 195 INTERNATIONAL TRAFFIC Inspections of aircraft for quarantine or immigration-medical pur¬ poses decreased from 70,383 in 1960 to 65,661 in 1961. The increased use of larger aircraft was shown by an 11.6-percent increase in quaran¬ tine inspections of persons arriving by air, from 2,165,664 to 2,417,238. Inspections of ships decreased from 33,180 to 32,105. Quarantine in¬ spections of persons arriving by ship decreased from 1,967,997 to 1,966,580. Persons subject to quarantine inspection arriving in the United States by all modes of travel, including land entry from the interior of Mexico, increased from 5,186,789 in 1960 to 5,607,218 in 1961. It was necessary to detain only 11 persons in isolation, compared with 37 in 1960. The number of persons who were allowed to continue to their destinations in the United States, but were subject to medical surveillance for a time, was 91,985 compared with 54,459 in 1960. MEDICAL EXAMINATIONS General 'program. — The number of alien applicants for visas who were examined by medical officers abroad increased 6.8 percent, from 173,402 in 1960 to 185,142 in 1961. They were mostly immigrants. There were 1,850 who were found to have diseases or conditions ex¬ cludable under immigration law. Aliens examined on arrival at United States ports increased 6.4 percent, from 2,945,264 to 3,132,313. There were 2,193 found to have excludable diseases or defects; 30 percent of these had been so diagnosed abroad, but they were admitted under special provisions of immigration law. Staff in Europe examined 7,056 refugee-escapees under Public Law 86-648, and 243 were found to have excludable conditions. Some with excludable conditions were admitted to the United States by the Immigration Service subject to necessary controls. Twenty-seven aliens arrived in New York with negative reports of serologic tests for syphilis but had positive tests upon reexamina¬ tion. Investigation in the country they came from revealed that visa applicants obtained negative reports from friends who were labora¬ tory technicians. In another country, tuberculous applicants substi¬ tuted negative X-ray films for positive films. Corrective steps were taken in both countries. Immigration of aliens with tuberculosis. — Immigration of certain aliens with tuberculosis continued for the fourth year under Public Law 86-253. The U.S. quarantine service placed 929 aliens under health controls after arrival in this country, compared with 794 in 1960. Migratory farm labor. — In the program of recruiting farm workers from Mexico, 305,574 laborers were examined, with 5,634 rejections, 196 Department of Health, Education, and Welfare, 1961 at 3 centers in Mexico; and 338,751 examinations were made, with 4,170 rejections, at 5 border reception centers in the United States. At the reception centers 300,736 serologic tests for syphilis were made, with 15,646 positive reactors. The rate of positive reactors increased from 49.7 per 1,000 men tested in 1960 to 52 per 1,000 in 1961. F acilities at reception centers were improved and expanded to speed up X-ray and serologic tests. Xew type X-ray equipment permits the processing of films in about one-third of the former time. ENTOMOLOGY AND SANITATION PROGRAMS Action was completed to remove the following States from the yellow fever receptive area : Arizona, Xew Mexico, Oklahoma, North Carolina, and the part of Texas west of a line from Del Rio to Wichita Falls. The change was possible because of elimination of Aedes aegypti mosquitoes in these areas. Aedes aegypti control was pursued with vigor and continued suc¬ cess at international traffic points in the yellow fever receptive area in the South, in Puerto Rico, and in the Virgin Islands. A report was published reviewing the insect control problem on aircraft arriving in this country during the past 13 years, with par¬ ticular reference to mosquitoes. Nearly a quarter of a million insects were intercepted during that time, with a yearly average of 19,175. More than 20,000 were mosquitoes, comprising 11 genera and 92 spe¬ cies, including many medically significant and nonindigenous forms. These findings point up the importance of continuing insect control in international traffic. Entomological contributions to human welfare through the Public Health Service were reviewed in another published report, which points out the important role played in the Service’s development by medical entomology and by arthropod-borne diseases such as yellow fever, malaria, typhus, plague, and Rocky Mountain spotted fever. Foreign quarantine is closely concerned with entomology, since the quarantinable diseases except smallpox and cholera are transmitted solely or chiefly by insects, and cholera is sometimes so transmitted. Studies were made on control of insects on aircraft leaving the United States, a procedure of special interest to other countries that have been freed of mosquitoes at great expense. A landmark in United States quarantine operations was reached in 1961 when ship fumigations by quarantine personnel were discon¬ tinued. Commercial facilities are now used for any necessary fumigation. The procedure is seldom required because of general improvement in the world plague situation. This resulted from more extensive ratproofing of ships (an important development in which the United States took the lead), the use of rodent poisons less dan- Public Health Service 197 gerous than fumigation with deadly hydrocyanic acid gas, and more extensive use of rat-trapping practices at sea and in ports. Food sanitation on foreign-flag passenger liners, a program for which the Division of Foreign Quarantine has particular responsi¬ bility, has shown steady improvement. The International Sanitary Regulations, issued by the World Health Organization, require every port and airport to be provided with a supply of pure drinking water. At the request of the Division of Foreign Quarantine, the World Health Organization is asking each country how the water quality is determined. Samples are taken from ships arriving at United States ports. Contamination is oc¬ casionally found, requiring correction. OTHER QUARANTINE ACTIVITIES The Surgeon General removed Cuba from the list of quarantine- exempt areas in January 1961 because the Public Health Service no longer had direct access to health information in Cuba. The Miami area staff faced the problem of inspecting Cuban refu¬ gees landing at numerous points. Many arrived in small boats, which often failed to reach shore under their own power; persons were picked up by other vessels, or the boats were towed in by the Coast Guard. Immigration officers helped arrange for refugees to receive inspection and vaccination by quarantine officers. One person being treated for sunburn was X-rayed by the Refugee Center and found to have far advanced tuberculosis. A small boat carrying several starv¬ ing refugees came to the Miami quarantine station dock; they were given food and water by a quarantine inspector living on the station. A survey was made among sample groups of travelers arriving in the United States by plane to find out the countries they had visited, in addition to the country of emplaning, during the 14 days before arrival. It was found that many passengers had embarked for the United States on planes in uninfected countries but had been travel¬ ing in countries where quarantinable diseases were present. If un- vaccinated, these persons can introduce dangerous diseases into the United States. To expedite international travel and help ensure personal and public health protection, the Public Health Service published a series of popular leaflets giving immunization information for international travel and containing general health hints. Health Services for Indians and Alaska Natives A 12-year-old Navajo boy with acute rheumatic fever has a good chance to grow up and lead a normal life because of the services 198 Department of Health , Education , and Welfare , 1961 available at the PHS Indian hospital opened in Gallup, N. Mex., in March 1961. The pediatric-cardiac clinic at Gallup, where the pediatrician in Shiprock Indian Hospital 93 miles away sent the boy, is one of numerous medical specialties at the new 200-bed, $4 million hospital. The Gallup hospital is a “first” in the Indian health program: the first hospital specifically planned to be a referral and consultative center for difficult medical cases emanating from Indian health facil¬ ities in a surrounding area. The territory served is the 25,000-square- mile Navajo Reservation and the Hopi and Zuni Reservations in Arizona and New Mexico. About 380,000 Indians and Alaska Natives look to the Indian health program for preventive and curative medical services : 337,000 Indians living on or near some 250 Federal reservations in 24 States, mostly west of the Mississippi; and 43,000 Alaska Natives (Aleuts, Indians, and Eskimos) in hundreds of villages in Alaska. Living for the most part in cultural isolation, these peoples for generations have not been exposed to modem medicine, or have resisted it. Social and economic conditions are depressed. The lack of adequate and safe water supply, overcrowded, substandard housing and dietary deficiencies, and the lack of opportunity to learn or practice rudimentary personal hygiene and community health pro¬ tection have contributed to their poor health and high death rate. Preventable diseases generally under control in the rest of the population still account for most of their illnesses and about a sixth of the deaths. Their mortality from these diseases — gastroenteritis, tuberculosis, respiratory infections (especially among babies), and the like — is from two to six times greater than for the rest of the Nation. In spite of an improving picture, the infant death rate remains high — almost twice that of other Americans. This is the major factor in the early average age at time of death — 41 compared with 62 for the general population. MEDICAL FACILITIES Medical facilities are located as close as practicable to the widely scattered communities. In 1961, the Division of Indian Health had in operation 52 hospitals, 22 health centers, 18 school health centers, and several hundred field stations. Where the Division does not have facilities, it provides medical and dental care through contract arrangements. Contracts were in effect in 1961 with 183 hospitals, 115 dentists, 281 physicians and clinics including local and State health and welfare departments, and 22 other specialists. In addition, to provide public health services where the Division has no facilities, 18 contracts were in effect between the 199 Public Health Service Division and state health departments and county boards of super¬ visors in 14 States including Alaska. An additional means of providing hospitalization under contract is by participating financially in the construction of community hospi¬ tals serving both Indians and the general population, under Public Law 85-151. Since the law was enacted in 1957, PHS has partici¬ pated in 13 community hospital projects for a total of 100 beds for Indians and Alaska Natives. Eight projects have been completed in five States; four projects in four States are under construction; and one project will be started as soon as the contract is awarded. Because of the leadership of tribal governing groups and the educa¬ tional efforts of the Public Health Service, greater use is being made of available medical care facilities. Since 1956, admissions to PHS Indian hospitals and contract hospitals have increased 30 percent. In 1961 there were nearly 76,000 admissions. Some 11,000 Indian babies were born in PHS and contract hospitals. Outpatient visits to the Indian hospitals and their related clinics rose to 686,000 in 1961 — an increase of nearly 27,000 visits over 1960. Visits to PHS health centers and to school health centers totaled 250,000 in 1961. This was a 60-percent increase in 5 years. The village clinic program in Alaska completed its first full year of operation in 1961. Physicians, accompanied by public health nurses or other health workers, conducted regular l-to-3-day clinics in 25 villages and visited 78 other villages en route. Altogether, 194 village clinics were held with 15,696 outpatient visits reported. Some isolated areas utterly lacking in any preventive health services or treatment for acute medical problems were reached for the first time. HEALTH EDUCATION Health education activities of the Division are designed to meet the unique needs of the Indian health program. By 1961 there were 33 members of the health education staff, most of them Indians with college training in education, anthropology, or sociology. Their goal is to create within the Indian people an understanding of the fundamentals of good health and a desire to assume responsibility for improving their own health. Staff members of the health educa¬ tion branch serve as educational consultants to the other branches in the Division. Educational techniques, including use of audiovisual aids, are adapted to the specific goal. THERAPEUTIC SERVICES There was a 7 percent increase in the size of the nursing staff, which reached a total of 1,669. Public health nursing caseloads continued to increase. Plans were made for the advanced training 200 Department of Health , Education , and Welfare, 1961 of Indian practical nurses to qualify them to provide additional assistance to the public health nurses. Pharmacy services continued to improve. Pharmacists were as¬ signed to four additional hospitals so that 84 percent of the patients and 76 percent of those who came for outpatient care were served by hospitals with pharmacies. The number of prescriptions dispensed increased by 39 percent. Social workers of the Division devoted their major efforts to prob¬ lems of children, the aged, the handicapped, the chronically ill. They participated in community planning for care and rehabilitation of the infirm aged. A continuing task is to interpret the changing social needs of the Indians and Alaska Natives to communities and public and private social agencies which share in the responsibility of providing to them the health and welfare services available to other citizens. Growing recognition of the role of nutrition in the promotion of health and prevention of certain diseases resulted in increased emphasis on nutrition education in clinics and in community education programs for adults. Since it takes a long time to change dietary patterns, these efforts were directed toward utilizing the known cultural food practices and available food resources of the group concerned. In some locations, education was provided for Indians in the use of commodity foods supplied by the Department of Agriculture. Cooperative planning was carried on with the Alaska area office of the Bureau of Indian Affairs for improvement of lunches served in Alaska Native day schools. Plans were made to conduct studies in 1962 to obtain information about the level of nutritional health of the Indians. The Medical Records Branch successfully undertook active re¬ cruitment for additional staff and held its first seminar for medical librarians. The seminar stimulated workshops and on-the-job training in the field. IMPROVED HEALTH OF CHILDREN The rate of infant deaths is declining. In 1959, latest year for which figures are available, the mortality rate was 46.8, compared to 56.7 in 1958. Of all Indian deaths reported in 1959, 21 percent were infant deaths, compared with 24 percent in 1958. Although the loss of babies aged 28 days through 11 months is still about 3 y2 times that for all babies in the general population (excluding Alaska), the decline in infant mortality rate between 1958 and 1959 was about 23 percent. Among Alaska Natives, infant death rates are almost twice the death rates of Indian babies in the continental United States. In an effort to save more babies from illness and death, various studies Public Health Service 201 on causes of infant morbidity and mortality and means of preventing them were begun in 1961, and ten additional physicians and nurses on the maternal and child health staff were assigned to health facilities. In the school health program, the Division continued to maintain close relations with the Bureau of Indian Affairs, especially in the treatment of mental and emotional problems of children and youth. A joint mental health demonstration project at the Flandreau Indian Vocational High School in South Dakota (in which the National Institute of Mental Health also participates) was continued, and there was evidence that its influence was reaching into the home communities of the students. Indian communities and other Indian schools requested assistance with mental health problems. A school health study made in the Oklahoma City area was com¬ pleted, and implementation of the study was begun in July 1961. A major health problem among school children is otitis media. Also needing emphasis are preventive services in the field of mental health and early diagnosis of tuberculosis. TUBERCULOSIS CONTROL Tuberculosis morbidity and mortality rates continued their down¬ ward trend. The rate of new cases reported among Indians has de¬ clined 48 percent in the 6 years since 1955, while the decline among Alaska Natives was about 76 percent in the same period. The death rates in 1959 were 31.1 per 100,000 Indians and 55.4 per 100,000 Alaska Natives — a reduction of 37 percent and 65 percent, respec¬ tively, since 1955. Despite improvement, the rate of death (exclud¬ ing Alaska) was still 4^ times higher than found in the general population. Accidents have replaced tuberculosis as the leading cause of death among Indians, with a rate from three to 3% times greater than for the rest of the Nation. Tuberculosis now ranks seventh as a cause of death. In 1961 the daily hospital census of tuberculosis patients was 720, which accounted for approximately 24 percent of the total daily cen¬ sus. In 1955 the number of tuberculosis patients in the hospitals was about 58 percent of the total. The decrease has been due to many factors: shorter length of hospital stays, outpatient treatment of tuberculosis, the chemotherapy program, and the drop in new cases of the disease. DENTAL HEALTH The goal of the dental program is to bring the Indians and Alaska Natives to a maintenance level of dental care. Visits to dentists in 626936—62 - 14 202 Department of Health, Education, and Welfare, 1961 1961 numbered 170,045, an increase of nearly 7 percent over 1960. Major emphasis was placed on services to preschool and school chil¬ dren, with close attention to preventive measures. Emergency treat¬ ment was given patients of all ages. Topical fluoride treatments were given to 15,861 children, an increase of 32 percent over the previous year. Dental health education was strongly stressed. The unmet needs in dentistry are vast : with available resources the Division was able to meet only half the dental requirements of the 22.1 percent of the beneficiary population examined in 1961. In an attempt to increase the amount of dental services given, the Intermountain School in Brigham City, Utah, began evaluation of a new type of dental equipment. A training program in efficient clinic management was started for dental officers and their assistants. Eighteen young Indian and Alaska native women were trained as dental assistants for assignment in the program. ENVIRONMENTAL SANITATION Better environmental sanitation is basic to improved health among the people served. Their water supplies are often polluted and usually inadequate for domestic use, and frequently must be hauled for great distances. Waste disposal is often primitive. Public Law 86-121, passed by Congress in 1959, authorized PHS to aid Indians and Alaska natives in building domestic and community sanitation facili¬ ties. In 1961 the appropriation of some $2 y2 million made possible the construction of 58 water supply and waste disposal projects to benefit about 5,000 families. These sanitation facilities are located on 34 reservations in 15 States and on nonreservation areas in Alaska and Oklahoma. The Indian people participated in the projects through contributions of funds, labor, equipment, and material totaling more than $P/2 million, and they will operate and maintain the facilities when finished. Seven engineering investigations were started on fu¬ ture projects. Environmental sanitation personnel have a prominent role in pre¬ ventive health education. Through their efforts, families and groups were motivated to improve or install 1,919 drinking water sources, 913 water storage facilities, and 2,799 waste disposal facilities. Tribal governing bodies have shown increased interest in adopting sanitary codes for Indian reservations. The Division continued support of special studies at the P HS Arctic Health Research Center in Anchorage, Alaska, on practicable facili¬ ties for water supply and waste disposal in native villages, and on improving methods of curing fish and protecting food. Public Health Service 203 TRAINING FOR INDIANS AND ALASKA NATIVES Formal courses and inservice training were provided for Indians and Alaska natives who are employed in the Indian health program. Some 83 young women were trained as practical nurses in the schools conducted by the PHS at Albuquerque, N. Mex., and Mount Edge- cumbe, Alaska, during 1961. The Mount Edgecumbe program ended in the spring of 1961 because similar training was to become available in the fall through the Anchorage public school system. Courses for sanitarian aides, dental assistants, and community health workers were given at various locations. More than half the employees of the Division are of Indian heritage. CONSTRUCTION New Indian hospitals were opened in Sells, Ariz., on January 17, 1961, and in Gallup, N. Mex., on March 24, 1961. The Sells hospital, a general medical and surgical hospital of 50 beds, replaces a hospital destroyed by tire in 1947. The Gallup hospital is a 200-bed regional referral and medical center. A new 50-bed hospital in Kotzebue, Alaska, and a hospital of 38 beds in Kearns Canyon, Ariz., were nearing completion at the end of the fiscal year. Also under way were five health clinics in Ponemah, Minn. ; in Pryor, Mont. ; and in La Plant, Wakpala, and Norris, S. Dak. Major modernizations of four hospitals were completed at Rosebud and Pine Ridge, S. Dak. ; Browning, Mont. ; and Whiteriver, Ariz. Contracts were awarded for a new 36-bed hospital at San Carlos, Ariz., and for new extensions to the Indian hospitals in Cass Lake, Minn., and Fort Defiance, Ariz. On the drawing board were plans for a new 12-bed field hospital, storage and living quarters in Barrow, Alaska; a new 25-bed wing for the Red Lake, Minn., hospital ; and a new outpatient wing and altera¬ tions at the hospital in Bethel, Alaska. New housing for health personnel of the Division included comple¬ tion of 47 units in connection with the Gallup and Sells hospitals, procurement of 14 mobile trailer quarters units for nine locations, and progress in construction of 118 other housing units at various locations. Medical Services for Federal Agencies The medical services of the U.S. Coast Guard and the Federal Bureau of Prisons are legal responsibilities of the Public Health Serv¬ ice and are operated by Bureau of Medical Services personnel assigned to these agencies. The medical programs of the Bureau of Employees’ Compensation of the Department of Labor and the Maritime Admin- 204 Department of Health, Education, and Welfare, 1961 istration of the Department of Commerce are conducted by personnel detailed to these agencies. UNITED STATES COAST GUARD, TREASURY DEPARTMENT Physicians were assigned to Coast Guard vessels on ocean weather duty in the Atlantic and Pacific ; medical and dental officers were as¬ signed to the Bering Sea Patrol and to icebreakers engaged in special operations in the Arctic and Antarctic; and various professional offi¬ cers were on duty at U.S. shore stations. In all, 101 PHS officers served the Coast Guard — 33 physicians, 52 dentists, 12 nurses, a phar¬ macist, a dietitian, a scientist, and a sanitary engineer. At sea, medical officers often were called on to diagnose and prescribe treatment by radio for illnesses aboard merchant ships and fishing boats that had no physicians. Sometimes it was necessary to rendez¬ vous at sea and bring the patient to the Coast Guard ship by small boat. An emergency of this kind arose in the North Atlantic during stormy weather in March 1961. A seaman aboard the Norwegian vessel APPIAN sustained severe burns covering 35 percent of his body. In spite of rough weather and seasickness, he was brought aboard the cutter OWASCO and given medical treatment, then was taken to the naval hospital in Argentia, Newfoundland. The man was considered in remarkably good condition when he reached the hospital. The medical officer was credited with saving his life. BUREAU OF PRISONS, DEPARTMENT OF JUSTICE The Public Health Service provided medical, psychological, dental, nursing, and related health services for 24,000 prisoners in the Federal institutions. The Medical Service operated 22 hospitals and 8 infirm¬ aries in the institutions. Fifteen of the hospitals are fully accredited by the Joint Commission on Accreditation of Hospitals. The 275 full-time PHS staff members assigned to the health program were augmented by 250 consultants in various medical specialties. About 900 prisoners assigned to the medical services received training and assisted with hospital care. The average daily population of the Federal prisons was 949 greater in 1961 than in the previous year. The hospitals provided a total of 416,149 hospital relief days in 1961. Medical staffs performed 865 major operations and 5,594 minor operations and gave 30,387 physical examinations. Outpatient departments gave 957,730 treatments. The two institutions for women reported 24 births. Deaths in all institu¬ tions totaled 49. Increasing demands for psychiatric diagnostic and treatment serv¬ ices, which are required under the provisions of the Youth Corrections Act, the New Sentencing Act, and the act providing for the care and Public Health Service 205 custody of insane persons charged with or convicted of offenses against the United States, were met by assigning additional psychiatrists and psychologists to operating programs, and by appointing additional consultants in these specialities. By giving special training to other staff members, these specialists are making important contributions to the treatment programs. Planning for a new 600-bed psychiatric facility for mentally ill Federal offenders was continued. A new dispensary building was opened at the prison camp in Safford, Ariz. The dispensary at the prison camp in Florence, Ariz., was modernized and redecorated. Modernization of the operating room at the Federal Correctional Institution, Terminal Island, Calif., was completed. A new anesthesia machine and two electrosurgical units were obtained for the Medical Center for Federal Prisoners in Springfield, Mo. Program Highlights Clinical 'psychiatry . — At the Medical Center and at several other institutions, the medical staffs continued their efforts to extend diag¬ nostic and treatment services to prisoners with mental illnesses. The staffs at the reformatory for women in Alderson, W. Va. ; the correctional institution on Terminal Island, and the reformatory in Chillicothe, Ohio, were augmented by the addition of psychiatric consultants. At the prison camp in Tucson, Ariz., which houses youthful offenders, the psychiatric consultant continued to develop a mental hygiene program. At all these institutions, the psychiatrists continued to use the newer psychopharmacologic agents as well as group and milieu therapy. Clinical psychology. — A training program for psychologists who are interested in the correctional field was begun at Chillicothe under auspices of the Bureau of Prisons, the Veterans Administration, and Ohio State University. The addition of a consultant psychologist to the Alderson staff made it possible to start a program of treating prisoners and training personnel. The psychologists at several insti¬ tutions played a leading role in efforts to train personnel in under¬ standing and handling behavior problems. Group work. — A number of staffs made continued use of group techniques both in treatment and training. At the correctional in¬ stitution in La Tuna, Tex., a group treatment program was imple¬ mented for certain narcotic addicts. At Lompoc, Calif., the group approach was used with addicts and homosexuals. The Medical Cen¬ ter continued to use a team approach with meetings of ward per¬ sonnel to consider most effective ways of handling patient problems. Medical , dental , and technical services. — Several units including the correctional institution in Tallahassee, Fla., endeavored to increase 206 Department of Health , Education , and Welfare , 1961 the effectiveness of their outpatient departments in the face of per¬ sonnel and space shortages. Medical staffs continued to make spe¬ cial efforts to help prisoners with such problems as obesity, hyper¬ tension, diabetes, tuberculosis, and acne and other disfiguring con¬ ditions. At the Detention Headquarters in New York, the program for denarcoticization of addicts continued to operate successfully. Dental services at all institutions were continued at a high level. The central dental laboratory at the Medical Center in Springfield com¬ pleted 2,617 dental prosthetic appliances. Many of the medical staffs have developed training programs to give prisoners skills in the medical technical fields, which will facili¬ tate their future adjustment in the community. For example, a prisoner trained at the correctional institution in Seagoville, Texas, successfully qualified for registration as a radiologic technologist. Upon release he was employed as chief laboratory and X-ray tech¬ nician in a large State hospital. Research . — Medical staffs of six institutions helped to select pris¬ oner volunteers for participation in a cold virus study which is being conducted at the Clinical Center, National Institutes of Health. The Alderson staff took part in an evaluation of a vaccine against infant diarrhea. The staff of the penitentiary on McNeil Island, Wash., assisted in a study of muscle tone, the findings of which will be ap¬ plicable in space travel. Malaria studies were continued at Atlanta. At Leavenworth the staff continued a follow-up study of narcotic addicts. At the correctional institution in Milan, Mich., the staff participated in a study to devise an improved test for glucose tolerance. Participation in community affairs. — Several staffs cooperated with state tuberculosis case-finding programs. Many formed excellent co¬ operative relationships with other nearby government activities. The medical department of the camp in Tucson gave assistance to persons injured in highway accidents. Prisoners donated 14,765 pints of blood to the American Red Cross and local blood banks during the year. BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR A Government employee was severely injured by electrical burns in May 1960 when a crane came in contact with a high-tension wire while he was helping to unload a 20-ton transformer. He lost his legs and his right arm. His left arm was disabled. Through closely coordinated physical and vocational rehabilitation services brought to the aid of the injured worker by the Bureau of Employees’ Compensation and cooperating agencies, he learned to walk again with artificial legs, to write, and to do other things, and he was trained for a new job as a radio dispatcher. Public Health Service 207 The case illustrates the increasing emphasis the Bureau of Em¬ ployees’ Compensation gave in 1961 to the rehabilitation of Federal employees who were injured or became ill in line of duty. Medical officers of the Public Health Service assigned to the Bureau are responsible for the medical program under the Federal Employees’ Compensation Act and related acts. About half of this work is carried on in Washington headquarters, the rest in district offices in New York, Boston, Chicago, and San Francisco. Increased utilization was made of Federal medical establishments, notably those of the U.S. Air Force. Outpatient and hospital facili¬ ties of the Public Health Service provided direct medical care and assistance in evaluation of patients’ work capabilities. In physical and vocational rehabilitation, the services of many facilities through¬ out the United States were used. Particular attention was given to rehabilitation of employees disabled because of a mental or psycho¬ neurotic condition. MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE The physician and two dental officers on duty at the U.S. Merchant Marine Academy, Kings Point, N.Y., provided health care for the 700 cadet midshipmen and 216 staff members, and the medical officer in charge of the Public Health Service hospital on Staten Island acted as professional consultant for the academy’s health program. There were 570 admissions to the academy’s Patten Hospital. Out¬ patient medical treatments and services numbered 2,660 ; dental visits, 4,060. The North Shore Hospital, a community hospital in Man- hasset, N.Y., provided emergency medical care for cadets when necessary. In Washington, the Service physician detailed as Chief Medical Officer of the Maritime Administration revised the standardized list of medical supplies and equipment for sickbays and emergency rooms of the Reserve Fleet; advised on overcoming an occupational hazard the Reserve Fleet encountered at Olympia, Wash., in the form of exposure to chlorine dioxide gas resulting from measures against incrustation on hulls of ships; advised on use of resuscitubes in first aid ; and helped with preparation of clinical abstracts. National Institutes of Health The scope of the various programs of the National Institutes of Health continued to expand during fiscal year 1961. This growth took place principally in the extramural programs and was accom¬ panied by necessary increases in NIH staff, and by reorganization and 208 Department of Health , Education , and Welfare , 1961 expansion at top management levels. Expenditures on medical re¬ search (including research training) increased by more than a third, reaching a level over five times greater than it was only 5 years ago and representing 40 percent of the total national effort in medical research. A proposal submitted to Congress by President Kennedy during this period would establish a new National Institute for Child Health and Human Development in which would be centered research into perinatal and childhood diseases, on the one hand, and the problems of aging on the other. An Institute of this kind would concentrate on such problems as congenital malformations, infant mortality, men¬ tal retardation, and maternal factors influencing child health and development. The process of aging, under this program, would be considered as a part of the dynamics of human development. NTH physical expansion has been rapid. For the first time in its history, the Division of Biologies Standards is consolidated under one roof. Dedication of the new building for the National Institute of Dental Research occurred in May 1961, and considerable progress was achieved in the construction of the new surgical wing of the Clinical Center and in the new Administration Building, which will house the several Institute grants programs and the six Institute Directors and their immediate staffs. In the construction planning stage are ( 1 ) a new building to house both the Mental Health and the Neurological Diseases and Blindness Institutes, (2) a new Cancer Institute building, (3) adequate housing facilities to provide for proper control, rigid caretaker practices, and testing procedures in the breeding of specific germ- free animals, (4) research and animal facilities at the newly acquired animal farm. The long-existing problem of recruiting and retaining high-calibre staff for NIH laboratories was intensified during this period. In one respect, this was a measure of the success of the NIH grant system, for the facilities, research environment, and superior pay which were attracting NIH researchers and research administrators to other institutions often could be ascribed at least in part to NIH grants. Several proposals have been formulated which, if they can be effected, will make it possible to maintain a professional staff of the highest competence in spite of the competitive situation. Criteria for grants and training awards are designed to assure high quality in results. The past year has seen a continuing emphasis on grant support to the basic medical sciences such as biology, genetics, biochemistry, biophysics, and pharmacology, all of which are crucial to medical progress. Biomedical research expenditures, from all sources, would consti¬ tute about 5 percent of the Nation’s total research and development Public Health Service 209 costs. The increased funds made available to NIH makes this agency responsible for 40 percent of the total medical research expenditure in the country. The impact of NIH grants on medical schools, university depart¬ ments, hospitals, and other biomedical research institutions has revealed a need for major program planning that anticipates and measures the cumulative effects on these institutions. For most of the medical schools, university departments, hospitals, and other institutions whose research is supported by NIH grants, these funds now represent a substantial part of their entire income. Time and effort devoted to research at these institutions have greatly increased with increased involvement of faculty and staff. For this reason, planning must henceforth relate not only to the needs of the individual investigator, but also to the cumulative effect on his institution. This new approach will not diminish the importance of the indi¬ vidual research project system. The new concern will be directed, however, to the overall needs of the institutions where the bulk of U.S. biomedical research is conducted. The new planning approach will seek fulfillment of the objectives of medical research without adversely affecting the grant-receiving institutions. Several plans have been proposed for attaining this new objective. All are designed to increase local, non-Federal control over medical research. These plans include the following : (1) Consolidation by universities of many of their smaller existing research projects into larger projects with coherent program objectives. (2) Support of Clinical Research Centers. Such centers, for which special support was begun in 1960, are intended to stimulate growth of additional local resources for complex investigations involving many diseases and the broad spectrum of medical specialties. (3) General Research Support. Such grants to schools of medi¬ cine, osteopathy, dentistry, and public health would be in proportion to contributions from the institution’s non-Federal research funds, and would permit a degree of initiative not possible under project grants. (4) Research Career Awards. These would provide support for highly qualified individuals who wish to pursue a research career under stable tenure conditions. Final mechanisms had not yet been worked out at the end of the period covered by this report. An important advance in the NIH program of support for research in other countries was the establishment of five International Center? for Medical Research and Training, under the provisions of the Inter¬ national Health Research Act of 1960. These Centers will permit scientists from American universities to work overseas, while retain- 210 Department of Health , Education , and Welfare , 1961 ing an integral relationship with their institutions. Under the pro¬ gram, an American university, in collaboration with a foreign institu¬ tion, establishes a research and training facility in the foreign country, primarily to study health problems common to both the United States and that country. This arrangement provides an opportunity to study such problems under environmental, ethnic and medical condi¬ tions not found in the United States, and also provides a basis for improved international relationships in the health sciences. During this period, Centers have been established by five American universities and their cooperating overseas institutions : University of California, and the Institute for Medical Research, Kuala Lumpur, and University of Malaya, at Singapore ; Tulane University and the Universidad del Valle, Cali, Colombia ; Johns Hopkins University and the All-India Institute of Hygiene, Calcutta School of Tropical Medi¬ cine, Calcutta ; the University of Maryland, and Field Unit, Rawal¬ pindi, West Pakistan; and the Louisiana State University School of Medicine, and the University of Costa Rica School of Medicine. Benefits of international medical activities derive not only from the obvious fact that problems of disease control are world-wide, but also because they make it possible to work effectively with the research talent, resources, and unique investigative settings in other countries. These benefits are being fostered through appropriate international organizations such as World Health Organization, Pan American Health Organization, World Federation of Mental Health, and World Federation of Neurology. Recognizing the importance of such planning, NIH has established the Office of International Research as a staff office of the Office of the Director. This office is responsible for coordinating all interna¬ tional activities of the National Institutes of Health. The office advises the Director and Surgeon General on matters relating to the international aspects of medical research and research training, and assists the Institutes in the development of international programs. It is specifically responsible for the central administration of all NIH activities utilizing U.S. -owned foreign currencies, and constitutes the central point of research relationships with the World Health Organi¬ zation, Pan American Health Organization and other international research and scientific organizations. During this reporting period, the total obligations for NIH inter¬ national activities exceeded $13 million (exclusive of the Foreign Currency Program). There were about 500 international awards for research and training, accounting for approximately $8 million of this. The global distribution of the awards is seen in the countries involved: Australia, Austria, Belgium, Brazil, Canada, Denmark, Eire, England, France, India, Italy, Japan, Mexico, Nigeria, Norway, Public Health Service 211 Scotland, Sweden, Switzerland, and West Germany. The remainder of the total figure included amounts awarded to American institutions for international centers for research and training, for U.S. Fellows studying abroad, for foreign Fellows studying in the United States, and for foreign visiting scientists brought to NIH. The reports that follow on the seven Institutes, the four Divisions, und the Clinical Center provide a closer view of NIH performance during the past year. Institute of Allergy and Infectious Diseases Institute studies during the year added substantially to the under¬ standing of a number of serious childhood illnesses. Results from a wide range of investigations included promising clinical tests of an antistaphylococcal drug and development of a new laboratory study model for a little understood allergic disorder. Respiratory syncytial virus (RS) was associated for the first time with infant pneumonia and other childhood respiratory diseases in a series of studies con¬ ducted at the Institute and Children’s Hospital, D.C. These findings, together with the results of previous Institute studies and findings by other scientists, may explain as much as 60 percent of children’s severe respiratory illnesses and suggest the need of vaccine development. A cooperative epidemiologic investigation by Institute and Navy scientists associated Eaton agent with 68 percent of atypical pneu¬ monia cases at Parris Island Marine Training Center. Their sero¬ logic findings, made during a 6-month period, constitute the most complete evidence presented in 20 years on the association of Eaton agent and atypical (non-bacterial) pneumonia. In a related study, the same group reported successful treatment of Eaton agent pneumonia with a tetracycline drug, thus resolving a decade of controversy regarding the efficacy of such drugs against this type of pneumonia. Institute clinical tests indicate that an antibiotic (still unnamed) developed by Hoffman-LaRoche Chemotherapy Laboratory is effective against certain systemic fungal infections. Several of these constitute extremely destructive diseases which hitherto have proved unrespon¬ sive to drug treatment. A new synthetic penicillin, called Staphcillin, developed jointly by Bristol Laboratories and a British firm, was tested at the Institute and found effective against severe staphylococcal and streptococcal in¬ fections. Difficulty in treatment of the former is usually the result of the emergence of resistant forms of bacteria. In the area of diagnosis, Institute scientists described a test which may make it possible for a single laboratory worker to screen many 212 Department of Health , Education , and Welfare , 1961 more suspects for malaria in a single day than hitherto possible. The new test, based on the fluorescent antibody technique, represents the first recorded instance in which a malaria parasite infecting humans has been viewed by this method. Resistance of human malaria to chloroquine has been definitely demonstrated for the first time by an Institute scientist and an in¬ vestigator from the University of Texas. Chloroquine has been an important adjunct to insecticides in global malaria eradication pro¬ grams since World War II. Allergic thyroiditis has been produced experimentally in a strain of inbred guinea pigs for the first time by Institute scientists. The successful experiment provides a model for study of this form of human thyroid disease which apparently is an autoimmune disorder. GRANT-SUPPORTED RESEARCH Studies leading to the first vaccine of demonstrated effectiveness against measles were supported in part by Institute grant funds. The vaccine, still in the experimental stage, probably will be submitted for Federal licensing in the near future. Studies have shown the vaccine to be easily administered and to cause only mild systemic reaction. A preparation conferring immunity comparable to natural measles is desirable, because of the disease’s significant mortality, fre¬ quency of bacterial complications, occasional involvement of the central nervous system, widespread morbidity of the uncomplicated disease, heightened virulence of outbreaks in isolated populations, and unfavorable effects on certain other pre-existing illnesses. Grantees at the University of Utah have developed a practical method of quantitative urine culture — utilizing equipment commonly employed in dairy bacteriology — that helps diagnose urinary tract infection more quickly and less expensively than do classical methods. Early detection is essential for effective treatment of urinary tract infections. Institute of Arthritis and Metabolic Diseases ARTHRITIS RESEARCH Studies by Institute scientists and grantees on the possibility of an immunologic basis for rheumatoid arthritis have pointed to a rela¬ tionship, in some way, of a number of rheumatic diseases to a hyper¬ sensitivity (“allergy”) to certain compounds in the body of patients, possibly to some of their own altered proteins. This concept of hypersensitivity derives from the discovery, several years ago, of the so-called rheumatoid factor (s) in the blood of many Public Health Service 213 arthritics and their relatives. These factors, whose presence in the blood helps confirm the diagnosis of rheumatoid arthritis, have many antibody characteristics, suggesting that immunologic reactions are involved in their formation. Institute grantees at the Hospital for Special Surgery in New York have reported finding in the blood of these patients still another sub¬ stance, which they have named the “inhibitor of complement fixation,” or ICF. Different from the rheumatoid factor, this substance inhibits processes that normally aid the removal of potentially deleterious items from the body. ICF together wTith the rheumatoid factor may comprise a unique immunologic system characteristic of arthritis and closely related diseases. Follow-up medical and serological examination studies of former Clinical Center patients who have returned to their homes after treatment at the Institute have been made possible by a specially equipped mobile clinic operated by the Institute across most of the country. The rolling laboratory is making possible a careful study of the familial incidence of Sjogren’s syndrome, a disorder related to rheumatoid arthritis. A collaborative study by NIAID and NCI scientists has provided the first definite experimental proof that osteoarthritis, a common joint disorder affecting older people, may be under hereditary control. The study used 1,700 mice and showed that a single gene may have accounted for much of the arthritis in these animals, although other genes and environmental factors also contributed to the condition. Clinical trials at the Institute have demonstrated the usefulness of two new drugs — sulfinpyrazone and zoxazolamine — in problem cases of gout which do not respond to older drugs. The new drugs remove the excess uric acid characteristic of gout. Institute scientists have also found that low doses of aspirin may interfere with the laboratory diagnosis of gout, since aspirin causes an increase in uric- acid blood levels. DIABETES AND OTHER METABOLIC DISEASES The new oral drugs continue to demonstrate their value in the treat¬ ment of diabetes. It now appears much less likely than once feared that these drugs will damage the pancreas. Their value has been enhanced by the work of Institute grantees at Harvard Medical School, Boston, and the Southwestern Medical School, Dallas, demon¬ strating that combinations of the oral drugs can benefit some who are not helped by a single drug alone. This combination therapy has permitted an estimated 35 to 40 percent of all known diabetics to substitute the oral drugs for hypodermic syringes. 214 Department of Health , Education , and Welfare , 1961 To determine how the drugs will affect the complications of diabetes that appear only after many years, Institute scientists are collabo¬ rating with a group of medical centers throughout the country in a long-term study to compare the effects on such complications of dif¬ ferent forms of diabetes therapy, including insulin, diet, the oral drugs, and various combinations of these. New findings were reported on the unusually high resistance to insulin of some patients, who, consequently, require many times the normal amount of insulin. In the blood of some of such diabetics, Institute studies have shown insulin antagonists even before they receive insulin injections. This supports the long-held view that insulin resistance, or interference with effective insulin concentration j to peripheral tissues, rather than the body’s inability to produce insulin, may be a factor in many cases of diabetes. In several other serious yet less-known metabolic diseases, Insti¬ tute-supported investigators reported encouraging advances. For Wilson’s disease, a grave disorder with abnormal accumulations of copper in the body, grantees have developed a basic regimen (copper- poor diet and administration of a metal-binding agent) that has brought definite improvement and may prevent the disease. For phenylketonuria, an inborn error of metabolism whose most disastrous consequence is severe mental retardation, a special low phenylalanine diet has been developed, which, if started soon after birth, appears to prevent the characteristic mental damage. BASIC RESEARCH Two research findings made this year may lead to a better under¬ standing of the basic functioning of hormones and enzy es. Grantees at the University of Pittsburgh, culminating 17 years of research, have achieved the first successful laboratory synthesis of pituitary ACTH (adrenocorticotropic hormone). The synthesis may clarify the functions of the pituitary gland and lead to new laboratory techniques for producing other important hormones — those “chemical messengers” whose influence is well-known, but not their mode of operation. Institute scientists have recently discovered that certain adrenal hormones can directly affect the action of a key enzyme within many cells by splitting its molecules into four parts. This is the first time a hormone has been found to influence an enzyme’s vital chemical activities by a direct effect on its physical structure. Other developments in basic research include the finding by the Institute’s Program on Geographic Medicine and Genetics that in¬ herited serum proteins called haptoglobins may be linked with various diseases. Studies have been planned in an attempt to iso- Public Health Service 215 late the different haptoglobin types and to confirm previous findings that haptoglobin concentration rises in different diseases. Cancer Institute Mounting emphasis was placed on research in the relationship be¬ tween viruses and human cancer. A critical stumbling block was the acutely limited supply of research materials and equipment for virus- cancer investigators. To remedy these deficiencies, The Institute has awarded a number of grants and contracts to nongovernmental in¬ stitutions for development of (1) pure virus strains and their diag¬ nostic agents; (2) laboratory animals whose normal complement of viruses has been characterized; (3) certified lines of mammalian cells for use in tissue-culture studies of viruses suspected of causing cancer; and (4) laboratory equipment, such as a small-scale liquid nitrogen refrigerator for handling viral materials. The Cancer Chemotherapy National Service Center is concerned with discovery, development, and clinical application of effective, perhaps curative, anticancer drugs. Program adjustments resulted in a slight reduction in the number of new materials accepted for evaluation and a corresponding increase in the volume of research on agents already proved active by laboratory tests. The number of drugs evaluated against human cancer under the chemotherapy pro¬ gram rose within the year from about 110 to more than 160, and the total number of participating patients reached 18,500. INSTITUTE RESEARCH Most dramatic, perhaps, was the achievement of 5-year survivals with no evidence of disease in a small number of patients with uterine choriocarcinoma, a rare and highly fatal tumor that develops during pregnancy. Sixty-three patients have been treated with the anti¬ cancer drug, methotrexate, widely employed in the management of acute leukemia. Fourteen of the women also received a newer drug, vinblastine, administered when methotrexate-resistance developed. In 30 patients, all trace of the disease disappeared, including meta¬ static lesions in the lungs and brain. A few of the women have now remained in apparent perfect health for 5 years or longer, the first report of such survivals produced by chemotherapy alone. Beneficial results were reported from the use of a new agent — o,p’-DDD — in patients with advanced adrenal cancer. The drug is of special interest because it seemingly is specific for adrenal cortex tissue and for malignancies that arise there. In 7 of 18 treated patients, tumor meta stases were measurably reduced, and in 7 others 216 Department of Health , Education , and Welfare , 1961 lowered amounts of hormone excretion indicated an antitumor effect. These results could be attributed entirely to the action of the drug, since spontaneous remission is unknown in adrenal cancer. Collaborating scientists of the Institute and the Division of Biologies Standards described a method for obtaining relatively large quantities of platelet-rich plasma from a single blood donor. Platelets are essential for blood clotting and therefore often urgently needed to control hemorrhage, one of the chief causes of death in leukemia patients. The new technique permits separation of plasma from the red blood cells, which are then immediately returned to the donor. In this way a single donor may contribute all the plasma needed by one leukemia patient. Furthermore, by reducing the number of donors, the risk of communicating infectious hepatitis is lowered. An Institute scientist reported the results of further studies of a j virus that induces leukemia in several strains of laboratory mice. The virus may be passed from one generation to the next through the placenta, an observation that may shed some light on the possible transmission of other leukemia viruses, theoretically including a human leukemia virus. Staff scientists working with investigators at the National Naval Medical Center adapted human epidermal cells to growth in a medium free of blood serum. Since serum may contain substances that inhibit the growth of viruses, the new medium may prove valuable in tissue-culture studies designed to detect or grow viruses suspected of causing human cancer. The Cancer Chemotherapy National Service Center reported new findings on survival rates of cancer patients by sex. Among patients treated surgically for localized lung cancer, women have a 5-year j survival rate double that of men. Differences in favor of women were also reported for cancer of the thyroid gland, tongue, and salivary gland, for skin melanoma and for Hodgkin’s Disease. The precise reasons for the superior performance of women are not known. GRANT-SUPPORTED RESEARCH Scientists working under an Institute grant reported results of a study of combination surgery and chemotherapy in the treatment of breast cancer, the leading cause of death from malignant disease in women. One hundred and seven patients were selected for radical mastectomy. Of these, 57 also received thio-TEPA on the day of operation and on the 2 following days. The remainder received no drug treatment. While half of the latter group showed tumor re¬ currence within 2 years, about 80 percent of the drug-treated patients remained free of recurrent disease during the same period. These results suggested a possible method of treatment for breast cancer Public Health Service 217 that may afford better control of this disease than is now ordinarily possible. An Institute grantee observed that 54 percent of rats surviving an acute hemolytic anemia acquired immunity to six different trans¬ plantable tumors. In others that did not completely resist tumor transplants, the neoplasm was found to be slow-growing and encap¬ sulated. Further efforts are in progress to determine the nature of the immunization process, since research of this kind may lead eventually to the discovery of similar phenomena in man. Testosterone, a male sex hormone, has been used for many years for the temporary control of certain types of advanced breast cancer. This agent, however, produces undesirable masculinizing effects. In grant-supported clinical trials of a related compound, scientists found that delta-one-testololactone was about as effective as the older agent but entirely devoid of virilizing properties. Studies of this and other related agents are continuing under auspices of the Chemotherapy Center. Grantees using a specially designed chamber to study the effects of cigarette smoke on bits of lung tissue reported the observation of a three-phase response. First, there was an immediate increase in the flow of mucus that normally covers this tissue. Next, they ob¬ served a sharp decrease of about 16 minutes’ duration. Finally, a 30-minute recover}7 period was seen. These findings led to specula¬ tion that lung cancer may result from the physical irritation caused by smoke products as well as other environmental irritants, and not specifically from cancer-producing chemicals in the smoke. Institute of Dental Research Dental research expanded in such areas as calcification, growth of development of teeth and their supporting structures, experi¬ mental dental caries, enzymatic changes in oral connective tissue, and epidemiology of oral diseases as related particularly to nutrition and genetic factors. In explaining the wide variations in the pattern of experimental tooth decay in rodents, many investigators have traditionally class¬ ified animals into resistant and susceptible strains. Recent studies by Institute scientists have shown that experimental dental decay is primarily a bacterial disease, and that many of the differences in type of decay previously attributed to hereditary factors, now may be related to the presence of specific microorganisms which can be transmitted from animal to animal. The pathogenicity of these microorganisms, however, depends upon the type of diet available and the animal’s heredity. 626936—62 - 15 218 Department of Health, Education, and Welfare, 1961 With information available on the origin of dental decay in certain animals, investigators undertook a systematic search for chemical agents that inhibit specific microorganisms. Three clinical com¬ pounds, already tested, have noticeably reduced animal caries by altering the normal growth process of various oral bacteria. In other biochemical studies dental decay in animals has been substan¬ tially reduced by adding certain mineral phosphates to the diet. Al¬ though the precise action of the phosphate compounds is still obscure, it is believed that some local inhibitory reaction may occur on the exposed surfaces of the teeth. Better understanding of the causal role of prenatal factors in various oral diseases was achieved during the year. In one investi¬ gation, pregnant rats, rendered acidotic by exposure to relatively high concentrations of carbon dioxide during the earlier stages of pregnancy, delivered offspring that developed a marked degree of dental caries. On the other hand, acidosis induced during the last trimester of pregnancy did not alter the caries susceptibility of the mother’s young. Other similar studies were directed toward a better understanding of the mechanism of cleft palate formation ; causal rela¬ tionships were established with maternal- fetal anoxia, and amniotic- sac compression. GRANTS AND AWARDS New research project grants were awarded in support of funda¬ mental studies in the various clinical and basic sciences of primary importance to dentistry. For example, invertebrate organisms, used as material for the investigation of the calcification mechanism, are being studied by grantees at Duke University. These materials offer a variety of experimental approaches not afforded by mammalian calcification systems. Grantees at Harvard University have com¬ pleted detailed histologic studies that identify the stages of pro¬ gression of periodontal disease in the rice rat, and relate the high susceptibility of these animals to this disease to genetic factors. Additional grants were awarded to non-Federal institutions to train clinical and basic science personnel for research work. Also, a new program was established to train under-graduate dental stu¬ dents to work with chairside assistants. Heart Institute Cardiovascular disease, the Nation’s leading cause of death, now takes 900,000 lives a year. The National Heart Institute strength¬ ened its programs for the conduct and support of research on this major disease problem. Public Health Service 219 Atherosclerosis, the form of hardening of the arteries that leads to heart attacks and strokes, is characterized by deposits of fatty materials in the vessel walls which progressively reduce the channels through which blood flows to vital organs. Much evidence has ac¬ cumulated linking these artery-clogging lesions with high levels of fatty substances, particularly cholesterol, in the blood. The amount and kinds of fat in the diet can influence the blood cholesterol level and may retard or accelerate formation of these lesions. Their under¬ lying causes, however, appear to lie somewhere in the complex process by which fats are transported, synthesized, stored, and broken down by the body — an area of major research emphasis in the Heart Institute. One approach to the control of high blood-cholesterol levels has been based on the body’s ready manufacture of cholesterol, and an intensive search has been underway in recent years for nontoxic drugs that interfere with this production. Study of one such compound by Heart Institute scientists has shown that it lowers blood-cholesterol levels by blocking the last step in the chemical sequence by which the body synthesizes cholesterol. It was found, however, that the fall in cholesterol in patients treated with the drug was accompanied by a rise in desmosterol (whose long-term biological effects are as yet un¬ known), the precursor of cholesterol, so that the total of sterols in the blood was not greatly changed. Another investigation seeks blockade of an earlier step in the synthesis of cholesterol — one far enough down so as not to interfere with other metabolic needs for the same inter¬ mediate compounds, but early enough to avoid sterol accumulations. Preliminary studies have shown that several compounds can block this step, but their effects have not yet been evaluated. Significant knowledge was gained from other studies of fat trans¬ port and metabolism. Findings of one study indicated that the inter¬ play of the rates of deposit and renuwal of cholesterol from the artery wall may be a major factor in development of atherosclerosis. Another study showed that the liver is the source of the protein as well as the lipid fraction of lipoprotein molecules, the form in which fats are transported in the blood. In the field of hypertension, because many drugs which alter the metabolism of amines also effectively lower blood pressure, much research was directed at obtaining more complete knowledge of the processes of amine metabolism. One promising family of compounds given clinical trials at the Heart Institute, known as decarboxylase in¬ hibitors, inhibit the synthesis of several amines, including norepineph¬ rine and serotonin. The compounds appear promising both as research tools in hypertension and as therapeutic drugs for treating the condition. 220 Department of Health, Education , and Welfare, 1961 Another family of enzyme inhibitors studied were compounds that block the action of monoamine oxidase, an enzyme that plays an important role not only in hypertension but also in mental disorders. Several of these compounds were found to be powerful blood-pressure lowering agents but were too toxic for therapeutic use. A new com¬ pound with a markedly different chemical structure appeared, from limited clinical trials, effective in lowering blood pressure and, thus far, to be largely free of toxic effects. Findings from epidemiological studies, such as those reported from 6 years of follow-up in the Heart Institute’s Framingham (Mass.) study, are helping to describe the “coronary prone” individual. It was found that the risk of developing coronary heart disease for men 40 to 60 years of age is almost three times as great for those who have either a high blood-cholesterol level, high blood pressure, or an en¬ larged left ventricle as it is for those who are normal in these respects. Combinations of any two or all three of the abnormalities further in¬ creased the risk. Excessive quantities of aldosterone, a hormone from the adrenal glands, are secreted in congestive heart failure and other diseases, contributing to the excessive water retention or edema that frequently accompanies them. Heart Institute studies have shown that aldosterone production and secretion are controlled by another hor¬ mone, a mysterious substance called the aldosterone-stimulating hormone. Strong evidence was also provided that the hormone is produced by the kidney. The discovery was made in physiological studies that there are reflexes, originating in the carotid sinus — the dilated portion of the carotid artery in the neck — which control the force with which the receiving chambers of the heart pump blood into the ventricles, thus importantly affecting the heart’s performance and output. Further studies showed that the carotid sinus also affects the circulation by constricting or dilating the veins and by modifying bloodflow through the kidneys. Advances were made in developing and refining techniques and pro¬ cedures for more precise diagnosis of congenital and acquired heart defects. Several procedures have now been shown by clinical studies to be highly reliable means for detecting, localizing, and estimating the size of abnormal openings in the partition separating the left and right sides of the heart. These include techniques utilizing radio¬ active krypton, ascorbic acid, and cold saline solution as indicators. Among the year’s productive efforts were those directed toward development of improved artificial heart valves and synthetic replace¬ ments for severely diseased artery segments and surgical procedures for installing them. One important aspect of these studies has been Public Health Service 22 the evaluation of synthetic materials, particularly those properties of a specific material which might either promote or inhibit the forma¬ tion of blood clots. Institute studies showed that the relative tendency with respect to clot formation was determined more by the chemical nature of the surface of the material than by its wettability or electri¬ cal charge. GRANT-SUPPORTED RESEARCH A new method of closed-chest cardiac massage to restore blood flow in patients whose hearts have stopped beating was reported by scientists of Johns Hopkins University. The operator places both hands, one above the other, on the patient’s breastbone and presses vertically downward once a second. The method is an important advance in emergency treatment since, unlike direct cardiac massage, it does not require surgical exposure of the heart and can be used any¬ where the need arises. Various aspects of the interrelationship of dietary factors and atherosclerosis were studied. Experiments with nibbling and meal¬ eating chickens at Michael Reese Hospital and Medical Center, Chi¬ cago, led to the conclusion that consuming food at periodic mealtimes may play a significant role in atherosclerosis. Chickens fed regular meals had much higher cholesterol levels and developed much more severe coronary atherosclerosis than chickens allowed free access to the same kind of food, even though the meal-eaters consumed less. Findings reported by scientists of the Veterans’ Administration Center, Martinsburg, W. Va., and George Washington University suggest that arachidonic acid — a highly unsaturated fatty acid found in certain fish oils, dairy products, and fowl — may be a significant factor in the relative immunity to atherosclerosis enjoyed by animals of certain species. Cholesterol fractions of serum from eight species were analyzed and compared. The arachidonic acid content was found to be highest in those species most resistant to atherosclerosis and lowest in the most susceptible species. A technique using a cardiac catheter to inject the clot-dissolving enzyme fibrinolysin into the coronary arteries of heart- attack patients was reported by investigators at the University of Miami. The pro¬ cedure, which was well-tolerated by the patients, assures high concen¬ trations of enzyme at the site of the obstructing blood clot. It also allows intermittent injections which appear to be more effective in dissolving clots than is continuous flow. Encouraging progress was made toward overcoming the problem of rejection of foreign tissues by the body. The first successful kidney transplant between nonidentical twins was reported by scientists of Peter Bent Brigham Hospital and Harvard Medical School in Boston. 222 Department of Health , Education, and Welfare, 1961 Irradiation of the whole body was used to modify the recipient’s immune response which would otherwise have caused rejection of the grafted kidney. Institute of Mental Health All aspects of mental-health activity — from basic and clinical re¬ search and training to the application of research findings in behalf of prevention, patient care, and rehabilitation — were covered by the Institute program. Special emphasis was placed on demonstration projects employing new and improved therapies, including an ever- expanding list of psychopharmacological agents. These, plus new techniques both in and out of the mental hospital, and the development of new mental-health programs and treatment facilities, are gradu¬ ally reducing the number who must be institutionalized in public mental hospitals. This steady advance in treatment and control of mental illness was reflected in the decline, for the fifth consecutive year, of the resident mental hospital population. GRANT-SUPPORTED RESEARCH The complexities of mental-health research demand a diversified approach. Thus, the more than 1,200 grants that were made to quali¬ fied researchers during this period spanned the medical, biological, psychological, and social sciences. Seeking clues to the etiology, pre¬ vention, and treatment of mental illness, these researchers examined the body’s chemistry as well as the quality of a mother-child relation¬ ship; the mechanisms of the brain as well as the social structure of the community; the effects of psychoactive drugs as well as those of the hospital environment and the patient-physician relationship. More than a third of the research-grant program was concerned with schizophrenia, a major medical and social problem accounting for more than half of all patients hospitalized for mental disorders in the United States. Strong emphasis in recent years has centered on possible biochemical origins of mental disease, particularly schiz¬ ophrenia, and significant findings have pointed to a factor in schizo¬ phrenia that alters the carbohydrate metabolism of red cells. During the past year, by applying pertinent tests to schizophrenic patients and normal volunteers, it was found possible to predict accurately in a highly significant number of cases the presence or absence of schizophrenia. Approximately one-fourth of grant funds went for studies with children — problems of normal growth and development as well as those of mental retardation, schizophrenia, juvenile delinquency. A large number of grants covered various aspects of aging — normal and Public Health Service 223 pathologic — including those assets of aging which might be more fully employed in attaining and holding on to mental health. A major event in the research-grant program was the initiation of two new types of grants — program project and center grants — for the support of broad-based, long-term research activities. Grants from the Psychopharmacology Research Center made it possible to accelerate studies of drugs used in mental illness. In February 1961, a 2-year collaborative study of phenothiazine treat¬ ment of acute schizophrenic psychoses was launched. Additional developments included a program of special grants for early clinical investigation of psychiatric drugs and an abstracting service, Psycho¬ pharmacology Abstracts. BASIC AND CLINICAL RESEARCH Research conducted in the Institute's own laboratories included basic metabolic studies, investigation of brain areas that control impor¬ tant aspects of behavior, and fundamental studies of body chemistry, utilizing psychopharmacological substances as research tools. The intramural program also included a wide variety of studies on child development, patterns of family living, and social interaction. Major research was done on the metabolism of the biogenic amines — neurological substances which appear important in brain activity and transmission of nerve impulses. Increased knowledge of the synthesis, degradation, and distribution of these basic elements prepares the way for comparative studies that may expose to light the hidden sources of mental illness. NIMH scientists investigating the response of free fatty acids to insulin found a reproducible alteration from the norm in a significant number of schizophrenic patients. This investigation is intended to determine to what extent either of these characteristics is basic to a subgroup of schizophrenia. Another investigation underway involves study of the intermediate metabolism of tryptophane. A related study has shown the existence of enzyme systems capable of giving rise to another psychotomimetic agent (dimethyltryptamine), thus raising the possibility that this substance may occur in man, and that variations in its metabolism may be related to certain mental disorders. New biochemical methods were developed to assess emotional as¬ pects of behavior. A series of psychoendocrinological studies was conducted with normal volunteers to trace the relation between en¬ docrine function, normal variation in emotional states, and a variety of psychological stresses, both induced and spontaneous. The findings have helped identify psychological conditions under which adrenal 224 Department of Health , Education, and Welfare, 1961 hormone levels may be diminished, as well as the more familiar distress conditions under which they are elevated. They are signif¬ icant in terms of future attempts to modify detrimental effects of stress. A major 2-year study completed during this period dealt with the behavior of competent adolescents in making the transition from high school to college, with the aim of delineating factors contributing to successful adjustment. Findings from this study are being com¬ pared with those from a related study of severely disturbed college freshmen, in an attempt to discover crucial factors that impair the effectiveness of disturbed students. At the Institute’s Addiction Research Center, Lexington, Ky., re¬ search centered not only on addiction liabilities of new drugs but also on the physiological and psychological characteristics of the addict and post-addict. Special efforts have been devoted to stimu¬ lating effective follow-up programs on discharged addicts; to this end, consultation and information services have been provided for communities, and for professional and lay persons. In an effort to trace the influence of specific drugs, neurophysiological studies were initiated. Because addiction has its roots in neurological character disorders, its investigation contributes substantially to our under¬ standing of many aspects of human behavior. TRAINING The Institute seeks to produce qualified manpower needed for a comprehensive mental health program. The training program has been directed at overcoming the shortage of qualified personnel in all areas of professional activities, including clinical services, teaching, research, consultation and administration. Support for the Institute’s psychiatric training program for gen¬ eral practitioners was extended; grants were made to encourage interdisciplinary training of biological and social scientists; and a new program of research career awards was launched. COMMUNITY SERVICES AND PROGRAM DEVELOPMENT Revolutionary changes in mental hospitals have made possible the return of many more patients to the community, thus increasing the community’s responsibility for care and rehabilitation. The Institute’s Community Services Branch, which aids in mobilizing the resources of state and local mental health programs through consultation and regional representation, encouraged dissemination of research information to states and communities. An expanded program of Mental Health Project Grants, awarded for the development of new and improved methods of care, treatment Public Health Service 225 and rehabilitation, has stimulated demonstrations and field projects, focusing on preventive and after-care services. The critical areas of juvenile delinquency, alcoholism, suicide, mental retardation, schizophrenia, aging and school mental health received special emphasis. Institute of Neurological Diseases and Blindness Faced with a staggering total of 20 million persons, in the United States alone, afflicted with neurological and sensory disorders, the Institute, in the past year, has vigorously conducted and supported research on these handicapping and crippling diseases. A number of significant advances have been made. COLLABORATIVE PERINATAL RESEARCH Continuing emphasis has been centered on the serious disorders of infancy and childhood, which include cerebral palsy, mental re¬ tardation, congenital malformations of the nervous system, and con¬ genital blindness and deafness. For the past 4% years, including 2 y2 years of preparation, the Institute has directed a long-term collaborative research project to demonstrate possible relationships between conditions existing during pregnancy, delivery, and early life and the later occurrence of neurological or sensory disorders. As of the end of 1960, the 15 collaborating institutions had collected data on some 13,500 expectant mothers and 8,000 babies. It was expected to take several more years to enroll and collect data on the 50,000 expectant mothers and their children who are to be used in this re¬ search. Preliminary analysis of the facts obtained is already pro¬ viding research leads and new knowledge which may be important in prevention of these tragic disorders. In addition, the collaborating institutions are carrying out numer¬ ous studies in areas which relate to the overall project. In one of these, a rapid test to diagnose infections of the newborn baby, through the microscopic examination of the umbilical cord, has been devised and is permitting prompt life-saving therapy. NEUROLOGICAL RESEARCH Grant-supported studies have yielded additional insight into diseases and conditions which cause mental retardation in infants. This year, new forms of inborn chemical disorders have been demon¬ strated, and for one (maple sugar urine disease) a promising dietary therapy has been developed. Surgical research on temporal lobe epilepsy, conducted at the In¬ stitute, has altogether freed a large number of patients from seizures, and in others has greatly reduced the number and severity of seizures. 226 Department of Health , Education , and Welfare , 1961 Complex chemical changes occurring in the brain during epileptic seizures have been further explored by both Institute and grantee investigators, who have demonstrated that certain chemical reactions influence the patient’s susceptibility to seizures. Seeking ways to conquer the demyelinating diseases such as multiple sclerosis, grantees have devised an ingenious method to induce the actual process of nerve demyelination in tissue culture, where it can be carefully and directly observed and studied. Of extreme im¬ portance has been the discovery of a “vaccine” that suppresses the myelin-destroying effects of a disease of animals which is similar to human multiple sclerosis. Through Institute research, advances have been made in our knowl¬ edge of the debilitating neuromuscular disorders. The chemical basis of one form of muscle disease — familial periodic paralysis — has been established. In treating myasthenia gravis, a new drug (galanthamine) may prove a useful addition to the means of control¬ ling disability. RESEARCH ON SENSORY DISORDERS During the year, research has scored considerable gains against the varied and insidious diseases which cause blindness. Techniques for cataract surgery have been refined, and Institute scientists have completed evaluations of alpha-chymotrypsin, a compound which simplifies surgery in some cases. Studies of glaucoma have produced more effective drugs for treatment, and mass screening methods are providing early diagnosis before irreparable loss of vision begins. Through supported studies, a new method of healing retinal detach¬ ment has been perfected — an intense light focussed on the eye’s surface seals the retina in place and prevents further detachment. Grant-supported investigations of hearing disorders have also resulted in noteworthy advances. New surgical techniques are pro¬ viding more effective relief of otosclerosis — a common cause of deaf¬ ness in middle age — and of certain forms of vertigo. In some cases, highly specialized techniques can now show whether impairment is caused by disease or by defects in the brain or nerve pathways ; each requires its own treatment. Improved diagnostic methods now make possible accurate testing and treatment of infants and young children before speech development is hampered. COOPERATIVE AND INTERNATIONAL RESEARCH Two cooperative studies supported by the Institute have yielded new information regarding prevention and treatment of cerebrovas¬ cular diseases. In a study of intracranial aneurysms, careful analysis of case histories is showing what types of patients are best suited for specific medical and surgical therapies. An evaluating study Public Health Service 227 of anticoagulant drugs has pointed out both the benefits and risks of such treatments. An Institute-supported cooperative study on glaucoma continues to seek better methods of screening and diagnosing this blinding eye disorder. A glaucoma family study, undertaken by grantees at one of the participating institutions, is confirming the heavier in¬ cidence of glaucoma among relatives of persons with the disease. In view of unique opportunities for international epidemiologi¬ cal and cooperative investigations, the Institute is continuing to evaluate research potentials and contributions of a number of for¬ eign countries. Limited support is now being provided for specially selected foreign investigations. Under the Institute’s regular re¬ search-grant program, 36 independent projects are being supported in 19 different countries. Also among our international research activities is a grant to the World Federation of Neurology to support the planning of a worldwide study of the epidemiology and neuro¬ pathology of strokes. During the year, the second Institute-sponsored mission of Ameri¬ can scientists to the U.S.S.R. surveyed Soviet progress in the field of maternal and child care. A report, prepared by the first medical exchange mission, presented observations on Soviet research activities in the physiology and pharmacology of the nervous system. Division of Biologies Standards This Division administers those provisions of the Public Health Service Act which establish standards for the safety, purity, and potency of biological products in interstate and foreign commerce. The Division issues licenses for the production and sale of such products, which include the vaccines, antitoxins, therapeutic serums, and human blood and its derivatives, and which are developed, for the most part, from pathogenic or potentially pathogenic micro¬ organisms, under carefully controlled conditions, to minimize hazards and ensure satisfactory potency. Additional safeguards are provided by the preparation and distribution of physical reference standards to manufacturers and laboratories engaged in biological standard¬ ization throughout the world. Approximately 4,000 vials of such standard preparations are distributed annually by the Division. At the close of the fiscal year, 190 establishment licenses and 277 product licenses were in effect, the latter covering 1,220 specific products. Tests of approximately 8,000 individual lots of various biological products were made, ranging from relatively simple ste¬ rility tests to potency determinations involving both animal and tissue-culture tests. The Division’s research seeks improved standards for production and testing of biologies. The development of standards for the pro- 228 Department of Health , Education , and Welfare, 1961 duction of live, oral poliomyelitis vaccine dominated the year’s activi¬ ties. This was a complex and difficult task, conducted in an atmos¬ phere of intense public interest. The standards were adopted on March 22 and it is anticipated that the vaccine will be available before the 1962 polio season begins. The rise in potency of the inactivated poliomyelitis vaccine con¬ tinued during the year and a change was proposed in the regulations to raise by 50 percent the minimum acceptable level of potency. Viral hepatitis — the contamination of blood products by the virus associated with homologous serum jaundice — is a serious problem and of interest to several groups in this Division. Under investiga¬ tion is an agent — recovered in tissue culture by a Division investiga¬ tor — which may have some relation to viral hepatitis in man. Potentially important is the discovery of the variable sensitivity of different types of virus to photodynamic inactivation with toluidine blue dye. Poliovirus is highly resistant to this technique, whereas many of the adventitious agents of simian origin are sensitive to it. Differential inactivation of contaminating viruses in preparations of live poliovirus grown in monkey kidney tissue appears to be feasible and may be useful in manufacturing live attenuated poliovirus vaccines. A safe procedure for separating platelets from red blood cells and plasma, using simple plastic equipment, has been developed by a Division scientist working with Cancer Institute investigators in studies of the use of platelets in leukemia. As part of this work, the effects on donors of repeated large platelet donations by plasma¬ pheresis are being investigated to establish needs for specific control procedures. Measles immunization, which appears feasible within the immediate future, has emphasized the need for reliable detection and measure¬ ment of measles antibodies. To establish a basis for standardization, a study of variables in test procedures was made, and a standard anti¬ serum was prepared to serve as an internal control. Division of General Medical Sciences This Division administers the ISTIH grant and fellowship pro¬ grams for research and training in the sciences basic to medicine and biology, public health, and certain clinical areas not covered by Institute programs, and directs the new Center for Research in Child Health, the Center for Aging Research, and the General Clinical Research Center Program. To meet current medical needs for basic knowledge — in addition to research into specific disease categories — DGMS programs are stress- Public Health Service 229 ing fundamental studies of organic life. This trend is effecting a con¬ vergence of previously separate approaches, with resultant increases in control of both normal and abnormal biological events. Consistent with the above development is the Division's aim to systematize still incomplete fields of biomedical knowledge. With this in mind, the Division’s research programs have been organized into five main areas: (1) Chemistry of Life Processes, (2) Develop¬ mental Biology, (3) Clinical Sciences, (4) Public Health, Medical Care, and Nursing, and (5) Methods and Tools of Science. The first two — covering the physiological events of reproduction, genes, growth and development, disease, aging, and death — receive about half of the Division’s research funds. Out of these efforts have come new insights. A clearer definition of the gene in its effect on the total organism is emerging, and work in progress with deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) no longer seems remote from practical application. A grantee in Israel has provided evidence suggesting that the RNA complex makes and stores the antibodies which form during immunologic re¬ actions. The greatest obstacle at present to organ transplantation is immunologic in nature, and the solution of the difficulties of replacing vital organs will be found in such basic research. There have been revelations on the response to drugs of the microsomes of liver cells. A new method for direct biochemical studies of components in the living intact cell is under development. New discoveries suggest that unsaturated fatty acids play important metabolic roles in tissues and cells. Experimental evidence indicates that congenital defects are associated with vitamin E deficiency. Although contributions from the fundamental biological sciences have been numerous, research continues to outstrip training, and critical personnel shortages persist. The Division’s training programs seek increased output of qualified researchers and teachers in these basic sciences. Grant funds are available to public and private nonprofit institutions (such as medical schools) for initiating or improving graduate research training. Since July 1958, when DGMS was providing support for training only in epidemiology and bi¬ ometry, regular programs have been established in 11 additional fields: Anatomical sciences, biochemistry, biomedical engineering, biophysical sciences, developmental biology, genetics, microbiology, nutrition, pathology, pharmacology, and physiology. At the end of this period, the Division was furnishing aid in 20 fields for 440 separate research training programs across the country. The research fellowship program provides outstanding students and scientists at various academic levels with opportunities for in¬ tensive training in the shortage areas. Support, in this period, was granted to 2,307 fellows. 230 Department of Health , Education , and Welfare , 1961 The medical student research training program has continued the successful experiment, begun in 1957, under which carefully chosen applicants are specially instructed to develop latent abilities and stimulate interest in research and teaching careers. The general clinical research center program was established in the fall of 1959 at the direction of the Senate Committee on Appro¬ priations to help meet national needs for improvement and inten¬ sification of clinical research. The program awards grants to medical schools and other research institutions to provide an adequate means for precise observations and control of research, and to extend labo¬ ratory investigations in animals into valid correlative studies in human beings. During fiscal year 1961, DGMS awarded 24 more grants for general clinical research centers, bringing to 32 the number of such centers established since the program’s beginning in 1960. CENTER FOR RESEARCH IN CHILD HEALTH In February 1961, the Surgeon General, at the President’s direction, established a Center for Research in Child Health. Placed in the Division of General Medical Sciences, the Center seeks to stimulate research in health problems of childhood and adolescence. CENTER FOR AGING RESEARCH The Center for Aging Research has continued to grow, with grants for research in aging increasing from approximately $12.5 million on January 31, 1960, to more than $16 million on January 31, 1961. A fifth large interdisciplinary program in aging research has been established at Brown University. Other like programs, with NIH support, are located at Western Reserve University, University of Miami School of Medicine, Duke University, and the Albert Einstein College of Medicine. During fiscal year 1961, Center personnel assisted in the White House Conference on Aging and helped the F ederal Aviation Agency determine the functional age of pilots. Division of Research Grants The Division of Research Grants continued to administer and co¬ ordinate the grant and award program — $453 million, in this period — of the National Institutes of Health, and to provide both technical assistance and review and appraisal services for the other grant¬ awarding units of the Public Health Service. Functions included processing and scientific or technical review of grant applications; providing fiscal, statistical, and information services; and direct management of the $30-million-a-year Health Research Facilities Construction Program. Public Health Service 231 Reorganization of the Division was necessitated by growth of the whole Public Health Service grant program. A Career Develop¬ ment Review Branch was formed to consolidate all the Division’s responsibilities in fellowships, traineeships, and training grants. A Special Program Review Branch, with responsibility for program- project grants and center grants, was established within the Division. Program-project grants, as contrasted with the traditional research- project grants, are for support of broad-based and usually long-term research programs, while center grants are solely for support of physical resources, excluding new construction, and are usually clinically oriented. To handle the mounting volume of applications for grants, the number of study sections comprising the Research Grants Review Branch was increased from 36 to 40. These study sections, whose primary function is technical review of applications, have continued to stimulate meetings and seminars for exchange and publication of information on specific health problems. Division of Research Services NTH took a major step in expanding its use of electronic processing of medical research data by arranging for installation of a new high¬ speed computer. This will be paralleled by an increase in the variety of data-processing and programming services available centrally through this Division. In anticipation of this development, DRS accelerated its recruitment and on-the-job training of mathematicians, engineers, and other technical personnel required in the data-process- ing program. This Division provides a wide range of other central technical and professional services and skills in support of Institute programs, such as the design and construction of unique environmental chambers. During this period, the Division completed a plant-growth chamber for the Mental Health Institute, blood-serum cold-storage rooms for the Neurological Institute, a low-level radiation counting facility for the Cancer Institute, and a hydrogenation laboratory for use by all Institutes. As part of a new central service, DRS veterinary scientists made plans for the production of specific pathogen-free animals under con¬ trolled environmental conditions. Allied planning called for transfer of the overflow in standard animal-production and -holding services to the new animal farm on completion of the needed facilities. As a first step, the existing buildings on the new farm were remodeled and all farm animals moved to the new location. Highly successful performance tests with gaseous ethylene oxide, in the Division’s environmental health service, now permit routine sterilization of surgical rubber gloves, plastic catheters, patients’ 232 Department of Health , Education , and Welfare , 1961 telephones, and other heat-sensitive items used in patient care. In other environmental studies, the search for a satisfactory means of detecting staphylococcal organisms was rewarded with a quite reliable test employing a modified commercial medium in which fresh egg yolk is the essential added ingredient. The modified medium also makes possible direct indentification of coagulase-positive staphylococci found in areas that tend to be heavily contaminated with other types of bacteria. Reorganization of the Division’s visual arts program was aimed at integration of central medical arts and photographic services, and a new focus on scientific film production. A study designed to increase the medical library’s usefulness had its initial effects in the stepped-up purchasing of scientific books and journals, and the inauguration of a new automatic photocopying service was expected to increase the circulation life of individual volumes. Clinical Center The Clinical Center’s mission is to provide the specialized forms of hospital care necessary for contrasting studies of normal and ab¬ normal physical and emotional conditions in man. In fulfilling its aim, the Center encourages interdisciplinary exchange of ideas and maintains an environment conducive to research and training. For the third year, optimal utilization of hospital beds was main¬ tained, with a satisfactory number of research patients being referred by physicians from all sections of the United States and from many foreign countries. Gratifying success has attended the recruitment of Normal Volun¬ teer control patients. Howard University has been added to the list of sponsoring agencies and arrangements with the Federal Bureau of Prisons have been expanded to include volunteers from midwestem penitentiaries so that three studies of infections may now be carried out where only one was possible previously. Further automation in the Clinical Pathology Department has made possible a greater number and variety of tests, with more exact¬ ing quality control — a development of prime importance, since the Clinical Center’s research mission requires such tests on a far greater scale than do general hospitals. Conclusion From the foregoing pages it can be seen that fiscal year 1961 was a year of great activity for the Public Health Service — and for the other forces in our society which contribute to better health for the American people. Medical and related research continued at a high level, and many productive results were achieved. Many new hospi- Public Health Service 233 tals, research centers, and other health facilities were built or planned. Health services of various kinds — particularly for the chronically ill and aged — were launched or strengthened. Increased attention was focused on the health problems associated with the complex modern environment. The Public Health Service played a central role in many of these developments. Following a penetrating self-study and evaluation, it began a process of reorganization to prepare for its expanding responsibilities in the decade ahead. This process is still under way. With the strength that comes from partnership effort, the Public Health Service hopes to continue to advance human health in this country and throughout the world in the years to come. Table 1. — Statement of appropriations , authorizations , and obligations , fiscal year 1961 [In thousands] Appropriations Funds available for obligation Total funds available Amounts obligated Appropri¬ ations and authori¬ zations Net transfers between appro¬ priations Repay¬ ments for serv¬ ices Prior year unobli¬ gated balances Total _ _ _ _ _ $1,039, 606 0 $42, 565 $142, 630 $1,233, 584 $1,058, 324 Appropriations, PHS. . 1,039,065 0 42, 565 142, 546 1,224,176 1,050,176 Control of tuberculosis _ 6, 493 35 6, 528 6, 494 Assistance to States, general _ _ 27, 277 —142 259 27, 394 27, 057 Communicable disease activities (1961—62) _ 1,000 1,000 108 Communicable disease activities (1961) _ 14, 393 898 15, 291 15, 256 Environmental health activities. . . . 27, 768 1,355 29, 123 28, 895 Foreign quarantine activities . _ 5,110 335 5, 445 5, 372 Hospitals and medical care _ 55,823 5, 960 61,783 61, 707 Salaries and expenses, hospital construc¬ tion services _ ... _ 1,736 1,736 1,719 Indian health activities. _ _ _ _ i 50, 177 797 50, 974 50, 545 Construction of Indian health facilities _ 9, 714 3, 790 13, 504 9,005 Grants for hospital construction (1961-62).. 186, 200 186. 200 61, 680 Grants for hospital construction (1960-61) . . 127, 050 127, 050 126, 272 General research and services, National Institutes of Health.. . _ _ _ ... 83,900 83, 900 83, 572 National Cancer Institute (1961-62) _ 700 700 8 National Cancer Institute (1961).. _ 110, 300 10 110,310 106, 264 Mental health activities _ _ 100, 900 -5, 139 68 95, 829 92, 120 National Heart Institute _ 86, 900 28 86, 928 86, 267 Dental health activities _ _ _ 15, 500 15, 500 14, 617 Arthritis and metabolic disease activities. . 61,200 437 61,637 59, 046 Allergy and infectious disease activities _ 44,000 1 44, 001 43, 780 Neurology and blindness activities _ 56, 600 -7,000 49,600 48, 348 Operations, National Library of Medicine- 1,738 35 1,773 1,758 Grants for waste treatment works con¬ struction (1961-62) _ 45,000 45,000 38, 493 Grants for waste treatment works con¬ struction (1960-61).. _ _ _ 5,277 5,277 5, 277 Grants for waste treatment works con¬ struction (1959-61) _ 1,816 1,816 1,811 Retired pay of commissioned officers _ 2 1,927 1,927 1,927 Salaries and expenses _ _ _ _ _ 7, 226 142 189 7, 557 7, 477 Grants for construction of health research facilities _ _ _ 30,000 1 30, 001 29, 985 Bureau of State Services management fund. 4,262 4,262 4,234 National Institutes of Health manage¬ ment fund _ 27, 678 27, 678 27, 580 Scientific activities overseas (special for¬ eign currency program) _ _ 3,707 3,707 28 Buildings and facilities 3, 776 4,548 8, 324 3, 298 Construction of mental health, neurology research facility _ 12, 139 12, 139 11 Consolidated working fund, HEW, grants for research _ _ _ _ _ 217 65 282 165 See footnotes at end of table. 626936—62 - 16 234 Department of Health , Education , and Welfare, 1961 Table 1. — Statement of appropriations, authorizations, and obligations, fiscal year 1961 — Continued [In thousands] Funds available for obligation Appropriations Appropri- Net Repay¬ Prior Total funds Amounts ations transfers ments year available obligated and between for unobli¬ authori- appro¬ serv¬ gated zations priations ices balances Appropriations, special project funds made available by other agencies _ 8,782 7, 804 Salaries and expenses, Bureau of Prisons, (transfer to HEW, PHS) _ 2,338 2, 337 American Sections,’ International Com¬ missions, State (transfer to HEW, PHS). Salaries and expenses, Office of Civil and 78 73 Defense Mobilization, (transfer to HEW, PHS) _ 364 360 Research and development, Office of Civil and Defense Mobilization, (transfer to HEW, PHS) _ _ _ 88 85 Emergency supplies and equipment, Office of Civil and Defense Mobiliza¬ tion, (transfer to HEW, PHS) _ 1,009 1,006 Farm labor supply revolving fund, Bureau of Employment Security, (transfer to HEW, PHS) _ 499 463 Civil defense and defense mobilization. functions of federal agencies, (transfer to HEW) _ 1,054 1,042 Administrative expenses, Section 411 Mutual Security Act, (transfer to HEW) _ 38 37 Technical cooperation, general, executive (transfer to HEW) 2,818 1,965 Defense support, general, executive, (transfer to HEW) _ 105 63 Special assistance, general executive, (transfer to HEW) _ ... _ 270 257 Grants, Cuban refugee health program. (transfer to HEW) _ 91 86 Military assistance, executive, (transfer to HEW) . . . 30 30 Gift funds donated for general and specific purposes . . 541.1 84.4 625.9 344.1 Contributions, Indian health facilities _ 308.7 308.7 130.1 Public Health Service unconditional gift fund _ _ _ _ 24.7 11.9 36.7 5.9 Public Health Service conditional gift fund.. _ .. 29.1 38.8 67.9 57.0 Patients’ benefit fund, Public Health Service hospitals _ _ 43.7 24.2 68.2 48.9 Special statistical work, vital statistics _ 134.9 9.5 144.4 102.2 1 Includes $435,000 contract authorizations, and excludes $529,000 liquidation of prior contract authoriza¬ tion. 2 Does not include $8,000 to be deappropriated. Table 2. — Commissioned officers and civil service personnel as of June 30, 1961 Public Health Service 235 Part-time Other 1 I* 2 “’SSS’- " £ Without compen¬ sation 215 44 "8 - ! 2 | When actually em¬ ployed i sN i *°S5 i ir H s Total part time I 8 : iO i i-i - i i ’ 1 Full-time Civil Service Outside United States 1,299 i i g = « jl i s States 12, 458 45 i i i ^ . i i CO < 9, 220 is iii o' ! eo 2,780 Washing¬ ton metro¬ politan area 10, 894 894 ssasgsasg $ j 1,262 1,321 Total s 1 rtT SggSKSKg $ : 11,634 O V 4,171 Commis¬ sioned officers § | 2 CO X lOJX*OCCrHlO 2 1,734 "■*8 ill 3 o 1 T-H 111 i § 3 - 1 CO «SSS8S o' 5, 328 Public Health Service . . . Office of the Surgeon General . . . . Immediate Office of the Surgeon General. . . . J Division of Finance _ _ .. Division of Administrative Services . . . . WlliUt; U1 -L LlbUilllUi _ Division of Public Health Methods _ _ _ Division of International Health _ _ _ Division of Health Mobilization . . . . National Center for Health Statistics _ Offices other than Immediate Office of the Surgeon General (Information. Executive! . _ . _ _ _ _ Details to other agencies _ _ _ _ Bureau of Medical Services. . . . Office of the Chief . . . . . . . . . Division oi Foreign Quarantine... . . . _ Division of Hospitals _ _ _ _ Freedmen’s Hospital. . . . . . . . _.| Division of Indian Health _ _ _ Details tn other aireneles Bureau of State Services . . Table 2. — Commissioned officers and civil service personnel as of June 30, 1961 — Continued 236 Department of Health , Education, and Welfare, 1961 1 Excludes those part-time employees not in pay status during the month of June 2 Includes 1,803 Regular Corps Officers, 2,025 Active Reserve Officers, and 151 1961. Commissioned Reserve Officers on Temporary Training Duty. Public Health Service 237 Table 4. — Payments to States , fiscal year 1961 238 Department of Health , Education, and Welfare, 1961 Public Health Service 239 Office of Education Section I Introduction: Quality Education We cannot now be satisfied with any educational endeavor that is not genuinely committed to the highest standards of which we are capable. Whatever may be the disposition of some individuals, the Nation cannot afford anything less than excellence in every aspect of education. At every step of the educational ladder we must make those demands for achievement that will call forth the full capabilities of every student. We have frequently been guilty of following a path of inordinate ease and comfort in our educational policy and practice. All too often we have sacrificed excellence to a large measure of mediocrity, because we have been unwilling to pay the price that excellence demands — rigor, discipline, and genuinely hard work. Mastery of Fundamentals l\ecessary We are in some difficulty at every level, because in our effort to relate education effectively to the lives of the students we have too often divided and splintered until far too much of our energy is dissipated on unrewarding peripheral detail or trivial matters that deserve no place in the economy of a serious formal education. An intensive mastery of fundamental principles and techniques that will have general theoretical application or practical usefulness should replace the not infrequent expansiveness that has made the curriculum attractive and interesting, but sometimes somewhat superficial. We have done well to encourage broad general education. But it is wise to remember that one cannot know anything in general without knowing something in particular. It is education in the most basic sense, whether it be in the humanities, the social or natural sciences, in technology or the professions that will be most rewarding to the individual and at the same time will best satisfy the needs of our 241 242 Department of Health, Education , and Welfare , 1961 society in providing adequate manpower for our trades and pro¬ fessions and in guaranteeing the expansion of knowledge and the disciplined habits of mind that are so crucial to the well-being of our people. Students* Capabilities Must Be Challenged To the extent that we have failed to challenge the full capabilities of our students, from kindergarten through graduate school, we have betrayed the domocratic ideal that is so precious to us. The meaning of democracy in education is not found in a dead-leveling process that attempts to conform all men to a simple equality. We believe not that all men are of equal capacity, but that all are entitled to the opportunity to develop fully such capacities as they have. We combine this with a belief in the inherent dignity of the individual person. These are powerful ideas with tremendous implications. They mean, certainly, that the creative artist, the professional person, and the artisan alike deserve the full esteem of their fellow men and that every man is entitled to his measure of self-respect who is doing his best in a vocation that contributes to the total life of our society. When we demand in our schools and elsewhere something less than the individual is capable of doing, we rob him of his self-respect and we corrupt our most basic ideals. We have been too often guilty on this count, and our schools must bear a large measure of responsi¬ bility for that guilt. A Twofold Task The task facing the leaders of American education is so to organize and administer our educational institutions that the best interests of every individual will be served and that this process will at the same time contribute to the fundamental quality of our culture and add genuine strength to our national character. We must make sure that the maximum cultivation of the individual’s intellectual, moral, artistic, and spiritual capacities that makes of him a genuinely free person yields also the protection and perpetuation of those in¬ stitutions that are essential to a free society. Here two things should be kept foremost in our thinking. First, that the total education of an individual is a task in which all of our social institutions participate. The schools should not be expected to do everything. Their primary task is the achievement and dis¬ semination of knowledge and the cultivation of the intellect. It is only when this task is firmly established as the central purpose of Office of Education 243 a school that it will produce effectively those results in personal and civic character that we rightly expect of it. Secondly, we must guard against the tendency to suppose that our national well-being is served primarily by advances in technology, however important and timely these may be. Knowledge is of value for its own sake as well as for its uses, and unless the sciences are supported in their own right the capital of knowledge on which our technology is nourished will surely diminish. The social sciences and the humanities and fine arts are as important to the quality of our culture and eventually to the strength of our Nation as are engineering and the physical sciences. The study of politics, history, and philos¬ ophy is fundamental to our cultural life, and no nation can achieve a lasting strength unless its character is expressed in great literature, art, and music. We should not fear that a more effective accommodation of education to social needs and national goals must destroy the freedom and in¬ dividual initiative and creativity of our people. On the contrary, countless persons would thereby find a new freedom: through in¬ stitutions designed for their peculiar abilities on the one hand and the needs of our social and economic order on the other, they would be brought into the educational process on a higher level. Teaching , the Basic Problem The quality of teaching is our basic educational problem. It will not be solved until all our teachers have the competence that is now enjoyed by those whom we all recognize for their great and inspiring work in our classrooms, seminars, and laboratories. The identification and education of teachers for our schools is now a matter of major concern for the Nation. It is a national tragedy that the generality of our teachers are not fully qualified to assume the burden of responsibility that we must place upon them in the future. Many are lacking the native talent demanded by the art of teaching. Others in large numbers are inadequately prepared by general education or education in their teaching specialities. The responsibility for this rests partially upon our society as a whole, for it has failed to raise the teaching profession to that level of stature and esteem that would make it attractive to highly talented people in numbers adequate to fully satisfy the demand for qualified teaching personnel, and our public leaders have not insisted that our colleges and imiversities devote their best efforts to the education of teachers. It would be unwise to suppose that this predicament of the teaching profession is due simply to inadequate salaries for teachers, even 244 Department of Health , Education , and Welfare , 1961 though the problem will never be solved until the average salary level of the profession is made competitive with that of other employed professions. It is due in part at least to the fact that the education of prospective teachers in our society has quite commonly failed to fully challenge the intellectual abilities and creative talents of the more capable segment of our students. Persons of high ability look to a profession that demands rigorous preparation and high compe¬ tence. The range of students entering our professional education schools is far too wide for the good of our Nation. It encompasses many who enjoy the highest capabilities, but also many who are near failures in any scholastic endeavor. In the future every effort must be made to identify persons of high intellectual competence and talent in the art of teaching and to attract them to the teaching profession. And the standards of our colleges of education must be raised to exclude those who do not have real promise. The finest education must be made available to those who qualify : first, a genuine and rigorous liberal education in the full sense of that word, an education in the arts and the sciences of the kind that frees the mind, that acquaints it with at least the rudiments of the world’s basic knowledge, and cultivates critical and creative intelligence. To insure this kind of education, the education school must become a part of the mainstream of the intellectual life of our universities. The education of teachers is properly the task of the entire faculty, not simply of those who specialize in the teaching art and its related sciences. It is a national scandal that large numbers of our teachers are inadequately prepared in the subject matter that they teach. We should not be satisfied until this situation is entirely corrected, as its perpetuation is the surest guarantee of mediocrity in the classroom. There will never be a substitute for a teacher’s full mastery of his subject. Finally, education in the art of teaching has too commonly been narrowly conceived in terms of psychological studies descriptive of the learning process. Teaching is an art that must be rooted in the entire gamut of the behavioral sciences as well as in psychology, involving such disciplines as sociology, descriptive ethics, and cultural anthropology. But far more than this, even a simple comprehension of the proper aims of education involves necessarily an intimate knowledge of the value structure of the culture and entails some acquaintance with the essentials of its intellectual and moral tradition. For the meaning of education is found in part in the great task of Office of Education 245 understanding, appreciating, criticizing, and perpetuating the culture of which we are a part and in which are lodged our value traditions and commitments. To put it briefly, there is no easy road in the preparation of teachers of the kind that we must now guarantee our schools. Our society will make heavy demands upon them in the future. Educational excellence, as a goal, is never realized. It is neither visible nor tangible. Perhaps it is not, strictly speaking, a goal at all, but an attitude that informs the total process of education. In any event, we can approach excellence in education only by demanding of all — administrators, teachers, students, and the general public — all that they are capable of achieving. If ever in the past there were reason for asking less, there is none now, for our times are perilous and will accept no less. — Adapted from a statement by Sterling M. McMurrin , U.S. Commissioner of Education , before the Subcommittee of the Committee on Appropriations , House of Representatives , Eighty -Seventh Congress , First Session , May 8 , 1961. The Role of the Office of Education The Office of Education operates in a society in which virtually all responsibility for the conduct of American education rests outside the Federal Government. States and communities have the right to organize and manage their schools and the chief responsibility for financially supporting them. The function of the Office of Education is to “aid the people of the United States in the establishment and maintenance of efficient school systems, and otherwise promote the cause of education throughout the country.” Cooperation and assistance by the Office are carried on principally through publishing its research findings, studies, and survey reports; through consultation and field work; through participating in con¬ tracting with colleges, universities, State departments of education, other public or private agencies, organizations, groups, and individuals to conduct research; and through administering financial assistance programs as directed by the Congress. From 1867, the year of its founding, to near the middle of the present century, the Office of Education was regarded principally as an agency for the collection and dissemination of information describing the state of American education. But as the educational system became increasingly complex, the Office began analyzing and inter¬ preting this descriptive information. During the past decade, new responsibilities have come to the Office, supplementing but not re- 246 Department of Health , Education , and Welfare , 1961 placing its historic duties. These responsibilities reflect a change in public conviction of the role of the Federal Government in education. While the American people have never swerved from the belief or the practice of the belief that responsibility for the conduct of Amer¬ ican education should remain outside the Federal Government, they have come to use the one Government they have in common to aug¬ ment and strengthen the activities of the several governments they have separately. Thus the Office is responsible for the execution of public policy as expressed in over 20 separate pieces of legislation, with grant and contract responsibilities amounting to approximately half a billion dollars a year. Included among the other responsibilities of the National Defense Education Act of 1958, was that given under title X for advising and consulting “with the heads of departments and agencies of the Federal Government responsible for” various “educational programs with a view to securing full information concerning” such programs and “to developing policies and procedures which will strengthen the educa¬ tional programs and objectives of the institutions of higher education utilized for such purposes. ...” Thus, out of the expanded role of the Federal Government in our society, a new function and respon¬ sibility of the Office of Education has emerged. Still another new dimension of Office responsibility has come to focus during the last decade. The character of world developments affects educational practices and educational organization. The mod¬ em foreign language development program authorized by the NDEA reflects but one area of those practices. The deeper involvement of the United States in international affairs will inevitably lead to identi¬ fication of other educational needs. Concurrently and continuously, the Office must be in a position to stimulate, encourage, develop, and strengthen professional leadership in education throughout the Nation. It must help to provide to educational leaders the informational resources essential to the identification and solution of educational problems, in the con¬ stant improvement of educational programs, and in securing under¬ standing, cooperation, and support of professional groups and lay citizens of the Nation. Whatever may be the problems facing the American people in defining the substance of education or in the administration of its educational system, it is the responsibility of educational leaders at all levels to work together to secure that degree of excellence and pro¬ ductivity which the good of society and of our Nation demands. Office of Education 247 Section II Examples of Office of Education Leadership in Fiscal Year 1961 The activities cited in this section do not constitute a complete description of Office programs ; but rather, they represent the manner in which the Office performed its assignments. The report of princi¬ pal continuing or recurring Office activities and their part of the gen¬ eral American educational scene will be foimd in section III. The projects of programs of section II originated, were completed, or were unusually active during 1961. Identification of Needs of American Education The traditional task of the Office has been the collection and dissemination of information vital to “promoting the cause” of Ameri¬ can education. This past year saw two major studies completed which placed before the people a measure of the next decade’s educa¬ tional problems. Two Critical Needs of Our Schools and Colleges : People and Build¬ ings. — The professional staffing and physical facilities of our public schools and our colleges were deemed to be goal areas of prime im¬ portance in achieving a higher base of educational development. In 1960 the Office undertook staff studies designed to determine the mag¬ nitude of the Nation’s requirements in terms of teachers and other pro¬ fessional personnel to be recruited and trained, and in terms of public school and higher education physical facilities to be constructed or restored. These requirements were translated into dollars of national need, without specific reference to the respective shares that would have to be met by Federal, State, local, and private sources. The studies were completed during fiscal 1961 and were released to the public as the discussion documents (1) Ten-Year Aims in Edu¬ cation , Staffing and Constructing Public Elementary and Secondary Schools , and (2) Ten-Year Objectives in Education , Higher Edu¬ cation Staffing and Physical Facilities. Each of the papers was developed with the assistance of outside technical experts and received critical review by leaders outside of government, representing the edu¬ cational community. There was considerable authority, therefore, behind the goal figures they proposed with respect to the number of school teachers, professors, and university researchers needed over the next decade, the average salary levels they would require, and the resultant aggregate national expenditures indicated for educational 248 Department of Health , Education , and Welfare, 1961 manpower and for bricks-and-mortar support of the educational establishment. Educational Needs in Relation to the Employment Economy : Voca¬ tional Education. — Recognizing that changes in occupational patterns and in the demands of the economy were occurring faster than wrere the educational adaptations needed to meet them, the Office undertook to identify the kind of education required to eliminate the shortages and imbalances. The resulting document, Vocational Education in the Next Decade , was released to the public and will be a major source paper for a panel of consultants on vocational education, to be con¬ vened in 1962. Organization and Dissemination of Educational Statistics and Research Results Through the years statistical and research programs have been at the core of Office programs. The following examples indicate devel¬ opments in fiscal year 1961 to improve and accelerate the process by which new educational knowledge is applied to educational practice : Dissemination of Results of Educational Research. — For a number of years, the Office of Education has maintained a clearinghouse of studies in higher education which compiles, analyzes, and interprets data on educational research and experiments by colleges and uni¬ versities with respect to their own programs. During the past year the clearinghouse released its first monographs. Included were titles on college admission with advanced standing and independent study programs. College and University Inventory of Physical Facilities. — During 1961 the editing and coding of this Inventory was completed. The data provide details of all building facilities for institutions enrolling almost 96 percent of the students in higher education. Analysis of these data can yield information including type of control, esti¬ mated value, condition, function of assigned areas, and total cost of physical plant. Periodic reports of new construction will be added to this basic inventory. The Office thus will be able to maintain a current file of almost all higher education facilities in the Ration. Dissemination of Results From Office Sponsored Research Pro¬ grams. — The Office’s extramural research support programs, partic¬ ularly projects under Cooperative Research and title VII of the RDEA (Educational Media), occupy critically important positions with respect to the responsibility for extending the frontiers of basic and applied educational knowledge. The final results of all projects completed by 1961 were circulated through the Library of Congress 1 Office of Education 249 Documents Expediting Project. Some results were published in the following 1961 Office monographs: The Gifted Student, Motor Char¬ acteristics of the Mentally Retarded , Social Climate in High School , Influence of Voter Turnout on School Board and Tax Elections , and Research Problems in Mathematics Education. A National Cooperative System of Educational Data. — An intel¬ ligent facing of educational problems requires, on the part of all authorities concerned — Federal, State, local, and private — adequate information on a national scale. These data are not available at the present time ; serious obstacles stand in the way of making them avail¬ able. During 1961 the Office studied this problem and developed the main conceptual features of a program proposal which would estab¬ lish, under the leadership of the Federal Government, a national coop¬ erative system of educational information which would employ the resources of electronic technology for storage, retrieval, and analysis of data. Both the internal technical problems and the field relationships and processes involved were carefully thought through. Appreciable progress was also achieved in establishing rapport with the principal field agencies — school administrators and university registrars — through which raw data would be channeled and upon which national cooperation must ultimately be based. Progress was made in coop¬ eration with the States to standardize educational information through development of publications designed to establish standard termi¬ nology for use in reporting pupil and school staff information. Mobilization of Leadership for Solving Educational Problems A third activity of the Office traditionally has been the encourage¬ ment and coordination of efforts to handle difficult educational issues which are increasing both in scope and number. In the following- examples, it may be seen that the Office has strengthened the effective¬ ness of a variety of organizations by providing the vehicle for them to meet common problems with mutual support and understanding. Cooperative Planning for the Educational Media. — An Educational Media Study Panel of prominent citizens appointed by the Commis¬ sioner has collected evidence on educational uses of television during the past 15 months. The findings will assist the Office in formulating a national policy for this medium. A series of Office media conferences led to the establishment of the Educational Media Council, the first national organization encompass¬ ing all major professional and industrial groups directly concerned with educational media. 626936—62 - 17 250 Department of Health, Education, and Welfare, 1961 The Media Program sponsored a conference among educators and equipment manufacturers on new and emerging equipment require¬ ments of the schools. A conference supported under contract with the National Associ¬ ation of Educational Broadcasters identified the feasibility and role of State and regional networks in educational broadcasting. Adult Literacy Education. — The Office recognized adult education for literacy as a major educational problem. In cooperation with the National Commission for Adult Literacy, it sponsored a con¬ ference to seek methods of strengthening and expanding educational provisions for the Nation’s functional illiterates. The conference dealt with the responsibility and role of the public school, private and voluntary agencies and the Federal Government in fundamental and literacy education and with community approaches to the problem. Regional Conference on Cooperation in Educational Research. — The stimulation of interstate cooperation and communication has been a key objective of the Office in promoting research programs. An example of such action was a conference of chief State school officials, their staff members and university representatives from Michigan, Illinois, Wisconsin, and Indiana. The conference, planned by the regional representative of the Commissioner of Education and attended by members of the Office staff, explored ways and means by which greater coordination of educational research programs within and between States could be realized and by which the findings of educational research could be more effectively translated into educational practice. Encouraging developments since the conference include: organi¬ zation of a Wisconsin Educational Research Council, organization of a Michigan Educational Research Council, creation of full-time positions of Research Coordinator and assistant in the Illinois State Department of Education, establishment of a Division of Research in the Indiana State Department of Education, and formulation of plans for a cooperative relationship between State departments of education and the Inter-Institutional Research Council of the Big Ten Universities (plus the University of Chicago). Conference of State Supervisors of Mathematics. — An Office- sponsored National Conference of State Supervisors of Mathematics was held for exploration of the theme, “Strengthening the Leader¬ ship of the State Supervisor of Mathematics.” The purpose of this conference was to find ways to improve the State supervisor’s work in developing mathematics curriculums, strengthening inservice and preservice training, supporting research in teaching of mathematics, and in evaluating State programs in mathematics. Office of Education 251 Consultative Service In addition to the thousands of inquiries directed to Office specialists by organizations, institutions, Governmental agencies, and individuals, major consulting services are sought from time to time by the States. Higher Education in South Dakota. — In 1961, the results of a survey of South Dakota’s entire system of higher education were published. The survey was requested and supported by the South Dakota Legis¬ lative Research Council and public and private institutions. Each of the State institutions was visited and evaluations of facilities, students, faculties, and curriculums completed. Reports of the survey recom¬ mended not only a statewide program in higher education, but also a program for each institution. Programs for Special Educational Problems With increasing frequency the American people have turned to the Federal Government for assistance on issues that are beyond the scope of their other governing bodies. Some examples of assistance by the Office of Education in fiscal year 1961 follow. Activities Relating to the Cuban Situation. — In support of the decision to provide direct assistance to the thousands of Cuban refugees who have fled the Castro regime and who are residing in this country, the Office of Education has administered a number of programs designed to facilitate adjustment of Cuban refugees in this country. Funds have been provided to the Dade County (Florida) School System to make possible the employment of additional teachers to accommodate some 5,000 children and to engage special personnel for their instruction. Assistance has been provided to the Dade County School System in establishing adult education programs to aid Cubans in acquiring English language training and orientation in American principles. A special program of loans to needy students has enabled 300 Cubans studying in American universities to continue their education. Additional funds already made available have enabled many students to continue or begin their college education in this country during the summer months. Funds granted to the University of Miami have been instrumental in training Cuban lawyers and doctors in United States practices. A project involving the study of economic problems of Cuban refugees has been supported with F ederal funds. Instruction in English. — The Office planned and gained budget support for a major attack on the deficiencies in the teaching of English. Taking guidance from the National Science Foundation 252 Department of Health , Education , and Welfare , 1961 efforts in science teaching and the NDEA programs in foreign lan¬ guage, mathematics, and science instruction, the Office has begun planning for the support of research, conferences, and the preparation and demonstration of curriculum materials and instructional practices. Developments Affecting Latin America. — Using the authority of title VI of the National Defense Education Act, the Commissioner declared Latin- American Spanish to be a critical language, thus mak¬ ing possible a program of language and area study centers, teacher training institutions in Latin- American countries, fellowships, and research, all dealing with Latin- American language and area studies. The Organization of American States, by contract with the Com¬ missioner of Education, has completed a study entitled Latin- Ameri¬ can Higher Education and Inter- American Cooperation and made recommendations to the Commissioner. The report, made in June 1961, is now under study in the Office. Review of Federal Programs in Education As the Federal Government has increased the number and size of programs in education, the necessity for analysis of the effect of such programs has grown. International Educational Activities of the Federal Government .