HEALTH, EDUCATION, AND WELFARE L960 HEALTH, EDUCATION, AND WELFARE ANNUAL REPORT For sale by the Superintendent of Documents U.S. Government Printing Office Washington 25, D.C. - Price $1.00 as t ‘ v Pr. | | 10 ThaMTHAae SSH FeASua. voirasues wre Qt | a oe aes ~ * 6 J =. “ * yrs) % a pe Oe ¥ ae a “Puy Ry. i CTs * y a ‘ i] bos ? a wip -_ ; a SP ; ; ra > i - ->, \o\ j : . 7) ak | 1 geal}: 3 =i ane a) Ay wry a es eo dy J Xo Nita : Fl a “ n.! ed i ets) Yo Sage ber attaky py? ahs oF claw ef Ps ait OD sulpeis'T need 2c OTE mT. 6), Oe watgxidn F U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1960 Artuur S. FLEMMING, Secretary Bertua §. Apxins, Under Secretary OFFICE OF THE SECRETARY Ropert A. ForsytHE ... . Assistant Secretary (for Legislation). Epwarp Foss Wiuson . . . . Assistant Secretary. WICANOY “c.f. Fs ee Special Assistant for Health and Medical Affairs. Byron E. Harter. . .... Legislative Liaison Officer. JAROLD A. KIEFFER ..... Assistant to the Secretary (for Program Analysis). RUMOR ATT Shc. at's. ommih swaths Assistant to the Secretary (for Public Affairs). PARKE M. BANTA .ctele «sien s General Counsel. Rurvus E. Mitzes, JR .. . . Director of Administration. Cuustnr B. LuND...... Director of Field Administration. HaRyEY A. BUSH . ...-+ . - Director of Public Information. FREDERICK H.Scumipr .. . Director of Security. SOCIAL SECURITY ADMINISTRATION Wiuuram L. MitcHett . . . . Commissioner of Social Security. JosppH H. Mnyrers ... . . Deputy Commissioner of Social Security. . Victor Curistgau .. . Director, Bureau of Old-Age and Survivors In- surance. Karuryn D. Goopwin. . Director, Bureau of Public Assistance. J. Deane Gannon. . . . Director, Bureau of Federal Credit Unions. KATHERINE B, OrnTtTinceR. Chief, Children’s Bureau. PUBLIC HEALTH SERVICE Leroy E. BURNEY. ..... Surgeon General. Joun D. PorterFIELD . . . . Deputy Surgeon General. James V. Lowry .. . . Chief, Bureau of Medical Services. CHARLES E. Bursripce . Superintendent, Freedmen’s Hospital. Davin E. Prick... . Chief, Bureau of State Services. James A. SHANNON .. . Director, National Institutes of Health. OFFICE OF EDUCATION LAWRENCE G. Dertuick . . . Commissioner of Education. Wayne O. REED... .. Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION Greorce P. Larrick ..... Commissioner of Food and Drugs. JOHN in LL ARV Yes see tes ee Deputy Commissioner of Food and Drugs. il iv. Department of Health, Education, and Welfare, 1960 OFFICE OF VOCATIONAL REHABILITATION Many Ho SWITZER ao caLens Director of Vocational Rehabilitation. E. Emory FeEREBEE ... . . Deputy Director of Vocational Rehabilitation SAINT ELIZABETHS HOSPITAL WINFRED OVERHOLSER. . . . Superintendent. Vacanex tf AG 2a . .. . Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Fints Davis .... . . . . Superintendent, American Printing House for the Blind. Leonarp M. Exsrap. . . . . President, Gallaudet College. Morpscat W. Jonnson .. . President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN . . Region I, Boston, Mass. JosEpH B. O’Connor ... . Region II, New York, N.Y. Epmunp W. Baxter. ... . Region III, Charlottesville, Va. Ricoarp H. Lyte... .. . Region IV, Atlanta, Ga. Metvitte H. Hosco. : . 2 Region V, Chicago, Til. JamMES W. DoaRN ...... Region VI, Kansas City, Mo. JAMEs‘H. > Bonn 7.72. USS 5 Region VII, Dallas, Tex. AuBert H. RosentHau. . . . Region VIII, Denver, Colo. so FAY W. HUNTER =s2 oe Region IX, San Francisco, Calif. Letter of Transmittal DeEpPaRTMENT OF HeattH, Epucation, AND WELFARE, Washington, D.C., December 1, 1960. Dear Mr. Presipent: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1960. Ge 4 Secretary. Respectfully, THE PRESIDENT, Tue Wuire Hovss, Washington, D.C. IIVMWH ViAsSViIV edesoyouy nom WOO Al} \ y wv \ | SGNV1S1 NIDUIA “O18 OLYINd \ + autre Il os Wee eae —,. 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SadijJQ pue Salepunog jeuoisey JUVITIM ONY ‘NOILVINGI ‘HLIW3H 40 LNIWLYVd30 SN Contents Page PERE OOTOOTY tees wi pec se es a ae sone eS 1 Social Security Administration ...........- ae by REA CULEE SELUICE seve a's, gs eee Caen a eee ee 93 ERSTE les Neste a aa Ae oN 179 Demana Urip Administration . . 2... 2 fs 231 Office of Vocational Rehabilitation ............ 261 peer a caverns Hospital >... so. eee sso 8s 287 American Printing House for the Blind. ......... 297 EIEPREC COLL OG s var cS tava ain a eis, “ae OG DE a et woh a 299 MEMES ELICTSELY dhol «rides sittin © Yio nies | Afie aba os 301 os detailed listing of the contents of this report, v4, topic headings, will be found on pages 307-314. a * e. a» « HO ay Eee. oe ea sehen Be srossatsbidnro A \pnoitm f + ie oe "i bets wu. bes Woe @ ee oe we ot A oct SOLS aia Lito tk. : i | lye , tremon @HEt Do nett nm add to naizail AILTOE eg rte Dawe ot Tie . ; 2 ‘ | t ~ Office of the Secretary _ Tue Orrice 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, 1960 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 (for 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 (for 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 3800 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 3 Table I.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1960 States, Territories, and possessions Total 80, 435, 586 {On checks-issued basis! Ameri- Office of | White can Social Secu- Public Office of |Vocational| House | Print- rity Admin- Health | Education | Rehabili- | Confer- ing istration Service ! tation ence on | House Aging | for the lind 2 $2, 730, 641, 306/$2, 106, 328, 929}$217, 515, 554/$357, 020, 720)$48, 606, 903) $759, 200) $410, 000 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] ......-5 26, 380, 743 16, 340, 457 1, 827, 698 7, 765, 577 428, 577 15, 000 3, 434 43, 272, 823 34, 141, 571 4,467,808} 3,531,233} 1,111,893 15, 000 5, 318 282, 010, 464 225, 581,317} 10,812,725 42) 789, 413) 2,778, 184 15,000} 33,825 47, 447, 460 36, 896, 039 2, 152, 706 7