- — The Office has been seriously concerned for some time with the extent to which education is being used as an instrument of foreign policy without adequate concern for the substance of the education involved. Inasmuch as our relationships with other peoples are vitally affected by our Nation’s international assistance programs, it is important that the education undergirding these programs be of the highest order. This end will be achieved only as we use the full resources of our domestic educational establishment. For this purpose, the Office has made careful analyses of various problems in this area. Review of the National Defense Education Act of 1958. — A panel of distinguished consultants was convened to assess the effectiveness of the National Defense Education Act in accomplishing its purposes. One major conclusion reached was that the Government will have a continuing role to play in helping students to finance college study. It was recommended, therefore, that the Student Loan and Graduate Fellowship Programs be extended indefinitely, with the latter substantially enlarged, and that a program of undergraduate scholar¬ ships be started to help talented but needy students attend college. Survey of Federal Programs in Higher Education. — During fiscal year 1961, the Office was engaged in a major study of the effect of Federal activities on institutions of higher education. This will pro¬ vide for the Office an opportunity to be a genuinely constructive force Office of Education 253 in the programing of Federal activities of concern to institutions of higher education. Because of the scope and size of Federal programs affecting all areas of education, it has been proposed that the Office be given continuing authority to conduct studies and make recommendations concerning all activities of the Federal Government affecting education at any level. New Responsibility and Change in the Office of Education An administrative agency must change to be current in its execution of responsibility. As the requirements of the American people have increased in range and size, so has the Office responsibility shifted to meet them. Examples of increase in authority and facilities are cited below : Improvement of Office Administration Through New Authority . — Considerable thought was given to new authority which might im¬ prove the administration of the Office and needed changes were formu¬ lated. These include the authority to interchange personnel with States so that persons with special competencies can be used to their best advantage on both the Federal and State levels, to accept gifts for the Office that in no way conflict with the expressed will of Con¬ gress, to enable delegation of authority by the Commissioner, and to broaden the authority of the Office of Education to make contracts and grants for the conduct of research and demonstrations. New Facilities for the Office of Education. — During the summer of 1961 the Office of Education moved into Federal Office Building No. 6, a new building located at 400 Maryland Avenue SW. This new building will provide not only for additional space needed by the Office, but also facilities for demonstrating the use of television as an educational medium. During the 1930’s the Office of Education was actively engaged in the utilization of radio for educational pur¬ poses. The educational television operation will be an extension of that early concern for educational media, and of the operations under title YII of the National Defense Education Act. * * * * * As an agency’s function is enlarged, it must, from time to time, reexamine its structure and mission and report to its constituents the understanding of deficiencies and suggestion for change that would provide maximum performance of current and predicted demands. Analysis of the Role and Organization of the Office of Education. — In October of 1960, the Commissioner of Education appointed a com¬ mittee to study the role proper to the Office of Education as well as the organizational structure of the Office. After completing its de- 254 Department of Health, Education, and Welfare, 1961 liberations in April 1961, the Committee issued recommendations which are being carefully studied and evaluated as a part of a general review of the effectiveness of the Office of Education in meeting its responsibilities to the Government, the educational institutions, and the general public. Section III Activities of the Office of Education In the preceding section examples of the kinds of service which the Office rendered in fiscal year 1961 were presented. In this section the impact of the Office on various aspects of American education and its relationship with other agencies will be indicated. Elementary , Secondary , and Adult Education ADMINISTRATION State educational agencies are the administration centers of public education in the United States. While the schools are actually oper¬ ated by local agencies, the States retain supervisory responsibility. In recent years, State administrative agencies have expanded their direc¬ tive, supervisory, and advisory functions. The Office of Education, at the request of State agencies, has frequently given its leadership and cooperation to assist States in the formulation of policies and programs for the strengthening of these functions. State Departments of Education Consultants to Local School Systems. — Most local school systems in the United States are not large enough to employ on a full-time basis all the highly trained professional specialists that are needed to pro¬ vide quality education programs. Since no school should be denied the services of these skilled consultants, it is imperative that each State make some provision to fill this need. States have found that the most economical as well as the most efficient means of making such services available to local school systems is to provide them through the State department of education. The average State department has, since 1955, more than doubled its staff of consultants. A sub¬ stantial part of the gain has resulted from the expansion of State pro¬ grams that receive no financial support from the F ederal Government. In all but a few States, specialists in science, mathematics, modern foreign languages, and guidance, have been added to department staffs through provisions of the National Defense Education Act. Office of Education 255 Fiscal year 1961 was the third year of substantial Federal aid to State educational agencies. During the year under title III of the NDEA, the Office of Education paid $1.7 million to the States for (supervisory, adminstrative, and other services related to the strength¬ ening of instruction in science, mathematics, and modern foreign languages. With these funds, which the States matched dollar for dollar, State educational agencies continued to increase their leader¬ ship to the local school districts. Approximately 200 specialists in I science, mathematics, and modern foreign languages accelerated their programs to improve the quality of instruction through support for higher teacher certification standards, demonstrations of effective uses of new instructional equipment and methods, production and dis¬ tribution of curriculum guides, and the organization of inservice train¬ ing of teachers. Approximately 265 State guidance supervisors, about 200 of whom have been added since title V (A) of the NDEA became operative, continued to work for improved counselor-pupil ratios and for higher standards for counselor certification. Statistical Reports and Services. — With the operational responsi¬ bility for public education vested in the States, the State education agency has taken the key role in establishing and maintaining systems for recording and assembling the statistical data needed for solving educational problems. The Office, working with State and local leaders, has long been making efforts to provide the resource materials, consultative and technical assistance, and leadership toward strength¬ ening State and local data systems so that they might provide accurate, complete, comparable, and timely information at local, State, and national levels. Standardization of educational terminology throughout the Nation received major attention during this year. Forty-three States and Territories were taking steps toward initial implementation or ex¬ panded use of the standard terms, items, and definitions which have been cooperatively developed. Excellent progress was made toward production of two additional handbooks of standard terms and definitions — one in pupil accounting and one in staff accounting. While the implementation, evaluation, and ultimate revision of these basic handbooks will require continuing staff effort, some attention in the next few years can be devoted to handbooks in program and service areas. Under title X of the National Defense Education Act, the office assisted the States in establishing record and report systems embracing standard terminology and in developing appropriate manuals and guides. Concerted efforts were devoted to encouraging the utilization of modern automatic data processing. 256 Department of Health , Education , and Welfare , 1961 Title X provides that States, on the basis of approved State plans may receive up to $50,000 in Federal funds to be matched equally with State funds. In fiscal year 1961, there were 53 approved plans under section 1009, title X. Fund requests totaling $1,278,658.97 were received from 46 States. Thirteen States requested the full $50,000 of Federal matching funds and several of these will overmatch the Federal funds. For the fiscal year 1962, it is estimated that at least 50 States will request Federal funds in an estimated total amount of $1,550,000. The grants available, along with the Office of Education staff efforts, have provided during this fiscal year a sorely needed stimulus toward the development of modern programs of educational information. Local School Board Effectiveness Increase of citizen interest in improving the schools has placed responsibilities on local boards of education, unparalleled in the history of public education. Plans and programs to assist boards of education in functioning more effectively received widespread attention in 1961. State school board associations expanded their program to include inservice training specially designed for new board members. They published handbooks, manuals, and periodi¬ cals; maintained close relationships with State legislatures; and organized workshops. During the fiscal year the Office virtually completed a nationwide survey of local school board organization, operating procedures, and characteristics of board members. This study, the first of its kind in more than a decade, is presented by size of district enrollment and geographical region, and will provide information to school board members and other citizens seeking information about board organization and practices. Variations in practices and trends will be analyzed and described. School Problems in Metropolitan Areas The trend toward concentration of the Nation’s population in a relatively few centers has continued over the past 10 years. The 1960 census reported that over one-half of the population resides in some 209 metropolitan areas. The bulk of the increase has been in the areas surrounding the central cities, with suburban school districts frequently reporting five-fold enrollment increases in the last 10 years. In large city school districts school enrollments have also continued to mount, often while the population of the city itself was declining. Growth of the population in the suburbs, coupled with heavy popu- Office of Education 257 Jation shifts within the city proper, has created severe problems for long-range planning. The problems facing cities are numerous and critical. The limited funds available for the construction and operation of the schools, the competition with more attractive suburbs for staff, and the constant mobility and shift of population within the city present deterrents to educational progress. But perhaps the problem of first importance is the general change in characteristics of the student population within our larger cities. The migration to metropolitan areas of large numbers of low-income families has created large student pop¬ ulation segments whose members are severely handicapped in their ability to adjust to an urban community. Of particular concern are those students who lack proper background in basic skills and the motivation necessary to profit from a comprehensive school program. Some of the metropolitan areas continue to provide leadership to educational progress throughout the Nation. The Higher Horizons Project of the New York City School Board and its Case Study Units in the Bureau of Attendance exemplify the use of curriculum adjustment, professional noninstructional services, and school-agency coordination efforts to improve education for the low-income, cultur¬ ally disadvantaged student. Looking toward a coordinated effort to benefit such students with programs of real significance, representatives from all national social agencies and from 38 States convened May 24-26, 1961, in Washington for the Conference on Unemployed Out-of-School Youth in Urban Areas. Dr. James B. Conant, chairman of the conference, referred to the thousands of out-of-school and unemployed youth in the large cities as “social dynamite.” Others who addressed or supported the conference were Vice President Lyndon B. Johnson, Secretary of Labor Arthur J. Goldberg, Attorney General Robert F. Kennedy, and Secretary of Health, Education, and Welfare Abraham Ribicoff. In an endeavor to find solutions to this problem, the Office of Education has encouraged the collaboration of specialists from various fields to formulate out-of-school programs of guidance and counseling for these youth. The Office has also sponsored informal meetings of representatives of national organizations of pupil personnel service professions and educational administration organizations. A na¬ tional commission to conduct studies of the functions, organization, and practices of inschool pupil personnel services and to carry on experimental research in these areas is being considered. Not least of the problems facing large city schools is that of main¬ taining a close relationship between patrons and schools. The rel¬ atively high mobility rate of our present society has had adverse implications for the traditional “neighborhood school.” The sheer 258 Department of Health , Education , and Welfare, 1961 increase in the size of our school districts, both urban and suburban, is acting to increase the distance between the school and its community. Many citizens to whom the schools have historically looked for support and leadership have moved to the suburbs. The need to identify, attract, and develop new sources of community support and leadership among citizens who have superseded the schools’ former patrons is well recognized. The Office of Education is initiating a study of methods by which schools in depressed areas of large cities are organizing activities which will encourage lay participation in the growth of the school program. STAFFING The growth of school enrollments has continued to pose a problem of staffing the public schools with sufficient numbers of well-qualified teachers. In the fall of 1960 there were 1,410,000 full- and part-time classroom teachers in the public schools: 861,000 in elementary schools and 549,000 in secondary schools. The public schools have been able for several years to meet their current needs for increased staff without an increase in the number of emergency teachers, but a chronic backlog of between 90,000 and 100,000 teachers with sub¬ standard State teaching certificates has existed for a number of years. Other “hidden shortages” are to be found in the continued existence of schools on double shifts and schools with curtailed pro¬ grams and services. The postwar increase in birthrates is now being felt in the secondary schools, and the greatest needs for increased staff are now found at that level. At the same time there is a lack of balance between the number of secondary school teachers being trained in various subjects and specialties and the number needed in each field. These and other problems in connection with staffing the public schools were reviewed in the report, Ten-year Aims in Education: Staffing and Constructing Public Elementary and Secondary Schools. This report, which had the benefit of review by technical and sub¬ stantive experts of national prominence, outlines a program for the improvement of public school teaching staffs through increases in teachers’ salaries and through improvement of selection for teacher education and preservice and inservice education. The report suggests a staffing program over the next decade, with a goal for providing a professionally qualified and competent teacher in each classroom of the Nation’s public elementary and secondary schools. To achieve this goal, the reports recommends (a) staff salaries that are competitive with those in other occupations requiring equivalent training and experience, and (b) an improvement of procedures for the selection of teachers. The report further recom- Office of Education 259 mends that programs of preservice and inservice education for teachers be increased. In order to attain the levels of teachers’ salaries recommended for the next 10 years, average salaries by 1963-64 will have to in¬ crease 50 percent in purchasing power over average salaries of 1958-59, and those salaries must then be further increased approximately 2 I percent yearly over the next 5 years in order to maintain the estab¬ lished salary status. The challenge of the second part of this goal — improvement of teacher selection procedures — is not chiefly a financial one (although the report assumes it will require an average of $100 million a year over the 10-year period), but it is rather a challenge directed toward the educational profession for mobilizing resources and for expanding cooperative action at the occupational level. Public concern must also be developed if this part of the goal is to be achieved. During the year, the Office issued a detailed study, entitled The Beginning Teacher: Stains and Career Orientations. This study showed some of the professional, social, and economic characteristics of beginning teachers, and related these factors to differences in career plans, job satisfactions and occupational values. Viewpoints and goals of men and women beginning teachers were often found to be different, but neither group tended to look upon classroom teaching as a lifelong career. Many women, of course, expected to leave teaching either temporarily or permanently because of family responsibilities, but large numbers of men also expected to leave, either for nonteaching positions in education or for noneducational positions. A follow-up study of this same group showed that only 68 percent were still teaching in the same school district the following year, and that 14 percent had left educational positions altogether. This latter group included 12 percent of the men and 15 percent of the women. The conditions revealed by this study emphasize the need to achieve the goals stated above. FINANCING PUBLIC EDUCATION Revenues for public school purposes have increased 20.6 percent in the past 2 years, but this must not be construed to mean that the increase has been available for improvement of school services. Gen¬ eral price levels rose an average of about 2 percent and consumed a portion of the increase in school revenue. Enrollment in the public schools increased more than 7 percent in the 2-year period and this accounted for absorption of an additional portion of the increased funds. Over and above these two factors, however, it appears that a 260 Department of Health, Education, and Welfare, 1961 Chart I.— REVENUE RECEIPTS FOR PUBLIC ELEMENTARY AND SECONDARY SCHOOLS, BY SOURCES: 50 STATES AND THE DISTRICT OF COLUMBIA, 1959-60 Total Revenue Receipts: $14,759,007,000 The proportions of revenue receipts from these sources have remained relatively constant in recent years. net gain has been made in revenues for improving public school serv¬ ices. This gain was approximately 5 percent per year for the period. For the 1959-60 school year 56.2 percent of the school revenue was derived from local and intermediate district taxation, 39.4 percent from State sources, and 4.4 percent from Federal appropriations. These proportions which have remained relatively constant in recent years are shown on chart I. Chart II indicates portions of expenditures for the current school program, for capital outlay, and for interest on school debt which was incurred in the provision of school facilities. Sources and problems of school revenue and school expenditures are discussed in the following paragraphs, beginning with the source of greatest revenue — local jurisdictions. Local School Revenue Somewhat more than half the school funds are provided from local taxes levied usually by the local boards of education. These are often Federal Government Office of Education 261 Chart II. — SUMMARY OF EXPENDITURES FOR PUBLIC ELEMENTARY AND SECONDARY SCHOOLS: 50 STATES AND THE DISTRICT OF COLUMBIA, 1959-60 Interest on School Debt Total Expenditures: $15,643,519,000 Total expenditures for public school education increased in 1959—60 approximately 15 per¬ cent over those of 1957—58. Current expenditures were up approximately 20 percent over the same 2-year period; interest on school debt rose nearly 34 percent during the 2-year period; but, for the first time during the postwar period, capital outlay declined. Despite a continuing need for additional instruction rooms and school plants, this expenditure decreased nearly 7 percent in the 2 years ending in 1959—60. discussed in terms of property taxes and nonproperty taxes for schools. Property Taxes. — Public funds obtained within the school district or received from county or intermediate district taxes are derived chiefly from the property tax. Effective tax rates on property have been rising during the 1950’s, and the school property tax rate increase has been two and one half times as great as that for other local govern¬ ment services. The importance of the property tax as a revenue producer has been maintained, and property taxes have more than doubled from 1950 to 1960, despite acknowledged inequalities and other weaknesses of this tax in our present complex economy. A study by the Office of Education indicated that revenue require¬ ments of the public elementary and secondary schools in the decade 262 Department of Health, Education, and Welfare, 1961 ahead will rise faster than revenue can be expected from property taxes. Property tax revenue generally increases more slowly than gross national product. With the property tax as the main revenue source for schools, general price level increases — and particularly rises in the teacher salary level required to maintain the competitive position of schools in a growing economy — are likely to lead to con¬ tinued fiscal crises for the schools. Nonproperty Taxes. — Proceeds of nonproperty taxes for schools such as local taxes on amusements, deed transfers, hotel occupancy, motor vehicles, sales, wages, and various business transactions, have increased only slightly in recent years. Pennsylvania remains the only State in which local school districts derive significant amounts from these sources. They now produce about 20 percent of local taxes for schools in that State. A number of other States have authorized the use of some limited types of nonproperty taxes for schools but these have produced relatively small amounts of school revenue. In school districts for which the local legislative authority, other than a school board, allots funds for school operation from general revenue, some broadening of the local tax base is evident through the additional nonproperty tax sources available to these governments. School Debt. — School facilities are financed very largely through the issuance of bonds. For assistance to local boards of education in the issuance of school bonds and the management of debt service, the Office of Education is reporting monthly and annually in School Life the average net interest costs on new school bond sales for each State and for the Nation. These reports supply boards of education with information of great significance on problems of offering bonds for sale, accepting or rejecting bids, and levying taxes required for debt service. According to the Moody ratings, the average net interest cost declined steadily from 3.94 to 3.42 percent during the 21-month period ending in June 1961. Nevertheless the total expenditure for debt service is a rapidly expanding item in school budgets. It includes amounts required for repayment of loans as well as for the payment of interest. Receipts from the sale of bonds are designated as nonrevenue receipts. School bond sales reached a peak of $2,420 billion in 1957-58, declined 20 percent in 1958-59, but came within 2.5 percent of the peak in 1960- 61 when sales totaled $2,360 billion. Bonded debt for public school purposes has risen from less than $5 billion in 1950 to more than $15 billion in 1961. The annual sale of school bonds has increased from $1.87 billion to $2.36 billion over the 5-year period ending in 1960-61. The total amount of school bond sales for that period was $10.8 billion. Office of Education 263 Debt service expenditures have risen from less than $.5 billion in 1949-50 to nearly $2 billion in 1960-61. While bonded debt was in¬ creasing about 200 percent, debt service expenditures were increasing about 300 percent. This is due partly to the fact that interest rates have increased from under 2.50 percent to approximately 3.50 percent. Another reason for this disproportionate increase in debt service may be the substantial increase in the sale of shorter term bonds in recent years. In 1954-55 the average net interest cost on school bonds was 2.32 compared to 3.91 in 1959-60. The average rate in 1960-61 has declined to 3.52 percent. State Funds for Schools Since 1947—48, school revenue from State sources has amounted to approximately 40 percent of total revenue collections for schools. Be¬ tween 1957-58 and 1959-60 State funds increased 20.4 percent. This increase was very similar to the 20.6 percent increase in total revenue for public schools during the same period. It indicates that the States have kept the same pace of increase that has occurred overall. Increased appropriations of State money have been provided not only for general improvements in education, but also for improvements for special school purposes. A current example of this latter use of State funds relates to the improvement of mathematics, science, and modern foreign language instruction, promoted under the National Defense Education Act, which provides that Federal funds be matched by State funds for the same purpose. Sources of tax income for the programs of State support generally include individual and corporate income taxes, sales taxes, death and gift taxes, taxes on natural resources, and motor vehicle licenses. However, these taxes are usually adopted by the States for the gen¬ eral support of all governmental services rather than the support of specific areas of service such as education. As much as 75 percent of the State funds for schools are from State taxes collected for this kind of general support. The remaining 25 percent of the funds are from taxes earmarked for schools by constitutional or legislative mandate. Federal Funds for Schools Federal support of education in State and local school systems increased 31.3 percent from the 1957-58 to the 1959-60 school year. Although the proportion of total school funds provided by Federal appropriations has remained relatively constant (approximately 4 percent), the scope and variety of Federal programs have been greatly expanded in the last decade. In addition to support of edu¬ cation through State and local school systems, Federal agencies 264 Department of Health , Education , and Welfare , 1961 provide funds through fellowship, traineeship, training grant, and research grant and contract programs. These programs recognize the Nation’s school system as the basic institution for the development of manpower resources to meet national defense and other needs. Programs of the National Science Foundation and the U.S. Office of Education provide significant support for teacher training, facilities for improved instruction, and studies in improving the content of courses. The National Defense Education Act of 1958 is providing assistance to State and local school systems, institutions of higher education, and to individuals to achieve its purposes. Other Federal programs provide support for school lunches, for agricultural research and extension services, for instruction in land-grant colleges, for the education and training of veterans, and for many other purposes. Expenditure Patterns Raising the standards of educational services wanted by the general public can be achieved through increases in expenditures, but modi¬ fications in expenditure patterns also offer opportunities for improve¬ ment. School superintendents and boards of education are constantly making decisions on apportioning funds among items of the school budget, decisions on reductions or eliminations when revenue is re¬ duced, and decisions on adjustments to be made when additional funds are available. Those having responsibilities for making these deci¬ sions are aware that more effective budgeting is extremely important in raising the standards of school services. Studies are being made of the relationship of the cost of instruction per pupil and the teacher-pupil ratio; also average daily attendance and the teacher-pupil ratio. These studies may help in the deter¬ mination of relationships between expenditure patterns and the quality of educational services. FACILITIES FOR PUBLIC EDUCATION Needs In the fall of 1960, there were 36,305,000 pupils enrolled in the Nation’s public elementary and secondary schools in the 50 States and the District of Columbia. Of this number, 1,868,000, or 5.1 percent of the total enrollment, were in excess of the normal capacity of the acces¬ sible publicly owned school plants in use. This number represented an increase of 122,000 pupils over 1959 figures. Not only were the pupils in excess of normal capacity affected by the shortage of classrooms, but also their classmates. The Office of Education estimated that approximately 8 million pupils were affected by overcrowding, by half-day sessions, and by the use of improvised Office of Education 265 or makeshift facilities. An estimated 2 million others were housed in obsolete or otherwise inadequate buildings. The total number of pupils, therefore, whose education was impaired in varying degrees by the classroom shortage is estimated to be at least 10 million. Chart III. — CHANGES WITHIN THE PUBLIC ELEMENTARY AND SECONDARY SCHOOL SYSTEM: 1957-58 TO 1959-60 Percent decrease Percent increase -30 -20 -10 0 +10 +20 +30 +40 Local school districts 1-teacher schools Enrollment: Grades K-8 Grades 9-12 and postgraduate High school graduates Current expenditures Capital outlay Interest Average annual salary of instructional staff Total instructional staff Current expenditure per pupil in average daily attendance Source: U.S. Department of Health, Education, and Welfare, Office of Education. School Life, Sep¬ tember 1961. Most of the increases represented below are either desirable or expected. The high per¬ centage increase in interest payments reflects the large amounts borrowed in recent years for school construction. The decreases in the number of local school districts and 1 -teacher schools are the result of reorganization and consolidation of small and nonoperating districts. Although the number of 1 -teacher schools decreased 6,000 during the 2-year period ending in 1959—60, there were still 20,000 such schools in operation, or about 22 percent of all elementary schools. The decline in capital outlay (money used for sites, buildings, and new equipment) was the first in the postwar period, and developed in spite of the well-known lag in construction of school facilities. 626936 — 62 — ■ — 18 266 Department of Health , Education, and Welfare, 1961 The accumulated shortage of instruction rooms (classrooms, lab¬ oratories, and shops) for the 5 years ending in 1959-60 remains high despite the fact that 343,000 were completed during that period. Although 69,600 rooms were scheduled for completion in 1960-61, only a small part of this total can be applied against the reduction of the backlog of 142,200 additional instruction rooms (reported by the States in the fall of 1960) needed to house adequately the pupils who were located in overcrowded or otherwise unsatisfactory facilities. This is due to the fact that thousands of rooms were needed in the fall of 1961 merely to provide for population shifts, the estimated annual enrollment increase of more than a million pupils, and for replacements of rooms abandoned during the year. Enrollments in public elementary and secondary schools will in¬ crease from 36 to 44 million during the decade 1959-60 to 1969-70. New facilities will be needed to accommodate these new students. In addition, hundreds of existing school plants will need to be remodeled and expanded. Current developments in new processes of teaching and learning — teaching machines, educational television, language laboratories, and new concepts of individual, small group, and large group instruction — make it imperative that these new and remodeled facilities be planned, constructed, and equipped to accommodate anticipated educational programs. In order to meet these needs, careful attention will have to be given to designing facilities that are adaptable to a variety of uses. The magnitude of the task of planning, designing, and providing instructional facilities for educational programs is compounded by steadily increasing costs of construction and equipment. To com¬ pensate for these rising costs, school plant planners will need to keep abreast of economical developments. The Office of Education will share information on technical advances with State departments of education, and through them, with local systems. Federal Funds for Facilities Under Public Law 815. — From the end of World War II to the be¬ ginning of fiscal year 1961, the American people spent approximately This chart shows the trends in a number of key areas of elementary and secondary education. A steady increase of more than 1 million students per year is evident. Until 1959 there was a slight decline in the “number of pupils in excess of normal capacity” roughly paralleling the general decline in “number of additional instruction rooms needed”; figures for 1960 show an increase over 1959. As would be expected, “total full- and part-time teachers” parallels and is only slightly more than the “number of instruction rooms available at be¬ ginning of year.” The “number of instruction rooms scheduled for completion” has not varied from year to year more than about 8,000 — the approximate 1960 increase over the previous year. The “number of teachers with substandard certificates" steadily increased from 1954 to 1959; but in 1960 the number decreased. Office of Education 267 Chart IV. — TRENDS IN ENROLLMENT, TEACHERS, AND SCHOOLHOUSING IN FULL-TIME ELEMENTARY AND SECONDARY DAY SCHOOLS, 50 STATES AND THE DISTRICT OF COLUM¬ BIA: FALL 1954 TO FALL 1960 Number 38,000,000 36,000,000 34,000,000 32,000,000 30,000,000 28,000,000 2,500,000 2,000,000 1,500,000 1,000,000 500,000 175,000 150,000 125,000 100,000 75,000 50,000 1954 1955 1956 1957 1958 1959 1960 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Fall 1960 Statistics on Enrollment, Teachers, and Schoolhousing. 268 Department of Health , Education , and Welfare, 1961 $28 billion for public elementary and secondary school buildings. Of this amount, the Federal Government, under provisions of Public Law 815, contributed more than $948 million. TJnder the NDEA. — The Office of Education, through its authoriza¬ tion to administer funds appropriated by Congress under the National Defense Education Act, has assisted many school systems in improving facilities and purchasing equipment that should improve the quality of education in instructional areas designated by the Act. For example, from 1959 to 1961, NDEA funds under title III were used to remodel 7,000 classrooms to accommodate laboratory and other equipment essential for quality instruction in science, mathematics, and modern foreign languages. During 1960, approximately 56,000 proj¬ ects for the purchase of materials and equipment costing $105 million were approved. Fiscal year 1961 ended with evidence that projects were approved in even more impressive numbers and at greater costs than those approved in 1960. The tendency among the States partici¬ pating in title III funds of the NDEA is to spend approximately 75 percent of these funds on science facilities and equipment, about 8 percent on equipment and facilities for improved instruction in mathematics, and about 17 percent on foreign language laboratory facilities. School authorities have increased the number of foreign language laboratory systems from 64 in 1958 to more than 2,500 at the beginning of fiscal year 1961. In addition to these laboratory systems, many schools have acquired audiovisual equipment such as tape re¬ corders and projectors for their language programs. CURRICULUM Experimental Programs The curriculum of the public schools is being increasingly influenced by technological developments which involve the use of new com¬ munications media within the classroom. Where these media are used as supplementary aids by a teacher, they offer much promise. Only in instances where the course would not be otherwise available is it considered advisable to use the filmed course, the TV course, or the teaching machine as a substitute for a teacher. Many educators feel that great care must be exercised in developing the content of and in programing filmed courses, TV courses, and courses for use in teaching machines, lest they lead to an undesirable uniformity of the curriculum or to an undesirable type of curriculum control by nonschool and commercial sources. English During the past year individuals and groups called attention to the need for improvement in the teaching of English. In a signifi- Office of Education 269 cant report, titled The National Interest and the T eaching of English , a committee of the National Council of Teachers of English stated that the teaching of English is not as effective as it should be and that the task of the English teacher is becoming increasingly difficult. The committee also called attention to the inadequate preparation of at least half of the persons now teaching English. To improve the teaching of English, the committee declared that, with the help of the Federal Government, “bold and immediate action must be undertaken on a national scale.” Instruction in reading is a major concern of teachers of English. As the first step in a long-range project to improve the teaching of reading, the Office of Education began collecting data on research in reading completed between 1955 and 1960. From these data pro¬ fessional bulletins on various aspects of reading will be published to illustrate how sound research findings may be used to improve classroom instruction. In conjunction with selected high school and college teachers, the Commission on English of the College Entrance Examination Board is developing and trying out sample curriculums and in¬ structional materials, grades 9-12, for college-bound students. Through summer institutes at colleges and universities, the Com¬ mission on English plans to upgrade the qualifications of English teachers. One of the primary concerns of English teachers is composition instruction. More writing assignments, especially during class time, were made possible in some places by a lighter teaching load and the hiring of lay readers to correct and evaluate themes. Ar¬ ticulation of high school and college composition programs was improved through State and regional conferences of high school and college English instructors. Office of Education concern with the teaching of English has been reported in an earlier section of this report. Youth Fitness On February 21, 1961, the Secretary of Health, Education, and Welfare, serving as Chairman of the President’s Council on Youth Fitness, called a meeting of national leaders in various fields related to youth fitness for the purpose of studying recommendations for using Federal resources more effectively on fitness programs through¬ out the Nation. This meeting was addressed by the President, the Attorney General, and other Cabinet officers. A Consultant to the President on Youth Fitness was appointed at this meeting. During the year a guide, Youth Physical Fitness , Suggested Elements of a School- Centered Program , was prepared. This pub- 270 Department of Health , Education, and Welfare, 1961 lication emphasizes the importance of health appraisals and the identification of the physically underdeveloped pupil and gives many practical suggestions for tests and activities. Conferences also were held with the State, city, and county directors of health and physical education. Science One of the most significant developments in science education during the past year was the expansion of the efforts of various national curriculum study groups. Two separate groups, supported finan¬ cially by the National Science Foundation, have developed new courses in chemistry. The Chemical Bond Approach project, intro¬ duced experimentaly in certain schools in 1959, has continued to furnish revised materials; and curriculum materials developed by the Chemical Education Materials Study was introduced into some schools in 1960. Experimental work in revising high school biology has been directed by the Biological Science Curriculum Study. The National Science Foundation has given financial assistance to hun¬ dreds of summer and inservice institutes for science and mathematics teachers. Three conferences, sponsored by the American Association for the Advancement of Science and supported financially by the National Science Foundation, were held to determine the feasibility of up¬ grading science instruction in grades K-9. These conferences sought ways of measuring the achievements of senior high school students who had studied various science courses, recent developments in the psychology of learning, and the problem of introducing major im¬ provements in science teaching into the elementary and junior high school. The Office of Education science staff has launched a program through which local school personnel, State supervisors, and Office of Education specialists work cooperatively to improve teaching in local schools. This program referred to as STEPS (Science Teach¬ ing-Exploration for Excellence — Program Steps) includes sugges¬ tions for evaluating and strengthening the school science program. The program emphasizes the formation of advisory committees of local persons with science backgrounds, the use of facilities provided through the National Defense Education Act, enlisting the cooperation of teachers in sharing with other teachers the new information they have gained while attending institutes, and the use of physical resources of the community. Pilot projects are underway in half a dozen States, and approximately 20 additional State supervisors of science are interested in the program. Office of Education 271 Mathematics Mathematics received major emphasis in elementary schools during the past year. Experimental centers throughout the country, spon¬ sored by the Federal Government and by private foundations or grants, reflected this increased attention to the structure and meaning of mathematics. Institutes held throughout the country for ele¬ mentary teachers and educational leaders in mathematics pro¬ vided training in a variety of new developments in the teaching of mathematics. In the area of secondary education, there was increased emphasis on the structure and meaning of school mathematics. Recent activities in improving secondary school mathematics include the work of the School Mathematics Study Group (SMSG). The SMSG, which is financed by the National Science Foundation, had previously made textbooks and teachers manuals available for use in the experimental programs in mathematics, grades 7-12. During the past year, SMSG prepared instructional materials for grades 4—6 which have been tried in selected experimental centers, as were instructional materials designed for slow achievers in grade 9. The mathematics programs of SMSG and other groups are cur¬ rently being evaluated by the Minnesota National Laboratory at the University of Minnesota. Educational Testing Service is also work¬ ing with SMSG in evaluating the new mathematics materials. Al¬ though SMSG is the largest experimental program ever undertaken in mathematics, there are many other significant experimental programs being carried on at a number of institutions of higher education. A number of eminent psychologists are engaged in studying patterns of concept formations. The Office of Education, in cooperation with the National Council of Teachers of Mathematics, sponsored a national conference on inserv¬ ice education programs, held March 17-19, 1960, in Washington, D.C. The conference report, Inservice Education of High School Mathematics Teachers , was published by the Office during the year. State departments of education have been active in improving in- service education at the local level. To assist in this effort, the Office of Education sponsored the National Conference of State Supervi¬ sors of Mathematics held in Washington, D.C., June 19-23, 1961. Foreign Languages As of July 1961, 53 State supervisors or consultants in foreign languages were functioning in 38 States and the District of Columbia. All but six of these posts were created between 1958 and 1960. In August 1960, a 2-week Research-Study Conference, attended by rep- 272 Department of Health, Education , and Welfare, 1961 resentatives from the States, was sponsored by the Office of Education to discuss problems of State-level supervision of instruction in modern foreign languages. One significant outcome of the conference was the establishment of the National Council of State Supervisors of Foreign Languages. Stimulated by the experiences and recommen¬ dations of the [Research- Study Conference, the supervisors have played a strong leadership role for the improvement of foreign language instruction in their individual States. The NDEA Summer Language Institutes for elementary and sec¬ ondary school teachers have retrained an increasing number of lan¬ guage teachers, as have inservice training courses in local areas. Many colleges and universities have also offered special summer programs and a few have already revised their regular teacher-training pro¬ grams to meet the changing pattern of foreign language study. All of this, in turn, has begun to stimulate research in the foreign lan¬ guage field. Vocational Education Area Vocational Education Programs. — Vocational education pro¬ grams for the training of highly skilled technicians under title VIII of the National Defense Education Act are making a significant impact. In fiscal year 1961 all of the 50 States, the District of Co¬ lumbia, and Puerto Eico conducted programs designed to alleviate the technical manpower shortage. An increased number of State legis¬ latures provided needed funds to accelerate this type of training. State technical institutes and area schools were constructed in a num¬ ber of States to make training available to more students. Under title VIII approximately 300,000 students have benefited from technical training programs during the past 3 years. Prepar¬ atory curriculums, generally 2 years in length, in broad fields of tech¬ nology included : electronics, mechanics, electricity, chemistry, aeronautics, production, instrumentation, and data processing. Elec¬ tronic technology programs accounted for approximately 40 percent of the total enrollment. About two-thirds of all preparatory enroll¬ ments were at the post high school level. Extension courses provided training for adults already engaged in technical occupations to improve their technical knowledge and skills for advancement in their occupations or for upgrading into new or more difficult jobs. Curriculum guides in mechanical, chemical, and data processing technologies are being prepared by the Office of Education. These follow the pattern of the curriculum guides in electronic and electrical technologies previously published by the Office and distributed to the States. Office of Education 273 Seven regional conferences, attended by over 400 State and local i personnel from 48 States and the District of Columbia, were con¬ ducted to develop ways and means of achieving quality in the basic elements of technical education programs. Advisory committees and consultants assisted State and local voca¬ tional educators with curriculum design and many other phases of program development. The Bureau of Employment Security coop- j erated with the States in screening prospective students for technician i training programs. States gave attention to the development of grad- ; uate follow-up procedures and some schools reported 100-percent ! placement of their first graduates. Trade ard Industrial Education . — Trade and industrial education I continued to contribute through preparatory and extension programs in over 200 occupational fields to the needs of youth, as well as to the skilled manpower requirements of the Nation. States reported an expansion of trade and industrial education especially for out-of- i school youth and for adults, and particularly in new area vocational schools. Enrollment gains occurred in cooperative work training programs and other occupational fields, especially the service trades and health occupations. A majority of all vocational education enrollments occurred in the fields of trade and industrial education. Enrollments in practical nurse training continued to grow. Prog¬ ress was made in curriculum development, several States reporting workshops in this area. Research in nursing education was carried on through cooperative action with other Federal agencies and na¬ tional associations concerned with the health occupations. Several Office programs have contributed to the manpower needs of industry. Emphasis on training of the unemployed as well as the underemployed resulted in a readiness to expand facilities to meet these growing problems. Enrollments in supervisory training vir¬ tually doubled in the past 5 years. Enrollment of apprentices, re¬ flecting results of the joint efforts of education, labor, and manage¬ ment, gained substantially. Expanded course offerings and technological change have placed heavy demands on curriculum development. Several States estab¬ lished curriculum laboratories, indicating an awareness for expanding and updating their instructional materials. Needs for improving skills in vocational education were studied. Differences in the requisites of full- and part-time instructors have brought about changes in teacher training programs in many sections. A number of State-initiated leadership development conferences, as part of long-range plans to meet State and local needs for adminis¬ trators and supervisors, were held during the year. 274 Department of Health , Education , and Welfare, 1961 Distributive Education. — The Office of Education distributive education program provides instruction in marketing and distribution. It emphasizes economic concepts and judgment skills that apply not only to occupations but also to functions in marketing. Its in¬ structional materials encourage career development from beginning jobs to management and business ownership. All the trainees in distributive education are employed or have definite promise of employment in the field. At the high school level, entry jobs assist the trainee in learning how to become a productive employee, in studying marketing functions within a business and a community, and provide opportunity for the instructor to analyse individual potentials and career objectives of trainees. In their endeavor to assist individuals who plan careers in distri¬ bution, States and communities used evaluative criteria to establish 1 quality standards of instruction and program operation, emphasized research to recognize economic developments significant in curriculum and learning activities, and strengthened curriculums and expanded opportunities for preparatory inservice teacher education. Most of the enrollments in distributive education are in adult ex¬ tension courses which stress small business management and the mar¬ keting of locally important products. Distributive education has gained recognition with management and labor groups and trade and business organizations as a vehicle through which training and re¬ training programs may be offered successfully. Office Education. — The office-education program continued its ef¬ forts to encourage and promote education for office careers. This program services the second largest employment classification in the 1 Nation (clerical and kindred workers), representing about 15 percent of the total number in all types of employment. Material of interest to office educators was widely distributed through Office of Edu¬ cation releases, professional journals and speeches. Home Economics. — The Office of Education is concerned with the extension and improvement of public school programs of home eco¬ nomics for young people and adults, of research in home economics education, and of home economics teacher education programs. In carrying out these activities during 1960-61, extensive use was made of the findings from a study of home economics in public secondary schools made by the Office in the spring of 1959. Data from the study have given direction on evaluation and revision of curriculums at State and national levels. Reports of the findings were given and implications for action considered at (a) three regional home eco¬ nomics education conferences organized by the Office of Education, Office of Education 275 Chart V. — VOCATIONAL EDUCATION ENROLLMENTS AND EXPENDITURES: 1940-60 Enrollment in Vocational Education by Type of Program Millions J ^ 1940 1945 1950 1955 1960 Source: U.S. Department of Health, Education, and Welfare. Health, Education, and Welfare Trends, 196?. In 1960 there were 3.8 million students enrolled in vocational education courses. Of these students, approximately 42 percent took courses in home economics, 21 percent in agricul¬ ture, 25 percent in trade and industry, and 8 percent in marketing. The remaining 4 percent were some 101,000 students who took courses in science, mathematics, and other related courses under Area Vocational Education Programs, and 40,000 who took courses in practical nursing. In 1960, of the approximate $239 million expended for vocational education pro¬ grams, State and local funds furnished 81 percent. 276 Department of Health , Education , and Welfare , 1961 (b) State meetings of teachers and administrators, and (c) meetings of professional organizations. STUDENTS Public High School Graduates In 1959-60, there were 1,764,237 pupils enrolled in the last year of high school of whom 92.2 percent were graduated. These 1,627,060 graduates represented 68.7 percent of the class which had entered grade 9 in 1956-57 — an increase of 8.3 percentage points over the rate of graduation in 1949-50 as compared with enrollments in grade 9 four years earlier. Identifying Talent The National Defense Education Act mider title V (A) grants funds to States to improve and extend their guidance, counseling, and testing services. Reports from the States indicate that the NDEA program lias been effective in helping many students who were plan¬ ning to drop out of high school or not planning to go to college, set their goals, plan their careers, and take advantage of educational opportunities. Most States have adopted a counselor-pupil ratio of 1 to 300 as their goal. In 1958, the national ratio for all high schools was 1 to 750; at the present it has dropped to below 1 to 600. Over 7,000 new counselors have been added since the beginning of the NDEA. Current statis¬ tics indicate that there is a shortage of approximately 20,000 guidance and counseling personnel at the secondary school level, and 2,200 at the undergraduate college level. Exceptional Children Exceptional children include those who are blind or partially seeing, deaf or hard of hearing, those who have impaired speech, who are crippled, who have special health problems, who are socially maladjusted, emotionally disturbed, mentally retarded, or who have above-average talent. These children now number approximately 6 million, only about one- fourth of whom are receiving the specialized education they need. One index of the increasing public understanding and acceptance of special means of education for exceptional children and youth is shown in data from a forthcoming statistical report of the Office of Education. Percentage gains in enrollments for the decade 1948- 1958 are shown below : 277 Office of Education Area of exceptionality Local Public Schools : Blind _ Partially seeing - Deaf _ Hard of hearing _ Speech impaired _ Crippled and special health problems. Socially and emotionally maladjusted. Mentally retarded - Gifted _ Percentage gain in enrollment _ 441 _ 11 _ 81 167 14 84 152 153 Residential Schools : Blind _ _ 32 Deaf _ _ 22 Socially and emotionally maladjusted - 63 Mentally retarded - _ 21 Likewise, the number of localities or operating units in which programs were carried on grew from about 1,500 in 1948 to nearly 3,700 in 1958. The increase was more than the total number of localities in 1948. Adequate preparation of teachers is probably the major key to quality education. In 1953 only about 120 colleges offered a minimum 1 sequence of preparation in one or more areas of exceptionality. A study is now underway to ascertain the current status of teacher preparation programs in these areas. There is much interest in curriculum development at the graduate and undergraduate college levels. This interest was accelerated by a nationwide series of studies conducted by the Office of Education on teacher competencies in the various areas of special education. When the Congress passed Public Law 85-926, a large forward step was taken toward the expanding of opportunities and programs, particularly at the graduate level, for the preparation of teachers of the mentally retarded. This law provides for the establishment of a fellowship program for preparation of (1) instructors and directors of college or university programs for the training of teachers of the mentally retarded, or (2) supervisors and directors of edu¬ cational programs for mentally retarded children in State and local school systems. About 170 fellowships have been available each year. During fiscal 1961 the Office of Education issued three publications in the area of the gifted student: a bulletin entitled Teachers of Children Who are Gifted , a report on a Cooperative Research Program project, entitled The Gifted Student , and a study entitled Educating the More Able Children in Grades Four, Five and Six. 278 Department of Health , Education , and Welfare , 1961 Dropouts The average age for graduation from high school is about 18 years. The average age of the high school dropout is 16+ years. High school graduates, based on enrollments 4 years before their graduation, have been increasing steadily since 1948 ( from 62 percent in that year to approximately 67 percent in 1960). But larger enrollments have actually increased the number of dropouts. Employment problems for these dropouts are further complicated by the growing number of aging workers who frequently compete with young workers for the same marginal jobs. Although some talented students and many with average ability are among dropouts, the majority are slow learners and pupils from homes of low-level education and culture. Pupils from these groups lack motivation to continue in school, but through the encouragement which is being provided by expanded guidance and counseling pro¬ grams under title V( A) of the National Defense Education Act, many of the talented and those with average ability complete their high school education and enter college, and a great number of those with below- average ability are led to continue their training in courses adapted to their capabilities. Three general approches to a solution of the drop-out problem are currently being tried out in school systems : 1. Attempts to raise the cultural level of children who are culturally deprived. 2. Better teaching with emphasis on acquiring basic skills in the elementary grades and junior high school with remedial instruction provided for slow learners. 3. School-work program where pupils spend one-half day in school and one-half day on a school supervised job. ADULT EDUCATION The concerns of adult education relate to some of the major prob¬ lems of our time. These problems involve the training and retraining of adults to meet the challenge of scientific and technological develop¬ ments ; the growing educational needs of older people ; and the pro¬ vision of educational opportunities for undereducated and uneducated American adults. During fiscal 1961 emphasis was on the development of more qualified adult education leadership in the States. Office of Education staff members provided assistance in strengthening adult education programs and services of State departments of education, universities and colleges, public schools, libraries, and voluntary citizen organiza¬ tions. The National Conference on Aging held in 1950 and the one Office of Education 279 held in 1961 included sections on education. From these conferences has come a clear delineation of the role of education for the aging. The Office of Education, in cooperation with committee members, prepared the supporting document, “Background Paper on Education for Aging,” used by the education section of the 1961 White House Conference on Aging. Office staff members also contributed the education section of a final conference report entitled “The Nation and Its Older People,” as well as a final conference report on “Educa¬ tion for Aging.” In cooperation with the National Commission for Adult Literacy, the Office called a national conference on June 1-2, 1961, for the purpose of studying ways and means of increasing and expanding educational opportunities for foreign-born and native adult citizens. An Office of Education bulletin released in 1961 entitled Education of the Adult Migrant analyzed the difficulty of absorbing migrants from farms and small villages in urban areas. This study will assist urban communities interested in providing special educational opportunities for new residents. Civil Defense Education The Civil Defense Adult Education Program was designed to teach the techniques of individual, family, and community survival in disasters, both manmade and natural. This educational program is conducted by instructors who have completed 15 hours of technical studies, and is offered to adults in a 12-hour course, through the public school systems. The course includes the study of defensive measures against radiological, chemical, and biological warfare, community planning for such emergencies, and protective measures against natural disasters. Instruction in Civil Defense. — Under contract with the Office, the States of California, Florida, Kentucky, Louisiana, Minnesota, Nebraska, and Texas prepared instructors to teach these courses. Eight more States have contracted to participate in the program during 1962. Higher Education INSTITUTIONAL NEEDS General Needs of All Institutions Of the 2,028 institutions of higher education listed in the Office’s Education Directory , Part III , Higher Education , 1960-61 , 1,325 operate under private or denominational control, and 703 under public control. A substantial share of the Office’s effort during fiscal 1961 280 Department of Health , Education, and Welfare, 1961 was devoted to providing services to these institutions, their officials, their boards of control, and to governmental agencies, denominations, and other organizations. A survey of the colleges and universities of South Dakota (7 public, 9 private), conducted at the request of a committee of the State legislature with the full cooperation of the private colleges, was the largest single effort of this kind. In addi¬ tion to providing consultive and professional services to scores of institutions, and to their duly constituted officials, the Office conducted comprehensive surveys of approximately a dozen individual colleges and universities in as many States. During fiscal year 1961, the problems of these institutions continued to relate primarily to the steady rise of enrollment and the prospect | of a sharp upturn of the rate of rise between 1964 and 1969. The Office completed, and on January 19, 1961 the Secretary of Health, Education, and Welfare released a staff paper entitled Ten-Year 1 Objectives in Education: Higher Education Staffing and Physical Facilities , which sketched in detail the requirements of the Nation’s colleges and universities for professional staff and physical facilities. The Office gave increasing attention to the needs of and trends in graduate education, completing the following studies: Graduate Education in Business Administration , Graduate Degrees Awarded by Members of the Association of Graduate Schools , Bibliography on Graduate Education , and Graduate Fellowships and Capacities of Graduate Schools. Several special studies designed to assist those responsible for higher education administration and planning were in progress or completed during fiscal 1961. Among them were Advance Planning for Higher Education , Internal Organization and Administration of Colleges and Universities , and Cooperative Projects Among Colleges and Universities. The Office also compiled and published a compre¬ hensive bibliography on The Administration of Higher Education. Higher Education Staffing Needs. — The prospective shortage of professional staff is one of the two most serious problems facing higher education. Today about 383,000 professional persons (about 298,000 full-time equivalent) are engaged in providing the teaching, research, management, and administrative services in higher education. During the next 10 years about 336,000 new, trained professional staff members must be recruited by the Nation’s colleges and universi¬ ties (at the master’s and doctor’s degree levels) to replace those lost by death, retirement, and resignation and to accommodate increases in enrollment (see chart VI). The Nation’s graduate schools must train not only these persons but similarly the far larger numbers of people required for business, industry, Government, and other areas. In order to keep pace with mounting enrollments, these schools must Office of Education 281 Chart VI. — PROJECTED HIGHER EDUCATION PROFESSIONAL STAFF TOTALS (FULL-TIME EQUIVALENT): 1959-60 TO 1969-70 Thousands 400 1959-60 1961-62 1963-64 1965-66 1967-68 1969-70 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Ten-Year Objectives in Education: Higher Education Staffing and Physical Facilities, 1960-61 Through 1969-70. The chart indicates the number of full-time persons required to meet the projected demands for instructional and administrative services and for the growing program of organized re¬ search. Of the total staff of 402,000 required in 1970, approximately 64 percent will be engaged in teaching; 16 percent in administrative services; and about 20 percent in organized research. 626936—62 - 19 282 Department of Health , Education , and Welfare , 1961 produce persons on the doctorate level at a greatly increased rate in order to avert serious deterioration in the level of academic training. The Office led in developing during fiscal 1961 a pilot project for encouraging competent youth to prepare for careers in college teach¬ ing. Fifty colleges in Wisconsin are cooperating with the University of Wisconsin and Marquette University in the project, in which 150 top sophomore students participated in a workshop on college teaching as a career, and in which plans for university-supervised paid intern¬ ships coordinated with graduate study are planned. The percentage of doctor’s degree holders among entering stall members in institutions of higher education declined from 31.4 percent in 1953-54 to 23.8 percent in 1958-59. It was estimated that to es¬ tablish the proportion at 30 percent for the decade 1960 to 1970, the Nation’s graduate schools would have to award an average of 16,800 doctor’s degrees annually during that period. When this number is compared with the current rate of about 9,800, and a projected 10- year average of 13,300 based on present increasing graduate enroll¬ ments (see chart VII), the staffing crisis is clear. Even the goal of 16,800 new doctor’s degree holders per year will be insufficient unless improved balance between supply and need by fields is achieved, and unless at least 60 percent of those receiving the doctor’s degree accept positions in higher education. During the year the Office investigated staffing problems of colleges and universities in surveys of faculty turnover, faculty load, staffing in selected subject fields, and studies of career characteristics and motivation. Higher Education Salary Problems . — The problem of recruitment of staff for higher education will become increasingly serious, at both master’s and doctor’s degree levels, unless salaries in colleges and uni¬ versities are increased during the next decade at an unprecedented rate. The increases in salary of professional staff in higher education dur¬ ing the last 5 years fall far short of restoring the economic ground lost by the profession since 1940. The Office’s report, Higher Education Planning and Management Data , 1959-60 , completed and published during fiscal 1961, provides data for use in evaluating the status of instructional and administrative salaries in the Nation’s colleges and universities. Higher Education Facilities Needs. — The Secretary’s staff paper, Ten-Year Objectives in Education , previously referred to, indicates that the colleges and universities need to spend $9 billion for facilities by 1965 and an additional $10 billion by 1970 to accommodate the anticipated rise in enrollment and to replace outmoded or obsolescent facilities. Projections of presently anticipated income indicate that even with full utilization of the Federal Government’s College Housing Program funds at the rate of $250 million a year, the funds Office of Education 283 Chart VII. — CUMULATIVE OUTPUT OF AND NEED FOR DOCTOR S DEGREES FOR HIGHER EDUCATION STAFFING: 1959-60 TO 1969-70 U . .. -I - 1 - - - 1 - — - - - - - - — - — - - - - 1959-60 1961-62 1963-64 1965-66 1967-68 1969-70 Source: U.S. Department of Health, Education, and Welfare, Office of Education. Ten-year Objectives in Education: Higher Education Staffing and Physical Facilities, 7960-61 Through 1969-70. Projection of cumulative need is based on two assumptions: (1) that 30 percent of new staff members should hold the doctorate in order to insure quality, and (2) that 60 percent of all doctor’s degree recipients can be counted upon to fill such positions. The comparisons of projected need with estimated cumulative output during the decade ending in 1970 identifies the “quality gap” (a shortage of approximately 35,000) threatening higher education if the output of doctorates is not both accelerated and increased. for facilities will fall short of needed expenditures by $1.5 billion by 1965 and $2.5 billion by 1970 (see chart VIII). During fiscal 1961 the Office completed and published part 3 of its College and University Facilities Survey: Inventory of College and University Physical Facilities , December 31 , 1957 : A Preliminary Report. In continuing the effort to provide information on the support of higher education, the Office planned or initiated surveys in college and university endowment investment and facilities needs. 284 Department of Health, Education, and Welfare, 1961 Chart VIII. — CUMULATIVE NEED IN HIGHER EDUCATION FOR PHYSICAL PLANT: 1959-60 TO 1969-70 16 12 8 4 Billions of dollars $2.5 billion gap at I onrl nf lQAQ-7n T. Cumulative Need (Annual Total ) $1.5 billion gap at end of 1964-65 Projectesl institutional Expenditures Source: U.S. Department of Health, Education, and Welfare, Office of Education. Ten-year Objectives in Education: Higher Education Staffing and Physical Facilities, 1960-61 Through 1969-70. These projections take into account the following factors: (1) enrollment increases, (2) condi¬ tion of plant — obsolescence and substandard conditions, (3) instructional facilities, (4) resi¬ dential facilities, (5) construction costs, (6) cost of additional, special needs. Note that the size of the gaps projected for 1965 and 1970 would be approximately doubled if College Housing Loan Program funds were not available. Trends in 2-Year Institutions The importance of 2-year colleges (community or junior colleges and technical institutes) to higher education is seen by the steady increase in the number of such institutions over the last 10 years as well as by the fact that an increasing number of these institutions are being operated under public control. Several important developments on the 2-year college scene occurred during fiscal 1961. In many States new laws affecting 2-year colleges were passed in the 1960-61 sessions: Missouri and Kansas provided Office of Education 285 State financial aid for 2-year colleges for the first time; Michigan, Colorado, and Maryland passed laws strengthening and clarifying the legal structure of 2-year colleges; and Ohio passed laws enabling different types of public 2-year colleges to be established. These and other legislative developments affecting 2-year and other colleges are cited in the Office’s annual summary: State Legislation Relating to Higher Education. In addition, the Office published during fiscal 1961, a definitive report bearing on the 2-year college movement : Cri¬ teria for the Establishment of 2-year Colleges. Trends in Professional Education The Office gave attention during fiscal 1961 to trends in engineering, and in technical, agricultural, and professional education. Among the related studies completed during the year were : Trends in Engi¬ neering Education , Organized Occupational Curriculums , 1958 and 1959 , The 3-2 Plan of Engineering Education , Transfer Students in Engineering , and College Enrollments and Degrees in Agriculture. Several titles were added to the series, “New Dimensions in Higher Education”: No. 8, Advanced Standing / No. 9, Reappraisal of the Credit System / and No. 10, Quality in the Undergraduate College. The Office also identified for priority treatment and drew plans to attack the problem of improving the quality of teacher education. STUDENT FINANCIAL NEEDS ISon-Federal Assistance During fiscal 1961, the Office completed and prepared for final re¬ porting a comprehensive study of institutional undergraduate student financial assistance for the academic year 1959-60. Scholarships from non-Federal sources constitute the largest single block of student assistance, estimated by leaders in the field at between two-thirds to three-fourths of the total volume of scholarship assist¬ ance. In the following tabulation the total value of institutional scholarships for 1959-60 and other related statistics are compared with the data of 4 and 10 years earlier : 1949-50 Number of higher institutions that awarded scholarships _ 1, 198 Total value of institutional scholarships _ $27, 000, 963 Number of students awarded scholarships _ 124, 223 Average institutional scholar¬ ship grant _ $217 1955-56 1, 341 $65, 736, 950 237, 370 $277 1959-60 1,559 $98, 157, 498 288, 521 $340 286 Department of Health, Education, and Welfare, 1961 Another student financial assistance project of the Office of Educa¬ tion, nearing completion at the close of fiscal 1961, was a study of State administered and financed scholarship programs. This study deals with : (a) scholarships authorized by State legislation and sup¬ ported by specific appropriations, which are not a part of institutional scholarship assistance; and (b) programs of State administrative agencies (such as education, health, highways, and welfare), which enable students to attend a college or university with an option of repaying the agency either in money or in service. Based upon data for the fiscal year 1958-59, the study reveals that 33 States, the District of Columbia, and Puerto Kico operated 104 scholarship grant programs which assisted 55,178 students with a total volume of scholarship awards of $19.5 million at an average grant of $355 per student. The programs of the States of California, Florida, Illinois, Maryland, New York, and Virginia account for the scholar¬ ship assistance to approximately four-fifths of all State-aided scholars and a corresponding portion of State scholarship expenditures. In recent years several States, including Georgia, New Jersey, Khode Island, and Virginia, have adopted general (noncategorical) scholarship programs. Moreover, California has amended its legis¬ lation to enlarge its general competitive scholarship program and has authorized a new scholarship program for agricultural students. Another substantial volume of scholarship assistance is awarded by a variety of business firms, corporations, labor unions, churches, civic organizations, parent-teacher associations, women’s clubs, and other voluntary organizations. It is estimated that for the year 1959-60, approximately 37,000 scholarship grants with a total stipend value of about $22.5 million were awarded. The largest segment of these scholarships is administered by the National Merit Scholarship Corporation. During 1959-60 this pro¬ gram provided scholarship aid to 830 first-year college students, who were awarded an average grant of $827, for a total of $686,150. The total scholarship payments to these students and to those of 3 previous years was almost $2.2 million and was in support of 3,937 students. Increases in Tuition and Required Fees. — An important consider¬ ation of student financial assistance is the adequacy of stipends to meet college costs, which have been sharply increasing since 1954. During fiscal year 1961 the Office continued its study of this trend. A comparison of the average annual institutional charges for tuition and required fees in 196 representative colleges and universities between academic years 1949-50 and 1960-61 is given below : 1 1 Figures are for 196 representative institutions for which continuous data for the period indicated were available. These colleges and universities, each of which enrolled more than 1,000 full-time undergraduate students, accounted for approximately 55 percent of the Nation’s undergraduate students and for a larger proportion of graduate students. These data apply, therefore, to the majority of college students. Office of Education 287 Tuition Increase since 1919-50 Academic and Year Fees Amount Percent Public Institutions 1960-61 _ _ $207 $95 85 1959-60 _ _ 194 82 75 1958-59 _ _ 179 67 60 1957-58 _ _ 168 56 50 1956-57 _ _ 155 43 38 1955-56 _ _ 147 35 31 1954-55 _ _ 135 23 21 1949-50. _ - _ _ 112 Private Institutions 1960-61 _ _ $938 $473 102 1959-60 _ _ 890 425 91 1958-59 _ _ 820 365 76 1957-58 _ _ 741 276 59 1956-57 _ _ 690 225 48 1955-56 _ _ 638 173 37 1954-55 _ _ 590 125 27 1949-50 _ _ 465 During the 11 -year period, public colleges and universities increased their tuition fees by $95, or 85 percent, while private institutions increased theirs $473, or 102 percent. While the average scholarship grant during the last 4 years increased by $63 (from $277 to $340), during the same period the average increase in tuition fees increased $242, or almost four times as much. A conservative estimate of the total volume of non-federal under¬ graduate scholarship assistance from all sources for the next academic year (1961-62) would be $150 million. In view of recent increases in tuition charges and other college costs and the number of high school graduates who have the requisite ability for higher education, it is doubtful that this sum is adequate to overcome the economic barriers to higher education. Federal Assistance During 1961, the Office’s higher education programs under titles II, IV, V(B) , and VI of the National Defense Education Act reached peak operation. Title II. — During fiscal 1961, 156,000 students borrowed $73.3 million. Loans totaling $108,360 were made to 390 Cuban students in 51 institutions in the United States. Title IV. — 1,500 fellowships were awarded and 476 new and ex¬ panded graduate programs were supported during fiscal year 1961. Support of these projects, together with the continuing support of approximately 2,500 fellowships awarded in the previous 2 years, amounted to $6 million during the year. A total of $12.6 million 288 Department of Health , Education , and Welfare, 1961 was appropriated for the graduate fellowship program for fiscal year 1961, approximately 50 percent of which was paid in grants to fellows and 50 percent in stipends to institutions conducting the graduate programs. Title V (B) . — A total of 2,744 counselors and teachers preparing to become counselors attended 83 summer institutes, and 612 attended 20 regular- session institutes. The experience of 2 years of NDEA guidance counselor training institutes led in 1961 to the following new approaches. To meet the demand of providing well-trained guidance counselors and better guidance programs, the Office improved the institutes by (a) placing greater emphasis on year-long training for regular enrollees, and (b) setting up short-term special-purpose institutes to provide an opportunity for persons who needed refresher training in new techniques, and for those who have not yet met certification requirements. At the suggestion of the Office of Education, the Association of Secondary School and College Administration Officers secured a grant that enabled the Association to send representatives from college ad¬ missions offices to the institutes conducted during the summer of 1960. These representatives were able to present the most current informa¬ tion on problems of college selection and admission. Special purpose institutes of 2 to 8 weeks’ duration will be estab¬ lished in 1962 to train counselors in handling new guidance problems. Concentration will be on problems associated with the increased num¬ ber of students aspiring to attend college — the wide ability range of these persons, the student’s choice of college and admission to college. These institutes will also stress the role of the counselor in developing and changing the school curriculum. Recognizing the necessity that the school administrator must under¬ stand and support the guidance program of a school, provision will be made at some of the special institutes in the summer of 1962 for a 1- or 2-day visitation by school administrators. Finally, a new program of full-year traineeships wTas proposed so that advanced training could be provided promising counselors and counselor supervisors. Title VI. — 2,003 elementary and secondary school language teachers attended 37 summer institutes, and 117 attended 5 regular-session language institutes. Language fellowship awards were made to 472 graduate students studying 31 neglected languages. This included 112 renewals of fellowships awarded the previous year. A total of 46 language centers at 30 colleges and universities received support amounting to $1,575,000 for improving and strengthening instruction in 44 neglected languages. Office of Education 289 A total of 46 new language research projects were initiated at a total cost of $811,416, and another $1,118,205 was obligated to con¬ tinue the 115 projects begun in the 2 preceding years. Improvement of Auditing Procedure for NDEA Funds. — The Office of Education has continued to improve its recently established program of auditing the expenditure of funds received under the National Defense Education Act by colleges and universities. This auditing program provides professional assistance and advice to insti¬ tutions which have received NDEA funds, in the establishment of adequate financial systems to assure accountability for Federal funds. International Education INTERNATIONAL EDUCATION AND THE NATIONAL CHALLENGE In earlier days the resources of an undeveloped country lay in the vast uncultivated land. These resources, in turn, demanded and pro¬ duced capital wealth. But today, the need is for trained manpower, which can be produced only through education. Indeed, there is a growing belief that man himself is the only permanent form of wealth, that societies become technically advanced, politically secure, and economically developed through the education and training of individuals. This idea of education as the foundation of economic, social, polit¬ ical, and cultural development, is a logical outgrowth of American tradition. But what was once regarded as an abstract right of the individual is now understood to be the foundation of national power, essential for national survival. Perverting this great concept to the uses of communism, Russia is using education as a political tool on the one hand, for creating “the new communist man,” and on the other, for building the power needed to support communism at home and abroad. Today this concept of education is of vital concern to mankind. Whether education is fostered by a nation as a means of teaching broad freedom of thought and action, thereby insuring self-govern¬ ment for its citizens, or is promulgated as an agency for suppressing those freedoms, thereby supporting totalitarian control over its sub¬ jects, is the choice many peoples of the world are now making or will make in the years immediately ahead. Since 1946 more than 800 million people have begun to govern themselves. In many new na¬ tions, only a small proportion of the children are in school. Their parents are generally convinced that only through education can they achieve a decent way of life. In some countries more than 40 percent of the government’s income is devoted to education. 290 Department of Health, Education, and Welfare, 1961 The Office has served as a bridge between educational developments at home and overseas since it was established in 1867. In 1896 this role was formalized by legislation which gave the Commissioner of Education basically the same reporting responsibilities toward both foreign and domestic education. As education has increased in impor¬ tance as an instrument of both national and international policy, the responsibilities of the Office in international education have grown rapidly. Likewise, it has become apparent that the Office should take the leadership in convening representatives from Government, indus¬ try, and education to discuss the adequacy of present programs of education at all levels to meet the manpower needs for the Nation’s international activities, and to educate our people for the international responsibilities of the future. INTERNATIONAL EDUCATIONAL RELATIONS During 1960-61 the Office performed a variety of services for gov¬ ernmental and nongovernmental agencies, professional organiza¬ tions, and institutions and individuals both here and abroad. Services Relating to International Organizations The Office provided information on education in the United States to international organizations, ministries of education, and institu¬ tions and professional educators abroad. Among many projects undertaken were the evaluation of UNESCO’s proposed education program for 1961-62 and the develop¬ ment of project plans for inclusion in the organization’s program for 1963-64. An adviser from the Office of Education was appointed to the United States delegation to UNESCO’s General Conference in Paris. The Under Secretary of the Department of Health, Education, and Welfare was official spokesman for education on the delegation. Work with the International Bureau of Education included, in addition to the usual multilingual progress report on education in the United States, the development of official replies to questionnaires on the one-teacher school and on preprimary education. These questionnaires were the basis of discussions at the Twenty-fourth International Conference on Public Education in July 1961. The Office reprinted and distributed the recommendations adopted by the conference, and in various publications described its proceedings and significance. Upon request, the Office furnished the names of specialists in various branches of education and nominated persons for member¬ ship on international boards or committees of experts to such organi¬ zations as UNESCO, the United Nations, and ILO. The Office was Office of Education 291 also asked to recommend persons for awards of international fellow¬ ships in education. Major reports prepared by Office specialists for inclusion in UNESCO publications included material on correspondence education and the teaching of geography, and a report on the accessibility of the teaching profession to women. Credentials Evaluation During 1961 comparative education specialists of the Office evalu- I' ated 5,355 credentials for university admissions offices, boards of certification and licensure, State Departments of Education, and other institutions and agencies. This was an increase of 918 cases over 1960. Staff members continued to work closely with the American Associa¬ tion of Collegiate Registrars and Admissions Officers, the Council on Evaluation of Foreign Student Credentials, the National Association of Foreign Student Advisers, and the Institute of International Edu¬ cation on matters relating to credentials. The Office participated in conferences and meetings of these associations, in the development of materials, and in the dissemination of current information helpful in interpreting education programs of institutions abroad. These ac¬ tivities are essential in improving and expanding American support of education in the new nations. Conferences and Studies on Comparative Education In the summer of 1960 a conference was held on education in Com¬ munist China, at which several papers prepared by specialists in the field were presented and discussed, and later published. Government specialists with particular knowledge of Soviet education were re¬ cently invited by the Office to present papers on themes related to their common field of interest. These papers will be published during the coming year. A brief study, Education in England , developed for an earlier con¬ ference, and an account of a 1960 conference, Foreign Understanding and Interpretation of United States Education , were published during 1961. Among comparative education studies published in 1961 for the use of United States educators and specialists were Education for Africans in Tanganyika , Soviet Education Programs , and Educa¬ tional Trends in the Caribbean. Other publications appearing during the year deal with aspects of education in Afghanistan, Libya, the United Arab Republic, Czechoslovakia, Rumania, the U.S.S.R., Switzerland, Communist China, Indonesia, Hong Kong, and the United Kingdom. 292 Department of Health , Education, and Welfare, 1961 These publications will promote understanding and comparison of programs and enable government and professional agencies to develop more effective educational aid to other countries. The studies have a special significance to American institutions accepting foreign stu¬ dents, and others whose widely divergent educational backgrounds and professional competencies need careful appraisal in order to place them in circumstances that will yield maximum value from their American experience. Clearinghouse of Educational Studies During the year the Educational Clearinghouse completed 122 statistical reports of the activities of approximately 8,000 exchange students, teachers, and other scholars on Government-sponsored pro- | grams who were engaged in more than 200 fields of specialization. The following fields of study attracted the largest number of foreign grantees in the order indicated : medicine, elementary education, eco¬ nomics, government, law, journalism, American literature and civiliza¬ tion, English as a second language, physics, and chemistry. American grantees, who went abroad to study during the same period, came from all States and Territories and pursued their studies in more than 60 different countries. These grantees engaged in some 150 specialized fields of study, among which the following, in order, attracted the greatest numbers : Romance languages and literature, music, English as a second language, English language and literature, Germanic language and literature, political science, elementary education, art, physics, and physical education. Specialists for International Assignments Education is an important area in the programs of technical assist¬ ance to the underdeveloped areas of the world. The Mutual Security Program and a somewhat similar program operated by UNESCO, together require a continuing overseas staff of approximately 900 educational technicians. The Office of Education is responsible for recruiting education specialists for both programs. The Office also selects an increasing number of technical assistants for educational specialists overseas and, periodically, sends packets of professional educational materials to them. The Office increased its activity to provide training for Americans serving abroad in Govern¬ ment or private enterprises. This function of the Office of Education is illustrated by a major effort in 1961 to develop resources in the African languages through centers, advanced language fellowships, and research under title VI of the National Defense Education Act. Language study in the land in which the language is spoken was given new emphasis in Office planning in 1961. The lack of authority Office of Education 293 to provide such opportunities was recognized as a gap in the existing National Defense Education Act language training program, and it was proposed that this authority be added in order to improve further the preparation of language teachers. International Educational Exchange The Office continued to conduct three major programs under agree¬ ments with the Bureau of Educational and Cultural Affairs and the International Cooperation Administration of the Department of State: the Teacher Exchange Program, the International Teacher Development Program, and the Technical Assistance Training Pro¬ gram in Education. It has worked with the Conference of Governors to develop State participation in international teacher exchanges. It has also provided nonscheduled advisory services to hundreds of individuals and institutions in this country and elsewhere. In addition, it provided extensive services for visitors who were not recipients of grants administered by the Office. The total number of participants in the four categories was 2,539. Teacher Exchange Program . — The Teacher Exchange Program expanded slightly from a total of 619 in 1960 to 624 in 1961. The participants were distributed as follows: teacher interchanges, 155 pairs (310 teachers) ; other United States teachers assigned abroad, 130 ; other foreign teachers assigned in the United States, 45 ; summer seminars abroad for United States teachers, 139. Eight seminars were conducted as follows: teachers of Spanish in Spain and Co¬ lombia; teachers of history in France, in Brazil, and in India; teachers of the classics in Italy; teachers of German in Germany; teachers of French in France. International Teacher Development Program . — The International Teacher Development Program increased from 486 visiting educators in 1960 to 529 in 1961. The number of participating countries in¬ creased from 65 to 67. Programs arranged at 16 colleges and uni¬ versities included four groups in the teaching of English as a second language; two groups each in elementary and secondary education; three groups in American civilization; an Irish teacher group; a Tunisian teacher group; and one group each in administration and supervision, science education, and vocational education. Individual itineraries were prepared for 12 participants at an advanced, specialized level. Two teacher-development workshops in elementary, secondary, and vocational education were held at the University of Puerto Rico — one in October and one in February 1961 — for 113 educators from South and Central America. 294 Department of Health , Education , and Welfare , 1961 Technical Assistance Training Program. — The number of partici¬ pants supervised during the year 1960-61 totaled 768. The trend toward emphasis on degree programs, first noted in the previous year, was again reflected in the Near East- African training projects. There was a slight decrease in the number of participants from the Far East, from 338 to 302. Countries with the largest number of representatives were Indonesia, the Philippines, Thailand, Vietnam, j the United Arab Republic, Iraq, Turkey, and the Sudan. Training was arranged for educators in approximately 60 different fields of education involving 150 training centers located in almost every State, the District of Columbia, and Puerto Rico. Secondary and Non-Grant Visitor Programs. — Secondary visitors are recipients of United States Government grants administered by agencies other than the United States Office of Education, but who are referred to the Office to pursue their interests in education. Non¬ grant visitors do not hold United States Government grants. They may be sponsored by their own governments, private foundations, or educational institutions, or may be traveling entirely at their own expense. The Office provides services for these visitors, ranging from single appointments to complete itineraries, including travel and hotel reservations and appointments with local sponsors in many communities. In 1961, the number of secondary and non-grant visitors reached 618, an increase of 170 over 1960 and almost double the figure for 1959. EDUCATIONAL MATERIALS LABORATORY The Educational Materials Laboratory is a collection of educa¬ tional materials of some 11,000 items — textbooks, supplementary reading materials, curriculums, professional literature, records, films, and filmstrips — published in the United States and abroad. These resource materials are used by United States and foreign educators as well as by specialists in the Office of Education and in other Government agencies. More than 1,700 visits to the Laboratory were recorded during 1961. The Office arranged for consultation periods, seminars, and work¬ shops for members of the Community Development Education Section of the Philippines, representatives of the Ministry of Educa¬ tion of Cambodia, several administrators from Costa Rica, and more than 500 participants in programs for foreign educators. For United States educators the Laboratory developed a program on educational materials for suburban librarians from Maryland and Virginia. A 5-day workshop was also arranged for a group of New York State teachers engaged in a project to improve teaching Office of Education 295 in world affairs. Such activities are increasing as more States re¬ quire teaching about world affairs. Annotated listings of educational materials are published in Edu¬ cational Materials Laboratory Report. The Report is issued about 10 times annually and provides current information on Laboratory holdings and recently published materials. Library Services LIBRARY NEEDS The problems facing the Nation’s library services fall into two groups : those related to securing recognition of the increasing needs for materials, facilities, and staff to serve our growing population and those related to the financing necessary for obtaining these services. Various aspects of these two needs, together with accomplishments in the field of library services during the past year, will be presented in the following discussion. PUBLIC LIBRARIES Although considerable progress has been made in the past 4 years in overall public library development, many serious deficiencies still remain. For example, there are still some 25 million Americans with¬ out direct access to local public library service. Many additional millions receive only token service. The basic components of factors necessary for adequate public library service are : trained and experi¬ enced leadership; an adequate number of professional and other li¬ brary personnel ; good physical facilities ; book and nonbook resources in all fields and at all reading levels; and continuing and adequate financial support. The absence of any one factor affects the impact and strength of the total program. The lack of adequately trained staff is now critical. The concentration of population in our urban areas has resulted in an increased use of the services and facilities of public libraries — particularly by the growing number of students and by research work¬ ers in specialized fields. Because of the demands for public library service to children and youth, adult library services in support of self- education beyond school years are frequently underdeveloped and understaffed. Increased library use has rarely been matched by in¬ creased financial support. How the public library serves as an educational agency is described in a new U.S. Office of Education publication titled The Public Li¬ brary — For Lifelong Learning. This 36-page illustrated brochure describes many specific ways in which the public libraries serve as vital community agencies of informal education and makes recom- 296 Department of Health , Education, and Welfare, 1961 mendations for improving library services in this area. However, not until recent years has the profession at large begun to accept and im¬ plement these recommendations. In order to assist the States in pre¬ paring or revising library standards including recommendations for larger units of service and interlibrary cooperation, the Office of Edu¬ cation published State Standards for Public Libraries , a compilation of State standards for public libraries together with the American Library Association standards of public library service. The Library Services Act (Public Law 597, 84th Congress), passed in 1956 and now extended until 1966, authorizes an appropriation of $7.5 million annually for the period of the legislation for grants to the States for the extension of public library services to rural areas without any service or with inadequate service. State Library Ex¬ tension Services: A Survey of Resources and Activities of State Library Administrative Agencies , 1955-56 , containing basic informa¬ tion on State library extension activities for the year prior to the passage of the Library Services Act, was published during the past year. This bulletin provides a bench mark for evaluating the effective¬ ness of this grant-in-aid program. A progress report of the participating States and Territories for the first 3 years of the act was issued under the title, State Plans Under the Library Services Act: Supplement 2. The basic statistics of the first 4 years are impressive : more than 34 million rural people now have new or improved services ; State funds for development of rural library services have increased 75 percent since 1956, and local appro¬ priations for such services have increased 50 percent since that date : more than 6 million books and other materials have been added to the resources of rural communities; and approximately 250 new book¬ mobiles are now operating. In the wake of county and regional de¬ velopments over iy2 million rural people have library service for the first time. State library agencies have added over 100 field con¬ sultants to their staffs. Scholarship programs under the act are now in effect in 17 States. There is still much to be done. Fourth-year reports from the States indicate that the number-one concern is adequate State and local support; the number-one problem, the shortage of trained staff; and the number-one goal, the achievement of library service which maintains high standards in staffing and resources to meet the needs of the users. It is expected that the extension of the Library Services Act to 1966, will permit some 24% million people living in rural areas (as yet unserved) to participate in the benefits of this program. SCHOOL LIBRARIES Two significant developments in the school library field occurred in 1961. The first was the establishment of the School Library Office of Education 297 Development Project, with a grant of $100,000 from the Council on Library Resources to the American Library Association for a project of the American Association of School Librarians. The purpose of the study is to assist in the promotion of higher standards for school libraries through the implementation of Standards for School Library Programs published in 1960 by the American Library Association. The project provides financial assistance to programs for implementing the standards and consultative service and materials to organizations and groups planning programs. As of June 1961, 21 grants had been awarded to State groups for conferences, studies, and special activities for the improvement of school library service. All States have been provided with newly developed materials designed to im¬ prove leadership in school library development. The Office of Education staff served as consultants in the develop¬ ment of a project which resulted in publication by the Council of Chief State School Officers of a policy statement, Responsibilities of State Departments of Education for School Library Services , pre¬ pared by the Study Commission of the Council. This statement supports the principle that school libraries are basic to instruction, recognizes the concept of the school library as part of an integrated center for storing and disseminating all types of instructional mate¬ rials, and states principles of relationships between school and public libraries. At the request of the American Library Association, the Office of Education is conducting a comprehensive survey of school libraries in the United States for 1960-61. This survey is collecting data on county, city, and town school library supervisory services; on cen¬ tralized processing services; on school library quarters; and on methods of use of the school library — areas which are valuable in planning for school library development but which have not been previously studied. In the past year, four State departments of education have for the first time included the position of State school library supervisor in their budgets. Twenty-four State departments of education now employ one or more school library supervisors. COLLEGE AND UNIVERSITY LIBRARIES In 1959-60, academic libraries spent approximately $136 million to serve students and faculty in 1,951 institutions of higher education. This expenditure represented an average of approximately 3 percent of the estimated total expenditures for educational and general pur¬ poses in these institutions. Most academic libraries, however, were hard-pressed to furnish library materials and staff services for ade¬ quate instructional and research programs. 626936 — 62 - 20 298 Department of Health , Education , and Welfare , 1961 A comparison of present conditions with the proposed standards promulgated by the American Library Association reveals the fol¬ lowing facts. While minimum standards for libraries in 4-year in¬ stitutions specify 50,000 well-selected volumes, a staff of three full¬ time professional librarians with adequate clerical help, and a budget amounting to 5 percent of total institutional expenditures for educa¬ tional and general purposes. The libraries in 55 percent of the 4-year institutions have fewer than 50,000 volumes; 52 percent have fewer than the recommended three full-time professional librarians; and only 3 percent of total institutional expenditures were spent for library purposes. The minimum standards for libraries in 2-year institutions specify a collection of 20,000 well-selected volumes, a staff of two full-time professional librarians, and the same 5-percent budget specified for 4-year institutions. The libraries of 87 percent of the 2-year colleges have fewer than 20,000 volumes, and 78 percent fall short of the number of librarians recommended. Academic libraries as a group would have to receive an additional $90 million for materials and professional staffing to reach the recom¬ mended level of 5 percent of total institutional expenditures for edu¬ cational and general purposes. Only 3 percent of total institutional expenditures were spent for library purposes. While academic libraries currently receive inadequate support, their problems will be magnified during the next 10 years when enrollments in institutions of higher education are expected to rise from 3.4 million to over 6 million students. At present, far too many institutions house their libraries in fa¬ cilities that are inadequate or unsuitable. In the next 10 years, li¬ braries will require upwards of 6 percent of the estimated $12 billion required for instructional physical facilities in higher education in¬ stitutions. According to a recent Office of Education study, the cost of library buildings planned for 1956-70 was only about $300 million, which represents less than half the actual need. Research and Statistics COOPERATIVE RESEARCH PROGRAMS The Cooperative Research Program continued through 1961 to be a prime source for support of educational research in the United States. As the results from studies commenced earlier under the Program have begun to be available, the direct educational implica¬ tions of these studies are becoming apparent in such fields as the Office of Education 299 teaching of the mentally retarded, the detection and encouragement of students with special abilities, and improved instructional methods in mathematics and science. The objectives of the Cooperative Research Program are to stimu¬ late and support high quality educational research. To enhance these objectives three new types of activity have been undertaken : 1. Three programs for research development have been initiated: (a) Contracts are being made for surveying the status of research in selected fields; (b) a series of conferences of prominent researchers has been commenced for identifying major needs in areas where re¬ search is lacking; and (c) seminars for the purpose of analyzing the status of the research and devising new approaches to troublesome problems have been planned. Leading experts in areas where con¬ siderable research has been done are expected to participate in these conferences. 2. F or the first time, the Program requested and reviewed proposals for field testing of research findings. F orty proposals were received, and seven of them were recommended and contracted. These field tests are based on the results of laboratory and classroom research and experimentation and are designed to translate these results into educational programs which are then tested in natural situations. 3. In view of the growing requirements of researchers and of the education community for information on the latest developments in educational research, the Program is expanding its dissemination activities. A series of monographs drawing together recent studies in areas of particular interest has been initiated. Among those pub¬ lished in fiscal 1961 were the following: The Gifted Student, Motor Characteristics of the Mentally Retarded, Social Climates in High School, Influence of Voter Turnout on School Board and Tax Elec¬ tions, and Research Problems in Mathematics Education. Summaries of the final reports of all the research projects completed under the Cooperative Research Program are also being written. Copies of the complete final reports are available in over 59 key libraries through¬ out the country serviced by the Documents Expediting Project of the Library of Congress. Clearinghouse of Studies in Higher Education Since 1958 the Office of Education has compiled, analyzed, and interpreted data on educational research and experiments related to programs of the colleges and universities which furnished the data. During fiscal year 1961 the Office published a number of monographs based on these data. Among these were titles on college admission with advanced standing and independent study programs. 300 Department of Health , Education , and Welfare , 1961 NEW EDUCATIONAL MEDIA Grants Approved The Advisory Committee on New Educational Media considered 221 separate applications for research grants during fiscal year 1961. Of these, 36 were approved by the committee and have been supported by grants of varying size. These 36 grants bring the total of National Defense Education Act, title YII research projects supported to 150. Final reports on 20 approved projects were submitted during this year. Approximately $3.41 million was expended during fiscal year 1961 for the support of new grants and continued support of grants ap¬ proved in previous years. Grants from preceding years required slightly over $2.4 million of 1961 funds, and the 36 projects approved in 1961 were supported with a little more than $1 million from 1961 funds. An estimated $360,000 was required in 1962 to bring these new projects to completion. These 36 grants were awarded to 25 separate institutions and nonprofit agencies in 15 States. Areas of major interest to researchers concerned with the newer- educational media are television, teaching machines, conventional audiovisual materials used singly and in combination, and the de¬ velopment of systems of instruction which would utilize the various educational media and teaching techniques. It is evident at this time that the research conducted under title YII will lead to more definitive statements concerning the production and use of educational televi¬ sion, and the instructional role of teaching machines and other newer media. This research is focused on programed self -instructional media, including teaching machines and specially programed printed materials, on investigations of learner-teacher variables involved in the most effective use of instructional materials, and on application of the principles of autoinstructional programing to such other media as motion pictures, television programs, and filmstrips. Dissemination of Media Information Slightly more than $1.3 million was obligated for the support, under contract, of dissemination activities during fiscal year 1961. Approxi¬ mately $131,000 was required for continuation costs of projects con¬ tracted for in previous years. During the past fiscal year, 44 contracts were negotiated with 31 institutions, agencies, and individuals in 11 States and territories and 2 foreign nations. These 44 projects re¬ quired the expenditure of almost $1.19 million during 1961 and are estimated to require $275,000 in additional support during fiscal year 1962. Thus, it is estimated that these 44 contracts will require ap¬ proximately $1.46 million to bring them to completion. Office of Education 301 A major emphasis during fiscal year 1961 was the dissemination of research information, both on title VII activities and on non federally supported research completed or in progress. Final reports on title VII research are deposited in each State department of public instruc¬ tion and in libraries throughout the country which participate in the Documents Expediting Project of the Library of Congress. In addi¬ tion, these reports may be purchased on microfilm or Xerox print from the University Micro-Films, Inc., Ann Arbor, Mich. Under contract with the Department of Audio-Visual Instruction of the National Education Association, each title VII project is also being abstracted, and quarterly accumulations of these abstracts are published in co¬ operation with the Office of Education. A second emphasis in the dissemination program during fiscal year 1961 focused on making instructional materials more available and accessible. The Educational Media Council investigated means for providing a comprehensive catalog of new issues of films, filmstrips, tapes, recordings, and slide sets. A contract has been made with the Council to develop a comprehensive media research cross-index. A pilot study was initiated at Western Reserve University by the Office of Education to determine the feasibility of electronic storage and retrieval of research in education. A number of high priority dissemination projects were completed in 1961. Some of these were solutions to immediate problems. Others were part of a long-range information program aimed at pro¬ viding the means for modifying and improving educational practices. Still others provided the basis for resolving fundamental problems regarding the role of communications media in the schools. A special bibliography project, undertaken by Syracuse University, is valuable primarily to teacher-educators. This project produced a catalog of instructional materials, coded for quick and accurate reference, for teaching audiovisual courses. The American Library Association issued Guides to Newer Educational Media , which like¬ wise includes annotated references to catalogs or lists in the new media field, issued between 1950 and February 1961. The capstone of fiscal 1961 activities may well be the report of a major study contracted with and begun during the year by the Na¬ tional Education Association. This project on the impact of tech¬ nology on education will culminate in memorandums, monographs, and a major study report which deal intensively with implications for the use of new media and technology in education. Surveys of media used throughout the United States and other countries which will aid in establishing national goals, standards, and guidelines, have moved forward. Information is being collected through surveys which are being made by the National Council on Visual Aids in London and 302 Department of Health , Education , and Welfare , 1961 by the International Christian University in Tokyo. These surveys of media research in Europe and the Far East, coupled with the Purdue University International Seminar on Instructional Television, will assist in assessing American programs and practices. CAPTIONED FILMS FOR THE DEAF The first full year of actual captioned film service to groups of deaf persons ended June 30, 1961. The program by that date had 572 registered users in all States except Nevada and Alaska. Approxi¬ mately 100 prints of feature-length captioned films became available as the year progressed and provided 948 bookings for a total audi¬ ence of 92,550 viewers. Many registered users were unable to secure films because of the heavy demand upon the limited supply. At present, there are approximately 472 more groups registered than there are prints available, and more groups are being added to the list weekly. These groups are served on a first-come-first-served basis, and many requests must be turned down. Operating under a contract budget of $150,000, the Office of Edu¬ cation negotiated 5-year leases with motion picture companies to cover 44 new feature titles. When completed, this will add 17 6 new prints. EDUCATIONAL STATISTICS During fiscal 1961 the Office conducted 40 basic, general-purpose surveys of American education, and reported data from them. It also conducted a total of 20 recurring surveys in the field of higher education, relating to enrollment, faculty and other professional staff, earned degrees, receipts and expenditures, property, research and de¬ velopment activities, and organized occupational curriculums. Two surveys of State school systems were made, dealing with problems of organization, enrollment, teachers, schoolhousing, and finances of public elementary and secondary education. Studies of local school systems provided data for reports on current expenditures per pupil, secondary school programs, teacher turnover, adult education pro¬ grams, and the beginning public classroom teacher. The Office also developed projections of elementary and secondary instructional staff requirements and salaries, school construction, and college enrollment. The first scientific national study of programs of adult education conducted in local school districts was completed during the year. The Office also began the first definitive survey of the status of college faculty members and how they regard and accept their careers. The study was based on a scientific sample of full-time instructional Office of Education 303 staff. This study should provide important insight into reasons for entry into and causes for separation from college teaching. Such information will enable higher education institutions to meet more readily their requirements for increased numbers of faculty members in the 1960’s. The Office initiated two important surveys of nonpublic education below the level of higher education. Assisted by funds provided by the National Science Foundation, and utilizing mailing lists grow¬ ing out of National Defense Education Act programs, basic surveys of organization, support, kinds of curriculums offered, number of graduates, teaching staff, and accreditation were begun for 5,000 sec¬ ondary and 12,000 elementary schools. During 1962 a study will be made of the course offerings of the secondary schools. The informa¬ tion obtained will provide the first national data on offerings and enrollments of nonpublic schools conducted on a comparable basis and at a comparable period with a survey of the public secondary schools, in progress during 1961. Under an agreement with the National Science Foundation, the Office began a complete survey of financial assistance received by graduate students attending American universities. When the amounts contributed from various sources are evaluated and com¬ pared with costs of graduate education, more complete data will then be available to assist in evaluating the financial resources for graduate education. During 1961 a special Office task force completed a proposal for a new cooperative record and reporting system involving educational institutions and organizations of all States and using modern high¬ speed computing and tabulating equipment for the production of educational statistics, which would provide with a minimum of delay the information needed on the condition and progress of education. Reorganization of the Statistical Operations Staff Reorganization of the statistical operations staff of the Office of Education was initiated and progressed satisfactorily during the year. The new arrangement reflects a clear definition of the role of the central statistical operation in the Office. This role will essen¬ tially have two parts: (a) the rendering of professional statistical service to those conducting surveys, and (b) the conduct of the bench mark, basic type recurring statistical surveys. When this reorganization is complete, it will strengthen, particu¬ larly, the capacity of the Office to plan and schedule its operations and to utilize efficiently electronic and electro-mechanical data-editing and processing equipment. 304 Department of Health , Education , and Welfare, 1961 Section IV Summary and Selected Goals This report has set forth first a statement of the Nation’s most urgent educational need: excellence — not expressed altogether in terms of buildings, equipment, and the necessary number of adequately paid teachers, but as an attitude which affects “the total process of education.” A new focus is thus given to quality as it relates primar¬ ily to the curriculum and the teacher. Excellence, though never fully reached, demands of all — “administrators, teachers, students, and the general public — all that they are capable of achieving.” In fulfilling its obligation “to promote the cause of education in the United States,” the Office of Education offers its leadership through assistance to all and cooperation with all in their commitment and dedication to this purpose. Summary of Achievements Among achievements of the Office of Education in five selected areas of activity during fiscal year 1961, the following are summarized: 1. The completion and release to the public of staff studies identify¬ ing the needs of American education on all levels. 2. The organization and dissemination of educational statistics and research results including (a) continued progress toward establishing a national cooperative system of educational data, (b) publishing of monographs on the results of educational research, and (c) continua¬ tion of the compilation and analysis of a nationwide inventory of physical facilities of colleges and universities. 3. The mobilization of professional leadership (and in some in¬ stances, lay leadership) to help solve educational problems in the areas of (a) educational media, (b) adult literacy, (c) coordination of educational research programs within and between States, and (d) the improvement and supervision of State programs in mathematics. 4. The administration of special educational programs such as (a) assistance to Cuban refugees, (b) Latin American language and area studies under title VI of the National Defense Education Act, and (c) the planning of corrective measures in the teaching of English, involving research, conferences, and the preparation and demonstra¬ tion of curriculum materials and instructional practices. 5. The review of Federal programs in education involving (a) in¬ ternational educational activities, (b) higher education in the United Office of Education 305 States, and (c) the effectiveness of the National Defense Education Act of 1958. Summary of Shortages The focus on quality in education, which was perhaps the outstand¬ ing characteristic of the educational year, revealed many inadequacies in American education. Educators, it would seem, are now more ready than formerly to entertain and to evaluate objectively, criticism of educational policies and programs, teaching and administration. They are coming to realize that such criticism is one of the bases of sound reevaluation and that healthy criticism of the status quo is necessary for progress toward excellence. 1. This report has pointed out in its introduction what must be considered a “major concern of the Nation” — the identification of in¬ dividuals who have the native talent for teaching and the education of these individuals in a manner that fully qualifies them to assume the responsibility of teaching. Supplying the necessary number of certificated teachers to take care of present and projected shortages will not in itself fill the need for qualified teachers. There are requirements for talent, personality, culture, and educational background which go far beyond the course requirements necessary for certification. Our society as a whole must place such a high regard on the teaching profession and must accord it such status and salaries that proper individuals will be attracted and committed to teaching, and the institutions that train teachers must revise their selection procedures to exclude those who have neither the talent nor the capacity to become teachers. 2. The need for adequate facilities for our elementary and secondary schools — instruction rooms and instructional materials — is a second area of shortage. The number of construction projects completed in fiscal 1961 and the number scheduled for the next few years will barely reduce the present backlog of approximately 142,000 instruction rooms reported by the States in the fall of 1960. The Federal Gov¬ ernment, by present legislation, must restrict its aid in school building and classroom construction to areas where school attendance is in¬ creased because of Federal activities within those areas. Funds approved under title III of the National Defense Education Act for improving facilities and purchasing equipment to improve the quality of instruction in science, mathematics, and modem for¬ eign languages have contributed to improvements in thousands of schools since 1958-59, and students in these schools have benefited from the higher quality of instruction thus provided. But this kind 306 Department of Health, Education, and Welfare, 1961 of improvement needs extension to certain other areas of instruction as well. 3. Allied to the needs for teachers and facilities in our schools are needs for providing opportunity for every student to develop his abil¬ ities to the highest degree of which he is capable. These needs are revealed in the unequal opportunities resulting from failure to identify students’ potentials (from the talented to the slow learner) ; and in those caused by cultural and economic disadvantage, physical handi¬ cap, and mental retardation. The needs are further reflected in prob¬ lems related to juvenile delinquency, unemployment conditions, and adult literacy. 4. The shortages in higher education institutions are in areas similar to those in elementary and secondary schools — an insufficient number of adequately prepared staff members and a lack of adequate facilities for housing and instructing the increasing numbers of students. The Federal Government has provided loans and scholarships to students (particularly those planning to teach), loans for housing construc¬ tion, and grants and loans to institutions for numerous other purposes. However, unless additional funds are available to meet the demands of the decade ahead, there will be critical shortages of teachers and facilities. 5. In the general area of research and statistics, there is great need for a more comprehensive program covering all aspects of the edu¬ cational process — administration, teaching, and learning — including plans for more effective dissemination of results. Research through¬ out the Nation must be coordinated to avoid dissipation of effort and to achieve direction toward essential objectives. Research must be coupled with rapid application of results of established value. Through demonstration and other means of dissemination of these results teachers should continuously be made aware of the best current methods of instruction. These needs are closely related to need for improvement of teaching services in specific curriculum areas — notably English and modem foreign languages. 6. With a recognition by the principal foreign policy makers that education is a key aspect of foreign policy, it is now evident that to formulate successful programs of international education there must be closer cooperation among the various Federal agencies in the de¬ velopment of policies and programs for more effective use of the resources of our own educational system. 7. Furthermore there is great need that in our educational planning we consider certain broad social issues which affect the lives of all Office of Education 307 citizens. Problems in this area are suggested by the need for a bal¬ anced education-manpower program which, while assuring the right of individual choice, would at the same time insure the Nation’s strength. These problems are seen in the growth of urban popula¬ tions and in the need for education in civil defense. Selected Goals Some of the major activities of the Office of Education for fiscal year 1961 have been summarized and certain shortages in the schools and higher education institutions of the Nation have been reviewed. The Office has formulated goals which it believes are necessary to meet the needs of the future. A selected list of goals covering some of the crucial areas and problems of American education follows. Goal Area I : General Support for Public Schools and Assistance to Colleges for Construction General School Aid. — The establishment of general Federal aid for public schools through the enactment of a school aid bill, or equivalent legislation for equalization of educational opportunity, and raising of the level of educational support. Higher Education Physical Facilities. — Enactment of proposals for loans to construct academic facilities. This goal recognizes the fact that funds necessary for the construction of these facilities cannot be supplied wholly from present sources of income. Goal Area II : Advancement of Knowledge and Dissemination of Information Relating to Education Educational Research: Organization and Program Scope. — Broad¬ ening of the Office’s extramural research program, and of its working relationships with the total enterprise of educational inquiry, so that it will stimulate far more research and development than it directly supports, and so that every area of major educational concern will experience a ferment of reexamination resulting from the interaction of research, planning, analysis, and appraisal engendered by the pro¬ gram. Greater enlistment of top-quality research effort in developing ways to identify and nurture talent; to find corrections for develop¬ mental deficiencies arising from deprived economic and social back¬ ground ; and to eliminate barriers which mental and physical handi¬ caps impose against social and economic productivity and personal self-realization. Establishment and maintenance of an effective pro¬ gram of basic and applied research, field testing, and demonstration of educational media. 308 Department of Health , Education , and Welfare , 2961 Acceleration of national dissemination of research results and edu¬ cational practice. Progress Toward a Nationwide System of Educational Data . — Adoption of the proposal for a national cooperative system of educa¬ tional information, based on scientifically precise reporting and machine processing of basic items of raw data ; and the development of a calendar of Administration- approved steps to carry out this proposal. Substantial and tangible progress, in cooperation with the States and private institutions, in developing common definitions of educa¬ tional terms and other prerequisites to common reporting practices. Goal Area III: Action Programs for Conservation of Human Resources The National Logistics of Manpower in Relation to Education . — The planning and initiation of studies in cooperation with other agen¬ cies calculated to yield concrete policy propositions for achieving a balanced education-manpower program for long-range national strength. Talent Development in Regular School and College Programs. — Confirmation of the favorable trends now tentatively indicated in the identification and guidance of able secondary students. General acceptance of the principle that nurture of talent must begin systematically in the elementary grades and that it must be a continuous process throughout formal schooling; application of this principle also to the first two post-secondary years, by extension of the NDEA title V provisions to those years. Enactment of provisions for a higher education Federal Scholar¬ ship Program. Prevention and Correction of Under achievement Related to Cul¬ tural and Economic Disadvantage. — Provision of educational assist¬ ance to children and adults of migrant labor families. Salvage and Rehabilitation of Persons Disabled by Mental or Phys¬ ical Handicaps. — Expansion of existing laws to include additional categories of exceptional children. (It is estimated that only one- fourth of the children who need such services are now receiving them.) Lack 01 adequately prepared personnel is a major obstacle to the de¬ velopment of proper programs for these children. Occupational Training and Retraining to Meet Problems of {a) Per¬ sistent Local Unemployment Conditions and (b) Obsolescence of Shills Through Automation and Other T echnological Developments. — Development of close working relationships with Department of Office of Education 309 Labor under the Area Redevelopment Act and under proposed acts which would assist in the adjustment of occupational skills to employ¬ ment opportunities. Youth Programs Related to Problems of Unemployment and Juve¬ nile Delinquency. — Establishment of interagency cooperation for the Office’s role in implementation of the pilot projects and training pro¬ grams of the Juvenile Delinquency Act of 1961. The Nation’s Adult Education. — Instigation of action, in an ap¬ preciable number of States, to provide trained leadership for adult education as an integral part of public education. Adoption by a sizeable number of States of new or expanded programs for adult literacy. The planning and initiation of national clearinghouse serv¬ ice for information on action programs in education for aging. Selection of urgent research problems, from the recommendations of the White House Conference on Aging, which fall in the area of adult education ; and promotion of research on these problems through the Office’s extramural research programs and through stimulation of institutions and other sponsors of research in education. Goal Area IV : Improvement of Provisions for International Education Federal Cooperative Planning. — Our position among the nations and the increasing role played by education in relation to foreign policy and international affairs requires a new dimension in our think¬ ing about the problems of education. We must cultivate a knowledge and an appreciation of our relation to other countries and other cul¬ tures, while at the same time we maintain a loyal though critical understanding of our own. The responsibility of the Federal Government for providing lead¬ ership to insure these achievements rests heavily upon the Department of Health, Education, and Welfare and the Office of Education. These agencies should lead out in cooperative planning and the formu¬ lation of policies and programs among Federal agencies concerned, whereby these goals may be realized. Education in International Understanding . — Early in 1962 the Com¬ missioner of Education will convene a conference of outstanding persons from a number of areas of American life, who are vitally interested in American education, to discuss the impact of our inter¬ national relations on American education. This conference will do much to clarify issues and to suggest approaches toward updating the curriculum of American schools and colleges and otherwise orient¬ ing it to changes throughout the world and to the position of the 310 Department of Health , Education , and Welfare , 1961 United States in international affairs. The conference will also con¬ sider the basic differences between American and totalitarian institutions. Goal Area Y : Action Programs for Improvement of Instruction C oordinated Attacks upon Instructional Deficiencies in Particular Fields , English and Foreign Languages Being Major Examples. — Strengthening the NDEA Language Development Program by add¬ ing opportunities for foreign study to the existing resources of the program, and by introducing a special focus upon Latin- American studies. The infusing into the curriculum of our schools and colleges of an overall recognition of our relation to other nations and cultures. Successful initiation of “Project English,” a closely articulated program of providing appropriate Federal stimulation and assistance to the national effort for improvement of English instruction. Extension to the field of English, by amendment to NDEA title YI, of the program of teacher training institutes. Extension of the benefits of the NDEA teacher institutes to teachers of English as a foreign language, in order to help American pupils whose native language is not English to receive proper language instruction in English. Reappraisal of Vocational Education Field and of Related Legisla¬ tion. — The rendering of advice and/or staff assistance to the Presi¬ dent’s proposed national advisory body on vocational education, to enable it to advance practical proposals to accomplish the following objectives: (a) provide vocational education with a flexibility to meet shifting employment patterns, (b) define the proper place of vocational in relation to nonvocational or general education, (c) estimate expenditure needed for the total vocational education effort. Study of Teacher Recruitment and Retention. — Develop the knowl¬ edge to recommend teacher personnel policies offering promise of improvement in staff quality and performance. As one example, the compilation of the most significant developments throughout the Nation relating to the recognition of individual merit in the compen¬ sation of teachers. School and Academic Libraries. — The enactment of legislation to eliminate the lack of school libraries in many of the Nation’s public elementary and secondary schools; eliminate the critical shortage of trained librarians ; and improve the poor quality of a large percentage of the libraries in junior colleges, 4-year colleges, and universities. Office of Education 311 Goal Area VI : Educational Adaptations Based Upon Other Broad Social Issues The Urbanization of American Life . — Substantial progress in ana¬ lyzing the educational implications of urban growth, in identifying solutions to urban educational problems, and in delineating the desir¬ able Federal role in these solutions. Educational Problems Attendant to School Desegregation . — Devel¬ opment of a program of research and analysis on the educational problems a school system faces when desegregation begins, and dis¬ semination of the results in a timely and appropriate manner. Civil Defense Education. — Strengthening of the Office’s civil defense educational activities by (a) increasing its capacity to pro¬ vide educational materials to elementary and secondary schools, and (b) extending its coverage of adult education in civil defense from the present 15 States to every State in the Union. Table 1. — Enrollment in 50 States and District of Columbia , 1959—60 and 1960-61 [Office of Education estimates] Grade level and type of school Kindergarten through grade 8: Public school system (regular full-time) . . . Nonpublic schools (regular full-time) _ _ _ Other schools 1 . . . . . Total, kindergarten through grade 8 . . Grades 9 through 12: Public school system (regular full-time) . . Nonpublic schools (regular full-time) _ _ _ _ _ Other schools ■ . . . Total, grades 9 through 12.. . . . Kindergarten through grade 12: Public school system (regular full-time) . . . -I . . . Nonpublic schools (regular full-time).. . „ . . O ther schools 1 . . . . . . Total, kindergarten through grade 12 . . . . . Higher education: Universities, colleges, professional schools, junior col¬ leges, normal schools, and teachers colleges (degree-credit enrollment) „ Total, elementary, secondary, and higher education. . . 1959-60 1960-61 27, 800, 000 5, 400, 000 180, 000 28, 400, 000 5, 200, 000 200, 000 33, 380, 000 33,800,000 8, 400,000 1, 100, 000 90, 000 8, 900, 000 1, 100, 000 100,000 9, 590, 000 10, 100, 000 36, 200,000 6, 500, 000 270, 000 37, 300, 000 6, 300, 000 300, 000 42, 970, 000 43, 900, 000 3, 750, 000 4, 000,000 46,720,000 47, 900, 000 ■Includes Federal schools for Indians, federally operated elementary-secondary schools on posts, model and practice schools in teacher training institutions, subcollegiate departments of colleges, and residential schools for exceptional children. 312 Department of Health , Education, and Welfare, 1961 Table 2. — Grants and other financial assistance to States, administered by the Office of Education, for fiscal year 1961 1 2 * 4 5 States and outlying parts of the United States Total* _ Alabama . Alaska _ Arizona _ Arkansas. . . California _ Colorado _ Connecticut _ Delaware _ District of Columbia. Florida... . Georgia . Hawaii . . Idaho _ Illinois . . Indiana _ Iowa _ Kansas - Kentucky _ Louisiana _ Maine - - Maryland - Massachusetts _ Michigan _ Minnesota. . . Mississippi - Missouri _ Montana _ Nebraska . . Nevada.. - - New Hampshire - New Jersey . . New Mexico _ New York _ North Carolina - North Dakota - Ohio _ Oklahoma _ Oregon _ Pennsylvania - Rhode Island . . South Carolina _ South Dakota _ Tennessee . . . Texas _ Utah _ Vermont. . . Virginia _ _ Washington _ West Virginia _ Wisconsin _ Wyoming.. . . Guam _ Puerto Rico . . Virgin Islands _ Wake Island _ Undistributed . Colleges for agri¬ culture and the mechanic arts Coopera¬ tive vocational education Mainte¬ nance and operation of schools (Public Law 874) School construc¬ tion (Public Law 815) Library services Defense educational activities Men¬ tally retarded Total 5, 051, 500 39, 797, 724 2 207,639, 466 59, 248, 636 7,414,221 4 50,189, 647 813, 682 372, 822, 569 100, 541 1,060,159 4, 271, 452 553, 142 207, 576 1, 734, 665 10, 200 7, 937, 737 71, 283 105, 652 6, 027, 884 1, 009, 446 49, 191 97, 954 8, 867 7, 370, 278 77, 477 206, 968 4, 467, 295 2, 017, 414 72, 485 154, 130 6, 995, 770 89, 047 781, 731 941,269 1, 089, 905 164, 544 756, 661 6,500 3, 829, 659 175, 599 2, 220, 802 38, 421, 578 10, 840, 539 239, 322 3, 342, 851 53, 601 55, 294, 293 83, 218 352, 907 4, 109, 053 557, 201 88, 084 808, 258 52, 337 6, 051, 061 90, 022 361, 691 2, 080, 633 880, 920 74, 755 1, 046, 073 11, 500 4, 545, 596 73, 172 179, 888 668, 678 51, 585 181, 449 1, 154, 775 33, 252 187, 768 221, 021 97,644 686, 591 5, 158, 191 1,302,700 133, 235 740, 415 16, 300 8, 135, 079 104, 360 1, 127, 357 4, 896, 258 1, 320, 036 221, 848 2, 471, 262 23, 200 10, 164, 324 52,299,985 178, 475 4, 502, 517 2, 844, 890 55, 087 158, 316 10, 039, 273 75, 871 234, 186 1,434,198 246, 120 75, 211 405, 704 11, 667 2, 482, 959 156, 905 1,677, 681 3, 236, 587 923, 064 230, 178 2, 769, 566 39, 100 9, 033, 084 109, 244 970, 816 1, 058, 263 664, 119 60, 341 386, 667 3, 249, 452 96, 145 839, 274 613, 681 105, 606 173, 427 835, 214 13, 400 2, 676, 750 89, 005 568, 505 4, 571, 963 1, 036, 504 75, 902 826, 332 19, 700 7, 187, 912 99, 374 1, 041, 638 1,128, 988 3, 200 221, 203 975, 497 3, 469, 902 96, 768 914, 629 752, 209 228, 409 158, 010 662, 605 15, 850 2, 828, 481 79, 115 231, 863 1, 912, 536 429,420 83, 021 297, 710 5,100 3, 038, 766 93, 371 437, 681 9, 675, 877 4, 133, 342 170, 000 868, 576 15, 378, 851 116, 788 724, 412 6, 374, 189 812, 195 86, 000 1, 558, 276 10, 600 9, 682, 464 133, 559 1, 402, 973 1, 506, 463 1, 977, 564 214, 885 3, 574, 758 36, 350 8, 846, 554 99, 750 914, 682 404, 564 205, 198 165, 888 1, 596, 483 30, 235 3, 416, 804 91, 735 908, 749 1, 245, 006 945, 015 191, 340 313, 243 3, 695, 090 109, 448 1, 120, 191 2, 528, 242 498, 417 185, 931 431, 165 4, 873, 397 75, 895 208, 601 1,503, 335 1, 358, 726 72, 427 285, 493 12, 200 3, 516, 680 83, 222 442, 032 2, 172, 308 914, 137 108, 519 676, 476 5,700 4, 402, 395 71, 596 181, 990 1, 097, 452 406, 353 50, 395 123, 823 9, 800 1, 941, 413 75, 319 177, 220 1, 178, 898 189, 228 62, 087 172, 333 1, 855, 087 118, 233 843, 663 3, 746, 583 1, 247, 677 103,153 1, 633, 281 17, 550 7, 710, 140 76, 794 230, 955 4, 835, 049 3, 394, 298 73, 042 497, 407 15, 468 9, 123, 015 217, 933 2, 558, 404 6, 312, 333 1, 017, 762 249, 152 3, 482, 012 106, 500 13, 944, 097 110, 518 1, 428, 296 2, 191, 066 894, 605 302, 331 1, 970, 039 14, 799 6, 911, 656 76, 180 292, 423 459, 215 743, 801 126, 436 51, 552 4, 900 1, 754, 510 149, 269 1, 747, 073 4, 745, 438 1,089, 004 270, 635 3, 501, 571 27, 035 11, 530, 026 92, 278 659, 456 6, 706, 965 1,878, 772 134, 239 1, 249, 461 10,721,173 85, 175 405, 819 911, 525 370, 018 127, 216 225, 959 13, 567 2, 139, 283 174, 719 2, 186, 230 5, 331, 567 12, 880 341, 396 2, 303, 339 53, 486 10, 403, 620 77, 899 158, 947 1, 751, 448 169, 625 59, 769 455, 594 20, 800 2, 694, 084 91,117 748, 626 3, 194, 899 708, 280 196, 082 388, 161 5, 327, 170 76, 511 297, 069 1,841,529 833, 962 82, 462 311,196 6,100 3, 448, 831 102, 835 1, 126, 372 2, 177, 206 192, 930 219, 097 858, 625 42, 069 4, 719, 138 146. 920 1, 966, 395 11,169, 323 3, 244, 827 285, 264 1, 240, 862 34, 000 18, 087, 592 76, 871 192, 098 1,686,798 602, 040 63, 275 204, 963 10, 600 2, 836, 649 73, 768 187, 028 73, 482 63, 385 137, 399 535, 063 103,104 1,017, 822 13, 413, 010 4, 120, 655 211,253 211, 604 18,654, 239 93, 730 589, 354 8, 497, 217 543, 555 125, 287 714, 370 10, 563, 518 90, 005 644, 329 107, 701 13, 884 167, 674 469, 499 10, 200 1, 503, 295 104, 260 989, 755 725, 150 198, 110 180, 736 1, 398, 357 34, 000 3, 630, 371 72, 898 168, 333 668, 243 274, 986 54, 209 67, 358 10, 400 1, 316, 429 72, 342 602, 140 204, 139 15, 495 79, 856 973, 972 50,000 839, 621 209, 077 664, 465 1, 763, 164 49, 291 83, 130 11,079 56,175 199, 678 105, 401 105, 401 8, 468, 858 8, 468, 858 1 On a checks-issued basis. Does not necessarily agree with allotments or expenditures for a given year. 2 Inasmuch as the cents have been dropped from this table, a totaling of any column may or may not equal the total given for that column. s Does not include payments made to Army, $5,174,772.85; Navy, $1,772,784.92; Air Force, $1,520,300.79; and Veterans Administration, $999.50. 4 Does not include amounts paid for loans and repayable advances or amounts paid to institutions under the National Defense Education Act for $93,057,049.15; or to jurisdictions other than States to assist Cuban refugees in educational pursuits for $442,690. 5 Includes $2,225,000 special land-grant college aid paid under Public Law 86-624. Food and Drug Administration Introduction The Food and Drug Administration is a unique agency. There is nothing quite like it in any other nation of the world. It is a scientific institution devoted to law enforcement to protect the consumer of foods, medicines, cosmetics, and common household chemical aids. Its charter was first established in the Federal Food and Drugs Act of 1906. This pioneering consumer protection law was the product of a budding industrial revolution, which saw the processing of food moving out of the home kitchen into the commercial cannery and which found the charlatan far ahead of medical science in his blatant claims for the “wonder drugs” of the day. But the original charter has been expanded many times by moderni¬ zation and extension of the law to keep pace with industrial and scientific progress in the production of new products. The courts have interpreted the law in full recognition of its original high pur¬ pose. The keynote of the philosophy of the Food and Drug Adminis¬ tration in carrying out its mission was sounded in the language of a Supreme Court decision interpreting the law as modernized in 1938 : “The purposes of this legislation . . . touch phases of the lives and health of people which, in the circumstances of modern indus¬ trialism, are largely beyond self-protection. Regard for these pur¬ poses should infuse construction of this legislation if it is to be treated as a working instrument of Government and not merely as a collection of English words.” 1 The Food and Drug Administration’s philosophy for the accom¬ plishment of its mission, consistent with this interpretation by the Supreme Court, is simply : To enforce the laws entrusted to it firmly but evenhandedly and without partiality; to seek prevention of violations to the fullest extent possible ; and to inform consumers of 1 U.S. vs. Dotterweiohj 1943, 320 U.S. 277. 626986 — 6! 21 313 314 Department of Health, Education, and Welfare, 1961 Chari 1.— RETAIL SALES OF FOOD IN THE UNITED STATES, 1951-60 Billions Chart 2.— RETAIL SALES OF DRUGS IN THE UNITED STATES, 1951-60 Billions $5 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 means by which they can help themselves to get the most protection with the least help from the Government. But if the Food and Drug Administration’s mission and philosophy can be so simplified, the accomplishment of the mission is tremen¬ dously complex. It requires the meshing together of law, science, and administrative judgment to assure a maximum of consumer protection, a minimum of interference with legitimate business, and a fostering of the progress which has made our Nation great. This is the task which confronts the F ood and Drug Administration. The Food and Drug Administration has in the past decade seen fundamental changes in the laws it enforces and in the industries subject to these laws. During this period there has also been a Food and Drug Administration 315 Chart 3.— RETAIL SALES OF COSMETICS IN THE UNITED STATES, 1951-60 growing awareness of the agency's responsibilities by the Congress and by the consuming public. The regulated industries are growing at an amazing rate. Sales of foods in the decade from 1951 to 1960 increased from $66.4 billion to $82.1 billion (see Chart 1). Expenditures for drugs showed an even more dramatic increase, rising from $1.8 billion in 1951 to $4.4 billion in 1960 (see Chart 2). During the same decade cosmetic sales nearly doubled, increasing from $913 million to $1.8 billion (see Chart 3). During this period, American consumer expenditures as a whole in¬ creased about 57 percent. It is estimated that about 300 out of every dollar now spent by consumers is for products falling under the juris¬ diction of FDA, and it is expected that this rate of increase for sales of foods, drugs, cosmetics, and household chemicals will be at least as great during the decade of the sixties. Some new developments are related only to the increasing volume of production required to supply a rapidly expanding population which is changing its patterns of living. But the putting to work of the discoveries of modern science itself is making these changes in living patterns possible. Producers and handlers of foods use more than 3,000 chemical additives. These additives are used in the processing and packaging of food so that it can be transported for thousands of miles and remain in good condition for long periods — a wonder of modern civilization. They are used in the commercial preparation of convenience foods which have brought a revolution in the domestic kitchen and freed homemakers of several hours a day to devote to other occupations. They have also eliminated seasonal restrictions on the widest variety of nutritional foods ever available to consumers. 316 Department of Health , Education , and Welfare , 1961 Manufacturers of 40 million tons of “special formula” commercial feeds each year add a variety of chemicals to promote growth, increase feed utilization, and control diseases of farm animals. Some are safe vitamins, others toxic chemicals, such as arsenicals and hormone¬ like substances that must be properly mixed at the plant and properly used by the farmers so that the meat, milk, and eggs these animals produce will be free of harmful chemicals. F armers must also avoid illegal residues in crops on which they use 600 million pounds of pesticides a year to produce the abundant variety of fruits and vege¬ tables found in every supermarket. The pharmaceutical industry has provided new drugs that have brought startling advances in medicine since 1938 when safety clear¬ ance before marketing was first provided by law. New drugs cleared by FDA after reviewing the manufacturers’ scientific studies during the 23-year span account for more than 90 percent of the prescriptions written today. Many dreaded and often fatal diseases are now readily and successfully treated. The hundreds of millions of dollars industry spends on research every year will continue to produce new technological developments that will bring new foods, drugs, and cosmetics. But every new development brings the need to know whether hazards are involved, and if so, how to solve the problems presented. There are and will be new hazards as well as benefits. Dangerous side effects often develop after the use of potent drugs. As more new chemicals are added to food the probability of misuse increases. Careful safety testing is required of cosmetics containing many new synthetic materials. Errors have occurred, recalls of dangerous drugs and cosmetics have been necessary, patients have had serious drug reactions. For¬ tunately, there have been no cases of spectacularly poisonous foods in the United States that have injured large numbers of people. Some other countries have not been so fortunate. In 1959 the deliberate addition of motor oil to cooking oil in one country caused paralysis of 10,000 consumers. In 1957 the use of an untested new emulsifier in margarine resulted in 50,000 illnesses in another country. However, in this country nitrite was used to “revitalize” stale fish fillets and caused a little boy to die and several others to become ill. And, in 1957, poisonous fat added to feed killed millions of chickens. Studies are still in progress to learn the nature and origin of the toxic factor or factors, and whether there are any implications for fats used in human foods. In the early days of food-law enforcement, chemists were dealing with crude and flagrant adulterations that did not require elaborate analytical techniques. Now, FDA scientists must contend with Food and Drug Administration 317 radioactive contamination and organic pesticide residues in food crops, the possibility of the addition to food of cancer-producing sub¬ stances, the bacteriological contamination of frozen precooked foods, and many other problems that are discussed in this report. For¬ tunately, the technological advances which have revolutionized the food and drug industries have also given the food and drug scientist new laboratory and inspection tools which can be applied to new enforcement problems. The major legislative changes in the past 7 years have centered around chemicals in foods, drugs, cosmetics, and household items — new products, new uses, and the urgent need for safety controls. The trend has been to establish the basis for preventive safeguards, so that the Government does not have to carry the full burden of proof of safety, as it did when the Food, Drug, and Cosmetic Act became the basic law in 1938. Those petitioning for regulations to establish safe use of chemicals under the Pesticides Chemicals Amendment of 1954, the Food Ad¬ ditives Amendment of 1958, and the Color Additive Amendments of 1960, must present their own scientific evidence that such uses will not endanger consumers — provisions similar to the new-drug safety clearance provided by the 1938 law. After these regulations are established by administrative pro¬ cedures — based on FDA’s evaluation of the safety studies reported, and consultation with outside scientific experts when necessary — the limits of use established become the yardstick for all to follow. This includes the manufacturers who label the chemicals with di¬ rections for use, the agricultural experts who advise the growers, the growers themselves, the control chemists in processing plants, FDA in its enforcement activities, and the courts in judging compli¬ ance with the law. Where deep conflicts develop between economic interests and the health of the American people, Federal, State, and local food and drug agencies must give health considerations top priority. They must make the best use of present knowledge and facilities but take a bold, enlightened approach — a look ahead to meet the problems that new developments will bring. Additional personnel, more and better scientific law enforcement facilities, and amendments to the basic laws where experience shows they are not strong enough are going to be necessary if adequate con¬ sumer protection is to be provided. Public support — the support of an aroused and intelligent public opinion — is essential to achieving these goals. People demand continuing improvements in tlieir foods, drugs, and cosmetics, but when they know the hazards that may be 318 Department of Health , Education , and Welfare, 1961 associated with some commercial applications of new scientific dis¬ coveries, they also demand protection from these hazards. Progress in Enforcement Operations To carry out FDA’s enforcement responsibilities — and this is the hub of all its activities — the coordinated efforts of all of its Bureaus and Divisions are required. The Bureau of Program Planning and Appraisal acquires basic data on the areas of FDA responsibility, such as size and location of various industries subject to the Federal laws, number and types of violations being encountered in each industry, and the comparative seriousness of violations in the whole spectrum of consumer protec¬ tion. These data, along with the pulse-taking of consumers’ needs through the Consumer-Consultant Program, are used in formulating enforcement policy ; in determining the best use of available manpower for attention to various types of violations; and in locating areas needing more attention when additional inspectors, analysts, admin¬ istrative staff, and facilities will permit. The Consumer-Consultant Program was expanded through a series of FDA-Consumer conferences arranged by Consumer Consultants in 16 of the FDA Districts, with programming assistance by the Dis¬ trict staffs. At these conferences the FDA’s enforcement programs were explained to consumers, and participants were given an oppor¬ tunity to express the viewpoints of their organizations about addi¬ tional areas of protection needed by consumers of foods, drugs, and cosmetics. The Bureau of Enforcement consults with industry representatives to assist in compliance and reviews cases forwarded by the Districts to determine whether or not they should be recommended to the De¬ partment of Justice for prosecution. It also establishes guidelines for the Districts to provide uniform enforcement criteria throughout the country. Food and Drug specialists in the Department’s Office of the General Counsel participate in these decisions, and also act in liaison capacity with the Department of Justice on court cases recom¬ mended for prosecution. The Bureaus of Medicine and Biological and Physical Sciences furnish scientific facts on which policies are based, both in regulation¬ making and in enforcement. Their scientists must keep abreast of the ever-changing developments and plan research that will serve as a sound basis for FDA activities. Never before in the history of food and drug enforcement have these Bureaus played such a crucial role. The later sections “Scientific Investigations” and “New Drugs” outline some of their scientific work in this area. Food and Drug Administration 319 The Bureau of Medicine and the Division of Nutrition also have the responsibility of separating the true from the false — a fact-finding process on which the FDA programs against quackery are based. Medical and nutritional quackery, now estimated to result in a billion dollar-plus annual “take” on the American pocketbook and, even more important, an untold burden on the public health, are deemed by public health experts to constitute a major problem in consumer protection. The Office of the Commissioner, which furnishes overall leadership in establishing and announcing policies after the Bureaus present and translate the facts and their long-range implications, has a number of staff divisions to assist in carrying out its functions. The Division of Public Information serves both consumers and industry in its information and education activities. All of the recent independent studies of the overall needs and deficiencies of the Food and Drug Administration have pointed to the public benefits to be derived from industry and consumer education programs. Often an inquiry from a consumer reflects the questions or views of a whole group. Prompt and helpful replies to such inquiries assist FDA regulatory work, because well-informed consumers can help protect themselves by intelligent reading of the material the law requires in labeling, and by refusing to become victims of quackery and fraudulent schemes. Consumers also need background and knowl¬ edge to benefit from new protective laws, such as the Federal Hazard¬ ous Substances Labeling Act which was designed to provide warning labeling and directions needed for the safety of the family. Industry education is aimed at explaining the law, regulations, and new programs to achieve better compliance. Informational services include news releases for the trade press, distribution of regulations and official notices published in the Federal Register, preparation of special publications and reports, and cooperation with trade associ¬ ations that are seeking to stimulate voluntary self-policing. In the fiscal year 1961, new food-additives regulations, changes in effective dates of food-additives regulations, and new color-additives regula¬ tions required many interpretive releases. In addition, the regula¬ tions under the Federal Hazardous Substances Labeling Act brought new educational responsibilities, because many industries never before subject to FDA enforcement were concerned. Increased emphasis has been placed on coordinated work with the States by expansion of the Division of Federal-State Relations. At the annual conference of the Association of Food and Drug Officials of the United States, held in Washington in June, emphasis again was placed on the benefits to the public of continued integration of Federal and State resources, the need for uniform food and drug 320 Department of Health, Education, and Welfare, 1961 legislation in the States that have not yet adopted the provisions the Association recommends, and the strengthening of State facilities. The Division of Administrative Management — among its other re¬ sponsibilities, such as budget, fiscal operations, procurement, and housekeeping work — has in its personnel activities a key task in the FDA expansion program. The increase in the staff in the past 6 years has required a program of recruitment designed to attract the best of the graduating scientists, who are often offered better financial returns from industry, and of training the recruits so that their skills may be used in this specialized field without undue delay. Personnel training is not limited to recruits, since the older mem¬ bers of the staff require continuous training in new techniques that must be employed, as for example, the use of new analytical tech¬ niques, such as spectrophotometry, chromatography, and radiological detection and measurement. Inspectors are given advanced courses in such areas as drug inspections, sanitation, and use of the senses of taste and smell to detect spoilage, all to increase their abilities to detect trouble spots during factory inspections. The clerical staff, too, requires training courses to keep records, travel, inventory, and other supporting activities operating efficiently with a growing staff. These basic training programs will be expanded in the next fiscal year. FDA has had a long tradition of vigorous enforcement of the laws assigned to it, but has long been aware of the fact that its stewardship must be reviewed from time to time by representatives of various interested groups of the public as a whole, in addition to the annual review by their representatives in Congress. Progress has continued during the fiscal year — in size of staff (see Chart 4), building construction for Washington and the field offices, in educational activities, and in streamlining administrative work for better efficiency as recommended by the 1955 Citizens Advisory Com¬ mittee. However, basic changes in the laws administered have brought new obligations not contemplated in the recommendations of that Com¬ mittee. A new overall study is underway by a new Citizens Advisory Committee appointed by the Secretary in October 1961 so that total current responsibilities may be taken into account, and a new evalu¬ ation made of the amount and kind of protection consumers need and how the desired objectives may be attained. A committee appointed by the President of the National Academy of Sciences and its National Research Council was requested to review the policies and procedures used by FDA in reaching decisions con¬ cerning the approval of new drugs and the certification of antibiotics. This Committee concluded that FDA decisions in these areas have been in the interest of public health. The Committee pointed to weaknesses in the current law and deficiencies in staff and funds and Food and Drug Administration 321 Chart 4. — BUDGETED POSITIONS FOR FOOD AND DRUG ADMINISTRATION ENFORCEMENT OPERATIONS (EXCLUDING FEE-SUPPORTED CERTIFICATION SERVICES), 1951-61 Thousands 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 recommended that FDA be given statutory authority to improve its protective controls over the production and distribution of drugs, including antibiotics, that pretesting procedures be extended to other important drugs in addition to antibiotics, and that more funds and stalf be given to FDA to strengthen its overall drug program and related research projects. Another group, appointed by the Secretary to investigate certain charges involving FDA employees and operations, reported to him that the inquiry did not develop evidence that any present employee of FDA has personal financial interests conflicting with the objectives of his employment. Among the conclusions reported were : “We conclude that the essential functions of the Food and Drug Administration have been and are being performed. “We conclude that FDA personnel are more than ordinarily dedi¬ cated to the purposes of the agency. “We conclude that decisions have not been made in defiance of the public interest or to conform with considerations of personal gain or aggrandizement.” The total budget for fiscal year 1962 is $21,854,000, compared with $18,848,000 for fiscal year 1961 — a net increase of $3,006,000. This budget provides for an increase in personnel of 213 positions so that the total staff authorized for 1962 is 2,412. The 1962 budget reflects increases occasioned by two major factors: (1) the rapidly growing demand placed on existing services of the FDA resulting from large increases in our population and corresponding increases in the number and volume of consumer products falling within the authority of 322 Department of Health , Education , and Welfare , 1961 the FDA, and (2) new programs and responsibilities of the FDA resulting from advancing technology and new legislation. About two-thirds of these new positions will go into areas particu¬ larly needing strengthening, the pesticides and drug programs. By an increase in sampling the estimated annual 2,500,000 interstate shipments of food crops, approximately 8,500 shipments can be sampled to test for toxic residues in 1962 in contrast to about 5,000 in 1961. Recommendations for staff increases for the drug program were discussed earlier in this report. Other staff increases will be made in field supervision, adminis¬ trative activities, enforcement review of cases, consumer and industry information and education services, and program planning activities. Provisions for special research include work on frozen foods, bacteriological training for inspectors, sanitation techniques, food sample analysis, cosmetics, fats, and fatty acids. The 1962 appropriation provides $1,397,000 for continued improve¬ ment of FDA field facilities. Renovation of the offices in Boston, Cincinnati, Minneapolis, and Kansas City (begun in 1961) will be completed in 1962. Partial first year costs to renovate New York facilities were supplemented. The appropriation also provides funds to begin construction in Baltimore, Chicago, New Orleans, and Seattle. The new Dallas District facility was dedicated in January 1961. (This new District brought FDA’s total to 18.) Completion of new buildings for Detroit and Atlanta were mentioned in previous reports. Construction was started in midwinter on the new FDA headquar¬ ters-laboratory building in Washington. The target date for occu¬ pancy of this badly needed structure is the fall of 1963. Meanwhile the staff is handicapped by dispersal into widely scattered locations with antiquated facilities. Some Bureaus have units in as many as three locations. An 195-acre site for the construction of a new animal research facility at Beltsville, Md., has been made available through the cooperation of the Department of Agriculture. The building is ex¬ pected to be completed in 1963. The facility will furnish housing for experimental animals and a laboratory building for conducting animal research work. Food , Drug , and Cosmetic Act ON THE FOOD FRONT Hurricane “Donna” caused commercial food losses along the Atlan¬ tic Coast in September 1960, from the Florida Keys to Rhode Island. Inspectors from FDA Districts assisted State and local officials in Food and Drug Administration 323 protecting the public from contaminated products through segrega¬ tion of stocks and supervision of cleaning and destruction operations. In most affected areas the major damage was to retail and wholesale stocks that were inundated or spoiled because of power failure. Polluted harbor water from Donna’s force damaged large quantities of food awaiting import entry or export loading on piers in lower Manhattan and Brooklyn. Local embargoes were placed on domestic products and FDA detentions on imported merchandise to permit an orderly handling of affected lots. Fifty- four domestic lots, aggre¬ gating 189 tons, were seized, and some 337 import lots — including more than 1,300 tons of coffee and cocoa beans and large quantities of tea and spices — were denied entry into the country. Torrential rains in February and March 1961 brought several Alabama and Mississippi rivers to their highest levels in 30 or 40 years. Close cooperation with State officials resulted in the sorting and destruction of damaged foods, drugs, and cosmetics valued at $100,000. Heavy losses of bulk wheat resulted from three large fires. At Portland, Oreg., State officials supervised salvage operations on 6,700 and 9,000 tons, respectively. A fire in a Colorado elevator resulted in seizure of 1,269 tons so that salvage could be monitored and proper disposition made of damaged wheat. Radioactivity in Foods In order to carry out the responsibilities assigned to the Department by the President and delegated to the Food and Drug Administration by the Secretary, FDA increased its radiological program staff to 116, a boost of 90 positions over fiscal year 1960. This staff is assigned to determining, establishing, and enforcing permissible levels of radioactivity in foods, drugs, and cosmetics, and monitoring these products by collection and examination of samples to determine current levels; conducting research for indentification, evaluation, and decon¬ tamination of radioactivity in such products; and regulatory and information work related to radioactivity. Equipment to test food for individual radioisotopes was installed in the Washington and 10 field District laboratories. Samples of 200 domestic and imported foods collected by all 18 field Districts wTere analyzed for strontium 90 and cesium 137. The highest values for strontium 90 and cesium 137 found in foods were wrell within the safe limits as suggested by the Federal Radiation Council. With the resumption of large-scale nuclear weapons-testing in the summer of 1961 the sampling and testing of foods for radioactive fallout is being increased several fold. 324 Department of Health , Education , and Welfare, 1961 Chemicals in Foods Food Additives. — FDA announced on December 1 that a scientific committee appointed by the Secretary had found that safrole is a “weak hepatic carcinogen.” Immediate action was taken to stop the use of safrole and oil of sassafras in root beer, sarsaparilla, and other beverages and foods, since the Food Additives Amendment prohibits use in foods of any substance which has been found by feeding or any other appropriate tests to produce cancer in man or animals. A year earlier upon hearing that the safety of these flavors was being questioned many manufacturers of soft drinks began to switch to other flavors. Also, the American Bottlers of Carbonated Bever¬ ages called for voluntary industry steps to eliminate these flavors from soft drinks. Thus when the harmful character of the flavors was definitely established, their use had already been discontinued. An extensive survey by FDA inspectors completed late in November, covering 3,200 bottlers and suppliers, disclosed that the industry had withdrawn safrole and oil of sassafras from use before the require¬ ment that they do so was published. Seizure was required of only one small lot of oil of sassafras located in a beverage plant several months later. Fifteen seizures were made between March and June of vitamin preparations and food supplements containing more than 0.4 milli¬ gram of folic acid per daily dose and not labeled for sale upon pre¬ scription only. The statement of policy announcing the application of the Food Additives Amendment to vitamins containing folic acid is discussed under “Begulation Making Activities.” One other seizure for violation of the food additives provisions involved mineralized cookies containing iodine and boron from kelp, for which no tolerance or exemption had been prescribed. As the number of tolerances established increases, the inspection load will grow proportionately, since checking on the proper use of food additives is now one of the essential elements of food establish¬ ment inspections. Pesticides. — In 1938, farmers commonly used less than a dozen pri¬ mary chemicals to control insects and other farm pests. Today, they use over 200 primary chemicals in more than 45,000 formulations, at the rate of 600 million pounds a year. To assure use of these pesti¬ cides so that they will not leave illegal residues in or on agricultural commodities, FDA surveys practices of growers, collects and examines samples for regulatory action if required, assists other groups in teaching farmers the importance of proper application of pesticides, and develops and improves analytical methods for their detection and measurement. Food and Drug Administration 325 Sixteen seizures totaling 385 tons were made during the year of raw agricultural commodities containing unpermitted pesticide chemicals or residues in excess of established tolerances. Eight of the seizures involved carload lots of grain contaminated with seed grain that had been treated with poisonous mercurial fungicides. Seven seizures were made of leafy vegetables with illegal residues of parathion, toxapliene, and DDT. Peanuts with excess DDT were also seized. The vegetable seizures all resulted from failure to follow recom¬ mended practices on the amount or timing of the insecticide applica¬ tion, or both. A West Coast artichoke grower, for example, entrusted spraying of the crop to an individual who was uninformed as to the U.S. Department of Agriculture recommendations. The applicator used whatever pesticide he wished, whenever he wished, and in what¬ ever amount he wished. The grower entrusted another individual to harvest the crop, which he did without attempting to correlate pick¬ ing times with spraying times. As a result, until two shipments of his high-residue artichokes were seized in Massachusetts, the grower had no knowledge that he was distributing violative products. In many cases growers withheld shipments when they learned that FDA had found that the produce contained excess residues. An in¬ novation, operated on a trial basis at the urging of several grower groups, was notification to the grower of the results of FDA exam¬ ination of samples of his crop for the presence of pesticides. These results are also reported to appropriate State officials to help prevent intrastate shipments of lots bearing illegal residues. Many States have intensified educational and enforcement activ¬ ities ; this has increased awareness of hazards involved in poor spray practices and in the feeding of field wastes to food-producing animals. In contrast to the previous year, no seizures were required of dairy products containing pesticides or antibiotics residues. Continued pressure is a “must,” however, if these gains are to be maintained. Color Additives . — FD&C Red No. 1 was removed from the provi¬ sional list of color additives on November 22 after new experiments had shown that it produced liver damage in test animals. This color was used in a variety of foods, including maraschino cherries, hot dog casings, and ice cream. Previously issued certificates for this color were cancelled on the same date to prevent any further use in foods, drugs, or cosmetics for internal consumption. Food color pastes were voluntarily recalled in June by a manufac¬ turer who had mixed certified color with vegetable fat without having the mixture recertified. Other Harmful Contaminants Soybeans contaminated with poisonous crotalaria seeds were seized in 34 Federal court actions involving 47 carloads containing 2,322 326 Department of Health , Education, and Welfare, 1961 tons. Twenty-three of the carlots originated in South Carolina, 18 in North Carolina, and 6 in Arkansas. In addition, Virginia State officials embargoed 49 carloads. Since the 1920’s, State and Federal agronomists have recommended planting crotalaria, a legume, as a soil-improving crop for sandy soil. This soil, originally used primarily for cotton, was later used more extensively for soybeans, particularly in the Southeastern States. Following reports that mortalities in poultry flocks were due to crotalaria remaining in feed, FDA investigated the extent to which the seed remained in grains and soybeans during harvest and its toxicity to experimental rats. When it was found injurious to rats, it was generally recognized by State and Federal agencies that the planting of crotalaria must be discouraged, since its presence in soybeans makes it a deleterious ingredient under the Federal law. The problem will be a continuing one since the plant is self-seeding and many fields are contaminated with it. The six Arkansas lots seized, for example, were grown on fields that had not been seeded since 1956. Food Poisoning. — Forty-four outbreaks of food poisoning involv¬ ing 937 persons were investigated. Bakery items produced under insanitary conditions and held without refrigeration were responsible for four outbreaks involving over 200 persons, and crabmeat from an insanitary plant was responsible for the illness of over 50 persons. The crabmeat plant discontinued operations and the case has been filed in Federal court. Canned seafood was suspected in five outbreaks of food poisoning; canned foods from abnormal cans were implicated in two outbreaks ; and canned chicken, subsequently recalled by the Department of Agri¬ culture, was responsible for one outbreak. Six outbreaks of botulism resulted in the illness of 17 persons and 8 deaths. Home prepared foods were involved in most cases. One out¬ break was caused by smoked fresh-water fish prepared commercially in vacuum-packed plastic bags. After many consumer complaints about red-hot candy jawbreakers, an investigation showed that the mislabeling of oil of capsicum for oil of cinnamon had resulted in the use of 450 times the amount of oil of capsicum intended per batch of jawbreakers. Outstanding stocks were promptly recalled. Just after the close of the fiscal year, FDA put out a warning on hollandaise sauce contaminated with salmonella organism when a food poisoning outbreak was traced by California State officials to this product. Food and Drug Administration 327 To Keep Food Clean Approximately 77 percent of the food seizures and 90 percent of the criminal actions against violative shippers and storers of food were filed on charges of filth and decomposition. Although seizures dropped from 571 in 1960 to 516 in 1961, the number of tons of un¬ fit food seized increased from 6,898 tons to 8,109 tons, respectively. More than half of the filth seizures involved food that became unfit after interstate shipment. In addition, owners voluntarily destroyed 20,726 tons of unfit food in 1,519 operations or converted it to suitable non-food use. These actions, which resulted from FDA inspections disclosing merchandise that would be subject to seizure if distributed, were conducted under the observation of Federal or local inspectors. Twenty-seven criminal actions were filed against 53 warehouses, wholesale groceries, and their owners and operators for storage of food under insanitary conditions that resulted in filth contamination. Penalties in 17 cases terminated during the year ranged from nominal fines, with probationary periods, to $4,000 assessed against a wholesale grocery and one of its partners. The defendants had received small fines and a severe lecture from the court in a case tried on similar charges in 1958 ; since the second action they have spent more than $7,000 in an effort to eliminate objectionable conditions. Many of the other concerns prosecuted for insanitary storage of food have also been taking corrective measures to provide protection to the food stored in their establishments. Sixty-four other criminal actions were filed against manufacturers or shippers of unfit food and 25 cases terminated during the year were based on preparation of food under insanitary conditions or use of unfit ingredients. With these notable exceptions, continued sani¬ tary improvement was found in most plants. A major exception was a bakery which a judge, in sentencing operating partners to fines and short jail terms, pronounced was operated under the dirtiest condi¬ tions he had had before him in 10 years. Bacteriological standards have been used in enforcement activities on nut meats and crabmeat for many years. A regulatory program was adopted in fiscal year 1961 for frozen precooked foods. It is designed to improve the overall sanitation of manufacturing plants preparing the growing number of frozen foods that are consumed with little or no heating. Two court actions were taken against operators of frozen food plants found during inspections to be operating under grossly in¬ sanitary conditions. One firm and its owners were permanently en¬ joined from shipping precooked frozen seafood until the plant is cleaned, rodent- and insect-proofed, all foods on the premises are 328 Department of Health , Education;, and Welfare , 1961 destroyed or denatured, and a sanitary program — including the hiring of expert personnel — is established. The second case was based on violation of a 5-year probation ordered in 1957 by the owner of a precooked frozen food plant. When inspections in September 1960 showed that the plant was currently being operated under filthy conditions and was shipping filthy frozen foods, the judge ordered the defendant to get out of the food business within 80 days or serve a jail sentence. Table 1. — Actions on foods during the fiscal year 1961 Projects Seizures Criminal prosecutions instituted Injunction petitions Total _ _ _ 707 106 11 Beverages and beverage materials _ 8 3 Bakery, ready to eat cereal, and macaroni products _ 14 22 1 Cereals and grain products: Human use _ _ 139 14 6 Animal use _ _ 9 3 Chocolates, sugars, and related products _ _ _ 25 4 1 Dairy products: Butter and churning cream _ _ _ _ 17 10 Cheese and other dairy products _ 9 0 1 Eggs and egg products _ 27 6 Flavors, spices, and condiments .. __ _ 16 1 Fruits and fruit products _ _ _ .. _ _ _ _ 61 1 1 Meat products and poultry _ _ _ _ . _ _ _ 11 0 Nuts and nut products _ 59 0 Oils, fats, and oleomargarine _ 6 1 Seafood _ _ _ _ 62 4 1 Vegetables and vegetable products _ _ _ _ . .. 106 9 Miscellaneous foods (mixed lots). 4 1 Warehouse foods _ _ _ _ _ 112 27 Foods for special dietary uses _ 9 0 Food adjuncts _ 13 0 1 Includes vitamin products intended as food supplements. Increased surveillance during cold weather months resulted in the seizure or voluntary destruction of a larger quantity of decomposed fish in New England than in previous years. This is attributed to longer periods the vessels are at sea in winter and the cutting of costs by using less ice. Detentions of whitefish at Great Lakes ports be¬ cause of cyst infections were also higher than in any recent year. The self -policing plan of the canned salmon industry in the Pacific Northwest generally affords the public protection from unfit canned salmon, but FDA surveillance over these voluntary operations needs to be maintained. A series of inspections of one cannery turned up grossly insanitary conditions and practices. Shipments of its canned and frozen salmon were seized. The racket of diversion of incubator reject eggs to food channels has been discussed in previous reports. The last of the organized ring of rotten egg dealers which operated seven frozen-egg packing firms was sentenced in January. Also in January, an undercover egg-break- Food and Drug Administration 329 ing and freezing operation using incubator-reject eggs was uncovered in New Jersey by State health and police officers and Federal Justice Department and FDA men who were cooperating in investigation of the counterfeit drug racket. All eggs on hand were placed under supervision of State sanitarians and the building was padlocked. In April, Delaware police and U.S. marshals apprehended a truckload of incubator rejects enroute from Maryland to New York City food plants. Six new criminal prosecution cases were filed during the year charging traffic in decomposed eggs in various parts of the country. Sampling of rail and truck shipments of bulk wheat was expanded during the fiscal year to obtain more uniform coverage of wheat moving from the largest producing States. Seizures of rodent con¬ taminated bulk wheat increased from 27 actions against 1,395 tons in 1960 to 53 actions against 2,249 tons in 1961. An additional 150 tons of insect-infested wheat were seized in 2 actions. While these increases reflect increased regulatory attention they also attest to the need for a continuance of the Clean Grain Program. Inspection of country elevators and terminal grain storage facili¬ ties is continuing. Six injunctions were requested; two were granted and four were held without court order being filed pending correction of insanitary conditions and elimination of contaminated grain. This regulatory pressure, coupled with educational programs in cooperation with the U.S. Departments of Agriculture and Interior, State officials and agricultural colleges, county agents, and industry groups, has raised the general level of grain quality and helped pro¬ vide the consumer cleaner wheat products. Four seizures, involving 988 tons of malting barley were made be¬ cause of insect or rodent filth, or both, and storage under insanitary conditions. Another seized shipment consigned to breweries consisted of 55 tons of brewers rice contaminated by rodents and insects and prepared under insanitary conditions. A major survey of the sanitary quality of cocoa beans offered for importation was made by the examination of 6,000 samples from 32 producing countries. Based upon the facts obtained, importation re¬ quirements that had been in effect since 1933 were raised to permit not more than a 6 percent total of moldy or insect-infested beans, but not more than 3 percent of either. Under the previous requirement, shipments containing up to 10 percent moldy and wormy beans, but not more than 5 percent moldy, have been allowed to enter the country. The new tolerance will go into effect February 22, 1963. This will allow producing countries time to make necessary adjustments in their grading systems. 626936 — 62 - 22 330 Department of Health , Education , and Welfare , 1961 Pocketbook Protection Continued reports of short- weight packages, or packages on which the required label information was “hidden” by small print or other device, led to an extensive survey beginning late in June. Each of the 18 field districts collected and examined samples and the results were reported weekly to be compiled later into a 5-week report to serve as the basis for regulatory actions. During the year, 18 products were seized on short- weight charges. These included coffee, bakery products, confectionery, seafood, condi¬ ments, and peas. A prosecution case, started in 1960 against a creamery which was deliberately making short-weight butter, re¬ sulted in a fine of $500 against the firm. While a Congressional committee was investigating industry prac¬ tices relative to short- weight and other types of deceptive packaging, a Federal court for the second time ruled against the Government in a case involving candy in what FDA charged was a deceptive con¬ tainer. ( See Court Interpretations. ) In another case FDA charged, among other things, that the package of a shortening product was misleading. The product was labeled “made by a revolutionary new process that actually whips out calo¬ ries.” The only difference between the old and the new product was that the new had been “fluffed up” with 22 percent nitrogen gas so that a cupful actually contained less shortening. The package was misleading because the 1-pound can familiar to consumers held only 14 ounces of the new product and the 3-pound can held only 2 pounds 10 ounces. Swiss cheese into which eyes were cut to give the appearance of a more expensive grade was seized on charges of concealment of inferiority. In cheats where the debasement is deliberate the adulterators often use surreptitious means to avoid detection. FDA laboratory analysts found that a “pure orange juice” product was adulterated with sugar and water. FDA inspectors visited the plant many times but never were able to locate the sugar because the plant was either shut down or it was packing pure orange juice. Finally the inspectors rented an apartment which overlooked the plant and nearby sheds, and by using binoculars observed an unmarked truck pulling up to a shed. The operators carried sugar from the truck into the shed then began a sort of bucket brigade in which the sugar was carried into the plant. The inspectors’ telephoto lens recorded the maneuvers. Conviction of the firm resulted in fines totaling $20,000, suspended jail sentences with long probations for three of the firm’s principals, and a 6-month jail term to be served by one defendant. The defendants also con- Food and Drug Administration 331 sented to an injunction. The case further led to another indictment of three defendants for perjury. In other economic cheats where cheaper ingredients than the labels led the purchaser to expect were added, one firm and its president were fined a total of $1,500 for adding salt to monosodium glutamate, and another firm was fined $1,000 for shipping black pepper adul¬ terated with ground buckwheat hulls and packing the product short weight. One firm was placed on a 1-year probation and another fined $100 for selling colored oleomargarine labeled as butter. Two firms were fined $400; one shipped oysters containing excessive water, and the other shipped cottonseed meal deficient in protein and containing an excess of fiber. A cooking oil labeled as containing 25 percent pure olive oil was seized on charges that it contained little or no olive oil but a blend of cheaper oils, and another purporting to be com oil was actually cottonseed oil. An industry complaint led to the seizure of grouper fish which were substituted for the more expensive red snapper. Other seizures included “pure” sorghum sirup which was blended with invert sugar sirup, “pure” vanilla in which imitation vanilla was added, and sauerkraut which contained excessive brine. Among the products seized for failure to comply with official stand¬ ards were butter that was low in milk fat; cheese that was high in moisture and made from unpasteurized milk ; nonfat dry milk solids in which sodium caseinate was added; evaporated milk with vitamin D omitted ; tuna that was below standard for fill of container — it also contained bone pieces and scales; canned apricots, beans, peas, toma¬ toes, and peaches which fell below standards of identity, quality, or fill; and enriched flour deficient in enrichment and failing to bear mandatory labeling information as to its vitamin and mineral properties. Foods for Special Dietary Purposes Within the year 900-calorie diet products for weight control have expanded into sales exceeding $100 million a year. FDA collected and examined 90 samples which resulted in seizures from 6 manufac¬ turers. Two actions were based on low protein content and other deviations from the declared ingredients. Four were based on charges of misleading dietary representations and unwarranted claims. Other actions against so-called dietary products are discussed with misbranded drugs because of their promotion for therapeutic uses. 332 Department of Health , Education , and Welfare , 1961 DRUGS AND DEVICES Recalls . — Forty-nine defective or misbranded drugs were recalled by manufacturers during the year, either on their own initiative or at the request of FDA. Twenty-six were defective because of such things as low potency, high moisture, nonsterility, off-flavor and odor, and gas pressure that caused bottles to explode. Fourteen of the re¬ calls were made because of improper labeling resulting from label mixups or absence of declared ingredients. Eight were shipped with¬ out clearance through antibiotic or new- drug requirements. For only one product recalled had FDA received injury reports: it consisted of eye drops that caused immediate unfavorable reaction. Patients recovered within 1 to 2 days after discontinuance of the medication. Illegal Sales of Prescription Drugs Illegal sale of dangerous drugs and their diversion into bootleg channels continue to be a serious problem. Most frequently involved are the amphetamine drugs. Abusive use of these drugs may cause highway deaths, mental and physical deterioration, juvenile delin¬ quency, and crime. Of 144 criminal cases terminated during the year on charges of illegal sales, 78 involved unlicensed outlets, such as truckstops, cafes, and peddlers, some of whom operated on a wholesale basis. Sixty- two were based on sales by drugstores or licensed pharmacists without prescription. Three physicians were involved in sales without a bona fide doctor-patient relationship, and in another case, involving use of drugs in reducing treatments in a beauty parlor, a “doctor front” was used. Fourteen unlicensed individuals and three pharmacists were re¬ quired to serve prison sentences ranging from 10 days to 4 years. Thirty-four others received jail sentences which were suspended on condition that illegal sales be discontinued. Many of the defendants fined were also placed on probation. Amphetamines are followed by the barbiturates in the drugs most often involved in both bootleg and unauthorized pharmacy sales. Other medicines sometimes sold originally or on refilled prescrip¬ tion in pharmacies without authorization of a physician are tranquil¬ izers, hormone preparations, antibiotics, sulfonamides, and thyroid. New criminal cases filed during the year numbered 137. Particular attention was given to investigating the primary points of diversion from legitimate channels to bootleg distribution of these dangerous drugs. In a criminal case pending at the end of the year, Federal and State investigators found that a North Carolina wholesale drug¬ gist had purchased and illegally distributed about 6 million units of Food and Drug Administration 333 drugs, largely amphetamines, within the past 3 years. It was esti¬ mated that this would supply all of the drugstores of the State with their legitimate needs for 12 years. In an attempt to apprehend as many of the big-time operators as possible, simultaneous arrests were made in various judicial districts. In one case where 8 criminal cases were brought in 4 Southeastern States, 15 individuals forming a syndicate were charged with con¬ spiracy as well as direct sales of dangerous drugs. J ail sentences of 2!/2 and 1 years have been imposed on two of the conspirators and the remaining were awaiting trial at the end of the year. At the time of the arrest, about 122,000 drug tablets were found in the trunk of one of their cars and seized. Counterfeit Drugs Counterfeit drugs present a potential hazard. The genuine drugs they imitate are usually expensive new drugs often prescribed for serious illnesses. The genuine drugs are manufactured under new- drug safety clearances that take into account the rigid manufacturing controls that will be exercised. The counterfeit drugs are not made under these control procedures, and may or may not be of standard potency. Some of the counterfeits seized had been transported in unlabeled paper bags, and later delivered in unlabeled bottles, a situ¬ ation lending itself to dangerous mixups. Tablet dies and punches with the monogram of the original manu¬ facturer are closely copied, and in some cases authentic ones have been stolen for use in duplicating drug tablet faces. The imitations are often so close that the spurious tablets can be distinguished only by microscopic examination and chemical analysis. Drug counterfeiting has been a recurrent problem through the years and is now one of increasing intensity. In the early 50’s a counterfeit racket in imitation hormone tablets was broken up by criminal and seizure actions. Efforts to control counterfeiting were renewed in the late 50’s and two more drug counterfeiters were con¬ victed in 1959. In the summer of 1960 an investigation began to develop evidence of suspected large-scale distribution of counterfeits of well-known trademarked drugs. New Jersey State officials and the Department of Justice cooperated in the investigation. Most of the counterfeits whose origin has thus far been determined have been linked with a New Jersey drug firm which was charged in a 24-count information filed in March with shipping counterfeit prescription drugs. A Long Island firm and eight individuals were included in the charges. All 10 were charged with conspiracy to violate the Food, Drug, and Cos- 334 Department of Health , Education , and Welfare , 1961 metic Act. Among the individuals were a Texas druggist and his son who were also indicted for shipments from Houston, Tex., and for bootleg sales from an automobile in two Louisiana cities. These cases have not yet been tried. Separate criminal cases charging counterfeiting were filed against 10 other individuals and 5 firms. Nine seizures were made of counterfeit drugs in retail drugstores. It is hoped that the backbone of the major counterfeit racket in the country has been broken by the 1961 actions, but constant vigilance must be maintained. Druggists have been urged in FDA press re¬ leases and in their own association bulletin to accept drugs only in the original, sealed manufacturer’s packaging, and to do business only with reputable firms whose representatives they know and respect. Repacked Physicians’ Samples Another situation inviting mixups and mislabeling is a mushroom¬ ing business in repacking physicians’ samples and prescription drugs collected from physicians and drug salesmen. Hundreds of thousands of samples initially prepared for distribution to physicians are involved. The repackers frequently destroy the essential labeling, such as “Caution: Federal law prohibits dispensing without prescription,” the common or usual name of the drugs, the identifying lot or control number, and the name and address of the manufacturer, packer, or distributor. New drugs or antibiotics requiring official FDA release before distribution are frequently involved. Some who do the re¬ packing are wholly untrained people. FDA investigators uncovered two serious mixups where potent drugs had been substituted for milder ones named on the labels. The seizure program initiated in mid- June was expanding rapidly at the end of the fiscal year. False and Misleading Claims The last remaining major source of the discredited Hoxsey cancer treatment, which has been discussed in many previous reports, was eliminated by a Federal court order in September. The decree against Harry M. Hoxsey, the original promoter, called for “complete and final discontinuation,” and a supplementary decree ordered him to cease sharing the profits of his former clinic in Texas which he had been leasing for 50 percent of the profits, for continued use of his cancer treatment. Another decree ordered the lessors to stop per¬ manently the sale of the Hoxsey medications. It is estimated that cancer patients or those who feared they had cancer, paid over $10 million for the worthless treatment since its inception, including 10 years of almost continuous litigation. Food and Drug Administration 335 A rapid halt was brought to the revival of the worthless Koch in¬ jection, a product sold until the midforties to unorthodox medical practitioners for the treatment of cancer patients. Its originator left the country after two long criminal trials terminated in mistrials. In November, a seizure of the injection equipment and promotional literature was made in possession of an unlicensed chiropractor who was operating a treatment clinic and a mail-order business in do-it- yourself injection kits. Use of such equipment by untrained persons would endanger their very lives. A temporary injunction was granted but by January it was necessary to bring a criminal contempt action for continued distribution. The defendant was fined and sentenced to jail. The penalties were suspended and he was placed on probation for 2 years on condition that he not violate the per¬ manent injunction simultaneously ordered by the court. A worthless arthritis “remedy” was forced off the market in March 1961 after 7 years of litigation by a permanent injunction in February prohibiting the introduction into interstate commerce of Tri-Wonda or any similar article claiming usefulness in treating or relieving any form of arthritis or rheumatism or their symptoms. Court action against the product began in 1953 with a seizure action. In 1954, FDA requested an injunction. This was granted in 1958, but permitted continued distribution of the product under label representations objectionable to FDA. On appeal, the circuit court ruled for the Government and remanded the case for further pro¬ ceedings. This protracted case illustrates the difficulty of providing prompt and adequate consumer protection and the need for more effective public education in this field, where laymen are not capable of self- diagnosis or proper treatment. The Arthritis and Rheumatism Foundation estimates that a quarter of a billion dollars is spent an¬ nually on falsely promoted “remedies” for these diseases. Seizures of vitamins and dietary supplements claiming to be effec¬ tive in curing or preventing almost every type of serious disease con¬ ditions included large bulk lots and literature from mail-order houses. One consisted of 26 mail sacks containing more than 1,000 individual parcel post shipments labeled for the treatment of 32 physical and mental conditions. It was also falsely claimed that each capsule was nutritionally equivalent to milk, meat, eggs, vegetables, and other foods that would have totaled 30 pounds. Another mail-order house shipment consisted of 7 million capsules misbranded with claims for circulatory, nervous, digestive, and mental ailments, damaged liver, as well as resistance to infection, sound teeth, nerves, bones, and muscles. In common with most of the vitamin and mineral products seized, “vim and vigor” was also promised. 336 Department of Health , Education , and Welfare , 1961 Vitamin seizures included products of some of the large firms whose products had traditionally been legally labeled but who had suc¬ cumbed to the financial lure of the exaggerated claim for prevention or treatment of serious diseases. The 1960 report mentioned seizures of Honegar, a combination of honey and vinegar, launched through a big publicity campaign re¬ volving around the popular interest in a book called “Folk Medicine” in which a New England physician attributed great healing powers to the product. In another seizure of this product, made in August, TOO copies of this best-seller book were seized on charges that it con¬ stituted false and misleading labeling because it was displayed near the product. The court permitted the claimant to take the Honegar involved in the first seizure out under bond and relabel it to bring it into compliance with the law ; the claimant posted a bond but has not attempted to salvage the product. Several other seizures of honey and vinegar, separate or mixed, were based on promotional tie-ins with the folk medicine book. Although medical authorities long ago concluded that there are no health benefits to be obtained by adding sea water to the diet, a wave of sea water products appeared on the market during the year, labeled with cure-all claims. Distribution was stimulated by a series of syndi¬ cated articles by a physician claiming that sea salt added to the diet would benefit such conditions as colds, middle-age diseases, diabetes, grey hair, baldness, multiple sclerosis, etc. He attributed the rejuve¬ nation of his 97-y ear-old father-in-law to sea salt. Concentrations of both Atlantic and Pacific sea water were seized, as well as sea salt. Ordinarily such products swindle the purchasers and threaten the health of those using them for treating conditions that should have medical care. Direct injuries were caused to a cardiac patient who developed a serious edema after taking sea salt for several days for pernicious anemia and cataracts, and to her hus¬ band whose ankles started swelling after using some of the salt for rheumatism. Multiple seizures were made of a number of brands of the ocean water products accompanied by reprints of the syndicated articles. Some concentrates sold for $3.75 a gallon, others for $1.95 a pint, and one brand of sea salt for $1.50 a pound. One of the articles re¬ printed and distributed with Atlantic ocean water promised that “by taking a little sea water per day, we can offer our glands a ‘chemi¬ cal smorgasbord.’ Figuratively, therefore, the pancreas, liver and spleen, bone marrow, thyroid, adrenals and other organs can march around this chemical smorgasbord helping themselves to whatever they require to produce the manufactured secretions that guard your health.” Food and Drug Administration 337 An injunction recommended to the Department of Justice in May 1961 to restrain one of the largest producers from distribution of misbranded Sea Brine resulted in a temporary decree early in June. Another drug injunction restrained a self-styled health and nutrition expert from olfering various foods as treatments for serious disease conditions to persons who attended his lectures. Many pro¬ moters, aware of FDA activity in this area, go to extreme length to disguise their claims in subtle statements still designed to sell their wares to the gullible on the basis of curing the ill and making well people feel even better. Promoters have more opportunity in house-to-house sales of making direct curative claims for “health foods” than do public lecturers. One agent for pills and capsules containing such ingredients as alfalfa, watercress, parsley, wheat germ, mint leaves, beets, buckwheat, yeast, rose hips, rice polishings, oyster- and egg-shells, clay, unsaturated fatty and amino acids, in addition to vitamins and minerals, was con¬ victed for claims in her home sales talk that the products were of value in the treatment of arthritis, high blood pressure, heart disease, goiter, etc. The defendant had even tried to persuade an FDA In¬ spector to become a distributor, and described to him in glowing terms the profits he could make. These are examples of several types of promotion of worthless sup¬ plements for serious diseases. In all, 145 seizures of such items and medicines misbranded with direct false and misleading claims were made, in addition to many others which were charged to be inade¬ quately labeled because they did not furnish directions in the labeling for uses for which they were promoted by other means. Substandard Drugs The 55 drug seizures made on charges of failure to meet official or labeled standards of composition included 34 subpotent vitamin and nutritional items, 8 drugs for human use, and 13 veterinary drugs and medicated feeds. Other substandard drugs, removed from the market by manufacturers’ recalls, are reported earlier in this section. Devices Devices seized included 45 charged to be misbranded and 19 to be adulterated because of defects. The defective items were IT ship¬ ments of rubber prophylactics with holes, one of nonsterile bandages, and one of clinical thermometers that did not register accurately. Among the misbranded devices were 14 consignments of air puri¬ fiers, filters, and humidifiers with claims not only to improve the air but also to ward off various diseases, including respiratory ailments, asthma, sinusitis, hay fever and other allergies ; and to screen out air- 338 Department of Health, Education, and Welfare, 1961 borne bacteria and viruses. One also was promoted with claims for the lowering of high blood pressure, and another for preventing diphtheria, smallpox, measles, anthrax, and tuberculosis. Nine of the devices seized were massagers, vibrators, and “passive exercisers” promising weight reduction, figure control, toning of the muscles, and elimination of wrinkles. Many also were promoted with misleading claims for the relief of arthritis and bursitis aches and pains. A tenth seizure of a massager was a vibrator for the gums, with claims for preventing loosening of the teeth, pyorrhea, and the promotion of strong health. Thirty contour chairs were seized for labeling suggesting their effectiveness in the treatment of arthritis, cardiac maladies, acute infectious diseases, nervous exhaustion, and other serious conditions. Among the other devices misbranded with false curative claims were “electronic” and “frequency” instruments to give pulsations when applied by pads to the patients’ bodies; porous clay discs to be used to add natural cosmic rays to water for consumption by man and beast; and bracelets to convert thermal energy into electric energy. All of these were seriously misbranded through diagnostic or curative claims, or both, for a variety of diseases but worthless for any medical purpose. One of the “frequency” instruments was claimed to de¬ vitalize “micro-living organisms detrimental to mankind” and thus overcome cancer, colds, ulcers, cataract, glaucoma, tuberculosis, bu¬ bonic plague, polio, and leprosy. These misbranded devices were innocuous apart from claims that turned people away from competent medical treatment, but a number of others seized were potentially dangerous. One was a head-harness traction device that had caused at least two fatalities from asphyxia due to strangulation. Other users were rescued after they had “blacked out.” Another dangerous device was a syringe for the self- administration of insulin on which improper dosage scales were in¬ scribed. An ultrasonic device was seized in possession of a beauty parlor operator who intended to use it to treat arthritis. This is a j prescription device that could cause serious injury when operated by untrained persons. Also potentially dangerous were breast “re- juvenators” employing hydro massage. New Drugs During the fiscal year 463 new drug applications were received, 201 of which were for veterinary drugs. Within this period 223 appli¬ cations became effective including 68 for veterinary drugs. Favor¬ able action was taken also on 931 supplemental applications which included 145 for veterinary drugs. Five effective applications were suspended without issuance of notice of hearing and with the consent Food and Drug Administration 339 of the distributors. One administrative hearing was held to deter¬ mine whether or not an application should be suspended ; the decision is still pending. No drugs were changed from prescription to over- the-counter labeling. Among new products introduced were six drugs for mental condi¬ tions; an injection for pre-anesthetic sedation and one to stimulate depressed respiration; two antibiotics, one useful for systemic infec¬ tions caused by gram-negative bacteria and some gastrointestinal infections, and one for Candida infections of the vagina; three anti¬ inflammatory steroids, two for topical use in skin conditions, and one for oral use ; a steroid to reverse wasting processes and to promote tis¬ sue building and weight gain; a diuretic for the treatment of edemas; two drugs to depress cough ; five drugs for gastrointestinal conditions, three which reduce spasm and stomach acid recommended for the treatment of peptic ulcer, one for diarrhea, and one to control vomit¬ ing ; an appetite depressant ; a remedy for pinworms ; an enzyme taken by mouth to treat various inflammatory conditions; an antithyroid drug; a drug for the treatment of arthritic conditions; two new anti¬ histamines ; a hormone preparation to coimteract overdosage of insulin; a drug for the treatment of high blood pressure; two skin antiseptics and two for fungal infections of the skin ; a pain-relieving drug; an anticancer drug useful for the palliation of Hodgkin’s dis¬ ease; a drug for tuberculosis; and one for treating certain types of epilepsy. Veterinary drugs cleared included a coccidiostat for chickens; injectable iron preparations for swine to correct iron deficiency anemias, a considerable economic problem in the past decade; an anti¬ biotic combination of oleandomycin and oxy tetracycline in animal feeds as growth promotants; and, for use in chicken feeds, the anti¬ biotic hygromycin, which is effective against three species of internal parasites that cause considerable economic loss in meat and egg production. COSMETICS AND COLORS Discovery on the market of eyebrow pencils containing synthetic organic (coal-tar) colors which are banned under the law and had not been encountered for many years led to an urgent collection and testing program by FDA’s inspectional and analytical staffs. Within a month in the spring of 1961, about 2,000 samples of pencils, refills, and cores were tested and more than 900,000 were seized. Nearly every major cosmetic house immediately recalled outstanding stocks, since 95 percent of the pencils on the market contained cores manu¬ factured by a single firm that had turned to the use of nonpermitted colors. This firm notified all customers to withdraw from the market 340 Department of Health , Education , and Welfare , 1961 all shades involved, for replacement, and within a short period all retail stocks contained permitted colors only. FDA inspectors witnessed the voluntary destruction of several million eye pencils and cores. Serious eye injuries that had occured before cosmetics were brought under Federal control in 1938 had led to the banning of coal-tar colors in cosmetics to be used in the area of the eye. The first seizures under the 1938 law— made within 3 weeks of its enactment — were of eyelash and brow dyes containing the potentially injurious colors. Another cosmetic recall removed from the market a shampoo containing a chemical that was dangerous to eye mucosa. Other cosmetics seized were lipsticks falsely claimed to contain i colors derived from raspberries and beets and to contain no coal-tar i| colors; a fingernail corrective and beautifier; dusting powder claimed 1 to contain milk solids from Tyrolean goats, the secret of “life-giving j nourishment”; and a consignment on the Brooklyn docks contami- i nated by polluted harbor water during hurricane Donna. Also seized ,i were 2,000 pairs of hosiery with claims to beautify the legs ; labeling : indicated that they contained turtle and mink oils, royal jelly, lanolin, and a secret formula. A number of other misbranded cosmetics were seized on charges that they violated the drug provisions of the law by promising correc¬ tive treatment for acne, skin regeneration, healing poison oak, altering i body circulation, etc. CERTIFICATION SERVICES Color additives . — All color additives used in foods, drugs, and cosmetics (except hair dyes) must be from batches certified by FDA as harmless. In 1961, 5,844 batches representing over 4,092 tons were certified, and 35 batches representing 16 tons were rejected. Insulin . — All batches of insulin must be tested and certified before distribution. Examination of 343 samples resulted in the certifica- tion of 279 batches of insulin drugs and 61 batches of materials for use in making insulin-containing drugs. One trial mixture of prota¬ mine zinc insulin was not approved because it did not meet the require¬ ments for a satisfactory biological reaction test. Antibiotics. — The predistribution testing and certification of certain antibiotics also is provided for by amendments to the act. Examina¬ tions were made of 12,937 batches of penicillin, tetracycline, chlortetracy cline, bacitracin, chloramphenicol, streptomycin, dihydro¬ streptomycin, neomycin, novobiocin, nystatin, oleandomycin, triacetyl- oleandomycin, polymyxin, erythromycin, amphotericin B, and paro¬ momycin intended for commercial distribution. The last nine anti¬ biotics are not included in the certification amendments, but are tested Food and Drug Administration 341 when they are mixed with those requiring certification. One hundred and fifteen batches were found unsatisfactory by either FDA or the manufacturer for failing to meet the following standards: potency (48), moisture (35), pH (9), high streptomycin content (8), sterility (7), pyrogens (5), melting point (2), and syringeability (1). An additional 16 batches were refused certification when factory inspec- tional evidence indicated that the samples submitted were not representative of the batches. Other Government agencies submitted 475 batches of antibiotic preparations for potency testing before extending their expiration dates. In addition, 222 dairy samples were tested for content of antibiotics and 75 antibiotic medicated feeds were tested for labeled potency. During the last quarter of the fiscal year, provisions were made for the certification of antibiotic sensitivity discs which are used to aid physicians in choosing the best drug to treat specific infections. Of the 207 batches tested, 41 were rejected for failure to meet potency and uniformity standards. Enforcement of Other^Acts A total of 107,029,133 pounds of tea was examined under the Tea Importation Act, a drop of more than 7 million pounds below last year’s imports. Rejections amounted to 232,050 pounds for failure to measure up to the standards set by the U.S. Board of Tea Experts. Four rejections were appealed to the U.S. Board of Tea Appeals, but the decision of the FDA examiner was upheld in all four cases. A bowl cleaner was seized because the word “poison” on the label was in smaller type than that required by the Caustic Poison Act. No actions were taken under the Filled Milk Act; one application under the Import Milk Act is pending a report from Canadian officials as to sanitary practices and tuberculin certification of the herds. No court actions were taken under the Federal Hazardous Sub¬ stances Labeling Act, since this was a preparatory year for surveys of the scope the program should cover, regulation formulation, and edu¬ cational activities. It is estimated that 5,000 to 8,000 manufacturers produce about 300,000 household items falling within the definitions of the act. Civil Defense Eleven civil defense positions were financed by funds appropriated for the Office of Civil Defense and Mobilization. The Biological Warfare Research Program proceeded beyond the planning stage which was developed in fiscal year 1960 to study the 342 Department of Health , Education , and Welfare , 1961 vulnerability of wholesale packages of foods and drugs to bacterio¬ logical agents which may be introduced by an enemy during overt or covert attacks, and to devise simple procedures for decontamination of affected products. Biological warfare stimulants were used in a specially equipped laboratory on food packaging materials to test the effects. Preliminary studies were undertaken with two stimu¬ lants. FDA started conducting studies using biological warfare agents in food products. Decontamination studies in this project are under¬ way. Fluorescent antibody antisera for detecting certain biologi¬ cal warfare agents in food were prepared and studies to develop detection techniques were begun. A project was set up to determine the amount of contamination of an average total diet caused by fallout of radioactive materials. The normal diet of a 19 -year- old boy is being used as the test diet i because it represents the largest customary food intake for this ( purpose (19-year-old boys eat more than any other comparable group in the population). Samples are being collected from four food stores in the metropolitan Washington area during 2- week periods and the food is being analyzed for radioactive material. The tests will be made quarterly for a year and may be extended later to i other parts of the country. The FDA Civil Defense Training Program for Federal, State, and local food and drug officials and industry food officials, which was reactivated in 1960, was expanded to include individual courses for each group. A radiological monitoring course for Department of Health, Education, and Welfare personnel was initiated. A total L of 1,033 persons attended the 33 training courses which were given J; in 27 cities. These courses showed the effects of radiological, chem- ; ical, and biological agents on food and drugs, monitoring techniques, procedures for testing exposed food and drugs, and methods of de- : contamination or destruction of contaminated food and drugs. The industry course was directed toward problems that must be solved by a ; specific food industry in case of enemy attack. New Court Interpretations The Court of Appeals for the Second Circuit held that the reach of the Federal Food, Drug, and Cosmetic Act extends to an oil blend made from individual oils received in interstate commerce, even though the final blend was sold only within the State where prepared. This reversed a lower court decision that the mixed oils were no longer subject to the Federal law and that such situations could be , dealt with adequately under State laws. Food and Drug Administration 343 The blended oil was labeled as containing 25 percent olive oil, but actually contained little or none. The individual oils making up the blend were properly labeled when shipped. The appellate court decision interprets the law most favorably from the standpoint of maximum consumer protection. The same court in another case upheld the authority of the Secre¬ tary of Health, Education, and Welfare to cancel previously issued certificates of harmlessness of batches of coal-tar colors when new evidence showed that the colors were not in fact harmless. In another case related to the point regarding the reach of the Federal law, the District Court for the Eastern District of Michigan held that a drug product sold locally but manufactured from in¬ gredients received in interstate commerce was subject to Federal jurisdiction. In its opinion the court stated: “The Supreme Court has wTarned against creating ‘loopholes’ at the expense of public protection, through restrictive or technical constructions of the Act.” In the fourth court contest of the section of the law that holds a product to be misbranded “if its package is so made, formed or filled as to be misleading,” the District Court of New Jersey again ruled against the Government. The case involved chocolate mints, in a package with hollow ends and dividers. The mints occupied only 44 percent of the total volume of the package, and only 75 percent of its practical volume. The Court of Appeals for the Third Circuit held that the district court had not made sufficient findings to support its ruling, and re¬ manded the case with instruction to the trial court that it might find that even though the package may lead the purchaser to think it contains more than it actually does, the form and fill of the package are justified to protect the product from breakage, taking into account alternative packaging methods available. The district court was told that the deception could only be justified by findings that the effective¬ ness of the package in protecting the contents outweighs its deceptive quality, and that the available alternative effective packages are no less deceptive. The district court again ruled that the product was not misbranded, and that the usefulness of the package, both from the standpoint of protecting the contents and of economy of manufacture, outweighs its deceptive quality. The Government has not decided whether to appeal the case again as this report goes to press. In a decision interpreting the specific prohibition in the law against non-nutritive substances in confectionery, a Federal court in Cali¬ fornia held that saccharine and sodium cyclamate were not non- nutritive substances of the type which Congress intended to bar. 344 Department of Health , Education, and Welfare, 1961 The Food and Drug Administration had charged that a shipment of “low-calorie” candy was adulterated because it contained these artificial sweeteners which are considered non-nutritive from the dietary point of view. The court based its interpretation on legisla¬ tive history of the section of the law involved, showing that primary concern at the time was to ban dangerous trinkets and other harm¬ ful and inedible substances in candy. The U.S. District Court of Kansas dismissed a case against a grain elevator when the Government was unable to supply the defendant with a portion of the samples on which the case was based. The Government charged that the elevator was operating under insanitary conditions. The Government took the position that inability to furnish the samples did not affect jurisdiction since the case was based on condi¬ tions found in the plant. The court held that the defendant was en¬ titled to portions of the Government’s samples in order to prepare his defense, and that failure to produce them prejudiced his sub¬ stantive rights. In a case involving decomposed brazil nuts, the District Court for the Northern District of Georgia ruled that it was not necessary for the Secretary to fix tolerances in order to enforce the prohibition against decomposition in foods. The Court of Appeals for the Fifth Circuit ruled that it is not necessary to allege actual contamination or a “reasonable probability” of contamination in order to seek an injunction against careless use of rodenticide 1080 in food warehouses by an exterminator firm. The appellate court held that what the Government was required to allege was that there was reasonable possibility that the rodenticide would contaminate the food. The case was referred back to the District Court for the Northern District of Texas for further proceedings. (The appellate decision occurred after the close of the fiscal year.) Changes in the^Lawjand ^Regulations The Color Additive Amendments to the Food, Drug, and Cosmetic Act and the Federal Hazardous Substances Labeling Act, both en¬ acted on July 12, 1960, were discussed in the previous report. On April 7, 1961, Public Law 87-19 was enacted, providing time ex¬ tensions for uses of food additives until not beyond June 30, 1964, provided that actions to develop scientific data necessary for a food additive order had been commenced before March 6, 1960, and ex¬ tension until March 5, 1961, had been granted or applications for such extensions were pending on that date. This amendment makes the same provisions for time extension of pesticide tolerances or exemp- Food and Drug Administration 345 tions under the Nematocide, Plant Regulator, Defoliant, and Desic¬ cant Amendment of 1959. REGULATIONS Drugs . — Revisions in regulations will affect the labeling of prescrip¬ tion drugs and devices and FDA’s program for inspecting the manu¬ facture of new drugs. These revisions are expected to cause the most sweeping change in labeling, including promotional literature sup¬ plied to physicians for potent pharmaceuticals, since the passage of the 1938 act. Promotional literature now must disclose hazards as well as advantages of the drugs and will provide the physician with the full information needed by him for using the drug in his practice. The label of a drug now must give more complete information about its ingredients. A change in the new-drug regulations permits FDA to stop the marketing of a new drug until it has been given an oppor¬ tunity to make a complete inspection of the methods, facilities, and controls to insure the purity of the drug. An amendment to the new-drug regulations requires the manufac¬ turer to submit to FDA more samples of the new drug and its in¬ gredients with information concerning tests run so that FDA may check the firm’s test procedures for identity, strength, and purity. A statement of policy limits potassium permanganate preparations to prescription sale because of the public health problem created by its misuse to induce abortion. A policy statement was published requiring the labeling of drugs given to milk-producing animals to warn against their use in these animals or to specify the time during which milk should be discarded after administration of the drug to avoid food use of milk contami¬ nated with drug residues. Formerly this type of label warning was required only for certain antibiotic preparations. An amendment to the antibiotic regulations affecting the labeling of chloramphenicol (Chloromycetin) requires greater emphasis on the warnings against its administration in minor infections and the necessity for adequate blood studies when used. The National Re¬ search Council confirmed FDA’s view that chloramphenicol is a valu¬ able drug, but it can cause serious or even fatal blood disorders and should therefore be administered only in those cases where its use is clearly justified. Labeling requirements were revised for the certification of human parenteral preparations containing dihydrostreptomycin to require a warning against its use except in patients who cannot tolerate strep¬ tomycin, or full doses of it, in the treatment of tuberculosis. Small amounts of dihydrostreptomycin may cause deafness. 626936—62 - 23 346 Department of Health , Education, and Welfare, 1961 An amendment to the regulations for the certification of antibiotic drugs provides for batch certification for safety and efficacy of anti¬ biotic sensitivity discs which are used in determining the drug best suited for the treatment of patients. Evidence showed that discs on the market were unreliable. The antibiotic regulations added 788 amendments and 13 new monographs. Food Additives. — Eighty-six new regulations were issued in fiscal year 1961 in accordance with the Food Additives Amendment and provide for both indirect and direct additives. These regulations will serve as models to expedite issuance of future regulations. The regulations proposed in the form of petitions, not all of which are suitable for filing, are now in excess of 500. Typical of the regulations providing for packaging materials are | those which deal with nylon resins, slimicides in paper, polyethylene, and cellophane. Direct additives included resins to be applied on fruits such as limes, lemons, oranges, etc.; modified food starch; a peroxide to be used for flour maturing; and antioxidants to be used in potato granules. In August 1960 a statement of policy was issued classifying vitamin preparations containing more than 0.4 milligram of folic acid per daily dose as drugs which must be labeled only upon prescription. Folic acid is not itself harmful but it has been known to mask the symptoms of pernicious anemia when used in sufficient quantities. Food supplements containing up to 0.4 milligram of folic acid per daily intake may be marketed temporarily under an extension of the Food Additives Amendment. Larger amounts require specific safety | clearance before marketing. Color Additives. — The Color Additive Amendments of July 12, 1960, provide that for 2 y2 years after enactment established color ad- j ditives may be listed provisionally, if consistent with the public health, before the permanent listing is issued. The first provisional regu¬ lations were published on October 12, 1960, with subsequent provi¬ sional regulations published on October 19, November 5 and 26, and January 10, 1961. These regulations listed most of the coal-tar colors j previously certified and also a number of non-coal-tar colors. The provisional listings of external D&C Yellow Nos. 9 and 10 were terminated and their use was prohibited for any purpose. The provi¬ sional listing of FD&C Red No. 1 was terminated and a color with its specifications was subsequently listed as Ext. D&C Red No. 15 for use only in external drugs and cosmetics. D&C Orange Nos. 5 and 17 ; and D&C Red Nos. 8, 9, 10, 11, 12, 13, 19, and 33 were listed provi¬ sionally for use in lipsticks (not more than 6 percent by weight of pure dye) and without restrictions for external drugs and cosmetics. Food and Drug Administration 347 D&C Orange Nos. 3, 4, and 5; and D&C Ked Nos. 8, 19, 33, and 37 were listed provisionally for use in drugs taken internally and in other preparations such as mouthwashes and dentifrices, but the amount ingested in 1 day was limited to 0.75 milligram of the pure dye. On January 24, 1961, proposed definitions and procedural and interpretive regulations were published which clarified the definitions of color additives, provided guidelines for submitting color-additive petitions, prescribed certification procedures, and provided fee sched¬ ules. The first color-additive regulation, permitting dried algae meal for use in chicken feeds to enhance the yellow color of chicken skin and eggs, was published on July 1, 1961. Pesticides. — One hundred thirty-seven pesticide tolerances or ex¬ emptions were established for raw agricultural commodities involving 36 pesticide chemicals. Three of these tolerances changed tolerance levels while temporary tolerances were established for 3 pesticides involving 17 commodities. The tolerance for DDT on sweet corn was changed because of the tendency for transfer of DDT residues from canning waste or corn stover used as livestock feed, to milk and meat. Two pesticide chemicals were added to the list of those gen¬ erally recognized as safe. Since the enactment of the Pesticide Chemi¬ cals Amendment, 2,300 tolerances or exemptions have been established for 122 pesticide chemicals. Six petitions for use of pesticides on 12 crops were withdrawn when it was determined that data were insufficient for reaching a conclusion of safety for residues from the proposed uses. Plant regulators and nematocides along with defoliants and desic¬ cants were brought under the pesticide amendment through Public Law 86-139. Clearances were given for certain of the regulators and nematocides when their use results in residues on raw agricultural commodities. Food Standards. — Final definitions and standards of identity were published for ice cream, french ice cream, ice milk, fruit sherbets, and water ices. Some parts of the order were appealed for judicial review, but most of the provisions became effective. The standards were later amended to permit the addition of an emulsifying agent and small amounts of edible oil to enhance smoothness. This estab¬ lished minimum requirements for milk fat and total milk solids and maximum limits on air and water content. As a result of objections filed to the order setting standards for orange juice and orange juice products, hearings were held and the standards were stayed until interested parties have time to file briefs stating their objections. Food standards were amended to permit the use of corn sirup, glucose, and dried forms of these sirups in canned sweetpotatoes ; the 348 Department of Health , Education, and Welfare, 1961 addition of traces of specified calcium salts to canned lima beans, and of stannous chloride to canned asparagus ; the use of oxystearin in salad oil to inhibit crystallization, and of hydroxypropyl methyl- cellulose as an emulsifying ingredient in french and salad dressings ; the addition of acetone-peroxides as bleaching and maturing agents in flour and of sodium aluminum phosphate, an acid-reacting ingre¬ dient, in self-rising flours ; the use of an oxidizing ingredient, calcium iodate, and of calcium stearyl-2-lactylate in bread ; and the addition of propylene glycol alginate in cream and neufchatel cheeses. Hazardous Substances . — Proposed general regulations for the Fed¬ eral Hazardous Substances Labeling Act, enacted in July 1960, were published April 29, 1961. A 60-day period was given in which to receive comments on these proposals ; final regulations were published August 12, 1961. They list special warnings required for certain products. For example, carbon tetrachloride and methyl alcohol must be labeled “DANGER,” and “POISON,” and bear the skull and crossbones symbol. In addition, carbon tetrachloride labels must bear the statements “May be fatal if inhaled and swallowed,” and “Avoid contact with flame or hot surface.” Methyl alcohol must be labeled “Vapor harmful,” “May be fatal if swallowed,” and “Cannot be made nonpoisonous.” Specific warnings also are given in the regulations for turpentine and petroleum distillates, and eth¬ ylene glycol and diethylene glycol. The regulations specify the placement and typography of signal words and statements of hazards. To give manufacturers adequate time to label their products in compliance with the law and final regulations, order No. 1 extended the penalty and condemnation provisions of the act until August 31, 1961 ; order No. 2 extended this date to February 1, 1962, the maximum time allowed by the act. Since the act itself contained definitions for “Highly Toxic” based on animal tests, and definitions for “Extremely Flammable” and “Flammable” (except for extremely flammable and flammable solids and self-pressurized containers) based on a physical test involving the flashpoint of the substance, the penalty and condemnation provisions for such substances became effective on February 1, 1961. Scientific Investigations Successful regulatory action would not be possible without reliable scientific information to serve as evidence of violations. The work of the seven laboratory divisions that comprise the Bureau of Bio¬ logical and Physical Sciences helps form the foundation on which enforcement of the law is based. Food and Drug Administration 349 The analytical problems which the scientists of the Food and Drug Administration must solve have increased in number and complexity as advances in the technology of producing and distributing foods, drugs, and cosmetics introduce new chemicals and processing tech¬ niques. Some of these problems could scarcely be solved by conven¬ tional procedures and apparatus ; however, new and ingenious instruments have been developed and have proved remarkably success¬ ful in detecting and identifying minute quantities of material. Their relatively high cost is more than balanced by the speed with which reliable results are obtained, and the consequent saving in man-hours of routine analytical work. Gas chromatography, for example, has been applied to the identifi¬ cation of aromatic diamines in dyes; to the separation of fatty acids, whose presence in food in large quantities is usually a sign of de¬ composition ; to the classification of the chick edema factor as a chlorin¬ ated organic substance; and to the detection of adulteration of commercial oils with inferior oils. In studies of adulterated peanut oil, gas chromatography has detected the presence of other oils, and the study is now being extended to include positive identification of the adulterants. Similarly, in a survey of commercial margarines pur¬ ported to have been made from corn oil (a “low-cholesterol” sub¬ stance), gas chromatography was used to distinguish between corn oil products and those made from cottonseed oil. Refined techniques are being developed to detect and identify the substances that emerge from the gas chromatographic apparatus to improve the sensitivity of the test and increase the speed of analysis even further. The substitution of cheaper species of fish in large lots of fish used in the manufacture of fish sticks and similar prepared foods is a practice which has been suspected for many years, but difficult to prove. Such adulteration can now be detected by separation and identification of characteristic fish proteins through starch gel zone electrophoresis. Analyses by this technique have been used success¬ fully as evidence in regulatory actions. The X-ray fluorescence apparatus, by which small quantities of ele¬ ments of higher atomic weights can be measured, has been used to determine heavy metals in inorganic dyes and zirconium in cosmetic creams. The basic apparatus has been modified to record data au¬ tomatically for more rapid and accurate measurement. Other examples of advanced instrumentation are the use of polar- ography to analyze drugs and to study the effects of light on pesticide residues ; the use of fluorescence measurements to detect the presence of polynuclear hydrocarbons in foods and to differentiate between vi¬ tamin D2 and vitamin D3 ; employment of a new instrument, the micro- 350 Department of Health, Education, and Welfare, 1961 goniometer, for study of surface active agents in the separation of insect fragments from food; and adaptation of an older instrument, the tensiometer, to measure surface and interfacial tensions between liquids in the detection of filth in foods and drugs. The infrared spectrophotometer has been used alone and in com¬ bination with other techniques to show the presence of petroleum hydrocarbon resins in foods and to analyze minute quantities of certain mixtures of sulfonamides, barbiturates, and adrenocortical steroids. A project has been initiated to record the infrared absorption spectra of all U.S.P. and N.F. Keference Standards. The published spectra will be of great value to all investigators who need to identify un¬ known drug substances, and will give further insight into the rela¬ tionships between the spectra and the chemical structures of the drugs. Many studies have been carried out by the use of established chemi¬ cal and biological techniques. The effects of combinations of anti¬ biotics on staphylococcus were compared to the effect of the single antibiotic, for example. Twelve strains of staphylococcus that were resistant to penicillin and to erythromycin separately proved to be inhibited by extremely small concentrations of mixtures of the two. A new semi-synthetic penicillin, 2,6-dimethoxyphenyl penicillin, was observed to kill strains of staphylococcus resistant to most forms of penicillin. Apparently the enzyme elaborated by staphylococcus, which counteracts the action of most penicillins, attacks the new peni¬ cillin only very slowly. Special microscopic techniques have been developed to identify drug tablets by manufacturer, and many cases of counterfeiting have been exposed as a consequence. The technique has been greatly refined and a special microscope accessory stage has been developed for use in these investigations. In continued studies of the chick edema factor, a newly developed assay, more sensitive than previous methods, was used to test fats from the market to determine whether the toxic factor was present in commercial fat derivatives for food use. Another toxic principle has been observed to occur in fatty acids, and is under investigation. Belated to this problem is the investigation of the presence of toxic products in heated fats. The toxic products are chiefly unusual mate¬ rials that do not form adducts with urea, which is a characteristic of normal fatty acids; to determine the nature of these substances, the urea filtrate containing the nonadducting materials is fractionated into groups and the composition of each group is determined. Other studies on food fats deal with their general nutritional properties, effects on blood cholesterol, caloric availability, and effects on oxidative metabolism. Food and Drug Administration 351 A test procedure has been designed to assess the nutritional ade¬ quacy of the so-called 900-calorie diets discussed in the section Foods for Special Dietary Uses. The unique feature of the procedure is the use of a high-fat diet for growing rats in the attempt to simulate the metabolic condition of an obese person who is in the process of losing weight. One-third of the caloric intake of the rat is derived from the test product; the other two-thirds is fat, corresponding to the human’s average loss of half a pound per day. The problem created by the use of crotalaria as a green manure crop is discussed in the section Potential Health Hazards. These seeds cause destruction of the liver, and edema in the lungs. As little as 0.015 percent of seeds, equivalent to about 3-4 seeds per pound of grain, has proved lethal to rats. Current work is designed to define exactly the toxic response to the alkaloid monocrotaline, derived from the seeds, to develop analytical methods for determining contamina¬ tion in grain products, and to study the distribution of the alkaloid in tissues of treated animals. The study of antibiotic residues in milk continues. Two methods for determining penicillin in milk, the rapid disc assay for field use and the so-called overnight plate assay, were compared in analyses of unknowm samples. The overnight plate assay, although not as rapid, is about 10 times more sensitive. The occurrence and persistence of dihydrostreptomycin, neomycin, bacitracin, polymixin, and erythro¬ mycin in milk as a result of treatment of cows for mastitis are being investigated and the effects of a number of variables and interferences are being evaluated. The conventional method of testing antibiotics for contaminants by addition of the antibiotic to a sterile growth medium has been improved by separating the contaminant from the antibiotic material through filtration. Methods proposed for the assay of very small amounts of bacitracin in feed have been evaluated and improved. Research has been initiated to determine whether colorants produce toxic derivatives when they are subjected to the conditions of normal food processing. The effect of heat on typical organic dyes has been investigated, and several of the decomposition products of these dyes have been isolated and identified. Similarly, the chemical reactions between selected colorants and food constituents, including common food additives, have been studied. Additional work on food additives included evaluation of methods proposed by the manufacturers for such substances as migrants from packaging material and food container closures. Attempts were made to measure migration by use of a solvent scheme that simulates actual food conditions. The physiological effects of food additives under a variety of nutrient conditions were studied by the use of tissue cul¬ ture, bacterial cells, and animal tests. An investigation was made of 352 Department of Health , Education , and Welfare , 1961 arsenicals in feeds with respect to methodology, migration of the arsenical from the feed into the portions of the animal used for food, and the fate of arsenic after it enters the body. Studies of decomposition in fish included the effects of chlortetra- cycline in the ice in which the fish are packed. The determination of carbonyls, purines, and trimethylamine has been investigated as a possible index of decomposition in fish. A collaborative study was made of a method for caffeine in bever¬ ages in which interfering substances (principally carbon dioxide) are eliminated and the final determination is made by ultraviolet spectrophotometry. Improved methods were developed to determine safrole, a weak carcinogen formerly used in flavorings. Efforts toward the development of specific and accurate methods of analysis for organic phosphorus pesticides continue. Paper chro¬ matography, measurements of organic phosphorus and organic sulfur, and infrared absorption are all under trial. Bioassay with fruit flies i and brine shrimp as test animals can be used for semi-specific evi¬ dence of the presence of these and other types of pesticides; more precise identification generally depends on paper chromatography. A more sensitive method for 3-amino-l, 2, 4-triazole has been de¬ veloped. This method detects the metabolites of the herbicide as well as the parent compound ; it is still uncertain whether the metabolites are equally toxic. A review of methods for identifying animal hairs in food and drug , products resulted in a better technique of mounting the hairs for exam¬ ination and a more satisfactory explanation of structural differences in hairs from different animals. The method for determining filth in import cheese has been improved by providing for histological differentiation of plant material so that the filth can be related to its source. A serological procedure for identifying staphylococcus enterotoxin and a rapid method for growing concentrated relatively pure toxin for antisera will be used to develop methods for determining the enterotoxin in foods. A survey of the extent of contamination of raw whole milk intended for use in manufacture showed that 83 per¬ cent of the 1,195 samples examined contained staphylococci, al¬ though only 10.3 percent contained more than 100,000 viable sta¬ phylococci per milliliter. Studies were also made of the temperatures best suited for isolation of coli and the presence of botulinus toxin in packaged smoked fish. Microbiological methods for the B vitamins and amino acids have been improved by changes in the basal medium for vitamin B12 and by J the greater precision achieved through using absorbance, rather than percent transmittance, in measuring the response of organisms. Food and Drug Administration 353 Investigations of the composition of several new synthetic adreno¬ cortical steroids revealed the presence of contaminating substances. Paper chromatographic procedures to detect these contaminants have been adopted as limiting tests for impurities in several monographs of the U.S. Pharmacopeia. Analytical methods have been perfected for the assay of many drug preparations, including solanaceous, curare, and ergot alkaloids; estrogenic hormones; and several antihistaminics. Thyroid preparations on the market have recently been encountered which appeared to be therapeutically inactive, even though they met the U.S.P. requirements. The official assay method depends on the chemical determination of organic iodine. Controlled animal tests for biological potency confirmed the suspected deficiency in therapeu¬ tic effect. The biological assay for these preparations is extremely slow and time consuming. Efforts are being made to develop more rapid biological methods, and more specific chemical assays. Toxicity experiments have shown that FD&C Red No. 1 produces liver damage and liver tumors, and on this basis the authorized use of this dye was denied recently. Further study has revealed that the animal body produces phenols, aromatic amines, and aromatic acids in the metabolic breakdown of FD&C Ked No. 1, and an attempt is being made to determine which of these detoxification products are chiefly responsible for the toxicity of the dye. In the Bureau of Medicine, as a part of the medical evaluation of hazardous substances and development of the medical aspects of their labeling, basic clinical and technical information is being collected from and exchanged with other Federal and interested private organizations. Hospitals reporting on adverse drug reactions increased from 12 to 35 during the year ; they include some of the most prominent centers in the country. While the program is still small, the groundwork is being established for a badly needed national repository of drug reaction information. Significant individual case reports point up the need for more informative labeling of some drugs for safe use. The clinical evaluation of various medical devices was initiated dur¬ ing the year under contract for studies to establish the falsity of extravagant claims. Seizure of a number of air purifying devices was the first result of this new program. In the second year of the Government Industry Cooperative Oyster Research Program analysis was completed of the extensive chemical and biological data compiled earlier. Statistical methods were ap¬ plied to the field and laboratory data collected. The objective of the study is to develop a sound basis for the formulation of enforceable standards to prevent excess water in shucked oysters. 354 Department of Health , Education , and Welfare , 1961 Enforcement Statistics The year’s activities included 26,276 inspections of factories and warehouses; 3,669 inspections of pesticide practices; 4,045 of public eating places to check on the notification of the serving of oleomar¬ garine ; 199 inspections involving illegal sales of prescription drugs ; 88 for radioactivity in foods ; 56 of spieler and lecturer activities ; 790 to check on manufacture of color additives; and 491 inspections of firms making or handling hazardous household substances. Of 44,466 domestic samples collected, 26,028 were foods, 15,860 drugs and de¬ vices, 2,483 cosmetics and colors, and 95 miscellaneous. In the 202 criminal actions terminated (or terminated for some defendants) in the Federal courts during 1961, fines assessed totaled $138,118. Jail sentences ranging from 10 days to 6 years were im¬ posed in 53 cases involving 63 defendants. Twenty-one individuals were required to serve imposed sentences, averaging 10 months; sen¬ tences were suspended for 42 on condition that violative practices be discontinued. Records of actions terminated in the courts were pub¬ lished in 1,010 notices of judgment. Table 2. — TSumber of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1961 Item Total Criminal prosecu¬ tions instituted Seizures accomplished Injunctions requested Violative samples Actions Violative samples 1 Actions Violative samples Actions Total _ _ Foods . . . Drugs and devices . Cosmetics (colors) _ 3, 543 1,326 1, 483 269 2,060 1,038 19 1,501 1,923 117 2 824 475 26 1 420 1,063 106 163 1,081 860 117 2 707 304 26 1 11 8 Caustic poisons . 1 The number of samples on which the actions are based always exceeds the number of actions; in seizures a variety of articles may be contained in a single shipment, while in criminal actions each sample usually represents a single shipment which forms one count of action. A regulatory report inevitably deals at some length with the activi¬ ties of the minority — the ignorant, the heedless, and the greedy — who violate the requirements of the law to the detriment of both consumers and ethical manufacturers. However, progress in con¬ sumer protection is best reflected by the vast number and proportion of producers and handlers whose products are in compliance with the law. In the final analysis, it is the responsibility of the public to be vigilant and sensitive to consumer protection needs, and to see that its laws and their administration are consistent with those needs. Food and Drug Administration 355 Table 3. — Import samples collected, examinations made, and lots detained during the fiscal year 1961 Item Samples collected Examina¬ tions made Lots detained Total . . . . . . . 14, 502 16, 422 5, 077 Foods _ - _ _ 11,051 3, 261 190 15, 731 533 158 2, 715 2, 286 76 Drugs and devices . _ Cosmetics, colors, miscellaneous _ Conclusion Nineteen sixty-one was a year of definite progress in carrying out the mission of the Food and Drug Administration to protect con¬ sumers. Drug counterfeiting was investigated vigorously and actions begun against major operators; a campaign w7as begun to stop abuses in repackaging of physicians’ samples; two major quack remedies — one for cancer and one for arthritis and rheumatism — were finally put off the market after several years of court action on each ; a major ring of packers of incubator-reject eggs was broken ; a major drive wTas begun against short-weight packages and concealment of label information required by law to be conspicuous. Regulations were tightened to assure that doctors and druggists are fully informed about the hazards as well as the potential benefits of new drugs. The Food and Drug Administration staff continued to grow, and construction of the new headquarters laboratory building got underway. But the unfinished business at year’s end left no room for com¬ placency. Still in the tooling- up stage for full administration were the new Food Additives and Color Additive Amendments, and the Federal Hazardous Substances Labeling Act. Approximately 99.7 percent of all shipments of fresh produce mov¬ ing to market were still untested for possibly harmful amounts of pesticide residues. The full impact of resumption of nuclear Aveapons testing by the Soviet Union on the safety of our food supply remains to be seen. Food and drug manufacturing and distributing establish¬ ments were being inspected on an average of only once every 3 years. And experience has shown numerous gaps in consumer protection that can only be closed by further amendments to the law. Much has been accomplished, but the problems have changed and the challenges are as great as ever. Office of Vocational Rehabilitation Rehabilitations of Disabled Persons Grow in Number as Research, Training, and Facilities Expand In the fiscal year that ended June 30, 196 1,1 another new high was reached in the number of disabled persons who were helped to over¬ come their handicaps and placed in satisfactory employment through the services of their State rehabilitation agencies. The 1961 tolal of persons rehabilitated through the State-Federal program was 92,500, almost five percent more than the year before. Despite a generally high level of unemployment during 1961, the placement of 92,500 handicapped workers in jobs for which they were prepared through the public program of vocational rehabilitation is a large step toward the ultimate goal of the national program — pro¬ vision of opportunity for all handicapped persons to make the most of their abilities. 1961 was a year in which there was a great amount of progress — and an even greater amount of consolidation of previous gains — in the three basic elements which do most to move the national rehabilitation program forward: Research and demonstration; a training program producing more and better qualified workers in the disciplines whose principles contribute to the art of rehabilitating disabled persons; and the addition of rehabilitation centers, workshops, and other facilities, where new rehabilitation knowledge can be applied with greater effectiveness. These advances were a high point in the march of vocational re¬ habilitation into the nation’s pattern of health and welfare activities. The State-Federal relationship for aid to the disabled began in 1920. In four decades it has progressed from training designed pri¬ marily for vocational objectives into services under a greatly expanded philosophy which holds that before vocational training is attempted 1 Unless otherwise indicated, all subsequent references to 1961 will be to the fiscal year, that is to say, the period between July 1, 1960, and June 30, 1961. 357 358 Department of Health , Education, and Welfare, 1961 disabilities should first be removed or reduced ; that disabled persons be aided in adjusting, if need be, to new sets of circumstances in their personal lives; and that rehabilitation services should be both more personalized and more comprehensive. There were several legislative actions along the wTay as ex¬ perience was gained, and as rehabilitation began to be viewed as a part of the national health program, and a measure having economic as well as social importance. Rehabilitation of the disabled was in¬ cluded as part of the social security laws of the early thirties ; mental troubles were recognized as targets for rehabilitative measures, and physical restoration was added as a program objective in the Barden- LaFollette amendments of 1943; and the State-Federal partnership was given a sounder financial base and improved resources for bringing disabled persons to productive employment in Public Law 565, enacted in 1954. Since 1954, advances have come more swiftly. The more severe disabilities are under harder attack. State rehabilitation agencies and private groups are concentrating on the effects of mental illness and retardation as handicaps to employment; communities are par¬ ticipating to a greater extent in activities for helping their disabled and a dynamic program of research is pouring new riches of informa¬ tion into the public knowledge. The research and demonstration program expanded in every way in 1961. There were 116 projects approved for action during the year, approximately a quarter of the total of 460 for which grants have been made since the first award in 1955. The geographical | spread among project locations has grown from the 8 States and the District of Columbia where the initial 18 projects of 1955 were located, ! to 48 States, the District of Columbia, Puerto Rico and the Virgin Islands. Expenditures for the 18 projects of 1955 amounted to less than $300,000. Grants for the 116 projects of 1961, and for continu¬ ation of prior projects amounted to $8.17 million. This brought the Federal investment in rehabilitation research and demonstration to approximately $26 million. The training program grew in several directions. A significant 1 action was a series of institutes, for which the Office of Vocational Rehabilitation contributed support, that brought organized labor and community agencies into closer relationships with State rehabilitation agencies, for ultimate benefits to handicapped or industrially injured workers. There was renewed response within the training program to the need for more social workers to cope with the impact of disability on individuals, families, and communities. There was a study of professional preparation in speech pathology and audiology, and ini- CHART 1. — DISABILITIES AND MAJOR OCCUPATIONAL GROUPS Office of Vocational Rehabilitation 359 Percent of rehabilitants, by types of disability at acceptance and by major occupational group at closure, fiscal year 1961 360 Department of Health , Education , and Welfare , 2961 tial planning for academic training to prepare persons for modem rehabilitative work with deaf persons. There were special training activities to prepare instructors for teaching the blind to get about with greater facility, and for other objectives. There was renewed emphasis on the training of counselors, which, next to the funds granted in support of instruction in rehabilitation medicine, received the most financial support. Forty schools of medicine and osteopathic medicine — almost half the total of such schools — received training grant funds in 1961 for instruction of undergraduate medical students in rehabilitation principles. The approximate level of construction of rehabilitation facilities that has spurred the progress of rehabilitation in recent years was maintained during the year. Two more States were added to the list of those that own and operate rehabilitation facilities for their own particular objectives. Seven States are now in this category — Virginia, West Virginia, Pennsylvania, Iowa, Kansas, North Caro¬ lina, and Arkansas. The 36 projects for construction of rehabilitation facilities that were approved during the year for partial support from the Federal government through the Hill-Burton Act — which was amended in 1954 to include rehabilitation facilities in its provisions — brought the total of facilities built with that support to a total of 176, a good indication of surging community interest in rehabilitation. REHABILITATIONS IN 1961 The new record in the number of persons rehabilitated into employ¬ ment — 5 percent more than in the previous year — reflected gains in a majority of the States, and in the District of Columbia, Puerto Rico, and Guam. The preponderance of these persons continued to be those with orthopedic disabilities — amputations and other crippling conditions. About 41 percent (38,000) were disabled by such conditions, and, of these, about three-fifths resulted from accidental injuries, about one- fifth were from poliomyelitis, osteomyelitis, or arthritis, and the re¬ mainder from other orthopedic impairments. Referrals came from many sources, but the largest proportion (34 percent) came from physicians, health agencies, or hospitals. An¬ other 14 percent was referred by public welfare agencies, and 7 per¬ cent by State employment service offices. About 12 percent applied for services on their own initiative. The remainder came from such sources as educational institutions, employers, and unions. Nearly half of the rehabilitants had dependents, and 63 percent were male. The occupations in which rehabilitants of 1961 were placed included nearly all types of work, including more than 4 percent who went into such short-supply professions as teaching, engineering, and medicine. Office of Vocational Rehabilitation 361 The proportions employed in other major occupational groups remain similar to those in previous years — skilled and semiskilled, 27 percent ; clerical and sales, 17 percent; service workers, 19 percent; family workers and housewives, 14 percent; professional, semiprofessional, and managerial, 8 percent; agriculture, 8 percent; and unskilled, 7 percent. At the close of the fiscal year, 197,000 other disabled people were receiving services from State rehabilitation agencies, against a total of 180,000 in 1960. ECONOMIC VALUE OF THE PROGRAM The extent to which the public vocational rehabilitation program can improve the economic status of handicapped persons, increase the Nation’s productive potential, and relieve some of the dependency upon public assistance was strikingly shown in 1961. About 70,000 of the 92,500 handicapped persons prepared for and placed in employment during 1961 were unemployed when their re¬ habilitation began. The group that had been working at the time they were accepted for service was earning at a rate of about $70 million a year and generally the individuals were employed in unsafe, unsuitable, or part-time work. In the first full year of employment for the entire group after rehabilitation, it is estimated that they will have earnings at the rate of $180 million. Nearly 18,500 of those who were rehabilitated received public assist¬ ance at some time during the process, at the estimated rate of $18 million a year. The estimated total cost of the rehabilitation of these persons was about $18 million, a one-time outlay. It is estimated further that those who were established or placed in employment through the public rehabilitation program will pay, during the remainder of their working lives, from seven to ten dollars in Federal income taxes for every Federal dollar invested in their rehabilitation, so that the conversion of so many persons from tax consumers to taxpayers is of pronounced economic benefit to the Nation. Research Points Out New Objectives The general nature of the research and demonstration projects for which the Office made supporting grants during the year revealed some sharpened objectives of the public program which are leading it into new paths. Rehabilitation research, in the first years after it was initiated under provisions of 1954’s Public Law 565, was, in a high proportion, di¬ rected toward developing means of assistance that voluntary groups 626936—62 - 24 362 Department of Health , Education , and Welfare , 1961 could give to State rehabilitation agencies, to help them to examine their on-going programs, and to improve their content and method. The need for such projects continues. Yet, in the increasing num¬ ber of project proposals submitted to the Office, there is evidence of a much stronger drive toward research into fundamental aspects of disability and rehabilitation. The psychological aspects of dis¬ ability, the attitudes of communities toward disabled people and those of employers toward hiring them, the adaptation of electronics and powered devices to artificial limbs and sensory aids, the special re¬ habilitation needs among the growing proportion of older disabled people in the population and among disabled mothers with dependent children, special help for severely disabled persons whose rehabilita¬ tion may be beyond the means or facilities of their State agencies — these are examples of the directions in which research and demon¬ stration are leading the program. In these ways the public program is reaching beyond specific tech¬ niques of treating ordinary forms of disability, and has gotten well into an unfolding three-fold set of objectives (1) to direct more atten¬ tion to the severer forms of disability, (2) to demonstrate in com¬ munities that disabilities can be helped more substantially and in better fashion by local application of new techniques and knowledge, and (3) to help communities to establish rehabilitation facilities and services on a sound basis so that they may continue when Federal support is ended. There are, for example, 83 special demonstration projects over the country for which the Office has given supporting grants so that communities and States may have greater opportunity to apply new knowledge in coping with forms of disability. Nine of them are now operating without Federal aid. At the end of the year, 460 research and demonstration projects had been completed, or were in operation, or approved for activation. They were about half the number of proposals that have been made to the Office of Vocational Rehabilitation. The approved projects represent a total Federal investment of approximately $26 million. Fifty- two percent of the grant awards were to private, nonprofit agencies; 31 percent went to colleges or universities; and IT percent went to public groups, including State rehabilitation agencies, which has been a growing trend in the program. The selection and approval of projects is through a National Ad¬ visory Council of 12 members, a statutory body appointed by the Secretary. The members are leaders in those phases of scientific, educational, and public affairs whose attainments qualify them for responsible judgments on the suitability of research grants for the particular purposes of the national rehabilitation program. Miss Office of Vocational Rehabilitation 363 Mary E. Switzer, Director of the Office of Vocational Rehabilitation, is chairman of the Council. The growing volume of applications for grants brought the neces¬ sity during the year for a preliminary screening process within the Office. Many applications propose ventures into areas where rami¬ fications of the many disciplines used in rehabilitation become in¬ volved, so that expert opinions in those fields are needed to relate the value of the proposals to rehabilitation objectives. Within the year, two Study Sections were established. One panel advises the Council on applications involving the psycho-social sci¬ ences, and the other gives preliminary consideration to applications concerning sensory disabilities. A third Section, which will consider applications primarily involving medicine, was being established as the year closed. NEW SERVICES FOR THE SEVERELY DISABLED A new type of research and demonstration project designed to in¬ crease and intensify rehabilitation services for persons with extremely severe disabilities was initiated during the year. Five of the new kind of projects were put into operation in Massa¬ chusetts, Texas, West Virginia, Michigan, and Pennsylvania. They are directed primarily toward services for people receiving disability cash payments under the disability provisions of Old Age, Survivors, and Disability Insurance legislation. Persons with such disabilities as cardiovascular, neuromuscular, or respiratory conditions are expected to be the chief beneficiaries of the services, extended to them because the severity of their conditions requires intensive and long-term services, generally at high cost, and frequently out of their residence area. The Federal government will bear part of the costs of these projects, which will include special surgery and other rehabilitative measures not ordinarily available to such disabled persons from their State rehabilitation agencies. Grants totaling almost $381,000 were awarded for the projects. Applications have been received from other States for grants to enable the adaptation of these projects as prototypes. SCIENTIFIC ADVANCES APPLIED TO REHABILITATION The application of scientific advances and principles to help dis¬ abled persons to cope with their handicaps was undertaken at two technological schools during the year. Basic and applied research is being undertaken at the Massachusetts Institute of Technology and at the Case Institute of Technology to discover ways in which elec¬ tronics, pneumatics, hydraulics, and other sciences may be used for 264 Hepartment of Health, Education, and Welfare, 1961 alleviation of various forms of disability; and to construct devices for practical application of theoretical principles. A part of this research will be in aids for blind persons. Studies will be made of the probing patterns of blind persons using guide canes, and ways will be sought to improve communication by Braille, including a high-speed machine which can operate at electric type¬ writer speeds for simultaneous Braille typing. Case Institute has a project for development of electronic and re¬ lated equipment capable of guiding a powered prosthetic device through several predetermined patterns. With such a device, a per¬ son having a completely paralyzed arm could perform several ac¬ tivities, such as feeding himself and meeting other personal daily needs. Another project will experiment with a device which will record differences in pressure produced on various parts of the body of a person lying in bed. There is no successful device of the sort avail¬ able, and its development would greatly benefit physical medicine and rehabilitation by more knowledge of the prevention and cure of “bed sores.” A fourth project will experiment with a tiny electronic device which, when permanently implanted in living tissue, could pick up and transmit nerve impulses, and in return activate an artificial limb or brace. MENTAL RETARDATION The widespread interest in mental retardation was accelerated during the year by increased activity in research and demonstrations relating to this disability. About one in every ten projects approved for activation has been in the field of mental retardation, and cumulative grant funds for projects concerned with social, psychological, and vocational prob¬ lems of retarded persons rank first in relation to other research areas. In all, 49 projects dealing with mental retardation have been approved since the beginning of the OVR research program. Of these, 20 are research and demonstration and 29 are selected demonstrations — which are occupational training centers to apply on a national basis the new procedures and services that were developed through research. Heavy emphasis was placed on helping mentally retarded high school students. A project in the Minneapolis public schools is estab¬ lishing facilities and developing techniques to give vocational guid¬ ance, training, and on-the-job experience to mentally retarded youths during their last year of high school. The project will serve as a prototype for extension to other school systems. A similar project to develop on-the-job work situations for retarded adolescents is in progress in Maryland. New York’s rehabilitation Office of Vocational Rehabilitation 365 agency is studying the early application of vocational services for retardates in a large urban area, and the Georgia agency is preparing a program to assist its public schools in developing skills and advancing maturity in mentally retarded youths prior to their entering the labor market. There are studies along related lines in Wisconsin, Missouri, and Oklahoma, and a New York project has the purpose of discovering ways in which vocational rehabilitation can be used among emotionally disturbed children who show tendencies toward delinquency. AID FOR DISABLED MOTHERS An experimental project which has nationwide implications was initiated in the District of Columbia during the year, designed to aid a category of disability that had been untouched — disabled mothers with dependent children. The purpose of the project is to prepare disabled mothers who receive public assistance for their children to become self-supporting and to care for their families. A mother must have a physical, mental, or emotional disturbance to be eligible for these services. With her children, she moves into a training center, where they continue to live until the mother is trained for and placed in employment, and finds a new home. Physical restoration services, hospital care, and medical treatment are available as required, and instruction is given in personal hygiene, homemaking, and child care. The project is assisted by teachers from public schools, public health nurses, recreation agencies, and the U.S. Employment Service; and the D.C. Department of Public Wel¬ fare shares responsibility with the District’s Department of Voca¬ tional Rehabilitation for the full operation of the endeavor. MENTAL ILLNESS AND PERSONALITY DISORDERS The role of the public rehabilitation program in the restoration of the mentally ill to community life and to employment was stressed more than ever during the year. The final report of the Joint Commission on Mental Illness and Health, “Action for Mental Health,” was published during the year. In it was the following statement : “The objective of modern treatment of persons with major mental illness is to enable the patient to maintain himself in the community in a normal manner. To do so, it is necessary (1) to save the patient from the debilitating effects of institutionalization as much as possible, (2) if the patient requires hospitalization, to return him to home and community life as soon as possible, and (3) thereafter to maintain him in the community as long as possible. Therefore, aftercare and rehabilitation are essential parts of all services to mental patients, 366 Department of Health , Education, and Welfare, 1961 and the various methods of achieving rehabilitation should be inte¬ grated in all forms of service, among them day hospitals, night hospitals, aftercare clinics, public health nursing services, foster family care, convalescent nursing homes, rehabilitation centers, work services, and expatient groups. We recommend that demonstration programs for day and night hospitals and the more flexible use of mental hospital facilities, in the treatment of both the acute and the chronic patient, be encouraged and augmented through institutional, program, and project grants.” The research and demonstration grants that have been approved in the field of mental illness — including 18 during 1961 — show a marked parallel to these recommendations. There have been projects concerned with establishing, developing, and improving therapeutic and vocational techniques of the community hospital, such as those at the Vermont State hospital and the Massachusetts Mental Health Center, and in the day hospital at the last-named institution ; half-way houses, as in Vermont, and those established during the year in West Virginia, Kentucky, and Missouri; greater use of work therapy, as in mental hospitals in Kentucky, Illinois, and the Goodwill Industries in Fort Worth, Texas; the screening of hospital patients for potential vocational rehabilitation, as is done by the agencies in Arkansas and Georgia; outpatient counseling and rehabilitation aftercare, as is done by the Manhattan Aftercare Clinic and the Butler Health Center, of Providence ; and the training and placement of emotionally disturbed persons in eight selected demonstrations. These projects illustrate a strong trend to weld together in the community a complete series of the services developed and tested in specialized projects. It will eventually be done through well- designed large-scale combined research and demonstration projects which have as a primary objective the logical organization and the controlled testing of cooperation and coordination of existing services of various types, as well as provision of additional services not yet available but needed to complete a basic sequence. OLDER DISABLED WORKERS AND THE CHRONICALLY ILL A project previously reported is a “Demonstration of Feasibility of Vocational Rehabilitation of Disabled Persons 60 Years of Age and Older,” initiated by the Federation Employment and Guidance Service of New York City. Recent statistics from this project cover¬ ing the past two years report 406 clients served with a median age of 64, a 75-percent placement rate for clients considered placeable, and a median gross pay of $44.50 per week (despite many part-time place¬ ments) as compared to a median weekly income of less than half this amount from all sources prior to entering the project. More than 60 percent of these older disabled clients had a secondary disability. Office of Vocational Rehabilitation 367 In fiscal 1960 this project and its established pattern of services was designated as a prototype around which other agencies could de¬ velop similar programs. To date the OVR has provided funds for five additional projects, in as many localities, of this nature. One of these is sponsored by the Kiwanis Opportunity Workshop in Mil¬ waukee, and is a good example of a service organization assisting in meeting the rehabilitation needs of a community. A similar project is being sponsored by the Mankato Rehabilitation Center, Mankato, Minn. The 1954 amendments to the Social Security Act give State voca¬ tional rehabilitation agencies a key role in the cash disability benefits program. It is essential that those responsible for administering such a program have available the best techniques and procedures with which to facilitate the screening of large numbers of applicants for OASI disability benefits. Recently the OVR approved projects with a university and two rehabilitation facilities, including the Sister Kenny Foundation in Minneapolis, to carry out, simultaneously in three regions, duplicate research programs which will provide quantitative as well as precise information on how the process of evaluation and determination of disability and the rehabilitation potential may be made more efficient. MOBILE REHABILITATION TEAMS The Oklahoma Division of Vocational Rehabilitation during the year inaugurated a mobile team of rehabilitation experts which is extending services of the agency to severely disabled persons in their own communities. The project is supported by a research grant, and the results will be evaluated for use in other States, particularly in extension of services to rural areas. A principal objective of the team is to stimulate community interest in rehabilitation and to create awareness of its potentialities. The team, in its visits, mobilizes all elements of the community that can help with the rehabilitation of disabled persons, and assists local counselors in cases that present special problems. STUDIES IN DEPRESSED AREAS A study of the rehabilitation needs of disabled persons residing in economically depressed areas was initiated during the year with a grant to West Virginia’s Division of Vocational Rehabilitation. The project is undertaking to study the prevalence of disability in depressed sections of the State; the need for rehabilitation services among the residents; the drain that unrehabilitated disabled persons are on the community ; and the contribution that vocational rehabili¬ tation can make in solving these problems. The project is regarded as a pilot endeavor for guidance of other States. 368 Department of Health , Education, and Welfare, 1961 ALCOHOLISM There was increasing activity in research relating to alcoholism as a personality disorder, and in several projects there are studies of work therapy and vocational counseling as means of countering alcoholism, and in applying general rehabilitation methods to this disability. INCREASING EMPLOYMENT FOR DEAF PERSONS Increased employment opportunities for deaf persons is the goal of three research grants made during the year. The Michigan Department of Public Health inaugurated a 3-year program to distinguish deaf persons from retarded persons in State training schools to determine whether the major disability is in hear¬ ing or retardation. The findings will shape the course of training in communications and in vocational skills. Another Michigan project is the establishment of a center by the Association for Better Hearing, which will make a 4-year effort to provide special personal adjustment and job training for about 100 deaf men now considered unemployable. A year-long study is in progress at the University of Pittsburgh to determine the extent that hearing loss caused by nerve impairment destroys the ability to localize sounds. Significant findings in this field could help development of hearing aids of greater use and adaptability. SELECTED DEMONSTRATIONS IN 1961 The number and geographical spread of selected demonstration projects grew during the year. These projects are in special cate¬ gories of severe disability, and are now operated in 83 communities in 40 States and the Virgin Islands to utilize new rehabilitation knowl¬ edge and methods. The number of projects had doubled since the first was established in 1958. The totals now : Occupational centers for mentally retarded _ 29 Work classification and evaluation centers for cerebral palsied _ 7 Work adjustment centers for disabled persons with emotional problems _ 8 Occupational adjustment services for epileptics _ 2 Services for the homebound : Industrial homework _ 3 Vocational adjustment in a community home-care program _ 1 Blind and visually handicapped : Optical aids clinics _ 18 Work evaluation of older disabled workers _ 9 Rehabilitation of the chronically ill _ 2 Services to blind farmers _ 1 Rehabilitation of the mentally ill _ 3 Total. 83 Office of Vocational Rehabilitation 369 Medicine and Counseling Are Emphasized in Training Program 1961 was a year of consolidation of the gains of the training program in previous years, rather than one of expansion, for the increase of only $1,060,000 over the 1960 appropriation permitted comparatively small increases in assistance to educational insti¬ tutions and scholarship assistance to students preparing for careers in rehabilitation. Of the $7,260,000 appropriated for training, grants totaling $7,253,- 719 were made. Teaching grants numbered 209, as compared with 201 in 1960. Traineeships were granted for 1,586 students, as com¬ pared with 1,460 in the previous year. Medicine received the largest proportion of support — 27 percent of the total granted for long-term training. Rehabilitation counseling was next, with 25 percent of the total. Speech pathology and audi¬ ology received 10 percent. Sixty-two of the 91 State vocational rehabilitation agencies received grants for staff development, largely to assist them in conducting organized in-service training for their staff. OVR funds supported 187 short-term courses which reached nearly 4,000 individuals and 26 persons received rehabilitation research fellowships. Definite strides have been made in improving the content of instruc¬ tion in rehabilitation counselor and undergraduate medical student training programs, through the medium of short-term training courses for faculty members. In rehabilitation counseling a workshop on occupational information and job placement was held during the year, supplemented by committee work in eight other aspects of the rehabil¬ itation counseling curriculum. REHABILITATION COUNSELING Training programs designed to prepare graduate students for work in State vocational rehabilitaton agencies and other community re¬ habilitation programs received OVR support in 32 universities, with a full-time enrollment of 531. Students receiving OVR traineeships numbered 459 (86 percent). The estimated number of graduates in 1961 was 225, or only 37 percent of the 600 graduates estimated to be needed annually for employment in expanding agencies or as re¬ placements for those leaving the field. The 1960 study of graduates of the training programs since 1954 indicated that about 800 students had been graduated from rehabilita¬ tion counselor training programs. Nearly 80 percent were employed in rehabilitation programs. Eight percent were enrolled in graduate 370 Department of Health , Education , and Welfare , 1961 study. Less than 5 percent were employed in work unrelated to rehabilitation of the disabled. MEDICINE Forty of the 87 schools of medicine and osteopathic medicine received teaching grants for instruction of undergraduate medical students in rehabilitation principles. These 40 schools have an enrollment of about 12,830 students, or about 40 percent of the total enrollment. Traineeships have been awarded to 182 physicians enrolled in residency training programs, chiefly in physical medicine and reha¬ bilitation and to 145 undergraduate medical students interested in a special training experience in research or clinical service in rehabilitation. OCCUPATIONAL THERAPY Grants in 1961 were made to 16 of the 31 AMA-approved schools of occupational therapy to permit them to employ additional faculty, to develop new teaching materials, or to strengthen the integration of the classroom courses with the students’ clinical experience. OVR traineeships were awarded to 230 students in the basic curricula, or 12 percent of the 1,850 enrolled in the schools in 1960-61. The graduate traineeship program, initiated in 1960 to produce personnel for teaching positions, gave scholarship assistance to 21 individuals in the 1960-61 academic year. A training grant for the instruction of occupational therapists in psychiatric aspects of rehabilitation was awarded to the University of Pennsylvania’s School of Occupational Therapy. A grant also was made to the American Occupational Therapy Association to support partially the services of a psychiatric occupational therapy consultant to schools and clinics. A pilot program of recruitment in New York City will serve as a demonstration for other communities and other schools. Its contacts with schools and colleges throughout New York and New England, plus a summer work experience in occupational therapy departments of hospitals for selected students, have increased the number of appli¬ cants for admission. PHYSICAL THERAPY Teaching grants were made to 22 of the 40 AMA approved schools of physical therapy, chiefly for expansion of the faculty. Schools are experiencing difficulty in recruiting students, chiefly because of lack of scholarship assistance for the 4-year training program plus the clinical affiliation. Office of Vocational Rehabilitation 371 Shortages of qualified teachers had impelled OVR to institute grants for graduate traineeships in 1959. In the 1960-61 academic year 20 individuals were enrolled in graduate training programs, the ma¬ jority in anatomy, physiology, and physical therapy. The majority of those who completed graduate study in the previous year are teachers. PROSTHETICS AND ORTHOTICS Seven educational institutions received a total of $607,483 in 1961 to enable them to employ faculty for a series of short-term training- courses in prosthetics (artificial limbs) and orthotics (braces and assistive devices). During the year these short-term courses reached over 600 physicians, surgeons, rehabilitation counselors, therapists, prosthetists, orthotists, and other personnel concerned with procure¬ ment of prosthetic devices. PSYCHOLOGY The need for trained psychologists with particular competence in serving physically disabled persons, especially in the area of psy¬ chological assessment of the potential for rehabilitation in severely handicapped persons, is being met. In 1961, grants were made to 5 universities interested in strengthening the rehabilitation content of basic curricula for all psychology students. Traineeships were awarded to 23 students specializing in rehabilitation at the graduate level. SOCIAL WORK OVR training grants have stimulated an increased awareness of the impact of physical and mental disabilities not only on individuals, but on families and communities as well. Several new training units for social work are now operating in State agencies, the most recent in the Rhode Island State agency. Establishment of these units indi¬ cates a growing recognition of the importance of social components in the rehabilitation process by State Directors and Regional Repre¬ sentatives, and has strengthened the relationships between the schools of social work and the staffs of the State agencies and Regional offices. Teaching grants were made to 33 schools of social work with a total enrollment of 3,164. Traineeships reached 138 students in the first and second years of the curricula. Estimates of the number of trained social workers needed for work in health and rehabilitation agencies are about 1,500 annually, so that OVR is contributing less than 4 percent of the needed graduates in the health and rehabilitation aspects of social work. 372 Department of Health , Education , and Welfare, 1961 SPEECH PATHOLOGY AND AUDIOLOGY A study of professional preparation in speech pathology and audi¬ ology was completed in 1961. Its findings have provided a valuable base for planning the future direction that training grants in this field should take. Conducted under the auspices of the American Speech and Hearing Association, the Office of Education, Children’s Bureau, and OVK, the study undertook to define both status and needs for training in this field. In the 1960-61 academic year 777 students received graduate degrees, about half of the 1,500 graduates estimated to be needed annually for rehabilitation of persons with communica¬ tions disorders. Teaching grants were made to 26 of the 193 training centers offering graduate training, and traineeships were awarded for 173 trainees. Initial planning for a new academic training program designed to prepare persons for modern rehabilitative work with the deaf has been completed and recruitment is under way for the 1961-62 academic year, as a cooperative enterprise of San Fernando Valley State College and the John Tracy Clinic in Los Angeles. Eight short-term training courses on social, economic, and personal problems of deaf persons have been held for audiologists, psycholo¬ gists, clergymen, social workers, rehabilitation counselors, and other persons serving the deaf. Slightly over $80,000 has been granted in this field in 1961. WORKERS FOR THE BLIND About 5 percent of the total appropriation for training in 1961 has been devoted to preparation of personnel for rehabilitation of blind persons. Two academic programs for instructors in mobility (independent travel) have been established. Boston College will graduate its first class in August; Western Michigan will probably accept it first stu¬ dents in 1961-62. Short-term training courses have been conducted in a number of significant aspects of service to blind persons. They have included courses on psychological aspects of blindness, supervision of vending stand programs, casework services, interagency cooperation, and place¬ ment of blind persons in competitive industry. SHORT-TERM TRAINING COURSES Continuous educational programs for practitioners in all profes¬ sional fields in 1981 included 187 short-term courses reaching nearly 3,500 individuals. Some courses dealt with rehabilitation of am¬ putees, services to the deaf, blind, and mentally retarded, reha¬ bilitation of the mentally ill, and treatment of organic voice problems. Office of Vocational Rehabilitation 373 Others were concerned with orientation of newly employed reha¬ bilitation counselors, or with raising the level of skill of administra¬ tors, supervisors, and medical personnel of State vocational rehabilitation agencies. LABOR’S INCREASING SUPPORT OF REHABILITATION Four regional demonstration institutes have been held for per¬ sonnel of State vocational rehabilitation agencies, rehabilitation centers, State Councils of AFL-CIO and other key community agencies. The institutes, held under the sponsorship of the National Institute of Rehabilitation and Labor Health Services, served to increase the knowledge of rehabilitation on the part of labor leaders and to stimulate interest in further cooperation on behalf of handi¬ capped or industrially injured workers. Rehabilitation Facilities Grow in Number Increasing utilization of rehabilitation medicine has led many more hospitals to request Federal assistance in establishing reha¬ bilitation facilities as part of their program. The facilities are of many kinds, ranging from comprehensive rehabilitation centers — some of which are located in the leading teaching and research institutions in the country — to sheltered work¬ shops which furnish transitional employment to severely disabled persons gradually returning to full employability in competitive industry. There are also smaller special purpose facilities such as half-way houses and speech and hearing centers. Fifty-eight State agencies now have a regulatory basis for estab¬ lishing rehabilitation facilities with regular program funds or Federal grants for extension and improvement of their programs. A third of the States have enabling legislation allowed them to provide services for independent living for disabled persons, as distinguished from vocational rehabilitation, if Federal funds become available for the purpose. One State has ventured into this endeavor without Federal assistance. In 1961, 32 States spent a total of $1.7 million of their own and Federal funds for facilities and workshops, the Federal share amount¬ ing to $1.2 million. STATE-OPERATED FACILITIES At the beginning of the fiscal year, five State rehabilitation agencies operated facilities designed to provide vocational training and other services especially needed by their rehabilitation clients. Now there are seven. 374 Department of Health , Education, and Welfare, 1961 The Office of Vocational Rehabilitation and the Surgeon General of the Public Health Service approved 36 community projects during the year for the construction of rehabilitation facilities under Hill- Burton legislation. The total cost will be $19,122,205. The Federal share amounts to $7,159,013. Since 1954, 176 such facilities in 50 States have been approved. They cost a total of $123,603,912, in which the Federal government participated to the extent of $37,607,059. Of the 176 projects, 61 were sponsored by nonprofit hospitals, 44 by State-owned hospitals, 4 by city or county hospitals, and 67 by nonprofit organizations other than hospitals. Of the 176, 129 were to serve a variety of dis¬ abled people. Thirty-one were for mentally retarded or emotionally disturbed cases, five for deaf and hard of hearing, four for blind persons, and seven for others with special problems. Counteraction in Isolation of Deaf Persons A basic need in the rehabilitation of deaf persons is to reduce their isolation so that they may take greater part in local and national community activities. Interaction for this purpose among national, State, and local groups was inaugurated at an OVR-supported national meeting attended by some 50 leaders in work for the deaf, some themselves deaf and others who could hear, where the ground¬ work was laid for nationwide efforts to foster dynamic programs for those with hearing loss. A similar result, but with a different approach, is being sought through religious groups, to spur the vocational rehabilitation of deaf persons within their congregations. Clergy and lay workers have for many years worked with deaf persons in spiritual, social, and vocational affairs. An OVR effort to direct these activities into wider and more productive channels came in 1961 in Washington, D.C., with a pilot workshop supported by the Office for priests, nuns, seminarians, and lay workers of the Catholic church, to acquaint them with their State agencies and the program of vocational rehabi¬ litation. The workshop was so productive that similar ones are planned within other denominations. NEW STUDIES IN BLINDNESS The vocational placement of blind persons was given substantial aid during the year by a wide study of well over 400 blind workers in professional fields. The study was made by Pennsylvania’s Office for the Blind, with the aid of a grant from the Office of Vocational Office of Vocational Rehabilitation 375 Rehabilitation, and covered workers in 42 States, the District of Columbia and Puerto Rico. Direct interviews were held with blind lawyers, judges, scientists, engineers, teachers, social workers, psychologists, and mathematicians, and were recorded on tape and transcribed. The compendium of material that came out of the study, showing how these blind persons function practically and successfully in their jobs, is a highly useful document in the placement of blind persons. There also was action during the year to bring into the programs for the blind the benefits of invention and of scientific advances, particularly in electronics. The research project under way at the Massachusetts Institute of Technology, to find ways to apply new scientific principles to the reduction of disability, is of great interest to blind persons and those who work with them. The principal area of concern for the blind in this project is in finding ways to improve the ability to read, to move about with greater ease and safety, and interpretation of sensory cues, such as traffic sounds. Another study of considerable importance to blind persons and their instructors was completed during the year. The American Association of Workers for the Blind, with the aid of an OVR grant, made an analysis of the functions and duties of home teachers of blind persons. The teachers — a large proportion of them blind — are now receiving reports of the study, which contain advice and suggestions from phys¬ ical and occupational therapists, social workers, persons in various public health activities, and others who are acquainted with the spe¬ cial problems of home instruction of the blind. Since the Office of Vocational Rehabilitation has had resources available for research and demonstration projects, 38 projects con¬ cerned with blindness have been supported by grants. In addition, there are 11 low-vision clinics where highly skilled personnel teach the use of optical aids to persons whose residual vision is so low that they are considered as blind. Shortage of trained personnel offers a particularly serious problem. In addition to other kinds of training, the Office of Vocational Reha¬ bilitation instituted a course for supervisors of vending stand opera¬ tors through the training facilities of Harbridge House. The vending stand program for the blind continued to set new records. At the end of the fiscal year a total of 2,174 stands operated by blind persons had been reached. Six hundred fifty-six of them were on Federal property, and the rest on State, local, or private prop¬ erty. Some, operated in such places as national parks, were seasonal. 376 Department of Health , Education, and Welfare, 1961 The stands had a gross business of $42,057,398 or $3,838,058 more than the year before; they returned $8,460,727 in net profits to 2,332 opera¬ tors ; and the average profit for all operators was $3,936. OASDI APPLICANTS Disability provisions of the Social Security Act, which provide insurance protection for workers against loss of income due to dis¬ abling injury and disease, hold as an equally important objective the rehabilitation of as many as possible of those who apply for disability benefits, the primary purpose being to return them to productive employment. State agencies (all but four of which are State vocational rehabilita¬ tion agencies) made approximately 365,000 initial determinations of disability of applicants applying for disability insurance benefits in 1961. About 400,000 applicants were screened for rehabilitation po¬ tential, and more than 40,000 were accepted for possible rehabilitation services. During 1960, 4,200 applicants were enabled to return to work through the provision of rehabilitation services. Efforts to develop new and improved methods to serve these appli¬ cants are being carried out through several research and demonstra¬ tion projects. Three projects concerned with evaluating the extent of disability of applicants and assessing the rehabilitation potential were initiated. Five others are designed to demonstrate how many :i of the severely disabled applicants can be rehabilitated through con- ' centrated and intensive medical, therapeutic and counseling services. Medical Training One of the acute needs in the public program of vocational reha- ^ bilitation is for physicians trained in the modern practice of physical medicine. In an effort to meet this need, the Office is supporting the training of more than 180 resident physicians in physical medicine and rehabilitation, which is an increase of some 40 percent over those in such training in 1960. Another effort in this direction was to stimu¬ late interest in residency training among those undergraduates in medical schools who attend summer sessions. Added recognition was given during the year to the specialty of rehabilitation nursing. A consultant in rehabilitation nursing was added to the central Office staff during the year and emphasis was given to the establishment of additional training facilities for nurses, resulting in an increase in applications for training grants in this field for the coming year. Office of Vocational Rehabilitation 377 Expenditures for the Support Program Grants to States and Territories for services for basic support of vocational rehabilitation services were $54,302,013 in 1961. This is an increase of about 11 percent over 1960 and more than 136 percent over the $23 million which States received in 1954. Eleven States, the Dis¬ trict of Columbia, and Guam acquired all of the Federal allotments available to them by making available sufficient matching amounts. Six States acquired more than 95 percent but less than 100 percent, 2 States 90-95 percent, 10 States and Puerto Rico 70-80 percent; 6 States and the Virgin Islands 60-70 percent, 5 States 50-60 percent, 3 States 40-50 percent, and 1 State less than 40 percent. The average per-capita expenditures for vocational rehabilitation services in all States and Territories rose from 22 cents in 1954 to 49 cents in 1961, an increase of 123 percent. EXTENSION AND IMPROVEMENT PROGRAM Federal grants totaling $1,019,483 were made in 1961 to provide additional financial assistance to State agencies for projects which would extend and improve their existing vocational rehabilitation programs. During 1961, grants were made for a total of 92 projects in 41 States. They were made for these purposes: establishment of workshops and rehabilitation facilities, including optical aids centers ; improvement of specialized services to disability groups such as men¬ tally ill, mentally retarded, homebound, epileptics, cardiac and other disability groups; and improvement of program administration. Among the disability groups served by the extension of program activity in 1961 were the mentally ill, mentally retarded, blind, aged, cerebral palsied, deaf, those with speech and hearing disabilities, and alcoholics. Twenty-six of the projects were for the establishment of either rehabilitation facilities or workshops and 32 were for the em¬ ployment of specialized counselors or other professional staff. STATE PLANS Six State agencies amended their plans for vocational rehabilitation services to include provisions for the establishment of workshops, bringing the total number of State agencies with such plan provisions to 57. The number of State agencies with plan provisions for the establishment of rehabilitation facilities remained unchanged at 58. State vocational rehabilitation legislation included, in 1961, an enactment of comprehensive basic legislation, by Kansas, embracing 626936—62—25 378 Department of Health , Education , and Welfare , 1961 authority for rehabilitation services to help disabled people achieve self-care rather than employment; and brings the States and Terri¬ tories with such authority to one-third of the total number. Small Business State rehabilitation agencies are authorized by legislation to use funds to encourage and establish disabled persons in small business enterprises when, in an agency’s discretion, it will be the most suitable and effective means of an individual’s rehabilitation. In such cases, vocational training is directed toward operation of a specific business, after which necessary tools, licenses and an initial stock of goods are provided, and the operation given nominal super¬ vision by the State agency. The small business enterprises which were established for disabled persons and supervised by State rehabilitation agencies in 1961 in¬ volved about one percent of the 92,500 rehabilitations during the year. A 3-year study of the causes of success or failure of small businesses operated by handicapped persons has revealed that, as a general rule, maturity, rather than age, was a factor for success ; that formal educa¬ tion was an insignificant factor, compared to good personality traits ; that the severity of disability does not seem to affect customer rela¬ tionships ; and that disabled operators who have a stake of their own in the business are more likely to succeed. The study was made possible through a research and demonstration grant from the Office, and the complete results will be available to all State rehabilitation agencies as a standard guide. International Research Rehabilitation research received added impetus during the year with institution of a cooperative program among the United States and nine foreign countries. Under provisions of Public Law 480 — the Agricultural Trade De¬ velopment and Assistance Act — the Congress alloted $930,000 in coun¬ terpart funds to the Office, to support cooperative research in India, Pakistan, Brazil, Yugoslavia, UAR-Egypt, Burma, Indonesia, Israel, and Poland. The funds have accumulated to the credit of the United States from the sale of surplus commodities to those countries, and may be spent only for beneficial purposes within their borders. Office of Vocational Rehabilitation 379 At the close of the year, 13 projects in three of the countries had been approved for activation — 6 in Israel, 4 in India, and 3 in Brazil. Projects in the six other countries were in various stages of develop¬ ment, and India and Israel were preparing additional projects. India has a great need for more research into vocational rehabilita¬ tion of lepers and is directing some of its research plans in this direc¬ tion, as well as into planning for vocational training of disabled per¬ sons according to prevailing industrial and agricultural patterns. Israel, among other projects, is experimenting with methods of train¬ ing blind persons for work in the textile industry, and methods of preparing cerebral palsied persons for employment. Plans were under way during the year to send 12 United States surgeons of outstanding reputation to India to do research work with Dr. Paul Brand at the Christian Medical College, in Vellore, and to help build a broad program for the rehabilitation of lepers. The surgeons will go in rotation and each will work in India for a period of appromixately 2 months. A request has gone out to the Indian Ministry of Health to nomi¬ nate Indian surgeons on an exchange basis. The Office of Vocational Rehabilitation, during the fiscal year 1961 planned programs for 18 long-term rehabilitation trainees from 13 foreign countries — Brazil, Chile, Uruguay, Costa Rica, Viet Nam, India, the Philippines, Israel, Sweden, Denmark, Finland, Guatemala, and Yugoslavia. The areas of study included rehabilitation philos¬ ophy and methods, physical therapy, prosthetics, occupational ther¬ apy, orthopedic surgery, and physical medicine and rehabilitation. Trainees were interested in both the physically and mentally handicapped. The Office also planned short-term visits for some 140 persons of professional and technical backgrounds related to rehabilitation who were interested in becoming better acquainted with the U.S. program. 380 Department of Health, Education, and Welfare, 1961 Table 1. — IS umber of referrals and cases, by agency, fiscal year 1961 Referrals Cases During fiscal year During fiscal year Agency1 Re¬ Closed from active load Re¬ Total Accept¬ ed for serv¬ ices Not accept¬ ed for serv¬ ices 2 main¬ ing at end of year * Total active load (receiv¬ ing serv¬ ices) Reha¬ bili¬ tated After reha¬ bilita¬ tion plan initi¬ ated * Befor reha¬ bilita¬ tion plan initi¬ ated s main ing at end of year 6 United States, total - 409, 295 140,476 135, 490 133, 329 320, 963 92, 501 11, 980 19, 460 197,022 Alabama . . 7, 660 3, 721 1,480 2,459 9,663 2,787 409 588 5, 879 Alaska - 334 88 72 174 286 43 14 26 203 Arizona: General . . 1,756 642 597 517 1,345 440 71 72 762 Blind - 125 53 40 32 176 36 8 6 126 Arkansas - 7, 543 2, 855 2, 523 2, 165 5, 598 2,459 183 129 2,827 California - - 27, 646 6, 900 16, 054 4, 692 16, 115 2, 487 1,052 2,839 9,737 Colorado _ _ 4, 712 2,004 1,126 1,582 3,992 1, 152 280 145 2,415 Connecticut: General - - 3, 273 1,435 1,056 782 3,904 874 173 207 2,650 Blind . . 211 82 75 54 212 62 24 0 126 Delaware: General - 1,216 581 476 159 1,300 520 16 76 688 Blind _ 64 37 23 4 55 17 12 2 24 District of Columbia. _ 4, 903 1,460 2, 792 651 2, 727 713 165 222 1,627 Florida: General— . . 15, 153 4, 661 6,277 4,215 9, 864 1,095 3,404 539 627 5, 294 Blind . 4,054 425 2, 343 1,286 300 59 44 692 Georgia . . . 21, 685 6,867 6,428 8,390 12, 816 6, 014 325 366 6,111 Guam.. - - 171 22 114 35 97 20 6 27 44 Hawaii: General . . . 1,953 626 491 836 1,037 210 97 124 606 Blind . 27 13 6 8 54 9 5 2 38 Idaho: General . . 2, 045 406 936 703 950 330 39 22 559 Blind . . 44 25 15 4 56 12 4 3 37 Illinois . - . 12, 519 6,702 3,436 2,381 15,404 3, 879 871 1,537 9, 117 Indiana: General . 3, 088 1,709 677 702 4, 217 1,162 61 130 2,864 Blind . 163 84 42 37 236 42 18 30 146 Iowa: General - - 5, 914 1,883 1,663 2,368 4,066 1,234 168 168 2,496 Blind . . 178 71 37 70 205 44 5 5 151 Kansas: General . . 3, 567 1,280 927 1,360 3,205 961 117 235 1,892 Blind . - . . 395 107 136 152 284 76 9 17 182 Kentucky - - - 7, 294 1,884 3, 120 2, 290 4,072 1,475 82 248 2,267 Louisiana: General . 5,298 3,288 1,062 948 8,390 1,996 239 529 5,626 Blind . 747 186 104 457 694 120 24 24 526 Maine: General . 2, 106 492 702 912 1,264 376 66 87 735 Blind . . 284 202 61 21 293 65 14 42 172 Maryland - - 5,652 2,304 1,407 1,941 5, 925 1,491 187 524 3,723 Massachusetts: General . 8, 974 2, 448 2,740 3, 786 5, 497 1,687 163 334 3,313 Blind . 303 134 32 137 407 85 15 20 287 Michigan: General . 9, 649 3,687 1,943 4,019 9, 777 3,000 435 158 6, 184 Blind . . 360 183 87 90 471 87 46 49 289 Minnesota: General . 6, 976 2, 169 2,223 2, 584 5, 644 1,311 280 137 3, 916 Blind.... . 1,025 130 327 568 448 99 10 24 315 Mississippi: General . 3,622 1,793 594 1,235 3,721 1,360 81 203 2,077 Blind . 1,168 454 485 229 1,044 343 56 39 606 Missouri: General . 7,721 2, 352 3,013 2,356 5, 149 1,625 248 204 3,072 Blind— . 720 193 242 285 516 142 24 11 339 Montana: General . 2, 188 647 759 782 1, 570 425 16 38 1,091 Blind _ _ 367 47 281 39 78 22 2 3 51 Nebraska: General . 1,703 889 220 594 2,433 570 40 64 1,759 Blind . See footnotes at end o 279 f table. 82 125 72 161 65 4 3 89 Office of Vocational Rehabilitation 381 Table 1. — Number of referrals and cases, by agency, fiscal year 1961 — Con. Referrals Cases During fiscal year During fiscal year Agency > Re¬ Closed from active load Re¬ Total Accept¬ ed for serv¬ ices Not accept¬ ed for serv¬ ices 1 2 main¬ ing at end of year 3 Total active load (receiv¬ ing serv¬ ices) Reha¬ bilitat¬ ed After reha¬ bilita¬ tion plan initi¬ ated 4 Before reha¬ bilita¬ tion plan initi¬ ated 3 * * main¬ ing at end of year 8 Nevada: General _ 796 205 518 73 389 116 55 60 158 Blind _ _ 53 22 12 19 54 14 2 2 36 New Hampshire: General _ _ 495 290 94 111 771 194 132 9 436 Blind... _ _ 45 20 10 15 69 15 4 3 47 New Jersey: General _ 6, 520 2, 440 1,934 2,146 4,901 1,521 210 261 2,909 Blind.... . . 827 216 206 405 531 161 16 16 338 New Mexico: General . 1,355 353 648 354 684 284 51 9 340 Blind _ 233 55 48 130 117 34 0 1 82 New York: General _ 28, 928 10, 003 9,113 9,812 21,221 6, 447 765 1,225 12, 784 Blind . — - 1,214 433 285 496 1,044 286 36 93 629 North Carolina: General . . 12, 022 7, 775 3,055 1,192 15, 532 5,328 464 608 9, 132 Blind _ _ 1,317 483 570 264 1,457 432 25 91 909 North Dakota . . 1,818 505 538 775 1,296 355 43 57 841 Ohio: General . . 9, 470 3, 343 2, 996 3, 131 7,062 1,875 212 439 4, 536 Blind _ 864 433 156 275 1,007 203 30 46 728 Oklahoma _ Oregon: General _ 6,292 2, 874 1,403 2, 015 8, 288 1,750 187 556 5, 795 5,640 984 2,693 1,963 2,650 745 165 242 1,498 Blind _ _ 244 41 121 82 151 38 8 7 98 Pennsylvania: General . — 30, 332 10, 692 7, 778 11, 862 22, 791 6,235 902 836 14, 818 Blind _ 1,753 362 547 844 996 221 40 46 689 Puerto Rico _ 9,400 2, 145 2,081 5, 174 5, 751 1,193 105 404 4, 049 Rhode Island: General . . 2, 740 1,134 485 1,121 2,547 803 158 24 1,562 Blind _ 115 90 7 18 271 58 16 8 189 South Carolina: General— . 10, 988 3,172 4, 712 3, 104 6, 461 2,008 174 227 4,052 Blind... . . 358 161 139 58 350 109 8 20 213 South Dakota: General . . 1,084 295 255 534 1,018 250 72 20 676 Blind _ _ 427 31 211 185 103 27 3 1 72 Tennessee: General _ 10, 067 3,329 3, 139 3, 599 7,293 2, 469 258 279 4,287 Blind _ 1,197 309 299 589 860 258 19 49 534 Texas: General _ 13, 764 3,863 4, 514 465 5, 387 11,513 2,720 300 1,196 7,297 Blind . . - 1,267 443 359 861 376 9 17 459 Utah _ 1,910 817 515 578 2,114 547 72 28 1,467 Vermont: General— . . 1,240 363 241 636 839 183 70 41 545 Blind _ _ - 50 19 23 8 53 10 11 3 29 Virginia: General _ 14,877 4, 428 6, 449 4,000 9, 091 3,239 213 587 5,052 Blind— _ _ 660 138 208 314 292 113 13 5 161 Virgin Islands - 91 27 0 64 81 21 1 0 59 Washington: General _ 5,821 1,720 2,224 1,877 4, 233 984 190 394 2,665 Blind— . - 336 122 121 93 259 71 12 10 166 West Virginia . . 16, 906 5, 578 4,301 7,027 12, 690 3, 490 70 1,104 8, 026 Wisconsin: General _ 8,172 2,201 2, 748 3, 223 6, 149 1,521 75 32 4, 521 Blind _ _ 161 88 40 33 217 56 7 4 150 Wyoming _ 611 171 219 221 393 110 15 10 258 1 In States with 2 agencies, the State division of vocational rehabilitation is designated as “general,” and the agency under the State commission or other agency for the blind is designated as “blind.” 2 Services declined, services not needed, individual not eligible, individual needing services other than vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc. 2 Eligibility for rehabilitation not yet determined. 4 Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 5 Closed prior to initiation of rehabilitation plan because of indifference of individual, increase in degree of disability, loss of contact, etc. * In process of rehabilitation on June 30, 1961. 382 Department of Health , Education, and Welfare, 1961 Table 2. — Vocational rehabilitation grants, 1961, State divisions of vocational rehabilitation Total . . Alabama . . Alaska . . Arizona _ Arkansas _ _ California . . Colorado . — Connecticut _ Delaware _ District of Columbia. Florida _ _ Georgia _ _ Guam.. . Hawaii _ _ Idaho _ Illinois . . . Indiana . Iowa . . . Kansas _ Kentucky _ _ Louisiana . Maine. . . . . Maryland _ Massachusetts _ Michigan. _ _ Minnesota _ Mississippi _ Missouri _ _ Montana. . . Nebraska _ Nevada _ New Hampshire . New Jersey . . New Mexico _ New York _ North Carolina. . North Dakota _ Ohio . Oklahoma. . . Oregon . . Pennsylvania . . Puerto Rico _ Rhode Island . South Carolina _ South Dakota _ Tennessee . Texas . Utah . . . Vermont _ Virginia . . Virgin Islands _ Washington _ West Virginia _ Wisconson. . . Wyoming _ State or territory Support grants Extension and im¬ provement grants Total £48, 498, 563 $925, 351 $49, 423, 914 ; 2, 251, 500 2,251,500 118, 966 118,966 | 422, 178 8, 414 430, 592 1, 468, 318 14, 554 1, 482, 872 2, 904, 802 121, 984 3, 026, 786 695, 958 14,253 710, 211 343, 416 16, 521 359, 937 136, 625 5, 000 141, 625 227, 958 3, 750 231, 708 1, 355, 417 1, 355, 417 2, 634, 810 32, 025 2, 666, 835 1 60, 969 5,000 65,969 181, 402 5,094 186, 496 172, 504 172,504 | 2, 080, 765 78, 418 2, 159, 183 1 473, 852 20, 312 494,164 807, 857 17, 869 825,726 1 604, 803 13, 580 618,383 ! 590, 332 24, 733 615,065 1, 082, 578 1,082,578 272, 174 272,174 , 632,250 632, 250 i 865, 966 32, 178 898,144 . 1, 343, 251 63, 841 1,407,092 | 963, 953 27, 155 991,108 | 836, 025 836, 025 642, 844 28, 693 671,537 184,058 5, 486 189,544 308, 849 7, 658 316,507 54,293 54,293 79, 339 79,339 961,625 39, 858 1,001,483 199,093 7, 245 206,338 , 3, 348, 146 47, 688 3,395,834 i 1, 922, 192 37, 145 1,959,337 368, 158 5, 148 373,306 1 1,034, 413 49, 929 1,084,342 | 1, 338, 755 18, 898 1,357,653 ) 491, 082 12, 551 503,633 1 3, 877,028 65,075 3,942,103 | 852, 431 852,431 ' 269,241 5, 738 274,979 1, 114, 295 1,114,295 ! 243, 100 4,451 247.551 1 1, 347, 754 1,347,754 1,462,031 12. 000 1,474,031 304, 680 7, 280 311,960 I 166, 182 166,182 ! 1,276,278 1,276,278 1 20, 037 20,037 879, 447 23, 160 902,607 1, 197, 729 15, 167 1,212,896 930, 843 22, 500 953,343 96,011 5,000 101,011 , Office of Vocational Rehabilitation 383 Table 3. — Vocational rehabilitation grants, 1961, State commissions or agencies for the blind Total State or Territory Support grants $5, 803, 450 Arizona . Connecticut. Delaware _ Florida . Hawaii . Idaho . . 84. 781 59, 075 35, 519 450, 000 38, 772 16, 584 Indiana . . Iowa . Kansas . Louisiana _ Maine _ Massachusetts. 58,345 156, 806 134, 000 150,000 79, 478 172, 250 Michigan.. Minnesota. Mississippi. Missouri— Montana.. Nebraska.. 116, 813 182, 073 398,711 240, 545 38, 655 73, 893 Nevada . . New Hampshire. New Jersey _ New Mexico _ New York . . North Carolina.. 15, 120 26, 715 203, 365 50,367 421,498 554, 274 Ohio . Oregon . Pennsylvania.. Rhode Island.. South Carolina. South Dakota.. 346, 199 89, 548 410, 301 63,897 74, 729 60, 767 Tennessee. . Texas. . Vermont _ Virginia... . Washington. Wisconsin.. 338, 183 293, 212 43, 703 107, 502 123, 472 94, 298 Extension and improve¬ ment grants $94, 132 2, 107 4. 130 4,601 3, 855 9,820 3, 829 5,000 1,250 3,693 29,653 9, 250 14, 439 1,200 1, 112 193 Total $5, 897, 582 86, 888 63,205 35, 519 450,000 38, 772 16, 584 58,345 161,407 137, 855 150, 000 79, 478 182, 070 116,813 182, 073 398,711 240, 545 38, 655 77, 722 20, 120 27, 965 207,058 50, 367 451, 151 554, 274 355, 449 89, 548 424, 740 65, 097 74, 729 61,879 338, 183 293, 212 43, 896 107, 502 123, 472 94, 298 Saint Elizabeths Hospital The past year has been one of activity; a number of changes have been made in the care of the patients and in the administration of the Hospital. Probably in no field of medicine is change so striking as in that of psychiatry. New concepts of patient care are emerging, a greater stress is being laid on the social rehabilitation of patients, and on the introduction of social concepts into the operation of the Hospital itself. Some of these changes in concept are illustrated by the report of the Joint Commission on Mental Illness and Health which appeared during the year. In general, it may be said that this volume points up first of all the drastic shortages which exist through¬ out the country in the professional and subprofessional fields relating to hospital treatment of the mentally ill. Space does not permit a full discussion of the various recommendations of the Commission, but the comment may be made that in spite of the recommendations it seems likely that for many years to come the large mental hospital will be needed. There seems no practical way of eliminating some of the large hospitals, among which Saint Elizabeths is to be counted. The best that can be done in the foreseeable future is to decentralize to some extent; this is being done in Saint Elizabeths Hospital as elsewhere. The two major problems which confront the Hospital are those of imderstaffing and overcrowding. Some progress has been made in remedying the latter situation. A vigorous attempt has been made to send to nonmental institutions patients who could properly be cared for outside the Hospital. A considerable number, for instance, have been sent through the years to the District of Columbia Village, and more recently, foster homes are being found. The Glenn Dale Hospital, formerly used entirely for tuberculosis patients, is being converted by the District into a chronic-disease hospital, and several patients have been sent there. A considerable number, too, are being referred to the Adult Mental Health Clinic of the District for out¬ patient treatment. Every attempt is thus being made to return patients to the community or to provide care in other types of institutions for patients who do not need the intensive care which can be given in a hospital like Saint Elizabeths. 385 386 Department of Health , Education , and Welfare , 1961 During the year, the admissions reached their highest point since 1945, namely 1,981. Discharges have risen at a somewhat more rapid rate, reaching the sum of 1,395 during the year, the live discharges equaling 77 percent of the total admissions. The number of patients on the rolls increased by almost 300, but this includes a large number who are on temporary or convalescent leave in the community, but not finally discharged. There has been a slight decrease in the average number of patients in the hospital, a situation quite different from that of two decades ago when an increment of 100 a year was to be expected. In the field of staffing, an active recruiting campaign has been carried on especially as to physicians and nurses. Thanks to the generosity of the Congress, a personnel increase of 323 took place during the year. There are still vacancies for physicians ; once again attention is invited to the fact that Federal salaries for trained physicians in the field of psychiatry particularly are not keeping pace with those offered by the several States. It is indeed an open question whether the salaries authorized under the Classification Act are adequate or can be made adequate to meet the increased competition from other sources. At least one other Government agency, the Veterans Administration, is able to pay substantially higher salaries. During the year, the nursing assistants were reclassified upward, and it is the hope that this may result in increasing the quality of the per¬ sonnel on the wards and in holding them once they are recruited and trained. The general health of the patient population has been good, thanks to the untiring efforts of the entire staff. Even though the physicians and nurses are working under pressure, they have shown a high degree of dedication to duty, and it is a pleasure to pay tribute to them. Various programs of patient care have been prosecuted and developed ; the use of open wards ; the setting up of remotivation programs ; the use of patients’ self-government, for example. The so-called “tranquilizers” are proving their value, although at times the cost appears almost staggering. The question may be raised whether, occasionally at least, the use of the tranquilizers does not do more to allay the anxieties of the physician than it does those of the patient ! The aged continue to be a problem, and this is not peculiar to Saint Elizabeths. The proper care of the aged person who is showing mild mental symptoms is a problem which has not yet been satisfactorily solved. As a result, the mental hospital seems to be the only way out for the families who are troubled by the vagaries of the patients. During the year, the Biometrics Branch has been reactivated. The statistical knowledge of mental hospital patients is extraordinarily deficient, and it is the hope of the Hospital that this Branch may cast, Saint Elizabeths Hospital 387 much light upon the details of the incidence and duration of mental ; disorders among those hospitalized. Mention has been made earlier of the apparent abuse of the writ of habeas corpus by the patients. It is realized that this writ is a constitutionally guaranteed remedy, but the fact remains that an inordinate amount of time of the physicians, ward and clinical per¬ sonnel, is taken up in answering in writing and by live testimony in court, the petitions filed by the patients. During the year, 212 orders to show cause were served on the Hospital and 177 writs of habeas corpus were issued. Each of the latter means that the physicians must go to court with the patient and testify as to why he is being held. It is of some interest that only three of these petitions were granted and one continued. This in itself indicates the frivolousness of many of the petitions. The Hospital has formally requested the District Court to arrange to have hearings on these writs held at the Hospital rather than in court. So far, this request has been denied, but it is still our hope that the saving of the time of the judges as well as of the Hospital staff may prevail and that this arrangement can be put into effect. As a part of its program of public education, the Hospital conducted [ a very successful Mental Health Week, as a part of which a Mental S Health Institute was held. At this Institute, several prominent i speakers appeared, including the Secretary of Health, Education, and r Welfare, the Honorable Abraham Ribicoff. Something over 5,000 [ persons visited the Hospital during the “Open House Day.” As usual, many visitors from foreign countries have come to the Hospital. This year especially, as a result of a tour of the Inter¬ national Hospital Federation, and the meeting of the World Congress of Psychiatry, no less than 37 countries were represented among the visitors. It is always gratifying to know that Saint Elizabeths ex- ! cites so much interest among the professional people of other coun- ' tries, and such visits are most stimulating to the Staff. The various agencies of Government have been most cooperative and helpful; notably, the Veterans Administration, the Department of Justice, and the Health Department, Public Welfare Department, and Rehabilitation Office of the District of Columbia. The interest of various individuals and organizations in the com¬ munity continues unabated, and indeed is growing. No less than 767 volunteers have during the year given 24,000 hours of uncompensated service. This has meant much to the patients, and indirectly has been of service in promoting understanding on the part of the public. Unfortunately, it is impossible to enumerate the various organizations, but the thanks of the Hospital are none the less most sincere. For 388 Department of Health, Education, and Welfare, 1961 the coming summer, a plan for the use of high school students as vol¬ unteers is being worked out. This promises to be very successful as the means of bringing to young people a true concept of what mental illness is like and how those afflicted may be helped. The Hospital is well aware of its primary obligation; namely, to give the best possible treatment to the patients. It has, however, other obligations, notably in the field of training of personnel and re¬ search into the causes and prevention and treatment of mental disorder. As for training, the George Washington University and Howard University Medical Schools have utilized the facilities of the Hos- pital for the training of their medical students. The Hospital, like¬ wise, is the only public mental institution in the country which is approved for rotating internship. It is approved, likewise, for a 3- year residency in psychiatry, and for residencies in surgery and in radiology. During the year, it has been approved for a 2-year resi¬ dency in anatomical pathology. The Hospital is fully accredited by the J oint Commission on the Accreditation of Hospitals. During the year, plans for a third-year of Chaplaincy residency have been de¬ veloped. There are also internships, residencies, and planned field¬ work in dentistry, psychology, social work, occupational therapy, and clinical pastoral work. Instruction in nursing is carried on on both the undergraduate and graduate levels, the former by affiliation with various hospital training schools. A closed circuit television has been a substantial addition to the training program. Forty percent j of the cost of training is now borne directly by the Federal Govern- ment, the balance, that portion representing service to patients, being i included in the per diem charged to the District of Columbia for its j patients. The other and third obligation of the Hospital is in the field of re¬ search. This has been very substantially expanded and this year for the first time a separate budget for research was included in the appropriations for the Hospital, the cost of this item being charged entirely to the Federal Government and not allocated in part to the District Government. The research activities of the Hospital have been thoroughly integrated with those of the Clinical Neuropharma¬ cology Kesearch Center operated by the National Institute of Mental Health in conjunction with the Hospital. No less than 23 clinical projects are under way in addition to a substantial amount of basic science studies. Several grants have already been made to the Hos¬ pital by the National Institute of Mental Health under legislation recently enacted. Saint Elizabeths Hospital 389 Division of Clinical Services CLINICAL BRANCHES At present, the general care and treatment of the patients is carried I on by four clinical branches, three of which are subdivided into serv- ‘ ices. In addition, a Medical and Surgical Branch is charged with the acute medical and surgical treatment of all patients and emergency attention to employees. There are three admission services. Civilian i patients under 64 years of age are admitted directly to the Dix Pavil¬ ion, those over 64 being admitted directly to the Geriatric Building. Sex psychopaths and male prisoners, under charges or sentence, or found not guilty by reason of insanity, are admitted directly to the John Howard Pavilion. It is planned to make the William A. White Service also an admitting service. As previously noted, there is a steady increase in the number of elderly and infirm patients, and there seems to be no reason to expect this to diminish unless other suitable facilities of a nonpsychiatric nature can be found or established in the community. The West Side Service, temporarily abolished when the transfer of patients was made from the old Howard Hall to the new John Howard Pavilion, has now been re-established. The number of voluntary admissions has increased slightly, being 226 during the year. This provision of law should be used more than it is, particu¬ larly since the present commitment laws of the District of Columbia are among the most cumbersome and traumatic to the patient of any in the United States. It may be hoped that some time in the future the commitment laws of the District may be revised to become at least as humane as those of most of the other States. All of the accepted treatments are being used ; group and individual psychotherapy, psychodrama, occasional electro-convulsive therapy, medications, milieu therapy, and remotivation programs. Two of the latter have been started during the year, one on the Detached Service and one on the West Lodge Service, which are showing ex¬ cellent results. In these particular projects, the use of volunteers has been invaluable. MEDICAL AND SURGICAL BRANCH A very considerable expansion of activity and of staff has taken place in this Branch and much more may be expected within the next year or two. A study is now under way by a group of hospital con¬ sultants as to the needs in building, organization, and personnel. The present Medical and Surgical Building is over 30 years old, and serious attention should be given to the possibility of its replacement. Pharmacy activities have been increased and now all of the wards 390 Department of Health , Education, and Welfare, 1961 are receiving their drugs directly from the Pharmacy. The Branch has cared for over 2,000 inpatients and 50,000 outpatients during the year, the average stay in the Medical and Surgical Building being 29 days. The Dental Section enumerated over 11,000 visits. The work of the Branch continues to be unusually varied and of high efficiency. NURSING BRANCH This Branch, in spite of its shortages, notably in the graduate nurse field, has rendered excellent service in the care of patients. An active program of in-service training for all types of ward personnel is carried on, and 12 schools of nursing and the Navy Hospital Corps send affiliates for instruction in the care of the mentally ill. Training- on a post-graduate level is provided for graduate students from Catholic University and from Columbia Union College. In this Branch, as in other parts of the Hospital, the employee development program has been utilized, employees being sent for longer or shorter periods of time to take courses of instruction which will make them more useful in their Hospital service. PSYCHOTHERAPY BRANCH This Branch embraces individual and group psychotherapy, psycho¬ drama, dance and art therapy. The Director of this Branch is also the coordinator of professional training. The various types of pro¬ fessional training continue to expand and it is expected very shortly that a new type of internship, namely, that of psychodrama intern, will be established. PSYCHOLOGY BRANCH Four research projects were completed during the year, one of them being a thesis for the degree of Doctor of Philosophy. Four are now under way. One hundred and seventy-five hours of teaching were carried out by the members of the Branch, and very nearly 5,000 tests were given. In addition, a certain amount of individual and group osychotherapy is carried on by the Branch. RECREATIONAL THERAPY BRANCH The personnel of this Branch has been expanded and the program accordingly. Many parties and entertainments, both on the wards and in the Bed Cross Building and in Hitchcock Hall, have been con¬ ducted. The Bolling Air Force Base has been most generous in per¬ mitting the patients to use the swimming pool. It is hoped that eventually the Hospital may have a pool of its own, as this form of Saint Elizabeths Hospital 391 exercise and recreation means much to the patient. Community par¬ ticipation in the whole program has been most remarkable. OCCUPATIONAL THERAPY BRANCH In this Branch too, the personnel and program have been sub¬ stantially expanded and must be expanded still further. Eight student interns have each received three months of affiliation in psychiatry as related to occupational therapy. VOLUNTEER SERVICES BRANCH As it has been mentioned above, the work of the volunteers is a particularly valuable feature of the Hospital, both from the point of view of the patient and the point of view of public understanding. During the year, 767 volunteers participated, giving 24,000 hours of entirely uncompensated work. The activities of this Branch continue to expand as public interest and understanding grow. SOCIAL SERVICE BRANCH This Branch, likewise, has shown a very substantial expansion in personnel and in activity, and works closely with the rehabilitation counselors provided by the District of Columbia Division of Rehabili¬ tation. During the year, members of the Branch conducted interviews with patients and others totalling nearly 24,000. Three hundred and seventy-one transfers, foster home placements, or referrals to other agencies were arranged, an increase over the preceding year of 254. The value of the return of this number of patients to the community can hardly be overestimated. There is need for further foster homes and nursing homes and adequate financing by the District of Columbia for them. If they were available, more patients still could be re¬ turned to the community. In addition to the work of the Social Service Branch, a special public health nursing project has been carried on at the Hospital under a grant to the Health Department of the District of Columbia. CHAPLAIN SERVICE BRANCH The Chaplain Service Branch, under Jewish, Protestant, and Roman Catholic chaplains, carries out religious ministry to the patients, both in chapel services and on the wards. New patients are visited, and such other patients as request the services of the chaplains of their faith. Training is carried on both for Protestant and Roman Catholic clergy and for theological students. The community clergy as well have been most helpful in participating in special services. The Director of Protestant Chaplain Services served during the year 392 Department of Health, Education, and Welfare, 1961 as the Chairman of the Mental Health Week Committee. The recent finishing off of the rest of the Chapel Undercroft has greatly im¬ proved the office facilities of the Branch. MEDICAL RECORDS BRANCH The value of readily accessible adequate records is important to any well regulated hospital. During the year, in addition to the con¬ tinuation of the open-shelf filing, which has worked out very well, preparations have been made for some microfilming, and for the elimination of some old duplicate records. The inauguration of the addressograph system has reduced the likelihood of errors in filing. The Branch has taken on the responsibility for the preparation of medical abstracts. LABORATORY BRANCH The demands on this Branch continue to grow, but they are being well met. An isotope unit is now complete and much new equipment has been obtained. The use of automation has been developed sub¬ stantially. If it were not for this, it is unlikely that the total of 204,000 tests could very well have been carried out. During the year, the Laboratory Branch was approved for a 2-year residency training in anatomical pathology. Considerable research is under way. During the year, 193 autopsies or 45.4 percent were performed. LIBRARY SERVICES The Medical Library provides library service to the medical staff, both by making accessible volumes in the Hospital library and the several branches such as those in the Nursing Branch, Laboratory, and Medical and Surgical Branch and obtaining others through inter- library loans. There were 1,120 accessions during the year, bringing the total of accessioned volumes to 22,000, plus a large number of reprints and other miscellaneous papers. Two hundred and eighty- six periodicals are subscribed to. It is expected that within the next few months, work will begin on the additions to the Administration Building, which among other things, will provide a very considerable additional space for the Medical Library. The space is greatly needed and the addition will be most welcome. The Patients’ Circulating Library carried on a very active program with the aid of 12 volun¬ teers. There are now 68,000 volumes in the library, with a gain during the current year of 3,950. Books are provided to the various wards, and a large number of additional programs are carried on, such as bookbinding, language lessons, typewriting and stenographic lessons, and book reviews. Saint Elizabeths Hospital 393 BEHAVIORAL SCIENCES BRANCH This Branch, set up during the current year, is operated in close coordination with the National Institute of Mental Health joint project previously mentioned. Eleven papers were published by members of the Branch during the year. This is the first year in which a separate appropriation has been made by the Congress for research at Saint Elizabeths Hospital. SANITARY ENGINEERING BRANCH This Branch carries out a number of important activites — insect and rodent control, inspection of food handling and service, among others. Division of Administration Unfortunately, space does not permit an enumeration of the various activities of the branches and sections in this division. They are varied and include such matters as financial, personnel, construction, engineering, grounds, purchasing and warehousing, laundry, dietary, budget, and maintenance. All of these sections have been extremely active during the year and highly efficient. Much is involved in the day-to-day maintenance of the physical plant of an institution of this size. In addition, various improvements have been carried out and some reconstruction. Work has been started on the Continued Treatment Building No. 9, and it is expected that within a few months construction will begin on the addition to the Administration Build¬ ing. Planning is now under way for the Rehabilitation Building for which preliminary appropriations have already been made. The employee development program should be mentioned as one which has contributed considerably to the efficiency of the employees. It has been actively utilized under the general supervision of the Personnel Branch. Needs of the Hospital In general, these may be summed up in the three words — personnel, buildings, and equipment. Although expansion of the capacity of the Hospital is probably not needed, many older buildings should be re¬ placed in line with modern ideas. A salary scale competitive with those of the States and of other agencies of the Federal Government is urgently needed, especially for trained psychiatrists. Saint Eliza¬ beths Hospital is a National institution, and should be a model for the States. This principle has already been recognized in part by the 626936—62 - 26 394 Department of Health , Education , and Welfare , 1961 Congress, and the support of the Secretary of Health, Education, and Welfare in the national goals of the Hospital is deeply appreciated. Over 100 years ago, the Superintendent of Saint Elizabeths Hospital wrote, “A government establishment situated at the capital of the re¬ public is in every respect a representative institution.” Those words are equally true today. Saint Elizabeths has always aimed, and will continue to aim, at the goal expressed in the organic act, “the most humane care and enlightened curative treatment” of the mentally ill . Table 1. — Movement of patient population , fiscal year 1961 Total Male Female White Colored Total White Colored Total Total number under care and treat¬ ment, fiscal year 1961 . 9, 827 2, 688 2, 299 4, 987 2,730 2, 110 4, 840 Remaining on rolls, June 30, I960.. . 7,846 2, 134 1,760 3, 894 2,234 1,718 3, 952 Admitted during fiscal year 1961... . 1,981 554 539 1,093 496 392 888 Total discharged and deceased. . 1,835 520 421 941 555 339 894 Discharged . . 1,395 397 334 731 401 263 664 Conditions on discharge: Recovered . . 56 20 20 40 9 7 16 Social recovery . . . 480 84 73 157 167 156 323 Improved . 593 175 148 323 186 84 270 U nimproved . . . . . 196 100 42 142 38 16 54 Worse . . . 0 0 0 0 0 0 0 No mental disorder . . . 67 17 49 66 1 0 1 Unknown . . . . . 3 1 2 3 0 0 0 Deceased . 440 123 87 210 154 76 230 Remaining on rolls, June 30, 1961 . 7, 992 2,168 1,878 4, 046 2,175 1,771 3, 946 Corrections, change in sex and color . 0 +1 -1 0 0 0 0 Adjusted on rolls, June 30, 1961.. . 7, 992 2,169 1,877 4,046 2,175 1,771 3,946 Absent on visit and elopement . 1,128 168 260 428 299 401 700 Patients in hospital, June 30, 1961 . . 6, 864 2,001 1,617 3, 618 1,876 1,370 3,246 Table 2. — Consolidated statement of movement of patients , by classification , fiscal year 1961 Saint Elizabeths Hospital 395 Nonreimbursable patients spuBjsi ujSjta © 00 ©C0©00 i 00 ^ ^ 1- .© 1 © ^ CO OS 1 SUOIJBAJOSOJ imopod oo co - OS © 1 © I © © pqojqng 1,626 500 621 38 583 1, 505 +222 1,727 181 1, 546 2, 126 Reimbursable patients aaqjO CO O OiOOSN i In. CO i-4 CO uoijBjjsimmpv .suBjajaA 386 12 72 18 54 326 +80 406 64 342 398 araoH .sjaipjog *g\Q oo © ©»ohh i i-h © r*. ^ rH i— l i— 1 © I © tH © ^jbjuuioa o-Q oo co co -5> io m o c'« CO CO co »o* to CO* (N* CO* O oT 00 uo* CO* CO rjT 1-T CO* t?* CO* -^* r-T CO CO 1-H COCO 1OC0H COrt i-h CO ^ i-H i-H CO i ISYO Lump-sum death payments 680 ‘Urt N^OOOWCOOOOO^^OOOOOOCOCOCOT^NH^OOaOWCOOO^Oi^ 1-H 00 ^lOiOHN^TrooOHio^TrwfOHNio 1C O^CS^OO^t^COCO W?OHNOO^^ONH»CoOTtGOCD«(NN of rH tH TjT rH of H®^lOlOe005iCfcfofofodofcdofcd of'cd^rHofcdcdcdr-fTtfofofr-HofofTdofrHTd i-H r-H 05 i-H CO r-H CO CO H H H H r-H CO IO 03 03 Number 17, 280. 4 05HHOCOCOOOCONNOONNNCO(N050COCOCOOMOCOM»OHOOOCOOO on * 06 0 06 id cd ’ cd r-i cd i-h 05 0 cd cd cd rH cd id 05 05 05 05 O 05 10 CO 10 05 1-H co CO 10 O 1-H CO CO 1-H oq 10 Coo«oirqa>c^o>ooT»‘»‘“rfS3-'^‘ sssa--' r^oooHio(N?ooo>ooN^ioococoo^oofONw:N»o |S|SSi|lSiS|S|fS5"|g|S82 ^ i-T : : i ! : 128 Department of Health , Education , and Welfare, 1962 Table 5. — Old-age, survivors, and disability insurance: Selected data on em¬ ployers, workers, taxable earnings, and contributions, by State for specified periods [In thousands, except for average taxable earnings. Preliminary, corrected to October 26, 1962] Employers reporting taxable wages July- September Calendar year 1959 State Workers reported with Reported taxable earnings 3 4 Contribu¬ 1961 i taxable earnings 1 2 Amount Average per worker tions 4 Total _ 4,260 71, 500 $202, 346, 000 $2, 830 $9, 884, 400 Alabama _ _ _ - 64 1,090 2, 419, 000 2,220 118, 300 Alaska _ _ _ _ 4 80 205, 000 2, 560 10, 000 Arizona - _ _ - 28 490 1,220,000 2, 490 59. 700 Arkansas _ - 40 580 1, 114, 000 1,920 53, 400 California _ _ _ _ 383 6,270 18, 256, 000 2,910 891, 500 Colorado .. _ _ . .. ... 42 680 1, 665, 000 2, 450 80, 300 Connecticut . . 66 1,150 3, 406,000 2, 960 167, 300 Delaware _ _ _ _ . 13 210 567,000 2,700 27, 900 District of Columbia _ 30 480 1, 141, 000 2, 380 56, 400 Florida _ _ 133 1,940 4, 268, 000 2, 200 207, 900 Georgia _ . .... 94 1,450 3, 098, 000 2, 140 151,500 Hawaii _ ___ ___ ___ 13 230 600, 000 2,610 29, 400 Idaho. _ _ 15 280 634, 000 2, 260 30, 200 Illinois _ 227 4, 500 13, 332, 000 2, 960 652, 300 Indiana . . ... 100 1,930 5, 585, 000 2,890 273, 100 Iowa . . .... .. ... 66 1,090 2, 751,000 2, 520 129, 700 Kansas _ __ _ . 54 880 2,110,000 2, 400 100,600 Kentucky _ _ _ . 61 980 2, 183, 000 2, 230 105, 300 Louisiana _ 67 1,050 2, 449, 000 2, 330 119, 700 Maine _ ..... 25 390 858,000 2,200 41, 800 Maryland _ _ . _ _ 77 1,190 2, 931,000 2, 460 143. 400 Massachusetts _ ... _ 122 2,240 6, 234,000 2, 780 306,600 Michigan _ _ _ 159 3,150 9, 941, 000 3, 160 488, 200 Minnesota _ .. . . 74 1,310 3, 453, 000 2, 640 166, 400 Mississippi _ 38 640 1,228,000 1,920 59,500 Missouri . . ..... ___. 108 1, 840 4, 753,000 2, 580 231.000 Montana. _ _ 16 280 706, 000 2, 520 33. 800 Nebraska _ _ .... 39 600 1,392,000 2, 320 65, 400 Nevada _ _ _ _ 8 150 356, 000 2, 370 17, 400 New Hampshire _ . _ _ 17 280 740, 000 2,640 36, 300 New Jersey _ . _ 158 2,700 7, 885, 000 2, 920 386, 900 New Mexico. . . . ._ _ 20 340 723,000 2, 130 35, 100 New York . . . 481 8, 100 24, 470, 000 3, 020 1, 202, 200 North Carolina _ ..... 104 1,740 3, 809, 000 2,190 185, 700 North Dakota _ _ _...._ 14 230 509, 000 2,210 23, 300 Ohio _ _ . ... 203 3, 850 11, 550, 000 3,000 566. 200 Oklahoma _ ..... 49 900 2,071,000 2, 300 100, 000 Oregon _ _ .... 43 790 2,033,000 2, 570 98, 600 Pennsylvania _ _ ... 257 4, 680 13, 662, 000 2,920 669,900 Puerto Rico _ .... 19 470 543, 000 1,160 26, 500 Rhode Island _ . ... .... 21 360 944, 000 2, 620 46, 300 South Carolina _ . . 51 830 1, 769, 000 2,130 86. 600 South Dakota _ 18 250 547, 000 2. 190 25, 300 Tennessee _ . _ _ 79 1,270 2, 865, 000 2,260 139, 500 Texas _ _ _ 236 3,740 8, 614, 000 2, 300 418. 200 Utah _ 17 360 870, 000 2, 420 42. 400 Vermont _ _ _ .. _ 11 150 331, 000 2, 210 16, 000 Virgin Islands _ .. _ 1 10 15, 000 1,500 800 Virginia _ 91 1,400 3, 282, 000 2, 340 160, 600 Washington _ _ 65 1, 150 3, 230, 000 2, 810 157, 400 West Virginia - 37 650 1, 660, 000 2, 550 81. 500 Wisconsin _ .. ... 94 1,620 4, 546, 000 2, 810 220. 700 Wyoming . . . . 9 150 340, 000 2, 270 16, 300 Foreign s _ _ ... 1 90 274, 000 3,040 13. 500 Oceanbome vessels _ _ _ _ 110 330, 000 3, 000 1,780 16, 500 294, 200 Uniformed services (on basic pay) _ _ 3, 300 5, 883, 000 1 Data represent number of employers reporting taxable wages by the State of their reporting headquar¬ ters. An employer is a legal entity such as a corporation, partnership, or a single ownership for which a single tax return is filed. Excludes agricultural employers. 2 Workers employed in more than one State are counted in each State. National and state totals repre¬ sent unduplicated counts of workers. 3 Annual taxable limit with respect to wages from a single employer, or on self-employment income was $4,800 in 1959. Averages rounded to nearest $10. 4 Contribution rate was 2]^ percent, each, for employees and employers; and 3% percent for self-employed persons in 1959. • Represents employment and earnings of U.S. citizens outside the listed States and groups by American employers and their foreign subsidiaries. Social Security Administration 129 Table 6. — Old-age, survivors, and disability insurance : Selected data on benefits, employers , workers, and taxable earnings for specified periods, 1960-62 [In thousands, except for average monthly benefit and average taxable earnings; corrected to October 18, 1962] Item 1962 1961 1960 Fiscal year Benefits in current-payment status (end of period) : Number (OASI and DI) 1 _ ..... _ 17, 280. 4 15, 624. 2 14, 726. 5 897.7 14, 261.8 Number (OASI) _ . . _ _ _ 16, 128. 5 13, 740. 3 521.6 Number (DI) _ _ . _ ... . . . __ _ 1,161.8 9, 347. 6 679.3 8, 414. 0 558.1 7, 813. 0 370.8 Disability (disabled-worker).. _ _ _ . _ .. Wife’s or husband’s (OASI and DI) _ 2,596.6 2, 463. 9 2, 432. 5 2, 329. 9 102.6 2, 279. 9 Wife’s or husband’s (OASI) _ _ _ _ _ 2, 223. 5 Wife’s or husband’s (DI) _ _ 132.7 56.4 Child’s (OASI and DI) 2. _ 2, 407. 5 2, 141.3 1,903.5 Child’s (OASI) 2. ... _ 2, 067. 6 1, 904. 3 1, 809. 1 Child’s (DI)2 _ 339.9 237.0 94.4 1, 778. 1 434.6 1,621.9 419.9 1,471.3 387.9 Mother’s _ _ _ _ _ _ _ _ . 36.7 36.4 35.5 $1, 128, 166 $1,053, 102 $992, 032 $889, 863 Total monthly amount (OASI) _ ... ... $931, 705 $851, 791 $75, 064 $60, 327 $38,071 $710, 736 $60, 948 $627, 400 $575, 295 $49, 895 $33, 123 Wife’s or "husband’s (OASI and DI).. $101, 821 $94, 195 $87, 701 Wife’s or husband’s ( OASI) _ . _ _ $97, 489 $90, 759 $85, 676 $4, 333 $3, 437 $2, 025 Child’s (OASI and DI) *_ _ _ _ $110,061 $99, 233 $84, 789 Child’s (OASI) 2 _ $100, 277 $92, 238 $81, 865 Child’s (DI)2 _ _ _ _ _ _ $9, 784 $6, 995 $2, 924 Widow’s or widower’s _ _ _ _. $116, 317 $94, 270 $84, 229 Mother’s _ _ _ _ $25, 797 $24, 823 $22, 609 Parent’s $2, 487 $76. 03 $2, 215 $2, 117 Average monthly amount: Old-age (retired-worker).. _ _ _ $74. 57 $73. 63 Disability (disabled-worker).. . .. _ _ _ $89. 73 $89. 41 $89. 33 Wife’s or husband’s (OASI and DI) . . ... _ $39. 21 $38. 72 $38. 47 Wife’s or husband’s (OASI) _ .... . _ $39. 57 $38. 95 $38. 53 Wife’s or husband’s (DI) _ _ . .... $32. 65 $33. 50 $35. 92 Child’s (OASI and DI) 2 _ _ _ $45. 71 $46. 34 $44. 54 Child’s (OASI)2 _ $48. 50 $48. 44 $45. 25 Child’s (DI) 2_. _ $28. 78 $29. 51 $30. 98 Widow’s or widower’s _ _ _ _ _ _ _ $65. 42 $58. 12 $57. 25 Mother’s _ _ _ . _ _ _ _ $59. 36 $59. 11 $58. 29 Parent’s _ . _ .. _ ...... . . $67. 68 $60. 85 $59. 67 Benefit payments during period: Monthly benefits (OASI and DI) ... . . _ $13, 495, 123 $12, 483, 747 $11, 721, 534 $10, 632, 223 Monthly benefits (OASI) --------- $11,017,539 $10, 103, 937 Monthly benefits (DI) _ ..... . .. $1, 011, 376 $703, 995 $528, 304 Old-age (retired-worker) _ . . . . $8, 339, 881 $7,371,205 $6, 803, 478 Disability (disabled- worker) .... . ... $816, 349 $589, 497 $450, 114 Supplementary (OASI and DI) _ _ ... $1, 485, 396 $1, 300, 137 $1,183,515 Supplementary (OASI)... _ ... . $1, 290, 369 $1,185,639 $1, 105, 327 Supplementary (DI) _ . _ _ $195, 027 $114,498 $78, 190 Survivor . _ _ _ _ $2, 853, 497 $174,089 $2, 460, 695 $166, 993 $2, 195, 132 Lump-sum death payments _ _ _ _ $165, 772 Workers insured for OASI benefits (midpoint of period— Jan. I):3 * _ _ _ 89, 300 85, 300 79, 600 Fully insured _ _ _ _ 88, 700 84, 400 76, 600 Currently but not fully insured _ _ 600 1,000 2,900 Workers insured for disability (midpoint of period — Jan. I):3 . Estimated number of employers reporting taxable wages, 1st quarter of fiscal year i _ 50, 900 4, 250 48, 800 4,230 46, 300 4. 170 Calendar year Estimated number of workers with taxable earnings _ 75, 000 74, 000 73, 000 Estimated amount of taxable earnings _ _ $220, 000, 000 1 $210,000,000 $207, 600, 000 Average taxable earnings 5 _ _ $2, 930 $2, 840 $2, 840 1 Benefits under the old-age and survivors insurance (OASI) parts of the old-age, survivors, and disability insurance program are payable from the OASI trust fund to old-age insurance (retired-worker) beneficaries 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) benefi¬ ciaries and their dependents. , , , 2 Includes benefits payable to disabled persons aged 18 or over — dependent sons and daughters 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 programs and (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported on more than 1 account number. * Excludes agricultural employers. 5 Rounded to nearest $10. 130 Department of Health , Education , and Welfare , 1962 Table 7. — Special types of public assistance under plans approved by the June 1962 , and total payments to recipients, [Including vendor payments for medical care and cases State Old-age assistance Medical assistance for the aged Aid to dependent children Number of recip¬ ients, June Payments to recipients Num¬ ber of recip¬ ients, June Payments to recipients Number of recipients, June Aver¬ age pay¬ ment, June Total, fiscal year (in thou¬ sands) Aver¬ age pay¬ ment, June Total, fiscal year (in thou¬ sands) Fam¬ ilies Total 1 Children Fiscal year: 1960 . 2. 358. 539 $68. 01 $1,894,639 794, 396 3, 023, 311 2, 330, 108 1961 _ 2, 295, 925 67. 90 1. 914; 946 46, 247 $201. 33 $42. 899 877, 961 3, 382, 095 2, 612, 611 1962 _ 2, 236, 870 72. 55 1, 899, 039 101, 634 171. 36 196. 127 944,043 3, 692, 566 2, 853, 387 Alabama - 101,234 62. 93 72, 076 162 183. 90 121 21, 794 88, 320 69,331 1,362 70. 45 1,157 1, 252 4, 301 3, 236 13, 690 59. 34 9, 961 9, 214 38. 003 29, 369 Arkansas . .. 55, 513 56. 54 35^ 302 1,343 47.40 355 6, 396 24, 662 19,011 California _ 257, 999 103. 42 292, 760 16, 429 290. 45 18, 002 90, 461 337,022 260, 052 49, 518 99. 11 58, 317 8, 761 33, 886 26, 697 Connecticut. . . 9, 851 80. 77 18, 945 3, 961 192.42 1,152 11, 146 42, 043 32, 141 1,129 49.44 692 2, 023 8,486 6, 634 District of Colum- bia. 2, 911 83. 99 2, 937 4,976 22, 724 18, 133 Florida _ 70,422 60. 19 50, 376 26, 321 97, 956 78, 339 93, 156 49. 17 53, 325 16, 758 62, 818 48. 761 Guam ...... .. 131 38. 39 37 17 (2) <*) 185 1,003 841 Hawaii _ 1,193 70.44 998 412 260. 06 811 3,018 12,351 9, 876 Idaho _ 5,742 71.42 5, 259 1, 168 143. 72 1,804 2, 476 9 337 6, 908 Illinois. _ _ 66,285 82. 90 66, 115 392 246. 76 634 61, 492 264, 520 206. 411 Indiana 24. 967 68.58 20, 439 12. 381 46, 887 35, 650 Iowa 31, 568 73.00 32, 904 10, 052 37, 718 28, 661 Kansas... 25, 880 86. 51 26, 894 6,662 25, 788 20, 462 Kentucky _ 54, 757 53. 86 35, 190 2, 164 18.40 311 22, 155 79, 655 59, 871 Louisiana _ 126, 995 81.24 114, 355 270 394. 15 359 22,327 92,231 71, 973 Maine . . 11,111 69. 85 9, 181 397 265. 72 402 6, 028 21, 540 16, 001 Maryland _ 9,435 69. 48 7,531 5,051 54. 79 1,832 11, 957 50, 527 39, 893 Massachusetts _ 59, 410 81. 72 62, 175 20, 391 179. 03 41, 673 19, 041 66, 180 49. 701 Michigan _ 53, 100 80. 30 51,398 4, 896 318. 81 17, 149 33, 342 120, 017 88,446 Minnesota _ _ . 44, 241 101. 22 51, 780 11,371 39, 940 31,344 Mississippi _ 78, 949 36. 03 33, 674 20, 522 80, 459 63, 159 Missouri. 109, 252 61.35 81, 287 26, 913 104, 970 80, 206 Montana . . 6, 183 65. 37 4, 937 1, 882 7, 212 5, 600 Nebraska _ 13, 534 77. 92 12, 794 3, 285 12, 880 9, 943 Nevada.. _ 2,483 83. 89 2, 394 1, 284 4, 683 3,740 New Hampshire... 4, 628 90. 66 5, 067 33 (2) 13 1,045 4,155 3, 189 New Jersey _ 18, 527 95. 03 18, 567 20, 996 76, 326 58, 193 New Mexico _ 10, 843 59. 66 8, 913 7,427 29, 221 22, 579 New York _ 58, 039 79. 39 57, 932 26, 965 135. 48 99,071 87,037 360, 547 277, 649 North Carolina _ 45, 908 50. 94 27, 402 28, 253 111, 727 86, 545 North Dakota - 6, 181 82. 50 6, 651 836 210. 45 1, 450 1,845 6. 922 5, 416 Ohio . . 87, 828 80. 93 83, 677 35, 238 140, 300 107, 517 Oklahoma _ 85. 399 84. 47 86, 478 571 239. 60 886 19,325 70, 652 53, 946 Oregon _ . .. 15, 815 86. 25 16, 064 (4) (4) 231 8,217 30, 476 23,371 Pennsylvania _ 48, 191 74. 55 41, 074 3, 926 245. 80 2, 883 69, 059 280, 685 214, 804 Puerto Rico _ 36,255 9.05 3,911 1, 913 26. 14 331 57, 560 226, 436 181, 595 Rhode Island _ 6,233 82. 74 6, 266 5, 019 19, 003 14, 500 South Carolina _ 28, 932 41.53 14, 999 494 156. 50 852 8, 991 36,040 28, 734 South Dakota . 8,145 77. 16 7, 510 2, 948 10, 438 7, 953 Tennessee _ 50, 479 45. 60 27. 993 678 57.21 182 22,391 84, 477 64, 445 Texas _ 221, 039 64. 84 155, 542 19, 643 81, 530 62, 196 Utah _ _ 6, 733 73. 85 6, 596 612 148. 08 508 4,063 15, 678 11, 998 Vermont _ _ 5, 483 72. 98 4, 796 1,345 4, 880 3, 668 Virgin Islands . 532 33.89 222 88 18. 10 24 302 1,043 877 Virginia.. _ _ 14, 084 56. 10 9, 327 10, 704 43, 652 34, 273 Washington 44 153 97. 00 48, 450 948 217 18 1,409 13, 424 49, 698 37 608 West Virginia _ 17,114 44! 30 8.’ 978 7, 517 36.' 97 3* 683 3l! 804 125, 872 97, 612 Wisconsin _ 31, 578 87. 63 34, 784 11,168 41, 814 32, 096 Wyoming.. . 2, 750 78. 35 2,649 764 2, 875 2,233 1 Includes as recipients the children and 1 parent or other adult relative In families in which the require¬ ments of at least 1 such adult were considered in determining the amount of assistance. Social Security Administration 131 Social Security Administration: Number of recipients and average payment , by program and State , fiscal year 1962 receiving only such payments; data corrected to October 15, 1962] Aid to dependent children— Continued Aid to the blind Aid to the permanently and totally disabled Payments to recipients Number of recip¬ ients, June Payments to recipients Number of recip¬ ients, June Payments to recipients Average payment per family, June Average payment per recipient, June Total, fiscal year (in thousands) Average payment, June Total, fiscal year (in thousands) Average payment, June Total, fiscal year (in thousands) $110. 78 $29. 11 $1,021,097 107. 978 $72. 85 $92, 309 362, 815 $65. 96 $271, 208 116. 70 30. 29 1,118, 991 105, 601 73. 36 93, 991 383, 675 68. 21 301, 361 123. 14 31.48 1, 338, 603 100, 398 77. 47 92, 819 417, 042 72. 00 334, 528 45. 35 11. 19 11, 089 1,628 43. 93 842 12, 753 40.85 5,998 86. 38 25.14 1,677 98 77.20 90 122. 36 29. 67 13, 014 865 71.94 754 62. 16 16. 12 4.885 1,967 61. 17 1,358 7,706 48. 32 3, 900 168. 61 45. 26 178, 448 12,886 121. 72 17, 909 21, 978 100. 79 21,258 134. 01 34. 65 13, 054 248 86.83 250 5, 647 71.85 4,718 159. 40 42. 26 21,397 301 99. 34 385 2,349 123. 41 3,614 91. 40 21. 79 2, 482 265 76. 51 221 450 64.50 342 151. 92 33. 27 9,887 196 69.92 171 3,049 75. 27 2, 499 62. 04 16.67 18, 710 2, 523 62.28 1,866 12, 908 66. 03 9, 197 86. 84 23.17 17, 237 3, 217 52. 20 2,179 24, 567 51.34 14, 555 67. 36 12.42 145 6 (2 3 4) 2 84 24. 85 26 148. 46 36.28 4, 894 83 99.66 86 1,037 107. 83 1,165 156. 32 41. 45 4, 478 130 73. 51 119 1,994 67. 74 1,348 199. 86 46.46 125, 553 2, 883 91.39 3,115 27, 167 98. 49 26,261 108. 78 28. 72 15, 705 1,850 76.68 1,702 146. 45 39. 03 15, 170 1,328 100. 21 1,620 801 67. 86 603 143. 16 36. 98 11, 359 566 87.08 592 4,175 90. 10 4, 418 90. 69 25. 22 23, 529 2, 418 60. 07 1,738 8,670 62. 70 6,267 100. 57 24.35 26, 361 2,754 81. 21 2, 666 17,649 57. 71 11, 504 100. 40 28. 10 7,150 411 71.40 340 2, 247 71. 23 1,887 128. 25 30. 35 17,273 418 66.00 333 6, 486 67. 63 5, 062 158. 49 45.60 34, 824 2, 228 121. 18 3, 251 10, 436 131. 77 15, 989 143. 92 39. 98 53. 027 1,723 81.55 1,660 5,981 102. 62 6.326 165. 06 46. 99 21, 232 1,026 108. 96 1, 354 2, 843 60.58 1,956 35. 87 9. 15 8,839 3, 485 38.13 1,893 13, 312 34. 44 5,356 95. 15 24.40 30. 235 4, 833 65.00 3, 820 15,032 63. 41 11, 584 130. 21 33.98 2, 981 295 73.54 273 1,260 73. 67 1,115 118. 13 30. 13 4,534 701 94.15 822 2,196 78.87 2,008 107. 21 29. 39 1,695 174 98.94 209 166. 55 41.89 2, 092 246 95.72 263 488 106. 13 564 172. 75 47. 52 39, 340 930 88. 78 965 7,533 94. 65 7, 512 122. 86 31.23 11, 272 362 69.57 283 2,898 72.80 2,390 177. 12 42.76 184, 879 3, 347 96. 61 3,963 35,383 110. 21 46, 990 87. 26 22. 06 28, 941 5,045 56.59 3, 400 21, 275 61.72 14, 465 153. 64 40. 95 3, 413 88 80. 40 81 1,247 103. 70 1,422 116. 93 29. 37 47, 321 3,438 80. 35 3, 198 15, 400 79. 77 13, 051 124. 32 34. 01 28, 222 1, 746 104. 75 2, 056 10, 855 98. 81 12,362 137. 83 37. 16 14, 025 315 94. 37 298 4,886 92. 65 5,345 130. 73 32.17 107, 256 17,857 74.68 16,079 18, 476 64. 13 13,327 14. 79 3.76 10,298 1,687 8.33 173 22,350 8.75 2,325 51.16 39. 92 9, 265 114 84.42 115 2, 740 86.24 2, 964 57.20 14. 27 6, 242 1, 699 48. 85 993 8,144 45.32 4, 443 103. 71 29. 29 3, 652 149 63. 77 117 1,109 65. 04 861 69.88 18. 52 19, 043 2,504 46.28 1,443 11, 522 45. 68 6, 150 78. 87 19.00 18, 115 5,345 61.86 4, 310 7,741 54. 00 4, 926 133. 37 34.56 6, 913 173 78. 10 175 3, 676 77.84 3, 165 110. 10 30. 34 1, 718 106 61.70 79 874 63. 85 656 56. 87 16. 47 205 16 (*) 6 96 34.08 41 99. 13 24. 31 12, 606 1,175 62.64 867 6,553 62. 09 4,834 148. 63 40.15 24, 759 675 108. 86 814 8, 419 94.70 7,971 109. 20 27. 59 37, 307 935 47. 32 522 7,327 45. 62 3,834 168. 35 44. 96 19, 539 880 94. 26 946 4, 700 104. 91 5,430 140.86 37.43 1,314 60 80.78 55 573 78.90 541 2 Average payment not computed on base of fewer than 50 recipients. 3 Less than $500. 4 No payments made In June 1962. 132 Department of Health , Education, and Welfare, 1962 Table 8. — Special types of public assistance under plans approved by expenditures and percent from Federal funds, [Includes vendor payments for medical care; amounts State Federal grants to States 1 Expenditures for assistance and ad¬ ministration Total Old-age assistance Medical assist¬ ance for the aged Aid to dependent children Aid to the blind Aid to the per¬ manently and to¬ tally dis¬ abled Old-age ass Amount iistance Percent from Federal funds Fiscal year: I960 $2, 033, 761 $1, 157, 523 $660, 232 $48, 824 $167, 182 $2, 014, 736 58.1 1961 _ 2, 180, 466 1,211,709 $33, 507 704, 108 48, 517 182, 625 2, 035, 554 59.9 1962 . . 2, 466, 974 1, 256, 388 109, 866 853,685 47.483 199, 552 2, 020, 168 62.8 Alabama . . 69, 592 54,403 200 9,569 653 4, 767 75, 231 72.9 1,865 748 1,062 56 1,257 59.8 17, 749 7, 254 9, 968 527 10, 196 70.9 Arkansas . 36, 586 27, 584 438 4, 373 1,020 3,171 36, 656 74.9 California . 288, 115 161,555 16,268 92, 247 7, 558 10, 487 314,459 49.6 Colorado... _ 41,749 29, 280 9, 190 143 3, 136 60, 677 50.7 Connecticut _ 19, 857 8,070 10, 281 152 1,355 20, 074 42.0 2, 960 514 2, 031 149 265 764 66.9 List, of Col _ 10, 271 1,957 6,716 102 1,495 3,250 59.4 Florida _ 62, 485 38, 035 16, 365 1,319 6, 766 52, 918 71.7 68, 951 41, 740 14, 204 1,725 11, 282 56, 537 73.7 125 25 81 2 17 42 50.0 Hawaii _ 4, 749 732 354 3,086 51 525 1,096 65.8 Idaho . . 8,721 3, 741 1,289 2, 582 81 1,027 5,477 69.7 Illinois . 120, 743 42, 766 646 62, 961 1,691 12, 681 72, 739 59.3 Indiana _ _ 27, 090 14, 149 11,837 1,104 22, 525 65.2 Iowa __ _ 33, 140 21, 588 10, 277 801 474 35, 296 61.8 Kansas _ 27, 855 17, 897 7,205 336 2, 416 28, 852 61.8 Kentucky . . 52,722 27, 141 253 19, 138 1,336 4, 854 36, 833 73.4 Louisiana _ 118,088 82, 149 1,614 23,347 1,659 9,320 119,034 70.5 Maine . . . 14, 146 6,675 360 5,549 230 1,333 9, 590 71.1 Maryland _ _ 22, 402 4, 998 842 13, 035 216 3,312 7,945 64.3 Massachusetts _ 84, 227 37, 105 22,319 17, 864 1,205 5,734 67, 902 57.3 Michigan... . . 75, 147 32,375 9,031 29,721 895 3, 126 55,323 60.2 Minnesota _ _ _ 42, 295 29, 267 10, 961 612 1,455 54, 553 55.2 Mississippi _ 41, 769 27, 601 8, 101 1,516 4, 552 35, 758 76.9 Missouri _ 90, 403 57, 240 22, 920 2,195 8, 048 85, 186 67. 1 Montana _ 6, 394 3,434 2,034 181 745 5,356 65.9 Nebraska _ 13, 998 8, 767 3,505 421 1,305 13, 793 65.0 Nevada _ 2, 862 1,459 1,295 108 2, 574 58.7 New Hampshire _ 4,927 3,158 111 1,226 143 288 5,439 59.3 New Jersey _ 34, 705 10, 490 19, 891 522 3,803 20, 184 53.7 New Mexico _ 17, 196 6,820 8, 446 214 1,715 9, 574 71.9 New York _ 203. 023 36,118 42, 669 101,648 2,054 20, 534 67, 507 58.4 North Carolina _ 59, 616 21, 571 24, 489 2, 712 10, 845 29,018 74.4 North Dakota _ 8,627 4,706 1,047 2,087 59 728 7, 220 66.1 Ohio _ _ 95, 322 50, 839 34, 478 1,939 8, 066 88, 906 59.7 Oklahoma _ _ 88, 846 61, 107 476 19,772 1,047 6,444 89, 248 68.4 Oregon _ _ 22,034 10,038 1,187 7, 889 152 2,768 17, 569 59.7 Pennsylvania . 119, 569 26,608 4,395 77,012 3,064 8, 491 44, 548 61.9 Puerto Rico _ 8,875 1,997 5, 431 101 1,345 4,492 46.2 Rhode Island _ 11,414 4,061 5,634 66 1,653 6, 855 60.3 South Carolina . 22, 447 11,926 770 5, 509 760 3,482 15,884 75.7 South Dakota _ 9,329 5, 498 3,058 93 680 8,021 70.6 Tennessee _ 44, 852 22, 108 244 16, 473 1,121 4, 906 29, 798 75.1 Texas _ 137, 702 115, 251 15, 371 3,227 3,852 160, 501 71.3 Utah. . 11, 670 4,493 396 4, 835 107 1,838 6,979 67.9 Vermont... _ 5,458 3, 511 1,372 63 512 5,070 70.4 Virgin Islands . 310 143 14 121 5 27 261 49.9 Virginia _ 22, 599 7, 515 10, 552 669 3, 864 10, 125 74.8 Washington . 50, 140 28,738 565 16,432 386 4,018 51,173 55.9 West Virginia . 44, 954 7,304 4,377 29, 615 407 3, 251 9,465 76.9 Wisconsin _ 33, 360 20, 398 10,001 498 2, 463 37, 541 56.0 Wyoming . . 2,947 1,745 839 31 332 2,895 61.4 1 Based on cash advanced for the year; may differ slightly from fiscal-year expenditures from Federal funds reported by States. ? Less than $500. Social Security Administration 133 the Social Security Administration: Federal grants to States and total by program and State , fiscal year 1962 in thousands; data corrected to October 15, 1962] Expenditures for assistance and administration— Continued Medical assistance for the aged Aid to dependent children Aid to the blind Aid to the permanently and totally disabled Percent from Percent from Percent from Percent from Amount Federal Amount Federal Amount Federal Amount Federal funds funds funds funds $1, 130, 515 58.9 $100,203 48.9 $302, 925 55.8 $45, 899 49.8 1,240, 092 57.8 102, 212 47.6 335. 615 54.7 208, 752 50.7 1, 488, 491 56.8 101, 493 46.9 373, 350 54.0 145 74.2 12. 162 79.4 888 74.2 6, 494 74.3 1,775 60.8 99 55.2 13, 430 73.6 793 64.7 436 74.4 5, 290 79.8 1,411 72.1 4, 324 72.9 19, 365 50.0 206, 966 44.7 19, 926 37.0 25, 119 42.3 14, 973 60.6 274 53.3 5,303 59.5 1,283 34.4 23. 623 43.9 410 39.2 3, 945 34.3 2,765 72.7 256 58.4 406 62.3 10, 897 60.3 185 59.5 2, 710 55.7 20, 593 79.4 1,974 68.0 10, 132 66.7 18, 655 75.6 2, 323 72.4 15, 786 72.1 (2) 50.0 155 50.0 2 49.9 31 50.0 839 53.2 5,547 57.6 114 48.6 1, 283 42.1 1,955 65.0 4,800 54.3 127 64.0 1,481 70.2 675 50.0 137, 943 45.3 3,567 47. 1 29, 146 42.7 17. 545 67.9 2, 010 55.0 16, 749 60.8 1, 763 45.6 717 64.3 12, 419 57.1 643 52.1 4, 816 50.7 453 67.6 25, 065 75.3 1,864 71.5 6, 753 70.9 485 66.7 30, 231 73.9 2, 834 58.6 13, 463 69.6 408 66.4 7, 720 73.5 355 68.2 2,057 65.1 1,953 50.0 19,175 66.4 352 63.3 5,426 62.7 43, 855 48.6 38, 755 44.2 3,457 35.1 17, 578 33.0 17, 578 50.0 56,530 52.4 1,737 51.9 6, 757 45.7 23, 335 47.3 1,448 42.1 2,153 67.4 10,240 77.9 2,020 75.3 6,119 74.7 32,798 71.8 4,171 53.5 12, 372 65.1 3,320 61.2 323 57.8 1,305 58.8 4, 971 68.7 884 47.9 2,237 56.8 1,940 65.8 244 44.0 14 57.5 2, 323 52.0 286 49.4 662 44.8 43, 475 44.6 1,111 48.4 8, 786 44.8 12, 346 69.1 307 71.4 2, 674 64.5 CM id o 49.9 212, 811 47.4 4, 820 44.3 54, 109 39.7 31,359 76.5 3, 863 70.3 15, 608 71.2 1,609 69.1 3, 780 54.5 97 61.0 1,593 47.4 51. 510 66.3 3, 733 53.8 14, 567 55.4 918 65.9 29, 636 66. 7 2, 136 49.2 13, 158 49.1 386 51.4 15, 819 50.4 324 46.7 5, 921 47.2 2, 935 50.0 118, 664 63.2 17, 030 18.6 15, 122 59.8 341 50.0 11, 633 46.3 214 47.1 2, 846 47.1 10, 219 52.4 129 50.9 3, 299 49.3 1,054 74.3 6. 843 79.5 1,068 72.6 4, 827 72.9 4,095 72.5 130 70.1 959 69.9 379 62.5 20, 763 78.2 1,532 73.4 6, 716 72.9 19. 688 77.8 4, 493 69.7 5, 513 69.4 534 62.8 7, 686 61.6 182 58.1 3, 361 56.2 1,910 71.3 87 70.6 727 70.0 43 50.0 256 49.8 8 50.0 47 49.5 14,035 73.8 961 70.4 5, 484 69.8 1,467 49.8 27, 383 56.5 872 43.4 8,636 47.1 4,239 67.7 38. 893 74.8 550 73.7 4,225 73.0 21, 482 47.4 1,046 48.5 6, 002 41.8 1,514 54.0 60 54.0 594 53.8 134 Department of Health , Education, and Welfare, 1962 Table 9. — Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, child welfare serv¬ ices, and research or demonstration projects in child welfare under the Social Security Act, by program and State, fiscal year 1962 1 [In thousands] State Maternal and child health services Crippled children’s services Child welfare services United States... _ $23, 851. 7 $24, 093. 5 $18, 645. 9 684.4 766.4 472. 5 Alaska _ _ _ 173.9 148.8 69.7 232.5 184.8 283.5 Arkansas _ . . _ _ 386.9 403.6 California _ 1, 338. 0 423.2 1, 080. 9 1, 027. 6 208.2 182.9 77. 4 304.6 396.2 286.2 130.1 129.6 District of Columbia _ _ _ _ _ 311.2 280.2 89. 2 Florida. _ 774.1 584.3 453. 7 Georgia _ _ 734.2 841.9 533.9 7.8 68.7 52.0 180.4 181.9 115. 4 Idaho _ _ .. . ... . 190.6 162.9 95.3 Illinois _ ... .. ... _ 673.3 748.0 700.9 Indiana _ _ . . ... ... ... _ 373.6 572.2 444. 5 Iowa _ _ _ _ _ ... ..._. 307.0 498.7 315.9 Kansas _ _ _ _ . _ _ _ . ... .. 260.5 287.3 251. 5 Kentucky _ 548. 7 526. 7 430. 5 Louisiana _ _ _ 480.5 569. 7 446. 0 Maine. _ _ _ _ . . _ _ . . 177.7 155.2 149.7 Maryland _ _ _ _ 451.3 465. 7 296. 6 Massachusetts _ 416.3 452.3 404. 4 Michigan _ _ _ 920.9 954.3 733.9 Minnesota _ _ . _ _ _ 509.4 693.7 380.9 Mississippi _ _ 625.4 565.0 362.3 Missouri _ 523.3 442.1 411. 4 Montana _ _ 141.7 193.3 119. 6 Nebraska _ 140.5 121.3 184.2 Nevada _ _ 123.2 82.3 71.7 New Hampshire _ 108.9 124. 0 100. 1 New Jersey _ 354.7 276.6 418.1 New Mexico _ 254.9 217.7 160.5 New York _ 1, 179. 3 894.5 1, 010. 7 631.6 North Carolina _ 889.0 1, Oil. 4 145.1 North Dakota _ _ 140.2 130. 1 Ohio _ _ _ _ _ _ _ _ ... 1, 005. 0 381.1 910.5 818.8 Oklahoma _ 366.9 283.7 Oregon _ _ 212.3 239.0 206.3 Pennsylvania _ 1, 091. 1 531.3 1, 130. 8 654.3 939.5 Puerto Rico _ 440.5 Rhode Island _ 220.1 178.0 120.9 South Carolina _ _ _ 527.0 583.1 400.4 South Dakota _ _ _ 63.4 140.5 130. 5 Tennessee _ 666.8 727.0 471.7 Texas... . . . . . 1, 036. 0 138.8 1, 485. 0 164.4 1, 039. 6 Utah _ _ _ _ _ _ _ 156.8 Vermont _ 125. 7 126.0 91.9 Virgin Islands _ 108.7 108.6 56.3 Virginia . _ 753.1 695.1 472.4 W ashington _ 389.4 320.3 284.9 West Virginia _ 431.1 404.4 278.8 Wisconsin _ 417.5 513.4 413.2 Wyoming _ _ _ 128.6 125.8 82.7 1 Based on checks issued basis. Additional payments were made for special project grants to institutions of higher learning and to public or other non-profit agencies and organizations as follows: maternal and child health services, $986.0; services for crippled children, $544.1; research or demonstration projects in child welfare, $131.3. Social Security Administration 135 Table 10. — Federal credit unions: Assets , liabilities , and capital , Dec. 31, 1960, and Dec. 31, 1961 Assets, liabilities, and capital Amount Percentage distribution Dec. 31, 1961 Dec. 31, 1960 Change during year Dec. 31, 1961 Dec. 31, 1960 Number of operating Federal credit 10, 271 9. 905 366 Total assets . . . . Loans to members . . . Cash - - - - - U.S. Government obligations - Savings and loan shares - Loans to other credit unions . . Land and buildings _ $3, 028, 293, 938 $2, 669, 734, 298 $358, 559; 640 100.0 100.0 2, 245, 223, 299 190, 190, 576 94, 652, 577 412, 428, 717 54, 943, 499 11,861,150 18, 994, 120 2, 021, 463, 195 157, 615, 757 93, 577, 264 306, 249, 764 61, 701, 066 9, 699, 908 19, 427, 344 223, 760, 104 32, 574. 819 1, 075, 313 106, 178, 953 -6, 757, 567 2, 161, 242 -433, 224 74.2 6.3 3.1 13.6 1.8 .4 .6 75.7 5.9 3.5 11.5 2.3 .4 .7 Other assets . . . . Total liabilities and capital - Notes payable - - Accounts payable and other liabil- bilities . . . . Shares _ _ _ Regular reserve _ _ Special reserve for delinquent loans.. Other reserves 1 _ Undivided earnings 2 _ 3, 028, 293, 938 2, 669, 734, 298 358, 559, 640 100.0 100.0 59, 698, 027 16, 151, 362 2, 673, 488, 298 133, 939, 870 4, 604, 374 7, 645, 471 132, 766, 536 71, 275, 679 12,372,686 2, 344, 337, 197 111,703,332 4, 456, 218 5, 899, 292 119, 689, 894 -11,577,652 3, 778, 676 329, 151, 101 22, 236, 538 148, 156 1, 746, 179 13, 076, 642 2.0 .5 88.3 4.4 .2 .2 4.4 2.7 .4 87.8 4.2 .2 .2 4.5 1 Reserve for contingencies and special reserve for losses. * Before payment of yearend dividends. Table 11. — Federal credit unions: Selected data on operations, as of Dec. 31, for each year 1934—61 1 Year Number of operating Federal credit unions Number of members Assets Shares Loans outstand¬ ing 1934 2 . . . 39 3, 240 $23,300 $23, 100 $15, 400 1935 - - 772 119, 420 2, 372, 100 2, 228, 400 1, 834, 200 1936 . . . 1,751 309. 700 9, 158, 100 8, 510, 900 7, 343, 800 1937 . . . 2, 313 483, 920 19, 264, 700 17, 649, 700 15, 695, 300 1938 . . . 2, 760 632, 050 29, 629, 000 26, 876, 100 23,830, 100 1939 - - - 3, 182 850, 770 47, 810, 600 43, 326, 900 37, 673, 000 1940 - - - - 3, 756 1, 127, 940 72, 530, 200 65, 805, 800 55, 818, 300 1941 _ 4, 228 1, 408, 880 106, 052, 400 97, 208, 900 69, 484, 700 1942 . . - . — - 4, 145 1, 356, 940 119, 591, 400 109, 822, 200 43, 052, 500 1943 _ _ 3,938 1, 311, 620 127, 329, 200 117, 339, 100 35, 376, 200 1944 . . . 3, 815 1, 306, 000 144, 365, 400 133, 677, 400 34, 438, 400 1945 - - 3, 757 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 1946 . . - . — - 3,761 1, 302, 132 173, 166, 459 159, 718, 040 56, 800, 937 1947 . 3, 845 1, 445, 915 210, 375, 571 192, 410, 043 91, 372, 197 1948 . — . 4,058 1, 628, 339 258, 411, 736 235, 008, 368 137, 642, 327 1949. . . 4,495 1, 819, 606 316, 362, 504 285, 000, 934 186, 218, 022 1950 . . . - 4, 984 2, 126, 823 405, 834, 976 361, 924, 778 263, 735, 838 1951 . — - . . 5, 398 2, 463, 898 504, 714, 580 457, 402, 124 299, 755, 775 1952 _ _ _ _ _ 5, 925 2, 853, 241 662, 408, 869 597, 374, 117 415, 062, 315 1953 _ 6, 578 3, 255, 422 854, 232, 007 767, 571, 092 573, 973, 529 1954 _ 7,227 3, 598, 790 1, 033, 179, 042 931, 407, 456 681, 970, 336 1955. . . . . . . 7, 806 4, 032, 220 1, 267, 427, 045 1, 135, 164. 876 863, 042, 049 1956 _ _ 8, 350 4, 502, 210 1, 529, 201, 927 1, 366, 258, 073 1, 049, 188, 549 1957. . . . - . 8,735 4, 897, 689 1, 788, 768, 332 1, 589, 190, 585 1, 257, 319, 328 1958. . — . . 9, 030 5, 209, 912 2, 034, 865, 575 1, 812, 017, 273 1, 379, 723, 727 1959 . . . . . 9, 447 5, 643, 248 2, 352,813, 400 2, 075, 055, 019 1, 666, 525, 512 1960 _ _ _ 9, 905 6, 087, 378 2, 669, 734, 298 2, 344, 337, 197 2, 021,463,195 1961. . . . - 10, 271 6, 542, 603 3, 028, 293, 938 2, 673, 488, 298 2, 245, 223, 299 1 Data for 1934-44 on membership, assets, shares, and loans outstanding are partly estimated, 2 First charter approved Oct. 1, 1934. Table 12. — Federal credit unions: Selected data on operations, by asset size and State, 1961 136 Department of Health, Education, and Welfare, 1962 Amount of loans to members Outstanding as of Dec. 31, 1961 (thousands) $2, 245, 223 995 3, 107 16, 116 38, 038 89, 670 257, 878 333, 838 424, 293 438, 589 390, 080 252, 619 NO®'^N050iOMOO)N'>JlO^HlOOONtOrHm(N Ctf'^OOlO'-'^Offiain'f-^OlNNOINNlOH NT((l»N^NO)N^rHO-H»fflo^tON(NOSrtNiO N N -H ® iC rH o ■')<“ ® O O OC N IH OO IN i4 N o“ N N 04 CO CO t- OONNiOrlCOtd 04 rp C4 04 CO CO Made during 1961 § ◄ $672 (NNiO^OOCOOC^O HHC^CO^iCKDNNOOCS N^|OO^NOCOONiaO<0<0©'fl©'*i05t^I>.COOOOO‘0!®COTt- <1-0 3)®0C'CO0>O®0)>0»t0ONr- i CO -H -*f CO OO 00 N'^(N>HLOO)OC0010100'«lt0005NOCOC4NtOCO 04 10 eo of 1^ 00 od© co co >0 0400 >-h co a? oco ■'C rH rH 1C O 00 rH 1C © 04 i— 1 CO C4 Tt< lO Amount of members’ shares Average 1 per member $409 COcDOCDCOCSJGOCOOOCOCi t-rrH©l-r04© 0400 ©00©''tfl04C^04 00l''.©tr.C0©©O (DCOCOOtO^INOOOltO'-iWTHiOOCOiOINOONOi^ coco-^|coTt|04-^(‘Ocococoeoco'^-^'>c05XC0 05»0 05 ^OOOT^OOoTr-rrHCOCOCO H(N^O)OHOOOIO OOOCOCO^OOOiiOOKNOOOiCOCOOONOiOOCOiOlN H^cO^HCO^iOrJ-^HCOOJ'H^cDOOWiMCOOCO^ HH(NCO.8 _$g3S_jI!l|sl ,5 lllllllllllllllllllilllllllllll C3 „ Ofl^O pill 55 665171 -10 Public Health Service Health of the Nation As the Federal Agency principally concerned with protecting and advancing the Nation’s health, the Public Health Service has a two¬ fold obligation. It must concentrate on the urgent health needs of today, while looking to and preparing for emerging needs and long range goals. Both parts of this obligation are heavily affected by the change and growth which are such notable characteristics of our present society : growth of the population, and change in its composition; growth of industries and cities, of medical science and health knowledge, of techniques and resources ; change in the way people live and work and use their leisure time. Responding to this changing scene and its implications for the fu¬ ture, the Public Health Service is placing major emphasis on several broad problem areas. They include environmental health and community health services. Last years annual report called special attention to these two topics, and the progress that has been made on them is discussed in detail in the appropriate sections of this report. Other broad areas which are receiving major attention include health manpower, where the need is great and will become more seri¬ ous; research, which must be continued and accelerated; scientific communications, where the object is to speed the application of new knowledge in the health care of the people ; the chronic conditions — heart disease, mental illness, cancer, and the others high on the list of causes of death or disability and of special import to the aged. The Service’s attacks on such problems are multifaceted. Typically they cut across more than one of the three major Bureaus and involve Divisions of the Office of the Surgeon General. Illustrative of both the need for this approach and the conduct of it is the realm of scientific communications. Here, the rapidly accel¬ erating research effort — world wide in scope — is reporting results in 139 140 Department of Health , Education , and Welfare , 1962 such, scope and volume that existing communication systems are not adequate to cope with the torrent of information. The Service’s response includes a vital action by the National Li¬ brary of Medicine — the design, development, and installation of an electronic storage and retrieval system known as MEDLARS (Med¬ ical Literature Analysis and Retrieval System) . The completion of this project will give the medical sciences in the United States access to a powerful tool unequaled elsewhere in the world. MEDLARS will provide a base for the centralized prelim¬ inary processing of information now conducted under circumstances of duplication and economic waste by multiple independent secondary publications. Further, it will constitute a new key to medical libraries generally, and, when coupled with photoduplication service, will en¬ able libraries to meet modern research requirements for information with unprecedented effectiveness. The impact of the MEDLARS system on future developments in electronic storage and retrieval in particular, and on the structure of medical communication in general, is expected to be considerable. At the same time, the National Center for Health Statistics has com¬ pleted installation of its computer facilities — modern data processing equipment which will result in more timely reporting of the health intelligence embodied in the national vital and health statistics pro¬ duced by the Center. Also, during the year the National Institutes of Health published for the first time a Research Grants Index . This is a comprehensive listing of the scientists supported through PHS research grants pro¬ grams, and it contains an index to the content of their work. It is unique in that it refers to work in progress rather than work that is described — months or even years after its completion — in published papers. Since the Service supports about half of all the medical re¬ search in the United States, plus some in other countries, the Index will help greatly to solve the mounting problem of keeping up with who is doing what and where it is being done. Other programs in all three Bureaus are aimed at the scientific com¬ munications problem. The importance of the subject has been recog¬ nized organizationally by the formalization in the Office of the Sur¬ geon General of the Office of Information and Publications, and the Surgeon General has scheduled for the fall of 1962 a meeting at which representatives of the health professions can discuss PHS actions and proposals and relate them to the responsibilities of other organizations and groups. Another broad area which provides an example of action on several fronts is that of health manpower — which has been the subject of con- CHART 1.— PUBLIC HEALTH SERVICE— 1962 Public Health Service 141 142 Department of Health , Education , and Welfare , 1962 tinuing and increasing Public Health Service attention. The Service recognizes that the need is both quantitative — in terms of the greater number of people that are required — and qualitative — in terms of the kinds and varieties of personnel needed — and is working on the prob¬ lem accordingly. The PHS has worked to increase the supply of physicians and den¬ tists. At the same time, the Division of Public Health Methods has completed two more of its series of health manpower studies — Sec¬ tion 12 on Medical and Psychiatric Social Workers and section 13 on Hospital House Staffs. It has also cooperated with the National League for Nursing in a study of practical nurse education published as “Education for Practical Nursing, 1960.” Many service programs support training of professional and technical personnel in a wide variety of disciplines. The institution of the NIH Research Career Award Program has given the Service a means of providing stable incomes for research careers in academic and research environments ; and since the inaugu¬ ration of the program in J anuary 1962, awards have been made to 106 individuals in 61 institutions. A variety of Service programs are designed to promote more effi¬ cient use of existing manpower. For example, experimental projects demonstrated that dentists who work with a chairside assistant can treat substantially greater numbers of patients than can those who work alone; and the demonstrations have now been followed by a grants program to support the training of dental students in the use of chairside assistants. Toward a better utilization of its own manpower, the Surgeon Gen¬ eral requested, and the Secretary of Health, Education, and Welfare appointed, an Advisory Committee on Public Health Service Person¬ nel Systems. The Committee made its report in March 1962, and the Office of Personnel has begun the implementation of its recommendations. The Service is working in a comprehensive manner also on some of the more circumscribed but equally important topics, such as the problem of infant mortality. In this area, where there remains a great deal we do not know, the research programs of the National Institutes of Health and the Communicable Disease Center are con¬ tinuously increasing medical knowledge of the factors contributing to infant mortality. The cooperative study now being sponsored by NIH, for example, is accumulating data related particularly to asphyxia in the newborn and congenital malformations. This study is certain to produce find¬ ings that will lead to the prevention of many infant deaths due to these causes. The Communicable Disease Center is conducting research Public Health Service 143 and developing control measures affecting the infectious diseases of infancy, particularly infant diarrhea and hospital-acquired infections. The accident prevention program also is cooperating in efforts to re¬ duce the toll of accidental poisoning and home conflagrations which account for a large number of deaths among infants and young chil¬ dren. Other work is going forward in other parts of the PHS. The Service carries out its programs through the Divisions of the Office of the Surgeon General, such organizational units as the Na¬ tional Center for Health Statistics, the National Library of Medicine, and the three major Bureaus — Bureau of Medical Services, Bureau of State Services, and National Institutes of Health. While each of the organizational entities has its own particular program responsibilities, certain types of activities are common to many of the organizational units. Thus, research activities are as¬ sociated with all areas of PHS responsibility. Cooperation with other agencies — State and local health departments, international organizations, public and private institutions, voluntary organiza¬ tions — is a conspicuous aspect of many programs. Grants-in-aid for a wide variety of objectives are administered by many Divisions. Many different programs are sources of technical aid, consultation, and training assistance. Health Record Latest data from the continuing National Health Survey indicate that Americans, except those in resident institutions, experienced 359 million acute illnesses and injuries in a year. This equals about two conditions per person per year. These statistics refer largely to short¬ term conditions involving either medical attention or at least a day of restricted activity. The 359 million acute conditions included 50 million accidental in¬ jury diagnoses among 45 million persons injured. Of the injured, 2.9 million were in accidents involving motor vehicles. The bulk of the remainder, 20.2 million, occurred in the home. In the same year, the average American’s activity was restricted some 16 days due to illness and injury. Six of the 16 days involved bed disability. Persons 17 years of age and older lost 5.4 days of work due to ill health, and children from 6 to 16 averaged 4.8 days lost from school. An estimated 74 million Americans — 42 percent of the population — were reported to have 1 or more chronic conditions of varying sever¬ ity. About 1 person in 12 — 14,217,000 in all, was limited in his major activity by chronic disease or impairment, and 1 in about 200 — some 915,000 in all — was confined to the house continually by a chronic ailment. 144 Department of Health , Education, and Welfare, 1962 After a long period of decline, the trend of the crude death rate appears to have leveled off. This phenomenon is not peculiar to this Nation: it seems to be occurring also in such countries as England and Wales, Finland, Norway, Sweden, Denmark, Japan, and Chile. The 1957 rate for the United States — 9.6 per 100,000 population was CHART 2.— DEATH RATES BY AGE AND SEX, 1945-61 (Rates per 100,000 population) Public Health Service 145 almost 5 percent larger than the 1954 rate of 9.2, which was an all- time low. In 1961, the crude rate stood at 9.3.1 Crude rates are calculated on the total population of each period covered. This population almost invariably changes in composition over the years in ways that may affect crude rates. Thus, the great¬ est risk of dying occurs in infancy and in old age, and our present population is simultaneously growing both older and younger in com¬ position. The proportion of the population over 65 probably has been increasing since the 18th century, while the proportion under 5 years of age has been increasing for more than 25 years. Since the leveling off of the crude death rate is also evident in the age-adjusted rate, the failure to decline cannot be ascribed to the changing age composition of the population. The 1961 age-adjusted death rate stands at 7.3 compared to the 1954 rate of 7.7. In recent years both the crude and the age-adjusted rates have varied only slightly from year to year, and almost entirely according to the presence or absence of respiratory disease outbreaks during the year. Obviously it is impossible for the death rate to decline indefinitely. But present levels of death rates in various countries do not seem to be at the irreducible minima, nor do they appear to be due to artifacts of registration or other technicalities; and an intensive study and evaluation of the situation is in order. For the United States, a primary reason cannot be found in the fact that death rates already are extremely low, since a number of countries have still lower rates. A general resistance to decline in recent years is evident as far as age and sex are concerned. Since the curves of the chart are drawn on a uniform logarithmic (ratio) scale, direct comparison between curves or any of their parts can be made by comparing degrees of slope. In no age group is the rate of decline greater since 1954 than before. The chart also shows that male death rates by age in general have declined less rapidly since 1954 than the rates for females. Closer study of the data also shows that the divergence between the sexes by age and color groups is greater over the 7 years since 1954 than over the 7 preceding years, except for persons aged 15-34 (whites) and 15-24 (nonwhites). Males, then, not only have lagged behind females but at present they are falling even further behind. In what areas? The four leading causes of death are now diseases of the heart, malignant neoplasms (“cancer”), vascular lesions affecting the central nervous system (“strokes”), and accidents. In terms of age-adjusted rates, these four causes accounted for a little over 68 percent of all deaths about 10 years ago, compared to about 72 percent now, so 1 All vital data are for calendar years. 146 Department of Health , Education, and Welfare, 1962 that their importance is increasing. While sizeable declines were recorded for white and nonwhite male groups when the four leading causes were excluded, these declines were nevertheless smaller than those scored by the female groups. For each of the four leading causes of death, males in each color group have fared less well in recent years than females. For dis¬ eases of the heart there was virtually no change in the male rates while each of the female rates was decreasing about 10 percent. For cancer, male rates increased while female rates were unchanged or decreased. For stroke, a decline for white males was surpassed by a greater decline for white females while non white males had an increase compared to a decrease for ^on white females. For acci¬ dents, the decline registered by each female group was greater than those scored by the comparable male group. About 1 infant in 40 died within a year of birth in 1961, com¬ pared to 1 in 10 during 1915. But while the infant death rate de¬ clined by 25 percent or more for every 10-year period until 1950, since then this rate of decline has been sharply reduced. Although the 1961 rate of 25.3 per 1,000 live births is the lowest yet recorded in the United States, the curve nevertheless is declining more slowly over recent years ; nor is the rate as low as that in some other countries. The maternal death rate — 31.7 per 10,000 live births in 1941 — reached 7.5 in 1951 and 3.7 in 1961. This rate has declined so far that it may be pressing against a virtually irreducible lower limit. As a summary expression of all the forces working to extend or shorten life, in 1961 for the first time the life expectancy of the country’s total population at birth exceeded 70 years, reaching 70.2. This compares to 68.4 in 1951 and 64.8 in 1941, giving gains of 2.6 and 5.6 percent for the later and the earlier periods. In 1960, life expectancy by color and sex was as follows: white males, 67.4 years; white females, 74.1 years; nonwhite males, 61.1 years; and non white females, 66.3 years. In recent years the average length of life has been increasing at a faster rate for women than for men, and at a faster rate for the nonwhite population than for the white population. Births , Marriages , and Divorces The total of 4,268,326 live births registered in 1961 were only slightly more than the 4,257,850 births of 1960. Since the number of births has not changed much during the past 5 years, and the population has continued to grow, the crude birth rate has declined somewhat each year since 1957. The rate was 25.0 per 1,000 live births in that year, 23.7 in 1960, and 23.3 in 1961. Public Health Service 147 * The fertility rate, or number of live births per 1,000 women 15-44 years of age, also has declined somewhat annually since 1957. The : 121.2 rate of that year was higher than any rate since World War I. : The 1961 rate of 117.3 is slightly below the 1960 rate of 118.0. In | recent years the fertility rate for nonwhites has been about 40 births I per 1,000 above the rate for whites. In 1961, about 1,547,000 marriages were performed, an increase of 1.3 percent over the 1960 figure of 1,527,000. Because of con¬ i'1 current changes in the country’s total population, however, the crude hi marriage rate remained constant for 1959, 1960, and 1961 at 8.5 mar- | riages per 1,000 population. Divorces were estimated at 391,000 in 1960, compared to 395,000 in 1959. The crude divorce rate was 2.2 per 1,000 population in 1959, 1960 and 1961. Funds The total funds available to the Public Health Service in fiscal year 1962 amounted to $1,633.4 million (see table 1, p. 226). Appropria¬ tions and authorizations accounted for about $1,392.4 million of this amount. The balance was made up of repayments for services given i to other agencies and of unobligated balances from previous years. About 72 percent of the total funds available was allocated to others, in the form of grants to State and local agencies, private in¬ stitutions, universities, hospitals, and individuals outside the Federal Government. The remainder was used to support the direct respon¬ sibilities of the Public Health Service, such as hospital and medical care for legally designated beneficiaries, foreign and interstate quar¬ antine, and Indian health services. Office of Personnel At the request of the Surgeon General, the Secretary of the Depart¬ ment of Health, Education, and Welfare appointed an Advisory Com¬ mittee on Public Health Service Personnel Systems to study the re¬ cruitment and retention of personnel. The Committee, headed by former DHEW Secretary Marion B. Folsom, began its study in October 1961 and completed it in March 1962. In brief, the recommendations of the Committee were : (1) that the Surgeon General personally accept responsibility for the direction of personnel management in the Service; (2) that personnel staff services be reorganized and strengthened; (3) that personnel opera¬ tions be substantially improved; and (4) that pay and rank be care¬ fully examined and if inadequate, to explore the possibility of legislation that would make them more equitable. 148 Department of Health , Education , and Welfare , 1962 A new Assistant to the Surgeon General for Personnel has been named, and under his direction, the Office of Personnel has begun the implementation of the recommendations of the Committee. PERSONNEL At the close of the fiscal year 1962, the Public Health Service had a total staff of 32,638. (See table 2, page 228.) This number includes 4,501 Commissioned Corps Officers, 26,808 full-time and 1,329 part- time Civil Service employees. (See table 3, page 230.) Commissioned Officers on duty included 1,909 members of the Regular Commissioned Corps, 2,366 members of the Reserve Corps on Active duty, and 226 Commissioned Reserve on temporary training duty. National Center for Health Statistics The National Center for Health Statistics, nearing the end of its second year in July 1962, has modernized its data processing by in¬ stalling computer facilities. This has resulted in more timely report¬ ing of Center activities. Another result is far better use of the Center’s professional manpower. When not being used for Center programs, the computer equip¬ ment is available to other elements of the Public Health Service, principally in the area of health statistics. As an experiment, the Center has undertaken negotiation of con¬ tracts with statisticians of foreign nations to provide analyses of mortality trends in those countries. This probably will be expanded to bring otherwise unavailable professional resources to bear on the Center’s statistical problems. NATIONAL HEALTH SURVEY During the year, the National Health Survey accelerated work on its newest data collection program — the Health Records Survey. With help from the Bureau of the Census, a master list of all types of resident institutions and hospitals in the Nation was constructed. This list will be used as a base for sampling studies. Next, pretesting be¬ gan in the first of a series of surveys based on the master list. This is a survey of Resident Places Providing Nursing or Personal Care, de¬ signed to produce up-to-date knowledge of a population known to consist almost entirely of old people. The National Health Survey Division also operates a program of studies to improve health survey methods. Among these are projects to develop new methods of gathering information on personal health expenditures and to evaluate and refine the collection of data on health insurance coverage in the general population. A third continues the Public Health Service 149 Health Survey’s series of studies to evaluate chronic disease informa¬ tion reported in the Health Interview Survey. By the end of the fiscal year, full-scale operation of the Health Examination Survey was beginning to be achieved. Data collection on the first cycle, primarily concerned with certain chronic diseases in the adult population, was more than three-fourths completed and work on the pattern of tabulation and analysis of these data was well under way. Meanwhile, plans were being completed for the second cycle, a nationwide probability sample of children from 6 through 11 years of age. The Health Interview Survey produced reports on several topics not previously reported on by the National Health Survey: (1) Persons receiving care in the home, (2) Proportion of hospital bill paid by insurance, (3) Duration of limitation of activity due to chronic condi¬ tions, and (4) Selected impairments by etiology and activity limita¬ tion. Estimates for topics discussed in earlier reports were updated with more recent data. Health interview data also served as the basis of a report on the health characteristics of currently employed persons. NATIONAL VITAL STATISTICS DIVISION During the year, the Division made substantial progress to reduce the lag between receipt and publication of data from the States. Considerable mortality and natality statistics for the 1961 data year were released well before the end of 1962. In fiscal year 1962 the Division published annual and provisional monthly data in vital statistics and six special studies: (1) Occupa¬ tional mortality, (2) Number and type of medical care institutions, (3) Matching birth certificates and census information, (4) Charac¬ teristics of Georgia marriages, (5) Improving national divorce sta¬ tistics, and (6) Standard error of age-adjusted death rates. The Division undertook its largest single reimbursable project to date, involving more than $300,000, to provide technical assistance for a series of monographs sponsored by the American Public Health Association to synthesize data of concern to public health and demog¬ raphy drawn from a wide array of sources. The Division’s computer programmer staff, built entirely during the year, is largely complete and trained. The Division and other Center components are developing ideas to use the computer facilities to strengthen vital statistics programs in the States. The ninth national meeting of the biennial Public Health Confer¬ ence on Records and Statistics in June 1962 was singularly successful in improving vital and health statistics and makng them more useful and usable. 150 Department of Health , Education , and Welfare, 1962 The Division is in the second year of the national mortality sample survey, based on a sample of deaths occurring throughout the country. ' Plans have been developed to begin a continuing national natality sample early in 1963. The third phase of a cystic fibrosis study is nearing completion. For the 1960 census year, marriage and divorce statistics were based on nationwide samples of marriage and divorce records collected from ! States and local areas. For 1961 and 1962, the samples are being col¬ lected only from the registration areas, which at the end of the fiscal ; year contained 35 States and 4 other areas for marriages and 21 States ; and 1 other area for divorces. The Division stimulated discussion and provided technical and con¬ sultative advice as required on the need for retaining the item on race- color on vital records, beginning with a panel discussion at the annual ; meeting of the American Public Health Association. Efforts have been intensified, cooperating with State and Federal agencies, to develop minimum safeguards to reduce fraud associated with vital records and promote the integrity of vital records. A draft of measures to be applied was written. OFFICE OF ELECTRONIC SYSTEMS During the year, the Office of Electronic Systems completed installation of computer equipment — and IBM 1401 and the more powerful 1410 system. Conversion of data processing from mechani¬ cal equipment and from rented electronic equipment is proceeding on schedule. OFFICE OF HEALTH STATISTICS ANALYSIS This Office made some progress in staff recruiting and training. A start was made in the development of an index of health. The Office continued its study of changes in the general mortality trend as well as the infant mortality trend in the United States. Contracts have been negotiated in several countries for study to determine, if possible, the factor or factors responsible for the change in mortality trends in various parts of the world. This approach significantly increases the professional resources the Office can bring to bear on the problem. National Library of Medicine The new building in Bethesda, occupied April 16, 1962, affords the National Library of Medicine an excellent facility for the implementa¬ tion of its computer-based bibliographic system termed MEDLARS. To become fully operational about September 1963, the new system will offer the capability of providing very detailed and specialized reference services, and enlarge, improve, and speed the preparation Public Health Service 151 of Index Medicus. The preliminary design phase of the MEDLARS project was completed in December 1961. Work is progressing on the second phase covering detailed system design, equipment and facility specifications, site preparation, personnel training, and computer pro¬ grams. Plans are to negotiate a contract for the final (implementation phase) in September 1962. BOARD OF REGENTS The Board of Regents held two meetings, on December 14, 1961, and on April 13, 1962. Building problems, moving problems, budget problems, the progress of MEDLARS, and the progress of the Extra¬ mural Program occupied the major part of the Board’s attention. Drs. Norman Q. Brill, Harve J. Carlson, and Saul Jarcho joined the Board in the fall. Dr. Worth B. Daniels served as Chairman of the Board during the year, and was succeeded in April by Dr. Warner L. Wells. SCIENCE TRANSLATION PROGRAM On July 1, 1961, the Russian Scientific Translation Program was transferred from the National Institutes of Health to the National Library of Medicine. This change presented a new challenge to the Library and the opportunity to coordinate and improve international medical communication activities. The objective of the Science Translation Program is to communicate the results of high-quality medical research published in languages unfamiliar to American medi¬ cal scientists. This program lias supported the cover-to-cover transla¬ tion of nine Soviet research journals, the comprehensive abstracting of Soviet research publications, and the preparation and publication of critical review papers. As a result of an extensive program evalua¬ tion begun early in 1962, the program has undergone some modifica¬ tion, stressing the coverage of such literature by abstracts and critical reviews. While full attention will be paid to Soviet contributions, the program will support translation and other communication activi¬ ties from such languages as Japanese, where the quality of research is high. These activities will be closely coordinated with the Public Law 480 translation program conducted by the Library, and with similar programs conducted by the National Science Foundation. PROGRAM STATISTICS In fiscal year 1962 the Library acquired 11,338 books, 63,959 serial pieces, and added 739 new serial titles, increasing its collections to 1,084,256 items. The History of Medicine collection was increased by 147 old and rare items. The staff cataloged 17,257 titles, and 471 pictures were added to the art collection. There were 161,090 volumes circulated, and 10,242 reference questions answered. Main entries 152 Department of Health, Education, and Welfare, 1962 published in the National Library of Medicine Catalog totaled 20,260. The Index Medicus published 141,911 items from 2,132 journal titles. Interlibrary loans increased to 113,485. Microfilm production amounted to 2,840,400 pages of which 570,662 pages were for preserva¬ tion purposes and 2,243,862 pages for interlibrary loan. Division of Public Health Methods The Division of Public Health Methods conducts studies to identify emerging national health problems and to assess the significance of social, scientific, economic, and educational developments to health services and resources. In these areas, the Division provides advisory and consultative services within the Service, to other governmental agencies, and to national professional and voluntary agencies. Divi¬ sion responsibilities involve it also in planning, policy coordination, and program development and analysis within the Service. Finally, the Division provides technical assistance, clearance, and reference services on legislative matters other than appropriations ; coordinates and analyzes plans of the several Service programs for substantive survey projects; and performs additional staff services in support of the Surgeon General and the Service as they are required. ORGANIZATIONAL CHANGES During the year, staff and resources engaged in studies and other activities in the general area of health economics were transferred to the Bureau of State Services to become part of the newly created Division of Community Health Services. The Division of Public Health Methods acquired from the Bureau of State Services the re¬ sponsibility for providing staff services in support of the Surgeon General’s annual conferences with State and Territorial health authorities. Responsibility for editing and publishing Public Health Reports , the Service’ official journal in public health practice and administra¬ tion, was transferred to the Office of Information, Office of the Sur¬ geon General. The Clearinghouse on Morbidity Projects, which puts out annual listings of current morbidity studies, was moved to the Division of Community Health Services, Bureau of State Services. PROFESSIONAL EDUCATION “Education for Practical Nursing, 1960,” published during the year, reports the findings of the first nationwide study of practical nurse training programs. The study was conducted in cooperation with the National League for Nursing. Data acquired from two questionnaires sent to all State-approved programs revealed great variation among them in number of students Public Health Service 153 admitted, size of affiliating hospital, curriculum length and content, I types of nursing experience, faculty size and qualifications, and costs. Study findings for practical nurse training as a whole include the following: State-approved training programs increased from 150 in 1950 to 662 in 1960, a decade in which yearly graduates from practical nurse programs rose from 3,000 to more than 16,000. Of the 23,000 students admitted to training programs in the 1959-60 school year, more than two-thirds were high school graduates. One-third of these entering students were less than 20 years old. Most training programs are a year in length, and all provide for clinical experience in hospitals. In response to a request from the Bureau of the Budget, the Divi¬ sion made a study of Federal support of schools of public health. Scheduled for publication in Public Health Reports , the report shows the amount and nature of Federal assistance in 1961 to the 11 schools of public health then in full operation and presents additional data concerning the schools’ enrollment, expenditures, and other sources of funds. Federal interest in higher education and the several meth¬ ods currently used for providing Federal support are also discussed. HEALTH MANPOWER During the year, two publications were added to the Health Man¬ power Source Book series : Section 12, “Medical and Psychiatric Social Workers,” analyzes employment characteristics, levels of education, and annual salaries for the estimated 11,700 of these workers employed full-time in 1960. Findings with respect to professional training showed the proportion of workers with 2 or more years of graduate education in a school of social work to be generally higher for psychiatric than for medical social workers, for those in health programs rather than programs pointed at other objectives, for employees of National rather than State or local agencies, and for those in supervisory or consultative rather than direct-service positions. “Hospital House Staffs,” section 13 in the source book series, pre¬ sents data for 1940-60 on internships and residencies in U.S. hospitals. The number of these positions offered, the number filled, and the num¬ ber filled by graduates of foreign medical schools are related to the control, size, and geographic location of hospitals. The marked increase in house staff positions and the hospitals’ growing depend¬ ence on foreign medical graduates to fill them are indicated by the facts : throughout the ’fifties more than 10 percent of all positions of¬ fered went unfilled, while the proportion of filled positions accounted for by foreign house staff was rising from 10 percent in 1951 to 25 percent in 1960. 665171—63 - 11 154 Department of Health, Education , and Welfare, 1962 A summary of trends since 1900 and current statistics indicating the Nation’s total health manpower resources, the numbers of workers in the major health manpower categories, and the general health status of the population, was published under the title, “Chart Book on Health Status and Health Manpower.” Several shorter manpower studies were completed for publication. The latest report in a series on trends in medical practice appeared in the Journal of Medical Education , November 1961. It reports changes in the professional careers of physicians shown in a recent resurvey of 1935, 1940, and 1945 medical graduates. A second study, on osteopathic college alumni, was published in the May 1962 issue of the Journal of the American Osteopathic Association. Another, presenting physician-population projections from 1961 through 1975 is scheduled for publication in the American J ournal of Public Health. Other projects underway include a nationwide study of the number, distribution, and characteristics of pharmacists, and an extensive study of medical specialists which will show age, sex, race, State lo¬ cation, medical school attended, membership in specialty societies, and type of practice for some 26 specialties. Division of International Health During the year, the Division arranged for official United States representation and members served on delegations to the 15th World Health Assembly in Geneva, Switzerland, in May 1962, the 28th and 29th Sessions of the Executive Board of the World Health Organi¬ zation also in Geneva, the 13th Meeting of the Directing Council of the Pan American Health Organization in Washington in October 1961, the 44th and 45th Meetings of the Pan American Health Organiza¬ tions’ Executive Committee in Washington in October 1961 and April 1962, and the 12th Session of the Western Pacific Regional Committee of the World Health Organization which was held in Wellington, New Zealand in September 1961. In addition a member of the Divi¬ sion served as Alternate Commissioner to the Regular Annual Session of the South Pacific Commission in October 1961. This meeting was held in Noumea, New Caledonia. Official U.S. policies on topics discussed at these meetings were developed by the Division in consultation with the Department of State and the technical areas of the Public Health Service. The Di¬ vision also participated in the deveiopment of policy on health re¬ lated matters which came before meetings of the Food and Agricul¬ tural Organization, the United Nations Childrens Fund, the International Labor Organization, the Social Commission of the United Nations, and the South Pacific Commission. Public Health Service 155 The Division assisted in the appointment of more than 300 U.S. ex¬ perts to serve as members of the WHO Expert Advisory Panels or as short-term consultants to the World Health Organization, or the Pan American Health Organization ; and continued the assignment of 73 officers to the Headquarters’ Staff and overseas missions of the Agency of International Development. Twenty-seven Public Health Service officers were detailed to staff the medical organization of the Peace Corps. These officers are principally responsible for the health of Peace Corps volunteers. In addition they supply such local health service as time will permit on a volunteer basis. The International Education and Training Branch of the Bureau of State Services was transferred to the Division of International Health and provided program and guidance services to 623 new visi¬ tors and students from 92 countries. Arrangements were made under U.S.-U.S.S.R. agreements negoti* ated by the Division for the exchange of four scientific missions in FY 1962. These were in the fields of medical ecology, neurophysiology and pathology, virology and thoracic surgery. The latest agreement, concluded early in 1962, calls for the exchange of nine missions in calendar years 1962 and 1963. The agreement also calls for the ex¬ change of up to 25 individual scientists from each country and the convening of joint meetings on specific subjects, including cancer, rheumatic diseases and virology. The Health Studies Program of the Division was combined with the International Survey activities of the Department, and the staff was transferred to the Office of the Secretary of HEW. The Division continues to provide the reference and research facilities for the program. Division of Health Mobilization The authority and scope of the health mobilization program were considerably increased during the past year through the issuance of two Executive orders which assigned to the Department of Health, Education, and Welfare full responsibility for (a) the development of requirements, plans, and operating procedures regarding the Nation’s Emergency Medical Stockpile; (b) the preparation of national emer¬ gency plans and the development of preparedness programs covering health services, civilian health manpower, health resources, and edu¬ cational programs. Prior to these orders, management of the emergency medical stock¬ pile and coordination of the health mobilization activities had been carried on under the program direction and policy control of the Office of Civil and Defense Mobilization. 156 Department of Health , Education, and Welfare, 1962 During the year, major program emphasis was concentrated in three areas : 1. Preparation of the civilan to meet his own health needs when deprived of the services of a physician. The medical self-help training course developed in cooperation with the American Medical Association and endorsed by all major gov¬ ernmental and private health organizations was introduced to the general population. Five thousand training kits containing film strips, projector, instructors’ lesson plans, student handbooks, and a resource manual, Family Guide — Emergency Health Care , were allo¬ cated to the respective States. All instruction is being conducted on a volunteer basis with training of one person in each family set as an ultimate goal. 2. Assistance to States and local communities to ensure an opera¬ tional capability to care for civilian health needs in an emergency. Effective preparedness depends on having sufficient quantities of medical and surgical supplies and hospital facilities for use where they are needed; and on having predesignated personnel organized and trained to act in a disaster situation and utilize supplies and facilties in the most efficient, prudent manner possible. The contents and condition of the nearly $200 million civil defense medical stockpile were reviewed and plans coordinated for its incorpo¬ ration into community survival efforts. Expansion was begun to in¬ crease the supplies of the 1,930 200-bed civil defense emergency hos¬ pitals (CDEH’s) stored throughout the United States to a 30-day capability from the former 3- to 4-day potential, and arrangements were made for the procurement, assembly, and distribution of an addi¬ tional 750 hospitals. Physicians and members of the allied health professions were given training in the health aspects of civil defense, setup and utilization of CDEH’s, and in expanded functions whereby the allied health pro¬ fessions can relieve physicians by performing additional duties in an emergency. 3. Development of a coordinated emergency program for Federal agencies having health or health-related responsibilities. Basic policy on the objectives, organization, functions and adminis¬ tration of the headquarters and regional Emergency Health Service structure was developed and issued in coordination with other agen¬ cies, and policy formulation begun for each field facility. To answer a need of community civil defense health planners, a guide is being prepared to give detailed advice on developing a com¬ munity emergency health service plan and organization and putting Public Health Service 157 them into operation. The guide will serve as a standard of compari¬ son for evaluating and improving community emergency health serv¬ ice plans and organizations already in existence, and for creating new ones where there is a need. Bureau of Medical Services The Bureau of Medical Services operates hospitals, clinics, health centers, and other health services in 256 full-time and 429 part-time locations, in this country and abroad, on land and on the sea, at major ports and on remote inland reservations. Some 13,000 staff members are engaged in these activities of the Public Health Service that pro¬ vide direct health care to many people and help to safeguard the Nation’s strength. Medical and hospital care is provided for American seamen. Inter¬ national travelers arriving from foreign points are checked against any possibility of contagious disease. American Indians and natives of Alaska are given comprehensive health care because they are not yet ready to provide it for themselves. Protection of the health of the men of the Coast Guard and the Coast and Geodetic Survey, and the cadets at the Coast Guard and Merchant Marine academies, is a re¬ sponsibility of the Bureau. Members and retired members of the armed forces and their families receive care at hospitals and clinics of the Bureau where more con¬ venient than military hospitals ; in turn, Public Health Service com¬ missioned officers may receive care in military facilities. A special hospital is devoted to treatment of leprosy. Treatment for narcotic addiction is given in two neuropsychiatric hospitals. The Bureau is responsible for medical and hospital care in all the Federal prisons and correctional institutions throughout the country. Medical and hospital care for civilian employees of the Government who are injured on duty or become ill from causes related to their work is administered by the personnel of the Bureau. In another program, health units are operated for a number of Federal depart¬ ments and agencies that have asked for this help in protecting their employees’ health. The Bureau of Medical Services conducts clinical research and carries on training programs for medical and health personnel. The Bureau is guided by recommendations of the BMS Advisory Committee on Hospitals and Clinics, and the Indian Health Advisory Committee, made up of experts from hospitals and health programs all over the country. 158 Department of Health , Education, and Welfare , 1962 Division of Hospitals The mission of the Division of Hospitals is primarily the operation of a medical care program for American seamen and other groups designated by Congress. In addition to seamen, patients include Coast Guardsmen and their dependents, uniformed service members of the Army, Navy, Air Force, Public Health Service, and Coast and Geo¬ detic Survey and their dependents, civil service employees injured in line of duty, persons with leprosy, narcotic drug addicts, and several other groups. It maintains working relationships with other components of the Public Health Service, constituent agencies of the Department of Health, Education, and Welfare, other Government programs, and public and private organizations that relate to the work of the Division. The Division contributes to the fulfillment of the Nation’s needs for scientific and technical manpower and for improved health care by training physicians, dentists, and paramedical personnel in its hos¬ pitals, by conducting clinical research, and by providing medical care to a substantial segment of the population, including persons having leprosy and those addicted to narcotic drugs. A problem yet to be resolved which is felt nationwide but partic¬ ularly in the larger cities is the need for post-hospital treatment and follow-up services at the local level for narcotic addicts. VOLUME OF PATIENT CARE Utilization of the 15 hospitals operated by the Division in fiscal 1962 exceeded that of the previous year. Admissions during 1962 totaled 51,251 — an increase of 3.4 percent over 1961. In addition, 948 babies were bom. The average daily inpatient census rose 1.4 percent to 4,801. Total outpatient visits increased 6.9 percent, to reach 1,277,965. Department of Defense uniformed service personnel and their de¬ pendents accounted for 33 percent of all admissions, 14 percent of the total average daily patient load, and 39 percent of all outpatient visits to PHS hospitals and outpatient clinics. COOPERATION REGARDING NARCOTIC PROBLEMS Thirteen Federal officials, representing the Interdepartmental Com¬ mittee on Narcotics, met at the Lexington PHS Hospital in June 1962 to become familiar with its operations and the program for the care of narcotic addicts. An Assistant Secretary of the Treasury headed the group. Members of the committee represented the White House, the Department of State, J ustice, and Defense, the Public Health Service, the Bureau of Narcotics, and the Bureau of Customs. Public Health Service 159 Three narcotic control officers from Thailand spent 3 days at the Lexington PHS Hospital observing its program for treating narcotic addict patients. Members of the National Narcotic Enforcement Officers Association, Inc., visited Lexington for orientation to the hospital’s program for medical care and vocational rehabilitation of narcotic addicts. The association has a membership of 80 Federal, State, and municipal enforcement officers. RESEARCH In cooperation with the National Cancer Institute, NIH, a collabora¬ tive cancer research program is being developed in Public Health Service hospitals. Initial plans primarily concern cancer chemo¬ therapy and involve the PHS hospitals at Baltimore and Boston. The San Francisco PHS Hospital and the Division of Chronic Diseases, BSS, are conducting joint research projects in heart disease control. A new program is underway for the early detection of oral cancer among patients in PHS hospitals and outpatient clinics. A pilot study is planned in the Staten Island, San Francisco, and Baltimore PHS hospitals and in the clinics in Washington, D.C., and Pittsburgh. A preventive medicine clinic was established in 1962 at the Boston PHS Hospital, in collaboration with the Division of Chronic Diseases, BSS. The new project aims to study and define the role of the hospital in the field of preventive medicine and public health. Intensive exam¬ ination of outpatients from the hospital’s regular outpatient popula¬ tion is conducted. Patients with detected disease entities are referred to the appropriate inpatient or outpatient service for definitive therapy. The coordinator of preventive medicine activities also stimulates the interest of the hospital staff in public health practices and methods and coordinates existing practices from the standpoint of preventive medicine. Twenty-one research projects were completed in the Division’s research program in fiscal year 1962. PROFESSIONAL TRAINING Ninety medical interns completed formal training in the hospitals in 1962. Of these, 59 remained in the Public Health Service. Forty residents completed formal training in the following cate¬ gories : anesthesiology, 2 ; dermatology, 1 ; general practice, 7 ; internal medicine, 9; obstetrics-gynecology, 1; ophthalmology, 3; pathology, 1 ; psychiatry, 3 ; radiology, 4 ; surgery, 8 ; urology, 1. Two medical officers completed 1-year residency training in oto¬ laryngology. Two specialists completed 2 years of training in research methodology. 160 Department of Health, Education , and Welfare, 1962 Plans were completed for the addition of full pediatric services at the Baltimore and Seattle hospitals. GOALS FOR FUTURE Goals of the Division include: improved physical facilities and equipment to enable the hospitals and clinics to provide medical care of a quality equal to that available in non- Government facilities; improvement of medical care for an increasing number of patients; continuation of present research programs and expansion of research ; continuation and increase of staff participation in teaching programs at medical and dental schools; expansion of approved residency train¬ ing programs in the hospitals. FEDERAL EMPLOYEE HEALTH PROGRAM Health protection for Federal employees was recognized as a respon¬ sibility of management in 1914 when the Treasury Department established a “relief room” in its main building. Today there has evolved an employee health service, sanctioned by Congress, which authorizes preventive health programs, with professional responsi¬ bility for the programs vested in a physician in charge. On a reim¬ bursable basis, the Federal Employee Health Program operates health units for Federal agencies requesting this service which serve as pat¬ terns of this type of health service. In 1962 two new health units were added, bringing the total to 39 serving more than 60,000 employees. Employee health maintenance examinations for personnel 40 years of age and older totaled 3,789. Immunizations were given as fol¬ lows : influenza, 32,322 ; poliomyelitis, 12,017 ; smallpox, 2,129 ; tetanus, 32,147. Screening tests given were: diabetes, 9,342; glaucoma, 728; visual acuity, 2,553. More than a quarter of a million visits were made to the health units. About 1 of every 5 visits was for some service prescribed by a private physician or dentist ; 1 of every 15 visits resulted in a referral to a private physician. FREEDMEN’S HOSPITAL Freedmen’s Hospital, Washington, D.C., provided care for 14,218 patients. The average daily census of 375 was the same as ill 1961. The average length of stay for the 14,211 discharged patients was 9.8 days. There were 3,199 live births. Outpatient visits in 1962 totaled 96,267, a slight increase over 1961. Inadequacies of the hospital’s physical facilities caused numerous operating problems in caring for these patients. Excessive crowding frequently occurred in the medical, obstetrical, and newborn serv- Public Health Service 161 ices. Renovations were undertaken on the third floor of the annex to allow the addition of 50 beds for medical and surgical patients. The attending and consulting staff of physicians and dentists totaled 217, an increase of 4 ; the courtesy staff consisted of 114. All training accreditations of the hospital were maintained. The hospital serves as the clinical teaching facility for junior and senior students of Howard University’s College of Medicine. The hospital also offers approved medical, dental, pharmaceutical, and dietetic internships and residency training in 14 medical specialties and in hospital administration. It has a school of nursing and a school of X-ray technology. The 50 available residency appointments at Freedmen’s Hospital were filled in 1962 ; among the residents were 20 graduates of foreign medical schools. There were also 22 medical interns, 2 dental interns, 2 pharmaceutical interns, 10 dietetic interns, 11 research fellows, and 1 administrative resident. The school of nursing graduated 35 student nurses, raising the total of the school’s graduates to 1,480. The school of X-ray technology continued efforts toward improving curriculum, clinical practice, and other activities. The six 1962 graduates of this 2-year course brought the total to 56. More than 32 clinical research projects were in progress during the year. Sixty or more scientific articles by staff members were published or were in press. Legislation authorizing the transfer of Freedmen’s Hospital to Howard University was approved by the 87th Congress on September 21, 1961. The actual transfer date had not been established as of the close of the 1962 fiscal year. Foreign Quarantine For the 15th successive year the Nation was free from quaran tin- able diseases known to have been introduced from abroad. Quarantinable diseases were introduced into some countries that had been free of such infection, and there was a resurgence of these diseases in some endemic areas of the world. The Division of For¬ eign Quarantine faces an increasingly significant challenge in prevent¬ ing the importation of quarantinable diseases. In 10 years there has been an increase of nearly 300 percent in the annual number of quarantine inspections of persons arriving in this country by air. Special vigilance was maintained at U.S. quarantine stations dur¬ ing the year on the basis of outbreaks of quarantinable disease. By direct efforts and through cooperation of State and local health de¬ partments and other organizations, the Division took action to raise the immunity level of the traveling public, of persons employed in 162 Department of Health, Education, and Welfare, 1962 port areas and adjacent communities, and of persons throughout the Nation who meet or treat the sick. QUARANTINABLE DISEASES There were five separate importations of smallpox into England and Wales, all from South Asia. These resulted in 69 additional cases with 24 deaths. One of the imported cases and one secondary case were not recognized as smallpox until resultant cases and deaths had been diagnosed. There were two smallpox importations into Germany, one from Africa, the other from South Asia. Several smallpox cases were detected on ships. The most signi¬ ficant instance occurred at Nowy Port, Poland, where one crew mem¬ ber of the S.S. Indian Resolve was found to have the disease. There were 70 secondary cases in crew members, and cases were confirmed in a quarantine officer and three Polish guards. There was a resurgence of smallpox in Ceylon. The disease is endemic in Brazil, Ecuador, and parts of Africa and Asia. The magnitude of the spread of cholera to areas of eastern Asia cannot be estimated. More than 7,000 cases were reported in the Philippines, where the presence of the disease posed a threat to other nations — especially danger of importation by small fishing craft into other Pacific islands. Sporadic cases of yellow fever continued to be reported from en¬ demic areas of South America and Africa. Plague cases occurred sporadically in old endemic foci, with two major outbreaks — in Kolar District, India, and in Ecuador, includ¬ ing the port of Manta. Two cases of plague were reported in the United States in persons who had been in contact with wild rodents or their ectoparasites in areas of New Mexico of no importance to in¬ ternational traffic. Typhus (louse-borne) continued to be present at a low endemic level in some areas of Mexico, Ecuador, and Peru and in Yugoslavia and the United Arab Republic. Typhus and relapsing fever are a major problem in Ethiopia, where more than 2,000 cases of each dis¬ ease were reported in calendar year 1961. INTERNATIONAL TRAFFIC In the United States, the number of inspections of aircraft for quarantine or immigration-medical purposes was about the same as in 1961 — over 65,000. There was an increase of 12.9 percent in quarantine inspections of persons arriving by plane — from 2,417,238 to 2,728,253. Inspections of ships increased from 32,105 to 32,980 and inspections of persons arriving by ship increased from 1,966,580 to 1,985,318. Public Health Service 163 Persons subject to quarantine inspection arriving in the United States by all modes of travel, including land entry from the interior of Mexico, increased from 5,607,218 in 1961 to 6,112,332 in 1962. It was necessary to detain 65 persons in isolation, compared with 11 in 1961. The number of persons who were allowed to continue to their destinations in the United States, but placed under medical surveil¬ lance, was 328,928 compared with 91,985 in 1961. MEDICAL EXAMINATIONS Establishment of Fee A fee of $10 was established for visa medical examinations per¬ formed by the Division of Foreign Quarantine, effective December 1, 1961. Fee collections will repay the Government for cost of the visa examination activities of the Division of Foreign Quarantine. General Program The number of alien applicants for visas who were examined by medical officers abroad increased 2.2 percent, from 185,142 in 1961 to 189,192 in 1962. Of these, 97 percent were immigrants. There were 1,765 who were found to have diseases or conditions excludable under immigration law. Aliens examined on arrival at U.S. ports increased 5.2 percent, from 3,132,313 to 3,295,999. There were 3,049 found to have excludable diseases or defects; 18 percent of these had been so diagnosed abroad, but were admitted under special provisions of immigration law. Staff in Europe examined 6,552 refugee-escapees under Public Law 86-648, and 111 were found to have excludable conditions. Some with excludable conditions were admitted to the United States by the Im¬ migration Service subject to necessary controls. Special arrangements were made for medical examination of Chinese refugees leaving Hong Kong for the United States. Immigration of Tuberculous Aliens The Division arranged for health controls for certain immigrants with tuberculosis whose entry is authorized by amendment to the Im¬ migration and Nationality Act effective September 26, 1961. The immigrants must be members of the immediate family of a U.S. citi¬ zen, of a resident alien, or of an alien who has been issued an immi¬ grant visa. Health control provisions contain improvements over those enforced under a similar, temporary law that applied to tubercu¬ lous aliens receiving visas before July 1, 1961. The U.S. quarantine service placed 800 arriving aliens under health controls for tuberculosis in 1962, compared with 929 in 1961. 164 Department of Health , Education , and Welfare , 1962 Additional Change in Immigration Late Amendment to the Immigration and Nationality Act also provided that “leprosy” and “tuberculosis in any form” are no longer specified within the act itself as conditions excluding aliens from admission to the United States. Leprosy and tuberculosis are now designated in Public Health Service regulations as “dangerous contagious diseases,” which are excludable under the act. Coverage of these two diseases by regulations allows more flexibility of terminology and procedures, in line with current medical concepts. Migratory Farm Labor In the program of recruiting farm workers from Mexico, 292,087 laborers were examined, with 4,533 rejections, at 3 centers in Mexico. At 5 border reception centers in the United States 310,247 examina¬ tions were made, with 5,519 rejections. At the reception centers 287,- 672 serologic tests for syphilis were made, with 13,267 positive re¬ actors. The rate of positive reactors decreased from 52 per 1,000 men tested in 1961 to 46 per 1,000 in 1962. Treatment is given to positive cases, and they are admitted to the country. ENTOMOLOGY AND SANITATION PROGRAMS The program for control of the yellow fever mosquito, Aedes aegypti , was carried on in more than 100 international traffic areas within the yellow fever receptive zone in southern United States and insular possessions. The infestation index was kept at zero in 88 of these areas and at a relatively low level in the rest. Inspections of aircraft arriving from foreign countries revealed the presence of more than 21,000 insects, including many of medical importance. There were 53 species of mosquitoes, 15 of which do not occur in this country. The Division’s entomologist in Honolulu discovered the presence of two species of mosquitoes new to Hawaii and Guam, respectively. Aedes vexans nocturnus , suspected in the transmission of Japanese-B encephalitis, was detected in Hawaii. Culex tritaeniorhynchus , the principal vector of Japanese-B encephalitis, was discovered in Guam. Only a small percentage of ships entering United States ports showed evidence of appreciable numbers of rats. The sanitation program has resulted in considerable improvements on many ships. OTHER QUARANTINE ACTIVITIES An improved surveillance method was adopted for use in placing arriving international travelers under control by local health officers. The U.S. Armed Services jointly issued revised quarantine regula- Public Health Service 165 tions affording stronger defenses against disease importation, in ac¬ cord with suggestions from the Division of Foreign Quarantine. At El Paso, Tex., procedure was initiated that permits certain private aircraft to enter from northern Mexico without inspection by a Public Health Service quarantine officer, provided the pilot com¬ pletes a health certification form in the presence of a customs officer. A quarantine officer must be called in if any health problem arises. Extension of the procedure to private aircraft throughout the entire border area can help provide protection where coverage of all traffic by each Government inspection agency would present tremendous practical problems. The International Certificates of Vaccination against smallpox, cholera, and yellow fever were included in a booklet form published by the Division. Health Services for Indians and Alaska Natives More than 380,000 American Indians and Alaska Natives (Aleuts, Indians, and Eskimos) look to the Indian health program for pre¬ ventive and curative medical service. The purpose of the Division of Indian Health is to provide this care to Indians and Alaska Na¬ tives where they are and when they need it, and to raise the level of health to that of the general population. MEDICAL FACILITIES In 1962, the Division operated 24 health centers, 17 school health centers, and several hundred field stations, 50 hospitals (seven in Alaska) with 3,280 beds, and had contract arrangements with 200 other hospitals with 1,000 beds. There were 18 contracts with State and local health departments for public health services. Physicians and dentists in private practice furnished medical and dental care on a contract basis. A new 34-bed hospital was opened at Kearns Canyon, Ariz. A new 50-bed hospital was opened at Kotzebue, Alaska — 150 miles across the Bering Strait from the Soviet Union. The Kotzebue Hospital serves 7,500 natives, mostly Eskimos, from an area of 68,000 square miles and 28 scattered villages. There are no roads leading into Kotzebue. Transportation is by plane, dog- sled, or boat. Additions to hospitals at Cass Lake, Minn., and Fort Defiance, Ariz., were completed. Health stations were constructed at Ponemah, Minn., Pryor, Mont., and La Plant, Wakpala, and Norris, S. Dak. HEALTH RESULTS Illustrative of the advances that have been made since the program was transferred to the Public Health Service in 1955 is the decline in 166 Department of Health, Education , and Welfare, 1962 the numbers of new cases and of deaths due to tuberculosis, a continu¬ ous downward trend since a peak in 1956. The downward trend results partially from the new drugs and other measures being used successfully in controlling tuberculosis during the last few years. Of equal importance is the substantial improvement in the quality and scope of health services provided. F or example, there has been an increase in outpatient treatment and in case finding. Even with the advances in the last 7 years, the average age at death is 41 for an Indian and 30 for an Alaska Native as compared to 62 for the general population. The tuberculosis rate is still 4% times greater among Indians and seven times greater among Alaska Natives than among the general population. The infant mortality rate has declined 40 percent since 1954 but is still three times greater than that of the total population. Despite the high prevalence of influenza, pneumonia, tuberculosis, and gastroenteritis, accidents are the leading cause of death. The rate of deaths due to accidents is three times higher among Indians and four times higher among Alaska Natives than in the total popu¬ lation. Accident prevention campaigns are imder way. The second most common cause of death is heart disease. Degen¬ erative diseases are less frequent than in the general population, be¬ cause half of the Indians are under 20 years of age. PROFESSIONAL STAFF Improvements have been made in correcting critical staffing defi¬ ciencies. Additional health workers — including physicians, dentists, sanitary engineers, sanitarians and sanitarian aides, pharmacists, public health nurses, trained practical nurses, dental assistants, social workers, medical record librarians, nutritionists, dietitians, and health education workers — have been added to the field staff. The full-time staff now numbers about 5,000 with less than 150 in Washington. More than half of the staff is of Indian descent. HEALTH EDUCATION The goal of health education activities is to bring to the Indian people a better understanding of the fundamentals of good health, and to create within them a desire to assume responsibility for taking the necessary steps to improve their health. That a measurable degree of success is being achieved is indicated by the increasing cooperation of Indians in program activities — im¬ munization, for example — and by the growing number of Indians who participate directly in program planning. Public Health Service 167 In 1962 the health education staff numbered 41, most of whom were Indians with college training in education, anthropology, or sociology. THERAPEUTIC SERVICES The more than 81,000 admissions to Indian hospitals in 1962 re¬ flected a changing pattern in Indian health. There were fewer tuber¬ culosis patients, and their hospitalization periods were shorter. This meant more facilities were available for the practice of preventive medicine. In 1962, the number of therapeutic services to outpatients and pre¬ ventive health services continued to increase. At the hospitals, 674,000 outpatients visits were recorded in 1962 — an increase of 7 percent over 1961. More than 400,000 visits for medical services were made to health centers, stations, and other clinic locations. There was a 6 percent increase in hospital nursing and a 5 percent increase in field nursing. The professional competence of nursing staff was upgraded through advanced training in nursing services administration and in maternal and child health. Additional train¬ ing in pediatrics, obstetrics, medical surgical nursing, operating room nursing, and central supply techniques was provided for practical nurses. In Alaska, the number of clinics held in villages increased. Almost 100 villages were reached by doctor, nurse, or technician. Three additional hospitals were staffed with pharmacists in 1962, so that 89 percent of patients and 81 percent of those coming for out¬ patient care received medical care at hospitals with pharmacists. Dur¬ ing the year 627,000 prescriptions were dispensed to 510,000 outpatients, an increase of 23 percent. The 175 health facilities which did not have pharmacists (schools, small hospitals, health centers, health stations and locations) received drugs and pharmacy services from hospitals with pharmacists. Many Indians living on reservations are almost untouched by present-day views of nutrition. Often their food customs have been handed down from generation to generation. In some instances their food resources are scarce. Thus education, in-service training, and cooperative research were important in the work of the nutrition and dietetics staff in 1962. Nutrition education and training materials were developed. Stud¬ ies of nutritional status and dietary practice were conducted on two Montana reservations, in cooperation with the Interdepartmental Committee on Nutrition for National Defense. A 3-year nutrition- dental study in Indian boarding schools in North Dakota and South 168 Department of Health , Education , and Welfare , 1962 Dakota was completed. A diabetes study among Oklahoma Indians was begun, in cooperation with the Division of Chronic Diseases, Bureau of State Services. Medical record librarians were added to the staffs of the hospitals in Gallup, N. Mex., Fort Defiance, Ariz., and Tuba City, Ariz. The goal is to provide a librarian for every hospital of 50 beds or more. For smaller hospitals, young Indians will be trained as medical record technicians. MATERNAL AND CHILD CARE An increasingly successful part of the Division’s work in maternal and child care has been in bringing to Indian mothers a perception of health practices that is in accordance with modern medicine. Eighty- eight percent of Indian mothers now give birth to their babies in hos¬ pitals, and there is greater acceptance of prenatal care. Infant mortality has declined 30 percent in the past 7 years but the death rate between the ages of 28 days and 11 months remains high. Principal causes of these deaths are diarrhea and respiratory diseases. Therefore, efforts have been increased to educate mother and family in good health habits, and to inform them of the availability of health facilities and the importance of early care for sick children. Sig¬ nificant reduction in infant mortality will be realized only as economic status, housing, sanitation, and living conditions in general are improved. Consultants and physicians with special training in maternal and child health have been added to the staff. Specialized training in many phases of maternal and child care has been provided. Rehabilitation of handicapped children received increased attention. TURERCULOSIS Tuberculosis, once the leading cause of death among Indians, has dropped to eighth place. The number of Indians entering hospitals with tuberculosis, the length of their stay, and the rate of new cases reported have declined, but in some areas tuberculosis is still several times more frequent than in the general population. In 1962 the daily tuberculosis census in the hospitals was approxi¬ mately 24 percent of the total daily census — a reduction of approxi¬ mately 58 percent in 7 years. The decline in the death rate in the last 7 years has been 48 percent among Indians and 83 percent among Alaska natives. DENTAL HEALTH Emphasis on preventive dental care was increased in 1962. Fluori¬ dation equipment was provided at Mount Edgecumbe, Alaska, and Public Health Service 169 Metlakatla, Alaska, and on the Menominee Reservation in Wisconsin, and a program was begun for the use of dietary fluorides where water fluoridation is not feasible or adequate. There were 203,000 dental visits during the year; 95,500 patients were examined and 85,000 received dental services. This means that approximately 25 percent of the 380,000 Indians and Alaska natives were examined and they received about 54 percent of the care needed. A periodontal program was instituted by a trained periodontist. A total of 33 dental officers and 19 auxiliary dental workers received some type of training. Twenty-four women, Indians and Alaska natives, were trained as dental assistants. New mobile dental units were placed in service in the Aberdeen and Albuquerque areas. ENVIRONMENTAL SANITATION Environmental sanitation is a basic problem. Water supplies are often polluted and inadequate for domestic use, and frequently must be hauled for great distances. Waste disposal is often primitive. Under Public Law 86-121, enacted in 1959, the Public Health Service was given authority to work with the Indians and Alaska natives in construction of sanitation facilities for their homes and communities. The work is handled on an individual project basis. Participation of Indians and Alaska natives in the project construction and their assumption of responsibility for operation and maintenance of com¬ pleted facilities are essential elements of the activity. In 1962, there were 57 projects authorized, on 30 Indian reservations and in 6 Alaska native villages and 6 Indian communities, to serve 4,800 homes and 24,000 persons. Funds appropriated aggregated $3 million. TRAINING FOR INDIANS AND ALASKA NATIVES More than half the employees of the Division are of Indian herit¬ age. Formal courses and in-service training are provided for them and for Alaska natives in almost every phase of the Indian health program. Fifty-eight young women were trained as practical nurses in the Public Health Service school of practical nursing in Albuquerque. For the first time, practical nurses were given additional training to assist public health field nurses. Courses for sanitation aides, dental assistants, community health workers, and food service supervisors were given at many locations. 665171-63- •12 170 Department of Health , Education , and Welfare , 1962 CONSTRUCTION ACTIVITIES A new 36-becl hospital at San Carlos, Ariz., was to be completed in the fall of 1962. Plans were developed for a new 12-bed hospital at Barrow, Alaska. Hospital additions at Red Lake, Minn., and Bethel, Alaska, were under construction. Alterations changing the former Fort Peck Hospital at Poplar, Mont, to an outpatient health clinic were underway. Contracts were being negotiated for plans and speci¬ fications for a new 27-bed hospital at Fort Yates, N. Dak., and for an additional wing and alterations at the Crow Agency Hospital, Crow, Mont. A study was underway of the feasibility of a 200-bed hospital in Phoenix, Ariz. Ninety-five new quarters for personnel at various locations were under construction, and 119 housing units were completed. PROSPECTS FOR THE FUTURE The success of the drive against tuberculosis and other critical health problems of the Indians has brought brighter prospects for the libera¬ tion of these Americans from the bondage of illness. Health educa¬ tion is contagious. More and more Indian people are learning and using improved health practices in their homes and communities. Tribes are creating new health programs of their own, and expanding existing activities. The low economic level of the Indians and Alaska natives, the barriers of language and culture, the hazards of travel over miles of desert or tundra are formidable obstacles. But a sound beginning has been made. The program is moving with faster pace toward the time when people now aided by the Federal Government may well assume the major responsibility for their own health services. Medical Services for Federal Agencies The medical services of the U.S. Coast Guard and the Federal Bureau of Prisons are legal responsibilities of the Public Health Service and are operated by Bureau of Medical Services personnel assigned to these agencies. The medical programs of the Bureau of Employees’ Compensation of the Department of Labor and the Mari¬ time Administration of the Department of Commerce are conducted by personnel detailed to these agencies. UNITED STATES COAST GUARD, TREASURY DEPARTMENT A crew member aboard the U.S.C.G.C. Northwind while on the Bering Sea Patrol was struck by a large section of falling ice as it was being cleared from the vessel, and was knocked unconscious. Examination by the medical officer found the patient in shock, bleed¬ ing from the mouth, ears, and nose, and with serious head and back Public Health Service 171 injuries with suspected fractured skull and ribs. Treatment for shock was successful, and the patient soon became conscious and rational although in critical condition. He was evacuated by air to hospital facilities ashore. The physician, a Public Health Service officer, was credited with saving his life. In all, 103 PHS officers served the U.S. Coast Guard in 1962 — 33 physicians, 52 dentists, 12 nurses, a pharmacist, a dietitian, a scientist, and a sanitary engineer. Most were on full-time duty. Some were on temporary assignment aboard vessels in the Bering Sea Patrol or icebreakers in the Arctic and Antarctic, or on ocean weather duty in the Atlantic and Pacific. A training program to provide a small group of flight surgeons for the Coast Guard was begun. A training officer was added to head¬ quarters staff to help develop training aids for nonmedical personnel, indoctrinate new professional personnel in military medicine, and review medical practices and standards. Improved utilization of mobile dental units was effected. BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR In July 1961 a student employed during the summer as a smoke jumper with the Aerial Fire Depot, Forest Service, Missoula, Mont., sustained serious back injuries when dashed against a rock by oscilla¬ tions of his parachute. This resulted in loss of use of both legs and loss of major functions of both arms. Following approximately a year of rehabilitation services at the Institute of Physical Medicine and Rehabilitation, New York City, he was able to move about in a wheelchair and was ready to go on with his education — to prepare for a suitable vocation. He planned to enter the University of Florida in the fall of 1962. The case illustrates the continuing emphasis the Bureau of Em¬ ployees’ Compensation gave in 1962 to the rehabilitation of Federal employees injured in the performance of duty. Rehabilitation facili¬ ties throughout the United States were used. Through cooperation with the Office of Vocational Rehabilitation, there was increased util¬ ization of State vocational rehabilitation services. Medical officers of the U.S. Public Health Service are assigned to the Bureau and administer the complete medical program under the Federal Employees’ Compensation Act and related acts. During the year the Bureau was completely decentralized. Field offices were established in San Francisco, Seattle, Chicago, Cleveland, Boston, New York City, Washington, D.C., Jacksonville, and New Orleans. Medical services for injured employees are provided by hospitals and clinics of the Public Health Service and other Federal hospitals. Where no Federal medical facilities are available, medical treatment 172 Department of Health, Education , and Welfare, 1962 in private hospitals is provided through the direction of private physicians designated by the Bureau. MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE The physician and two dental officers on duty at the U.S. Merchant Marine Academy, Kings Point, N.Y., cared for the health of 700 cadet midshipmen. The medical officer in charge of the Public Health Service Hospital on Staten Island acted as professional consultant for the academy’s health program. There were 692 admissions to the academy’s Patten Hospital. Out¬ patient medical services and treatments given by the physician num¬ bered 4,066. There were 4,053 dental visits. The North Shore Hos¬ pital, a community hospital in Manhasset, N.Y., provided emergency medical care for cadets when necessary. BUREAU OF PRISONS, DEPARTMENT OF JUSTICE For the 32d year, the Public Health Service provided medical, psychiatric, psychological, dental, nursing, and related health services for Federal prisoners. The Bureau of Prisons operated 24 hospitals and 6 infirmaries in institutions over the country. Fifteen of the hos¬ pitals have been fully accredited by the Joint Commission on Ac¬ creditation of Hospitals. Full-time staff assigned to the program numbered 272. The staff was augmented by 275 consultants in the various medical specialties. Approximately 900 prisoners were assigned to the medical services where they receive training and assist with hospital care. There were more than 23,800 Federal prisoners at the end of the year. The hospitals provided 417,838 hospital relief days during the year, medical staffs performed 862 major operations and 6,649 minor op¬ erations, and the outpatient departments provided 1,054,502 treat¬ ments. A total of 36,634 physical examinations were performed. The two institutions for women reported 31 births. Deaths in all in¬ stitutions totaled 45. There was a continued increase in the demand for psychiatric diag¬ nostic and treatment services, which are required under the provisions of the Youth Corrections Act, the New Sentencing Act, and the act providing for the care and custody of insane persons charged with or convicted of offenses against the United States. Efforts to recruit additional trained personnel to provide these services were continued. Plans for New Psychiatric Hospital In May 1962 the Attorney General announced that a new 700-bed psychiatric hospital for Federal prisoners will be located at Butner, N.C., a site within easy commuting distance of the Duke University, University of North Carolina, and Bowman-Gray medical schools. Public Health Service 173 Planning of the facilities was completed with the assistance of con¬ sultants from the National Institute of Mental Health, Saint Eliza¬ beths Hospital, and the Veterans Administration. An architectural competition for the hospital design was held, and a design prepared by A. L. Aydelott and Associates of Memphis, Tenn., was chosen by the judges. The new hospital will provide a full range of facilities and resources for diagnosis, treatment, training, and research. Recommendations of Advisory Committee The Surgeon General’s Advisory Committee on Hospitals and Clinics met at Atlanta in April 1962, following visits to prison hos¬ pitals, to consider the prison medical care program. The committee made a series of recommendations which included increases in staff and improvements in hospitals. These recommendations are receiving continued study. Hospital Improvements Modernization of the hospital at Chillicothe, Ohio, was completed ; one wing was converted into office and conference rooms for the psy¬ chology training program. New offices were completed at the Atlanta penitentiary for the psychiatrist and psychologist. The hospital in Danbury, Conn., was renovated. Planning and construction of im¬ proved facilities for the care of disturbed psychiatric patients was underway in several locations. Some refurbishing of the hospital at Terre Haute, Ind., was completed. Construction of a new central dental laboratory was begun at Lewisburg, Pa. Clinical Services Cancer detection and the control of tuberculosis and other infectious diseases were stressed in preventive health programs at several insti¬ tutions, including Alcatraz ; Alderson, W. Va. ; Atlanta ; Leavenworth ; El Reno, Okla. ; and McNeil Island, Wash. Psychiatric services were extended in several institutions through use of consultants. For example, members of the psychiatric staff at the Public Health Service Hospital, Lexington, Ky., now visit the Federal Reformatory for Women at Alderson regularly to provide much needed psychiatric consultative services for women prisoners. This gives the Lexington staff access to certain unusual cases with important teaching value, which can be transferred to Lexington for continued study and treatment. The staff at Chillicothe obtains specialized eye, ear, nose, and throat treatments for young men through a similar cooperative arrangement with the Ohio State Uni¬ versity Hospital. 174 Department of Health , Education , and Welfare, 1962 Continued emphasis was given to high quality dental care, use of group treatment methods, and careful control of sedative-type drugs to prevent any abuses in their use. Improvements were made in training programs for medical technical assistants and in the pro¬ grams for training prisoners in nursing techniques. The central dental laboratory at the Springfield Medical Center completed 2,505 dental prosthetic appliances. Demonstration Counseling A demonstration project in group counseling was begun at the National Training School for Boys, Washington, D.C. Directed by a psychologist and a psychiatric social worker, the project is de¬ signed to establish a group counseling program using existing staff, and to measure the effect of the program on individual boys and on the school as a whole. Early reports indicated that the program was having a favorable effect in rehabilitation of youthful offenders. Research Recruitment of prisoner volunteers for cold virus studies conducted at the Clinical Center, National Institutes of Health, was continued. The staff at Leavenworth continued studies of prisoners with histories of drug addiction. At Lewisburg, a study to improve the standardi¬ zation of the glucose tolerance test was begun. The psychiatrist and psychologist at Lewisburg are participating in this study with a pilot program designed to learn more about the motivation of prisoner volunteers. The staff at Atlanta worked with the Communicable Disease Center in a study of the transmission of gonorrhea, employing prisoner volunteers. Malaria studies at Atlanta were continued. Participation in Community Affairs Medical personnel shared professional experiences with colleagues in nearby communities. For example, the staff at Leavenworth at¬ tended medical grand rounds at the Wadsworth Veterans Administra¬ tion Hospital and clinical pathological conferences at the Kansas City Medical Center. The staff at Ashland, Ky., exchanged visits with the Department of Psychiatry at the University of Cincinnati. The staff of the Medical Center for Federal Prisoners in Springfield, Mo., is active in the Greene County Medical Society, and psychiatric person¬ nel from the Medical Center assist in the staffing of the Greene County Guidance Clinic. Prisoners’ blood donations to the American Red Cross and local blood banks in 1962 totaled 12,531 pints. Public Health Service 175 Bureau of State Services Programs of the Bureau of State Services are primarily responsible for the application of health knowledge in two broad areas of need — to encourage the development of comprehensive health services in the Nations’ communities, and to safeguard human health against hazards of the natural and man-made environment. The solution to both these problems depends in large measure upon the actions of State and local health agencies. Therefore the Bureau concentrates a major share of its attention upon strengthening these activities — through grants in aid, through training and demonstration projects, and in many other ways. The programs of the Bureau have been grouped into two operating units, concerned respectively with community and environmental health, to make possible a more efficient and effective attack on these problems. Among the year’s highlights was the passage of the Community Health Services and Facilities Act of 1961, designed to stimulate improved community programs, particularly for the chronically ill and aged. In the first 6 months of operation, 44 grants were awarded under this act, totaling $2.3 million in Federal funds, to help support a wide range of special projects in this field. The Robert A. Taft Sanitary Engineering Center, now directly under the administration of the Bureau, conducts an extensive pro¬ gram of research training and consultation in problems of air and water pollution, radiological health, and food sanitation. Many of its projects are reported by the divisions in these program areas. The Arctic Health Research Center at Anchorage, Alaska, conducts studies of special health problems related to life in cold climates. Division of Accident Prevention Support of research into accident causes and preventive measures increased about 50 percent, both in funds and in projects, in fiscal year 1962 over fiscal year 1961 — 38 grants and $1,917,419 as against 25 grants and $1,254,666. This graphically illustrates the increasing interest and ability of the scientific community to devote its capabili¬ ties toward providing needed basic knowledge of both the human and the environmental factors involved in accidents — still the fourth leading cause of death in the United States, the leading cause in the age groups from 1 to 35 years old, and the leading destroyer of the Nation’s military and productive strength. 176 Department of Health, Education, and Welfare, 1962 Similar progress accompanied the Division’s efforts in areas of immediate, practical interest. A dramatic increase in the installation and use of automobile seat belts resulted largely from the Division’s national campaign in cooperation with the American Medical As¬ sociation and the National Safety Council. Results of the study on community organization and publicity to reduce accident rates in the j Shenandoah Valley of Virginia were distributed to all public-health agencies. The Arkansas fire-prevention project continued to draw wide interest and praise from health and fire authorities. The “Blue¬ print for Life” program in Cleveland, Ohio, is providing valuable experience in the integration of all official civic and voluntary agencies on a concentrated effort to reduce accidents in a metropolitan area; the seven films produced in connection with it are now in nationwide use, and two were awarded Certificates of Merit by the National Committee on Films for Safety. Among many major new projects begun in fiscal year 1962 are: 1. Establishment of a center for the study of accidents to the aged, in cooperation with the Florida State and Pinellas County Health Departments. 2. A study of emergency medical services, in cooperation with the California State and San Francisco City-County Health Departments. 3. A study of methods to prevent injuries to the head (especially dental, visual and hearing impairments) in contact sports and out¬ door recreation. 4. A study of accidental poisonings among children, with empha¬ sis on preventive measures, in Charleston, S.C. (The Division is a cooperative member of the Steering Committee for National Poison Prevention Week, which was proclaimed for the first time in March 1962 by the President. Over 470 poison-control centers are now af¬ filiated with the National Clearinghouse in this Division.) 5. A study of prevalence and prevention of accidents involving glass doors and glass areas adjacent to glass doors. 6. A study in Philadelphia, Pa., into the effectiveness of the group- discussion technique in reducing accidents. Many other projects are in various stages of planning, operation, and reporting, including such diverse subjects as mouth-to-mouth resuscitation ; incorporation of accident prevention into the daily rou¬ tine of local public-health nurses and sanitarians ; accidents involving the use of power lawn mowers, flotation devices, guns, and coin- operated dry cleaners ; and the comparative value of various media of communication in indoctrinating specific audiences. Public Health Service 177 Division of Chronic Diseases In fiscal 1962 the program activities of the Division of Chronic Diseases focused largely on the expansion and improvement of com¬ munity-based, out-of -hospital services for the chronically ill and the aged. These activities were carried out in two principal stages: 1. The utilization of a 1.7 million dollar appropriation to stim¬ ulate and support a series of pilot projects in selected States and communities, and; 2. The rapid extension of such pilot projects to additional States and communities following passage in mid-year of the Community Health Services and Facilities Act of 1961. The Division carried the major burden of administering the ex¬ panded program of formula grants in the Act as well as a new pro¬ gram of special project grants. Under the former responsibility $4,858,872 (81 percent) of the total $6 million appropriation was utilized by the States. Of the 44 special project grants in the community health area which were approved and funded, 26 are being administered by the Division. These 26 projects account for nearly $1 million of the total $2.3 million first-year appropriation. CANCER CONTROL The Cancer Control Program is concerned with communication of “practice-ready” research information to medical and health workers in a form which will enable them to use it in their own communities. Demonstration Projects Grant projects offer (1) a means of testing and evaluating pilot programs under field conditions, and (2) an instrument utilized to demonstrate to local communities techniques and procedures of proven and established value. Since the inception of the project grant program in 1959, there have been 255 grants approved, in 34 States, the District of Columbia, Puerto Rico, and in cooperation with 4 na¬ tional medical organizations. The amount of money involved totals $6,564,219. More than 250 conferences were held with staffs of health agencies in all of the States and Puerto Rico, largely to bring results of the experiences of demonstrations and pilot projects to other groups en¬ countering similar problems. It is generally accepted that the best opportunity for cancer control lies in cancer of the cervix, since the Papanicolaou smear offers the possibility of early detection. However, this program is an extremely 178 Department of Health, Education , and Welfare, 1962 complex one which has in it many chances for error. Based upon 3 years of intensive work with cervical cancer detection programs, the Cancer Control Program stated the 14 elements which are essential to the successful detection project. Utilizing resources available in the demonstration grant system, 18 communities throughout the country, which have technical resources available for good control programs, were selected for “model” programs. These showcase communities are to be used to communicate the procedures of good cervical cancer control to other areas. Clinical Traineeships, State Grants During the year, a program of senior clinical traineeships was initiated. Support in the form of stipends is made available to fully- trained physicians who have completed resident training in a medical specialty and who desire additional training in the specialty as it deals with the management of patients with neoplastic diseases. A system of grants to States for development of cancer control pro¬ grams is being administered by the Cancer Control Program. In the fiscal year 1962, the amount granted to States was $3,500,000. DIABETES AND ARTHRITIS PROGRAM Activities of the Diabetes and Arthritis Program continue to be directed toward the goal of minimizing the severity and complications of diseases in its area of interest by early detection and prevention. Program Application Consultative services to States and regions were continued along with provisions for supplying screening materials and temporary loan of personnel. Continued evaluation of diabetes reporting by States was executed. A system designed to facilitate statistical reporting was developed and initiated on a pilot basis. Field trials of a teaching machine began. Adapted with a film se¬ quence on diabetes, the machine was placed in various clinic settings for evaluation as a teaching method. Preliminary data suggest that it will be a valuable tool for education of both newly diagnosed pa¬ tients and those with disease of long standing. Plans for a similar application of the teaching machine method to professional education resulted in extensive work on the filmstrip portion. Toward the end of the fiscal year, a physician director and a public health advisor were assigned to the Branch full-time for arthritis activities programing. Applied Research Plans took shape for studies in arthritis by the Boston Laboratory. Preparations were made for investigating methods of screening for gout and estimating its prevalence. Public Health Service 179 A study was initiated in a Federal prison to determine tlie repro¬ ducibility of the Glucose Tolerance Test and its proper place in the diagnosis of diabetes. Preliminary evaluation of data on the Federal Employee’s Health Study was begun. Factors relative to the predic¬ tion of diabetes and its long and short-term effects on new found cases are being considered. HEART DISEASE CONTROL PROGRAM The Heart Disease Control Program provides professional, techni¬ cal, and financial assistance to health departments in all States and Territories to help them apply heart disease research findings in as many communities as possible. A major method is assignment of field officers to stimulate or con¬ duct heart disease control programs. This year, 131 officers — medical, nursing, nutrition, social service, physical therapy, or public health advisors — have been assigned to States that requested them. Eleven career medical officers are training in public health. Heart Disease in Children Sixty-six laboratory technicians from all 50 States, 4 Territories, and 5 cities have now been trained in cooperation with the Communi¬ cable Disease Center in the fluorescent antibody technique for the rapid identification of the organism associated with the onset of rheumatic fever and rheumatic heart disease. In-State training courses have been conducted in IT States for 320 technicians, and full use of training equipment and personnel is scheduled into late 1963. The aim is to make the technique widely available so that physicians will have a rapid means of diagnosing “strep throats” in order to pre¬ scribe antibiotic prophylaxis. Inexpensive portable equipment to tape- record heart sounds was developed for use in screening school children for heart disease, and preliminary field testing of the equipment was conducted in Dickinson, N. Dak., and Michigan City, Ind. Heart Disease in Adults Various projects have demonstrated effective methods of rehabil¬ itating stroke patients, and services are being expanded. Prevention of strokes, though difficult, may be practical as a community service. A Portland, Oreg., study is investigating methods of preventing major strokes by early diagnosis and medical and surgical treatment of patients with signs and symptoms of cerebrovascular insufficiency. Childhood obesity in relation to adult morbidity and premature mortality from cardiovascular and other diseases is being evaluated in a Hagerstown, Md., study. An electronic system, including a digital computer, for analyzing electrocardiograms was developed and installed in Washington, D.C. 180 Department of Health, Education , and Welfare, 1962 Tests relaying electrocardiographic signals by telephone from San Francisco and other locations to Washington will be conducted to demonstrate the use of the computer system as an aid to physicians in the diagnosis of heart disease. The program is conducting four field stations. The Heart Disease Control Laboratory at the Communicable Disease Center serves as a “bureau of standards” for many State and epidemiologic laboratories for the development and standardization of cholesterol determinations. A field and training station was established in San Francisco to pro¬ vide professional consultative and laboratory services to health agencies and medical groups in the West. The reasons for the large geographic differences in the occurence of heart disease will be studied at the new Ecology Field Station in Columbia, Mo. The present study of the family aggregation of hypertension will be continued and new hypertension programs will be developed at the Memphis, Tenn., field station. NEUROLOGICAL AND SENSORY DISEASE SERVICE PROGRAM The Neurological and Sensory Disease Service Program, established in J anuary 1962, launched a major national program to hasten commu¬ nity application of research knowledge in the care of persons with epilepsy, cerebral palsy, multiple sclerosis, Parkinson’s disease, mental retardation, vision, speech, and hearing defects, and other disorders of the nervous system. Project Grants The first project grants made by the new program gave impetus to the development and support of State and local efforts to improve and expand community services. Twenty-three grants were awarded to official, voluntary, and private nonprofit agencies, medical schools, and medical centers in 13 States and the Virgin Islands to support projects encompassing a broad spectrum of activities. V ision Conservation The Glaucoma Collaborative Study, involving validation of various screening tests to identify glaucoma in the earliest stage, continued in its third year at five university clinics in California, Iowa, Maryland, Missouri, and New York. At the University of Tennessee School of Medicine 300 of 4,500 persons screened for glaucoma have been selected for continuing study to confirm the efficiency of the Schiotz-type tonometer as a screening instmment. Evaluation of the effectiveness of followup procedures as a means of increasing the rate of successful referrals from glaucoma detection programs was inaugurated at the University of North Carolina School of Public Health. Public Health Service 181 Glaucoma test demonstration manikins were developed to provide physician orientation in testing for glaucoma. The plastic life-like models of the human head have movable eyelids and eyes that provide tension readings in the normal and glaucomatous range in alternate eyes when tested with the Schiotz tonometer. Hearing Conservation A regional audiometric calibration center is being established at the North Carolina School of Medicine. The purpose is to determine the feasibility of such regional facilities for use by local programs, and their relationship to promotion of community speech and hearing conservation programs. HEALTH SERVICES FOR LONG-TERM ILLNESS PROGRAM The program is concerned with the development of programs and projects for preventing the onset or progression of chronic disease and disability as well as care services both in nursing homes and in non- institutional settings. Support of Projects An increase in direct operationg funds during the fiscal year enabled the program to award $1.2 million to 47 nonprofit organizations and official health agencies in the form of contracts and cooperative agreements. The projects varied in complexity and scope from the creation of a homemaker program by a hospital in a rural community in Nebraska to a nationwide program by the National Sociey of Crippled Children and Adults to eliminate those architectural barriers in public build¬ ings which prevent disabled persons from participating in normal activities. The program supported a 2-week national conference at Michigan State University attended by nutritionists and dietary consultants from 28 States to demonstrate new teclmiques for improving food service standards in nursing homes. An experimental and intensive 6-week summer school course in nursing home administration carrying degree credit, the first of its kind in the Nation, was conducted by the University of Oklahoma; 33 students from 16 States attended. Development of Materials , Data Collection The Kenny Rehabilitation Institute in Minneapolis received finan¬ cial support from the program to develop resource material for the training of personnel who will provide rehabilitation nursing. A project intended to stimulate medical schools and schools of public health to incorporate into their curricula the concepts and methodology for the prevention of disability is in progress. 182 Department of Health , Education , and Welfare , 1962 Four workshops based on a simplified method of teaching nursing skills were conducted by the program. An Instructor’s Guide for Teacher Training Courses is being prepared. Program staff worked on the compilation of data received from the first national inventory of coordinated home-care programs. Two regional workshops on home care were held during the year and a second National Workshop for Home Care is scheduled for December 1962. Communicable Disease Center The Communicable Disease Center, Atlanta, Ga., carries out Public Health Service programs in the control of infectious diseases. It con¬ ducts epidemiological, field, and laboratory studies and provides var¬ ious types of technical assistance to State health departments. Be¬ cause of the global nature of infectious diseases, CDC also participates in health efforts around the world. It provides technical support and personnel for the health programs spearheaded by the International Cooperation Administration. It also cooperates with the World Health Organization through representation on expert advisory panels and committees and as a laboratory diagnostic and study center. Plans were completed for the physical transfer of the Tuberculosis Branch from Washington to the Atlanta headquarters, although the move did not take place until the beginning of the 1963 fiscal year. This transfer brings to the Atlanta headquarters all of the CDC Branches: Epidemiology, Laboratory, Technology, Tuberculosis, Ve¬ nereal Disease, Training, and Audiovisual, which was given branch status this year. Of special note was a series of 13 3-day seminars on hepatitis be¬ ginning early in 1962 and continuing throughout the spring, summer, and fall. Sponsored in cooperation with State public health associa¬ tions, the seminars were designed to communicate existing knowl¬ edge of hepatitis and its control to State and local practitioners of public health. The seminars followed in the wake of an unusually high number of cases of hepatitis in 1961. Additional seminar series are planned in other important diseases. Also of special interest was a program of communicable disease control demonstrations sponsored by CDC in cooperation with State and local health departments and DHEW Regional Offices. The dem¬ onstrations are designed to measure selected communities for their health status, including immunization levels and conditions favorable to transmission of communicable diseases. Effective prevention and control measures will later be demonstrated. Demonstrations have Public Health Service 183 been initiated in Huntsville, Ala. ; Fredericksburg, Va. ; and Lebanon, Pa. EPIDEMIC AND DISASTER AID Epidemic aid included calls in 27 States, four Indian reservations, an interstate steamboat, a U.S. Navy base, Chile, the Philippines, Honduras, and American Samoa. Also investigated was a Salmonella hartford epidemic involving 19 States. Hepatitis led with eight epidemic aid calls. There were five in¬ fluenza calls and four poliomyelitis calls. Other calls were for enteric diseases, Coxsackie infections, diphtheria, encephalitis, staphy¬ lococcal infections, plague, tularemia, histoplasmosis, erythema infec- tiosum, rabies, measles, and typhoid. CDC assisted the Texas State Department of Health with vector control during hurricane Carla in 1961. REPRESENTATIVE DISEASE STUDIES Quota Sample Surveys The quota sample survey, a useful tool developed at CDC in 1959 to assess polio immunization levels of different population groups within a community, was adapted to include diphtheria, whooping cough, and tetanus. CDC has contracted with the Bureau of the Census to include questions on immunization against these four dis¬ eases in its Current Population Survey. Methods are being developed to improve the immunization level of infants in the lower socio¬ economic groups shown by quota sampling surveys to be the hardest to reach. Venereal Diseases The threefold increase in reported cases of infectious syphilis since 1957 underscores the urgency of the National Venereal Disease Pro¬ gram’s syphilis eradication campaign. All available resources of the National Program are directed toward implementing the recom¬ mendations of the Task Force on Syphilis Control in the United States. This five-member Task Force, in its report to the Surgeon Gen¬ eral, pressed for increased effort in epidemiology, development of a comprehensive educational program, continued research in im¬ munology, therapy, and laboratory procedure, and expansion of re¬ search in the sex behavior of adolescents and young adults. Epidemiologic activities were strengthened along lines recom¬ mended by the Task Force. Shortage of venereal disease control personnel has always hampered operations in the field. On July 1, 1962, the National Program assigned 461 persons to State and local health departments to assist them in eradication activities. 184 Department of Health , Education , and Welfare , 1962 Another high-priority item was the development of a compre- j hensive educational program to reach the general public and also pro¬ fessional personnel, including physicians, nurses, teachers, social work¬ ers, ministers, and youth and family-serving agency personnel. Laboratory research was continued to develop new diagnostic tests and to refine widely-used older ones for syphilis and gonorrhea. Of particular interest in syphilis serology was the development of the Rapid Plasma Reagin (RPR) card test. Featuring the use of a plastic-coated card, this test can be completed quickly outside the 1 laboratory. It is intended primarily for screening purposes. Addi- j tional progress was made in the effort to develop an effective fluor¬ escent antibody procedure for detecting Neisseria gonorrhoeae. Such ; a procedure would have particular value in diagnosing gonorrhea in the asymptomatic female. T uberculosis Continued gains in the control of tuberculosis are contingent on bringing all known patients under treatment. In 1962 Congress for the first time authorized special project grants for tuberculosis. Twenty-six areas with unusually severe tuberculosis problems received grants to improve their services to these patients and their contacts, and, in some instances, to increase diagnostic services for persons with X-rays suggesting tuberculosis. Funds were used also to provide three 3-day regional symposia on “Rational Therapy and Control of Tuberculosis” for physicians. Some 350 physicians in public health and clinical practice attended the symposia. Large-scale prophylactic trials of isoniazid, a drug widely used in the treatment of tuberculosis, showed it to be effective in preventing disease among household contacts of patients during the year the drug was taken. Further observations are being made to determine the duration of protection after the drug is stopped and to see whether there are any unsuspected beneficial or detrimental long-term effects of the drug. Influenza Warning of expected widespread outbreaks of influenza in the United States in the winter of 1962-63 was made public in April. The warning was based on findings of the Surgeon General’s Advis¬ ory Committee on Influenza, which met in Washington, D.C. The public was informed that population groups at highest risk should begin immunization by September. In their capacity as International Influenza Center for the Ameri¬ cas (WHO), CDC’s respirovirus laboratories were instrumental in identifying strains of virus active within the Western Hemisphere. Public Health Service 185 Isolation of influenza A from other countries led to the prediction that Asian influenza would recur during the winter of 1962-63. Poliomyelitis Pending the licensing of all three types of Sabin oral polio vac¬ cine, CDC urged mass use of Salk vaccine during the fall and winter to protect infants, pre-school children, and other susceptible groups in advance of the polio season. The CDC epidemic reserve of oral polio vaccine has been used to stop epidemics in Syracuse, Atlanta, Laredo, San Antonio, and Newberry County, S.C. These areas re¬ ceived over 3 million doses. Also, in a gesture of international good will, CDC rushed 354,000 doses to Chile to stop a severe epidemic. Measles Vaccine Trials Trials were conducted cooperatively with health departments in Seattle, Cincinnati, Rochester, Buffalo, and in DeKalb County, Ga. A series of three injections was given to 4,860 children : 50 percent re¬ ceived placebos, 25 percent received 2 injections of killed vaccine and 1 of live vaccine, and 25 percent received 3 injections of killed vaccine. Leprosy , Other Diseases For the first time in medical history, a technique of growing lep¬ rosy bacilli (Mycobacterium leprae) has been developed. It is being grown in the footpads of mice at CDC, and will provide an effective means for testing different drugs. Preliminary results of experi¬ mental work at CDC also indicate that a vaccine against leprosy is likely. Research shows that BCG vaccine imparts significant levels of immunity against M. leprae. The CDC also made important progress with regard to salmonel¬ losis, rabies, mosquito-borne viral encephalitis, and vector control. LABORATORY A major step benefiting diagnostic laboratories in the world is the development of model specifications for production of bacterial and viral reagents. Diagnostic reagents standardization is being devel¬ oped in close cooperation with the NIH program for developing specifications for respiratory virus reagents. An ad hoc committee of experts drew up model specifications for the Laboratory Branch. Production specifications for most commonly used reagents should be available to commercial companies within 3 years. Three years of effort in developing a single standard complement fixation test applicable for use as a diagnostic procedure for identifica* tion of fungal, viral, parasitic, and bacterial infections met with success during fiscal year 1962. A standard test, the “Laboratory Branch Complement Fixation Test” (LBCF), has been evaluated, its 665171—63 - 13 186 Department of Health , Education , and Welfare , 1962 sensitivity and specificity found acceptable, and the protocol distrib¬ uted to State laboratories. AUDIOVISUAL On January 1, 1962, the National Archives of Medical Motion Pic¬ tures were transferred from the National Library of Medicine to the Public Health Service Audiovisual Facility at CDC. The Facility is developing as a national information center on medical films and where they can be obtained. During the year, the Facility completed 28 motion pictures, 26 filmstrips, and 26 exhibits. More than 50,000 showings of CDC films throughout the country reached an estimated audience of more than 2 million people. TRAINING More than 9,000 persons from State and local health departments, Federal agencies, academic institutions, industry, and other organiza¬ tions attended 379 CDC courses in communicable disease control pre¬ sented throughout the country and at CDC headquarters. Of these, more than 2,000 persons participated in short seminars — developed to present current data on single subjects of immediate, widespread interest — at 13 State public health association meetings, and 148 at¬ tended the MEND symposium on Control of Infectious Diseases in Emergencies. CDC’s training personnel also developed courses and training ma¬ terial for other Divisions of the Public Health Service and for the Peace Corps. Under contract with the Department of Defense, they reviewed now rare communicable diseases that might become im¬ portant in a major disaster. Division of Community Health Services In the area of community health services, an important forward step was the establishment in November 1961 of the Division of Com¬ munity Health Services. The Division’s responsibilities are to coordinate the Service’s activi¬ ties in the fields of medical care administration, health economics, and public health administration. It administers public health training grants and awards programs, and coordinates the administration of special project grants affecting community health services. Health education, migrant health, and school health are also Division responsibilities. Public Health Service 187 GRANTS FOR IMPROVING COMMUNITY HEALTH SERVICES Special Project Grants One hundred and ninety-four applications were received and 44 projects approved and funded this year under provisions of the Com¬ munity Health Services and F acilities Act. The applicants represent a wide variety of public and other nonprofit national, State, and local groups. Many of the projects now in progress are concerned with some particular aspect of out-of-hospital care for the chronically ill and aged. Others are aimed at basic problems of comprehensive care and community coordination involving all pertinent public and private organizations in their areas. One community project would provide a full range of medical and other out-of-hospital services to medically indigent individuals on an outpatient basis. The center represents the combined resources of five of the community’s hospitals. It will also coordinate home nursing, physical therapy, homemaker, psychiatric, and screening services through inter-agency cooperation. Another is working toward the establishment of a regional health information center. It will utilize electronic equipment to store pa¬ tient data and will make this information rapidly available in order to improve patient care. The center will also serve teaching and research purposes. No organized community efforts have responded effectively to health problems identified by Selective Service rejections. Now two large cities are operating pilot projects to pave the way for a nationwide program for helping these young men. Formula Grants The strongest direct impact of Federal aid on community health probably is to be found in the response of State health departments to the new chronic illness formula grants. With a few exceptions, State health departments are using the bulk of these funds to strengthen central staff concerned with the chronically ill and aged. As a result, for example, additional numbers of these people will re¬ ceive some measure of community health service in their own homes ; more nursing homes will offer a better than minimum standard of care to their patients; more people will be screened for certain chronic conditions. TRAINING Larger appropriations to the Public Health Service have enabled schools of public health, nursing, and engineering to increase enroll¬ ment and strengthen their educational programs. An encouraging 188 Department of Health , Education , and Welfare , 1962 amount is going into programs in the newer aspects of public health — such as medical care administration, air and water pollution, control of chronic diseases, radiological health, accident prevention, and metropolitan planning. MIGRATORY AGRICULTURAL WORKERS The Division has developed plans for implementing the Presi¬ dent’s recommendations on migrant health in his Health Message of 1962. Under these plans, special project grants to public and private organizations will be made for establishment and operation of family health service clinics and other projects to improve migrants’ health services and conditions. OTHER DIVISION ACTIVITIES A source book on medical care financing and utilization was completed. The Division assisted in planning and carrying out the Interna¬ tional Conference on Health and Health Education, held in the United States for the first time. Studies conducted or under way include one to correlate chronic illness morbidity with expenditures for medical care; an analysis of X-ray and laboratory costs for a defined population; two studies on prepayment for drugs; and several projects in the area of the be¬ havioral sciences. In cooperation with the Children’s Bureau and the Social Security Administration, the Division published a Directory of Homemakers Services — 1961. Division of Dental Public Health and Resources The Division seeks to promote an adequate supply of dental man¬ power and to assure that professional skills are used most efficiently and effectively ; to assist State and local health agencies in expanding dental health programs and to experiment with methods for their improvement ; to influence more people to seek dental care and to find ways of making care available to those whose needs cannot be met under current patterns of dental practice. It is concerned as well with both research into the prevalence of dental diseases and a wider ap¬ plication of known measures of prevention. STRENGTHENING MANPOWER AND EDUCATIONAL RESOURCES A better trained and more productive dental force is essential to adequate dental care for all our people; and the Division em¬ phasizes programs which will stretch the available manpower supply by teaching dentists more efficient methods of practice. In 1962, Public Health Service 189 undergraduate students in 42 dental schools were learning to work effectively with chairside assistants under a grants program admin¬ istered by the Division. Proper use of a chairside assistant enables the dentist to provide improved services for more people. In cooperation with the Division, six universities, junior colleges, and vocational schools were engaged in experimental programs test¬ ing how much and what kind of training a qualified dental assistant should have. The Division continued its effort to stimulate interest in dental assisting as a career by preparing brochures and a recruit¬ ment film and by developing a program to aid vocational educators in inaugurating and expanding dental assistant training courses. Continuing activities in dental education included preparation for a comprehensive survey of the costs of dental education, to be con¬ ducted in cooperation with the American Association of Dental Schools, and consultative services to domestic and foreign dental schools on facilities planning. Research in programmed instruction in selected aspects of dental education initiated this year will seek ways of improving the dental curriculum. SPECIAL PATIENT CARE The dental health of millions of aged, handicapped, and chronically ill persons poses a particular challenge to dentistry and public health agencies. The institutionalized and homebound cannot go to the den¬ tist ; the dentist traditionally is neither prepared to go to the patient nor schooled in the techniques of care for patients with handicaps. Pro¬ grams initiated this year in 10 dental schools are giving students nec¬ essary technical training and practical experience in treating institu¬ tionalized and homebound persons. Extension of the programs to other schools will assure that future dentists are prepared to treat special patients. Publication of Dental Care for the Chronically III and Aged: A Community Experiment , a report on the Division’s 4-year study of the dental treatment needed by the chronically ill and aged of Kansas City and a service program conducted to meet that need, provides guidance and stimulus for community action. A hospital- centered program established this year in Missouri will obtain addi¬ tional information on the problems of service for special patients and provide a second prototype for community programs. DENTAL CARE FINANCING PLANS Dental prepayment plans have proved to be a potent weapon not only in reducing the cost barrier to the receipt of dental care but in increasing utilization of services. The Division encourages the devel¬ opment of dental care financing plans by assisting professional and 190 Department of Health , Education, and Welfare, 1962 consumer groups in their organization and operation and by operating a national clearing house for information on prepayment. ATTITUDE STUDIES Studies conducted by the Division attempt to reveal why people seek, or fail to seek, dental care, why they support, or oppose, such measures as the fluoridation of water supplies, and why they choose to enroll in dental prepayment plans. COMBATING DENTAL DISEASES To strengthen its efforts to promote the use of fluoridation, the one best means of preventing dental caries, the Division established a spe¬ cial fluoridation unit staffed by specialists in engineering, social sci¬ ence, information, and statistics to provide assistance to States and communities seeking to adopt water fluoridation. As of June 30, 1962, over 42,350,000 people in 2,245 communities were enjoying the protec¬ tion derived from drinking artificially fluoridated water. Testing of home fluoridators, intended for areas where central water supplies are not used, devices for defluoridation of water with exces¬ sive fluorides, and the effects of fluoridating school water systems continued. First-year examinations were conducted in a study of the effectiveness of a stannous fluoride dentifrice on 2,200 children in Seattle, Wash. Continuing also was a study of cytological testing of oral smears as a screening method in the early detection of oral cancer. IMPROVING DENTAL PUBLIC HEALTH PRACTICE Completion of a comprehensive survey of State dental programs, which includes details of activities, staffing, and financial support, provided information necessary to efforts to improve the practice of dental public health. A similar survey of community dental health programs was initiated in 1962. A NATIONAL DENTAL CENTER FOR RESEARCH AND TRAINING Formally opened on November 6, 1961, the Dental Health Center in San Francisco is a new facility for applied research into the epidemiol¬ ogy of dental diseases and methods for their prevention and for the training of dental public health workers. Already underway is the first comprehensive birth-record study ever undertaken of cleft lip and palate, malformations which afflict 250,000 people. Training programs at the Center, now just beginning, ultimately will teach dental public health personnel from State and community agencies and foreign countries better methods of conducting public programs. Public Health Service 191 Division of Hospital and Medical Facilities In steadily increasing numbers, communities around the Nation are finding that their growing health facility problems can best be resolved through coordinated commmunitywide planning. Thus, the Division of Hospital and Medical Facilities, during the past year, has directed much of its efforts to providing guidance along with the necessary incentive for communities to carry out such planning. In addition to providing leadership to State and local planning agencies in the planning process, grants were awarded to a dozen communities where planning activities are being accelerated. The experience gained will have widespread application for other communities with similar problems. These grants are the first to be made for this pur¬ pose under the newly expanded Hill-Burton hospital research and demonstration program made possible by the 1961 Community Health Services and Facilities Act. There are many other continuing activities in the planning area in which the Division staff is engaged. PROGRAM HIGHLIGHTS For the public at large, the Hill-Burton program is thought of chiefly in terms of its tremendous impact on hospital and medical facility construction in every section of the United States. While in itself an outstanding achievement, of equal — if not greater — importance are the qualitative contributions of the program enumer¬ ated below: Continuous statewide planning for additional hospitals and health facilities was initiated, bringing a sense of orderliness to the improve¬ ment and distribution of facilities within each State. Standards of bed and facility needs were introduced. A better distribution of facilities has been achieved, vitally needed physicians and board qualified specialists have been attracted to many rural areas, and, in general, the quality of medical care in rural areas has been upgraded. Health facility operations have been improved through the require¬ ment of the Hill-Burton program that States adopt standards of main¬ tenance and operation for health facilities constructed under the program. Most States have gone much farther than is required by this legislative provision by making such standards applicable to all health facilities and establishing such standards in the form of a licensure program. THE CONSTRUCTION PROGRAM Although a large portion of the Hill-Burton funds goes into the construction of general hospitals, other types of facilities are also 192 Department of Health , Education , and Welfare , 1962 provided grants. These grants average approximately one-third of the total cost of the projects. Other facilities aided include nursing homes, diagnostic and treatment centers, chronic disease hospitals, mental hospitals, public health centers, rehabilitation facilities, tuberculosis hospitals, and State health laboratories. Federal funds in the amount of $1.8 billion have been channeled into the construction and remodeling of these facilities as of June 30, 1962. Since the first Hill-Burton grant was awarded in 1947, a total of 6,236 projects have been approved. Of this total, 4,728 were completed and in opera¬ tion as of June 30, 1962. The remaining 1,508 are under construction or in the planning stage. These projects will provide 274,208 inpa¬ tient beds and 1,644 other health facilities. RESEARCH ACTIVITIES A growing activity in the Hill-Burton program is hospital research which operated on a budget of $8.1 million last year as compared with $1.2 million which was authorized during previous years. Some of the areas of investigation include the development of more effective organizational patterns for providing services; better community planning and coordination of hospital facilities and operations; improvements in architectural and equipment design; noise control; fire and explosion hazards; bacterial contamination in hospitals and other health facilities ; and the various aspects of progressive patient care. UNMET NEEDS A constant effort is being made to adjust the program to resolve the wide array of health facility problems which still confront the Nation. Chief among these are: obsolescence of many facilities — mainly in metropolitan areas; an ever-increasing critical shortage of long-term care beds ; the need for better planning and coordination of health facilities ; and the acute shortage of community-based facili¬ ties and services for the mentally ill and mentally retarded. Division of Nursing The Division of Nursing, with its responsibility for a diversified program of consultation to health agencies and institutions, training for nurses, and research, is constantly seeking new and improved ways to meet the increasing and pressing nursing needs. TRAINING IN RESTORATIVE NURSING Funds were made available by the Congress this year for demon¬ stration training for public health nurses in new methods of restor¬ ative nursing services for the chronically ill at home ; and the Division Public Health Service 193 negotiated special contracts with two universities and one hospital to sponsor intensive courses. As a result, about 100 nurses will have the opportunity to learn the newest restorative measures which can be applied for patients in their own homes or in nursing homes. OUT-OF-HOSPITAL NURSING CARE Still the greatest single nursing need is for more care available to patients outside hospitals, and especially to the chronically ill at home. The Division made a significant contribution in this area through provision of consultation, methods and materials to help States and agencies developing programs of nursing care in the home. Two projects were completed and publications issued to promote extrahospital nursing services. ‘‘How to Determine Nursing Expendi¬ tures in Small Health Agencies” (PHS Pub. No. 902) outlines a simple time study method which agencies with limited accounting resources can use for establishing appropriate fees for various nurs¬ ing services. Conferences to teach its application have been held on request in 10 States to date. “Nursing Care of the Sick at Home in Selected U.S. Cities” (PHS Pub. No. 901) updates the information first collected and analyzed by the Division in 1959 on the extent and distribution of agencies in the Nation which regularly provide home nursing care for the sick. A survey planned last year is underway to determine the propor¬ tion of patients receiving care at home who are over 65, the services they require, and source of payment. Extensive consultation was given to State health departments on the use of formula grants for extension of nursing services and on applications for nursing project grants. Five nursing projects were approved this year. HOSPITAL NURSING Studies of outpatient nursing activities to improve services were completed this year cooperatively with three university hospitals. Findings show that administration could be improved so that patients could receive more skilled care if professional personnel were relieved of messenger, clerical, and other miscellaneous duties. Consultation was given to 18 hospitals in two States on studies of nurse utilization in inpatient units, and to another State which is conducting a state¬ wide study of nurse utilization in 25 hospitals. FIELD CENTER FOR NURSING STUDIES Initiating a response to a long-recognized need, the Division was able to establish, equip, and staff in San Francisco, a small nursing research field center for nursing studies and demonstrations. Studies have already been undertaken, cooperatively with the Public Health 194 Department of Health , Education , and Welfare, 1962 Service Hospital there, to determine optimum staffing patterns and standards for quality of care. MANPOWER AND RELATED STUDIES The most comprehensive inventory of the Nation’s nurse supply ever conducted will be carried out by the American Nurses’ Associa¬ tion under contract agreements arranged by the Division. To be completed by October 1963, the inventory will provide an enumera¬ tion of nurses by city and State, as well as other data including areas of specialization. The Office of Civil Defense, Department of De¬ fense, contributed funds to help finance this project. The Division’s biennial census of public health nurses has been expanded this year to include data on the work of nurse consultants in State and local health agencies and boards of education. For several years communities have been offering refresher courses to reorient inactive nurses to current practice and encourage their return to nursing, but the effect of such courses had not been evalu¬ ated. This year, in cooperation with the Chicago Council on Com¬ munity Nursing, a follow-up study was completed of 453 refresher “graduates,” most of whom had been professionally inactive for 10 to 24 years. The study revealed that three-fourths of their number are now at work and making a significant contribution to nursing. Inactive nurses in 12 States are being asked if they plan to return to work and under what conditions they would do so. Some 9,000 nurses in 6 States have already responded to their questionnaires. Data from 6,000 questionnaires are being analyzed to determine what proportion of needed nursing service the 66,000 “part-time” nurses in hospitals actually supply. A tentative finding is that a part- time nurse works about 20 hours a week. All 1,800 nurses in Wyoming are being asked by questionnaire about their employment history for a 2-year period to find out more about the factors contributing to mobility. For the 1964 conference required by law to evaluate the profes¬ sional nurse traineeship program, work is progressing on the study of educational needs of nurses. PROFESSIONAL NURSE TRAINEESHIP PROGRAM A total of $6,604,000 was appropriated this year to help prepare professional nurses as teachers, supervisors, and administrators. Ninety-three schools of nursing and of public health received grants to support full-time long-term study for 2,000 nurses. The pro¬ gram also enabled 6,000 nurses to participate in 125 short-term inten¬ sive courses, including 10 home health institutes for 200 students. Public Health Service 195 SUPPORT OF EXTRAMURAL RESEARCH AND RESEARCH TRAINING Awards under the Research Grants and Fellowships Program reached almost $1,900,000. Of this total $1,500,000 was for research projects and the remainder for fellowships and a new program of research training. The first grants for research training for nurses were awarded to the University of California at San Francisco, which will offer nurses preparing for research a doctoral program in sociol- ogy and to Boston University for similar programs for nurses in psychology, biology, anthropology, or sociology. Full-time predoc- toral fellowships were awarded to 62 Fellows, including 26 new ap¬ pointees, for study at 27 universities. Fellows are enrolled for re¬ search training in graduate departments of education, social and biologic science (including human growth and development), and biostatistics. Funds for research supported continuation grants for earlier stud¬ ies and 15 new projects — more than half of which are in clinical areas. INTRA-AGENCY COOPERATION To assist the Surgeon General’s Consultant Group on Nursing in arriving at recommendations for the Federal role in improving nurs¬ ing service, the Division supplied staff and services. Statistical and research personnel made projections of future nurse supply and de¬ mand, interpreted study data on costs of nursing education and pro¬ fessional school capacity, and developed an analysis of needs in re¬ search and graduate education. Division of Air Pollution With the swift advances of our scientific-technologic age, the pro¬ tection of the air around us as a vital environmental resource has surged into a national problem of critical importance. The problem is compounded by the concentration of population in metropolitan areas. To help combat this growing problem, the Division of Air Pollution is authorized (by Public Law 84-159) to conduct a national program with three principal features : research, personnel training, and tech¬ nical assistance to States and communities. RESEARCH In response to the directive contained in Public Law 86-493, the Division made a thorough study of the health effects of motor vehicle emissions. The final report, entitled “Motor Vehicles, Air Pollution, and Health,” incorporated the findings of many intramural research 196 Department of Health , Education , and Welfare , 1962 projects and extramural research grants, and was presented to Congress in June 1962. Continuing field studies sought to determine the relationship of air pollution to asthma, industrial absenteeism, respiratory infections, respiratory symptoms, pulmonary function, and infant mortality. Laboratory studies on health effects were expanded. Many of these explored the biological and physiological effects of air pollutants on animals. Lung cancer of a type found in humans was produced in mice exposed to ozonized gasoline following recovery from an influ¬ enza virus infection. Animals were also rendered more susceptible to respiratory infections from a bacterium causing pneumonia follow¬ ing exposure to ozone or nitrogen dioxide. INSTRUMENTATION, SAMPLING, AND ANALYSIS Further advances were made in designing instruments for sampling pollutants or assessing their effects. Improved filter devices were developed for industrial-type installations. The National Air Sampling Network continued sampling particu¬ lates and certain gaseous pollutants. A Continuous Air Monitoring Program was established in seven cities to record continuously the con¬ centration of seven different gases. TECHNICAL ASSISTANCE AND TRAINING Statewide air pollution surveys were completed, in cooperation with each State’s health agency, in Colorado, South Dakota, and Kansas; and substantial assistance was given in surveys conducted by State or local health departments in eight other States. Intensive technical courses in air pollution were given at the Sani¬ tary Engineering Center to 193 trainees. Two field courses were pre¬ sented 8 times, to 801 trainees. GOALS To explore ways of utilizing more widely and more rapidly tech¬ nological control measures which are already available is one of the major objectives of a forthcoming National Conference on Air Pol¬ lution, called by the Surgeon General, to be held in Washington December 10-12, 1962. The Division continues to be guided by the basic recommendations for air pollution research and time phasing which were presented in the 1960 report (by the Surgeon General’s Task Group) entitled “National Goals in Air Pollution Research.” The 1962 report of the Surgeon General’s Committee on Environmental Health Problems (the Gross Committee) endorsed these goals but found the recom¬ mended level of support to be “minimal.” The report identified the following areas as currently in need of particular emphasis: studies Public Health Service 197 of urban pollution levels; interrelationships of air pollution and the social and economic development of communities; development of automatic instrumentation for identification and measurement of air pollutants; interactions of pollutants in the atmosphere; and syner¬ gistic effects of pollutants on physical and biological systems. The Division will undertake to provide that emphasis. For the long run, the Division’s primary goals will be to learn more about the health effects of air pollution and — above all — to expedite the translation of what is now known and what is learned hereafter about air pollution into actual control measures. Division of Environmental Engineering and Food Protection Programs carried out in this division are directed to safeguarding drinking water, milk, and other food supply; controlling environ¬ mental dangers which arise because of urbanization; and protection against environmental risks encountered in the home, at work, while aboard common carriers in interstate travel, and in outdoor recrea¬ tional areas. MILK AND FOOD BRANCH Technical assistance was given to all States and to industry. More than 120 seminars and training courses on milk and food sanitation attended by over 7,000 individuals were sponsored or participated in by PUS milk and food personnel. Participation by States in the Cooperative State-PHS Program for the Certification of Interstate Milk Shippers increased for the tenth consecutive year. The 1962 Food Service Sanitation Manual was published as a guide for both public health agencies and the food service industry in the conduct of effective food protection programs. A method has been devised for removing strontium-90 from milk by ion-exchange resins. A pilot project, cosponsored by the Public Health Service, the Department of Agriculture and the Atomic Energy Commission has been established at Beltsville, Md. Studies have been initiated on iodine-131 countermeasure proposals in cooperation with State and local health agencies and national dairy industry organizations. SHELLFISH SANITATION BRANCH During the year a new Shellfish Sanitation Branch within the Di¬ vision was created to strengthen and emphasize this activity. Two Shellfish sanitation research centers, one at Kingston, R.I., and the other at Dauphin Island, Ala., were authorized. 198 Department of Health , Education , and Welfare , 1962 During 1962, 22 shellfish producing States participated in the Co¬ operative Program for the Certification of Interstate Shellfish Ship¬ pers. The Fourth National Shellfish Sanitation Workshop was held in Washington, D.C., with an attendance of 148 persons including in¬ dustry, State agencies, the Federal Government, and the Government of Canada. A survey party from the Division visited the Hiroshima area of Japan at the request of the Japanese Government to review the san¬ itary aspects of shellfish production prior to the completion of an agreement between the U.S. and the Japanese Government covering- importation of fresh or frozen shellfish between the two countries. SPECIAL ENGINEERING SERVICES BRANCH Two publications dealing with recreational sanitation were issued, and special efforts were devoted to solid waste engineering activities. In cooperation with the Office of Education a manual on environmental engineering for the schools was produced and distributed. A major aspect of the Branch’s activities continues to be the handling of re¬ quests from individuals, organizations, and governmental agencies on problems of general sanitation. INTERSTATE CARRIER BRANCH In carrying out PHS regulatory functions under the Interstate Quarantine Regulations, special citations and letters of commendation for excellence in sanitation were awarded to 20 railroad and 41 vessel operating companies during the year. The Advisory Committee on Revision of the Public Health Service Drinking Water Standards completed its work and the 1962 stand¬ ards became effective April 6, 1962. Drinking water supply quality was determined nationally by analyses of 194 public water supplies in 134 cities. Studies were continued on possible relationships between drinking water quality and cancer, heart disease, and infectious hep¬ atitis. The Division assisted Alabama University research scientists in their study of water quality and possible relationship to the inci¬ dence of arthritis; the State of Maine in a study of agricultural in¬ secticides and water supplies; and the Department of Defense in a study of drinking water stored in public fallout shelters. Division of Occupational Health As American technology develops, occupational health must not only continue the application of conventional methods for the detec¬ tion of old and new toxic agents, but must also extend its traditional concept in new dimensions. The combined effects of physical and Public Health Service 199 chemical agents, for example, require deeper study. The psychological component of occupational health problems must also be persistently considered. The role of the occupational environment in the cause and progression of chronic diseases, too, must be studied more thoroughly. The establishment last year of a section of physiology and the addi¬ tion of a staff psychologist will permit a new depth and direction in studies by the Division of Occupational Health. This new direction is reflected in a changing emphasis in the noise studies being con¬ ducted by the Division. Long interested in the effects of industrial noise on hearing, the Division is now probing psychologic and neurophysiologic effects. In toxicology, a new area of exploration is opening up with recent work on a predictive test of hypersusceptibility to hemolytic chemi¬ cals and drugs. This test is based on the detection of inherited defi¬ ciencies of specific enzymes. Predictive tests may have great sig¬ nificance for industry, where approximately one million workers are involved in the manufacture of industrial chemicals and several times that number are exposed to chemicals through handling and use. Field studies during the year ranged from health hazards in ura¬ nium mining to health and medical problems at airports. Field work in the revaluation of the silicosis problem in the metal mining industry was completed, and the extensive data are now being analyzed. The strengthening of the Division’s statistical competence has per¬ mitted expanded studies of occupational morbidity and mortality. Currently, mortality records of workers in the asbestos products indus¬ try throughout the country are being examined, with a detailed and searching analysis of the mortality experience of asbestos products workers in a selected State. This epidemiologic technique, using records of the Federal Bureau of Old-Age and Survivors Insurance, will be extended to other industries. At the request of the governor, the Division undertook a study of occupational health problems and needs in the State of Washington. As part of its program to offer short-term training courses not given elsewhere, the Division presented 16 separate courses. In addition to basic courses on industrial hygiene engineering and chemistry, four special technical courses were given on ion exchange techniques for fluoride and mercury, heat stress and its control, solvent analysis techniques, and air sampling and evaluation. Special workshops and courses were also held for local health officers, occupational health nurses, and sanitarians. 200 Department of Health , Education , and Welfare , 1962 Division of Radiological Health The Division of Radiological Health is responsible for the develop¬ ment of a public health program to prevent undue radiation exposure of the population. The principal components of this program are environmental surveillance and special radiation safety activities, technical assistance to the States, basic and applied research, and train¬ ing of radiological health personnel. ENVIRONMENTAL SURVEILLANCE With the resumption of Soviet nuclear testing in September 1961 and U.S. testing in April 1962, the Division’s radiation surveillance activities were accelerated and expanded. A Radiation Surveillance Center was established in the Division to provide comprehensive and continuing evaluation of environmental radioactivity data collected by the Federal-State monitoring networks. More than 20 air sampling stations were added to the existing 45- station Radiation Surveillance Network; operation of this Federal- State activity was placed on a round-the-clock schedule. Sampling of milk, water, and food was increased to determine more specifically the amounts of radioactive materials likely to be ingested. The analytical laboratories went on double-shift operations when required in order to handle the increased work-load. Early in 1962, a third regional laboratory was opened at Winchester, Mass., to conduct radiochemical support activities for 15 northeastern States. The Institutional Diet Sampling Program, initiated in 1960, was expanded. The purpose of this program is to secure an estimate of the total dietary intake of radionuclides by children and teenagers aged 5 to 18 years. In conjunction with this program, the Division contracted with Consumers Union of U.S.A., Inc. to sample teenage and infant diets in 30 cities for the presence of strontium 90 and other radionuclides. In connection with the development of a Radiation Intelligence System, a pilot project was conducted during the summer of 1961 in Montgomery County, Md., to evaluate the effectiveness of household interviewing techniques in assessing radiation exposure to the popula¬ tion. The findings were sufficiently encouraging to warrant extension of the methodology on a national scale, utilizing the interview system of the Bureau of the Census. The Division participated in a number of special long-term radi¬ ation safety projects during the year, including surveillance activities with Joint Task Force-8 in Hawaii and the Pacific testing area; med¬ ical and health physics support for the nuclear ship Savannah during its sea trial period ; and off-site and on-site surveillance at Savannah ports-of-call. Public Health Service 201 STATE ASSISTANCE A major step was taken to strengthen State radiological health programs with the approval by Congress of a system of matching grants to the States — $1,500,000 for the first year. Fifty professional staff members of the Division have been assigned to State health departments; some 25 more are being trained for early State assignments. Through the Division’s diagnostic X-ray inspection and correction program, more than 50,000 dental X-ray machines in some 45 States have been inspected, either by physical survey or the Surpak (mail survey) method. Work is in progress to adapt the Surpak technique for use in the inspection of medical X-ray machines. RESEARCH A number of long-term research projects were initiated to determine more accurately the genetic and somatic effects of low-level radiation. A Radiological Health Animal Research Laboratory was estab¬ lished at Colorado State University, Fort Collins, Colo. At this facility, a large colony (2,000) dogs will be studied for their response to low-level radiation. The development of a Registry of Radiation Pathology will further the knowledge of radiation effects through the study of morbid anat¬ omy. The Registry has been established under the auspices of the Research Council of the National Academy of Sciences and is located in the Armed F orces Institute of Pathology. Other projects of long-term significance include a tri-State study cf congenital malformations, a joint study of radiation effects on primates, a nationwide bone sampling program for radio-strontium analysis, and a midwest environmental health study. In addition to intramural and contract research, the Division com¬ pleted its first full year of managing a system of extramural grants formerly funded by the National Institutes of Health. There are now 66 active grants funded by DRH in the amount of $1,196,000. TRAINING For the second year, the Division provided grants to universities for the training of radiation health specialists. Congressional sup¬ port of the program was increased to $1 million in fiscal year 1962, enabling assistance to 20 schools. The Division also stepped up its own training programs: short- course training was provided for more than 1,100 public health per¬ sonnel in government and industry. 665171—63 - 14 202 Department of Health, Education , and Welfare, 1962 Division of Water Supply and Pollution Control Since the turn of the century, while the national population has a little more than doubled, there has been an eightfold increase in water use. Present use of 325 billion gallons a day is expected to double by 1980 and triple by the year 2000. Wise management of the water resource has therefore assumed a position of number one social-economic importance. Prominently involved is the abatement, control, and prevention of pollution, for there is now nearly six times as much pollution in the Nation’s surface waters as 60 years ago. Since its beginning in 1948, this program has emphasized Federal- State-local cooperation under a declared policy to “recognize, pre¬ serve, and protect the primary responsibilities and rights of the States.” The Water Pollution Control Act goes beyond the usual public health legislation, directing the conservation of “waters for public water supplies, propagation of fish and aquatic life and wild¬ life, recreational purposes, and agricultural, industrial, and other legitimate uses.” Thus it assigns to the Department of Health, Edu¬ cation, and Welfare a major role in conservation and water resource development. During the first year under major amendments (July 1961) to the Federal Water Pollution Control Act the Division’s program has nearly doubled in size and scope. CONSTRUCTION GRANTS, PROGRAM GRANTS As a result of increased funds for construction grants, fiscal 1962 set an all-time record with a 22 percent increase over the preceding year in municipal sewage treatment construction. Approved were 754 proj¬ ects to which the Federal grants contributed $65 million, and local governments $332 million, a ratio of about 1-5. In the 6-year history of this grant program 3,500 awards totaling $290 million have been made to support municipal funding of $1.4 billion. All this will pro¬ vide sewage treatment for 35 million people and improve water quality in. over 38,000 miles of streams. Despite this massive effort, there are still 5,290 U.S. communities of 43 million total population needing new, enlarged, or improved sewage treatment facilities. Grant funds to State and interstate agencies, increased from $3 mil¬ lion to $5 million per year under the 1961 legislation, have enabled most of the States to expand their water pollution control programs. Stim¬ ulated by the grants, State funding has risen from $4.2 million in 1956 (before grants) to $7.6 million in 1961 (under the $3 million authoriza¬ tion) to $9 million in 1962 (under the $5 million authorization). Water pollution control budgets of 33 States showed substantial increases in 1962 over 1961. Public Health Service 203 BASIC DATA To maintain continuous intelligence on the nature and extent of pollution, the National Water Quality Network of major water¬ course sampling stations was enlarged from 91 to 121, with 300 as the ultimate goal. Thus are regular checks made on more than 15 physical and chemical parameters in water, including radioactivity, organic chemicals, coliform organisms, temperature, alkalinity, plankton, dis¬ solved oxygen, and others. Experiments in electronic measuring and recording promise completely automatic network monitoring of water¬ ways in the early future. Continuing data are also collected, analyzed and published on water and waste treatment facilities and needs, on bond issues to finance these public works, on contracts awarded for the construction of such facilities, and on pollution-caused fish kills. Completed during the year was the first nationwide inventory of Federal establishments to determine the extent of pollution coming from them. ENFORCEMENT Five enforcement actions (two at request of the Governors of Wash¬ ington and Michigan under the new intrastate provision of the Water Pollution Control Act) were initiated as follows: (1) Puget Sound, Wash.; (2) Detroit River, Mich.; (3) Raritan Bay, N.Y.-N.J. ; (4) Mississippi River, Clinton Area, Iowa-Ill.; and (5) North Platte River, Nebr.-Wyo. Additional conference sessions were held in pending cases : ( 1 ) the North Fork of Holston River, Va.-Tenn. ; and (2) the Colorado River Basin, Ariz. -Calif .-Colo.-N. Mex.-Nev.-Utah-Wyo. The three-step Federal enforcement procedure — conference, public hearing, and court action — has been initiated in 18 situations in the history of the program. In only one case has the third (court action) step of the enforcement procedure been necessary. RESEARCH AND TRAINING Research activities include both intramural projects at the Robert A. Taft Sanitary Engineering Center, Cincinnati, and extramural research projects supported by grants in some 80 universities and other institutions in about 40 States. Together they seek answers to prob¬ lems in wastes origin ; more efficient and economical characterization, treatment and disposal of wastes ; improved methods in water quality measurement; and the supplementation and conservation of water supplies. A major project in advanced waste treatment to approach 100 percent purification of wastes, is continuing. Research grants awarded during the year supported 159 projects totaling $2.67 million, including 1 in support of the first international 204 Department of Health, Education , and Welfare , 1962 conference on water pollution research scheduled for September 1962. Newly implemented in fiscal 1962 were fellowships totaling $98,000 to scientists and engineers at academic institutions in 16 States and 1 foreign country; 11 demonstration (applied research) grants total¬ ing $300,000 in 10 States ; and 23 grants totaling $693,000 to institu¬ tions in 13 States to establish or expand training programs in the field of water supply and pollution control. Sites were selected for four of seven regional laboratory and research facilities authorized in 1961. COMPREHENSIVE PROGRAMS, INTERAGENCY COORDINATION Comprehensive water pollution control programs to protect and conserve water quality for all uses for a projected period of 50 years have been initiated or expanded in basins of the Columbia River, Great Lakes and Illinois Waterway, Susquehanna River and Chesapeake Bay, Delaware River, Ohio River, and Colorado River. In addition, field study projects on problems of national significance have been established with respect to the effects of pesticides on water quality and of recreational uses on water supply reservoirs. Coordination of programs with other Federal water resource devel¬ opment agencies continued. Technical services under such interagency agreements represent a major and expanding activity. Of particular significance in Federal reservoir construction are requirements of the Water Supply Act of 1958 and of the 1961 amendments to the Water Pollution Control Act requiring, respectively, a determination of municipal and industrial water supply needs and stream flow regula¬ tion for quality control. Serving much the same as a consulting engineer, the Division has prepared reports for the Federal construc¬ tion agencies on 97 projects, and has 209 others in progress or scheduled. ADVISORY BOARD The nine-member Presidentially appointed Water Pollution Control Advisory Board continued its policy of holding certain of its meetings outside of Washington to provide public forums to assess regional problems and progress in water pollution control. The National Institutes of Health jk fk National Institutes of Health continued to grow and reorganize as necessary to meet its expanding role in support of biomedical research. At the period’s end, plans were completed for establishing the new Division of Research Facilities and Resources. Designed to centralize administration of some of NIH’s major research support activities, the new Division will oversee programs for : health research facilities con- Public Health Service 205 struction, support for primate centers, general clinical research cen¬ ters, special resources centers, and general research support grants. In this period a new branch was set up in the Viruses and Cancer Program to help fulfill the broadened program for study of virus- cancer relationship, and the Cancer Chemotherapy National Service Center was reorganized to quicken the search for drugs useful in cancer treatment. At the request of the President, legislation to convert the Division of General Medical Sciences to Institute status and to establish a new National Institute of Child Health and Human Development was in¬ troduced early in this period. The new Institute — which wTould incorporate both the Center for Aging Research and the Center for Research in Child Health — would conduct and support research and training relating to child health and human development, particularly the special health problems of children and aged persons. Its research would cover the gamut of development and adaptation beginning with reproduction and termi¬ nating in old age. Increased costs of large-scale clinical research facilities and enlarged manpower needs have caused a sharp upswing in expenditure per professional worker. Anticipated large-scale population studies ; use of more complex, automated instrumentation; and expanding U.S. involvement in international medical research are expected to swell the requirements for highly skilled technicians and professionals. In the decade, 1960-10, it is expected that the existing pool of trained biomedical investigators will increase each year by 4,500, in contrast to the 3,500 annual increment in the 1954-60 interval. To help achieve this goal, plans were made for a steady growth of training facilities, so that, by 1970, the medical research manpower pool would be doubled. Steps taken include: (1) Expansion of the pre-doctoral fellowship program to attract research students in the medical sciences. (2) Expansion of the medical student research program, which ex¬ poses selected undergraduate students to research. (3) Extension of the post-doctoral fellowship and graduate train¬ ing programs to provide advanced training for research. (4) Provision of support to graduate schools. (5) Increase in training of foreign nationals in the United States and of U.S. citizens for research overseas. Growth has now brought the training program to a point where a simpler mechanism is needed within NIH to help training institu¬ tions plan, finance, and conduct a more orderly program of science education. Such education must look to the long-range needs in medi¬ cal research manpower : a large, strong group of medical and biologi- 206 Department of Health , Education , and Welfare, 1962 cal scientists not limited in training to a specialized aspect of a disease problem, but so schooled as to be able to meet unpredictable problems. Communicating results of research is, ultimately, a function of edu¬ cation and training. The continued growth of knowledge and tech¬ nology requires incorporation of new findings into the educative scheme of the health sciences. NIH programs continue to have pro¬ found influence upon education and training in these sciences. More than half of the $400 million in research grants made available during this period through NIH has gone to medical, dental, and other health professional schools of the country. In addition, NIH devoted over $135 million to direct support of fellowships, training grants, and other training activities, many of which seek improvement in content of the undergraduate and graduate curricula and effective communica¬ tion of current research information to health practitioners. NIH maintained close liaison with the State Department in carry¬ ing out its research obligations under the International Health Re¬ search Act of 1960 (which for the first time explicitly established the authority of the Public Health Service to support research and related activities in foreign countries) and under Public Law 480 (which authorizes use of excess U.S.-owned foreign currencies for the mutual benefit of those countries and the United States). Public Law 480 funds have thus far been made available in nine countries : Brazil, Burma, Egypt, India, Indonesia, Israel, Pakistan, Poland, and Yugoslavia. In these countries, NIH has developed a total of 58 proposals for collaborative research projects, covering an extensive range of pertinent subjects. Since NIH’s foreign program is primarily designed to improve health in the United States, any grant under this program must nec¬ essarily be of benefit to the United States as well as to the host country. The obligation to the latter, however, is a continuing one and NIH has been giving increasing attention to the effects of a grant on the medical research of a recipient country. To facilitate more effective administration of foreign grants through increased mutual knowledge and understanding of the problems, NIH’s Office of International Research established a small unit in Paris during this period, as an extension of the office of the Science Attache housed within the American Embassy, and plans were being made for setting up two or three similar units in other countries. Steady annual increases in support since 1946 have produced, as of the end of this reporting period, a research grants program of $400 million, supporting more than 15,000 research projects conducted in almost 1,500 institutions throughout this country and abroad, and covering the full gamut of biomedical research. While the major portion of the program continues to aid investigations originating in Public Health Service 207 grantee institutions, a significant number of grants sustain programs (cancer chemotherapy, psychopharmacology, and other collaborative projects) which reflect initiative of NIH staff. Careful review and reassessment have been undertaken of policy and operational procedures of the NIH extramural programs, which, for the past 5 years, have experienced unprecedented growth. The mutual dependence of Federal Government and Institutions of higher learning resulting from this growth necessitates examining the instru¬ ments — the grant and the contract — which have been the basis of their relationship. The programs of the National Institutes of Health have utilized almost exclusively the grant as the basic means of providing support for research and research training activities carried out in universities and institutions of higher learning. Although it has been acknowl¬ edged that there are circumstances where a contract is preferable to a grant — as in sponsoring research by a profit-making organization — the grant will continue as the basic instrument for sponsoring research. A contract — in essence a procurement instrument — is a promise to deliver a specified product for a predetermined price. It makes a recipient of funds an agency of government, and thus subject to the full extent of restrictions that bear upon use of Federal funds by a Federal department and its agents. A grant, on the other hand, is a conditional gift, a bestowal in response to a request, representing a mutual pursuit by grantor and grantee of a common objective. The grant establishes a relationship of trust; it imposes on grantor and grantee the obligation to act in the public interest. In accepting the grant, the grantee assumes the obligation to use the funds for their designated purpose and with the same probity and prudence with which that institution uses its own funds. It is under conditions of mutual trust and restraint made possible by a grant that scientific freedom can best be guaranteed. Improved administration of grants and tighter control over monies granted (more detailed accounting and more precise audits) have been introduced with the purpose of furthering the quality and pro¬ ductivity of medical research, while maintaining freedom and flexi¬ bility for investigator and institution. In this period, the Research Career Award Program was put into effect. Consisting of two groups — Research Career and Research Career Development Awards — the program is designed to assure younger as well as more mature investigators some measure of support early in their careers, thus permitting individuals of superior potential to reach their maximum productivity. At the end of the period, there were a total of 50 General Clinical Research Centers. Authorized by Congress in 1960, the Centers pro- 208 Department of Health , Education , and Welfare, 1962 vide a special setting for unrestricted but significant clinical investi¬ gation in medical schools and other medical research institutions, per¬ mitting precise controls and observations of the patient, his diet, therapy, and necessary tests and procedures. Institute of Allergy and Infectious Diseases This Institute is concerned with a formidable array of diseases, such as measles, asthma and hay fever, hepatitis, viral encephalitis, small¬ pox, streptococcal and staphylococcal infections, tuberculosis, polio¬ myelitis, rabies and others. Steady progress is being reported in every area, particularly in the field of upper respiratory infections, our most prevalent illnesses. Due to accomplishments in clarifying the causes of respiratory diseases, the opportunity is now present to design protective vaccines. During the past year, the Vaccine Development Program was initi¬ ated. A number of contracts have now been awarded to non-Federal research groups experienced in developing and testing vaccines. This major collaborative effort to design vaccines against the widespread respiratory infections often grouped under the term “common cold” is also aimed at serious complications of colds, such as viral pneumonias. One of the infectious organisms being employed in the experimental vaccines is the “Eaton agent,” an important cause of pneumonias in children and adults. As a step toward culturing this formerly little- understood microbe for vaccines and for diagnosis of illness, Insti¬ tute investigators collaborated with specialists at the Wistar Institute in Philadelphia and succeeded for the first time in growing it in cell- free media. They also resolved the question of the precise nature of this agent, previously thought to be a virus, by identifying it as a member of the obscure pleuropneumonia -like organisms group. This is the first “PPLO” linked with any human disease. The new finding provides the rationale for tetracycline therapy of the infection. The Institute also has established a Viral Reference Reagents Pro¬ gram of wide import. It will provide standardized reagent materials which eventually will permit virus researchers throughout the world to recognize the viruses they isolate and compare their results. The Institute continued its assessment of resistance of malaria strains to widely used drugs and participated in development of new antimalarials. Its scientists developed a sensitive and reliable blood test for observing antibody production in response to malaria infec¬ tion. This may help identify previously undetected human reservoirs of the disease which afflicts hundreds of millions of people, imposing a heavy tribute on world health and economy. Public Health Service 209 Institute of Arthritis and Metabolic Diseases One of the most significant and dramatic scientific accomplishments of the year — representing a major breakthrough in the chemistry of heredity— was the partial “cracking” of the so-called genetic code by Institute biochemists. This code involves the two hereditary chemicals, DNA and ENA, and provides the means by which living cells store and transmit genetic information. In collaboration with researchers from the University of California, these scientists have demonstrated that a universal genetic code may control the develop¬ ment of a variety of organisms. These findings, illuminating certain aspects of the systematic reproduction of all living matter, have at¬ tracted world-wide attention. From continuing studies of rheumatoid arthritis it has become ap¬ parent that both immunologic and genetic aspects are involved in this crippling disease. During the past year, major emphasis has been given to the immunological mechanisms, particularly those relating to the so-called rheumatoid factors. The rheumatoid factors are found in the blood of most rheumatoid arthritics, and recent studies of their source as well as their physical, chemical, and biological characteristics suggest they are large anti¬ bodies produced as a body defense against an altered type of gamma globulin in the blood. Under continuing investigation are such aspects of the rheumatic diseases as genetic and environmental factors. Institute scientists making a family study of patients with Sjogren’s syndrome, a dis¬ order often accompanied by rheumatoid arthritis, have found that normal blood relatives of patients often have a variety of hidden or ignored signs of the disease, thus indicating a genetic predisposition. Advances have also been made in management of the various forms of arthritis. Institute scientists have found, for example, that a high calcium diet may offset further “bone-thinning” that often occurs in patients treated with the corticosteroid hormones. Striking progress was made in studies of gout, another of the rheumatic disorders. Scientists at the Institute were able to dem¬ onstrate that deposits of sodium urate crystals are the cause of the acute inflammation and painful and disabling attacks of gout. They have shown also that the painful symptoms of gout probably result from the metabolic activity of white blood cells in the inflamed joint, and that the familiar drug colchicine decreases the activity of these cells, and thus interrupts the gouty attack. In diabetes research, one of the most promising advances of the year has been the development by grantees at the Joslin Clinic in Boston of special tests which can reveal the “pre-diabetic” patient 210 Department of Health, Education , and Welfare, 1962 before he develops frank diabetes and is discovered through current tests. Encouraging results have come from studies of several other serious but less known diseases including Wilson’s disease, marked by accu¬ mulation of excess copper in the body ; a newly-discovered metabolic disease, histidinemia, which may cause speech and hearing defects in some children; and an uncommon but serious form of blood disease occurring in newborn infants, which has been found to result from blood-platelet differences in mother and offspring. The Institute has continued to extend its extramural research program in gastroenterology. Grantees at the University of Minne¬ sota Medical School have been able to produce rapid healing of duo¬ denal ulcers in a substantial number of patients by freezing stomach mucosa for short periods of time. Freezing is done by a subzero cooling liquid circulated through a balloon placed in the stomach. Further studies are needed, but the new technique may avoid the need for surgery in many duodenal ulcer cases. Another advance in the field of gastroenterology has been the development of a unique, flexible endoscope by a grantee at the University of Alabama Medi¬ cal School. The device has a revolutionary optic system, employing fiber optics, which permits examination of gastrointestinal areas not previously accessible with conventional instruments. Cancer Institute There are, according to a new estimate, approximately 105 basic kinds of cancer, and each presents a somewhat different set of prob¬ lems in research on causes, detection and diagnosis, and treatment. Accordingly, an increasing share of the research conducted and sup¬ ported by the National Cancer Institute is focused on specific kinds of cancer and on the individual who has cancer. During the year, the 25th since the establishment of the National Cancer Institute, its programs were strengthened to take maximum advantage of the resources provided by the Congress and to capitalize on the latest experimental and clinical findings. An effort was begun to coordinate and accelerate research on treatment of acute leukemia patients and on the relationship of viruses to leukemia. A contract- supported program set up to provide essential supplies and services for virus-cancer investigators moved rapidly toward full-scale opera¬ tion. A series of steps was taken to increase the effectiveness of the nationwide cancer chemotherapy research program, which the Na¬ tional Cancer Institute administers. Experimental and epidemiologi¬ cal studies of potential cancer hazards in the environment were expanded. And finally, the investment in efforts to develop improved methods of diagnosing cancer was increased. Public Health Service 211 INSTITUTE RESEARCH The advantages of orienting research toward specific kinds of can¬ cer were exemplified by advances made in caring for patients with acute leukemia. Thanks to the work of scientists in many places, gradual progress has been made in drug treatment and supportive therapy, with the result that 50 percent of acute leukemia patients now live a year or more from diagnosis. The results of clinical re¬ search during the year raised the prospect of an additional increase. The leading achievement was a reduction in the risks of fatal hemor¬ rhage and infection, complications that often take the lives of acute leukemia patients before drug treatment has had time to take effect. Transfusions of pooled platelets from numerous donors proved highly effective in preventing and controlling hemorrhage. Tests of two new drugs rang another hopeful note. One of them, vincristine, a periwinkle plant extract, showed promise in acute lymphocytic leukemia, the type that children usually have, and in lymphomas, such as Hodgkin’s disease and lymphosarcoma. The other new drug, a synthetic compound known as methyl-GAG (for methylglyoxal-bis-guenylhydrazone), though its side effects re¬ quired careful attention, induced remissions of acute granulocytic leukemia more often than any drug previously available. A promising approach to direct studies of the role of viruses in human leukemia materialized early in the year as a result of work with a virus-induced leukemia of mice and rats. An electron-microscope study provided the key by revealing virus particles in the blood of animals bearing the experimental leukemia. The same technique is now in use for studies of blood samples from acute leukemia patients. Also in virus research, a new experimental leukemia virus was iso¬ lated that causes recognizable effects in mice in 7 days, thus making available a system potentially useful for rapid testing of new drugs. There were also a number of noteworthy accomplishments in re¬ search on other aspects of cancer. The effects of a gene on normal growth and on the occurrence of liver tumors in mice of an inbred strain were eliminated by removing the pituitary gland from animals l-to-2 months old. Thus, the mice were prevented from growing normally, and when they were 16 months old none had liver tumors, though 60 percent or more would ordinarily have had them at that age. Several other genes are also known to influence the occurrence of certain tumors in inbred mice in addition to governing the inherit¬ ance of normal characteristics. A broader understanding of these ef¬ fects and of the role of normal growth processes in the genesis of cancer is being sought. 212 Department of Health , Education , and Welfare , 1962 GRANT-SUPPORTED RESEARCH A long-term investigation of the transmission of a virus that causes leukemia in chickens turned up evidence that chickens born with the virus, unlike those infected later in life, became tolerant of it ; that is, they did not form antibodies to it. The virus survived and was reproduced in their bodies as long as they lived. The virus passed from hens to their offspring during pregnancy; roosters played no role. Chickens that were not born with the virus picked it up from those who were. Thus, the virus spread through an entire laboratory flock. Though few chickens developed leukemia, the incidence was six times as high in those born with the virus as in those infected by contact. Evidence was obtained that virus-caused tumors can be reproduced with nucleic acid isolated from them even when they appear to con¬ tain little or no whole virus. This was one achievement in experi¬ ments with virus-induced tumors in rabbits. A similar approach is being used for human cancer studies at the National Cancer Institute and elsewhere. Also, an experimental vaccine was developed that in¬ creased the frequency with which virus-induced benign tumors in rabbits regressed instead of becoming malignant. A monkey virus that contaminated some lots of polio vaccine and caused cancers when tested in newborn hamsters was found to cause abnormalities in adult human cells in tissue culture. An abnormal chromosome, called the Philadelphia chromosome, previously seen in white cells from a few patients with chronic myelocytic leukemia, has been found in a high percentage of untreated patients. It disappears from the blood after treatment. That it is related to the genesis of leukemia has yet to be determined; no flow like it has been seen regularly in other types of leukemia, nor has the Philadelphia chromosome appeared in all cases of the chronic myelo¬ cytic type. Encouraging preliminary results were achieved with two investiga¬ tive methods of therapy for lung cancer, in which the prognosis has long been poor. Published reports on work with small numbers of patients indicated that high-voltage cobalt-60 radiation prior to sur¬ gery made operations possible in some cases originally deemed in¬ operable, and that combined radiation and treatment with a drug, AB-132, brought about marked regression of inoperable cancer. Both approaches are being studied in larger groups of patients. New evidence that exposure of pregnant women to X-rays in diag¬ nostic doses makes their children’s risk of dying from cancer abnor¬ mally high came from a survey of births in 37 large hospitals from 1947 to 1954. Public Health Service 213 One of the year’s outstanding accomplishments by a grantee won recognition from scientists everywhere for its significance in the un¬ derstanding of one of the basic phenomena of life — the immune re¬ sponse, which helps protect man against disease and causes him to reject transplants of tissue from any donor except an identical twin. Institute of Dental Research Laboratory research reaffirmed previous findings that, as an infec¬ tious and transmissible disease, experimental dental decay is far more specific than has been realized, and is highly dependent on the critical interaction between host, diet, and microflora. Knowledge that dental decay could be induced in a strain of caries-inactive hamsters by oral inoculation of a specific strain of streptococcus opened the way for studies to determine the feasibility of vaccines for immunizing test animals against tooth decay. Although it would be premature at this time to apply any of these findings to humans, the Dental Insti¬ tute plans to direct a major emphasis to clinical studies. Studies of nutrition and dental caries emphasized changing concepts of the dietary etiology of dental caries. Focus on the necessity for calcium and the avoidance of sugar was widened to include such diet factors as the quantity and quality of protein, the role of lysine, and the cariogenicity of certain heat-processed food. Gains were made in new knowledge of the submicroscopic structure, and physical and chemical properties of teeth. In research on peri¬ odontal disease, a better understanding of calculus formation was achieved through use of new techniques of germfree study, electron diffraction, and X-ray and electron microscopy. Significant results of studies of hereditary conditions with oral manifestations included: description of a heretofore unrecognized hereditary disease (benign intra-epitlielial dyskeratosis) affecting the conjunctiva and the soft tissues of the mouth; description of a new neurological condition inherited as a recessive trait which, in addition to causing spasticity and certain skin changes, also causes defects of speech and chewing ; and clarification of mechanisms of abnormal oral development based on longitudinal twin studies and analysis of family data. A new clinical program was launched in a multidisciplinary ap¬ proach to physiological studies of laryngeal and pharyngeal anatomy and function in children, and cleft-palate patients with speech and feeding disorders. GRANTS AND AWARDS Basic studies bearing on periodontal disease with special emphasis on the physiology of occlusion and the responses of tooth- supporting 214 Department of Health , Education , and Welfare , 1962 tissues to traumatic or other injurious influences are being pursued by grantees at Eastman Dental Dispensary, Rochester, N.Y. Grant¬ ees at the University of Kentucky Medical Center are studying chromosomal abnormalities as possible causes of a cleft palate in association with one or more unrelated physical defects, and the dis¬ tribution of such genetic defects in families of children with cleft palate. Increased grants were made to non-Federal institutions to train clinical and basic science personnel for research, and support was continued to dental schools for training undergraduate dental students to work with chairside assistants. Heart Institute In 1962, the attack on the complex of disorders of the heart and blood vessels was accelerated by strengthened programs of the National Heart Institute in support of research and training, and the aid pro¬ vided, through its appropriation, for community programs. In atherosclerosis, the complicated processes of fat metabolism were the focus of productive investigations, and cholesterol continued to receive much attention. Heart Institute studies have defined the prob¬ able sequence of steps involved in cholesterol synthesis and identified the intermediate products evolved ; this basic knowledge has been of notable importance and current pertinence with relation to cholesterol¬ lowering drugs. Recent findings in other basic studies suggest that the body may regulate its serum lipid levels through nerve, hormonal, or other mechanisms that affect triglyceride synthesis or breakdown, and that one of the most important regulatory factors may be glucose. Glucose appears to be essential to the synthesis of triglycerides, the form to which fatty acids absorbed from the circulation or synthesized from other substances are converted for storage in adipose tissue. With¬ out glucose, triglycerides broken down to release their fatty acids to supply metabolic fuels could not be replaced. In hypertension research, the study of amines received much atten¬ tion since a number of these substances are powerful stimulants and blood-vessel constrictors, and several are thought to be involved in the mechanisms by which the body regulates blood pressure. One of these, norepinephrine, is of particular interest because it seems to be the key to the action of many drugs now used to treat hypertension. Alpha methyl dopa is a new drug, still in the experimental stages, that appears to act by blocking the storage sites of norepinephrine at nerve terminals. Findings reported during the year suggest that the drug may have advantages over other blood-pressure-reducing agents. Public Health Service 215 ) 1 1 Questions of toxicity and tolerance have not yet been completely answered, however. Another experimental blood-pressure-lowering drug undergoing clinical tests is MO-911. Among advances in diagnosis of heart attacks was the modification and improvement of precordial scanning as a simple and sensitive technique for detecting left-to-right shunts, one of the most frequently occurring signs of congenital heart disease. The technique has also been adapted to detect acquired valvular defects and for measuring heart output, although catheterization is required for these. Findings from epidemiology studies further defined factors asso¬ ciated with an increased risk of developing coronary heart disease. Among these factors are an elevated serum-cholesterol level, elevated blood pressure, enlarged left ventricle, cigarette smoking, and low vital capacity. Accumulated data indicate that combinations of factors increase susceptibility, so that those at high risk can now be determined to some degree. GRANT-SUPPORTED RESEARCH Successful long-term use of implantable artificial cardiac pacemak¬ ers in patients with Stokes-Adams syndrome was reported by scientists at Harvard University and at the University of Minnesota. In this syndrome, the heart’s conduction system — which originates and trans¬ mits the electrical impulses causing the heart to beat — is damaged by disease and partial or complete heart block may result. Kegular heart rhythm can be restored with use of an artificial pacemaker, set at a pace suitable for normal activity, and then implanted under the skin to remain until its batteries require replacement in about five years. A significant achievement was the development by investigators at Marquette University of instrumentation and techniques for accu¬ rately locating the heart’s specialized conduction system during open heart operations. Investigators at Jefferson Medical College reported that blood stored in acid-citrate-dextrose solution, the most widely used anticoagulant and preservative for banked blood, can be restored to a nearly normal biochemical state by a combination of anion and cation exchange resins. Serum cholesterol levels can be reduced by thyroid hormones, but the doses needed to maintain low serum cholesterol also increase basal metabolic rate and may cause angina pain in heart patients. In do¬ ing studies at the University of Louisville it was found that several synthetic analogs, near relatives of thyroxine, appear able to hold serum cholesterol down without elevating basal metabolism in pa¬ tients with normal thyroid function. 216 Department of Health , Education , and Welfare , 1962 i Angiotensin II, a blood-vessel constrictor that results from the ac¬ tion of a kidney enzyme called renin, has been suspected of playing ! an important role in essential hypertension, since blood angiotensin j levels have been reported higher in patients with high blood pressure | than in others. Findings from recent radioactive tracer studies by ! scientists at Mount Sinai Hospital, New York City, indicate that the ' metabolic inactivation of angiotensin proceeds more slowly in hyper- | tensives than in normotensives, and may account for the higher con¬ centrations found in hypertension. Improved techniques for accurately locating clots and lesions ob¬ structing coronary arteries and for preventing constriction of small blood vessels at the site of surgical incision have increased the safety and effectiveness of surgery to remove such atherosclerotic obstruc¬ tions. Impressive results continued to be reported by investigators at Bay- ior University and other institutions in surgical treatment of certain clots and atherosclerotic deposits that prevent an adequate supply of j blood from reaching the brain. Institute of Mental Health Progress in the field of mental health has proceeded at an acceler¬ ated pace during recent years and important advances were made dur¬ ing the past year in the various Institute programs. The Institute’s activities have included both those designed to develop more effective methods of treating mental and emotional disorders, and those which attempt to find ways of preventing such disorders. The Institute’s program was given impetus this year through the wide public interest aroused by Action for Mental Health , the Re¬ port of the Joint Commission on Mental Illness and Health. The Report, sharply focusing attention on needs in mental health and the promise for control of the mental disorders that lies in knowledge now at hand, has stimulated the initiation of new programs for action at community, State, and Federal levels. Its impact will increasingly be felt on mental health programs in the years ahead. GRANT-SUPPORTED ACTIVITIES The Institute’s grant program is designed to support a complex variety of research programs, mental health projects and training activities — all ultimately aimed at the solutions of mental illness in its many forms. More than a third of the grant program was concerned with the major psychosis, schizophrenia, which accounts for more than half of all patients hospitalized for mental disorders in the United States. Research covered a wide range of studies, including testing of prom- Public Health Service 217 ising therapeutic measures; the collection and analysis of trends in hospital populations, as well as programs for advanced training of personnel; and the development of hospital, clinic, and community services for diagnosis, treatment, and rehabilitation. Over 18 percent of grant funds were directed to the important prob¬ lems of mental retardation, juvenile delinquency, and other abnormal and behavioral problems. Grant support in the area of alcoholism and drug addiction has made possible the relocation at Kutgers of the Center of Alcohol Studies, and such investigations as thyroid therapy for acute alco¬ holic stupor, studies on detection of problem drinkers among indus¬ trial employees, and programs for the rehabilitation of drug addicts. The past year was a period of major development in the Institute’s international research grant program, and a continuing expansion of this program is seen for the next several years. The Psychopharmacology Service Center was engaged in stimulat¬ ing and facilitating grant support of research in studies of drugs used in mental illness. To facilitate dissemination of information on developments in psy¬ chopharmacology, an abstracting service was initiated. The publica¬ tion, which provides coverage of world- wnde current literature in this field, fills an important need in bringing together relevant information on drugs for the benefit of clinicians and scientists approaching the subject of psychopharmacology through many disciplines. BASIC AND CLINICAL INTRAMURAL RESEARCH Extensive research continued in the synthesis, degradation and dis¬ tribution of the biogenic amines in the body and brain, in an effort to determine whether abnormalities in the metabolic processes may play some role in the etiology of mental illness, particularly schizo¬ phrenia. The studies begun last year of factors affecting mobilization of free fatty acids (FFA) in schizophrenic and normal patients were extended. The results indicate that some schizophrenics do not ex¬ hibit a normal fall in FFA in response to insulin. A major continuing project in the area of schizophrenia research is the study of families. NIMH investigators, for example, have found that the presence and variety of schizophrenic illness can be predicted from the form of thinking in the rest of the family in which the patient has developed. The findings suggest an environmentally determined rather than a gene-determined interpretation of schizo¬ phrenic thought disorder. Testing the addiction liabilities of new narcotic drugs remains an important part of the Institute’s research program at the Addiction 665171—63- 15 218 Department of Health , Education , and Welfare , 1962 Research Center, Lexington, Ky. A search for analgesic compounds with effects differing from morphine has been the subject of intensive research at the Center in the past years. A new series of compounds, the indanes, has now become available. These indanes differ from agents previously studied in that they are analgesic in animals and in man. The intermediate metabolism of psychoactive drugs, and the indi¬ vidual differences in their handling in the body, represents a principal research interest of the Institute’s Clinical Neuropharmacology Re¬ search Center at St. Elizabeths Hospital, Washington, D.C. COMMUNITY SERVICES AND PROGRAM DEVELOPMENT The development of comprehensive community mental health pro¬ grams was encouraged through grants-in-aid to the States, profes¬ sional and technical assistance to States through consultation, surveys of special mental health problems, conferences, demonstration proj¬ ects, and support of research projects designed to develop improved methods of diagnosis, care, treatment and rehabilitation of the mentally ill. The Institute also extended its program development activities in special problem areas of significance for mental health — rehabilita¬ tion, aging, juvenile delinquency, mental retardation, suicide preven¬ tion, alcoholism, drug addiction, among others. The Institute played a major role in activating a large demonstra¬ tion project, Mobilization for Youth, designed to attack the problem of juvenile delinquency on the lower east side of Manhattan. TRAINING The Institute’s training programs were widened this past year through increased support for psychiatric training of general practi¬ tioners, including both specialized residency training, and post¬ graduate education in psychiatry to enhance general practice skills. Institute of Neurological Diseases and Blindness To a decade of progress, observed by the Institute this year, may be added important gains in the Institute’s programs toward increased prevention, control, and cure of disabling neurological and sensory disorders. COLLABORATIVE PERINATAL RESEARCH Useful and encouraging clues have begun to emerge from the Institute-supported mother-child study aimed at shedding light on the relationship between events of pregnancy, birth, and the first month of life, and the occurrence of brain- damaging disorders of infancy and childhood. Public Health Service 219 Analysis of information collected on 7,500 of the more than 25,000 I pregnancy studies to date at the 15 collaborating medical centers has I confirmed that expectant mothers who smoke are more likely to give j birth to a premature infant than the nonsmoker. This finding is I significant because prematurity is an important factor in brain | damage and infant deaths. Prematurity has also been linked to some symptomless infections f in the expectant mother. This finding underscores the need for im- j proved diagnosis and early treatment of maternal infections during I pregnancy. Special related studies conducted at some of the collaborating l hospitals have also proved fruitful. For example, an Institute grantee developed a simple, inexpensive screening test which permits early detection of the brain- damaging but treatable disorder known as phenylketonuria, or PKU. PRIMATE RESEARCH IN PUERTO RICO The broad study of perinatal problems in humans is paralleled by I studies of monkeys at Institute laboratories in Puerto Rico. Now in its sixth year of operation, the project has established conclusively that birth asphyxia causes brain damage resulting in syndromes resembling cerebral palsy and mental retardation in humans. Cur¬ rent research is aimed at developing means of prolonging survival of asphyxiated monkeys and preventing brain damage. MULTIPLE SCLEROSIS, MUSCULAR AND NEUROMUSCULAR DISEASES, EPILEPSY Further strides were made toward understanding the biochemical process by which myelin, the protective sheath around nerve fibers, is formed and is also caused to disintegrate. Observations of diseases in animals which have strikingly similar resemblances to multiple sclerosis support the theory that this and other disorders which rob nerve fibers of this protective sheath may be due to a latent viral agent. Also highly suspect as a possible cause is auto-immunization or sensitivity to certain substances normally occurring in brain tissue. This year scientists identified a substance which induces an experi¬ mental disease in animals (allergic encephalomyelitis) as a small basic protein found in the nerve sheaths in the brain. Moreover, this same substance not only induced the disease but was utilized to suppress it as well. In similar studies of allergic encephalomyelitis in tissue culture, grantees helped demonstrate that an antibody-like factor in the blood of multiple sclerosis patients destroys myelin. Developments in the intriguing field of immunology, especially in regard to auto-immune diseases, have also had an impact on neuro¬ muscular research. Preliminary results reenforce earlier predictions 220 Department of Health, Education , and Welfare, 1962 that myasthenia gravis might be an auto-immune disease. Grantees have determined that a constituent of serum, called serum complement, from myasthenic patients varies in concentration in relation to the severity of the symptoms. The constituent is involved in immune reactions of the blood. Encouraging preliminary reports were made on the use of a new anticonvulsant drug, R594, in children with certain types of epilepsy previously resistant to drug therapy. In other studies of the clinical course and therapeutic evaluations, grantees have found brain-wave recordings to correspond to the type, degree and localization of seizure. VISION, HEARING, HEADACHE Research progress in the Institute’s laboratories and at other re¬ search centers promises to aid in controlling and treating eye disorders which affect millions, especially older persons. In glaucoma, the second leading cause of blindness in the United States, Institute scien¬ tists identified an important enzyme in the fluid formation within the eye which causes increased pressure. This basic discovery is expected to pave the way to the clinical use of a new type of drug to inhibit formation of the excess fluid and prevent damage to eye tissue. Last year an Institute trainee discovered a cure for herpes keratitis, or “winter pink eye,” by applying an antiviral drug to the treatment of this common inflammatory eye disorder. The treatment rapidly cleared the acute inflammation without scarring the cornea. When the treatment is perfected, many people may be saved from blindness. Outstanding basic research by an Institute grantee has established the mechanisms by which sounds received in the inner ear are con¬ veyed to the brain. These findings make it possible to determine whether deafness is caused by damage to the ear or to the portion of the brain concerned with hearing. To the countless sufferers from migraine headache, the release in 1962 of a research drug to physicians generally for prescription use brought hope that effective prevention was at hand. This drug was carefully checked by a “double-blind” technique by an Institute grantee and other specialists, and its minor side effects cautiously evaluated. Called methysergide maleate, the compound may not be used for all patients, but under medical guidance is proving helpful for many patients as a preventive. Grantee findings that persons subject to migraine headaches had about twice the incidence of abnormal brain-wave patterns as other persons encouraged treatment with anticonvulsants. The reported results have been favorable in 80 percent of a highly selected group of cases. Public Health Service 221 Division of Biologies Standards This Division is responsible for the administration of control measures for all biological products used for the prevention and cure of disease in man. These products — the vaccines, antitoxins, thera¬ peutic serums, and human blood and its derivatives— are developed for the most part from potentially pathogenic microorganisms. Rigorous control procedures are essential in their preparation to re¬ duce to a minimum the hazards which might occur in processing, and to ensure final products of satisfactory potency. Effective administration of these responsibilities requires the design and development within a research context of adequate and practical standards for the production and testing of biologies, careful sur¬ veillance of production methods, and the continuous improvement of testing procedures. Thus, the varied research activities of the Di¬ vision’s six laboratories — Bacterial Products, Biophysics and Bio¬ chemistry, Blood and Blood Products, Control Activities, Viral Im¬ munology, Virology and Rickettsiology — are essentially product- oriented. Their scope, direction, and intensity are dictated by the need to provide essential information for the formulation of require¬ ments and regulations governing the licensing and release of biological products. An appreciable part of the Division’s research this year has been devoted to work on the adventitious simian virus, SV-40, found in some kidney-tissue cultures from which live and killed polio vaccines and adenovirus vaccine are prepared. Since, with few exceptions, the role of animal viruses in the production of human disease is un¬ known, their exclusion from all commercial vaccines is required by the Public Health Service. In addition to devising elaborate test systems for the detection of SV-40 during the processing of the vac¬ cines, the Division is continuing to study the pathogenesis of the virus for man, monkeys, and other laboratory animals; the development of simpler tools for working with it ; and the exploration of its ecology in monkeys in their native habitat as well as in the laboratory. During the year, the solution of problems relating to the licensing of live poliovirus vaccine was of pressing urgency. This involved working out delicate testing methods to assure the genetic stability of the three virus strains, as well as developing techniques for detect¬ ing the presence of SV-40. These problems were satisfactorily re¬ solved, and in March, Type 3 was licensed, thereby making available the complete series of oral vaccines for protection against all three types of polio. The development this year of regulations for measles vaccines neces¬ sitated the formulation of an extensive array of controls covering three products — inactivated measles vaccine, live measles vaccine, and 222 Department of Health, Education , and Welfare, 1962 standardized gammaglobulin. Concurrently, the Division is develop¬ ing standard reference materials which will serve to correlate labora¬ tory results so that the potency of the vaccines produced by individual manufacturers can be evaluated on a sound common basis. Throughout the year, the Division’s Laboratory of Blood and Blood Products carried on an extensive investigation of alleged violations of the Biologies Law in the sale of plasma and whole blood. The evi¬ dence, involving the updating of whole blood and the processing of plasma for sale without license, was turned over to the U.S. Depart¬ ment of Justice. At the close of the fiscal year, 288 biological products were licensed under the provisions of the Public Health Service Act for commercial use in this country and abroad. Division of General Medical Sciences The primary responsibility of this Division is the administration of NIH grant and fellowship programs for research and training in the sciences basic to medicine and biology and in certain clinical areas which encompass or cut across categorical Institute programs. It administers certain other grant programs also, and the NIH centers for Aging Research and for Research in Child Health. RESEARCH GRANTS Grant-supported research has indicated that the genes of all living vertebrates may have a common evolutionary origin, so that deviation in the molecular structure of a gene actually constitutes a kind of “molecular disease.” This approach to genetics may lead to practical methods of fighting diseases which originate in the germ plasm. The hitherto mysterious role of the thymus gland is being analyzed. This has bearing on such varied things as skin grafts and growth, i Here is a new approach to transplantation of organs as well as to ! stimulating healthful growth and inhibiting harmful growth. Four different patterns of defective bilirubin metabolism have been described in jaundiced premature infants, and these have been tied to the patterns for recovery. RESEARCH TRAINING GRANTS Grant funds have been made available to research institutions to extend and improve graduate research training. Fellowships at vari¬ ous levels have been awarded to promising scientists and teachers. The Division is providing training aid in 20 different basic fields and for 596 separate programs. THE GENERAL CLINICAL RESEARCH CENTERS This period has seen the emergence of the General Clinical Research Center as a genuine research tool. By the end of the 1962 fiscal year, 223 J Public Health Service 56 awards had been made and 25 centers were open for patients. In I addition to general centers for study of metabolic diseases, nutritional ailments, surgical conditions and other problems in adults, centers j have been established for study of children’s diseases and even for the special study of prematurity. Reports from the basic scientists and physicians associated in the ; Centers indicate new leads in muscular dystrophy; knowledge of a new inborn error of metabolism ; a new method for the use of a tran¬ sistorized pacemaker for cardiac stimulation, a technique for utilizing the artificial kidney on a regular basis over a period of years, and a method for the determination of the life span of human blood platelets. CENTER FOR RESEARCH IN CHILD HEALTH In 1961, a Center for Research in Child Health — designed to achieve greater understanding of the pattern of human life and development — was established in the Division. The Center will be a focal point for research in health problems of childhood and adolescence, infant mor¬ tality, mental retardation, congenital abnormalities, and other condi¬ tions which primarily afflict children. CENTER FOR AGING RESEARCH The Center for Aging Research has encouraged research programs in the field of aging through the Division of General Medical Sciences and the Institutes, and has also provided a central clearing house for research information in the entire field of aging. Grants for research in aging continue to increase, now constituting some 300 projects. GENERAL RESEARCH SUPPORT GRANTS General research support grants provided stable allotments to a substantial number of medical research institutions for developing and maintaining well-balanced programs of general research and research training. These broad institutional grants can be used with great flexibility within the research framework and within prescribed objectives to provide resources and personnel for new projects. SPECIAL RESOURCE CENTERS Research facilities of a highly complex type which can be used for several colleges or several departments within a parent institution con¬ stitute Special Resource Centers. If, for example, a university has dozens of projects which would benefit from the presence of a computer center, a special research resource facility for this can be established with grant funds. Such centers are designed to facilitate the many varying aspects of research, in broad scope or fine detail. 224 Department of Health , Education , and Welfare , 1962 Division of Research Grants The Division of Kesearch Grants continued to administer and coordi¬ nate the grant and award program of the National Institutes of Health, and to provide both technical assistance and review and appraisal services for the other grant awarding units of the Public Health Service. Functions included processing and scientific or tech¬ nical review of grant applications, and the providing of fiscal, statis¬ tical, and information services. In response to the mounting volume of applications for grants, the number of study sections — whose primary function is technical review of applications — was increased from 40 to 45. During the year the Division undertook to improve financial man¬ agement of grants through the strengthening of its policies and the coordination and streamlining of accounting procedures to be followed by investigators and budget officers in grantee institutions. A major contribution to medical and scientific communication was the Division’s first issue of an annual subject-matter index of active PHS research grants. A new “Grants Associate” program, designed to recruit and train professional staff for Institute and Division grants branches and for DEG, was established. The Division published a survey of the current professional status and geographic distribution of 2,917 former PHS fellows. The survey showed that approximately 87 percent of former fellows remain engaged in some research activity, and that approximately 67 percent spend some time in teaching. Division of Research Services The NIH research investigator looks to the Division of Kesearch Services as a central source for biomedical computing and data-proc- essing services; for studies of environmental conditions having a bearing on his work ; for planning and consultation on laboratory and structural design; for noncommercial scientific instruments, fabrica¬ tion of necessary equipment, and plans for laboratory automation ; for supplies of laboratory animals, glassware, and media ; for visual docu¬ mentation of research findings by means of exhibits, motion pictures, and other aids ; and for central and satellite library services. Pioneering work in germfree technology begun by the Division in 1954 led to the establishment of germfree laboratories in three of the Institutes. Most recently, in anticipation of the time when scientists will demand genetically defined animals, the Division has established foundation breeding colonies leading to the routine issuance of germ¬ free and specific pathogen- free animals. Public Health Service 225 The NIH Animal Center at Poolesville, McL, is slated to become a model installation. The present schedule calls for completion of a farm animal building, kennel building, power plant, roadways, fenc¬ ing, and utilities in 1964. Far-ranging improvements leading to increasingly useful library and bibliographic services are under way. Satellite libraries have been inaugurated to serve the specialized information needs of geo¬ graphically distant groups. An ad hoc steering committee is studying the long-term needs of the Institutes for computer systems and data processing. The high-speed digital computer acquired in 1961 was operating near the two-shift level at the end of the fiscal year, with an almost equal balance be¬ tween research, extramural, administrative, and epidemiological program applications. Clinical Center To meet the demand on all central services stimulated by an in¬ crease of 1,500-bed days over its predicted 75 percent utilization of available bed days, the Clinical Center, in this period, introduced automation and expanded services wherever feasible. Clinical Center staff, collaborating with NHI and NINDB staff, expended much effort on preparations for the opening of the new surgical wing, scheduled for late fiscal year 1963. This unique facil¬ ity will offer opportunities to observe parameters of surgery to a degree never before possible. The Clinical Pathology Department, by adapting advanced re¬ search laboratory techniques and developing standards of precision, not only provided services crucial to the research patient’s welfare, but also aided the entire field of medical diagnosis. The use and further development of automatic data computers illustrate the Pa¬ thology Department’s techniques for solving the problems stemming from the large number of laboratory tests now available to the clinical investigator. 226 Department of Health , Education , and Welfare, 1962 Table 1. — Statement of appropriations , authorizations, and obligations, Public Health Service, fiscal year 1962 fin thousands] Funds available for obligation Appropriations Appro¬ priations and au¬ thoriza¬ tions Net transfers between appro¬ priations Repay¬ ments for serv¬ ices Prior year unobli¬ gated balances Total funds avail¬ able Amounts obligated Total . . Appropriations, PHS _ Buildings and facilities _ Accident prevention _ Chronic diseases and health of the aged . . . . Communicable disease activities $1, 392, 485 1, 391, 977 18,230 3,616 10, 955 0 0 $2,000 $71, 985 $159, 478 71, 985 159, 197 . 5, 027 31 74 $1,633, 437 1, 623, 159 23, 257 3,647 13,029 $1,323,267 1,314,311 2, 171 3, 574 10, 585 (1962) _ _ _ Communicable disease activities (1961 and 1962) _ Community health practice and re¬ search... . . . . Control of tuberculosis . . Control of venereal diseases _ Dental services and resources _ Nursing services and resources - Hospital construction activities (1962) . . . . Hospital construction activities (1962-63) _ _ _ Hospital construction activities (1961-62). . . . . . Air pollution. . . . Milk, food, interstate, and com¬ munity sanitation.. . . Occupational health _ _ Radiological health... _ _ Water supply and water pollution control _ Grants for waste treatment works construction - - - - Grants for waste treatment works construction (1960-62) _ Grants for waste treatment works construction (1961-62) . . Hospitals and medical care _ Foreign quarantine activities (1962). Foreign quarantine activities (1962- 63) _ Construction of Indian health facili¬ ties - - - General research and services, NIH. National Cancer Institute (1962) _ National Cancer Institute (1961-63). Mental health activities - National Heart Institute (1962) _ National Heart Institute (1962-63) .. National Institute of Dental Re¬ search . . . . Arthritis and metabolic diseases ac¬ tivities . . Allergy and infectious diseases activi¬ ties (1962).. . . . . Allergy and infectious diseases activ¬ ities (1962-63).. . . Neurology and blindness activities.. Grants for cancer research facilities.. Gra nts for construction of health re- s earch facilities - Sc ientific activities overseas (special ■foreign currency program). . . National health statistics . . Operations, National Library of Medicine . . . Retired pay of commissioned offi¬ cers . . . . Salaries and expenses, Office of the Surgeon General - Construction of mental health, neu¬ rology research facility... . . 9, 988 24,331 6,493 6, 000 2,500 7, 673 1, 772 209, 728 8, 590 7, 422 3, 970 10, 502 20,304 80, 645 i 50, 009 6, 082 8,285 127, 589 142, 738 108, 838 131, 862 1,000 17,335 81,802 56,074 70, 762 5,000 30, 000 9,000 4, 642 3 2, 360 5, 374 -2,000 -100 -32 -734 734 -750 750 186 1,030 235 16 829 505 6, 574 376 391 12 171 14 323 892 124, 515 1, 101 6, 507 4, 498 26 692 16 3, 679 12, 128 11,018 10, 956 892 747 22,347 6, 502 6,000 2, 400 7,645 21, 958 6,463 5,985 2,293 7,553 1,772 1,766 209, 728 62, 849 124, 515 8, 597 124,423 8,283 7, 657 3, 986 11,311 7, 595 3, 930 11,230 20, 775 19,383 80,645 57, 996 1, 101 1,098 6. 507 56, 583 5,724 6, 507 56, 875 5,641 734 563 12, 783 127, 589 142, 764 692 108, 910 131, 880 1,000 17,335 7, 018 118. 157 117, 660 385 108. 084 110,867 15, 103 82, 193 79,318 55,336 54, 013 750 70, 763 5,000 658 62, 987 5,000 30,016 30,011 12, 679 4, 813 3, 915 4,658 2,080 1,870 2,360 2,360 5,883 5,789 12,128 406 i Supplemental appropriation bill pending. * Does not include $17,000 to be deappropriated. Public Health Service 227 Table 1. — Statement of appropriations, authorizations , and obligations. Public Health Service, fiscal year 1962 — Continued fin thousands] Funds available for obligation Appropriations Appro¬ priations and au¬ thoriza¬ tions Net transfers between appro¬ priations Repay¬ ments for serv¬ ices Prior year unobli¬ gated balances Total funds avail¬ able Amounts obligated 3 $53, 007 10,000 $901 $53, 908 10, 000 $53, 596 8, 104 Hospital and medical facility re- Bureau of State Services manage- 5,026 5,026 5,005 National Institutes of Health man- 34,613 34, 613 33, 734 General research support grants, NiH _ _ _ _ 20,000 20,000 20, 000 Civil defense medical stockpile ac- 35, 433 35,433 24, 507 Consolidated working fund, HEW, 199 $116 315 165 Consolidated working fund, HEW, PHS . . - 538 538 517 Appropriations, special proj¬ ect funds made available by 9, 489 8,489 Salaries and expenses, Bureau of Prisons (transfer to HEW, PHS). American Sections, International Commissions, State (transfer to HF W pHR) . _ 2, 457 2, 455 93 90 Salaries ’ and expenses, Office of Emergency Planning (transfer to HEW PHS) .. . . 115 114 Research and development, Office of Emergency Planning (transfer to HEW PHS) . . . 3 Civil Defense, Department of De- frmco to HEW PHS) 1 16nS6 VbrailolLi l/W nij »* , a Farm labor supply revolving fund, Bureau of Employment Security Cfroncfcr tn TTF.W PHS) 430 410 ^transier j_m< »» , 1 / - - - Inter American social economic pro- ftrciTiQfpr to HEW ) 588 487 grain (tiaiioici uw xxxj ” ) - Civil defense and defense mobiliza¬ tion, functions of federal agencies, Office of Emergency Planning (transfer to HEW, Office of Secre- 502 501 Administrative expenses, economic assistance, Executive (transfer to HEW) _ 39 38 Development grants, economic as¬ sistance, Executive (transfer to HEW) _ - _ 3,709 3,003 Supporting assistance, economic as¬ sistance, Executive (transfer to HEW) _ 580 432 Contingency fund, economic assist¬ ance, Executive (transfer to HEW) _ 405 400 Military assistance, Executive 51 51 (transier lu nrj »» ; - - Consolidated working fund, DHEW, Office of the Secretary.. 516 508 Gift funds donated for general and specific purposes . - 508.2 281.5 789.7 467.0 Contributions, Indian health facili- 288.9 178. 5 467.4 283.2 Public Health service unconditional 35.3 30.8 66.1 25.9 Public Health service conditional 10.9 10.9 21.8 12.1 Patients’ benefit fund, Public 40.0 19.1 59.1 43.3 Health services hospitals — — ----- Special statistical work, vital sta- 133.1 42.2 175.3 102.5 a Includes $432,000 contract authorization, and excludes $435,000 liquidation of prior contract authori¬ zation. Table 2. — PHS total paid employment by Bureau and Division , as of June 30, 1962 228 Department of Health , Education, and Welfare, 1962 < S hhomin' jjj 2 g O 3 O 0-0 CO H 03 CO ia*^OOiOCOOi pt— « ^OOOOOOOgg wm” g “ “ “ “ “ g g.s.s^ © I .►►►►►eess’stss & 2 m w;g gg . §3 °£wg|SS“-S ° o o o o PJ+a+a-w+a O OT w co to ) .a ‘3 '3 '3 '3 •rt "© © © © ppppp += w -"a Pi Pi O o o o « $.£> Oflfl Public Health Service 229 I f Jspf | 1!“^ u i's 230 Department of Health , Education , and Welfare , 1962 Table 4. — Research grants and awards , fiscal year 1962 Public Health Service 231 Table 5. — Payments to States or localities within States for public health services , fiscal year 1962 1 [In thousands of dollars] 232 Department of Health , Education , and Welfare, 1962 < CO (NOHiON ^ 03.2 o3 ® - jog o S’ S 'S ^3 2 o 03 2 0 ^ a lOCDOHTf CO CO Tt* CO O c^oooo CO ^ H OlOCOlOO i 03 CO O COOO rt« CO iO rH 03 CO CO CO»OOOH(N CO CO O 1 *0*0 ^GOOO^C^ NC0 03tN!N LQ O] (M (N .2o •£ S o c3 .9 c/3 d § cO CO ^ CO u-j ^ 03 ^ CO *0 00 £ .9 O CD §§15.SS &gg§’S B3.2.S.2 -SS-gg OWS55 swwag 23SSS Public Health Service 233 11SSI §§sls 5S2II llg»l| *4 rSr* HH a> a) o o,c^j &£!z;;z;;z;oo< BflBflll 111! gp£>iSjSjS !SoS>C 290 Department of Health, Education, and Welfare, 1962 other Federal agencies to provide school services for 38,000 children residing on Federal property. A total of $247 million was appro¬ priated for this program in fiscal year 1962. Over $1,426 million has been appropriated for this program since its enactment in 1950. Vocational and Technical Education The Federal Government and the States cooperate in the adminis¬ tration of programs of vocational education of less than college grade. The controlling purpose of vocational education is to fit persons for useful employment. Under authorization of the Smith-Hughes Act of 1917, the Vocational Education Act of 1946, usually referred to as the George-Barden Act, and supplementary legislation enacted since 1917, Federal funds are available for allotment to the States and in¬ sular and territorial possessions for vocational education in agricul¬ ture, distributive occupations, home economics, trades and industry, practical nursing, fisheries occupations, and for area vocational edu¬ cation programs for the training of highly skilled technicians. The needs of two distinct groups of people are served by programs conducted under the provisions of the F ederal acts : those who have entered upon, and those who are preparing to enter upon the work of various occupations in these fields. Vocational education pro¬ grams provide training for young persons in regular day schools and for out-of-school youth and adults, both employed and temporarily CHART 9. — VOCATIONAL EDUCATION ENROLLMENTS AND EXPENDITURES: UNITED STATES, 1935-65 Source: U.S. Department of Health, Education, and Welfare. Health, Education, and Welfare Trends, 1962. Office of Education 291 unemployed. This Federal-State cooperative endeavor is based upon the fundamental ideas that vocational education is in the national interest and is essential to the national welfare, and that Federal funds are necessary to stimulate and assist the States in making ade¬ quate provisions for such training. AREA VOCATIONAL EDUCATION Recent studies pertaining to programs for the training of highly skilled technicians authorized by title VIII of the National Defense Education Act of 1958 emphasize the need not only for larger numbers of highly skilled technicians to support engineers and scientists, but also for technicians with an increasing knowledge of scientific and mathematical principles and their applications. Vocational educators have been concerned with improving the quality of instruction in these programs, and emphasis has been placed on the depth and rigor of the curriculums in the preparation, upgrading, and updating of tech¬ nical personnel. It is estimated that 50,000 persons were enrolled in preparatory programs and 100,000 in extension programs during fiscal year 1962, an increase of 150 percent since the area program began in 1959. Ten States report 70 new area schools in the planning stages, under construction, or already completed, and other States are expanding or improving their present facilities. The number of extension enrollments each year and in the scope and extent of extension training in the total technical program is indicative of the rapid changes in industrial technology and the need of technical workers to keep pace with the rapid developments in their fields. The role of extension training programs in the industrial complex is illustrated through the recent experience of the aircraft industry with the changeover to missile production. Extension courses were developed to retrain technical workers for new jobs with a minimum disruption of employment and consequent effect on the local economic situation. The first group of technicians was graduated from 2-year prepara¬ tory programs in June 1961. A report of the placement of these graduates indicates that the average wage rate for those who were placed in the technical field for which they were trained was $4,600 for graduates of 2-year post high school programs, and $4,200 for those graduated from high school technical programs. The recruitment of instructors for courses in programs for the training of highly skilled technicians continued to pose serious prob¬ lems to the States and local communities. Only a few communities have been successful in attracting qualified teacher personnel from industry whose background included engineering or technical insti¬ tute education and advanced technical employment experience. 292 Department of Health , Education , and Welfare , 1962 Progress has been made in the training of teachers of technician train¬ ing courses. Some of the States report summer institutes to update the technical competencies of instructors ; elsewhere, teacher training institutions offered industrial educational curriculums with an applied technology option. The States and local communities conducted studies, frequently in cooperation with other interested agencies and groups, to determine the need for technicians, to define job clusters in technical occupations, and to evaluate students’ interest in preparing for employment as highly skilled technicians. TRADE AND INDUSTRIAL EDUCATION Trade and industrial education programs were attended by slightly in excess of 1 million secondary school youth and adults during this past year. Reports from the States suggest that the number of em¬ ployed adults seeking job upgrading and retraining opportunities in programs of vocational education is on the increase. Occupational transition programs are being initiated at an accel¬ erated rate. These are designed to retrain employed workers from dead-end type jobs for other occupational areas before unemployment becomes a reality. There are evidences of growth in these training programs. Several States are in the process of developing statewide courses of study in some of the occupational categories in which trade pre¬ paratory training programs are offered. Summer workshops involv¬ ing instructors, supervisors, and teacher-training personnel have been conducted for the purpose of developing courses of study. This activ¬ ity is often supplemented by regional and area workshops and con¬ ferences in which the services of experts from industry are utilized to bring to the education group the latest techniques and industrial methods. Rapid technological advances have caused a decided impact on en¬ rollments in trade extension programs. Skilled workers must return to the school for training at regular intervals to keep up with the ever-changing demands of industry. Sizeable enrollment advances are occurring in many of the more complex occupational areas. After a leveling-off period during recent years, enrollments in related classroom instruction for apprentice training have increased ; trade and industrial educators, along with management, labor, and various government agencies, have provided the impetus to this move¬ ment. National studies indicate that the number of apprentices being trained should be several times the present rate to fill existing needs for skilled artisan replacements. Both management and labor have assisted educators in formulating programs of related instruction for Office of Education 293 apprentices. Many schools conduct related instruction classes in excess of the minimum 144 hours of required extension instruction per year. Placement potential in the service occupations far exceeds the num¬ ber of persons currently in training. Air conditioning and refrigera¬ tion, to name but two areas, are in need of a substantial number of new workers each year. Many programs are being broadened to in¬ clude training opportunities in service occupations currently in de¬ mand. Representatives of several industries have given generously of their time, talent, and equipment to vocational schools to help educators assure success in these programs. The number of practical nurse education programs continues to increase. The national demands for more and better nursing services, as well as for other health services, has attracted the immediate atten¬ tion of trade and industrial educators having a responsibility for program promotion and development. Many graduates of these pro¬ grams are offered positions before they complete their courses of study. DISTRIBUTIVE EDUCATION Distributive education is a program of instruction in marketing, merchandising, and management. Availability of instruction is limited by provisions of the national vocational education acts to persons already employed in distributive occupations. Instruction, therefore, has been developed around four categories of need — em¬ ployee updating, employee upgrading, career development, and opera¬ tional management. Current emphasis is being directed to the improvement of teacher- education programs, and to the encouragement of needed research. Conferences and publications have emphasized the activities which can be developed at State and local levels to improve preservice and inservice teacher education. States have been encouraged to place greater emphasis on the subject matter fields, including economics, marketing, and management, in the preparation of teachers. Re¬ search projects have been undertaken by State agencies and through the facilities of universities and colleges. One of the most encourag¬ ing developments has been the fact that many practical research proj¬ ects conducted by local teacher coordinators have resulted in new approaches to teaching distributive subjects. AGRICULTURAL EDUCATION The character of agriculture has changed and is continuing to change rapidly. No longer does the term agriculture encompass only the actual producing of crops and livestock; it now includes many closely associated occupations. 294 Department of Health , Education , and Welfare , 1962 Vocational education in agriculture must be sensitive to economic, social, and technological factors affecting farming. Changes that in¬ volve these factors include new methods of processing and distribut¬ ing farm products ; marked progress in the mechanization of farming, advances in the use of labor saving devices ; applications of science to farming in the areas of plant growth, soil conservation, and the conservation of other natural resources ; improvement in the breeding of livestock; widespread use of artificial insemination; use of hybrid varieties and strains of seed ; utilization of fertilizers ; use of herbicides, pesticides, and antibiotics ; the application of improved farm management practices; and the availability and use of farm credit resources. These and other steps in more efficient farming have made it possible for 1 farmer today to feed himself and approximately 25 others, thus making it possible to produce the goods and services needed by the rapidly expanding population. Agriculture is one of the primary areas of scientific research and discovery. In 1962, the amount spent for agricultural research was approximately $275 million of Federal and State funds. Approxi¬ mately the same amount was spent by industry. The accumulation of research findings thus made possible would, however, be of little value if not communicated to farmers and put to use on their farms. Vocational agriculture programs have had, and should continue to have, an important role in helping farm youth and farmers under¬ stand and use the information made available by this extensive research. There is a need for greater competence on the part of those who farm if they are to be successful in attaining an economic status com¬ parable to that of persons engaged in other occupations. This re¬ quires an effective program for full-time day school students and a greatly expanded program through the public schools for upgrading young and adult farmers in extension programs. Even though the number of farms is declining, not enough students with 3 or more years of training in vocational agriculture are graduating each year and entering upon farming to replace the farmers who retire or other¬ wise leave this field of work. OFFICE EDUCATION The office education program is concerned with the second largest employment group in the United States — the more than 10 million persons who work in offices, or better than 15 percent of the employed. The primary goal of the program, to help meet national manpower needs by developing the maximum skill potential of those persons who will follow an office career, serves both the individual and society. The Office of Education for this purpose provides consultative service to States and encourages the development of office training. Office of Education 295 HOME ECONOMICS EDUCATION A long-range curriculum development project has been initiated to provide additional leadership and assist in the coordination of cur¬ riculum work done by States. The ultimate goal of the project is to identify the basic topics in home economics for the secondary schools and set up guides for curriculum organization. Home economics supervisors, teachers, teacher educators, college subject-matter special¬ ists, and representatives of national organizations met with the Office of Education staff to plan this project. Staff members have participated also in curriculum work of organ¬ ized college groups in order to relate the secondary school curriculum to teacher-education programs. TRAINING AND RETRAINING Automation and technological advances, changing economic con¬ siderations, and other factors have created unemployment for many individuals and in somes cases have affected whole communities. The unemployment and concomitant manpower problems of workers whose skills become obsolete have attained national proportions, for they are often beyond the capacity of individual industries, local governments and school officials, or State governments to correct. Only a few States had, prior to 1961, programs which could offer more than a token solution to the problem of providing training for unemployed and underemployed adults. Recognition of this situ¬ ation led the Congress to provide training for these persons through passage of the Area Redevelopment Act in May 1961. The effective¬ ness and scope of the training provisions of this act were limited, however, to areas of chronic unemployment and also limited by financial considerations. The Manpower Development and Training Act of 1962 provides a broader program of training and authorizes comprehensive research and investigation into both current and future manpower requirements and resources. Area Redevelopment Act This act (Public Law 87-27) is designed to provide stimulus to the expansion of employment opportunities in areas of the United States designated by the Secretary of Commerce as redevelopment areas, i.e., areas suffering from substantial and persistent unemployment and underemployment. Specifically, section 16 of the act provides for training and retrain¬ ing of unemployed and underemployed persons who reside in re¬ development areas. Vocational training under the act is actually a joint venture in which the Department of Health, Education, and Welfare and the Department of Labor, working closely with State 296 Department of Health , Education, and Welfare, 1962 and local officials, plan, organize, and finance training projects. The Office of Education is directly responsible for the administration of training funds, for providing adequate training facilities and serv¬ ices, and for assisting the States in conducting the training courses. Specialists in the Office assist the States and through them the local school districts in developing training proposals specially fitted to the training needs of individuals referred by the Department of Labor. Since its passage, the Area Redevelopment Act has provided the means by which approximately 9,074 unemployed or underemployed persons have been trained for over 40 different types of occupations in 147 approved projects in 34 States and American Samoa. Manpower Development and Training Act Although no funds became available during fiscal 1962 for the administration of the Manpower Development and Training Act (Public Law 87-415), which was signed into law on March 15, 1962, many preparatory activities were undertaken by the Office of the Secretary, the Office of Education, and State boards for vocational education. Programs in Higher Education LAND-GRANT COLLEGES Aid to land-grant colleges through the Division of Higher Edu¬ cation for the fiscal year 1962 amounted to $10,744,000, of which $7,140,000 was allocated to each State on a uniform quota. The re¬ maining $3,604,000 was paid to the States in variable amounts based on a proportionate population formula. These are funds supple¬ menting the original land-grant endowments of 1862, the income from which totaled more than $3.5 million in fiscal year 1962. TEACHERS OF THE DEAF On September 22, 1961, Public Law 87-276 was enacted to encourage and facilitate the training of a greater number of teachers of the deaf through grants-in-aid to approved institutions of higher education. By early 1962 the Advisory Committee on Training Teachers of the Deaf had been appointed and criteria and procedures established for the review, evaluation, and approval of applications for scholarships and training grants to colleges and universities. The institutions were notified in the spring so that students could begin their training in the fall of 1962. Forty-three institutions of higher education were approved to pro¬ vide this specialized training to 288 graduate and 159 undergraduate students. The scholarships include a cost-of-living stipend of $2,000 Office of Education 297 for graduate students, $1,600 for fourth-year undergraduate students, and tuition and fees paid by Federal grants to the institution. In addition, training grants were made available in varying amounts to the participating institutions, not only for strengthening existing pro¬ grams but also for stimulating new ones. Scholarships awarded under this law are for a year of study. National Defense Education Act During the fiscal year 1962, the higher education programs under titles II, IY, Y (B), and VI, of the National Defense Education Act (Public Law 85-864) continued at their maximum authorized levels. Student Loans. — Since the inception of the student loan program in February 1959, about 350,000 students have received approximately $225 million in National Defense Student Loans. In 1962, loan funds supported under title II at 1,452 colleges and universities pro¬ vided assistance to 190,000 qualified graduate or undergraduate stu¬ dents. The loans, which averaged about $470 each during this year, are long-term, carry a low rate of interest, and may be used to help defray the cost of tuition or books or to meet living expenses. A recent survey of those who have obtained loans under this title showed that over 90 percent were enabled by their loans to start, or continue, their education on a full-time basis. Five out of seven of the borrowers were members of families with annual incomes of $6,000 or less. More than 60 percent planned to teach. About one- fourth of the borrowers now repaying loans received under this pro¬ gram are currently teaching in elementary or secondary schools. Funds available for title II loans during the 1961-62 academic year totaled $99.2 million, from the following sources : Million Appropriation _ $73. 8 Contribution by institutions _ 8. 2 Amount committed or obligated as of 6/30/61 - 14. 2 Repayments by borrowers _ 3.0 From separate funds, allocations totaling $955,772 were made dur¬ ing the year to 171 institutions in the United States for loans to approximately 1,200 Cuban refugee students. Graduate Fellowships. — The aim of title IY is to increase the number of well-trained college and university teachers by providing graduate fellowships, by assisting institutions to expand and improve graduate-level programs, and by broadening the geographic distribu¬ tion of facilities for education at the doctoral level. During 1962, 1,500 additional fellowships were awarded for study beginning in 1962-63, bringing the total number of active fellowships to 4,113 for the year, at a total cost of $21,371,800. Funds under this program are 665171—63 - 20 298 Department of Health , Education , and Welfare , 1962 about equally divided between stipends and allowances for the fellows and grants to institutions to cover the costs of the program in which the fellows are enrolled. During the 4 years ending J une 30, 1962, the title IV program ap- ; proved 849 new or expanded doctoral programs and awarded 5,500 fellowships, at a total cost of $59,103,300, in the following fields: , science and engineering (41 percent), humanities (25 percent), social science (26 percent) , and education (8 percent) . Counseling and Guidance Institutes. — Title V(B) authorizes the operation of short-term and regular-session institutes by colleges and universities to improve the competencies of secondary school personnel engaged in counseling and guidance and of secondary school teachers preparing to become counselors. During the summer of 1962, 1,959 counselors and teachers preparing to be counselors attended 66 summer institutes, and 633 will have attended 21 regular-session institutes during the 1962-63 academic year, at a total cost of $7,062,000. The Counseling and Guidance Institute Program continues to place in¬ creased emphasis on year-long training for regular enrollees and to arrange short-term, special-purpose institutes for those needing train¬ ing in new techniques and for those who have not yet fully met the certification requirements. The cost of the program for the first 4 years was $22,406,000. Language Programs. — The Language Development Program (title YI) is designed to strengthen instruction in modern foreign languages at all levels of education through four allied operations : language in¬ stitutes, language fellowships, language and area centers, and lan¬ guage research. A total of $44,670,000 was appropriated for the first 4 years of the program’s operation. Language institutes are conducted by institutions of higher educa¬ tion, under contract with the Office, to provide advanced training for teachers and prospective teachers of modern foreign languages in elementary and secondary schools. The training emphasizes the use of new instructional methods and materials. During the summer of 1962, 4,368 teachers attended 80 summer institutes, and during the aca¬ demic year 1962-63, 119 attended five regular-session language insti¬ tutes. Some 490 teachers who had previously participated in an NDEA language institute in the United States attended second-level institutes held during summer 1962 in Puerto Rico, Germany, France, Russia, Mexico, Argentina, and Ecuador at a total cost of $7,250,000. Federal support of a total of 53 language and area centers amounted to $2,080,000 in fiscal year 1962 funds. These centers are conducted, on a matching fund basis, by 33 institutions of higher education for the study of 52 “uncommon” languages and of the culture and economy of the areas in which the languages are spoken. In order to strengthen Office of Education 299 President Kennedy’s “Alliance for Progress,” support in 1962 was extended to five new centers for Latin American studies. Many modern foreign languages not commonly taught in the United States have been listed by the Commissioner of Education as needed by the Federal Government or by business, industry, or education. Graduate students of these languages are eligible to apply for fellow¬ ships under title VI. During the year, fellowships for the study of 55 of these “neglected” languages were awarded to 1,040 graduate students; 417 of the awards were extensions of existing fellowships. A total of 190 fellowships were awarded in Spanish, Portuguese, and the Amerindian languages in support of the special emphasis on Latin-American studies. In April 1962, 34 postdoctoral fellowships were awarded for intensive study of Portuguese, Spanish, and Sub- Sahara African languages during the ensuing summer. The total cost of this program for fiscal year 1962 was nearly $4 million. Under the language research program, individuals and organiza¬ tions working under contract with the Office develop specialized instructional materials (basic courses, grammars, readers, and diction¬ aries), primarily for the neglected languages, devise new methods of language instruction, and conduct surveys and investigations of lan¬ guage needs and resources. The various projects conducted under this program involve more than 100 modern foreign languages. During the year, 42 contracts involving 34 new projects were negotiated at a total cost of $740,873. An additional $1.25 million was obligated to continue 161 projects begun during preceding years. Library Services The factors affecting library development in the 1960’s are in¬ creased demands resulting from population growth, enlarged school enrollments, stress on research and developmental activities by com¬ merce, industry, and government in the face of rising costs of library materials, the shortage of trained librarians, and the emerging area of automated information storage and retrieval. The impact of the population explosion and its effect on libraries was surveyed in The Future of Library Service, Demographic Aspects and Implications , a staff-edited publication which appeared under the imprint of the University of Illinois. The increasing cost of library materials was brought to the public’s attention in an Office publication, The Cost of Library Materials: Price Trends of Publications , which indicated that, while between 1947-49 and 1961 the cost of the average book increased by 62 percent and the average periodical subscription by 55.5 percent, during the same period consumer prices rose by only 27.8 percent. 300 Department of Health , Education , and Welfare , 1962 While there are now about 60,000 librarians serving in public school, college and university, and special libraries, it is estimated that there were about 7,000 openings in 1960-61. Since library schools gradu¬ ated 2,370 students, they filled only about 1 out of every 3 vacancies, although the number of schools and the number of degrees have sub¬ stantially increased during the last decade. An advisory panel of the National Science Foundation and the President’s Committee on Scientists and Engineers prepared a report on scientific, technical, and other highly trained manpower. Its rec¬ ommendations crystallized into a special survey of a large sample of persons recorded in the 1960 census as college graduates, to determine the relationship between training and subsequent occupation and to provide information on demographic, economic, social, and profession¬ al characteristics. Several Government agencies, including the Office of Education, are supporting this “Post Censal Study of Professional and Technical Manpower,” which includes public and school librarians. The Office is engaged in the collection and dissemination of current data and trend analyses on library resources, services, personnel, and finances. In this connection the Office published Statistics of Li¬ braries: An Annotated Bibliography . The dissemination of ongoing library science research throughout the country is carried on through the occasional publication, Library Research in Progress. Public Libraries. — In the past year the Nation’s public libraries have made a positive advance in the acquisition and use of resources and the provision of services. However, many libraries still have not attained the standards of minimum adequacy set forth by their national association. In 1961, according to State reports, 18 million persons did not have access to public library service, and 110 million had access only to limited service. Of the 8,190 public library systems in the country, the 825 largest, serving population groups of over 35,000 (65 percent of the total population), were surveyed. During the year they added 10.5 mil¬ lion items to their holdings of 130.5 million volumes and circulated nearly 455 million volumes. Employing 35,500 staff members, one- third professionals, they reported operating expenditures in excess of $194 million and capital outlay amounting to nearly $35 million. However, these resources indicate the availability of only 1.17 volumes per capita. To provide minimum adequate service as defined by the American Library Association, 19 percent of these libraries would have to expand their collections, 22 percent would have to increase their staff, and 42 percent would require larger operating expenditures. Rural Services. — The Library Services Act (Public Law 84-597), passed in 1956 and extended by Congress until 1966, authorizes an appropriation of $7.5 million annually for grants to the States for Office of Education 301 the extension of public library services to rural areas. This amount was appropriated by Congress for fiscal 1962. All of the States plus Guam, Puerto Rico, and the Virgin Islands are now participating under the Act. Statistics compiled from 5 -year summary reports submitted by the States clearly show the progress made under the Library Services Act. Thirty-six million rural people now have either new or im¬ proved public library services available to them, two million for the first time because of county and regional library development. Highlighting the partnership aspect of the act is the fact that, in most cases, State and local governments are continuing their efforts to support good libraries. During the first 5-year period, State ap¬ propriations for the development of rural public library service in¬ creased 75 percent, local funds 60 percent. The 115 field consultants added under State plans have been a factor in making possible the progress described in the State reports. The many positive achievements of the program should not over¬ shadow the size of the job yet to be done. Preliminary data for 1961 indicate that more than 16 million rural residents had no access to local public library service, and that an additional 49 million rural people had only inadequate service. Moreover, because libraries in communities of over 10,000 population are ineligible for benefits under the Act, these communities have had little incentive to extend their library services. As a result, some States have undertaken less promis¬ ing, but legally eligible, projects. Stress continues to be placed on analysis of progress under the act with as much effort as possible being made to help each participat¬ ing State develop the best possible plan of library development. A progress report of the participating States and Territories for the first 5 years of the act was completed and will be published under title, State Plans Under the Library Services Act: Supplement 3. School Libraries . — An important contribution of the Office to the development of school library service to education during 1962 was a 3-day conference, requested by the State school library supervisors to discuss such questions as how modern instructional programs and methods can be served best by the school library ; what competencies school libraries and teachers need to administer and use the instruc¬ tional materials center for the achievement of educational aims ; what professional tools should be developed to give assistance in the selec¬ tion and organization of all types of printed and audiovisual materials ; and what changes in the preservice and inservice education of librari¬ ans and teachers are necessary to provide for the instructional ma¬ terials concept. State programs for the implementation of the 1960 standards for school libraries published by the American Library Association have 302 Department of Health , Education , and Welfare , 1962 stimulated the formulation of new or revised regional and State school standards. The Office has undertaken a compilation, sum¬ mary, and analysis of these standards for publication. All data for the survey, Statistics of Public School Libraries , 1960- 61 , were collected and are in the process of tabulation and analysis. This survey, when completed, will update the 1953-54 comprehensive information on school libraries in the United States. College and University Libraries. — Some libraries of institutions of higher education have collections that are among the most out¬ standing in the Nation. Almost 2,000 of these libraries now have a total of nearly 180 million volumes. They employ approximately 9,700 librarians and an equal number of subprofessional and clerical employees. Their total operating expenditures reach $159 million. While 9 of the largest institutions have collections of almost 30 million and a staff of over 1,000 librarians, over half of all academic libraries in 1959-60 did not measure up to the minimum staff requirements set by ALA and 1,200 libraries failed to meet the minimum requirements for adequate collections. While noticeable improvements were made over the previous year, the ever-growing enrollments and increasing cost of library materials prevent many of these libraries from provid¬ ing the services considered to be essential as supplements to modern teaching methods. An analysis of management and salary data was completed which should prove of value to academic administrators and librarians. Special Libraries. — For the first time the Office embarked on a new program to provide information, conduct surveys, and render con¬ sultant service to special libraries, which contribute substantially to the Nation’s research efforts. It is estimated that there are approxi¬ mately 10,000 of these libraries and information centers which em¬ ploy as many as 8,000 librarians serving Federal, State, and local government agencies, commercial and industrial organizations, and private organizations and associations. Their total annual expendi¬ tures are almost $60 million. These libraries, which have unique collections in specialized areas of many fields of knowledge, make their resources available on request to other libraries and to the re¬ search community. The statistical coverage of this group of libraries will make it possible to report in the future on the Nation’s total effort in librariansliip. International Education Education today has become the third arm of international rela¬ tions. The traditional first arm has been diplomacy backed up by force. After World War II, when it became obvious that the use Office of Education 303 of force to achieve international objectives might destroy mankind, there was a search for peaceful means for the achievement of inter¬ national goals, thus economics became the second arm of international relations, and large sums were invested in commercial enterprises. Recently, economists such as Schultz and Harbison in the United States and Vaizey in England have said that the development of human resources is the foundation of economic development. This doctrine has long been fundamental to the Communist theory of eco¬ nomic, political, and social development and was borrowed by them from Jetferson and other 18th century intellectual leaders. One result of the fact that the Communist world has long understood the con¬ nection between human and economic development is that they have planned ahead, and their education mechanism has produced ex¬ portable surpluses of experts in many fields, including public health and the teaching of English, in which the United States has a deficit of personnel. The development of education as the third arm has had many effects on education in America. The Bureau of International Edu¬ cation is deeply involved in some of these matters. First, the nature and goals of comparative education as a discipline are changing from “photographic” studies of education as it exists in other countries, to analytic and truly comparative studies required for effective cooperation in educational development between the United States, the United Nations, and the emerging new nations. American education is Western European in origin, and concen¬ trates on North America and Western Europe. But political power is shifting toward four other major cultural groupings: the Slavic, Far Eastern, Indian, and Arabic worlds. There are other important ethnic and political areas, such as Latin America, about which most Americans are not sufficiently informed. The Office of Education is increasingly involved in helping American States and local com¬ munities develop a broader, more realistic educational introduction to the modern world. Many public and private agencies are active in international edu¬ cation. The Office has helped to develop an effective working partner¬ ship with other Federal agencies, thus reducing duplication of effort and increasing the effectiveness of existing programs. Since World War II, 45 nations have become independent and are seeking to attain almost immediately through education those stand¬ ards of living which other nations required decades or centuries to achieve. In these countries, illiteracy rates range from 25 to 95 per¬ cent. Where education has been available to a privileged few, it is now demanded as the right of all. Thousands of teachers must be trained and thousands of classrooms must be built. New curriculums 304 Department of Health , Education , and Welfare , 1962 and textbooks must be developed which contribute directly to eco¬ nomic, social, and political growth. Existing universities and related institutions must be strengthened and new ones established. During 1961-62, over 72,000 foreign students and others seeking further training and practical experience came to the United States. Foreign faculty members and research scholars at our universities numbered 5,530, and 8,497 doctors of medicine served as interns and resident physicians in our hospitals. The Agency for International Development brought approximately 6,500 participants to the United States for training in many fields and arranged for another 2,000 to be trained in other than their own countries. Under the Fulbright-Hays Act, the Department of State’s Bureau of Educational and Cultural Affairs brought 4,800 foreign students, teachers, professors, research scholars, leaders, and special¬ ists in different fields to the United States. Educational Exchange and Technical Services The Office of Education in 1962 continued to work cooperatively with the Department of State’s Bureau of Educational and Cul¬ tural Affairs, in administering the Teacher Exchange and the Inter¬ national Teacher Development Programs, and with its Agency for International Development, in arranging for the orientation and placement of participants under the Technical Assistance Training Program. The Office has worked with many public and private agencies, participating in conferences of numerous organizations and advising on the problems and status of the various international edu¬ cational programs. It worked with the Chief State School Officers and the Conference of Governors to remove obstacles to teacher ex¬ change and to provide a wider participation in these projects. Fur¬ ther, it assisted a growing number of educators from other lands who did not hold grants under any program administered by the Office by providing program planning services, counsel, and publications about various phases of American education. TEACHER EXCHANGE PROGRAM The Teacher Exchange Program showed an increase from 624 in 1961 to 718 exchanges in 1962, as follows: teacher interchanges by which two teachers exchange positions, 152 pairs (304 teachers) ; U.S. teachers assigned abroad on a one-way basis, 167; foreign teachers placed in the United States on a one-way assignment, 54; summer seminars overseas for United States teachers, 173. A seminar was held in Italy and the Netherlands for 20 American school administra¬ tors in which the respective systems of education were compared at all levels. Eight summer seminars were conducted for groups of Office of Education 305 Spanish teachers in Spain and Colombia; teachers of French in France; teachers of German in Germany; teachers of the classics in Italy; teachers of history in appropriate fields in Brazil, France, and India. Teacher interchanges in many different subject fields at the elemen¬ tary and secondary levels continued with Great Britain, Canada, Australia, and New Zealand. Foreign language exchanges predom¬ inated with other European and Latin American countries and gave impetus to the movement for an earlier beginning of foreign language study. The majority of U.S. teachers abroad on a one-way basis taught English as a foreign language, although many in Africa and the British West Indies were teaching in other fields. The interchange of teachers with the United Kingdom remained the largest single project in 1962. TEACHER DEVELOPMENT PROGRAM The International Teacher Development Program brought 516 teachers and school administrators to the United States for training and for visits to schools in 1961-62. Bepresentatives from 65 countries and dependencies took part in the program, and 16 colleges and univer¬ sities cooperated with the Office of Education in arranging special seminars. Seventeen groups of teachers, teacher trainers, and school administrators were interested in the following fields : four groups in the teaching of English as a second language; three groups in American civilization; two groups each in elementary education, secondary education, and administration and supervision; one group in science education ; one group in history teaching. Two workshops in elementary, secondary, and vocational education were held at the University of Puerto Rico for 108 educators from South and Central America. TECHNICAL ASSISTANCE TRAINING PROGRAM The Office of Education supervised programs for 796 participants from 53 countries during 1961-62, including participants from minis¬ tries of education or similar offices who came on short, itinerary-type programs. There were also many long-term academic placements, and degrees were awarded to 155 participants, of whom 96 came from the Near East- African Area, 43 from the Far East, 15 from Latin America, and one from Europe. Countries with the largest number of representatives were Vietnam (82), Turkey (69), the Congo (64), Sudan (48), Ethiopia (41), Iraq (35) , Philippines (32), Tunisia (28), Somalia (24), and Thailand (23). Training was arranged for educators in approximately 60 different fields of education, involving approximately 150 training centers located in almost every State, the District of Columbia, and Puerto Rico. It is estimated that 950 306 Department of Health, Education , and Welfare, 1962 educators will have programs arranged by the Office in 1962-63. The greatest increase in number of participants is expected from Africa. NONGRANT VISITOR PROGRAMS The number of nongrant visitors continued to increase in 1962, reaching a total of 909 compared to 618 in 1961 and 254 five years ago. Several factors contribute to this steady growth : increased expendi- ! tures by foreign governments and institutions for educational missions to the United States; increased travel with personal funds; and an increase in group travel (for example, a group of 150 German teachers, another group of 40 Swiss teachers) . Another factor is the growing awareness abroad of the services provided by the Office of Education. Numerous visitors to the Office in 1962 were referred by friends who had received program assistance from the Office. To meet the increas¬ ing requirements of the nongrant visitor program a Facilitative Services Unit was established within the Bureau of International Education. INTERNATIONAL ASSIGNMENTS FOR SPECIALISTS The improvement of national programs of education is a major objective in programs of technical assistance to countries in the under¬ developed areas of the world. Programs of this nature conducted by AID (the Agency for International Development of the State I Department) and by UNESCO (United Nations Educational, Scien¬ tific, and Cultural Organization) require a continuing overseas staff of approximately 900 education advisors. The Office of Education assists in recruiting education specialists for both programs. The Office also provides professional backstopping services to educa¬ tion advisors abroad and periodically forwards to the various AID missions overseas packets of education materials. CLEARINGHOUSE ON EDUCATIONAL EXCHANGE The Office provided for the Department of State 118 statistical tabulations on Government-sponsored grantees entering and leaving this country during the year, a service it has given annually since j 1952. The statistical studies include such information on grantees as country or State of origin and of destination, fields of specializa¬ tion, age groupings, and veterans’ status. These studies show that 4,800 foreign nationals from some 86 countries associated with Ameri¬ cans in all 50 States and territories. They had an opportunity to understand America as it really is, while engaged in study, teaching, research, and other projects in over 180 specialized fields of study. The fields attracting the highest numbers of individuals were : Medi¬ cine, American civilization and literature, economics, law, secondary education, teaching of English as a second language, business admin¬ istration, mathematics, youth activities and organization, and physics, Office of Education 307 Over 1,500 of these grantees attended some 400 different institutions of higher learning. The universities in which most grantees were placed: California, Columbia, Cornell, Harvard, Illinois, Kansas, Michigan, Pennsylvania, Wisconsin, and Yale. The 2,000 Americans who went abroad during the year also had an opportunity to gain a deeper understanding of the problems, needs, and hopes of other peoples. They came from the 50 States and Ter¬ ritories and went to more than 60 countries to study, lecture, or con¬ duct research in some 150 specialized fields, chiefly the following: Romance languages and literature, music, teaching English as a second language, Germanic languages and literature, English language and literature, elementary education, art, political science and interna¬ tional relations, secondary education, and American literature. In addition to providing the above types of statistical information, the Office prepared records giving the name, address, category, specialty, occupation, and institution of placement of every foreign grantee entering this country under the international educational exchange programs. CREDENTIAL EVALUATION University admissions offices, boards of certification and licensure, State departments of education, and other agencies and institutions called upon the Office to interpret over 6,000 individual cases of foreign academic credentials, an increase of approximately 13 percent over the previous year. Office specialists participated in national meetings of the American Association of Collegiate Registrars and Admissions Officers and the National Association of Foreign Student Advisers. The Office maintained and strengthened its close association with the work of the Council on Evaluation of Foreign Student Cre¬ dentials in promoting studies of foreign education and in developing placement recommendations for persons educated in other countries. International Studies Comparative education studies completed or underway in fiscal 1962 were designed to contribute to a better knowledge and understanding of foreign educational systems and developments. There have been increasing demands from educational institutions, Government agencies, and other organizations and individuals for this kind of information, as their educational programs and interests in other countries expand, and as growing numbers of persons with foreign educational preparation seek admission to institutions or professional employment and licensing in the United States. Major studies published in the fiscal year 1962 included Higher Education in the Philippines , School Reform in Sweden, Education 308 Department of Health , Education , and Welfare , 1962 and the Development of Human Technology , and The Peoples Friend¬ ship University in the U.S.S.R. Others issued during the year were concerned with certain aspects of education in Argentina, Bolivia, Morocco, India, Yugoslavia, the Caribbean area, Western Hemisphere countries, and with educational grants overseas by American founda¬ tions. Other studies underway and at various stages of completion in fiscal year 1962 dealt with ministries of education around the world (issued in August 1962) and with education in the following countries or regions: Argentina, Ceylon, Colombia, Communist China, Cuba, Czechoslovakia, Ecuador, France, Hungary, Indonesia, Iran, Ireland, Latin America, New Zealand, Peru, Poland, Rumania, Scotland, Southeast Asia, Uganda, Uruguay, USSR, Yugoslavia. Under contracts negotiated pursuant to Public Law 480 (the Agri¬ cultural Trade Development and Assistance Act of 1954), the first reports on the scanning, translation, and annotating of foreign ma¬ terials were received from Burma, Colombia, and Poland. In May 1962, the Office of Education and the Comparative Educa¬ tion Society jointly sponsored the annual Eastern Regional Conference of the Society at the Office. The program dealt with the general theme “Education and National Development.” Areas covered were Africa, Latin America, and Communist China. The use of films in teaching comparative education, as exemplified by a film on Yugoslav education, was also a program topic. During the year, comparative education specialists served as educa¬ tional advisers on official trips, one going to Africa and another accom¬ panying a congressional delegation to the Soviet Union. EDUCATIONAL MATERIALS LABORATORY The Educational Materials Laboratory is maintained to display books and materials available for school programs in the United States, and foreign textbooks and other educational material. Repre¬ sented among its 12,000 items are books, periodicals, charts, films, filmstrips, tapes, and discs. Emphasis is given to the collection of textbooks used by elementary and secondary pupils in the United States, supplementary reading books, and publications related to teacher education. Teachers and librarians accounted for 3,900 visits to the Laboratory last year, more than doubling the figure for the previous year. As the number of visitors has increased, the proportion of U.S. educators has grown from approximately one- third to one-half the total. Interpretative services in connection with these materials was pro¬ vided to foreign educators studying in this country, to U.S. techni¬ cians serving in education missions abroad, to teachers in American schools overseas, to Office of Education specialists, to educators in Office of Education 309 U.S. schools, and to both American and foreign research workers. The Laboratory received an increased number of requests for advice on the organization and maintenance of materials centers in the United States. The Educational Materials Laboratory Report provides informa¬ tion on the nature and availability of publications held in the Laboratory. Food and Drug Administration Introduction A Listing of some of the year’s accomplishments, regulatory prob¬ lems, and issues up for decision demonstrated that consumer pro¬ tection was dynamically on the move in 1962 : • AMA-FDA Congress on Medical Quackery Held • First Seizures of Unlabeled Hazardous Plousehold Substances Made • Campaign on Packaging Violations Intensified • Drug Counterfeiting Ring Ended • Bootleggers of Dangerous Drugs Jailed • Incubator Reject Egg Handlers Sentenced • Physicians’ Samples Abuses Curbed • Scheduled Hearings for Whole Fish Flour Standards Postponed • President Sends Message to Congress on Consumer Protection • Overhaul of Special Dietary Regulations Proposed • False Promotions via Books, “Doorbell Doctors,” Radio Spiel¬ ers Attacked • Fake Medical Devices Seized — Others Destroyed by Owners • FDA Doctor Prevents Sale of Baby-Deforming Drug • Controls on Investigational Drugs to be Tightened • FDA Scientists Explore New Fields of Consumer Protection • Kefauver-PIarris Drug Amendments Enacted From this sample of headlines similar to those that have been appearing in the daily press throughout the year, it is evident that 1962 was a banner year for consumers through major enforcement accomplishments. However, it is also apparent that consumer pro¬ tection is still inadequate and almost unbelievably complex in its ramifications. 311 312 Department of Health , Education , and Welfare , 1962 Consumers may take a considerable measure of encouragement from the accelerated pace at which both the executive and legislative branches of the Government were moving to strengthen consumer protection during 1962. Of special interest in this connection was President Kennedy’s message to Congress on consumer protection delivered on March 15, 1962 — the first such message ever devoted exclusively to consumer problems. The President’s message cited four basic consumer rights : 1. The right to safety 2. The right to be informed 3. The right to choose 4. The right to be heard The Federal Food, Drug, and Cosmetic Act and the Federal Hazardous Substances Labeling Act are f omided on these basic rights. The consumer is a principal beneficiary of these laws. This report is an account of the stewardship entrusted to the Food and Drug Administration to protect consumers through enforcing these laws. 1. The right to safety. — The benefits to consumers from miraculous new drugs and chemical aids to food production and processing are now largely taken for granted. But any tendency to take for granted that these products are without potential danger was brought to a nerve- jangling halt in the early summer of 1962. Complacency van¬ ished like mist before the breeze as the story unfolded of the narrow escape by American families from the tragedy of grotesque deformi¬ ties in babies caused in European countries by a sleeping pill contain¬ ing the drug thalidomide. During the late winter and spring it had become increasingly certain that thalidomide was responsible for thousands of such deformities in countries around the world where it had been marketed for several years. This drug did not reach the market in this country because of the safety clearance requirements in the Federal Food, Drug, and Cos¬ metic Act, and because of the stern refusal of an FDA medical officer to clear the drug on what she believed to be inadequate safety evidence provided by the manufacturer. The President conferred a Distin¬ guished Federal Civilian Service Award on the medical officer, Dr. F ranees Kelsey, with the following citation : Her exceptional judgment in evaluating a new drug for safety for human use has prevented a major tragedy of birth deformities in the United States. Through high ability and steadfast confidence in her professional decision she has made an outstanding contribution to the protec¬ tion of the health of the American people. Thalidomide had been widely distributed to doctors in the United States under provisions in the law allowing distribution for investi- Food and Drug Administration 313 gational use to determine safety and usefulness of new drugs. As the extent of the investigational distribution was learned, it became apparent that tightening of controls over such distribution of un¬ cleared drugs was necessary. Proposed new regulations were issued. Congress quickened its pace on drug legislation before it, as statutory gaps in consumer protection came to be interpreted by the public in terms such as the possibility of deformed babies, and public clamor arose for strengthening the law in every respect necessary to close these gaps. Newspapers day after day headlined developments in the thalidomide episode and reported legislative progress toward strengthened drug provisions in the law. The importance of premarketing safety clearance of new drugs had been indelibly stamped on the minds of American consumers. Despite safety clearance requirements, large-scale use of a drug after release sometimes results in discovery of side effects not observed during the premarketing investigations. And a breakdown in factory control procedures may result in the marketing of off-strength, con¬ taminated, or mislabeled drugs. Altogether 67 defective or mislabeled drugs had to be recalled from the market during the year, some of them after injuries occurred. Until passage of the Drug Amendments of 1962, FDA had no au¬ thority to require manufacturers to report such injuries, nor could FDA inspectors require manufacturers to permit a check of complaint files. Previous approval of new drugs could be revoked only when there was new evidence on which to establish that the drug was unsafe. It is self-evident that the safety rules for pesticides, food additives, and color additives are just as important as those for new drugs. Agricultural chemicals have revolutionized the farmer’s production methods in horticulture and animal husbandry. Technological ad¬ vances in food processing, packaging, and distribution have brought a tremendous and ever-increasing variety and volume of convenience foods whose main or entire preparation is on the factory processing line instead of in the home kitchen. Over 45,000 chemical formulations are available to the operators of 3.8 million farms today for more effective production of crops. There are an estimated 2,200 chemicals used in foods and food packaging, produced by approximately 6,500 manufacturers. In turn, these chemicals are used by 73,000 manufacturers, processors, and packers of food. Approximately 15,000 establishments manufacture and distribute drugs. The necessary checking on how new products are controlled after they get into commercial production has multiplied the workload of FDA’s inspectional and analytical staffs, and has posed many research problems. ©65171—6; -21 314 Department of Health , Education , and Welfare , 1962 Chart 1.— RETAIL SALES OF FOOD IN THE UNITED STATES, CALENDAR YEARS 1952-61 Billions $100 - 1952 1 953 1954 1 955 1 956 1957 1 958 1 959 1960 1 961 Chart 2.— RETAIL SALES OF DRUGS IN THE UNITED STATES, CALENDAR YEARS 1952-61 Billions 1952 1 953 1954 1 955 1956 1957 1958 1 959 1960 1961 2. The right to be informed. — Major laws enforced by FDA seek to secure this right by affirmatively requiring that information needed by consumers for intelligent purchase and use be prominently and truthfully stated on product labeling. F alse and misleading labeling is specifically prohibited. Enforcement of these requirements has re¬ ceived increasing emphasis as FDA resources have grown, and reached an all-time high in 1962. However, enforcement efforts to bring about honest and informative product labels are insufficient of themselves. Equally or perhaps Food and Drug Administration 315 Chart 3.— RETAIL SALES OF COSMETICS IN THE UNITED STATES, CALENDAR YEARS 1952-61 Billions ^ 51 Wmm mm mm §§|l SISS mm mm ISflil . ~ - - mm pm IS »i mM mm mm i *3 ?v < ^ ; ttt ; “ — r — — wim — MU iii§t HI mmi mm III Hi Wmm Wm 1952 1953 1954 1955 1956 1 957 1958 1 959 1960 1961 more important is the combatting of misinformation. Prospective consumers of foods, drugs, and cosmetics are constantly barraged with misinformation through channels often deliberately calculated to be outside the reach of the law and within the constitutional protection accorded to freedom of speech and press. Such misinformation is peddled in books, magazines, newspapers, radio-TV and live lectures by self-styled experts, and by door-to-door salesmen operating within the sanctity of the home. Such misinformation may be presented in the guise of health suggestions, medical advice, nutrition advice, weight reducing tips, advice to the elderly, and so on. There is no field in which misinformation is more vicious or more dangerous than that of medical quackery. Quackery is big business. Its cost to the Nation in lives, injuries, and money are not precisely known, but it is reliably estimated that consumers spend needlessly more than a billion dollars a year on falsely represented drugs, foods, and cosmetics. The first National Congress on Medical and Nutritional Quackery, sponsored by the American Medical Association and the Food and Drug Administration, was held in Washington in October 1961. It gave 650 representatives of more than 200 organizations an opportun¬ ity to take an overall look at the growing problem of quackery. A follow-up meeting was held in Chicago in March 1962 to appraise the results of the Congress. It was agreed that the Congress had accomplished its main objectives. These were to strengthen existing liaison among various Government enforcement agencies and public service groups, and to stimulate widespread public awareness of the threat posed by the rackets in quackery. 316 Department of Health, Education , and Welfare, 1962 Many articles on the quackery problem have appeared in nationally distributed magazines and more are in preparation. Many State and local organizations have held meetings similar to the FDA-AMA meeting to bring further public attention to the problem of quackery. Dietary products, vitamins and minerals, and so-called health foods represent another major area of exploitation of the consumer through misinformation. In June FDA published proposals for a major over¬ haul of the special dietary food regulations governing the labeling of such products. These regulations were first promulgated in 1941. The proposals are designed to give consumers the benefit of advances in the science of nutrition since that time, and are aimed at eliminating the false and misleading claims which constitute “nutritional quackery.” The Federal Hazardous Substances Labeling Act requires consumer protection information on labels of hazardous household articles, such as cleaning agents, paint removers, and polishes. After enforcement began on February 1, 1962, seizures were made of corrosive and highly toxic products which did not contain the warning information required by law. As the labels of hazardous substances are brought into com¬ pliance with the new law and its regulations, accidental injuries, espe¬ cially to children, should be materially reduced. If the law is to accomplish its purpose, however, consumers must be educated to read and heed the label cautions and directions. FDA participation in the first observance of National Poison Pre¬ vention Week focused public attention on the consumer protection objectives of this new law. To carry out the consumer education responsibilities of the Depart¬ ment in line with the President’s message, the Secretary has designated a Special Assistant to the Secretary for Consumer Protection, and announced the formation of a Departmental Committee for Consumer Protection. The Special Assistant was selected from the FDA staff. Within FDA, a Consumer Education Branch was established in the Division of Public Information, to develop further FDA’s con¬ sumer education programs for adults and students, and to respond to consumer inquiries. A new “Consumer Memo” series was initiated as a medium for explaining matters of special interest, such as pesticides, food additives, food standards, and labeling. 3. The right to choose. — This is inseparably bound to the right to be informed. To exercise a truly free choice, the consumer must have accurate information about the product to be selected. In the super¬ market she is frequently seriously confused in her choice when she is confronted with exaggerated claims for competing products. But the consumer also must be free of false notions about other similar products available. The consumer who believes that crops Food and Drug Administration 317 raised with the aid of chemical fertilizers and other properly used agricultural chemicals are nutritionally inferior or dangerous cannot exercise her right of choice; nor can the consumer who believes that a vitamin-mineral preparation containing nutritionally insignificant amounts of 57 ingredients in a shotgun mixture is superior because of them. Further, a free choice cannot be exercised between two products which are in fact very different in acceptability if the determining factors cannot be detected or measured by the consumer. If one drug is up to strength, the other inferior; if one food is clean, the other produced under insanitary conditions ; if one product is pure, the other contaminated — the consumer is not ordinarily able to dis¬ tinguish between them, yet one is acceptable and the other would not be so if a free choice could be exercised. The consumer thus must rely on law enforcement to eliminate insofar as possible the type of product variability which in effect deprives one of the freedom of choice. Programs to assure cleanliness and wholesomeness of foods and safety and integrity of composition of all regulated products serve this consumer interest. But there are other areas in which the exercise of the right to choose depends upon the presence of certain information on the product label. This is more fully discussed under item 2 above. In 1962, 85 seizures were made of products so labeled that important consumer information was hard to find, hard to read, or partly or entirely absent. 4. The right to be heard.- — FDA encourages consumer participation in the administrative process to the fullest extent possible, just as similar participation by industry, scientific groups, and other inter¬ ested parties is encouraged. Consumer participation is especially invited in the setting of food standards, for example, and in the formu¬ lation of labeling regulations as in the case of special dietary foods. The Consumer Memo series mentioned earlier will carry informa¬ tion about food standards to enable consumers better to understand controversial issues and to provide authoritative and meaningful com¬ ment. Consumer correspondence also provides a pulse by which to observe opinion on matters of current interest. FDA’s Consumer Consultant Program, with consultants in each of its 18 Districts, serves as a channel through which consumers can ex¬ press their views about additional areas of protection they need, or about FDA programs and policies. Numerous consumer conferences were held throughout the country during the year for forum discus¬ sions directly with consumers. As stated in the President’s message, this program will be expanded. A Public Service Advisory Com¬ mittee of consumer leaders has been established to serve as a source of consumer opinion on important matters. 318 Department of Health , Education, and Welfare , 1962 Administrative Progress The enforcement appropriation for fiscal year 1963 is $28,280,000. This compares with $23 million for fiscal year 1962, representing a net increase of $5,280,000. This provides for an increase of 542 posi¬ tions, bringing the authorized enforcement staff to 3,012. This does, not include employees assigned to certification services and pesticide petitions, which are financed on a self-supporting fee basis. Of the increases in personnel, 342 will be assigned to the field to bring the field staff to 1,860. The field increases of 1962 and 1963 should permit inspections of the regulated firms at an average of about once in every 4 years. The goal is to inspect most establishments at least once a year. Of the 647 man-years for inspectional work in the fiscal year 1963, 431 (or 67 percent) will be assigned inspections involving health, 165 (or 25 percent) to sanitation inspections, and 51 (or 8 percent) to work involving economic cheats, largely misbranded and substandard foods. The 1963 budget provides manpower for FDA to undertake an inventory of these establishments, using a new integrated automatic data processing system for headquarters and field use. This system is designed to supply information for use in appraising FDA’s work obligation and regulatory accomplishment, and for planning immedi¬ ate and long-range needs and activities. In 1962 all establishment inspection data were prepared for computer input and processing. Under the increased appropriations several other important pro¬ grams will receive substantial increases in both manpower and equip¬ ment. The program to protect consumers of fresh fruits and vege¬ tables against harmful residues of agricultural poisons will be strengthened by 190 new positions to permit the sampling and exami¬ nation of a higher percentage of shipments for residues. Other food programs will be accelerated by 96 new personnel for food research, food additives, and food standards work. Drug protection will be stepped up by the addition of 126 positions. These new employees will be assigned to new drugs and efforts to combat the illegal sale of prescription drugs and traffic in counterfeit drugs. Twenty new positions have been assigned to the coverage of imports offered for entry. The total retail value of these imports is approxi¬ mately $6 billion dollars a year. The relatively small percentage of coverage has been inadequate to assure that foods, drugs, and cosmetics produced under the regulations of other countries meet the require¬ ments set for domestically produced goods. All other staff increases will be used to improve FDA’s Washing¬ ton and field management functions, its information services, coopera- Food and Drug Administration 319 Chart 4. — BUDGETED POSITIONS FOR FOOD AND DRUG ADMINISTRATION ENFORCEMENT OPERATIONS (EXCLUDING FEE-SUPPORTED CERTIFICATION SERVICES), FISCAL YEARS 1953-63 Thousands 3.5 - 1953 1 954 1 955 1 956 1 957 1 958 1 959 1 960 1 961 1962 1 963 tion with State and local agencies, scientific research on cosmetics and animal feeds, processing of regulatory actions, and the staffing of a new pharmacological animal laboratory building. In nonstaff areas, the 1963 budget will permit FDA to start reno¬ vating the four remaining district offices and laboratory facilities yet to be expanded and modernized under the program begun several years ago. It will also permit substantial steps to be taken in the program of replacing and modernizing scientific equipment. A study of State and local food and drug programs will be made with $300,000 of the appropriation. This will be undertaken by a private research group under contract. The main objective of this study, in which State and local governments will cooperate, is to find out where coordination of Federal and State and local activities can be expanded and improved. FDA has had an organizational unit devoted to cooperation in Fed¬ eral, State, and local food and drug enforcement programs since 1914. More than half the States have food, drug, and cosmetic laws parallel¬ ing the Federal law before enactment of the Drug Amendments of 1962, and most of the others have similar laws in one or two of these areas but not in all. 320 Department of Health , Education , and Welfare , 1962 Additional FDA personnel have been added to provide closer co¬ ordination of Federal-State activities in each of the past several years. Many joint inspections are made, with actions taken by the organiza¬ tion that could handle the problem most effectively. Joint training programs in inspectional and analytical procedures, and exchange of information on programs and methods are all contributing to better consumer protection. Some of the areas in which joint activities were most productive re¬ cently were in sanitation programs ; the breaking up of rackets, such as traffic in incubator reject eggs, and counterfeit drugs; activities against illegal sales of dangerous drugs; the removal of stilbestrol- treated poultry from consumer markets; food poisoning investiga¬ tions ; and monitoring recalls of dangerous drugs. FDA’s total employment almost doubled between the fiscal years 1958 and 1962. Attending such rapid growth are a variety of problems in recruitment, placement, position classification, employee-manage¬ ment relations, and training. Special emphasis has been given to recruitment of promising college graduates who may be able to fill key positions in the future. The training programs have been developed not only to orient and teach necessary specialized techniques to new employees, but also to help those already on the rolls to keep abreast of new techniques and to make effective use of new and often intricate apparatus. Training programs have been developed for scientists, inspectors, supervisors, administrators, and clerical employees. Some of these programs were extended to State employees with similar new responsibilities requir¬ ing specialized training. These training classes were attended by 3,000 personnel. Organizational changes were put into effect in 1962 to facilitate operations in enforcement, administrative management, and consumer and industry education functions. The handicap of operating the headquarters staff in five scattered permanent and temporary buildings in Washington will be alleviated when the new FDA building is ready for occupancy. Actual construc¬ tion began in January 1961 and is expected to be completed in March 1963, followed by installation of equipment. The building may be occupied in the late fall of 1963. A contract has been awarded for the construction of a new animal laboratory building at Beltsville, Md. This facility will permit FDA to make basic tests under optimum conditions to determine the toxicity of food and color additives and other substances in foods, drugs, and cosmetics. This fundamental work is now being conducted in crowded and antiquated facilities in Washington. Food and Drug Administration 321 Food , Drug, and Cosmetic Act ON THE FOOD FRONT Radioactivity in Foods With the resumption of nuclear testing by the Soviets in September 1961, the installation of radiological equipment in 10 districts was stepped up and additional equipment was purchased. The district laboratories became operational in the latter part of 1961 and the num¬ ber of samples of food examined for strontium 90 was tripled. Prior to the resumption of nuclear testing there was a trend toward lower strontium 90 value for food when compared with prior years. This trend has now been reversed but the values are still low. A pilot program to determine the strontium 90 content in a typical “moderate income plan” diet for boys from 16 to 19 years old, who consume more than any other age group, was started in May 1961 in the Washington, D.C., area with quarterly samplings. The amounts of strontium intake from the total diet, including milk, are not consid¬ ered high enough to warrant any action by the Government or any change in consumer dietary patterns. This study was expanded late in the fiscal year to include Atlanta, Minneapolis, St. Louis, and San F rancisco. Samples for cesium 137 are analyzed in the Washington labora¬ tories, also with no unsafe levels encountered. Research and studies are conducted in the Washington laboratories to develop methods of radiological detection, identification, and decontamination. FDA has a total of 116 positions for radioactivity work in Washington and the 18 field districts. Chemicals in Foods Food Additives . — Surveillance of food additives used in food pro¬ cessing is one of the essential elements of food establishment inspec¬ tions. Attention is given not only to whether additives being used are permissible but also whether they are being used at safe levels. Labo¬ ratory analyses of some foods are conducted to check these levels. Inspections are also made at plants manufacturing regulated additives for assurance that the additives used by food processors meet labeled specifications. The first seizure of a food containing mineral oil under the Food Additives Amendment involved a consignment of biscuits containing up to 6,700 parts per million. Inspection of the manufacturer showed the biscuits were being brushed with a mixture of mineral and soybean oil to prevent them from sticking together in the package. A consign¬ ment of the biscuits was seized at the warehouse of a market chain. Later, 140 gallons of extra heavy mineral oil labeled for both food 322 Department of Health , Education , and Welfare, 1962 and drug use were seized under the Food Additives Amendment. The label of the product stated: “excellent for use as a nonfattening oil in salads” but nutritionists have found that mineral oil inhibits the absorption of fat-soluble vitamins, particularly A and D. For this reason it should not be consumed at mealtime. Most of the manufacturers of stilbestrol pellets for artificial capon- ization of chickens voluntarily discontinued their production late in 1959, after tests by improved methods had shown residues in the liver, skin, and kidneys of treated birds. Since this compound had been found to induce cancer in test animals under certain conditions, any use of it which results in a residue in any human food product is illegal under the Food Additives Amendment. In December 1961 the New Drug Applications of the firms which refused to discontinue volun¬ tarily the manufacture of the pellets were revoked. Two firms are contesting FDA’s authority to revoke the previous safety clearance of the drug for this purpose. As a result of Federal, State, and local surveillance, more than 25,000 pounds of stilbestrol-treated dressed poultry and 3,000 live chickens were destroyed by New York City officials. Philadelphia health officials condemned and destroyed poultry containing stilbestrol at 15 locations in their city. Federal seizure was made of 6,880 pounds of frozen chickens and chicken livers and necks. A meat seasoning containing niacin and polyvinylpyrrolidone, a stabilizer, was seized because these additives had not been cleared as safe for use in such a product. The amount of niacin in the product was far greater than would be used in a food supplement ; when too much is consumed, severe flushing of the face may result. Although labeled as a seasoning, the product would act as a preservative and color fixative thus preventing the detection of aging or spoiling ground meat. Several other chemicals used in the product were undeclared preservatives. Among the other foods seized for nonpermitted or above-the-limit additives were imitation vanilla containing coumarin, flour and nonfat dry milk containing inorganic bromide residue from fumigants used, and vitamin preparations and goat milk with excessive folic acid. Pesticides were found in three seized processed products — wheat bran, butter, and fish oil (see Pesticides in this section) . It is believed that the three chlorinated hydrocarbons found in the fish oil were derived from contaminated sea water. Faulty processing equipment and careless handling resulted in a number of seizures of chemically contaminated foods. A chemical flavor in canned fruit cocktail was traced to kerosene reaching the air jets of the filling machines as the result of pressure drops in a high pressure tank one night during recurring power failures. The manu- Food and Drug Administration 323 facturer recalled outstanding stocks in possession of a food chain. Lead contamination of puffed cereals resulted from continuing use of worn lead gaskets in the “popping guns.” More than $8,000 worth of contaminated feed had to be destroyed because a truck normally used to haul fuel oil was used to haul molasses for the feed without being cleaned before such use. The accidental substitution of a poison¬ ous chemical for a safe one in a dip for peeled potatoes is discussed under Food Poisoning. Pesticides. — There is increased public awareness of the potential danger that produce in the market place may bear toxic residues from agricultural poisons. These are a necessity in modem agriculture to protect crops from insects, mold, and weeds, and in other ways to aid production and prevent spoilage during transportation and marketing. After FDA sets limits or tolerances for the amounts of such poisons that may safely remain on raw agricultural products, it must enforce these tolerances. This is done through surveillance of the practices of growers, by collecting and analyzing samples for regulatory action if required, and by assisting other groups in teaching growers the importance of following recommended application practices. An essential element in the pesticide program is the development of better, faster methods of detecting and measuring pesticide residues. Prog¬ ress in this area is reported under Scientific Investigations. It is estimated that there are 2*4 million interstate shipments of raw agricultural commodities a year. In 1962, samples collected totaled 6,978, a marked increase over the 3,148 samples collected in 1961, but still not adequate to make sure that safety rules are being followed. FDA will have a sufficient staff before the end of the fiscal year 1963 to reach a sampling level of 25,000, or 1 percent of shipments, to enable a more accurate appraisal of the problem. The heavy volume of perishable, seasonal products which move rapidly to the market after round-the-clock harvesting represents a crash program for the inspectors checking pesticide residues. A num¬ ber of the districts have made effective use of trailer laboratories located in the growing areas, to eliminate transportation of samples to district headquarters laboratories sometimes located several hun¬ dred miles away. On-the-spot determination of pesticide residues, with analysis completed before the product reaches its destination, provides more effective enforcement, and also assists local agencies in coping with that part of the problem which is within their respon¬ sibility. FDA has continued the practice of notifying both growers and State officials when its analyses of samples show nonpermitted or excess residues on crops. Twenty-seven seizures totaling 1,903 tons were made of raw agricul¬ tural commodities containing illegal residues. Corresponding figures for the previous year were 16 seizures totaling 483 tons. 324 Department of Health , Education , and Welfare , 1962 The largest seizure involved, a 748-ton warehouse lot of wheat that had been treated with DDT, lindane, and aldrin during a 3-year stor¬ age period, to keep down insect infestation. There is no tolerance for residues of any of these chemicals on wheat. Ten carloads of wheat and one of barley, totaling 581 tons, were seized because of contamination with seed grain that had been treated with poisonous mercurial fungicides. Fifty-six tons of milo maize were also seized because of contamination with mercury. Four other seizures of milo maize and milo sorghum followed re¬ ports of deaths of several animals consuming the products. Bags of captan and heptachlor for seed treatment had been shipped to a feed dealer in the same car with milo. Apparently some of these bags broke and contaminated the milo. In other cases it appeared that the intact bags were dumped into the feed troughs and were chewed by the animals. Among the other foods and feeds seized for pesticide violations were soybeans with residues of thiram, dried red beans with dieldrin, three lots of alfalfa meal with DDT, three lots of lettuce with DDT (one also containing toxaphene), and two lots of cabbage with residues of endrin. Severe drouth conditions in the Dakotas were followed by an ex¬ tremely heavy infestation of grasshoppers. Many roadside areas and marginal croplands were heavily sprayed with dieldrin or aldrin, or both. The drouth also created a serious hay shortage and some farmers allowed their cattle to graze on the heavily sprayed areas. The situation presented a potential danger of contamination of milk produced from animal grazing on treated lands. A shipment of butter from a creamery in the area was seized because it contained dieldrin. No other Federal seizures of dairy products containing pesticides were made. A general improvement in pesticide practices of growers has been observed, resulting in part from activities of State officials in quaran¬ tining milk with chlorinated hydrocarbons derived from the use of trash feeds, such as packinghouse wastes. Other Harmful Contaminants The last report discussed the seizure of 47 carloads — a total of 2,322 tons — of soybeans contaminated with poisonous crotalaria seeds as a result of the growing of crotalaria plants to improve sandy soils. Only 1 carload, containing 53 tons, was located and seized in 1962. It originated in Mississippi; the contaminated lots found the previous year had been grown in four other States. Iron fragments that flaked off from rusty machinery into bread crumbs caused one seizure. Another involved iron fragments in cracker meal resulting from the partial disintegration of a mesh con¬ veyor belt when the chain pulling it broke. Food and Drug Administration 325 A cheese spread was seized because it contained sharp, pointed crystals of lactose monohydrate. The crystals were capable of caus¬ ing injury. Also seized for potential injury to health were ready-to- freeze confectionery pops on plastic sticks capable of harming child consumers. Five seizures of foods for the illegal use of color additives are discussed under Cosmetics and Colors. Food Poisoning. — Forty outbreaks of suspected food poisoning in¬ volving more than 1,300 persons were investigated during the year to determine whether bacteriological contamination was the cause. Samples of the suspect food involved or from the same lots or dealers were obtained in 12 cases. With two exceptions, the lots remaining on the market were found to be normal. Canned tomatoes involved in one outbreak were shown to be decomposed, and seized. Hol- landaise sauce found to be contaminated with salmonella, as mentioned in the report of the preceding year, was responsible for a number of illnesses. The firm discontinued production and the product was re¬ moved from the market by recall and seizure. A majority of the incidents investigated, which involved a large number of individuals, resulted from insanitary handling or from lack of proper refrigeration during preparation or serving of the food. In a few of these cases, where the suspect food was available for examination, staphylococci in large numbers were identified either by FDA laboratories or by State or local laboratories. In other cases the foods had been consumed or destroyed but the epidemiological evi¬ dence implicated staph as the probable causative agent. In one out¬ break, involving questionable handling procedures, turkey salad appeared responsible for the serious illness of 176 individuals, and the time of onset and symptoms were suggestive of Clostridium per- fringens food poisoning. A California family became ill twice in a few weeks after eating a meal which included commercially frozen potato patties, and one member had to be hospitalized in the second incident. The hospital reported the incident to the county health department which in turn referred the facts to the State health officials which relayed them to FDA. No packages of the suspect patties remained in the family’s home freezer, but samples drawn from the retail supplier showed coagulase-positive staphylococci present in quantities sufficent to ac¬ count for the illnesses, and also contamination with E. coli. An establishment inspection of the commercial freezer, one of the largest potato processors in Seattle district territory, showed the need for improved bacterial and sanitation control of operations. After seizure of a shipment of contaminated patties, the firm initiated a nationwide recall voluntarily destroying an estimated $211,220 worth 326 Department of Health , Education , and Welfare , 1962 of returned goods, and began capital and procedural improvements costing nearly a quarter million dollars. Restaurant operators were warned in J anuary to stop using a peeled potato bleach because of contamination of some lots by sodium fluosili- cate, a deadly poison. The manufacturer had accidentally substituted this ingredient for sodium bisulfite normally used in the antioxidant compound. Illnesses after eating french fried potatoes in restaurants were reported in two States, but there were no fatalities because the bleach is used in very dilute concentrations. Seizure was made of one lot, and a public warning was issued. The manufacturer recalled all outstanding lots from widely scattered areas. Potential injury was forestalled when an exterminator company was enjoined to stop using rodenticide “1080” in any way that could result in contamination of stored food. The firm, which provides exterminator services for food warehouses and mills, was charged in the complaint for injunction with causing the rodenticide to be placed in food plants in uncovered bait traps in close proximity to foods. To Keep Food Clean With some notable exceptions, continued sanitary improvement was found in most plants. Increased pressure was put on warehouses, wholesale groceries, and their owners and managers to maintain sanitary storage. Thirty-five criminal prosecution actions were brought against 71 firms and in¬ dividuals for storage under insanitary conditions resulting in poten¬ tial filth contamination. Penalties in 36 convictions for such violations during the year ranged from nominal fines with proba¬ tionary periods to $6,250 assessed against a firm and two of its officers. Many of the criminal actions have resulted in corrective measures to provide better protection for the stored food. Sixty-one other prosecutions were filed against manufacturers or shippers of unfit food, and 49 cases terminated during the year were based on preparation of food under insanitary conditions or use of unfit ingredients. Approximately half of the food seizures and more than 80 percent of the prosecutions of violative shippers and storers of food involved charges of filth and decomposition. The lower percentage of filth seizures as compared to recent years may be attributed in part to the increased attention devoted to detecting economic cheats, such as short weight and labeling violations. Seizure actions on filth charges dropped from 516 in the fiscal year 1961 to 426 in 1962 and the total volume seized from 8,109 to 7,542 tons. In more than 40 percent of the filth cases the food had become unfit after interstate shipment. Food and Drug Administration 327 Table 1. — Actions on foods during the fiscal year 1962 Projects Total.. . Beverages and beverage materials. . . Bakery, ready to eat cereal, and macaroni products Cereals, grain products, and feeds: Human use . . . . Animal use _ _ _ _ _ _ Chocolates, sugars, and related products _ Dairy products: Butter and churning cream _ _ Cheese and other dairy products _ Eggs and egg products . . . . Flavors, spices, and condiments _ Fruits and fruit products _ _ Meat, meat products and poultry _ Nuts and nut products _ _ Oils, fats, and oleomargarine. _ _ _ _ _ Seafood. . . Vegetables and vegetable products _ Miscellaneous foods (mixed lots) _ Warehouse foods . . . . Foods for special dietary uses 1 _ _ Miscellaneous chemicals (food adjuncts) _ 1 Includes vitamin products intended as food supplements. Seizures Criminal prosecutions instituted Injunction petitions 867 117 13 33 1 1 84 18 1 140 22 5 9 1 67 6 1 10 5 26 1 14 2 38 1 61 6 5 78 9 1 6 2 46 1 92 6 2 7 2 106 34 42 2 1 2 1 Voluntary destruction or conversion to nonfood use by owners of filthy and decomposed foods totaled 4,626 tons in 1962. These actions were taken under the observation of Federal or local inspectors after the goods were found during inspections to be subject to seizure if distributed. There has been widespread use of field bacteriology during inspec¬ tions of food processing plants where bacteriological contamination is a real possibility. Crabmeat, dressed shrimp, nut meats, and other foods partly prepared by hand, and frozen precooked food are par¬ ticularly susceptible to such contamination, which may lead to food poisoning outbreaks. One Texas crab packer was sentenced to 3 months in jail and fined because he shipped crabmeat contaminated with E. coli. A State health official had traced a food poisoning out¬ break to crabmeat from this firm. Two other criminal proceedings terminated by fines were based on E. coli found in pecans shelled under insanitary conditions. After injunction of a bakery in Atlanta the other bakeries in the Southeast reevaluated their flour-handling equipment, housekeeping practices and other sanitation programs, and accelerated those that were lagging. In 14 criminal actions terminated during the year bakeries and their officers or managers were fined for operating under insanitary conditions. One manager was fined $2,000 for a second offense. The firm moved its plant after the first violation to rid the bakery of rodent contamination, but permitted insects at the new location to become progressively worse despite FDA inspectors’ warnings. 328 Department of Health , Education , and Welfare , 1962 There has been encouraging improvement in sanitation in the grain industry in recent years. Close cooperation with State officials con¬ tinues to foster such improvement. Industry groups have shown their interest by making more requests for FDA speakers at their meetings and for more literature on grain sanitation. Seizures of rodent-contaminated bulk wheat increased from 53 actions against 2,249 tons in 1961 to 74 actions against 3,820 tons in 1962. An additional 323 tons of insect-infested wheat were seized in 4 actions. Five injunctions were requested of the courts to prevent shipment of unfit wheat and barley from elevators and other storage facilities where adequate ventilation was not maintained. Three were granted and two, forwarded to the Department of Justice near the end of the year, are awaiting action. A serious situation with respect to rodent and insect filth in several rice mills in the southeastern region of Louisiana resulted from in¬ adequate storage facilities for rough rice, infrequent cleaning of equipment, and improper storage of milled rice. Approximately 237 tons shipped from this area to Alabama were seized, and criminal prosecutions are pending against three shippers. Incubator rejects are still being diverted to food use, but persons engaged in this illegal practice have gone further underground. Fifty-four tons of decomposed frozen eggs in 30-pound cans and a truckload of 600 cases of reject shell eggs were seized in 14 actions. A west coast egg dealer was sentenced to 6 months in jail and as¬ sessed court costs of more than $5,600 for shipping rotten eggs. The judge said that the defendant “has been getting away with the use of contaminated putrid eggs for a number of years.” The first case against a hatchery in connection with the incubator reject program was terminated with a fine. Companion cases against two dealers in incubator rejects are still pending. They have filed motions to dis¬ miss on the grounds of illegal search and seizure and because stand¬ ards for decomposition have not been issued. State officials are cooperating increasingly in tracking down incu¬ bator rejects shipments and securing the evidence necessary to convict conspirators in the racket. The increased surveillance of the New England fishing industry began in 1961 to protect consumers from decomposed fish. The num¬ ber of violative lots still being encountered points to the need to con¬ tinue the stepped-up program. In addition to decomposed fish, the amount of parasitized fish encountered has also increased. This prob¬ lem is especially troublesome in ocean perch (red fish) . Twenty-four percent of the lots of imported whitefish examined had to be detained because of the presence of cysts. Two prosecution cases based on preparation of food oil under in¬ sanitary conditions were terminated with fines. Two new prosecu- Food and Drug Administration 329 tions were filed against other firms and individuals, and several others are being prepared for filing. The breakdown of controls formerly exercised in parts of the Near East resulted in detention of more than 3.6 million pounds of dates because of insect infestation. Educational work was undertaken to tell the foreign control officials why the dates were refused entry and what steps would be required to bring the dried fruit into compliance. Pocketbook Protection Total seizures to protect consumers from economic violations reached 350 in 1962 in comparison with 92 in 1961. The intensified program against short- weight and inconspicuously labeled foods that was started late in the 1961 fiscal year was continued in full force throughout 1962. More than 70 different foods and beverages were seized in 183 actions because of short-weight or volume. One puffed cereal product ranged up to 15 percent short-weight. The manufacturer started to use an “improved” puffing process which increased the volume beyond the capacity of the carton to hold the stated weight of the old product, but the weight declaration for the new, lighter product was not changed. The Food, Drug, and Cosmetic Act gives the consumer “the right to choose,” by requiring certain information that will assist in intel¬ ligent purchasing to appear prominently on the label in understand¬ able terms. There was a sharp increase in the number of seizures charging failure of mandatory labeling to appear conspicuously on the label. Eighty-five seizures were made because this information was hard to find, hard to read, or was partly or entirely missing. Common causes of “hidden” labeling were the use on transparent bags of printing ink the same color as the product in the background, and other packaging features which did not provide adequate printing contrast. In some cases the type was too small or too blurred to be easily read. Promotional items, gifts, “2-cents off” stickers, etc., were sometimes attached to the original package in such a way as to cover mandatory labeling. The press focused public attention on FDA reports of seizure of well-known and popular packaged 5-cent candies short-weighted to maintain the customary cost. It also publicized other “pickpocket packaging” and labeling of items displayed to attract selection by customers. Some were soaps, scouring powders, paper goods, and other items not subject to the Food, Drug, and Cosmetic Act. However, foods, drugs, and cosmetics are also sometimes involved in extravagant and misleading promotions via the labeling and then may be subject to control under the Food, Drug, and Cosmetic Act. An example encountered during the year was instant coffee labeled 665171—03 - 22 330 Department of Health, Education , and Welfare, 1962 “Giant Economy Size,” which actually cost more per ounce than the same product in smaller containers. It was seized on charges of false and misleading labeling. Court actions were also taken against foods that were below official standards, or did not have the composition claimed on their labels. The 1961 report discussed an episode in which the “pure orange juice” was adulterated with sugar and water by surreptitious operations in the warehouse and factory. In September 1961, the president of the firm was fined $1,000 for perjury in the trial reported last year and received a suspended 5-year jail sentence. The previous sentence had been a 6-month jail term for this defendant and fines totaling $20,000 j for the firm and its principals. Both sentences are on appeal. After a 9-day trial, a chain store and one of its employees wrere convicted of shipping enriched bread deficient in enrichment, and were fined $5,500 and $2,000 costs. The court instructed the jury to disregard charges of failure to declare the minimum daily require¬ ments statements called for by the regulations, since he did not agree that enriched bread could be considered a dietary food. Among the other substandard items seized were noodles containing 1 less egg solids than the quantity fixed by standards, “early J une” peas ; prepared from soaked dried peas, low- fat butter, canned peaches and other fruits not packed in heavy sirup as labeled, canned beans with excess fibers, artifically colored canned cauliflower, strawberry pre¬ serves containing cherries in lieu of strawberries, and an avocado salad dressing that did not meet the official specifications for salad dressing. Charges that foods did not meet their labeled composition were made in seizures of low-quality salmon deceptively labeled as the pink variety, grouper fillets labeled “red snapper,” broken pieces of shrimp instead of the whole shrimp promised by the label, an arti¬ ficially colored product declared to be paprika, cheese with artificial holes sold under a “swiss” label, imitation lemon-flavored crystals j palmed off as dehydrated lemon juice, grapefruit juice with a sodium compound added to make it appear to be the juice of mature fruit, and frozen orange juice concentrate adulterated with sugar and water. FOODS FOR SPECIAL DIETARY PURPOSES Of about 100 seizures of vitamin products and other foods for special dietary uses, 16 were substandard in labeled potency, 6 failed to bear the special labeling required of such products, and 2 were con¬ taminated with filth. Sixteen seizures were based on folic acid con¬ tent in excess of 0.4 milligram of folic acid per daily dose and not labeled for sale upon prescription only. The principal violation of the labeling requirements of foods for special dietary uses involved low calorie claims for foods not entitled to such designation. Recently published proposals for revised regu- Food and Drug Administration 331 lations for special dietary foods contain specific provisions aimed at curbing abuses in labeling foods for use in weight-control diets. The remaining seizures were based on false and misleading claims for the cure or prevention of disease. Some of the most significant are discussed below. Nutritional Quackery An estimated $500 million is wasted by the public each year on unneeded vitamins and faddist food products. Most of them are foisted upon the public by false representations that sound health is impossible without the addition to the diet of the special item pro¬ moted. Usually the myth is propounded that our soils are depleted because of years of intensive cultivation, and our food supply is poor because of modern commercial methods of production and processing. Contrary to this propaganda, the fact is that the American food sup¬ ply is unsurpassed in quality and nutritional value. A balanced diet of foods available throughout the land supplies all of the average individual’s nutritional needs. The problem of enforcing the law against nutritional quackery is greatly increased by lack of knowledge on the part of the public of the true facts of nutrition. Reference is made earlier in this report to the first meeting of the National Congress on Medical Quackery sponsored by the AMA and FDA. In March these organizations and the National Better Business Bureau were joined by the Associa¬ tion of Colleges of Pharmacy in efforts to issue and distribute infor¬ mative public statements to combat nutritional quackery. Seizure, injunction, and criminal prosecution actions were com¬ pleted during the year against several purveyors of sea water and sea salt who made use of the writings of Dr. George W. Crane, a nationally syndicated medical newspaper columnist. In his columns, which were widely reprinted by sellers of sea-water products, he extolled the virtues of minerals derived from sea water for practically every serious disease of mankind, including cancer, but with special emphasis on arthritis and other afflictions of the aged. In comparison with ordi¬ nary table salt, any usable quantity of ocean water would supply insig¬ nificant quantities of needed mineral nutrients, in addition to the fact that none of the serious diseases for which claims were made are caused by mineral deficiencies in the diet. Several seizure actions were instituted during the year against Nutri-Bio, a vitamin-mineral supplement nationally promoted through door-to-door peddling by approximately 75,000 distributors. In the privacy of the prospects’ homes many of the peddlers made claims for cancer, heart trouble, diabetes, tuberculosis, and other serious diseases. They also recommended the supplement for persons show¬ ing lack of normal intelligence, for “radiant living,” and for preven- 332 Department of Health , Education, and Welfare, 1962 tion of “premature death.” Many of these claims were incorporated in a book written by Bob Cummings, a movie and TV actor who was designated by the Nutri-Bio corporation as executive vice-president in charge of research. The book was also displayed to sell the supple¬ ment in some cases. Other promotional material charged to contain misleading claims included sales manuals, sales and recruiting kits, leaflets, reprints of magazine articles, records, and filmstrips. The ■ area salesman in Chicago alone destroyed 50 tons of books and litera¬ ture after FDA charged that this material contained false claims. Criminal and injunction actions were completed against Dr. Royal Lee, a nonpracticing dentist who recommended more than 115 so-called ; nutritional products for more than 500 different diseases and condi- ; tions. The recommendations were made in articles in a “Therapeutic | Food Manual” and in other writings of Dr. Lee. These products ! were administered primarily by practitioners whose licenses did not j permit the use of drugs, but who nevertheless prescribed the articles ; for incurable and fatal diseases, as well as for many conditions which could have been cured or alleviated by proper treatment. Also en¬ joined were the two related corporations, Vitamin Products Co., Inc., ! headed by Dr. Lee, and the Lee F oundation for Nutritional Research, a ; nonprofit foundation set up by Dr. Lee for “research” and sales of the literature promoting his products. In the criminal action the Vitamin Products Co., Inc., was fined $7,000, and Dr. Lee received a suspended 1-year prison sentence. Another major promotional effort that ran afoul of the law during the year involved safflower oil for weight reduction and for lowering of blood cholesterol, associated by the public with prevention of heart i disease. A best-seller book “Calories Don’t Count” written by a physician and stockholder in Cove Vitamin and Pharmaceutical Inc., j was used to promote sales of the product and was charged to be mis- ; branding labeling. In addition to misleading weight control claims, the seizures were based on false and misleading claims in the book and other labeling for lowering the cholesterol level of the blood, for treating arteriosclerosis and heartburn, for improving the complexion, ; for increasing resistance to colds and sinus trouble and promoting health, and for increasing sexual drive. The firm denied the Govern- I ment’s charges, but later withdrew from its contest of the case. The firm then ordered a recall of all outstanding capsules. There were also seizures of other safflower oil products during the year. Nature Food Centres, a corporation selling “natural and organic” foods, and two of its officers were convicted for shipments of food products represented for the treatment of many serious diseases. One of the defendants during public lectures in Philadelphia and Chicago, in an effort to promote sales of the products, represented them to be Food and Drug Administration 333 effective for the treatment of conditions ranging from heart diseases and hepatitis to mental sluggishness, impotency, and colds. Fines of $5,000 for each individual and $10,000 for the firm represented the highest total fines assessed during the year. Royal jelly, a substance secreted by bees to feed the queen bee, has been promoted as a “miracle” ingredient to increase sexual vitality, extend the life span, normalize the growth of underdeveloped children, cope with the ailments of old age, improve memory, stimulate the appetite, etc. A vigorously contested trial of the seizure of a shipment of royal jelly, Jenasol RJ Formula, in 1962 gave FDA its first court victory to establish such claims as unfounded. Following the decision in favor of the Government, the court granted its request for an injunc¬ tion to prevent further misbranding of royal jelly by the firm. Numerous other actions against royal jelly products have been won by default. In another case involving the product of bees, the Government seized iy2 tons of honey misbranded with misleading claims for the treatment of waning virility, arthritis, weak heart, and as a cure for premature death. Lelord Kordel, a “health food” lecturer, is president of the distributing firm. The honey did not differ from ordinary honey. One product misbranded by false and misleading claims for losing or gaining weight and for figure control had been extolled by Jack LaLanne in a nationally televised calisthenics show. Cairrot juice and beet juice were seized on the basis of labeling claiming effectiveness for cancer, cardiac conditions, rheumatism, anemia, infectious diseases, etc. Garlic tablets were seized because of misleading claims for reduction of high blood pressure. Forty-three of a mail-order distributor’s line of vitamin, mineral, and other food supplements were seized because of misbrandings in the course of national radio broadcasts by Carlton Fredericks, a self- styled nutrition expert. He recommended the products for such con¬ ditions as circulatory and respiratory diseases, club feet, multiple sclerosis, sexual frigidity, cerebral palsy, tooth decay, grey hair, strokes, and many others. The Government also charged as false and misleading the broadcaster’s claim that he is “America’s Fore¬ most Nutritionist.” This statement appeared on the front cover of his diet book entitled “Eat, Live and Be Merry” which was seized in a “health food” store where it was displayed beside the supplements. In June 1962 a major overhaul in the special dietary food regula¬ tions was proposed as a step toward curbing nutritional quackery. These regulations spell out the specific labeling information deemed necessary to facilitate intelligent purchase and use. The new pro¬ posals would replace regulations in effect since 1941 and made obso¬ lete by scientific progress in the field. 334 Department of Health , Education , and Welfare , 1962 An organized attempt to block the proposed changes by those want¬ ing “health foods” to remain in status quo resulted in a deluge of protests to Congress and the Department. Thousands signed post¬ cards furnished by organizations opposed to the regulations. Many of those who filled out the cards obviously misunderstood the pro¬ posals. They had been led to believe that the regulations would re¬ quire prescriptions for vitamin and mineral products, put “health food” stores out of business, and interfere with the sale of nutritional products from natural sources. On the contrary, the proposed regulations are an attempt to give consumers the advantages of 1962 knowledge of nutrition and are not intended to prevent the sale of any useful, honestly represented product. They aim at providing the public with labeling facts needed for intelligent purchase, and at curbing “shot-gun” formulas containing 50 to 75 ingredients of which only a handful have been proved to offer nutritional benefits. The time for receiving com¬ ments was extended for 2 additional months, making the final date mid- October. DRUGS AND DEVICES Recalls. — Sixty-seven defective or misbranded drugs were recalled by manufacturers during the year, either on their own initiative or at the request of FDA. Thirty-seven were defective because of such failures as low potency, nonsterility, high moisture, off-taste or odor, lack of stability, poor consistency, use of a delisted color, and internal pressure causing bottles to break. Seven of the recalls were made because of labeling errors, two of which caused injuries. One was an analgesic containing alcohol, menthol, and methyl-salicylate which was labeled as an eyewash and resulted in a severe eye injury. The other was turpentine labeled as castor oil. Although the firm knew of the mixup shortly after dis¬ tribution, it made only feeble efforts to recall. FDA did not know of the error until an injury complaint was received. The suspension of applications for new drugs which caused ad¬ verse reactions is discussed under New Drugs. Kecalls were con¬ ducted for outstanding stocks of each of these products. In another adverse reaction case, the firm issued a recall letter to 250,000 physi¬ cians, wholesalers, and direct account pharmacies but called for a hearing when FDA recommended that it request a suspension of its application. (This hearing resulted in the suspension after the close of the fiscal year.) Three other recalls involved new drugs not cov¬ ered by effective applications. Injuries caused the recall of soda mint tablets and a tuberculosis drug both of which were contaminated by stilbestrol. Cross-con¬ tamination had resulted from failure to clean processing equipment Food and Drug Administration 335 thoroughly before starting the manufacture of another drug. An¬ other recall was made of a penicillin product contaminated with sulfonamides. Antibiotics seized included two intermammary infusions which left penicillin in the milk of the treated cows, and antibiotic sensitivity discs for which certification had been suspended pending correction of objectionable control procedures. In another case, FDA re¬ quested the manufacturer to recall penicillin shipments when an FDA inspector discovered during a factory inspection that samples sub¬ mitted for certification were not representative of the batch. After continued promotion of a drug seized for false and mislead¬ ing claims to cure acne, the Commissioner made a finding that the labeling was “in a material respect misleading to the injury or damage of the purchaser or consumer.” This finding, under which multiple seizures can be made, brought agreement by the firm to recall shipments. One veterinary preparation, an iron injection manufactured to the prescription of a veterinarian, was recalled when 168 steers of the 172 injected died. Illegal Sales of Prescription Drugs Illegal sale of dangerous drugs and their diversion into bootleg channels continue to be a serious problem. Most frequently involved are the amphetamine drugs. Abusive use of these drugs may cause highway deaths, mental and physical deterioration, juvenile delin¬ quency, and crime. Barbiturates now rank second as the drugs most often involved in both bootleg and unauthorized pharmacy sales. Tranquilizers and hormone preparations are also found among the drugs being sold without prescription or without authorization for a refill of an original prescription. Of 136 criminal cases terminated during the year on charges of illegal sales, 40 involved unlicensed outlets, such as truckstops, cafes, and peddlers, some of whom sold in wholesale quantities. Ninety- four actions were based on sales by drugstores or licensed pharmacists without prescription. Two physicians were prosecuted for sales with¬ out a bona fide doctor-patient relationship. Fifteen unlicensed individuals and five pharmacists were required to serve prison sentences ranging from 1 day to 2% years. Twenty- eight others received jail sentences which were suspended on condition that illegal sales be discontinued. New criminal cases started during the year numbered 150. Particular attention was given to investiga¬ tions to learn where these dangerous drugs are first diverted out of legitimate channels to bootleg channels of distribution. 336 Department of Health , Education , and Welfare, 1962 One couple was prosecuted in three F ederal courts for participation in a ring engaged in illegal peddling of amphetamines to truck stops and filling stations in the Southeastern States. The two were fined a total of $21,000 in the three cases. The husband was sentenced to a total of 4 years in jail (later reduced to 2 years) and the wife to 1 year plus 1 additional year suspended. A 21^-year jail sentence was assessed against an individual who supplied this couple and other large bootleg peddlers. The case was based on the purchase and illegal distribution of about 6 million tablets and capsules of drugs, largely amphetamines. In passing sentence, the Federal judge called attention to the fact that the de- j fendant had attempted to buy additional large quantities of the drug after his arrest. Three “goof ball” peddlers were arrested for sales of barbiturates and amphetamine in the Newark area. A fourth criminal informa¬ tion was filed against a man already in jail on another charge. Most of the sales by the gang were to teenagers. A number of injuries requiring hospitalization were associated with this distribution. A Maine physician pleaded guilty to selling large quantities of • barbiturates and amphetamines outside of his legitimate practice. He was fined $5,000 and received a 6-month suspended jail sentence. Other doctors and a hospital had complained to FDA that this j physician was selling amphetamine by mail to patients under care of other physicians. FDA inspectors who posed as patients were not given physical examinations but were able to buy the drugs in peanut butter and coffee jars even after they told him they were reselling the drugs. An Arkansas physician was fined $1,000 and placed on probation after his arrest in a tourist cabin while attempting to sell 200,000 | amphetamine tablets to FDA inspectors posing as drug peddlers, j Seizure was also made of amphetamines in possession of a Pennsyl¬ vania physician who had sold an FDA inspector 10,000 tablets and had some 12,000 when the U.S. marshal made the seizure. In another case, an unlicensed, self-styled naturopath was sentenced to 2 years in jail for selling barbiturates and tranquilizers in the guise of a practicing physician. The jury found him guilty on 12 counts charging illegal sales. State enforcement agencies have been increasingly active in attack- ing the problem of illegal sales of dangerous drugs. Some of these agencies have laws permitting them to take action on the basis of illegal , possession of drugs, thus they are not required to obtain evidence of traffic in them. Their inspectors have also given effective assistance to FDA inspectors in obtaining the proof needed for Federal prosecutions. Food and Drug Administration 337 Safety Controls The 1961 report discussed new regulations that will require manu¬ facturers to provide the medical and pharmaceutical professions with more information in the labeling of prescription drugs. It also outlined changes in the new-drug regulations which require the manu¬ facturer to submit more samples of new drugs and their ingredients and information concerning tests run so that FDA may check the firm’s control procedures. The marketing of a new drug may be held up until FDA has made a complete factory inspection. Twenty-five drugs were seized because they did not have new-drug clearance, in comparison with 11 in 1961. An injunction and a criminal prosecution case based on cancer “cures” shipped without effective new-drug applications are discussed under Medical Quackery. One firm enjoined from shipping new drugs without safety clear¬ ance had not even been attempting to submit applications for such clearance. A previous new-drug application granted under another firm name had been suspended after investigations disclosed significant variations from claimed procedures. In discussing the probation re¬ port filed before a permanent injunction was granted, the judge made the following comment “* * * there isn’t really very much in the re¬ port to commend the defendant favorably to this court and, in fact, some of the interested agencies have described and characterized the defendant as a con-man, you might say, in the food and drug business * * The 1960 report told of the conviction of the operator of a drug testing laboratory for giving faked data on drug analyses made for small drug manufacturers. He was fined, given a 1-year suspended jail sentence, and placed on probation for 3 years under strict super¬ vision of FDA. When it was found that he was continuing to fake his reports of analyses, he was brought back to court for violation of his probation. He was found guilty after a 3-day trial in the fall of 1961 and was sentenced to 6 months in jail, fined $2,000, and his pro¬ bation period was extended to a total of 5 years. The court later va¬ cated the jail sentence on a plea that the defendant was showing signs of mental illness. Thirty-six drugs (excluding dietary products, devices, and medi¬ cated feeds, which are discussed separately) were seized because they were below labeled composition, or failed to meet official standards. New regulations became effective in February 1961 requiring pre¬ scription drugs to bear lot control numbers. The first seizure for violation of these requirements was made in November of shipments of reserpine and a sulfonamide from which the control numbers had been scraped off from the labels while the drugs were in original manu¬ facturers’ packages. These lot control numbers are needed by both 338 Department of Health, Education, and Welfare, 1962 the manufacturer and FDA to pinpoint the affected lots if something is found wrong with the drug. Counterfeit Drugs Two surveys of the extent of drug counterfeits on the market were made in the summer of 1961. No counterfeits were found in a 1,300 sample survey of those drugs believed likely candidates for counter¬ feiting but not previously known to be counterfeited. These are drugs of relatively high cost used over long periods of time for chronic ailments, and purchased in large quantities by retail druggists. The second survey covered 300 drugstores known to have done business with a leader of the counterfeit ring who had been indicted for distributing counterfeit drugs. Thirty-two of these stores were found to have counterfeit drugs in their possession. In February 1962 this ringleader and his son whom he employed pleaded guilty in Federal court in Texas. The father was sentenced to jail for 6 months and fined $1,000. Payment of the fine was sus¬ pended, and he was placed on probation for 5 years. The son was placed on a similar probation after a 1-year jail sentence and $1,000 fine had been suspended. Both face prosecutions in Federal courts in Louisiana and New J ersey for participation in the counterfeit drug racket. A number of criminal prosecutions were filed for the dis¬ pensing of counterfeit drugs. One of these cases has been terminated with a $3,000 fine. Apparently these criminal actions and seizures of counterfeit drugs, which were largely effected before the prosecutions, have virtually stopped the counterfeit racket, at least temporarily. Repacked Physicians 9 Samples About 40 seizures of drugs valued at more than $1 million were | made during the year in a program to curb dangerous abuses in the j collection and selling of discarded physicians’ samples. Most of these cases involved repacking, usually by the dealers whose stocks were seized. In the repacking cases, the Government charged that the drugs were misbranded because of the absence of all or part of the labeling re¬ quired to maintain the integrity and safety of drugs. Information lost in the repackaging operation included the common or usual name of the drug and each active ingredient, adequate directions for use, lot or control numbers, expiration dates for drugs with a limited shelf life, the statement “Caution : To be dispensed only by or on prescrip¬ tion of a physician,” and the name and address of the manufacturer. Mixups encountered in the repacked samples illustrate the ex¬ tremely hazardous nature of such operations. In two instances the repacked bottles bore names of drugs different from those they con- Food and Drug Administration 339 tained. In another case there were two different strengths of the same drug actually in one bottle. Outdated antibiotics and overage drugs were encountered, as were new drugs still in investigational status. In several instances drugs were found in completely unlabeled bottles. Retail drugstores have for the most part cooperated with FDA in its efforts to correct the physicians’ sample situation. Medical Quackery Sixty-six seizures and seven criminal cases were filed charging false and misleading curative claims for drugs. Actions were taken against the promoters of several worthless cancer cures. A jury found a firm and its secretary- treasurer guilty of promoting Millrue, a product labeled as an “iron tonic,” for cancer, arthritis, diabetes, ulcers, high blood pressure, and other serious diseases. The court assessed a total fine of $7,500 and sentenced the secretary-treasurer to 6 years in prison, to be followed by 3 years of supervised probation. He had been convicted on similar charges in 1958. This is the maximum jail sentence the law provides for a second-offense violation on a two-count information. Millrue was distributed by agents and “health food” stores, and was advertised in a “health” magazine. The defendant personally filled mail orders induced by these ads and although he had no medical training, he also engaged in consultations with prospective customers during which he “diagnosed” their ailments as cancer or diabetes and recommended the use of his tonic. Another cancer “cure,” KC-555, was banned by a Federal court in¬ junction on the grounds that it was shipped as a drug without a prior showing of safety. It was an African-grown herb juice to be mixed with wine, and was labeled in part “it is used as an adjunctive treat¬ ment in malignant diseases, and as a stimulant when you feel run¬ down or listless.” The Laetrile cancer remedy was exposed as worthless in California medical circles more than 9 years ago. When recent F ederal investi¬ gations showed interstate traffic in a number of drugs not cleared for safety, criminal prosecution was filed against Ernst T. Krebs, J r. and the “John Beard Memorial Foundation” he directed. In March they were fined, and Krebs was placed under probation for 3 years, with conditions strikingly similar to those of injunction decrees. The last report discussed an attempt to revive the worthless Koch cancer injection and the suspended jail sentence and probation issued to stop the sale of the treatment at a clinic in Texas. When FDA learned that the clinic operator was still shipping the treatment, FDA inspectors and a deputy marshal found 12 hypodermic syringes under a sofa in the operator’s living room, together with correspondence 340 I Department of Health , Education , and Welfare , 1962 which showed that he had never stopped his activities. He was sent to jail for 2 months for violating the terms of his probation. There are millions of arthritics in this country who will grasp at any straw in the hope of relief from pain. Many are led to believe in so-called cures for arthritis because of remissions which naturally ■ occur in the disease. This sets the stage for unscrupulous promotion of worthless remedies. Numerous seizures were made of such products, and in June a mail-order firm, the manufacturer, Specifics Drug Co., i and individuals associated with them in the distribution of Specifex Adrenal Hormone Cream were permanently enjoined from interstate ;! shipment of the ointment. Mail-order sales had soared on a nation¬ wide scale in recent years because of false claims of curing rheumatism, arthritis, fibrositis pains, and for other pain-associated conditions. One of the statements made in promotional literature was “Rush by ■ Return Mail * * * Works Like a Shot.” Seizures of more than $185,000 worth of Acnotabs, promoted as “medical science’s latest discovery” for treating acne (pimples) in ' teenagers, followed the Commissioner’s multiple seizure findings mem- tioned under Recalls. While a contested seizure was awaiting trial i the firm continued to promote the tablets with such misleading claims as “Remarkable new tablets work internally as no lotion, no ointment [ possibly can! Pimples clear up beautifully — AND YOU DON’T GIVE UP SWEETS !” After the multiple seizure findings the com¬ pany recalled many outstanding shipments to avoid further seizures until the first seizure was tried in court. (The Government was | upheld in this action after the close of the fiscal year.) Seizure of a coated chewing gum containing essential oils and a small quantity of benzocaine was made on charges of misleading claims that the gum would aid the appetite and aid in reducing. The labeling of ■ the gum claimed “Eat What You Want — Yet Lose up to 3-5-9 Pounds a Week,” and included menus suggesting a restricted daily intake of ' about 1,200 calories. The claimant contested the seizure and the dis- trict judge ruled that the Government did not sustain its burden of proof. The Government lost an appeal in which it contended that the claimant’s own evidence did not substantiate the labeling claims. Medicated Feeds Figures are not available as to what proportion of the 42 million tons of animal feed manufactured in 1961 was medicated, but the volume was immense and it is increasing year by year. The addition of antibiotics, hormones, arsenicals, and other drugs to feeds has revolutionized livestock and poultry production and brought many important benefits. Production costs have been reduced, output increased, and animal diseases brought under more effective control. Food and Drug Administration 341 | This, in turn, is reflected in what the consumer pays for poultry, meat, I eggs, and dairy products. But the use of drugs in feeds also has presented potential health ! hazards that have conferred tremendous new responsibilities on FDA. The agency must refuse to sanction the use of any feed additive that would injure either the animals fed or the people consuming food derived from them. Directions for use must be adequate to result in safe use if they are followed. The feed mixer must demonstrate that the manufacturing pro¬ cedures he will use will assure uniformity and labeled potency of the feed before his new-drug application for permission to manufacture and market the medicated feed will be cleared. Inspection is neces¬ sary to check on processing procedures or to catch misuse of medicated feeds. Laboratory analysis of samples of the finished feed is a neces¬ sary final step and represents another heavy workload for FDA. Twenty-eight lots of medicated feeds were seized in 1962, compared with five in 1961. Five criminal actions and one injunction were filed in 1962 — one criminal case in 1961. In five of the seizures the manufacturer had not obtained safety clearance to mix the drug in his feed. In eight other seizures non- certified antibiotics had been incorporated in violation of regulations. In nearly half of the seizures the feeds were either above or below the strength declared on the label. The gravity of overdosage was demonstrated by a turkey feed that killed more than 700 turkeys. It contained about twice the labeled amount of drugs added for treating poultry diseases and stimulating growth. The firm was fined and permanently enjoined from further shipments. In three seizures the Government charged false and misleading veterinary claims. New Drugs There were 693 new drug applications received during the fiscal year; 282 for human and 411 for veterinary drugs. Within the same period 273 applications became effective; 109 for human and 164 for veterinary drugs. A total of 1,110 communications on effective appli¬ cations for human drugs and 2,387 for veterinary drugs was also handled including many formal supplements. Of the supplements, 760 were made effective for human and 427 for veterinary drugs. Safety clearances previously granted for five drugs for human use were suspended on the basis that clinical experience since the appli¬ cations became effective showed that they were unsafe for use. Since some of these drugs were included in different products, the suspensions applied to 10 applications. All products were promptly removed from the market. The drugs concerned were: (1) zoxazolamine , used for 342 Department of Health , Education , and Welfare, 1962 relaxing skeletal muscle spasm and also for increasing excretion of uric acid in gout. It was found to cause severe liver damage in some instances. (2) amphenidone , a mild tranquilizing agent for the relief of anxiety and tension. Agranulocytosis, a serious blood condition, was encountered in some patients. (3) triparanol , used to lower blood cholesterol. Evidence developed associating it with cataract forma¬ tion, loss of hair, and certain skin conditions. (If) etryptamine acetate , for relief of mental depression in psychiatric conditions. Agranulocy¬ tosis was also encountered with this drug. (5) thihexinol methylbro- mide , an atropinelike drug used for the treatment of diarrhea. Atropinelike side reactions occurred in infants, and the labeling claims went beyond those authorized in the original safety clearance. Approximately 6 months prior to the suspension of the application for triparanol, the distributor, in collaboration with the Food and Drug Administration, issued a letter to physicians informing them of toxic effects which had been encountered with the product. At that time the evidence was not deemed legally sufficient for suspension of the safety clearance. Additional information, resulting in part from this publicity and from continuing investigations, made it evident that the product should no longer be marketed. Also in collaboration with the Food and Drug Administration, dis¬ tributors of two drugs, triacetyloleandomycin and erythromycin estolate, issued letters to physicians calling attention to liver injuries resulting from use of the drugs in investigative studies and in general practice after the drug was cleared for distribution. The letters en¬ closed revised package inserts which referred to the above effects. One product containing triacetyloleandomycin in combination with other drugs was seized on charges that its labeling included claims extend¬ ing beyond those provided for in the effective new drug application. As discussed in the Introduction, an application was prevented from becoming effective for a sedative and hypnotic, thalidomide. This drug was marketed in other countries and was later shown to cause serious malformations of the fetus when used in early pregnancy. New regulations, discussed in the 1961 report, requiring applicants to submit specific samples with applications, have permitted the testing of the adequacy of the manufacturers’ methods in district laboratories on approximately 40 applications. The authority in the regulations to verify by factory inspection the adequacy of a manufacturer’s facili¬ ties and controls has been used to advantage in evaluating approxi¬ mately 20 applications. Significant drugs on which favorable action was taken during the fiscal year include one for dilating the coronary arteries (dipyrida¬ mole) ; an intravenous blood-pressure-elevating agent for the treat¬ ment of shock (angiotensin) ; one for lowering the blood pressure Food and Drug Administration 343 (mebutamate) ; another potent diuretic which also helps to lower blood pressure (polythiazide) ; a drug for the palliative treatment of some types of cancer (5-fluorouracil) ; an anti-infective sulfonamide (sul¬ famethoxazole) ; one for the control of itching (cyproheptadine) ; two anti-inflammatory steroids for topical use (fluandrenolone and fluocinolone) ; a tissue-building steroid (stanozolol) ; and an andro¬ genic steroid for treating inoperable cancer of the breast (dromostano- lone propionate) ; a diagnostic agent for testing function of the pituitary gland (methopyropone) ; two drugs for relaxing smooth muscles and which aid in the treatment of peptic ulcer (clidinium bromide and glycopyrollate) ; a mild tranquilizing agent (hydroxy- phenamate) ; an agent for the control of nausea and vomiting (thiethylperazine) ; a drug for the treatment of vascular headache (methoxyflurane) ; an oral contraceptive agent (norethindrone and ethinyl estradiol) ; two drugs for the control of cough (pipazethate and levo-propoxy phene 2-napsylate) ; a progestational agent for the treatment of menstrual abnormalities (isopregnenone) ; some oral enzyme agents recommended for the treatment of inflammations and injuries; and some radiopaque compounds for use in X-ray examina¬ tions. Devices Of 57 devices seized, 40 were charged to be misbranded and 17 to be defective. The latter included 14 shipments of rubber prophylactics with holes, two of clinical thermometers that did not register accu¬ rately, and an automatic metering infusion set that did not deliver the flow at the rate indicated on the meter. Shipments of seven types of worthless devices to health practitioners throughout the country by Electronic Instrument, Inc. (Ohio) were permanently banned by an injunction order in April 1962. The elec¬ tronic and diagnostic devices were accompanied by literature con¬ taining claims for treating disease conditions of the brains, tonsils, prostate, spinal cord, trachea, lungs, kidneys, stomach, heart, liver, and numerous other diseases. Some are supposed to measure electrical frequencies emanating from the body, although such frequencies do not exist, and then match them with high-frequency electrical cur¬ rents which give the patient nothing but a tingling sensation. Thousands of the instruments, costing up to $1,000 each, have been distributed to practitioners over the years, and a number have been seized — eight in three actions shortly before the in j unction order. The use of these devices by health practitioners can in no way help patients, and great harm may be done by reliance upon them. Fred J. Hart, president of the Electronic Medical Foundation (California) , who was permanently enjoined in 1958 from distributing 344 Department of Health, Education , and Welfare , 1962 13 misbranded diagnostic and treatment devices based on “emana¬ tions” supposedly given by a drop of blood, was prosecuted during the 1 year for criminal contempt of the injunction. He was fined just after the close of the year. The action was based on delivery of one of the banned devices, Short Wave Oscillotron, to an out-of- State practitioner in July 1961. The foundation he headed, which was dissolved just before the contempt case decision, was set up many years ago as the College of Electronic Medicine by the late Dr. Albert Abrams, inventor of many of the electro-medical theories involved in previous FDA device actions. Another injunction ordering the Ellis Research Laboratories and j Robert W. Ellis, president, to stop misbranding a diagnostic electrical device, Micro-Dynameter, brought an appellate court finding that the device was not safe even in the hands of a licensed practitioner. The FDA Commissioner called the machine “a peril to public health because it cannot correctly diagnose any disease.” On June 11, 1962, ; the Supreme Court refused to review the actions of the lower court. Over 5,000 of the devices had been sold, for as much as $875 each, with promotion through about 50 items of misbranding labeling, ! including hard-cover books, pamphlets, case histories, and alleged sci¬ entific research reports. The first seizure, effected in 1954, charged that false and misleading claims were made for cancer, tuberculosis, tooth decay, and 30 other diseases and conditions. After the Supreme Court refused to review the case, a nationwide seizure campaign was immediately instituted in an effort to take the device out of the offices of health practitioners. Publicity given to the injunction and seizure campaign by the press, State enforce¬ ment agencies, and practitioners’ associations, brought many offers by practitioners to destroy their machines, thus making seizure actions unnecessary. Other practitioners, and some of their patients, have vigorously protested the seizures. Another type of device seized was massaging instruments for beautifying the face and figure, toning flabby muscles, removing “dowager’s hump” and double chin, reducing weight, relieving ten¬ sion, curing fallen arches, and improving skin texture. Adolphus Hohensee, a “health lecturer” promoting a massage device for such diseases as cancer, was arrested by New York City authorities when he protested seizure of the device and precipitated a disturbance among his students. Various types of “air purifiers,” ranging from vacuum cleaners to devices to force air through canisters of activated charcoal, were charged with making false and misleading claims for relief from hay fever, sinus, and asthma allergies; killing air-borne bac- Food and Drug Administration 345 teria ; counteracting substances in tobacco smoke to protect the smoker | from lung cancer; banishing irritation of nose and throat mem- ! branes; and preventing infections and parasitic diseases. A Federal court decree filed in the District of Columbia against continued mis- ' branding of Puritron devices drastically limits the claims which may | be made for health benefits from household air purifiers. Other devices seized included lamps for the treatment of aches, pains, and skin problems; juice extractors claimed to produce juices I beneficial for cancer, arthritis, colds, ulcers, etc.; quartz broilers to prepare healthier foods, protect against heart disease by destroying cholesterol in food prepared in them, and permit one to live longer ; a bust developer; and a number of other devices with serious claims. Three types of devices were charged to be potentially dangerous as well as worthless. An injunction decree was issued against Mercier Radioactive Devices that were dangerous to both the practitioner and the patient because of leakage of radioactive materials. The device supposedly radiated blood drawn from the patient, and the blood was to be re-injected to “increase the energy quantum in the blood plasma.” An ultrasonic device was seized in possession of a masseur not licensed to use it. Such devices may cause injuries when used by the ignorant or unskilled. Also seized were electric toothbrushes and gum massagers that might cause severe or fatal shock after immersion in water. Con¬ trary to labeling claims, the motor and cord units were not sealed. The Government also took exception to the claim that it offered “the best in a complete home dental treatment.” COSMETICS AND COLORS Nearly 32,000 bottles of hair dressing were seized in 13 actions against a cosmetic counterfeiting operation. The counterfeiter had recently been sentenced on a currency counterfeiting charge. The counterfeit cosmetics could be easily detected because the dressing, containers, and labels all differed from the genuine. The product itself contained coal-tar colors not present in the imitated product, and the container and labels differed in several respects. For ex¬ ample, light would pass through the counterfeit label, whereas the genuine label is lightproof. Another seizure removed approximately 17,000 plastic tubes of deodorant from the market on charges of inconspicuous labeling. The product was distributed through orders taken by door-to-door salesmen. The labeling, in small print, was formed in the plastic container and was the same color as the background. It was placed 665171 — 63 - 23 346 Department of Health , Education , and Welfare , 1962 on the plastic plunger by which the deodorant stick is pushed up out of the container as it is used. This made it progressively less read¬ able as the product was used up. Inconspicuous labeling was also charged in the seizure of a spray perfume. A window placard explained the symbols used for differ¬ ent scents of “Famous Name Perfumes,” but only the symbols were used on the individual cartons, which did not bear the name of the manufacturer, packer, or distributor. Two shipments of eyeliner pencils, eye shadow, and mascara of various shades were seized because of use of synthetic organic colors that had not been provisionally listed for cosmetic use. One line had been manufactured in Paris; the other lot was of domestic origin. Another eye cosmetic containing a nonpermitted dye was recalled from sales distribution. Foods seized because they contained unpermitted colors included two shipments of a cake mix containing the delisted FD & C Red No. 1, popcorn oil containing the delisted FD & C Yellow No. 4, imported bottled cherries in cherry liqueur containing an isomer of FD & C Red No. 2 not covered by a regulation or exemption, and imported red plums containing a noncertified coal-tar color. CERTIFICATION SERVICES Color Additives. — All color additives used in foods, drugs, and cosmetics (except hair dyes) must be listed for such use pursuant to the Color Additives Law of 1960. Synthetic organic colors used must be from batches certified by FDA as safe for such use. In 1962, 5,798 batches representing over 4,088 tons were certified, and 37 batches representing 9 tons were rejected. Insulin. — All batches of insulin must be tested and certified by FDA before distribution. Examination of 362 samples resulted in the cer¬ tification of 294 batches of insulin drugs and 60 batches of material for use in making insulin-containing drugs. One batch of protamine zinc insulin was rejected because it contained excess protamine. The request of approval of one trial mixture of isophane insulin was with¬ drawn because the composition of the materials was questionable. Four batches of 20-unit insulin were found suitable for use at the labeled strength, but were not of a strength listed as certifiable under the FDC regulations. Two batches of insulin held in cold storage from 5 to 8 years by the Office of Defense Mobilization were found to have retained 88 percent of the labeled potency. These batches are usable in an emergency if no better product is available, but certifica¬ tion ceased to be effective when the expiration date had passed. Antibiotics. — The predistribution testing and certification of cer¬ tain antibiotics also were provided for by amendments to the act, Food and Drug Administration 347 before the Drug Amendments of 1962 included all antibiotics for hu¬ man use under the certification provisions. Examinations were made of 15,539 batches of penicillin, streptomycin, dihydrostreptomycin, chlortetracyline, tetracycline, chloramphenicol, bacitracin, sensitivity discs, amphotericin, erythromycin, neomycin, novobiocin, nystatin, triacetyloleandomycin, and polymyxin. The last seven antibiotics mentioned were not subject to certification but were submitted for test¬ ing to determine their suitability for use in combination with certi¬ fiable antibiotics. Of the samples tested, 183 were unsatisfactory because of failure to meet the following standards: potency and purity (110), moisture (22), pyrogens (18), sterility (13), pH (9), heat stability (4), uni¬ formity (2), resuspension difficulties (2), short volume (1), crystallin¬ ity (1), and solubility (1). The rejection rate is deemed significant in view of the fact that the batches rejected had undergone rigorous testing by the manufacturer in anticipation of Government tests before samples were submitted. Six hundred and four sensitivity discs were certified and 32 were rejected. Other Government agencies submitted 1,066 batches of anti¬ biotic preparations for potency testing before extending their expira¬ tion dates, and 1,559 official and investigational samples of drugs, medicated feeds, and food for human use were examined. Federal Hazardous Substances Labeling Act The Federal Hazardous Substances Labeling Act requires consumer protection information on labels of hazardous household products such as cleaning agents, paint removers, and polishes. Enforcement of the act began on February 1, 1962. Thirteen products were seized and removed from consumer channels because they were devoid of the labeling required by the act or the regulations. Included were soldering materials (5) ; turpentine (3) ; carbon tetrachloride (2) ; a lacquer; lacquer thinner; and a sanding sealer. The first seizure made under the new law involved soldering salts, which had been linked to the death of a child. The father, a repair¬ man for electronic equipment, had a workshop in the family kitchen and had transferred soldering salts from the original container to a soda pop bottle. While standing, it had absorbed moisture from the air and had become a clear, sirupy liquid. The child found the innocent looking pop bottle and took a swallow. The corrosive solution burned out the child’s esophagus and stomach, and he died despite an emer¬ gency operation. The salts as shipped did not bear any warning labeling. The father of the child said that if the product had had such a warning, he would have been more careful with it. 348 Department of Health , Education , and Welfare, 1962 Enforcement of Other Acts A total of 119,551,434 pounds of tea was examined under tlie Tea Importation Act, an increase of about 12,000,000 pounds above last year’s imports. Rejections amounted to 164,748 pounds for failure to measure up to the standards set by the U.S. Board of Tea Experts. Eight rejections were appealed to the U.S. Board of Tea Appeals, but the decision of the FDA examiner was upheld in all cases. No actions were taken under the Filled Milk Act. Three permits were issued for importation of milk — two from Canada and one from New Zealand — under the Import Milk Act. Civil Defense The civil defense work of FDA, financed by funds appropriated for the Office of Defense Mobilization, centers around radiological, biolog¬ ical, and chemical warfare agents that may contaminate foods and drugs in the event of enemy attack. The main emphasis has been on training FDA employees; other food and drug officials at F ederal, State, and local levels ; and industry officials in the recognition and the solving of problems that may arise from enemy use of such agents. Six different courses for these offi¬ cials were presented in 37 classes attended by 1,530 people. These courses dealt with such matters as the effects of these warfare agents on foods and drugs, monitoring and testing techniques, and methods of decontamination or destruction of contaminated products. The industry course is directed toward problems which must be solved by a particular industry in case of attack. FDA also conducts research to help deal with the effects of bio¬ logical warfare agents on foods. Studies were made concerning two such potential agents in staple foods. Although incomplete, they have demonstrated that the relatively fragile P. tularensis survived up to 6 months in some food. As expected, B. anthracis survived well. Studies of decontamination of six staple food commodities and of the heat stability of S. aureus enterotoxin were started. New Court Interpretations The 1961 Annual Report discussed a case involving chocolate mints in a package with hollow ends and dividers, charged to be deceptive. At that time the Court of Appeals had remanded the case to the dis¬ trict court with the instruction that deceptive packaging could be justified only by findings that the effectiveness of the package to pro¬ tect the product outweighs the deceptive quality. The district court again ruled that the candy was not misbranded, and that the useful¬ ness of the package both from the standpoint of protecting the contents Food and Drug Administration 349 and of economy of manufacture, outweighs its deceptive quality. The Government again appealed to the Court of Appeals for the Third Circuit on the grounds that the decision was contrary to the weight of the evidence. The appellate court upheld the decision of the district court, in an opinion filed in April 1962. This is the fourth contested deceptive packaging case, and the courts have in every instance ruled against the Government. However, the case provides useful guidelines for future cases. In several seizure cases involving physicians’ samples of drugs, the labels of which bore legends such as “professional sample,” “Physi¬ cian sample,” and “physician sample not to be sold,” district courts have held that such samples in the original containers were not mis¬ branded, even though they were no longer to be used as physicians’ samples, but were to be sold to the public on prescription. These decisions are being appealed. A defendant charged with contempt of an injunction prohibiting claims for treatment for obesity and depression of appetite for a phenylpropanolamine hydrochloride drug preparation defended on the grounds there was no intent to violate the temporary restraining order and preliminary injunction. The court in finding the defendant guilty of contempt held that intent is not an element of the offense in a contempt of injunction under the act. A judge in the U.S. District Court for Pennsylvania, in a seizure contest involving high mold counts in tomato catsup, reaffirmed a number of earlier decisions that the act does not require a food sub¬ stance to be unfit or injurious to health in order to be filthy or decom¬ posed within the meaning of the statutory definition. The Government lost a seizure action involving “Nut Caramels” in which misbranding was charged because the net weight and ingre¬ dient statement were printed on the label in a silver color against a noncontrasting background and the only nut ingredient was peanuts which was declared in the allegedly inconspicuous ingredient state¬ ment. In its opinion the district court found that the evidence estab¬ lished the net weight and ingredient statements were easily readable by the average person at a distance of 29 inches, and that there was a lack of evidence that the ordinary consumer was misled by the name of the product. The court further remarked that any person allergic to nuts of any kind was put on notice by the word “nut” in the product name which was many times more visible than the word in the ingre¬ dient statement. The author of a book which was seized as labeling along with a stock of vitamins and minerals petitioned to intervene. The Government opposed intervention on the grounds that the action was in rem and the author did not own either the books or the product. The district 350 Department of Health , Education , and Welfare , 1962 court ruled in favor of the author holding that FDA’s press release gave the action an in personam nature. The Court of Appeals for the Seventh Circuit affirmed a lower court’s issue of an injunction prohibiting the interstate disposition of a costly diagnostic and therapeutic device which was of no value. In upholding the allegation of misbranding of the device, the appellate court held that it was dangerous even in the hands of a practitioner because of its worthlessness for any diagnostic or therapeutic use. The case was appealed to the U.S. Supreme Court which denied certiorari. A district court jury in Texas returned a verdict in favor of the Government in an action intended to restrain an exterminating com¬ pany from placing a highly toxic rodenticide (1080) near stored food products of interstate origin in a food warehouse in such a way as to make contamination possible. The Government alleged that such careless placement of the rodenticide was an act which resulted in the food becoming adulterated because it may be rendered injurious to health. Changes in the Law and Regulations Enactment of the Drug Amendments of 1962 (Public Law 87-781) came after the close of the fiscal year, on October 10, 1962, but various amendments to strengthen the drug law were under active considera¬ tion throughout the Second Session of the Eighty-Seventh Congress. These drug amendments, designed to assure a greater degree of safety, effectiveness, and reliability in prescription drugs, are a mile¬ stone in the protection of public health. Drug manufacturers will be required to conduct their establishments in conformity with good manufacturing practices, using quality controls that will rule out inadequate facilities and poorly trained operators, to assure that drugs have the identity and strength and meet the quality and purity characteristics they are represented or purport to possess. Firms wishing to market new drugs will be required to establish not only the safety of the drugs but also must produce substantial evidence of their effectiveness in accomplishing the purposes claimed in their labeling. Government approval must be affirmative rather than by failure to disapprove, and 180 days, in contrast to 60 days, are allowed for initial consideration of the application. Previously cleared new drugs may be ordered off the market imme¬ diately if new information indicates an imminent danger to health. And, any prior approval may be withdrawn, after a hearing accorded to the manufacturer, in any case where tests or experience shows the drug unsafe, or new evidence shows that the drug has not been shown to be safe, or will not be effective for its intended uses. Food and Drug Administration 351 New requirements confer statutory authority on the Secretary to regulate the testing of experimental drugs on humans. All antibiotics for use by man will be subjected to the batch-by-batch testing previously required for only five antibiotics and their derivatives. The new law grants FDA more effective factory inspection author¬ ity with respect to firms manufacturing prescription drugs and con¬ sulting laboratories, and requires biennial inspections of drug factories. It also requires every drug manufacturer to register with FDA once a year. Other amendments will lead to simpler nonproprietary names for drugs, to appear in type at least half as large as the brand name when it appears on the label and in labeling and advertising. Prescription drug advertisements must also contain a brief summary of information as to adverse side effects of the drug and warnings of when it should not be administered as well as the formula and a statement about conditions for which it is effective. The new law took effect on approval of the President on October 10, 1962, except for certain requirements to go into effect on May 1, 1963, and transitional provisions for drugs on the market at the time the amendments were enacted. REGULATIONS Drugs. — A revision of the labeling regulations effective June 3, 1962, requires packages of prescription drugs and devices to contain ade¬ quate information for their professional use, including all relevant information concerning any adverse effects. This “package insert” requirement, following the recent regulation requiring “full disclo¬ sure” information in prescription product promotional literature, is part of a program to require manufacturers to make readily available to physicians complete and accurate information on the dangers, as well as the usefulness, of prescription products. The regulation applies to all prescription drugs and devices excepting those for which the uses are commonly known. Lists of drugs entitled to this exemp¬ tion were published in the Federal Registers of December 29, 1961, and June 8, 1962. A statement of policy was issued requiring preparations of phen- indione, a drug used as an anticoagulant, to bear warning statements on the label and in other labeling to disclose that certain blood dis¬ orders, liver damage, and sensitivity reactions have been associated with its use. Drug manufacturers have revised the labeling of these drugs to include the recommended warnings. A proposal was published to convert anthelmintic drugs containing piperazine from prescription to over-the-counter sale. Comments on 352 Department of Health , Education , and Welfare , 1962 the proposal showed a difference of opinion among medical experts as to the ability of the layman safely to diagnose and treat pinworms and roundworms without medical supervision. In view of these comments, a final order was published on April 18, 1962, denying the petition. A proposed statement of policy was published on preparations for the treatment of pernicious anemia. Comment was invited on the pro¬ posal that would require oral preparations intended for use in perni¬ cious anemia, particularly intrinsic factor with vitamin B12, to be labeled with the caution that the article may not be a reliable substitute for treatment by the injection of vitamin B12 and that periodic exami¬ nations and laboratory studies of pernicious anemia patients are essen¬ tial. The proposal would also limit intrinsic factor preparations to prescription sale as drugs. A final order has not yet issued. A statement of policy was issued explaining the conditions under which a statement of usual dosage will not be required on prescription drug labels, i.e., when the label does not have sufficient space for an informative dosage statement but the information is contained in a package insert. The policy statement limiting preparations of potassium permanga¬ nate to prescription sale was amended to allow the sale without pre¬ scription of certain preparations solely for veterinary use. During the year, the antibiotic regulations were amended 334 times and 14 new monographs added. The thalidomide incident focused public attention on the need for strengthened controls over new drugs during investigational trials. On August 10, 1962, new regulations were proposed to keep FDA fully informed of the initiation and progress of clinical studies. Adequate studies on animals and other appropriate preclinical studies to assure safety to humans administered the drug in clinical trials would be required. The manufacturer would also be required to furnish FDA with the names and qualifications of the investigators and to make the reports of such investigators available to FDA on request. Until October 10, 1962, the first information about new-drug safety studies might have come to FDA with the new-drug application after the studies had been completed. In the case of thalidomide, more than 1,200 investigators had been furnished 2.5 million tablets of the drug for use while safety data were being evaluated by FDA. Affected persons were permitted 60 days for comment on the proposed regulations. Food Additives. — The past fiscal year saw an increased activity in regulations writing. This was true in all areas of responsibility — human food, animal feed, and packaging materials. Whereas regula¬ tions applying to only 60 human food additives were issued in the 1961 fiscal year, more than three times as many additives were made Food and Drug Administration 353 , subjects of regulations in 1962. New regulations involving human I foods totaled 33, and 48 amendments were made to the existing regula¬ tions. Twelve new animal feed regulations and 22 new amendments | were issued in 1962, involving 38 new feed additives. I It was in the area of indirect additives that new regulations pro¬ vided a significantly large number. Thirty-three new regulations and 119 amendments involved 1,606 additives. Previous to the 1962 fiscal year, 457 indirect additives were covered. The petitions must not only II present adequate proof of safety, but also must furnish acceptable analytical procedures for enforcement use. Legislation was enacted which provided for further extensions of the effective date of the amendment to June 30, 1964. In fiscal 1962, 1,253 indirect additives and 797 direct additives were made subjects of extension orders. Flavors accounted for the majority of the extended additives. One important aspect of current extension orders is the responsibility of the petitioners to furnish progress reports of their investigations. The subject matter of new regulations involved such diverse products as boiler water additives, modified hop extract, paraformal¬ dehyde to control microbial or fungal growth in maple tree tapholes, fatty acids, sodium lauryl sulfate as an emulsifier, animal glue, sur¬ face lubricants on metallic articles, and silicon dioxide in certain animal feeds and feed components. Color Additives. — The Color Additive Amendments of July 12, 1960, provide for listing of safe color additives. They also provide that for 2i/2 years after enactment established color additives may be listed provisionally, if consistent with the public health, before a permanent listing is issued. A number of color additives were pro¬ visionally listed in 1960. Additions to the provisional list were made in August 1961 and June 1962. D & C Orange Nos. 3 and 4 were added to the provisionally listed lipstick colors, and D & C Red No. 12 was added to the colors provisionally listed for drug use. A number of vegetable colors for foods were also added to the provisional list. Four petitions for permanent listing were received in 1962, of which three — D & C Green No. 6 to color polyethylene terephthalate sutures, iron oxides to color drugs, and annato extracts to color foods and drugs — were filed, but regulations have not yet issued. The Food and Drug Administration continued its study of the toxicity of the FD&C colors now being certified. Various studies by industry groups were planned or underway for a number of the colors formerly listed under the coal-tar color provisions of the law and for some inorganic pigments and vegetable colors. Pesticides. — One hundred fifty-nine pesticide tolerances or exemp¬ tions were established for raw agricultural commodities involving 27 pesticide chemicals ; 5 of these had no previous tolerances. 354 Department of Health , Education , and Welfare , 1962 Eighty-five inert ingredients used in pesticide formulations (from a list of several hundred) were exempted from the requirement of a tolerance when used in accordance with good agricultural practice. Forty-three temporary tolerances were established for raw agri¬ cultural commodities, involving 7 different pesticide chemicals, to permit marketing of crops experimentally treated with pesticides in accordance with permits granted by the U.S. Department of Agriculture. On June 30, 1962, there were 2,450 tolerances or exemptions and 8 declarations of general recognition of safety on a total of 127 pesti¬ cide chemicals in addition to exemptions for the 85 inert ingredients of pesticide formulations used in the production of food crops. Six petitions for pesticide tolerances were denied filing because of inadequacies. Food Standards. — A number of food standards actions were con- cemed with identity standards for various cheeses. A tentative order embodying findings of fact based on the record of the hearing on mozzarella, scamorza, and related cheeses was published. The standards for swiss cheese and the American-type cheeses — cheddar, colby, washed curd, and granular — were amended to provide for the making of these cheeses from milk treated with limited amounts of hydrogen peroxide and catalase. Amendments were made of the standards of swiss cheese and the Italian-type cheeses — provo- lone, caciocavallo siciliano, romano, and asiago — to permit them to be made from milk bleached with benzoyl peroxide and to prescribe a label statement showing the cheese to have been made from bleached milk. The standards for blue cheese and gorgonzola cheese, which since 1950 have permitted bleaching with benzoyl peroxide, were amended to require label declaration. A standard for muenster cheese for manufacturing was promul¬ gated, and the standards for 10 processed cheese products were amended to permit muenster cheese for manufacturing to be used in the processed products. The standard for cream cheese was amended to add guar gum to the optional vegetable gums permitted, and pro¬ posed amendments of the standards for cottage cheese and creamed cottage cheese were published. A standard of identity for peanut butter was published, but objec¬ tions were filed requiring the order to be stayed until a public hearing is held. The bread standards were amended to provide for the use of 1- cysteine and for hydroxylated lecithin to facilitate processing in the bakery. The standard applicable to enriched self -rising commeal was amended to increase the level permitted for calcium. New standards were established for enriched vegetable macaroni and noodle products. Food and Drug Administration 355 Also, a new standard was set for artificially sweetened canned pine¬ apple. The standard for evaporated milk was amended to permit the adding of small amounts of carrageenan or salts of carrageenan to improve its stability. The ice cream standard was amended to change from 1.5 to 2.5 the factor used in allowing for sugar in choco¬ late-flavored ice cream. A manufacturer who proposed to make a powdered fish product by grinding up whole fish, including heads, tails, fins, entrails, and in¬ testinal contents, was told informally by FDA that the law prohib¬ its such a product because of the incorporation of filth in the food. The manufacturer sent in a proposed standard for whole fish flour and it was published for comment. Following receipt of some 2,000 letters concurring in FDA’s view that consumers generally would regard the whole fish product as filthy, an order was issued for fish flour made from cleaned fish only. The proponents of whole fish flour demanded a public hearing and a date was set for it. The proponents later re¬ quested a postponement to get more evidence that whole fish flour is, in fact, safe for use. Hazardous Substances. — The Federal Hazardous Substances La¬ beling Act was enacted in July 1960 and all its provisions became fully effective on February 1, 1962. Because the affected industries could not meet all the requirements of the final regulations pertaining to the placement and conspicuous¬ ness of the warning statements by that date, the effective date for these requirements was extended to August 1, 1962, and further extended to February 1, 1963. Administration of this law provides for exemptions from the label¬ ing required by it. The Commissioner has received over 100 requests to exempt certain products from such requirements. Forty-six re¬ quests have been granted, and the exemptions were published in the Federal Register. Twenty- six of the requests have been denied be¬ cause they were not in the interest of the public safety. Scientific Investigations A vigorous, well-organized program of scientific investigation is indispensable to FDA’s enforcement activities. The domain of the regulated industries is scientifically complex, and it is expanding at an accelerated pace. In the course of this expansion, scientific problems involved in law enforcement have become increasingly complicated. The function of research in FDA is to provide the scientific informa¬ tion and techniques which are needed for the intelligent, effective administration of the law. Scientific investigations are performed in both the field and head¬ quarters laboratories. Responsibility for conceiving, designing, de- 356 Department of Health , Education , and Welfare , 1962 Chart 5.— TIME (IN MAN-YEARS) SPENT ON FDA RESEARCH FOR ENFORCEMENT AND CERTIFICATION, FISCAL YEARS 1957-63 *Based on estimated reports veloping, and executing research studies is assigned primarily to the seven scientific divisions comprising the Bureau of Biological and Physical Sciences. These divisions are furnished with professional staffs and scientific instruments necessary for conducting research in chemistry, radiochemistry, biochemistry, bacteriology, analytical microscopy, pharmacology, and related disciplines. One of the most significant achievements of modern technology has been the discovery of powerful new chemicals which are valuable as drugs, food additives, or pesticides. However, misuse of these bio¬ logically potent substances may contaminate food and drug products, and thus endanger the health of the public. In devising sensitive, specific analytical methods to determine such contaminants in low concentrations, FDA research protects the consumer in two ways. It affords a means to detect contaminated products by reliable tests, so that they may be removed from commerce. It also provides the manufacturer with a control procedure whereby he can check the in¬ tegrity of his product, rejecting those which he finds contaminated. During the past year, a drug product for the treatment of tuber¬ culosis was shown to be adulterated with traces of diethylstilbestrol. The quantities of this potent estrogen in the product were about one- millionth of an ounce per tablet. But this minute concentration was sufficient to cause symptoms of sexual precocity in the infant girls treated with the antitubercular drug. Food and Drug Administration 357 Inspection of the plant where the drug originated revealed that the manufacturer neglected to clean his machinery after processing high potency products. By means of specially designed ultraviolet irra¬ diation tests, FDA examined a series of products fabricated immedi¬ ately after diethylstilbestrol preparations. Many of them were con¬ taminated with significant proportions of diethylstilbestrol. A similar set of drugs following penicillin products in the manufacturing sched¬ ule were found to be adulterated with this antibiotic. Other products from the same manufacturing plant and the products of other labora¬ tories are being examined systematically by appropriate analytical methods, devised as needed, for evidence of such cross-contamination by dangerous drug substances. Antibiotics, in addition to their well-known clinical uses, are widely used in drugs for the treatment of mastitis, and in animal feeds. After the infusion of mastitis preparations into the udder, the milk of the diseased cows is discarded until the fluid is free of antibiotics. Even in low concentrations, antibiotics may be toxic to sensitive individ¬ uals. A study of several mastitis preparations administered to cows disclosed that three of the drugs caused persistence of penicillin in the milk beyond the prescribed withholding period. Certification of these products has been suspended. Similar investigations are in progress to determine whether the use of antibiotics in chicken feeds leads to residues of the drugs in eggs. New instrumental techniques have proved invaluable for the identi¬ fication, detection, and determination of pesticides and food additive residues. A special extraction cell devised in FDA laboratories meas¬ ures the potential concentrations of food additives substances extract- able from packaging materials. Spectrophotofluorometric and plios- phorimetric techniques are being developed for the determination of polynuclear hydrocarbons in petroleum products. The newly con¬ structed “electron capture” detector for the gas chromatograph is sensitive to a nanogram (one-thousandth of a millionth of a gram) of the common chlorinated pesticides. It can be adapted also for the measurement of organo-phosphate pesticides and other trace contam¬ inants in food. The utility of microcoulometric gas chromatography for the analysis of chlorinated pesticides has been established. Gas chromatography seems to have unlimited potentialities for the solution of analytical problems in the field of food adulteration. The adulteration of butter with small quantities of vegetable oil or the substitution of cheaper oils for peanut oil can be demonstrated clearly by means of gas chromatography. Adulteration of cottonseed oil with soybean oil also can be detected by this means. It may even be possible to differentiate between refined olive oil and the material ex¬ tracted by solvents from olive pits and pomace. 358 Department of Health, Education, and Welfare, 1962 Other researches employing gas chromatography have been initiated for the study of food constituents. Volatile amines and fatty acids which are characteristic components of decomposed foods can be sep¬ arated and identified in the gas chromatograph. The chick edema factors may be isolated and measured by a combination of chromato¬ graphic techniques which are being incorporated into a physiochem- ical method for detecting these toxic substances. Related studies in industry laboratories and FDA indicate that the chick edema factors which caused large losses of birds in the broiler industry are chlori¬ nated aromatic substances. Their origin and their pathway into chicken feeds are still under investigation. Column chromatographic procedures have been employed for the determination of synthetic organic colors in foods. Even bakery goods, which form an intractable combination with many dyes, can be analyzed by the newly devised procedure. The food is ground to a paste with water, and mixed with a porous bulking material. The entire mass is then packed into a suitable tube. Organic solvents con¬ taining selective resins are percolated through the mass to strip the color from the food particles, and the fluid emerging from the bottom of the tube contains the dyes. By the use of appropriate resins and solvents many of the stable synthetic dyes can be recovered almost quantitatively from foods. The tendency of organic dyes to decompose in a variety of physical and biological systems has been investigated, and the toxicity of some of the products has been measured by long-term feeding experiments. Studies on the metabolites of FD&C Red No. 1 and related azo dyes indicate that bases oxidized to aminobenzoic acid derivatives may be toxic dye constituents. Similar long-term pharmacological investigations have been con¬ ducted for various flavoring substances and for pesticides. There is a need for analytical procedures which yield reliable toxicity data more rapidly than the classical methods of pharmacology. Two promising approaches to such procedures are the injection of chemicals into chick embryos and the tissue culture technique. In the chick embryo procedure, chemicals are injected directly into the yolk sac of fertile eggs, and the treated eggs are incubated together with untreated eggs as controls. Toxicity is then measured by: (1) interference with embryonic development; (2) percentage of hatch; and (3) secondary effects after hatching, such as weight retardation or abnormal tissue development. In the tissue culture technique, toxicity is indicated by the deleterious influence of the chemical when introduced into the environment of cell cultures derived from liver, kidney, or other tissues. Certain arsenicals and alcohols have proved as toxic when tested by these rapid methods as in the long-term studies. Food and Drug Administration 359 A luminescent micro-organism has been employed as a biological indicator to detect minute quantities of radioactivity. Standardized colonies of the luminescent organism are cultured, and their produc¬ tion of light energy is measured. Ionizing radiation emitted by radio¬ active isotopes damages the organism, resulting in diminished light output. Accurate systems have been devised to measure the light emitted. Correlation of quenching effects with known concentrations of radioactive isotopes would indicate that this microbiological method is reliable. Research on the toxin responsible for staphylococcus food poisoning has progressed. Media for the production of the enterotoxin as well as analytical methods have been improved to such an extent that pure toxic staphylococcus cultures can be detected without preliminary concentration. Enterotoxin A (the new designation of the food poisoning type) is being purified in order that extremely sensitive serological techniques may be applied to the detection of trace amounts of enterotoxin in foods. These findings will be employed in studying the staphylococcal types isolated from over 3,000 samples of raw milk collected throughout the country. A new investigation on toxic molds has been undertaken, following reports this year from England that peanuts infested with Aspergillus flavus had proved fatal to turkeys and ducklings. Toxic strains of this mold have been obtained, and have been cultured to produce mate¬ rial for chemical and biological studies. Peanut products and grains will be examined systematically afterwards for the occurrence of toxic Aspergillus flavus contamination. Research continues on the adverse nutritional effects of overheated fats. Among the side products obtained when fats are continually heated is a group of unnatural fatty acids consisting of branched and ring compounds, dimers, and polymers in contrast to the normal monomer linear chain compounds. On feeding these substances to test animals, it has been clearly demonstrated that fatty materials con¬ taining branched and ring compounds or dimers are low in nutritive values and lead to retarded growth. In high concentrations these abnormal fatty acids are markedly toxic to rats. A new investigation on nutritionally important trace elements is studying the transfer of minerals across cell membranes and the role of enzymes in this process. Since the concentrations of these elements in the body tissues are extremely low, sensitive methods of analysis are required. Neutron activation techniques have been considered for this purpose. In this technique the element sought is rendered radioactive by neutron bombardment, and the resulting isotope is measured by means of radioactivity counters. 360 Department of Health , Education , and Welfare , 1962 The availability to the body of vitamins or other nutritional in¬ gredients administered as drugs is a recurrent problem. It has been stated that some tablets which contain the proper quantities of the labeled active ingredients may not release the substances to the or¬ ganism because the tablet does not disintegrate, or for other reasons. Studies have shown that several vitamin tablets which did not appear to disintegrate, nevertheless released the vitamin to test animals. Similar observations have been reported for other drug preparations. It is apparent that the accepted tests for tablet disintegration will re¬ quire modification. Application of new techniques to the analysis of pharmaceutical preparations has revealed that some compounds previously thought to be pure may be materially contaminated with closely related sub¬ stances. The presence of foreign steroids in adrenocorticoids and of ergotaminine in ergotamine are two examples of significant impurities detected by paper chromatography. The initial phase of an inves¬ tigation to study the purity of pharmaceuticals concentrated on com¬ pounds whose synthesis favors the formation of isomers. A project to record the infrared, ultraviolet, and visible spectra of Reference Standard drugs has been completed. These spectra will be published soon as an aid in the regulatory identification of drugs. Spectra of other drug substances of significance to enforcement work also will be measured. In addition to these and many other scientific investigations in the Bureau of Biological and Physical Sciences, research was conducted to devise analytical methods utilizing new instrumental techniques and improved biological procedures. Hospitals reporting to the Bureau of Medicine on adverse drug re¬ actions increased from 35 to 44 during the year. They submitted 2,745 reports of which more than 700 were considered significant enough to be reported in considerable detail. The value of these case reports is increasingly evident. Some have led to labeling changes to prevent recurrences of adverse reactions. Enforcement Statistics The year’s activities included 43,913 inspections of factories, ware¬ houses, and pesticide practices ; 4,150 of public eating places to check on the notification of the serving of oleomargarine; 117 inspections involving illegal sales of prescription drugs; and 99 of spieler and lecture activities. Of 62,712 domestic samples collected, 43,047 were foods, 16,954 drugs and devices, 480 cosmetics, 1,356 color additives, 835 hazardous household substances, and 40 miscellaneous. Food and Drug Administration 361 In the 274 criminal actions terminated (or terminated for some defendants) in the Federal courts during 1962, fines assessed totaled $280,502. One case was dismissed because the firm had gone out of business. Jail sentences ranging from 1 day to 6 years were imposed in 47 cases involving 55 defendants. Twenty-four individuals were required to serve imposed sentences, averaging 9 months; sentences were suspended for 31 on condition that violative practices be dis¬ continued. The highest combined fine of the year was $20,000 imposed on a distributor of “health foods” and two officers of the firm. Records of actions terminated in the courts were published in 903 notices of judgment. Table 2. — Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1962 Item Total Criminal prosecu¬ tions instituted Seizures accomplished Injunc¬ tions requested Violative samples Actions Violative samples 1 Actions Violative samples Actions Total _ Foods... . . . . . . ... Drugs and devices _ Cosmetics (colors) _ _ 4, 063 1, 612 1,661 314 2, 402 1,273 25 1,794 2, 211 38 20 997 583 19 13 492 1,169 117 197 1, 302 1,042 38 20 867 374 19 13 13 12 Hazardous household sub¬ stances. _ _ _ 1 The number of samples on which the actions are based always exceeds the number of actions; in seizures a variety of articles may be contained in a single shipment, while in criminal actions each sample usually represents a single shipment which forms one count of action. Table 3. — Import samples collected , examinations made , and lots detained during the fiscal year 1962 Item Samples collected Examinations made Lots detained Total _ _ _ 14, 541 21,810 6, 588 Foods . . .. _ _ _ _ _ _ . _ _ _ 11,266 3,050 225 20, 462 1,054 294 3,286 3,194 108 Drugs and devices Cosmetics, colors, miscellaneous _ Conclusion This report records what the Food and Drug Administration has been doing to protect consumers in an ever-changing environment over which they have little control. The highlights, listed at the beginning of the report, show progress in both health and economic protection. But the coverage is still inadequate to appraise and act on all of the problems existing in food, drug, device, and cosmetic areas. The consumer is receiving increased recognition and will receive 665171—63 - 24 362 Department of Health , Education , and Welfare , 1962 added protection in the year to come through new tools to meet the ever-growing responsibilities of the F ood and Drug Administration — more staff, better facilities, and new laws aimed at making drugs safer and more effective. Studies are continuously being made to assure the most efficient use of these tools. Recommendations of the Second Citizens Advisory Committee to this end have been under consideration since they were received late in October 1962. Office of Vocational Rehabilitation More than 100,000 disabled persons were rehabilitated successfully to productive employment in 1962 through the public program of vocational rehabilitation. The total — 102,377 — was the largest ever reached in 1 year in the 42-year-old State and Federal partnership in rehabilitation and was 1 1 percent greater than the previous year and about 85 percent more than in 1954, the year in which new Federal legislation gave the public program renewed incentives and a sound basis for expansion. The public program of rehabilitation is built around the vocational rehabilitation agencies in each of the States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. In 36 of these jurisdic¬ tions there are, in addition to general rehabilitation agencies, separate agencies that provide rehabilitation services for blind persons. All the State agencies are joined in a partnership with the Federal Government through the Office of Vocational Rehabilitation, which provides national leadership for the program and administers several systems of grants for various rehabilitation purposes. The 90 State agencies — which provide the actual rehabilitation serv¬ ices — reported to the Office of Vocational Rehabilitation at the end of the 1962 fiscal period 1 a total of 102,377 disabled persons rehabili¬ tated during the year. It was a significant figure in several respects. Halfway to a Long-Time Goal The year’s work had great importance to those who, in the nature of their interests and responsibilities in the public program, have especial concern for its progress on a nationwide basis. For, in passing the 100,000 mark, the public rehabilitation effort has 1 Unless otherwise indicated, all subsequent references to 1962 will be to the fiscal year, that is, to the period between July 1, 1961, and June 30, 1962. 363 364 Department of Health , Education , and Welfare , 1962 climbed halfway to a national goal that was set with the enactment of the 1954 legislation. The year’s work also brought recognition from the President, who, for the first time, announced the results and assured the country that “we are making a determined national effort” to reach the 200,000 mark in numbers of people rehabilitated annually. As well as can be estimated, there are more than 2.5 million dis¬ abled persons in the United States who could benefit from services available through their State vocational rehabilitation agencies. Moreover, an estimated 207,000 or more persons come to need re¬ habilitation services each year from disabilities arising out of disease, injuries, or congenital conditions. The Steady Climb Since 1954 The climb of the public program toward its 1962 achievement is shown in chart 1. The first ascent began with the entrance of the United States into World War II. In 1943, manpower shortages dic- CHART 1.— REHABILITATIONS BY YEARS 1925 1930 1935 1940 1945 1950 1955 1960 Office of Vocational Rehabilitation 365 tated a necessity for bringing more disabled persons into the war effort, and the Barden-LaFollette Act provided a liberalization of services for the disabled, gave the F ederal Government greater finan¬ cial participation in State programs, made specific reference to voca¬ tional rehabilitation of the blind, and, for the first time, made persons with mental handicaps eligible for rehabilitation services for which the Federal Government paid part of the cost. After a swift climb during the war years the inevitable readjust¬ ments of the postwar period brought a short decline in the totals of rehabilitated people, and a reassessment of the program was under¬ taken to smooth the transition from the emergency manpower require¬ ments to the longer-range objectives of peacetime. But a new philos¬ ophy of rehabilitation was gaining ground, and there was widespread feeling that the State-Federal partnership needed a new legal base to support some new concepts. In 1954, enactment of Public Law 565 gave the program a fresh start on a basis suited more to the needs that were outlined to the Congress in lengthy hearings. A new system of Federal grants to States was inaugurated in support of their basic rehabilitation activi¬ ties. Authorization was given for Federal support of research and demonstration projects in rehabilitation, as well as for support of projects in educational institutions throughout the country that could offer instruction in several disciplines required for a new concept of the public program. The framework that was built under the new law had several direct consequences. Substantial increases were successively recorded in the number of persons rehabilitated into successful employment; there was elevation in the quality of services; and the public program was greatly broadened in scope and direction. All these effects were highly apparent in 1962. For several years there has been a fairly consistent pattern in many of the statistics of the program. The principal causes of disability among those who were rehabili¬ tated in 1962, for instance, were orthopedic troubles — amputations, limb impairments, muscular and skeletal difficulties — accounting for 39 percent of the total. This figure has hovered around 40 percent for several years, and before the past few years generally was well above 50 percent. As can be seen on chart 2, the disabilities of blindness and impaired vision were 11 percent of the 1962 rehabilitants ; deafness, impaired hearing, and speech difficulties ran 7 percent ; mental troubles, 10 per¬ cent, and others as shown. There were also some small changes in the numbers who entered several broad categories of employment after their services were com- 366 Department of Health, Education , and Welfare, 1962 CHART 2.— PRINCIPAL CAUSES OF DISABILITY AMONG 1962 REHABILITANTS AMONG 1962 REHABILITANTS Muscular, /Skeletal Amputations 39% All others 22% Tuberculosis 6% \ Cardiac — Defects 5% Mental / ' / Retardation 4% / / Mental Illness 6% / Hearing and Speech 5% Blindness 5% -Visual Impairment 6% Deafness 2% pleted. As can be seen from chart 3, those who became skilled and semiskilled workers were 26 percent of the total; unskilled workers were 6 percent ; clerical and sales people, 16 percent. All these were down slightly from the previous year. Those who entered the service trades, or became family workers, or professional or managerial workers were up slightly. Agricultural workers remained at the same level. Too, the economic value of the program to the Nation increased in proportion to the high level of activity that set the new record in rehabilitated persons in 1962. For instance, some 74,000 of those rehabilitated in 1962 were unemployed when they began to receive rehabilitation services. Those who had been working at the time they were accepted for services were earning at a rate estimated to be about $44 million a year, and generally they were in unsuitable or part-time work. The entire group is estimated to earn, in its first full year of em¬ ployment after rehabilitation, at the rate of $211 million, or 5 times the group’s income rate when their services began. Another measurement of the economic value of the public program is in the number of persons who were removed from public assistance rolls through their rehabilitation into employment. Office of Vocational Rehabilitation 367 CHART 3. — MAJOR OCCUPATIONS OF REHABILITATED PERSONS IN 1962 Skilled and semiskilled 26% Agriculture 8% ■ Professional, managerial 9% Unskilled 6% About 18,000 of those who were rehabilitated in 1962 were receiving public support at some time during the course of their service. Their support was at an estimated rate of $18 million a year. The conver¬ sion of these persons from tax consumers to productive citizens cost about $18 million in a one-time outlay, thus saving many millions of dollars in F ederal and State assistance funds. A third way of looking at the national aspects of vocational rehabili¬ tation is in the payments that persons who were rehabilitated into em¬ ployment in 1962 are estimated to make to the Federal Government in income taxes during the remainder of their working lives. For every Federal dollar that was expended for their rehabilitation these persons will pay an estimated minimum of $7 — and perhaps more — in F ederal income taxes, in addition to taxes they pay to State and local jurisdictions. Seeking Out the Disabled One of the more beneficial factors in the 1954 legislation was the mandate it gave to those working in and for the program to dis- 368 Department of Health, Education, and Welfare, 1962 CHART 4.— SOURCES OF REFERRALS OF 1962 REHABILITANTS Self or other individual Hospitals, Rehabilitation Centers, Health Agencies Physicians Welfare Agencies Education Institutions State Employment Service! BOAS I |J2% Workmen's Compensation £ 2% Other 11% 6o;' seminate information about the availability of rehabilitation services and to encourage and persuade disabled persons to make use of them. As the program has become more widely known over the country in the past half dozen years, the sources of referrals of disabled persons to State rehabilitation agencies have become wider and more varied. Self-referrals and those coming from families and friends are the most numerous. Not far behind is the number coming from hospitals, rehabilitation centers, and health agencies, followed by the consider¬ able volume from physicians and welfare agencies. Other sources are shown in chart 4. The Growing Funds for State Programs The fiscal foundation under the State-Federal partnership in re¬ habilitation is in several parts. The largest section is that of Fed¬ eral grants to the States in support of their basic programs of services to disabled people. The mechanics of the fiscal arrangements include a statutory allot¬ ment formula which takes into account a State’s population, per capita income, and other factors. The allotments are matched by the States at rates related to their per capita income. The amount of its Office of Vocational Rehabilitation 369 CHART 5.— FUNDS FOR STATE VOCATIONAL REHABILITATION PROGRAMS allotment which a State receives is conditioned upon the amount of matching funds it makes available. Nationally, this proportion works out to about three Federal dollars for every two State dollars. The amounts made available for the F ederal allotments have grown substantially, as shown in chart 5. In the past 2 years the climb has been especially rapid, with a top of $90 million in 1962. The chart reveals, too, that the total of Federal funds actually granted to the States from their allotments has also risen but not nearly as sharply as it could have, had the States made more of their own funds available. The actual total of Federal grants made to States in 1962 for basic support of their program was $62.95 million, matched by a total of about $39.5 million in State money. Nevertheless, some States have excellent records in obtaining their full Federal allotments. In 1962, Arkansas, Delaware, Georgia, New York, Pennsylvania, Rhode Island, and West Virginia, as well as the District of Columbia and Guam, obtained 100 percent of their allot¬ ments. Kentucky, Massachusetts, and Nevada were in the 90-to-100 percent range. Although the rest obtained smaller amounts there have been impressive increases in almost all the States. 370 Department of Health, Education , and Welfare, 1962 A New Look at Rehabilitation An entirely new perspective on vocational rehabilitation and the uses of the public program began with the 1954 legislation. The basic premise was the same — to prepare people for work and get them into suitable jobs. But those in the State and Federal Governments who shared responsibility for broad direction of the program had a new vista of the future. The sciences were offering an immense array of tools for dealing with disease, injuries, congenital defects, and mental disorders. There was emerging a new image of the disabled person. His projec¬ tion as one to receive whatever benefits could accrue from standardized treatment of his condition and training for an unrealistic employment goal was fading. In its place was the image of a disabled person, through accurate diagnosis of his disability and appropriate treatment for better physi¬ cal and mental functioning, becoming able to undergo vocational training designed to complete his stature as a whole human being, with personality focused on a new kind of life, able to meet his re¬ sponsibilities as an independent, productive citizen. There was space in the new rehabilitation structure for develop¬ ment of areas of service to give expression to this concept and to the hard realization that rehabilitation is a fixed part of the Nation’s health program, requiring its own set of principles — expandable, highly adaptable to individual cases, and widely available. With this kind of thought, rehabilitation was being prepared to become a science in itself, requiring its own specialized techniques and processes and broader areas of services that were almost unthought-of before the 1954 legislation made them possible. Research — Window on Progress The new image evoked more widely and more intensively psycholo¬ gist and psychiatrist, social worker, vocational specialist, and practi¬ tioners of physical and occupational therapies to treat and condition and equip the disabled person to meet the obligations of full citizenship. Those who framed and enacted the 1954 legislation recognized the coming responsibilities of a revitalized program and provided a way to meet many of them in a system of grants for research and demon¬ stration so that rehabilitation would keep pace with the times. The Mechanics of Research Almost 600 research or demonstration projects have been completed, are in being, or are approved for operation since the 1954 legislation Office of Vocational Rehabilitation 371 provided the authority and means. Some 200 have been finished. The research and demonstration programs represent a Federal invest¬ ment of some $36 million through 1962. The sharp advance in Federal funds is shown in chart 6. Projects are submitted by colleges and universities, medical schools, hospitals, rehabilitation centers, a broad range of private groups, and State rehabilitation agencies. They are considered by a statutory National Advisory Council on Vocational Rehabilitation, which makes recommendations to the Director of the Office of Vocational Rehabilitation. Amounts of grants are in the discretion of the Council and Director, and the basic criteria of a project’s value lie in its promise of solution of common problems and improvement of services. As in all research of this nature, there are two parts to the total endeavor. One is the development of knowledge ; the other, its valida¬ tion and translation into action. The Program Begins To Move In 1958 the Office of Vocational Rehabilitation launched a series of selected demonstrations to put to use new knowledge gained from research into some of the more severe forms of disability. Priority of support was given for projects in which the knowledge and practices could be applied on a broad geographical basis. The selected categories were mental retardation, mental and per¬ sonality disorders, visual impairment, chronic illness, cerebral palsy, epilepsy, and the problems of older disabled workers. All these were regarded as areas in which new knowledge and practices could have widespread and rapid effect. Help for the Mentally Retarded One of the outstanding achievements of these selected demonstra¬ tions is in the area of mental retardation. Out of a grant made in 1955 to the Association for Help of Retarded Children in New York City for development of new techniques for evaluation, training, and placement, there has grown a network of 34 occupational training workshops for the mentally retarded in 27 States, each using the New York project as a prototype. In these places a retarded young person is evaluated for mental capacity, ability to adjust to direction and to work situations, and related factors. If there are positive answers, then training is pro¬ vided for a suitable employment. Scores of retarded young people have been evaluated and trained in these centers and have found work — many in competitive jobs, others in sheltered employment. 372 Department of Health , Education , and Welfare , 1962 CHART 6.— FEDERAL FUNDS EXPENDED FOR RESEARCH AND TRAINING IN VOCATIONAL REHABILITATION ions RESEARCH FUNDS TRAINING FUNDS Office of Vocational Rehabilitation 373 The training encompasses such elementary steps as learning to make change, use a phone, travel by bus to and from work, and eventually proceeds to the teaching of a skill — usually in a repetitive process. Results in these centers have shown that there can be substantial help for the retarded. The public attitude is changing rapidly, and new points of attack are being developed. One of them is designed to close the gaps that often occur in the lives of mentally retarded youths as they enter the period where edu¬ cational and vocational processes begin to merge. This endeavor involves interaction between the State rehabilitation agencies and the educational system, and it is growing rapidly. There are excellent examples in places such as Georgia, whose Di¬ vision of Vocational Rehabilitation has a demonstration project in operation to assist the State’s secondary schools in coordinating educa¬ tional, rehabilitation, and community resources, so that the skills of retarded children can be developed and a degree of maturity attained prior to entrance into the labor market. The Minneapolis school systems and the Jewish Vocational Service of Milwaukee have proj¬ ects to demonstrate the practicality of integrating academic courses with job experience for retarded youths in their last year of high school. Detroit’s school system is demonstrating an intensive coordi¬ nation of school facilities with vocational rehabilitation resources to meet problems of handicapped youths with emphasis on those who are mentally retarded. And on the college level, the Universities of Alabama and Colorado are developing similar systems for use in local school systems to train both educable youths and those whose capacity is below that level. There are research projects in various phases of rehabilitating the mentally retarded. They include such studies as investigation of job factors, personal characteristics, and educational experience of adult retardates in relation to their vocational and social adjustment; a study of employer, parental, and retarded adult attitudes toward employability; and similar projects to increase the volume of knowledge about retardation. By such means the public program is being prepared to take an even greater part in meeting the vocational problems among the estimated 5 million mildly retarded children, adolescents, and adults in our society. They present a host of problems — to themselves, their families, and their communities. The modern approach is to the whole life cycle, from pregnancy onward. In that segment relating to vocational preparation and employment for the retarded the public program will continue to have an important part. 374 Department of Health , Education , and Welfare , J962 More Aid for the Mentally III Since 1943, when the Barden-LaFollette Act provided authority for mental illness to be included as a disability within the range of the public program of vocational rehabilitation, the State rehabilitation agencies have made substantial moves toward helping mentally ill persons to regain normal lives. The effort was helped greatly by the funds and the new opportuni¬ ties to expand services for the mentally ill that came with the new legislation in 1954. There was authority under the new law for State rehabilitation agencies to extend and improve their services and facilities, with the Federal Government providing 75 percent of the cost of approved projects. Such projects have a maximum duration of 3 years on this basis, after which the States are expected to absorb them into their regular programs. Through 1962 there have been 58 such projects involving the men¬ tally ill. Some are for establishment of rehabilitation units in State mental hospitals or for adding trained staff so as to emphasize psychi¬ atric rehabilitation, and others are for creating “halfway houses,” to help discharged mental patients to adjust to community life. Since 1956, when the program for the mentally ill began to pick up speed, some 35,500 such persons have been rehabilitated into em¬ ployment. About 8,850 of this number were in the 1962 total of rehabilitations, an increase of about 28 percent over the previous year. About $3 million of the total of $36 million in Federal funds in¬ vested in the rehabilitation research program has been awarded for 54 projects concerned with rehabilitation of the mentally ill, probing into new ways of evaluating, training, and placing persons who have been emotionally disturbed in employment. Better Sight for Better Jobs Demonstration projects in rehabilitation work for those with impaired vision take a most practical course. In 19 places in 18 States there are optical aids clinics, where persons with low visual acuity may be fitted with devices that increase their visual perception to the point where they have better opportunities for jobs. Five of the clinics are in universities, eight are in hospitals, five in agencies for the blind, and one is in a State rehabilitation agency. Most of the clinics operate 1 day a week, and most of them have a social worker and a counselor experienced in the problems occasioned by visual loss. Office of Vocational Rehabilitation 375 The Rehabilitation Complexities of Older Persons The growing proportion of older persons in the population has a great many implications for the public program of vocational rehabili¬ tation, for the actual number, as well as the proportion, will grow to staggering size, as new drugs, better medical and surgical practices, increased leisure, and other factors contribute to the longevity of our citizens. According to the 1960 census, almost 53 million of our citizens are 45 or more years old, including 16.5 million who have reached 65 years or more. There is an estimate of chronic illness showing that 5 million of those persons above 45 years have been disabled for at least 3 months by such illnesses as heart and other cardiovascular disorders, arthritis, rheumatism, genito-urinary troubles, or by impair¬ ments of limbs, sight, or hearing. A further projection is that 1.5 million of those over 45 years — including 115,000 who are 65 or more — could probably be rehabilitated into employment. The remaining 3.5 million might not be rehabili¬ tated into employment, but, with appropriate services, could be returned to varying degrees of self-care and nondependence on family or on institutional care. Chart 7 shows the actual results over the past 17 years. CHART 7.— PERSONS OF 45 YEARS OR MORE REHABILITATED, 1945-62 1945 1950 1955 1960 1962 376 Department of Health , Education , and Welfare, 1962 This cluster of problems is receiving a concentration of attention in the public program. A rapidly growing number of research and demonstration projects is concerned with the complexities of this phase of rehabilitation. A glowing accomplishment arose out of an early project in New York City, in which the personnel undertook to show that disabled persons of 60 years or more who have been generally regarded as past employment age could be retrained successfully and placed in jobs. At the close of the 4-year period of OVK support, 498 of 835 partici¬ pants in the project had been placed ; about 200 of them in competitive employment, including one more than 80 years old. The results of the project led 10 additional groups to establish simi¬ lar ones in Missouri, Minnesota, Wisconsin, Florida, Texas, Pennsyl¬ vania, and the Virgin Islands, all of them helping older disabled men to a new independence. One of the endeavors in this phase of research is to discover ways to assist older people who are confined to nursing homes and similar institutions to become more nearly self-sufficient. The University of Michigan, the Illinois Public Aid Commission, Highland View Hospital in Cleveland, and the Utah rehabilitation agency are developing training techniques and methods that will aid chronically ill persons in nursing homes to reach a state of nondepend¬ ence on facilities or families ; and Our Lady of F atima Hospital in North Providence, E.I., has shown that it is possible to rehabilitate older disabled workers into gainful employment through a compre¬ hensive program of diagnosis and therapeutic services that it has developed. The Disabled Worker \ A phase of rehabilitation for the disabled worker that began with ; disability insurance provisions of the social security laws has greatly broadened the program’s scope of activities on behalf of the aging. The social security amendments make provisions for the payment of insurance benefits to those who become disabled to the extent that they can no longer engage in substantial gainful activity. Under this legislation, most State rehabilitation agencies have con¬ tracted to make initial determinations among applicants for the bene¬ fits allowable from the Bureau of Old-Age and Survivors Insurance, to find if they are disabled within the meaning of the law and to assess their capacities for rehabilitation into employment. There were two immediate effects. A much heavier load was placed on the evaluating machinery of the State agencies; but there was also a considerable increase in the number of identifiable persons whose disabilities made them feasible for rehabilitation services. Office of Vocational Rehabilitation 377 There were, for instance, almost 520,000 applicants for OASDI benefits during 1962. The States’ screening operations among this group gave a total of more than 53,000 who were judged to have some potential for rehabilitation. Not nearly all of them were finally accepted for services, but, from the total of those cases who entered the rehabilitation process during 1962 and those from previous pe¬ riods, some 7,270 persons were rehabilitated into employment during the year, and about 15,000 remained on State rehabilitation rolls for more services. More than half of these persons were 50 years old or more. About 42 percent had limb loss or injuries or other orthopedic impairments, and the others ranged through disabilities of many kinds. In an effort to give this effort more positive results there are now three demonstration projects — at Tulane University’s School of Medi¬ cine, The Ohio Rehabilitation Center at Columbus, and the Sister Kenny Institute in Minneapolis — to carry on a coordinated study of OASDI applicants. From studies of groups of applicants selected at random, the proj¬ ect supervisors are endeavoring to find new and more suitable ways to determine the extent and degree of disability, ability to perform work under limitations of individual handicaps, the indicated treat¬ ment, and the prospects for improvement and for eventual employ¬ ment through rehabilitation practices. A preliminary report on one of the projects shows that more than 58 percent of those who were evaluated had possibilities for rehabilita¬ tion, and another had a 65-percent ratio, considerable increases from the prior level. With refinement of the newer processes even greater percentages may be expected. Most of those involved in the studies are severely disabled people, and the costs of effective rehabilitation services for them will be high. The Severely Disabled Worker It frequently happens that severe disabilities are found among the disabled persons receiving monthly disability cash benefits under OASDI provisions. A new avenue of rehabilitation ivas opened for such persons in sev¬ eral States in 1961. A type of grant was established by the Office of Vocational Rehabilitation to aid States in meeting unusually high costs of medical or surgical services, or long-term hospital care for gravely disabled persons, if the costs are above the means of the agency. If there is inability to provide the required services in their own areas, States are enabled to purchase the required services where they are available. 665171—63 - 25 378 Department of Health , Education , and Welfare , 1962 Eleven States — Massachusetts, Pennsylvania, West Virginia, Mich¬ igan, Texas, Iowa, Arkansas, Nebraska, Utah, California, and Illi¬ nois — have so far availed themselves of this new provision and are thus rounding out their abilities to help all eligible disabled workers regain their economic equilibrium. Living Without Sight Two basic considerations — both of them intensely practical — shape the activities of the public program of vocational rehabilitation in helping blind persons. The first is preparation of blind persons to perform the ordinary activities of modern life with a minimum of assistance. The second is to prepare them for employment and other¬ wise make them self-sufficient. The problems of blind persons are manifest. Because blindness is one of the most conspicuous of disabilities and because blind persons trying to get about arouse emotionalism in the public mind, a great deal is done for them, publicly and privately. Universal sympathy for blind persons has placed activities in their behalf on an international scale. A great deal of experimentation, research, and demonstration is carried on in many countries. This was the thought behind a joint project of the Office of Voca¬ tional Rehabilitation and the American Foundation for the Blind to sponsor an International Congress on Technology and Blindness. It was attended by specialists from many countries. The delegates to the Congress exchanged information and views on all aspects of blindness. There was particular interest in the work of a group of scientists at Massachusetts Institute of Technology who are engaged in conceiving and developing electronic and mechanical devices to assist blind persons to go about without guides and devices to translate the printed word into some form of communication that ! blind persons can understand without the use of an intermediary. One of the early things they considered, for instance, was a typewriter that would simultaneously produce Braille and typescript, as a means of simplifying communication for those without sight. In some immediate aspects of developing increased mobility for blind persons, the Office of Vocational Rehabilitation has provided support for the training of instructors in the known principles of mobility. Short-term courses have been held in conjunction with the American Association of Instructors of the Blind. Long-term courses are in progress at the graduate schools of Boston University and West¬ ern Michigan University, and graduates of these courses began to go into the field in 1961. An interesting phase of providing additional employment for the blind is conducted at Georgetown University in Washington, D.C. Office of Vocational Rehabilitation 379 Several young blind persons have been given a fluency in the Russian language, which enable them to teach others and to serve as transla¬ tors and interpreters. In the 1962 term, additional blind students are pursuing the same course in the German language. These activities help to fill a great need in this field and enable a growing number of blind persons to live independently and with added usefulness to society. One of the widest single sources of employment for blind persons is the growing number of vending stands they operate in Government establishments, private office buildings, national parks, and similar places. The stands are operated under the general supervision of State rehabilitation agencies and the provisions of the Randolph-Sheppard Act of 1936, which is administered by the Office of Vocational Rehabil¬ itation. There were 2,257 such stands operated during 1962. They did a gross business of more than $4.5 million and returned an average profit of $4,140 to 2,425 operators. The Tragedy of the Deaf-Blind One of the most completely tragic forms of disability is the person who congenitally is both deaf and blind. Historically, these persons have been an enigma in rehabilitation. Except in such rare instances as represented by Helen Keller and the lesser-known Robert Smithdas, there has seemed to be little that could be done for them. An inspired group brought together in 1956 by the Industrial Home for the Blind of Brooklyn, however, attacked this most difficult problem with the aid of a grant from the Office of Vocational Rehabilitation. In a monumental publication issued in 1958, this group provided a comprehensive manual of instruction for dealing with disability. The manual was a realistic appraisal of the situation in which outstanding authorities participated. Greater utilization of the sense of touch was the lever the group advocated to open the minds of these persons, and methods were outlined to reach the understanding of persons who are without use of 2 of the primary senses. The process has been refined and improved, and confidence has been gained that these persons can be rehabilitated in some degree. In 1962 the Office of Vocational Rehabilitation made another grant which will enable the Industrial Home for the Blind to establish a regional center for instruction of persons who will in turn go forth to become educators in the new service. The center will prepare people to serve in 15 States in the eastern part of the country, and it is expected that they will eventually reach a good part of an estimated 800 deaf-blind persons over the area. 380 Department of Health , Education , and Welfare , J962 From there the work will spread to the rest of the country and prob¬ ably much of the world. The World Without Sound Deafness, one of the more inconspicuous disabilities, has not until recent years received the concentrated attention it should have. The problems of the deaf are now undergoing hard study, stimulated by a concentrated effort in many circles to provide greater public under¬ standing of the isolation in which these people live. Deafness and hearing impairments are among the areas of disability in which the public program of vocational rehabilitation can cooperate with other parts of the nationwide health and education structure to counteract, during the younger years of such disabled persons, some of the effects of their hearing handicaps. In this kind of operation the child with hearing difficulties can be treated and conditioned during his more formative years, so that by the time of preparation for a vocation he will be in much better posi¬ tion for the public program of vocational rehabilitation to help him. A considerable volume of research is being performed in the gen¬ eral areas of education of those with hearing problems. Two proj¬ ects in particular tie into the transitional period for the deaf. Both are under direction of the Clarke School for the Deaf in Massachu¬ setts. One, now reaching the completion stage, is investigating the effects of deafness on the learning process and the relation of learning deficiencies to the vocational and social adjustment of the deaf. The second, just starting, is studying the effects of school experience on the intellectual capacity and personal adjustment of deaf adolescents in preparation for adult vocational life. Another source of great help was the recent initiation of a grant system by the Office of Education for the training of teachers of the deaf by several qualified institutions. The program started in the fall of 1962, and, at the end of the course, some 400 teachers are expected to enter the field. This is a conspicuous example of interagency cooperation to meet disability problems. A significant action on behalf of the hard-of-hearing population is taking place currently through a joint effort of the Office of Vocational Rehabilitation and the American Hearing Society. In a demonstra¬ tion project in the Cleveland area, hearing service centers are being established on the outskirts of the city, which have liaison with central services in Cleveland. If hearing difficulties of a person in the satellite centers cannot be handled there, then the person can be referred to the metropolitan service. Through a spread of this approach, the established hearing Office of Vocational Rehabilitation 381 facilities of the Nation’s cities can be expected to reach a consider¬ ably larger proportion of rural residents. One of the more favorable aspects in working with the deaf is their high degree of mobility. A restriction on this, however, is the dis¬ position of some traffic agencies and officials to restrict deaf persons in the operation of motor vehicles. Statistics show conclusively that deafness is not a serious obstacle to safe driving. The deaf driver compensates by greater visual alertness, and there is no added danger to the public from this source. Early in 1962 a National Symposium on the Deaf Driver was held in Denver, with the aid of a grant from the Office of Vocational Re¬ habilitation. Nationally known experts in traffic safety and law enforcement were present, and there was considerable agreement on ways to give greater protection for the rights of deaf drivers. Training for a Complex Program There "was general recognition when the new vocational rehabili¬ tation legislation was enacted in 1954 that the anticipated growth of the public program would necessitate training of new personnel in the several disciplines that were becoming a part of the nationwide re¬ habilitation effort. Many of the complexities of the coming years were beginning to reveal themselves. The concept of help for disabled persons in reach¬ ing full potentialities for physical, mental, social, educational, and economic welfare through a selective series of services was gaining ground. It presented the strongest indications of need for an exten¬ sive training program. The 1954 legislation provided a modest start for an immediate training program. In 1955 there was $900,000 available to provide support for 77 teaching programs, 201 traineeships for students, and 16 short-term courses in several subjects. Each year has seen an increase. In 1962, with an appropriation of $9.8 million, grants were made for 420 teaching programs and more than 2,100 traineeships and research fellowships. The climb of Fed¬ eral grants for training is shown in chart 6. In allocating available training funds among the professional fields, the Office of Vocational Rehabilitation attempts to achieve a suitable balance related to the more acute personnel shortages, to geographical distribution, and schools’ abilities to offer the kind of training needed to improve the work of State agency and other rehabilitation personnel. In addition to these considerations, the training program offers en¬ couragement to schools that have or will develop curricula to train specialists in rehabilitation of the blind, the deaf, the mentally re- 382 Department of Health , Education , and Welfare, 1962 tarded, and the emotionally disturbed. There is also support for training that is interdisciplinary in nature, and pilot projects in col¬ laborative practices are encouraged. Rehabilitation Medicine — A New Specialty As will be seen from chart 8, a large proportion of training funds is expended in grants for the teaching of medicine. CHART 8.— 1962 TRAINING GRANTS IN AREAS OF SHORTAGES OF PERSONNEL IN VOCATIONAL REHABILITATION Medicine Counseling Speech-Hearing Social Work Prosthetics Physical Therapy Occupational Therapy Psychology Nursing Deafness This is purely a reflection of an acute shortage of physicians quali¬ fied in the specialty of physical medicine and rehabilitation, one of the newer fields in medicine. The emphasis placed on this discipline is an expression of hope for two results : that there will be an increas¬ ing amount of rehabilitation content in the training of medical stu¬ dents and that more practicing physicians will become knowledgeable about rehabilitation concepts and practices. These hopes have reached new heights in 1962. Teaching grants to schools of medicine went to 53 of the Nation’s 89 approved schools of medicine and osteopathy — almost a third more than in 1961 and a marked increase over 1956, the first year of such grants, when 6 schools received awards. Office of Vocational Rehabilitation 383 Similar advances are recorded in residency training programs for physicians. In 1955, four physicians received stipends for their res¬ idency study in physical medicine and rehabilitation. By 1962, this number had grown to 129, with 24 others pursuing training on a part- time basis. The Rehabilitation Counselor The rehabilitation counselor has emerged as the key worker in the public program. It is the counselor who first hears the story of the disabled person and who makes many evaluations and decisions of consequence. The counselor is liaison between the realities of the pub¬ lic program and the individual needs of the disabled person and is a person of growing stature in private and public operations in rehabili¬ tation. The counselor guides the client through the growing complex¬ ities and the many technical and social considerations that are involved in the rehabilitation process, balancing its operations with the personal problems of the disabled person and, in many cases, his family. Consequently, the counselor must have a knowledge of social work, of psychology, of public health and welfare procedures, of medical, surgical, and hospital practices in relation to physical and mental res¬ toration, and of employment practices, especially in his own area. This last factor carries a special responsibility, for it is upon the suc¬ cess of the counselor in matching the abilities of the disabled person with work opportunities that the ultimate success of the public pro¬ gram depends. There is another growing responsibility in the training program for counselors, brought about by a necessity for specialization. The en¬ larged category of disabilities with which the public program is con¬ cerned — mental illness and retardation are conspicuous among them — is stimulating the provision of training for counselors in the special implications of certain disabilities. State agencies are placing special counselors in mental hospitals, in rehabilitation centers, sheltered workshops, and a variety of special programs, where they work with the medical profession, social work¬ ers, specialists in mental troubles, and vocational experts to evaluate and prepare disabled persons for the prospect of employment. These are some of the considerations that impel the Office of Voca¬ tional Rehabilitation to encourage educational institutions to establish or broaden curricula for counselor training. Its efforts have given rise to two results. One is that the total of training grant awards for counseling is second only to those for medicine. The second is that the number of grants in support of counselor training has risen from 25 in 1955 to 34 in 1962, but with the number of traineeships making the startling gain from 53 to 639 in that period. 384 Department of Health , Education , and Welfare, 1962 — Even so, the growing number of persons attracted to counseling as a vocation is not meeting the requirements of the public program. The rate of graduation from these courses is about 250 a year, and the estimated need is two to three times that number. The potential employers of counselors — State agencies, clinics, hos¬ pitals, rehabilitation centers, and others — recognize the need for well- trained counselors, and the salary scale is coming into line with the extent of training and the capacities of graduates of counseling courses. Meeting Other Shortages There are serious shortages in other disciplines that are allied to the public program of vocational rehabilitation. One of them is the number of trained persons in the field of speech and hearing. An estimated 8 to 9 million of our people have speech and hearing difficulties. Currently there are about 10,000 clinicians to serve them, half the number needed to provide an adequate volume of services. Here again is a situation in which the Office of Vocational Rehabilita¬ tion’s training program has made great advances through grants in this area over the past 3 years. Since the training program began to emphasize courses in speech and hearing therapy in 1959, the number of grants for this purpose has i multiplied three times ; the total amount of awards has increased al¬ most three times; and the number of trainees has increased three times. Yet to come close to the need for personnel in this field the number of graduates for this discipline must grow six times over the number of those who finished their courses in 1962. There are grave shortages in physical therapy, occupational therapy, in psychologists, in prosthetists, in social workers. In occupational therapy the estimated need is for 16,000, the number in practice is about 6,000, and there are about 500 graduates each , year. The shortage of physical therapists is acute. The present number of 8,400 in practice should be one-third more. Enrollments in ap¬ proved courses are far below capacity. In consequence the Office of Vocational Rehabilitation has initiated a system of undergraduate trainee grants to attract students, and in 1962 all but 4 of 40 approved schools had such projects in operation. The Rehabilitation Team Since orthopedic impairments constitute the major disability among persons seeking rehabilitation services, the facilities for training pros¬ thetists (specialists in the design and fitting of artificial limbs and Office of Vocational Rehabilitation 385 other assistive devices) and orthotists (specialists in the making and fitting of braces) are of significant interest in the program. It was a constant preponderance of orthopedic cases on the rolls of State rehabilitation agencies that led to development of “team” therapy for physical restoration. For a decade practitioners of several disciplines that since have grown into integration with the rehabilitation program attended col¬ lege courses that provided instruction in orthopedic practices. In 1957, the Office of Vocational Rehabilitation began to make grants to several universities where such courses were given, so as to extend knowledge of orthopedic practices. There immediately arose the feeling that, if all these disciplines could be brought together in re¬ habilitation centers and hospitals, their combined effect would speed up the rehabilitation process immeasurably. It became evident to workers in the public program several years ago that the impact of disability of the individual had wide ramifica¬ tions. Loss of income, strains on family relationships, physical shock, mental depression — these and other matters had great bearing on the success of rehabilitation services. So there were added to the team the physical therapist to restore physical functions and teach the uses of prostheses ; the occupational therapist to test, evaluate, and re¬ store manipulative abilities; the psychologist and psychiatrist to ex¬ amine and improve the mental state; and the social worker to help with the inevitable personal problems that arose. The growth of this concept has brought greater demand for ortho¬ pedic specialists. They are needed in the growing number of re¬ habilitation centers that are being established or expanded, in hospitals that are getting into rehabilitation work, and in clinics and other in¬ stitutions where they can help the orthopedically disabled regain or improve their bodily functions. In 1962 almost 1,400 people associated with rehabilitation were en¬ rolled in 78 short-term courses that had OVR support, to become acquainted with orthopedic and orthotic principles. At the same time, several universities and other groups were delving deeper into re¬ search designed to enrich all the services that are available for orthopedically handicapped persons. The Social Worker in Rehabilitation In the modern concept of rehabilitation there is no room for neglect of the implications that disability has on the individual lives of those who are vocationally and socially handicapped. The social worker has been called into the rehabilitation scheme to provide skilled assistance in helping to relieve the anxieties that arise with disability — to relate the disabled person to his situation, to his 386 Department of Health , Education , and Welfare , 1962 family, and to the community, and to resolve any difficulties that are created or intensified. The social worker also has a place in the broader aspects of State and community rehabilitation programs, in activities that help to sell the rehabiltation program itself to the community, and to organize the resources of the area for meeting its rehabilitation problems. Social work in rehabilitation requires, of course, a special knowl¬ edge of the public and voluntary programs for helping the disabled. In recognition of this, the Office of Vocational Rehabilitation makes teaching grants to accredited schools of social work. In 1962, 34 of 56 accredited schools were awarded such grants, and 40 schools had traineeship grant awards for 169 students. This amout of training is far below the level that will produce an adequate number of social workers for the program, for at least 1,500 graduates are needed each year for vacancies in health and rehabilitation work. The Rehabilitation Facility In the rapid expansion of the public program of vocational reha¬ bilitation and the evolution of new concepts of disability, of a new image of the disabled, and the purposes and uses of the program, there developed naturally a new concept of rehabilitation facilities. A facility, in the usual language of the public program, is an in¬ clusive term embracing many kinds of places where rehabilitation services are available. New kinds of facilities come into being for many reasons, and, over the years other kinds have faded away. In the beginning, rehabilitation facilities were almost always medi¬ cal in nature. But, as physical restoration grew in accomplishment, there came a natural query about work for those who became employable. The answer is in facilities that are now available. There was orga¬ nization of centers which specialized in vocational services, and this led to development of vocational counseling, of work evaluation of the disabled, and other special vocational services. Yet there was need for another kind of facility, and there evolved the psycho-social center. It was concerned with the increasingly baffling problems of motivation, where mental and emotional problems of many persons lowered their probabilities for employment. It became obvious, too, that all disabled persons cannot be placed in private, competitive employment after physical or mental restora¬ tion. Many persons are revealed as having little possibilities for open jobs. Others need specific training, work experience, and personal adjustment. So many new sheltered workshops came into being, and they are of two principal types. One provides work experience and adjustment leading to private Office of Vocational Rehabilitation 387 employment. The second deals with disabled persons who, for any of a variety of reasons, need long-term jobs doing work compatible with their condition, in terms of physical capacity and daily hours. There are, too, workshops that provide services of both kinds. Some are created and maintained by private or community groups — for which Government financial aid is available — and others by State rehabili¬ tation agencies. Another kind of facflity that is growing in usefulness is the halfway house. This kind of facility is an adjunct to rehabilitation of the mentally ill. Halfway houses are built around a homelike atmosphere where selected patients who are discharged from mental hospitals may spend a transitional period between institutional care and life in the community. Still another type is the evaluation center, which specializes in high¬ ly intensive rehabilitation diagnoses and evaluations, to chart courses in individual cases for the reaching of specific goals through the variety of services available. Many hospitals are creating rehabilitation facilities as part of their services. Not all attempt to be comprehensive but are especially con¬ cerned with getting indicated rehabilitation measures started as early as possible. With the broadened scope of the public program there has risen a good measure of response from State rehabilitation agencies — and from private and community sources, too — in building a variety of large rehabilitation centers. These also vary in types and purposes. Some centers serve persons with one type of disability. Others work among larger categories of handicaps, and many offer a virtually complete series of services to persons with most types of disabilities. Some are operated by State rehabilitation agencies, using portions of their basic grants in combi¬ nation with their own funds. Others may be created with the help of funds that are available through the Medical Facilities Survey and Construction Act, enacted in 1954. This legislation was an amend¬ ment of the Hill-Burton hospital construction legislation of an earlier date and allowed Federal funds to be granted to aid the construction of rehabilitation facilities. Thirty-nine new facilities of various kinds, sizes, and types were established or expanded in 1962 with the aid of Hill-Burton grants. Their total cost was $26.8 million, of which the Federal contribution was approximately one-third. There are large rehabilitation centers operated by six States — Pennsylvania, Virginia, Iowa, West Virginia, Georgia, and Arkansas, as well as one in Puerto Rico. But there are other large centers — no¬ tably in Mobile, Ala. ; the Institute of Physical Medicine and Reha¬ bilitation in New York City; the Rehabilitation Center of Minneapo¬ lis ; the Goodwill Industries in Omaha, Cincinnati, and the District of 388 Department of Health , Education, and Welfare, 1962 Columbia; the National Orthopaedic and Rehabilitation Hospital in Arlington, Va. ; and the Carruth Center in Dallas, among others — where rehabilitation is practiced according to modern concepts and practices, with the preponderance of construction and operating funds arising in private sources, but with Federal aid in most cases. The role of the large rehabilitation center is essentially to provide an appropriate setting where specialized staffs can apply modern tech¬ niques and provide adequate services to more people, rapidly and conveniently. This role is reaching greater fulfillment with new kinds of activi¬ ties. New York University and The University of Minnesota received grants from the Office of Vocational Rehabilitation to create reha- ; bilitation research training centers within the clinical settings they ; afford. Similar regional centers may be established soon. The objective is to combine, in schools of medicine where physical medicine and rehabilitation can be taught, their resources for research and training and develop new methods of rehabilitation under the most favorable circumstances. Rehabilitation Around the World A general awakening to the needs and possibilities for rehabilitation of the disabled has been noted in many countries in the past few 1 years, particularly in new nations that have arisen as political entities, and some older countries that have recognized need for more attention ; to health and rehabilitation. In some of these countries rehabilitation research and activities had ; begun in 1960, and others stood ready to begin but lacked funds and guidance. In that year the Office of Vocational Rehabilitation was given authority to spend more than $900,000 in counterpart funds in ; several countries to establish research resources for investigation of 1 rehabilitation problems pertinent to their own needs, with the proba- ! bility of international interest as well. The counterpart funds are available for international research under provisions of Public Law 480 — the Agricultural Trade Development and Assistance Act. Surplus commodities sold by the United States to certain countries build up these foreign currency credits, which are expendable within their borders for beneficial purposes, with approval of the U.S. Congress. Counterpart funds for international research are now available in India, Israel, Pakistan, UAR-Egypt, Brazil, Burma, Poland, Yugo¬ slavia, Indonesia, and Syria. The Office of Vocational Rehabilitation has approved 26 research projects in these countries — 11 in Israel, 9 in India, 3 in Brazil, and 1 each in UAR-Egypt, Burma, and Pakistan. Others are being prepared. Office of Vocational Rehabilitation 389 The legislation also provides the way for an exchange of scientists . ! between the United States and various countries which are capable in disciplines related to rehabilitation. Arrangements have been made under which 18 surgeons from some of the outstanding medical schools of the United States will perform research in plastic surgery with victims of leprosy at the Christian Medical College in Vellore, India. Six have gone to India in the past 10 months, each for a 2-month period. Many of the techniques they have perfected for these people have been used successfully in the United States in treating similar disabling conditions arising from disease or accidents. In the other direction, two Indian experts in cerebral palsy are to perform research in two U.S. rehabilitation centers, and plans are in the making for exchanges of other experts with other countries. Programs of study, consultation, and observation were arranged by OVR for 110 individuals from 42 countries interested in rehabili¬ tation of the disabled who were brought to the United States by the Agency for International Development, the United Nations, World Health Organization, the Department of State, by voluntary agencies and foundations, or were sent by their own governments. Among these were officials from newly independent countries such as the Congo, Senegal, and Somalia and administrators and specialists from Malaya, Ceylon, and Turkey, where programs for the disabled are being established or expanded, who came to study program administra¬ tion and operation. The Hard Fight Against Dependency The public program of vocational rehabilitation has been a crusade in many respects, and a great deal of the spirit of the crusader, as well as the pioneer, remains in the program. The movement toward an ultimate goal of 200,000 rehabilitations of the disabled each year into employment and other satisfactions of life requires an even greater amount of imagination, of expediency, and determination to encompass all the complexities inherent in the kind of rehabilitation structure that is being built. There are, in reality, three facets of the vocational rehabilitation program. One is the humanitarian side, concerned with the personal problems of the individual. The second is the economic worth of vocational rehabilitation. And the third is the inroad that the pro¬ gram is making into the haunts of dependency. The humanitarian side of the program is obvious. There is great warmth in the knowledge that more than 600,000 disabled persons have been helped to overcome their handicaps in the past 8 years and are pursuing their own forms of happiness in their own ways. It is when we look at rehabilitation measures as a defense against 390 Department of Health , Educationy and Welfare , 1962 the further encroachment of dependency on human dignity, as well as on the public purse, that the course of rehabilitation becomes more clearly marked. Already the Congress has moved to realine the relationship between public welfare and vocational rehabilitation agencies so that the devel¬ oping facilities of the rehabilitation program can be used to reduce the costs of public assistance and its eroding effects on the human spirit. President Kennedy summed up the aims of new public welfare amendments when he signed the measure in July 1962. He said: “This measure embodies a new approach — stressing services in addition to support, rehabilitation instead of relief, and training instead of prolonged de¬ pendency. This important legislation will assist our States and local public welfare agencies to redirect the incentives and services they offer to needy families and children and to aged and disabled people. Our objective is to pre¬ vent and reduce dependency and to encourage self-care and self-support — to maintain family life where it is adequate and to restore it where it is deficient.” This new legislation underlines an unprecedented challenge to those concerned with vocational rehabilitation — both public and private agencies — to serve disabled persons who get public assistance and to serve them well. Several hundred thousand adults with physical or mental disabilities get public assistance. How many of them could be restored to employment cannot be foretold. But a large number of referrals to State rehabilitation programs come from public welfare sources, and a considerable part, of rehabilitation energy will go toward services for them. There is another facet of dependency that arises from disability. Most of those who are acquainted with rehabilitation matters know that disability often involves a whole family and its relationships. For a long time there have been cooperative agreements in every State between their welfare and rehabilitation agencies, so that, where disability strikes hard at families to bring dismaying financial circum¬ stances, there will not be unrelieved suffering. This relationship between welfare and rehabilitation activities has come under renewed scrutiny in recent years. Now, greater emphasis is being placed on cooperative measures designed to strengthen this relationship — to reduce family frustrations, to provide food, clothing, and shelter where these are lacking, to hold families together, and to counsel the members in living with a disability in the family while the rehabilitation process is going on with a disabled member. This is a necessary direction for the program to take. It requires service out of the normal range of the rehabilitation program. Intensive social services that can be performed best by State welfare agencies come into play here, so that a climate can be maintained for the disabled person that is conducive to rapid restoration of physical abilities and a return to work. Office of Vocational Rehabilitation 391 Table 1. — IS umber of referrals and cases , by agency , fiscal year 1962 Referrals Cases During fiscal year During fiscal year Agency 1 Remain¬ Closed from active load Re¬ Total Accepted for sendees Not ac¬ cepted for services 2 ing at end of year 2 Total active load (re¬ ceiving services) Reha¬ bili¬ tated After reha¬ bili¬ tation plan initi¬ ated 1 Before reha¬ bili¬ tation plan initi¬ ated * main¬ ing at end of year « United States, total . 439,401 148. 763 150, 903 139, 735 345, 635 102, 377 14, 524 20, 649 208,085 Alabama . . . . 7, 176 371 4, 022 139 937 2,217 162 9, 901 3,059 427 601 5,814 Alaska . . 70 342 77 19 IS 227 Arizona: General _ 1,854 588 548 718 1,350 405 99 91 755 Blind . . . 134 60 45 29 186 32 11 3 140 Arkansas . . 7, 840 29, 980 2, 979 3.240 1,621 5, 806 2,500 226 124 2,956 California . 7, 594 17. 202 5,184 17, 331 4,299 2, 670 1,243 1,249 2,927 10, 485 Colorado . 4, 534 1,884 1,261 1,389 517 223 2,316 Connecticut: General _ _ 3,018 1,561 621 836 4,211 907 211 307 2,786 Blind _ _ 179 86 62 31 212 58 21 0 133 Delaware: General _ _ 1,116 554 351 211 1,242 527 20 61 634 Blind _ _ 50 24 20 6 48 18 6 3 21 District of Columbia.. 4,011 1,288 1,873 850 2, 915 847 261 228 1,579 Florida: General . . 20, 175 6,009 8. 918 5,248 11,303 4, 000 611 613 6,079 Blind . . . . 4,338 491 2,500 1,347 1,183 301 61 42 779 Georgia _ _ 22, 776 7, 485 5, 874 9,417 13, 596 6, 105 424 484 6,583 Guam _ 96 33 32 31 77 13 5 13 46 Hawaii: General . . 2, 043 528 863 652 1,134 240 76 51 767 Blind _ _ 29 10 6 13 48 4 2 2 40 Idaho: General . . 2,003 470 931 602 1,029 385 49 7 588 Blind.... . 38 20 14 4 57 15 3 3 36 Illinois . 11,608 6, 193 3, 132 2, 283 15,310 3,926 978 1,370 9,036 Indiana: General _ _ 3, 666 1,945 904 817 4,809 1,434 138 186 3,051 Blind . 141 39 38 64 185 31 18 17 119 Iowa: General _ _ 6, 237 1,789 1,756 2, 692 4, 285 1,293 185 175 2.632 Blind . . 189 79 39 71 230 50 3 7 170 Kansas: General . 3,609 1, 523 883 1,203 3, 415 1,087 130 237 1,961 195 Blind . 389 122 110 157 304 85 11 13 Kentucky _ _ 7, 171 2, 103 2,726 2,342 4,370 1, 776 120 248 2, 226 Louisana: General . 5, 370 3, 124 1,208 1,038 8, 750 2, 037 318 591 5, 804 Blind . . . 825 187 210 428 713 122 8 13 570 Maine: General . 2,026 486 644 896 1,221 360 48 88 725 Blind . 246 131 81 34 303 72 22 52 157 Maryland.. . 6, 628 2,638 1,909 2, 081 6,361 1,691 342 696 3, 632 Massachusetts: General . . . 11,128 2,496 4, 479 4, 153 5,809 1,661 214 537 3,397 Blind.... . 309 141 28 140 428 88 26 20 294 Michigan: 3, 181 General . . 9, 970 4,074 2,270 3, 626 10, 258 487 169 6,421 Blind _ _ 342 165 76 101 454 81 35 31 307 Minnesota: General _ _ 6,944 2,048 2,607 2, 289 5, 964 1,377 314 164 4, 109 355 Blind . 1,108 192 403 513 507 99 32 21 Mississippi: 96 2, 139 General . 3, 562 1,695 774 1,093 3,772 1,392 145 Blind . . 1,118 347 538 233 953 283 82 42 546 Missouri: General _ _ 8,682 2, 852 3,078 2,752 5,924 1,930 235 234 3, 525 Blind . . 760 183 294 283 522 187 26 30 279 Montana: General _ 2, 401 921 777 703 2,012 456 40 92 1,424 Bl.nd . . 414 36 286 92 87 24 3 0 60 Nebraska: General _ _ 1, 663 795 267 601 2,554 152 634 64 112 1,744 Blind . . . 242 63 115 64 57 8 5 82 Nevada: General . 764 235 457 72 393 120 62 46 165 Blind . . 50 21 5 24 56 16 2 3 35 See footnotes at end of table. 392 Department of Health, Education , and Welfare, 1962 Table 1. — 1\ umber of referrals and cases, by agency, fiscal year 1962 — Con. Referrals Cases During fiscal year During fiscal year Agency 1 Total Accepted for services Not ac¬ cepted for services 2 Remain¬ ing at end of year 2 Total active load (re¬ ceiving services) Closed from active load Re¬ main¬ ing at end of year 6 Reha¬ bili¬ tated After reha¬ bili¬ tation plan initi¬ ated 4 Before reha¬ bili¬ tation plan initi¬ ated 5 New Hampshire: General - 626 353 181 92 789 198 88 19 484 Blind - 73 29 4 40 76 15 2 8 53 Newr Jersey: General . 7, 706 2, 963 2, 198 2, 545 5, 872 1, 888 252 253 3, 479 Blind _ 930 203 323 404 541 143 33 9 356 New Mexico: General - 1,345 328 569 448 668 286 43 17 322 Blind _ 214 45 66 103 127 35 5 7 80 New York: General . - - ... 31, 745 10, 571 10, 226 10, 948 23, 355 7, 008 733 1,493 14, 121 Blind _ 1,418 525 266 627 1, 154 332 47 73 702 North Carolina: General - 11,311 6, 303 3, 360 1, 648 15, 435 5,647 450 542 8,796 Blind _ 1,588 640 602 346 1,549 455 17 103 974 North Dakota. . . . 1,899 495 478 926 1,336 372 40 72 852 Ohio: General - .. . 9, 891 3, 916 3, 068 2, 907 8, 452 2, 391 281 620 5, 160 Blind _ 936 425 213 298 1,153 201 61 101 790 Oklahoma _ _ 7,292 3, 091 1,944 2, 257 8, 886 1,913 161 512 6, 300 Oregon: General _ _ 6, 032 1,200 2, 603 2, 229 2,698 670 186 214 1,628 Blind _ 245 58 116 71 156 40 6 8 102 Pennsylvania: General . . 37, 139 12, 760 10, 867 13, 512 27, 578 9, 060 1,215 800 16, 503 Blind _ 2, 020 309 668 1,043 998 251 26 41 680 Puerto Rico _ _ 9, 900 1,653 1,967 6, 280 5,702 1,226 116 282 4, 078 Rhode Island: General . . 3,891 1,329 653 1,909 2,891 871 158 20 1,842 Blind _ _ 129 100 9 20 289 59 16 20 194 South Carolina: General. . . 12, 193 4, 144 5, 079 2,970 8, 196 2, 380 169 309 5,338 Blind _ 402 162 168 72 375 113 10 19 233 South Dakota: General _ _ 1,272 357 229 686 1,033 276 45 6 706 Blind _ 513 49 216 248 121 27 5 2 87 Tennessee: General _ 9, 690 3, 253 2,966 3, 471 7, 540 2, 612 276 269 4, 383 Blind _ _ 1,211 334 400 477 868 302 23 37 506 Texas: General _ 14, 352 4, 457 6, 686 3, 209 11, 754 2, 931 748 1,164 6, 911 Blind _ 1,235 390 526 319 849 378 18 26 427 Utah _ 1,963 851 556 556 2,318 581 87 38 1, 612 Vermont: General _ _ 1,263 283 170 810 828 226 53 31 518 Blind _ 56 21 27 8 50 18 4 2 26 Virginia: General . . 16, 122 4, 384 7, 343 4, 395 9, 436 3, 517 219 646 5, 054 Blind _ 704 138 198 368 299 107 11 6 175 Virgin Islands _ 102 27 0 75 86 31 0 0 55 Washington: General... . . .. 5, 092 1,536 2, 221 1,335 4, 052 1,100 217 354 2, 381 Blind _ _ 302 117 109 76 283 68 17 13 185 West Virginia _ 17, 155 5, 451 4, 063 7, 641 13, 477 3,710 69 1,283 8,415 Wisconsin: General . . 9, 480 2,846 3,914 2, 720 7, 367 1,811 226 74 5, 256 Blind _ 153 86 31 36 236 53 14 8 161 Wyoming _ . ... 488 133 158 197 391 119 32 4 236 1 In States with 2 agencies, the State division of vocational rehabilitation is designated as “general,” and the agency under the State commission or other agency for the blind is designated as “blind.” 2 Services declined, services not needed, individual not eligible, individual needing services other than vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc. 3 Eligibility for rehabilitation not yet determined. 4 Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 5 Closed prior to initiation of rehabilitation plan because of indifference of individual, increase in degree of disability, loss of contact, etc. « In process of rehabilitation on June 30, 1962. Office of Vocational Rehabilitation 393 Table 2. — Vocational rehabilitation grants , 1962 , State divisions of vocational rehabilitation Total _ Alabama- . . Alaska - - Arizona _ Arkansas _ California _ Colorado - Connecticut . Delaware _ _ District of Columbia Florida _ Georgia _ Guam _ Hawaii _ Idaho . . Illinois _ _ Indiana - Iowa - - Kansas _ Kentucky - - Louisiana . . Maine _ Maryland - - Massachusetts - Michigan _ Minnesota _ Mississippi - Missouri _ Montana - Nebraska _ Nevada . . New Hampshire - New Jersey _ New Mexico _ New York _ North Carolina - North Dakota - Ohio - - - Oklahoma _ Oregon _ Pennsylvania . - Puerto Rico - Rhode Island _ South Carolina - SouthDakota _ Tennessee _ Texas - - Utah _ _ Vermont _ Virginia . . Virgin Islands _ Washington _ West Virginia _ Wisconsin _ Wyoming _ State or territory Support grants $56, 503, 310 2, 578, 524 129, 912 456, 770 1, 832, 540 3, 135, 950 785, 506 330, 549 134, 341 223, 802 1, 877, 901 3, 363, 693 76, 761 207. 125 191,116 2, 360, 002 559, 477 785, 574 648, 165 735, 226 1, 703. 771 252, 054 715. 125 1, 122, 039 1, 370, 650 1, 065, 596 789, 707 995, 078 275, 223 284, 338 60, 468 116, 445 1, 039, 797 211,386 4,220,173 1, 955, 857 390, 939 1, 213, 735 1,454, 710 565, 652 4, 934, 167 1,004, 298 364, 055 1, 300, 780 249, 991 1, 480, 909 1, 605, 449 283, 481 198, 263 1, 420, 517 25, 193 771, 091 1, 429, 335 1,111,345 108, 759 Extension and improve¬ ment grants $904, 655 21,117 8, 549 14, 500 128, 537 14, 256 16, 521 5, 000 6,179 32, 025 5,000 5, 094 77, 260 12, 921 17, 064 13, 600 24, 710 7,900 33, 522 63, 644 27, 784 28, 099 5, 499 7, 644 39, 102 7, 245 11,250 37,003 5, 142 63, 178 18, 920 12, 270 16, 987 5, 738 4, 425 77,990 6, 570 2, 351 15, 059 5,000 Total $57, 407, 965 2, 599, 641 129, 912 465, 319 1, 847, 040 3, 264, 487 799, 762 347, 070 139, 341 229, 981 1, 877, 901 3, 395, 718 81,761 212, 219 191,116 2, 437, 262 572, 398 802, 638 661, 765 759, 936 1, 703, 771 259, 954 715, 125 1, 155, 561 1, 434, 294 1, 093, 380 789, 707 1,023,177 280, 722 291, 982 60, 468 116,445 1, 078, 899 218, 631 4, 231, 423 1, 992, 860 396, 081 1, 276, 913 1, 473, 630 577, 922 4, 951, 154 1, 004, 298 369, 793 1, 300, 780 254, 416 1, 480, 909 1, 683, 439 290, 051 200, 614 1, 420, 517 25, 193 771, 091 1, 444, 394 1,111,345 113, 759 665171—63 - 26 394 Department of Health , Education , and Welfare, 1962 Table 3. — Vocational rehabilitation grants, 1962, State commissions or agencies for the blind Total State or territory Support grants $6, 446, 690 Arizona _ Connecticut. Delaware. .. Florida _ Hawaii _ Idaho . . 91, 730 69, 703 34, 665 499, 654 50, 000 34, 906 Indiana - Iowa - - Kansas _ Louisiana _ Maine _ Massachusetts. 61. 241 190, 589 214, 000 175, 000 94, 944 214, 843 Michigan. . Minnesota. Mississippi. Missouri.. . Montana.. Nebraska. . 120, 619 223, 062 386, 734 247. 266 46, 222 70, 782 Nevada - New Hampshire. New Jersey _ New Mexico _ New York _ North Carolina.. 21, 752 30, 757 191, 632 55, 303 567, 762 587, 597 Ohio _ _ Oregon _ Pennsylvania. . Rhode Island- South Carolina. South Dakota. . 349, 245 106, 381 404, 995 81. 927 92,131 66, 558 Tennessee.. Texas _ Vermont _ Virginia _ Washington. Wisconsin.. 379, 181 295, 265 47, 787 125, 000 122, 806 94, 651 Extension and im¬ provement grants $153, 617 2, 140 4, 133 5, 326 1,950 4, 500 3, 822 22, 222 8, 595 66,482 1, 106 500 9. 656 23, 185 Total $6, 600,307 93, 870 73, 836 34, 665 499, 654 50, 000 34,906 61,241 195, 915 215, 950 175, 000 94, 944 219, 343 120, 619 223, 062 386. 734 247, 266 46, 222 74, 604 21, 752 30, 757 191, 632 55, 303 589, 984 587, 597 357, 840 106, 381 471, 477 81, 927 92, 131 67, 664 379, 181 295, 265 48, 287 134, 656 145, 991 94, 651 Saint Elizabeths Hospital Psychiatry as a specialty of medicine continues to evolute rapidly. New ideas, some of them rediscovered from past experience, are being proposed in the care of patients. Research into the causes of mental disorder is progressing rapidly, as is the training of much-needed personnel. In all these fields Saint Elizabeths is active and is en¬ deavoring in every way possible to further its traditional position of leadership. Much of the care of the mentally ill takes place in the com¬ munity at the hands of private practitioners, but there still is a need of mental hospitals, and presumably there always will be. In the treat¬ ment of mental illness the social concepts are gaining strength. There is a greater use of community resources such as foster homes, nursing homes, halfway houses, and outpatient clinics. The role of public education is an important one ; the understanding and tolerance of the community have increased markedly, thanks to the attempts of various agencies to bring about a greater public under¬ standing of the nature of mental disorder. At present some debate is underway as to the relative merits of the small and the large mental hospitals, and it is being urged that no hospitals of over 1,000 beds be maintained or established. The fact is, however, that some hospitals, Saint Elizabeths among them, are considerably larger than that allegedly ideal maximum. It has been suggested, too, that large hos¬ pitals be broken down into smaller units. There is much of value in the smaller units, but it should not be forgotten that structure in an organization is necessary and that the various parts cannot be allowed to go their separate ways without control or coordination. The trend is toward reducing, rather than increasing, the population of mental hospitals by more intensive early treatment, by establishing new hos¬ pitals, and by sending more patients back to the community for care there rather than keeping them in the institutions. Saint Elizabeths 395 396 Department of Health, Education, and Welfare, 1962 has not been unmindful of this tendency and actually during the year reduced its resident population by 160 in spite of the highest admission rate since 1945. For the first time in 17 years the admissions to the hospital ex¬ ceeded 2,000, the actual number being 2,024. During the same period 1,649 patients were discharged, or 81 percent as many as were received. Somewhat more voluntary patients were admitted informally, namely, 251. This rate of only 12.3 percent is far below what it should be. Through an arrangement with the District of Columbia Health Department, voluntary patients may now be admitted at any time, including weekends and evenings. An increase in the voluntary admissions is much to be desired, especially in view of the fact that the commitment laws of the District of Columbia continued to be among the most legalistic, cumbersome, and traumatic to the patient of any jurisdiction in the United States. It is encouraging to note that a bill has been introduced in the Congress which would moderate some of the inequities and undesirable features of the present com¬ mitment laws. The aged continue to be a serious problem, as does the chronicity of a considerable number of the patients. At the close of the fiscal year, 63 percent of the patients in the hospital had been in residence for 5 years or more. The difficult problems of the care of the chronically mentally ill and of the aged are receiving much attention and hopefully some satisfactory arrangement can be worked out. Desirable as it is to reduce the population of mental hospitals, it should not escape attention, as it sometimes seems to do, that the aged and the chronically mentally ill are sick persons and are entitled to suitable medical care. They should not be relegated to some modern equivalent of the oldtime “poor farm.” The principal problems of the hospital continue to be overcrowding and understaffing. During the year, thanks to an increased appropria¬ tion by the Congress, there were over 233 net additions to the hospital personnel. Ten physicians were among these, as w^ere 23 graduate nurses, an encouraging state of affairs. There are many needs, how¬ ever, in all the activities of the hospital. A survey recently made would indicate that instead of the present 3,515, the hospital should ideally have a total personnel of as many as 8,200. An active recruiting program has been underway during the past year in all fields, with particular emphasis on the ward personnel. Under Civil Service rules physicians now receive salaries at the “top of the grade,” but it is highly doubtful whether the salaries are yet on a really competitive basis with the States or with private practice. It should be pointed out, indeed, that one Government agency is permitted by law to pay a 15-percent premium to diplomates of speciality boards. Saint Elizabeths Hospital 397 A bill has finally been proposed which would extend this provision to Saint Elizabeths Hospital ; such legislation has not yet been enacted. The general health of the hospital population has been good, thanks to the continuing efficient efforts of the physicians, nurses, dietitians, sanitarians, and the rest of the hospital personnel. All the accepted types of treatment are being utilized, among them individual and group psychotherapy, milieu therapy, drug therapy, electroshock, habit training, and various methods of resocializing the patients. One habit-training program was developed during the year very suc¬ cessfully, but there have been others as well, both recently and in the past. One project was that of interesting a group of patients in repairing toys which might be given to the needy children at the District of Columbia Village or other institutions. Much has been done in recreation, and in the John Howard Pavilion a “Gavel Club” was organized. The rehabilitation activities have been extended and amplified, and the number of patients released to the community, many of them on a self-supporting basis, is most gratifying. In a number of areas remotivation programs have been undertaken very successfully. The number of open wards has been increased; self- government activities have been encouraged; and in every way an effort has been made to create a permissive, encouraging, and opti¬ mistic atmosphere among the patients. A special program has been set up to deal with the young adults, children, and adolescents. There are in the hospital 5 children under 12, 46 adolescents (13 to 18), and 6 young adults ( 19 years of age or slightly older) . In an institution designed primarily for adults, these patients have not benefited to the full from the programs which were available, but it is now expected that much more can be done for them in the line of education and training. One problem wdiich has caused much concern at the hospital is the continued very free use by the patients of petitions for writs of habeas corpus. The right to file such writs is, of course, guaranteed by the Constitution, but some of the petitions are repeated frequently and are quite obviously frivolous. During the year, for example, 187 orders to show cause were served on the hospital, and 169 orders to produce the patient in court on a writ of habeas corpus. Only eight releases were granted, a fact which in itself suggests that most of the writs had little if any basis. Since every hearing calls for the presence of a physician and sometimes of several, the drain on the physicians’ time is inordinate. During the year, in fact, 1,084 hours were spent in court by the doctors. The hospital has suggested formally to the court that arrangements be made to hold the hearings at the hospital. This vrould save much time, both on the part of the judges and of the physicians. Some administrative improvements have been made in 398 Department of Health , Education , and Welfare , 1962 the court, thanks to the interest of the chief judge, but much improve¬ ment is yet possible. In the field of public education the hospital has taken its part. In May “Mental Health Week” was held, with suitable community ar¬ rangements in the line of lectures and sermons, a public dramatic production, and an “open house.” The total number of visitors on the two latter occasions was about 3,000. A program was prepared and distributed to approximately 450 radio stations. In addition, State and county hospitals and mental health associations have re¬ quested the transcriptions for their libraries. This is a series of 5 -minute talks, and the reception seems to have been very favorable. Indeed, considerably over 300 stations have indicated their desire for an extension of the program. The Information Officer has been very active; 10 feature articles appeared in the local papers, plus many news items, and a TV presentation of the activities of the hospital is being prepared. A publication known as the “Saint Elizabeths Re¬ porter,” designed primarily for hospital personnel, was established during the year. As usual the hospital has been visited by many pro¬ fessional persons, physicians, social workers, and others from many foreign countries, 23 nations being represented this year. It is always a source of satisfaction and stimulation to have such visitors. Many Government agencies, and those of the District Government, have cooperated with the hospital and to them thanks are extended. The same is true of various private groups and individuals, notably vol¬ unteers. These groups are altogether too numerous to mention, but the value to the patients, to the hospital, and to the public’s under¬ standing is inestimable. The program of training has been not only continued but expanded during the year. The accreditation by the J oint Commission has been renewed. A third-year chaplaincy residency has been set up, as has a residency in psychodrama. Training is given at the hospital in these fields among others : internships (the only public mental hospital in the United States so approved), residencies in psychiatry, path¬ ology, surgery, radiology, physical medicine, psychology, occupational therapy, psyhcodrama, and field training in social work and recrea¬ tional therapy. Some of these activities will be detailed below. Forty percent of the costs of training are now borne by the Federal Government. This in itself is a recognition of the national impor¬ tance of the hospital. Research activities of the hospital have been very considerably ex¬ tended. The joint project between the National Institute of Mental Health and the hospital, known as the Clinical Neuropharmacology Research Center, has been in operation for 5 years with most gratify¬ ing results. In addition, a behavioral studies program operated Saint Elizabeths Hospital 399 largely with hospital funds is in successful operation. In that pro¬ gram some criminological studies have been undertaken during the past year, as well as some researches in experimental psychology. It is proposed to set up a third division (the others being the Medical and the Administrative Divisions) in the hospital to be known as the Behavioral and Clinical Studies Division, but final approval has not yet been given by the Department on that proposal. Psychiatric Services Brief comments relative to the clinical activities of the hospital fol¬ low herewith. There are four admission services, each under a clini¬ cal director: Dix Pavilion for civil patients under 64, the Geriatric Service for patients over 64, the John Howard Pavilion for male prisoner patients, and the William A. White Service, which is basically a research service operated jointly with the National Institute of Mental Health. The other wards and services of the hospital are di¬ vided between two clinical directors. The general supervision of the activities of the clinical directors is vested in the first assistant physician. MEDICAL AND SURGICAL BRANCH This Branch, although not an admission service, plays an extremely important part in the operation of the hospital. It furnishes special¬ ized medical and surgical services to the patients of the hospital, both of an inpatient and outpatient nature. The present main building of this Branch, the so-called Medical and Surgical Building with a capacity of 179 patients, is over 30 years old and with the advancing techniques and activities of medicine is, at present, highly inadequate. A recent study was made by a firm of hospital consultants, and it is hoped that in the very near future funds may be forthcoming for plans for a building to replace or supplement the present building. Considerable improvement of the operating rooms has been under¬ taken during the past year. A neurology service has been added, and the dental services have been much expanded. During the year 2,222 inpatients were cared for in the Branch (a total of 186,386 patient- days), and 62,000 patients received outpatient care. In the podiatry clinic, 4,350 patients were seen; and in the dental service there was an increase of 1,500 over the preceding year, a total number of 4,528 patients receiving care. A speech and audiology clinic has been added recently ; much research work is planned in this interesting but some¬ what neglected field. The staff has been increased in the Medical and Surgical Branch, and care of a high order is being given to the patients who come under its attention. Much better service can be rendered, however, when the new building becomes a reality. 400 Department of Health , Education , and Welfare, 1962 NURSING BRANCH The basic responsibility for the ward care of patients is vested in this Branch, which is effectively discharging this duty. There has been an increase in the number of registered nurses during the year and an increase of 84 in the total personnel. Much training is done in this Branch, both of affiliates and of postgraduate students, the latter coming from Catholic University and Howard University. An inservice training program is carried on, and the employee develop¬ ment program is being expanded. CLINICAL TRAINING BRANCH This Branch has the general supervision especially of the psychiatric resident training program but also coordinates the various other train¬ ing programs which are carried on. One of its functions is the super¬ vision of the Psychotherapy Section, in which we find not only many group and individual psychotherapeutic activities but also dance therapy and psychodrama. This latter form of group psychotherapy was introduced in Saint Elizabeths Hospital over 20 years ago. More recently this hospital, the first public institution to introduce psycho¬ drama, was the first to establish an approved training program. PSYCHOLOGY BRANCH This Branch operates in close connection with the various ward services in performing tests, in counseling, in participating in staff conferences, in doing psychotherapy, and in training psychologists. There has been an increased use of psychology on the wards, and a reorganization of the Branch has divided the hospital into five areas for purposes of more efficient service. During the year there was an increase of 51 percent in the patients referred to the Psychology Branch, and nearly 5,000 tests were performed on 1386 persons, mostly but not entirely patients. The speech pathology and audiology activi¬ ties referred to under the Medical and Surgical Branch are attached primarily to the Psychology Department. During the year 711 audio¬ metric tests were carried out. The psychology staff has been active in lectures and seminars, as well as in training. There have been two residents, nine interns, six field Avork students and volunteers, and three externs in speech pathology during the year. RECREATIONAL THERAPY BRANCH This Branch has been considerably expanded both as to staff and activities. It is active in the school program mentioned above and has engaged in various recreational activities such as dramatics, social activities, writing and speaking, music, and dance. Saint Elizabeths Hospital 401 OCCUPATIONAL THERAPY BRANCH The activities of the Branch have been numerous, one of those being the educational rehabilitation program, involving 213 patients. There has also been an educational program for the maintenance em¬ ployees. This has proved very helpful in orienting the maintenance personnel in the proper concepts and methods for working with mental patients, many of whom work with the maintenance areas. The indus¬ trial therapy activities carried out under this Branch have to do particularly with the placement of patients in activities which may be helpful to them in securing livelihood after they leave the hospital. The Branch also trains occupational therapy interns. VOLUNTEER BRANCH The development of this Branch has been most gratifying from many points of view. During the year an average of 864 volunteers have worked each month, giving a total of 40,000 hours of service. Some of these activities have been carried on through organizations and others by individuals, in many fields of contact with the patient. The value of volunteer service to the community, as well as to the patients, should not be underestimated; these workers carry back to their associates and friends a much sounder conception of a mental hospital than was formerly entertained by their associates. SOCIAL SERVICE BRANCH The staff of this Branch has been increased during the year from 25 to 32. A total of 1,817 patients was serviced and 28,500 interviews carried on. The Branch has been very helpful in finding placements for patients ; 98, for example, were placed in foster homes and others in the D.C. Village, or referred to the Mental Health Clinic or the Public Assistance Division of the District. Another service was in relocating some of the Indian patients who were referred back to State hospitals in their own States. BIOMETRICS BRANCH This Branch has been extremely active and useful during the year. The hospital has been recognized as one of the model reporting areas, being the 29th jurisdiction thus to be recognized. The bills to the Dis¬ trict for the care of patients are now being prepared by this Branch. A thoroughgoing statistical system is being set up, and eventually there is every reason to believe that we shall know much more about the facts of the hospital care of mental disorder than has been known in the past. 402 Department of Health , Education, and Welfare, 1962 MEDICAL RECORDS BRANCH The Medical Records Branch not only files and reviews records but now abstracts them for other hospitals on appropriate request. The need of medical records is sometimes overlooked by physicians, but there is no question about the value of them for reference purposes, studies, and further knowledge concerning patients. LABORATORY BRANCH The demands on this Branch continue to increase, but they have been met very well, thanks to a considerable increase in automation. No less than 264,000 tests were carried on during the year, this amount¬ ing to almost 30-percent increase. Autopsies came to 45.1 percent of the deaths. A residency in pathology has been approved, and there are two residents in this program. An isotope laboratory is in operation, and it is planned to do cytological investigations routinely on female patients who are admitted to the hospital, this method being valuable in giving early evidence of cancer of the uterine cervix. SANITARY ENGINEERING BRANCH This Branch has operated most effectively on a hospitalwide basis, not only as to insect and rodent control but to food preparation and serving and general housekeeping. CHAPLAINS BRANCH This Branch operates under the auspices of the three major faiths, namely, Jewish, Protestant, and Roman Catholic. The patients of all these faiths are served as to worship and pastoral counseling, each new patient being seen very shortly after admission by a clergyman of his own faith. The senior Protestant chaplain reports a consider¬ able increase in the worship services, including two services in the chapel on Sunday mornings, and an increase in the training program with the addition of a third year of clinical pastoral training resi¬ dency. There were 11 full-time trainees plus 58 part-time trainees during the year including seminarians and community clergy. Dur¬ ing the year the members of the Protestant Branch gave no less than 305 addresses and lectures. The senior Protestant chaplain was elected president of the Association of Mental Hospital Chaplains during the year. A director of chaplain studies was added to the staff, who will make studies concerning the various relationships of religion to mental health in a hospital setting. The Roman Catholic program has likewise been increased, espe¬ cially as to training. There were six full-time interns during part of the year, and four of them remained all of the year. In addition, seminarians from a number of seminaries have received instruction, Saint Elizabeths Hospital 403 and of the community clergy approximately 79 have received instruc¬ tion in this section. During the year the senior Catholic chaplain celebrated his 25th Jubilee as a priest. The Jewish program deals with a much smaller group of patients, but much attention has been given to the worship and festival aspects of their religion. In this field the volunteers have been of inestimable value. LIBRARY SERVICES The Services are divided into services to the medical staff and to patients, both of these activities being under the supervision of trained medical librarians. The Medical Library gives service to the medical staff and to other staff members of the hospital in the line of references, bibilographies, and of providing books. The collection of Saint Elizabeths is an excellent one, totaling now about 19,000 volumes with a total of accessions during the year of 1,314. There were 314 periodi¬ cals subscribed to. It is unfortunate that some of the other libraries in the area are actually cutting their services, so that interlibrary loans are becoming somewhat more difficult to manage. Space is at a pre¬ mium, but there will be some relief when the new wings of the Adminis¬ tration Building are completed. The Patients’ Library now numbers 68,000 volumes, with a gain during the year of almost 2,800, much of the latter by gifts. In addition to having the central reading room and storage of books, the patients’ librarian keeps active a considerable number of ward libraries and maintains active circulation of books among the wards. The library is also involved in bookbinding, shorthand, and other classes with the assistance of volunteers. Office of Personnel During the year the Office of Personnel was made directly respon¬ sible to the Office of the Superintendent, partly as a result of the report of the Civil Service Commission inspectors who carried out inspection in the spring. A very active program of recruiting was carried on during the year, somewhat to the disadvantage of some of the other programs. The number of disciplinary actions is increas¬ ing substantially, and the requests, not to say demands, from various credit stores occupy a great deal of the attention of the Office. There are now 3,511 positions in the hospital which are filled. One hundred and nineteen summer students were recruited, this being a part of the campaign to interest more young people in possibly entering Government service. The employee development and training pro¬ gram has been substantially expanded during the year. Space is 404 Department of Health , Education , and Welfare , 1962 crowded, but some relief is expected when the wings of the Adminis¬ tration Building are completed. Division of Administration The various branches of this Division are essential to the proper operation of the hospital, and during the year they have functioned very effectively. The activities include such things as purchasing, warehousing, the dietary department (which prepared over 7 million meals during the year), registrar’s office, maintenance office, laundry, garage, grounds, sewing room, payroll, and patients’ funds. The Division has been greatly aided during the year by the services on a part-time basis of a lawyer detailed by the General Counsel’s Office of the Department. A new section on managament analysis was set up during the year. Construction underway involves the wings of the Administration Building, the Continued Treatment-9 Building due for occupancy about April 1963. Plans for a Rehabilitation Building are being developed. The Anacostia F reeway is being con¬ structed on the hospital grounds ; this resulted in the loss of about 15 acres to the hospital. Needs of the Hospital The future of the hospital should be clarified at an early moment. It seems clear to all who are familiar with the history of the hospital, its international reputation, and the consistent support which has been given to it by Congress that the founders intended that there should be a national institution to set the pace for the various States in the lines of patient care, training, and research. Saint Elizabeths is in a unique position to do this, yet there are certain forces which appear to be interested in downgrading the institution to that of a District hospital. The hospital has exerted leadership through more than a century, and at this moment, when mental health is securing so much public attention, it would be little short of a tragedy not to emphasize the national goal of an institution, the example of which State and local institutions do not resent. The program already underway of replacing antiquated facilities with new should be con¬ tinued, and it is to be expected that the advancing needs of psychiatry and the correlative advancing needs of personnel and equipment will be recognized by the Bureau of the Budget and by the Congress. The organic act passed in 1855 set forth the aims of the hospital as the “most humane care and the most enlightened curative treatment” of the mentally ill. Toward these aims the hospital has always striven and will continue to do so in the future. Saint Elizabeths Hospital 405 Table 1. — Patients , admissions , and discharges , fiscal years 1935—62 Fiscal year Average i pati On rolls lumber of ents In hospital Admissions Discharges Discharges as percent of admis¬ sions Deaths 1935-39 5,624 987 474 48 296 1940-44 6,849 1,885 1,295 69 387 1945-49 6,832 1,815 1,477 81 431 1950-54.. _ _ 7,175 6,896 1,481 920 62 440 1955-59 _ _ 7,458 7,039 1,501 951 63 524 1950 - - 6,897 6,587 1,648 960 58 495 1951 _ _ 7,053 6, 783 1,412 928 66 424 1952 _ _ 7,172 6, 915 1,438 814 57 431 1953 _ 7, 361 7,079 1,524 977 64 436 1954 _ 7, 392 7, 117 1,385 921 66 416 1955 _ 7,461 7,216 1,349 748 55 502 1956 _ 7, 438 7, 120 1, 327 884 67 600 1957 _ 7,413 6, 994 1,615 1,014 63 507 1958 _ _ 7, 466 6,965 1, 605 1,076 67 532 1959 _ _ 7,512 6,900 1,607 1,034 64 479 1960 _ 7,691 6, 983 1,894 1, 101 58 504 1961 _ _ 7,933 6, 976 1,981 1,395 70 440 1962 _ 7, 940 6,838 i 2, 024 i 1, 649 81 484 i Differs slightly from comparable numbers for earlier years in that the earlier figures include “paper” discharges and readmissions made in order to change legal categories. Table 2. — Patients on the rolls , by status and by sex , time since admission , ethnic group , and age , June 30, 1962 Patients Resident patients » On con¬ On Sex, time since admission, ethnic group, and age on rolls, total Total In hospital On tem¬ porary visit On vacation valescent leave unauth¬ orized leave Total _ 7,883 6,894 6,617 277 83 837 69 Males _ 3,987 3,587 3,446 141 34 314 52 Females _ _ _ 3,896 3,307 3,171 136 49 523 17 Time since admissions Less than 6 months _ _ 773 686 625 61 5 74 8 6-11 months _ ...... 474 326 311 15 6 133 9 1 year... _ . ... 780 562 529 33 18 187 13 2 years _ _ _ _ . . 587 439 406 33 13 120 15 3-4 years _ _ _ 719 576 539 37 19 111 13 5-9 years _ 980 866 824 42 9 100 5 10-19 years _ _ _ 1, 574 1,483 1,439 44 10 76 5 20 years and over _ ... _ 1,996 1,956 1,944 12 3 36 1 Median time since admission (years) - - 8 10 11 3 3 2 2 Ethnic group White _ 4,160 3, 765 3, 618 147 43 322 30 Non white _ 3, 723 3,129 2,999 130 40 515 39 Age ( years ) Less than 15 _ 15 11 10 1 0 4 0 15-17 _ 36 24 22 2 0 11 1 18-24... _ _ _ _ _ _ 267 219 194 25 3 42 3 25-34 _ _ _ 854 650 587 63 16 160 28 35-44 _ _ _ 1,304 1,039 958 81 21 227 17 45-54 _ _ _ 1,508 1,284 1,223 61 20 193 11 55-64 _ _ 1,623 1,470 1,445 25 12 136 5 65-74 _ _ _ 1,172 1,119 1,106 13 7 42 4 75-84 _ _ _ 831 807 801 6 4 20 0 85 and over _ _ _ 273 271 271 0 0 2 0 Median age. _ ... _ 55 56 57 41 46 44 36 i Resident patient status should not be confused with the D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit. 406 Department of Health , Education , and Welfare , 1962 Table 3. — Movement of patients on the rolls , by sex , time since admission, ethnic group , and age, fiscal year 1962 Sex, time since admission, ethnic group, and age Patients on rolls June 30, 1961 Admis¬ sions Discharges Deaths Patients on rolls June 30, 1962 Total.. - - - - 7, 992 2,024 1, 649 484 7,883 Males - 4,047 1, 129 962 233 3,981 Females - 3, 945 895 687 251 3, 902 Time from admission to June SO, 1962 Less than 6 months _ 1,080 290 19 773 6-11 months. . _ 944 402 65 474 1 year _ _ 472 77 780 2 years _ _ 165 50 587 3-4 years _ 117 52 719 5-9 years _ 86 71 980 10-19 years _ _ _ 72 64 1, 574 20 years and over _ _ 45 86 1, 996 Ethnic group White _ 4, 244 1,036 836 284 4,160 Non white _ 3,748 988 813 200 3,723 Age (years ) 1 Less than 15 - - - - 16 12 20 0 15 15-24 _ 280 235 150 3 303 25-34 _ 873 446 393 5 854 35-44 _ _ 1,345 434 447 19 1, 304 45-54 _ _ 1, 610 303 323 29 1, 508 55-64 _ _ 1, 608 192 171 69 1, 623 65-74 _ 1,197 175 104 109 1, 172 75-84 _ 799 158 35 155 831 85 and over _ _ 264 69 6 95 273 Median age _ 54 42 41 75 55 i For individual age groups, the number of patients at the beginning of the year plus admissions minus discharges and deaths do not equal the number of patients at the end of the year. This is because some patients age from one group into the next during the year. For example, 7 patients who were less than 15 years of age on June 30, 1961, became 15 years old by June 30, 1962. Saint Elizabeths Hospital 407 Table 4. — Patients on the rolls by status and legal category , June 30, 1962 Patients Resident patients 1 On On un¬ Legal category on rolls, total Total In hospital On tempo¬ rary vist On vacation conva¬ lescent leave author¬ ized leave Total _ 7.883 6.894 6. 617 277 83 837 69 Reimbursable — . - . 6.228 5. 378 5. 144 234 77 741 32 D.C. resident . . 5.382 4,714 4. 534 180 58 587 23 D.C. voluntary . ... Veterans’ Administration.. 310 187 158 29 11 106 6 411 364 341 23 5 39 3 U.S. Nationals from aboard. 59 55 54 1 1 3 0 U.S. Soldiers Home . 41 35 34 1 0 6 0 Indians (PHS) - 21 21 21 0 0 0 0 Other reimbursable . 4 2 2 0 2 0 0 N onreimbursable . 1. 655 1. 516 1. 473 43 6 96 37 Total, excluding pris¬ oners - - - 803 757 731 26 4 42 0 D.C. nonresident . . 313 275 261 14 2 36 0 Military . . . . 252 250 248 2 0 2 0 Virgin Islands - - 134 132 132 0 1 1 0 Federal reservation . . 36 33 26 7 1 2 0 Public Health Service _ 17 17 16 1 0 0 0 Coast Guard _ 14 14 14 0 0 0 0 Canal zone . . . 15 15 15 0 0 0 0 Other, excluding prisoners. 22 21 19 2 0 1 0 Prisoners . . . . 852 759 742 17 2 54 37 D.C. total . . 782 689 672 17 2 54 37 For examination . . 87 81 81 0 0 2 4 Mentally incompetent. 248 238 235 3 0 6 4 Not gulity by reason of insanity . . 296 240 233 7 2 32 22 Under sentence - 90 89 89 0 0 0 1 Sex psychopath . . 61 41 34 7 0 14 6 U.S. prisoners . 49 49 49 0 0 0 0 Military prisoners . . 21 21 21 0 0 0 0 1 Resident patient status should not be confused with D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit. 408 Department of Health , Education , and Welfare , 1962 Table 5. — Movement of patients on the rolls by legal category , fiscal year 1962 Legal category Patients on rolls, June 30, 1961 Admis¬ sions Dis¬ charges Deaths Net changes in legal category Patients on rolls, June 30, 1962 Total _ _ - - 7,992 2,024 1.649 484 7.883 Reimbursable. . 6.265 1, 432 948 432 -89 6, 228 D.C. Resident - - 5, 464 1, 213 618 401 -276 5 382 D.C. voluntary - - - 292 192 227 10 +63 310 Veterans’ Administration - 406 12 58 16 +67 411 U.S. Nationals from abroad _ .. 0) 3 1 1 +58 59 U.S. Soldiers Home - ... 51 7 15 3 +1 41 Indians (PHS) _ 45 0 23 1 o 21 Other reimbursable _ 7 5 6 0 -2 4 Nonreimbursable - - - 1, 727 592 701 52 +89 1,655 Total, excluding prisoners - 889 186 385 38 +151 803 D.C. nonresident - - 313 0 248 14 +262 313 Military _ _ _ _ 272 0 7 12 -1 252 Virgin Islands _ _ 138 4 3 5 0 134 Canadian insane. .. . - 51 0 0 0 -51 0) Federal reservations - - - 37 83 75 3 -6 36 Public Health Service - 28 2 12 2 +1 17 Coast Guard - ... - 14 0 0 0 0 14 Canal Zone - - - - - 16 0 0 1 0 15 Foreign Service (Employees) - .. 10 0 4 0 -6 0) Other, excluding prisoners - 10 97 36 1 -48 22 Prisoners _ 838 406 316 14 -62 852 D.C. total - - - 786 364 295 13 -60 782 For examination.. . - - Q49 / 188 146 2 1 0 f 87 Mentally incompetent _ OTZ l 53 91 9 / ° l 248 Not guilty by reason of insanity. . 229 79 23 1 +12 296 Under sentence - . ... 151 39 27 1 -72 90 Sex psychopath.. - - - 64 5 8 0 0 61 U.S. prisoners - - - - . 30 42 21 0 -2 49 Military prisoners - 22 0 0 1 0 21 1 Two categories, Canadian Insane and Foreign Service (Employees), were discontinued effective Novem¬ ber 1961 and January 1962 respectively. Patients in these categories were transferred to the new Category U.S. Nationals from Abroad. Saint Elizabeths Hospital 409 Table 6. — Discharges by status from which discharged and by condition , environment , and employment , fiscal year 1962 From resident patient status 1 From From Legal category Total Total Direct from hospital From temp¬ orary visit From vacation conva¬ lescent leave unauth¬ orized leave Total _ 1, 649 954 926 28 35 572 88 Condition or type Medical discharges _ 973 361 342 19 31 533 48 Condition on discharge: Recovered _ 60 19 17 2 1 40 0 Socially recovered _ 604 143 131 12 24 413 24 Improved. _ _ 233 138 133 5 5 77 13 Unimproved _ . . 68 53 53 0 1 3 11 No mental disorder _ 8 8 8 0 0 0 0 Administrative discharges _ 676 593 584 9 4 39 40 Type of discharge: Against medical advice _ 72 57 56 1 0 1 14 To legal or police au¬ thorities _ 224 224 224 0 0 0 0 To home State or coun¬ try _ 80 77 77 0 0 2 1 To VA hospital _ 37 36 36 0 0 1 0 Expiration of limited stay, court order, for admission to private hospital, etc _ 263 199 191 8 4 35 25 Environment Lives alone _ _ _ 194 78 74 4 4 95 17 With spouse _ _ - 265 109 103 6 6 144 6 With relatives (not spouse) _ 426 217 202 15 13 184 12 With others _ 63 32 31 1 0 31 0 In foster-care home _ . _ . 10 0 0 0 0 10 0 In D.C. Village _ 34 3 3 0 0 31 0 In other home for aged, nurs¬ ing, or convalescent home _ 19 14 14 0 0 4 1 In inpatient psychiatric insti¬ tution _ ... _ 184 167 167 0 2 10 5 In penal institution. . _ 235 234 234 0 0 1 0 In other institution _ 54 38 38 0 1 14 1 Unknown environment _ _ 165 62 60 2 9 48 46 Employment Full time _ _ 244 67 62 5 7 167 3 Part time or intermittent _ _ 40 14 14 0 0 25 1 Not employed _ _ .. . ... 1, 079 757 738 19 13 277 32 Unknown employment _ . 286 116 112 4 15 103 52 1 Resident patient status should not be confused with D.C. resident legal category, as patients in the hospital plus those on temporary visit. The former is defined 665171—63 - 27 American Printing House for the Blind As the Official schoolbook printery for the blind in the United States, one of the principal functions of the American Printing House for the Blind, in Louisville, Ky., is the provision of special educa¬ tional books and supplies for the blind school children throughout the country through the Federal act “To Promote the Education of the Blind.” This act, originally passed in 1879, authorizes an annual ap¬ propriation to the Printing House for this purpose. Allocations of books and materials are made on a per capita basis. Only those pupils may be registered whose vision comes within the accepted definition of blindness as follows: “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20 degrees.” The Printing House maintains large catalogs of Braille books, Talking Books, recorded tapes, Braille music publications, large-type texts, and tangible apparatus. A rich collection of educational mate¬ rial is thereby provided for the kindergarten through the high school grades. A total of 7,706 blind pupils was enrolled through public edu¬ cational institutions for the blind and 8,267 through State depart¬ ments of education — a total of 15,973 blind pupils being served by the Printing House — for the fiscal year ending June 30, 1962. During the 1962 fiscal year, Braille books, educational periodicals, and music made up approximately 49.8 percent of the materials re¬ quired by the schools; Braille slates, Braillewriters, maps, and other mechanical devices about 15.7 percent ; Talking Books about 2.5 per¬ cent; recorded educational tapes about 0.5 percent; and large-type books about 29 percent. Approximately 2.5 percent was used for mis¬ cellaneous items. 411 Gallaudet College Gallaudet College, established in 1857, is the only institution of higher learning in the world devoted exclusively to the education of the deaf. It is accredited by the Middle States Association of Col¬ leges and Secondary Schools. Public Law 420, 83d Congress, approved June 18, 1954, clearly defines its status as a college, its relationship with the Federal Government and its responsibility to provide educa¬ tion and training to deaf persons and otherwise to further the educa¬ tion of the deaf. The college’s principal activity is a 4-year undergraduate course of studies leading to the B.A. and B.S. degrees. In addition, Gallaudet offers a 1-year college preparatory course. Deaf children of nursery age are taught in the Hearing and Speech Center. Elementary and secondary education for deaf children of the District of Columbia and adjacent States is provided by the Kendall School, a laboratory school serving the college’s Department of Education. This depart¬ ment, established in 1891, trains graduate students, both deaf and hearing, for positions as teachers and administrators in schools from 48 States, the District of Columbia, and 9 foreign countries. Enroll¬ ment in the Kendall School was 92, of which 80 came from the District of Columbia. The editorial offices of “dsh Abstracts” and of the “American An¬ nals of the Deaf” are on the Gallaudet campus. 413 Howard University Howard University, located in the District of Columbia, was chartered by an act of Congress, dated March 2, 1867. The university consists of 10 schools and colleges, offering programs of higher education on the undergraduate, graduate and professional levels. Undergraduate students are registered in the college of liberal arts; graduate students seeking the master’s and doctor of philosophy degrees are registered in the graduate school; professional students are registered in the colleges of medicine, dentistry, pharmacy, fine arts (including the school of music and the departments of art and drama) and the schools of engineering and architecture, social work, law, and religion. (The school of religion receives no support from Federal funds.) The educational program of the university is conducted in keeping with the democratic purposes of land-grant colleges and State univer¬ sities, with the low tuition fees and living costs which characterize these institutions, and with an educational program resting upon and permeated by the content and spirit of a general or liberal education. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and undertakes to discharge a spe¬ cial responsibility for the admission and training of Negro students. ENROLLMENT OF STUDENTS During the school year 1961-62, the university served a total of 8,704 students as follows: 6,338 during the regular academic year and 2,366 in the summer session of 1961. The total net enrollment, exclud¬ ing all duplicates, was 7,118 distributed in the 10 schools and colleges as follows: liberal arts, 3,552; graduate school, 805; engineering and architecture, 778; fine arts, 375; social work, 126; medicine, 377; dentistry, 726 ; pharmacy, 177 ; law, 128 ; and religion, 74. The enroll- 415 416 Department of Health , Education , and Welfare , 1962 ment of Negro professional students at Howard continues to be greater than in all the public-supported universities in all the Southern States. GEOGRAPHICAL DISTRIBUTION OF STUDENTS Of the total of 6,699 students seeking degrees, 5,762 or 86 percent came from the States and the District of Columbia, while 937 students or 14 percent came from outside the continental United States includ¬ ing 2 possessions of the United States, 58 foreign countries, and 13 island possessions of the British, French, and Dutch West Indies. The percentage of foreign student enrollment to the total student en¬ rollment at the university continues to be the highest in any American university. The students from the United States were distributed as follows : New England States, 2 percent; Middle Atlantic States, 17 percent; East North Central States, 6 percent; West North Central States, 2 percent ; Mountain States, 0.5 percent ; South Atlantic States, 58 per¬ cent; East South Central States, 7.5 percent; West South Central States, 6 percent ; and Pacific States, 1 percent. The 937 students from outside the continental United States came from 58 foreign countries including Greenland, Canada, and Mexico, 5 countries in the Caribbean area, 3 countries in South America, 9 countries in Europe, 17 countries in Africa, 12 countries in the Near and Middle East, and 9 countries in the F ar East. In addition, there were students from Puerto Rico, the Virgin Islands, and 13 of the British, French, and Dutch possessions in the West Indies. VETERANS During the 1961-62 school year, the student enrollment included 291 veterans and dependents of deceased veterans receiving allowances from the Veterans’ Administration. One hundred eighty-nine of them were enrolled in the four undergraduate divisions of the university, and 102 were enrolled in the graduate and advanced professional schools. The number of enrolled veterans is steadily decreasing, and unless there is new legislation providing benefits for “peacetime vet¬ erans,” there will be few veterans wdio have educational benefits still available to them after the 1962-63 school year. ARMY AND AIR FORCE ROTC A'tvmy ROTC . — There were 610 students enrolled in Army ROTC during the 1961-62 school year. Of this number, 284 were in the first- year course, 245 were in the second year, 44 were in the third year, and 37 were in the fourth year. There were 33 students commissioned as reserve officers in the Army during the year. Air Force ROTC. — A total of 537 students was enrolled in Air Force ROTC. Of this number, 303 were in the first-year course, 201 were in the second year, 19 were in the third year, and 14 were in the Howard. University 417 fourth year. During the year, 8 students were commissioned as reserve officers in the Air Force. THE FACULTY There were 801 teachers serving the university during the school year. Of this number, there were 431 full-time teachers, while 370 were part-time. The full-time equivalent of the teaching staff was 533.6. Of this full-time equivalent, 472.7 were teaching in the rank of instructor and above. The university continues, as always, to seek for its faculty the most able persons who are selected on the basis of their competence and character, without regard to sex, race, color, creed, or national origin. It is to be noted, however, that the Howard University faculty has always included the largest group of Negro teachers and scholars at the university level found anywhere in the United States. Indeed, many of the most outstanding Negroes in public life have served at Howard University at some time during the course of their careers. Among such persons were the founder and operator of the first blood plasma bank, a governor of an American possession, an under secre¬ tary of the United Nations, and a member of the United States Court of Appeals. The faculty continues to remain active in making a valuable contri¬ bution to education and the advancement of knowledge through significant research and scholarly publications. GRADUATES During the 1961-62 school year, there were 731 graduates from the 10 schools and colleges. These graduates came from 36 States, the District of Columbia, Puerto Rico, the Virgin Islands, 22 foreign countries, and 7 island possessions of the British, French, and Dutch West Indies. The 22 foreign countries included Greenland, Haiti, Cuba, British Guiana, Panama, 4 countries in Europe, 4 countries in Africa, 3 countries in the Middle East, and 6 countries in the Far East. The 731 graduates were distributed among the 10 schools and col¬ leges as follows: liberal arts, 311; engineering and architecture, 93; fine arts, 19; the graduate school, 68; social work, 43; medicine, 72; dentistry, 57 ; dental hygiene, 11 ; pharmacy, 28 ; law, 19 ; and religion, 10. In addition, honorary degrees were conferred upon three persons. From the date of its establishment in 1867, Howard has graduated 23,174 persons. The great majority of these graduates have been Negroes. Throughout its 95-year history, Howard has been a pioneer in providing Negroes with educational opportunities which were either not available or offered in only a limited amount elsewhere. Among institutions in which Negro students are in a majority, the university 418 Department of Health , Education, and Welfare , 1962 still stands as the only one affording a complex system of under¬ graduate, graduate, and professional training. The largest number of graduates has entered the held of teaching, especially in the Southern States. In the field of medicine, there have been 3,239 graduates; 2,547 graduates have gone into dentistry and dental hygiene; 2,452 have entered the field of law; 822 have entered the ministry ; 954 have gone into the fields of engineering and architecture; and 571 graduates have gone into social work. Numer¬ ous graduates of the university have been engaged in government activities, not only in the United States but also in many countries abroad. PUBLIC SERVICE AT HOME AND OVERSEAS Throughout the history of Howard, teachers and students have rendered valuable and distinguished service to government in the United States and overseas. This we view as being intimately related to the functions of a university — teaching, research, and public service. During the 1961-62 school year, the university systematically undertook programs to aid in the improvement and development of the local community. As an illustration of this, the Vice-President for Special Projects provided leadership in the establishment of an interdisciplinary program involving social work, sociology, religion, psychology, medicine, government, law, and other departments, which, together with the churches in the 49th census tract in Washington, are giving guidance and assistance to the people in that area in solving their most pressing social, economic, and cultural problems. A more limited program lias also been initiated along similar lines in a second neighborhood area in the community. Early in the summer of 1962, Howard undertook an extensive Peace Corps training project which involved the training of volunteers going to Niger, Senegal, Togo, Sierra Leone, and Cyprus. In pro¬ viding training for programs in five countries simultaneously, Howard had a greater number and variety of Peace Corps training programs at one time than any other institution in the country. Many members of the faculties gave significant public service as individuals. A professor of law was on leave of absence to serve as chairman of the Public Utilities Commission of the District of Columbia, a professor of sociology was appointed to the Advisory Board of the National Capital Transportation Agency, an associate professor of government was appointed to the District of Columbia Board of Elections, and a professor of preventive medicine and public health was presented a “community service award” by the Health and Welfare Council of the National Capital Area. These examples are illustrative of the service being given by many other members of the staff. Howard University 419 In 1961-62 as in the past, there were teachers from Howard work¬ ing- and studying abroad. An associate professor of government, with the aid of a Rockefeller grant, was engaged in studying guerilla war¬ fare in Laos and Viet Nam ; a professor of English was working for the United States Information Agency in West Germany; the librarian of the university served as an adviser at the library of the University of Rangoon in Burma; the director of recording was on leave to serve as registrar in the establishment of a new educational institution in Sukka, Nigeria; and a professor of anatomy was working in India on the staff of the Agency for International Development. Members of the staff were studying and teaching abroad, including one in Japan and another in Italy. There were many students traveling and studying in other countries, including 18 members of the university choir who participated in a choral workshop in Puerto Rico. It is readily recognizable, therefore, that students and members of the staff are continuing the Howard tradition of significant service to people both at home and elsewhere. THE BUILDING PROGRAM During the school year 1961-62, construction proceeded on the new home economics building, which was expected to be ready for use in the fall of 1962. Work was begun on the construction of a new building providing for the physical education programs for men. The new physical education building will contain about 113,000 square feet and will include the following general categories of space: a gymnasium area for 2,500 spectators; a gymnasium for regular pro¬ gram work; two special exercise rooms; a standard intercollegiate-size swimming pool with seating for approximately 400 spectators; class¬ rooms and offices; locker space and shower rooms; and equipment storage and other related spaces. Plans and specifications were in preparation for the construction of a proposed new classroom building for the college of liberal arts and a new women’s residence hall. Construction is expected to begin near the end of this school year. In addition, the university leased a facility to serve as a warehouse service building. The university began a program of intensive study of its educational and physical plant needs for a number of decades in the future. The present master development program was completed in 1951. Its basis, however, rests essentially on a program which was designed in 1931. In view of the severe limitations placed upon its growth by t lie present limited campus, the university is endeavoring to make an even more intensive use of its present land resources, as well as exploring wa}7s of expanding its campus area. Detailed Contents THE SECRETARY’S REPORT Page To Promote the General Welfare.. ....... _ 1 Organization for Action. . _ 2 Past as Prologue _ 3 Progress— 1962. 4 Tasks for Tomorrow _ 9 Table 1. — Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1962 _ 12 SOCIAL SECURITY ADMINISTRATION SOCIAL SECURITY IN 1962_ . _ 13 International Activities _ 17 Cuban Refugee Program 19 Assistance Provided to Cuban Refugees. _ _ _ 22 Unaccompanied Cuban Refugee Children’s Program _ 22 OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE _ 23 Unmet Needs. 26 Health Insurance for the Elderly. _ _ . _ 26 Keeping Benefits Up To Date _ ...... _ _ 29 Extension of Program Coverage _ 31 Disability Insurance 34 The Retirement Test _ 35 Other Objectives _ _ _ _ . .. _ 36 What the Program Is Doing. _ _ _ 36 Beneficiaries and Benefit Amounts _ _ _ _ _ 36 Disability Provisions _ 38 The Protection Provided. _ 39 Income and Disbursements. 40 Administering the Program . _ _ 41 Research Activities _ . ... . ... _ 47 Financing the Program _ _ . 48 Old-Age and Survivors Insurance Benefits. _ 49 Disability Insurance Benefits _ 49 Summary and Conclusions _ _ _ _ _ _ 49 BUREAU OF HEARINGS AND APPEALS _ _ 50 PUBLIC ASSISTANCE _ 55 Administrative Actions in Fiscal 1962 _ _ __ . 57 State Agency Reaction to Administrative Changes _ 58 421 422 Department of Health , Education , and Welfare , 1962 Page Public Welfare Amendments of 1962 _ 59 To Promote Self-Reliance _ 60 To Upgrade Staff Skill in Providing Services _ 61 To Provide Work Incentives and Encourage Efforts To Achieve Self-Support _ 61 To Extend the Adequacy and Scope of Public Assistance _ 62 To Assure More Effective Administration _ 63 Trends in Caseloads and Expenditures _ 64 Caseloads _ 64 Expenditures _ 66 Source of Funds for Public Assistance Payments _ 68 Program Developments _ 68 Developments in Medical Care _ 68 Medical Assistance for the Aged (MAA) _ 69 Increased Medical Care Provisions Under Old-Age Assistance (OAA) _ 72 Efforts To Improve Medical Care Programs _ 75 From Work Relief to Work and Training _ 77 Effect of Federal Aid to the Unemployed _ 79 Assistance to U.S. Citizens Returned From Foreign Countries _ 80 Civil Defense Emergency Welfare Services _ 82 Administrative Developments _ 82 Welfare Services _ 83 Administrative and Fiscal Standards _ 84 Staff Development _ 1 85 Program Interpretation _ 87 International Activities _ 87 CHILDREN’S BUREAU _ 88 Legislative Developments _ 92 Public Welfare Amendments of 1962 _ 93 Intercountry Adoptions _ 95 Juvenile Delinquency _ 95 1962 Appropriations for the Children’s Bureau _ 95 Youth Development Unit _ 96 The Interdepartmental Committee on Children and Youth _ 96 The National Committee for Children and Youth _ 97 Services to State Committees for Children and Youth _ 97 United Nations International Children’s Fund (UNICEF) _ 98 Civil Defense _ 98 Programs of the Bureau _ 99 Research in Child Life _ 99 Technical Research _ 99 Statistical Reports _ 101 Research Interpretation _ 101 Health Services for Mothers and Children _ 102 Maternal and Child Health Programs _ 102 Crippled Children’s Services _ 106 Child Welfare Services _ 107 Research and Demonstration Projects in Child Welfare _ 107 Teamwork To Improve Child Welfare and Family Services _ 108 Financing the Ongoing Child Welfare Program _ 108 Improvement in Child Welfare Services _ 109 Steps To Meet Continuing Staff Shortages _ 109 Changes in State Structure for Services _ 109 Development of Child Welfare Services in Specialized Areas _ 110 Detailed Contents 423 Page Juvenile Delinquency Service. 113 International Activities _ _ ..... 115 International Research (Foreign Currency Program) 115 International Training. 116 Assistance to Other Training Agencies _ _ 118 Summary _ _ 118 BUREAU OF FEDERAL CREDIT UNIONS. 118 Consumer Protection. ........ 120 Student Loans for Higher Education. 120 Manpower Utilization _ 120 Strengthening Research and Statistics _ . _ 121 InternaTxONal Activities _ .121 Extending Coverage to Low-Income Groups. . 122 Table L — Social Security Administration: Funds available and obliga¬ tions incurred, fiscal years 1962 and 1961. 123 Table 2. — Financing social insurance under the Social Security Act: Contributions collected and trust fund operations, fiscal years 1960-62. _ 124 Table 3. — Old-age, survivors, and disability insurance: Number of fam¬ ilies and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of December 1961 and December 1960 _ 125 Table 4. — Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1962 and amount of benefit payments in fiscal year 1962, by State _ 126 Table 5. — Old-age, survivors, and disability insurance: Selected data on employers, workers, taxable earnings, and contributions, by State for specified periods _ _ 128 Table 6. — Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1960-62 _ 129 Table 7. — Special types of public assistance under plans approved b> the Social Security Administration: Number of recipients and average pay¬ ment, June 1962, and total payments to recipients, by program and State, fiscal year 1962. 130 Table 8. — Special types of public assistance under plans approved by the Social Security Administration: Federal grants to States and total ex¬ penditures and percent from Federal funds, by program and State, fiscal year 1962 _ ... 132 Table 9. — Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, child welfare services, and research or demonstration projects in child welfare under the Social Security Act, by program and State, fiscal year 1962. _ 134 Table 10. — Federal credit unions: Assets, liabilities, and capital, Dec. 31, 1960, and Dec. 31, 1961 _ 135 Table 11. — Federal credit unions: Selected data on operations, as of Dec. 31, for each year 1934-61 135 Table 12. — Federal credit unions: Selected data on operations, by asset size and State, 1961. . . ... _ . 136 Chart 1. — 82 percent of aged beneficiaries had half or more of their retire¬ ment income from benefits _ 24 Chart 2. — When hospitalization becomes necessary, medical costs for the aged run high _ 27 424 Department of Health , Education , and Welfare, 1962 Page Chart 3. — Old people go to the hospital more often and stay longer than younger persons _ 28 Chart 4. — Between 1940 and 1961 the percentage increase in average earn¬ ings exceeded the percentage increase in average benefits _ 30 Chart 5. — -The earnings base covers the total annual earnings of a smaller percentage of regularly employed men than in the past _ 32 Chart 6. — 9 out of 10 workers are covered under the OASDI program _ 33 Chart 7. — Both benefit payments and number of beneficiaries have in¬ creased rapidly since 1950 _ 38 Chart 8. — The number and percentage of population aged 65 and over eligible for OASDI benefits are increasing _ 40 Chart 9. — Hearing requests: total received, cleared, and pending _ 51 Chart 10. — Reviews before Appeals Council: receipts, disposals, and pending _ 53 Chart 11. — Cumulative civil actions filed, decided, and pending, Decem¬ ber 1957 through June 1962 _ _ 54 Chart 12. — Why increased public assistance expenditures? _ 56 Chart 13. — Medical assistance for the aged: average payment per recipient for vendor payments for medical care, June 1962 _ 74 Chart 14. — Vendor payments for medical care _ 75 Chart 15. — Salary, public assistance caseworker and other selected posi¬ tions, July 1962 _ 85 Chart 16. — Increasing child population _ 90 Chart 17. — Births out of wedlock are increasing _ 91 Chart 18. — Trends in juvenile court delinquency cases and child popula¬ tion 10 to 17 years of age, 1940-60 _ 92 Chart 19. — Maternal and child health services are reaching more people - _ 103 Chart 20. — Trend in the number of children served in the crippled chil¬ dren’s program and in the number per 1,000 children under 21, 1937-60- 106 Chart 21. — Child welfare agencies provide social services for children- _ 111 PUBLIC HEALTH SERVICE HEALTH OF THE NATION _ 139 Health Record _ 143 Births, Marriages, and Divorces _ 146 Funds _ 147 Office of Personnel _ 147 Personnel _ 148 National Center for Health Statistics _ 148 National Health Survey _ 148 National Vital Statistics Division _ 149 Office of Electronic Systems _ 150 Office of Health Statistics Analysis _ 150 National Library of Medicine _ 150 Board of Regents _ 151 Science Translation Program _ 151 Program Statistics _ 151 Division of Public Health Methods _ - 152 Organizational Changes _ 152 Professional Education _ 152 Health Manpower _ 153 Detailed Contents 425 Page Division of International Health _ 154 Division of Health Mobilization _ 155 BUREAU OF MEDICAL SERVICES _ 157 Division of Hospitals _ 158 Volume of Patient Care _ _ . . 158 Cooperation Regarding Narcotic Problems _ 158 Research _ _ 159 Professional Training _ 159 Goals for Future _ 160 Federal Employee Health Program _ 160 Freedmen’s Hospital _ 160 Foreign Quarantine _ 161 Quarantinable Diseases _ 1 62 International Traffic _ 162 Medical Examinations _ 163 Establishment of Fee _ 163 General Program.. _ 163 Immigration of Tuberculous Aliens _ _ _ _ 163 Additional Change in Immigration Law 164 Migratory Farm Labor _ _ _ . 164 Entomology and Sanitation Programs _ 164 Other Quarantine Activities _ _ 164 Health Services for Indians and Alaska Natives- 165 Medical Facilities _ 165 Health Results _ 165 Professional Staff _ _ _ 1 66 Health Education _ 166 Therapeutic Services _ 167 Maternal and Child Care _ _ __ _ _ 168 Tuberculosis _ _ _ _ 168 Dental Health _ 168 Environmental Sanitation _ 169 Training for Indians and Alaska Natives _ 169 Construction Activities _ 170 Prospects for the Future _ 170 Medical Services for Federal Agencies _ 170 United States Coast Guard, Treasury Department _ 170 Bureau of Employees’ Compensation, Department of Labor _ 1 7 1 Maritime Administration, Department of Commerce _ 172 Bureau of Prisons, Department of Justice _ - _ 172 Plans for New Psj^chiatric Hospital _ 172 Recommendations of Advisory Committee _ 173 Hospital Improvements _ 173 Clinical Services _ 173 Demonstration Counseling _ 174 Research _ 174 Participation in Community Affairs-- __ 174 BUREAU OF STATE SERVICES _ 175 Division of Accident Prevention _ 175 Division of Chronic Diseases _ 177 Cancer Control _ 177 Demonstration Projects _ 177 Clinical Traineeships, State Grants _ 178 665171—63 - 28 426 Department of Health, Education, and Welfare, 1962 Page Diabetes and Arthritis Program _ 178 Program Application _ 178 Applied Research _ 178 Heart Disease Control Program _ 179 Heart Disease in Children _ 179 Heart Disease in Adults _ 179 Neurological and Sensory Disease Service Program _ 180 Project Grants _ 180 Vision Conservation _ 180 Hearing Conservation _ 181 Health Services for Long-Term Illness Program _ 181 Support of Projects _ 181 Development of Materials, Data Collection _ 181 Communicable Disease Center _ 182 Epidemic and Disaster Aid _ 183 Representative Disease Studies _ 183 Quota Sample Surveys _ 183 Venereal Diseases _ 183 Tuberculosis _ 184 Influenza _ 184 Poliomyelitis _ 185 Measles Vaccine Trials _ 185 Leprosy, Other Diseases _ 185 Laboratory _ 185 Audiovisual _ 186 Training _ 186 Division of Community Health Services _ 186 Grants for Improving Community Health Services _ 187 Special Project Grants _ 187 Formula Grants _ 187 Training _ 187 Migratory Agricultural Workers _ 188 Other Division Activities _ 188 Division of Dental Public Health and Resources _ 188 Strengthening Manpower and Educational Resources _ 188 Special Patient Care _ 189 Dental Care Financing Plans _ 189 Attitude Studies _ 190 Combating Dental Diseases _ _ _ 190 Improving Dental Public Health Practice _ 190 A National Dental Center for Research and Training _ 190 Division of Hospital and Medical Facilities _ 191 Program Highlights _ 191 The Construction Program _ 191 Research Activities _ 192 Unmet Needs _ 192 Division of Nursing _ 192 Training in Restorative Nursing _ 192 Out-of-Hospital Nursing Care _ 193 Hospital Nursing _ 193 Field Center for Nursing Studies _ 193 Manpower and Related Studies _ 194 Professional Nurse Traineeship Program _ 194 Support of Extramural Research and Research Training _ 195 Detailed Contents 427 Page Intra- Agency Cooperation-- - _ _ - - - - 195 Division of Air Pollution _ 195 Research _ 195 Instrumentation, Sampling, and Analysis _ - _ 196 Technical Assistance and Training _ 196 Goals _ 196 Division of Environmental Engineering and Food Protection _ 197 Milk and Food Branch _ 197 Shellfish Sanitation Branch _ _ _ 197 Special Engineering Services Branch _ 198 Interstate Carrier Branch _ _ _ _ _ _ 198 Division of Occupational Health _ 198 Division of Radiological Health _ 200 Environmental Surveillance _ 200 State Assistance _ 201 Research _ 201 Training _ 201 Division of Water Supply and Pollution Control _ 202 Construction Grants, Program Grants _ 202 Basic Data _ 203 Enforcement _ 203 Research and Training _ 203 Comprehensive Programs, Interagency Coordination _ _ 204 Advisory Board _ 204 THE NATIONAL INSTITUTES OF HEALTH. 204 Institute of Allergy and Infectious Diseases _ _ 208 Institute of Arthritis and Metabolic Diseases _ 209 Cancer Institute _ 210 Institute Research _ 211 Grant-Supported Research _ _ _ 212 Institute of Dental Research _ 213 Grants and Awards _ 213 Heart Institute _ 214 Grant-Supported Research _ 215 Institute of Mental Health _ 216 Grant-Supported Activities _ 216 Basic and Clinical Intramural Research _ 217 Community Services and Program Development _ 218 Training _ 218 Institute of Neurological Diseases and Blindness _ 218 Collaborative Perinatal Research _ 218 Primate Research in Puerto Rico _ 219 Multiple Sclerosis, Muscular and Neuromuscular Diseases, Epilepsy _ 219 Vision, Hearing, Headache _ 220 Division of Bi oi.ogics Standards _ 221 Division of General Medical Sciences _ 222 Research Grants _ 222 Research Training Grants _ 222 The General Clinical Research Centers _ 222 Center for Research in Child Health _ 223 Center for Aging Research _ 223 General Research Support Grants _ 223 Special Resource Centers _ 223 Division of Research Grants _ _ 224 428 Department of Health , Education , and Welfare , 1962 Page Division of Research Services _ 224 Clinical Center _ 225 Table 1. — Statement of appropriations, authorizations, and obligations, Public Health Service, fiscal year 1962 _ 226 Table 2. — PHS total paid employment by Bureau and Division, as of June 30, 1962 _ 228 Table 3. — PHS total paid employment by Bureau, commissioned officers, and civil service, as of June 30, 1962 _ 230 Table 4. — -Research grants and awards, fiscal year 1962 _ 231 Table 5. — Payments to States or localities within States for public health services, fiscal year 1962 _ 232 Chart 1. — Public Health Service — 1962 _ 141 Chart 2. — Death rates by age and sex, 1945-61 _ 144 OFFICE OF EDUCATION HIGHLIGHTS OF THE YEAR’S ACTIVITIES _ 235 Social Problems and Education _ 237 Problems of Urban Areas _ 237 Freedom and World Understanding _ 239 Equal Opportunity for Education _ 239 Special Programs _ 240 Exceptional Children _ 240 Captioned Films for the Deaf _ 241 Early School Leavers _ 242 Physical Fitness Survey _ 243 Programs and Service for Adults _ 243 Training the Unemployed _ 244 Civil Defense Education _ 244 Interagency Cooperation _ 245 International Organizations and Programs _ 247 EDUCATIONAL RESEARCH AND DEVELOPMENT _ 248 Elementary and Secondary Education _ 248 Strengthening State Departments of Education _ 248 Staff in Public Schools _ 249 Facilities Needed _ 251 Financing Public Education _ 254 Local School Revenue _ 255 State Funds for Schools _ 256 Federal Support _ 258 Offerings and Enrollments _ 259 English _ 259 The Arts _ 259 Foreign Languages _ 259 Science _ 261 Mathematics _ 263 Guidance and Testing Services _ 264 Identifying Talent _ 264 Testing Programs _ 265 Professional Personnel _ 265 Higher Education _ 267 Administrative Problems and Services _ — - 267 Students and Curriculum _ 270 Detailed Contents 429 Page Land-Grant Institutions _ 276 Federal Programs _ 276 Educational Statistics _ 277 Sponsored Research _ 279 Cooperative Research Program _ _ 279 Project Talent _ 280 Project English _ 280 Project Social Studies _ 282 New Educational Media _ 282 Research _ 282 Dissemination of Information _ 283 EDUCATIONAL ASSISTANCE PROGRAMS _ 286 New Federal Legislation. _ _ 286 Federally Impacted Areas _ 287 Vocational and Technical Education _ 290 Area Vocational Education _ 291 Trade and Industrial Education _ _ 292 Distributive Education _ 293 Agricultural Education _ 293 Office Education _ 294 Home Economics Education _ 295 Training and Retraining _ 295 Area Redevelopment Act _ 295 Manpower Development and Training Act _ 296 Programs in Higher Education _ 296 Land-Grant Colleges _ 296 Teachers of the Deaf _ 296 National Defense Education Act _ 297 LIBRARY SERVICES _ 299 INTERNATIONAL EDUCATION _ 302 Educational Exchange and Technical Services _ 304 Teacher Exchange Program _ 304 Teacher Development Program _ 305 Technical Assistance Training Program _ 305 Nongrant Visitor Programs _ 306 International Assignments for Specialists _ _ 306 Clearinghouse on Educational Exchange _ 306 Credential Evaluation _ 307 International Studies _ 307 Educational Materials Laboratory _ 308 Table 1. — Enrollment in grades 9-12 in public and nonpublic schools, and population 14-17 years of age: United States, 1889-90 to 1961-62. _ 254 Table 2. — Office of Education enrollment estimates: United States, 1960- 61 and 1961-62 _ 257 Table 3. — Gross national product related to total expenditures for educa¬ tion: United States, 1929-30 to 1961-62 _ 258 Table 4. — Earned degrees conferred by institutions of higher education: United States, 1869-70 to 1961-62 _ 276 Table 5. — Grants and other financial assistance to States, administered by the U.S. Office of Education, fiscal year 1962 _ 288 Chart 1. — Changes within the public elementary and secondary school system, United States 1957-58 to 1959-60 _ 250 430 Department of Health , Education, and Welfare, 1962 Page Chart 2. — Summary of expenditures for public elementary and secondary schools: United States, 1959-60 _ 252 Chart 3. — Revenue receipts for public elementary and secondary schools, by source: United States, 1959-60 _ 256 Chart 4. — Trends in enrollment in full-time elementary and secondary day schools: United States, fall 1954 to fall 1961 _ 260 Chart 5. — Approximate retention, fifth grade through college entrance: United States, 1924-32 and 1954-62 _ 266 Chart 6.— Percentages of degree-credit students enrolled in various types of institutions of higher education: United States and outlying parts, fall 1961 _ _ _ 271 Chart 7. — Total degree-credit enrollment in relation to population aged 18-21: United States, fall 1939 and fall 1946 through fall 1961 _ 273 Chart 8. — Trends in degree-credit enrollment for 4-year institutions and junior colleges, by types of institutional control: United States and outlying parts, fall 1939 and fall 1947 through fall 1961 _ _ 275 Chart 9. — Vocational education enrollments and expenditures: United States, 1935-65 _ 290 FOOD AND DRUG ADMINISTRATION Introduction _ 311 Administrative Progress _ 318 Food, Drug, and Cosmetic Act _ 321 On the Food Front _ 321 Radioactivity in Foods _ 321 Chemicals in Foods _ 321 Other Harmful Contaminants _ 324 To Keep Food Clean _ 326 Pocketbook Protection _ 329 Foods for Special Dietary Purposes _ 330 Nutritional Quackery _ 331 Drugs and Devices _ 334 Illegal Sales of Prescription Drugs _ 335 Safety Controls _ 337 Counterfeit Drugs _ 338 Repacked Physicians’ Samples _ 338 Medical Quackery _ 339 Medicated Feeds _ 340 New Drugs _ 341 Devices _ 343 Cosmetics and Colors _ 345 Certification Services _ 346 Federal Hazardous Substances Labeling Act _ 347 Enforcement of Other Acts _ 348 Civil Defense _ 348 New Court Interpretations _ 348 Changes in the Law and Regulations _ 350 Regulations _ 351 Scientific Investigations _ 355 Enforcement Statistics _ 360 Conclusion _ 361 Detailed Contents 431 Page Table 1. — Actions on foods during the fiscal year 1962 _ 327 Table 2. — Number of samples on which criminal prosecutions and sei¬ zures were based and number of court actions instituted during the fiscal year 1962 _ _ 361 Table 3. — Import samples collected, examinations made, and lots de¬ tained during the fiscal year 1962 _ 361 Chart 1. — Retail sales of food in the United States, calendar years 1952-61 _ 314 Chart 2. — Retail sales of drugs in the United States, calendar years 1952-61 _ 314 Chart 3. — Retail sales of cosmetics in the United States, calendar years 1952-61 __ 315 Chart 4. — Budgeted positions for Food and Drug Administration enforce¬ ment operations (excluding fee-supported certification services), fiscal years 1953-63- 319 Chart 5. — Time (in man-years) spent on FDA research for enforcement and certification, fiscal years 1957-63 _ 356 OFFICE OF VOCATIONAL REHABILITATION Halfway to a Long-Time Goal__ _ _ _ _ 363 The Steady Climb Since 1954 _ 364 Seeking Out the Disabled _ _ _ _ _ 367 The Growing Funds for State Programs 368 A New Look at Rehabilitation. _____ _ 370 Research — Window on Progress _ _____ 370 The Mechanics of Research _ 370 The Program Begins To Move _ _ 371 Help for the Mentally Retarded _ _ 371 More Aid for the Mentally III _ 374 Better Sight for Better Jobs _ 374 The Rehabilitation Complexities of Older Persons _ 375 The Disabled Worker _ 376 The Severely Disabled Worker _ _ _ _ 377 Living Without Sight _ 378 The Tragedy of the Deaf-Blind _ _ 379 The World Without Sound _ 380 Training for a Complex Program _ _ 381 Rehabilitation Medicine — A New Speciality _ _ _ _ 382 The Rehabilitation Counselor _ 383 Meeting Other Shortages _ 384 The Rehabilitation Team _ _ 384 The Social Worker in Rehabilitation _ 385 The Rehabilitation Facility _ 386 Rehabilitation Around the World _ 388 The Hard Fight Against Dependency _ 389 Table 1. — Number of referrals and cases, by agency, fiscal year 1962 _ 391 Table 2. — Vocational rehabilitation grants, 1962, State divisions of vocational rehabilitation _ 393 Table 3. — 'Vocational rehabilitation grants, 1962, State commissions or agencies for the blind _ 394 432 Department of Health, Education, and Welfare, 1962 Page Chart 1. — Rehabilitations by years _ 364 Chart 2. — Principal causes of disability among 1962 rehabilitants _ 366 Chart 3. — Major occupations of rehabilitated persons in 1962 _ 367 Chart 4. — Sources of referrals of 1962 rehabilitants _ 368 Chart 5. — Funds for State vocational rehabilitation programs _ 369 Chart 6. — Federal funds expended for research and training in vocational rehabilitation _ 372 Chart 7. — Persons of 45 years or more rehabilitated, 1945-62 _ 375 Chart 8. — 1952 training grants in areas of shortages of personnel in voca¬ tional rehabilitation. _ _ 382 SAINT ELIZABETHS HOSPITAL Psychiatric Services _ 399 Medical and Surgical Branch _ 399 Nursing Branch _ 400 Clinical Training Branch _ 400 Psychology Branch _ 400 Recreational Therapy Branch _ 400 Occupational Therapy Branch _ 401 Volunteer Branch _ 401 Social Service Branch _ 401 Biometrics Branch _ 401 Medical Records Branch _ 402 Laboratory Branch _ 402 Sanitary Engineering Branch _ 402 Chaplains Branch _ 402 Library Services _ 403 Office of Personnel _ 403 Division of Administration _ 404 Needs of the Hospital _ 404 Table 1. — Patients, admissions, and discharges, fiscal years 1935-62 _ 405 Table 2. — Patients on the rolls, by status and by sex, time since admis¬ sion, ethnic group, and age, June 30, 1962 _ 405 Table 3. — Movement of patients on the rolls, by sex, time since admission, ethnic group, and age, fiscal year 1962 _ 406 Table 4. — Patients on the rolls by status and legal category, June 30, 1962 _ 407 Table 5. — -Movement of patients on the rolls by legal category, fiscal year 1962 _ 408 Table 6. — Discharges by status from which discharged and by condition, environment, and employment, fiscal year 1962 _ 409 AMERICAN PRINTING HOUSE FOR THE BLIND Services of Schools and Classes for the Blind _ 411 GALLAUDET COLLEGE The College’s Activities _ 413 Detailed Contents 433 HOWARD UNIVERSITY Page Enrollment of Students _ 415 Geographical Distribution of Students _ 416 Veterans _ 416 Army and Air Force ROTC _ 416 The Faculty _ _ 417 Graduates _ 417 Public Service at Home and Overseas _ 418 The Building Program _ 419 U S. GOVERNMENT PRINTING OFFICE: 1963 : . .... . ' - -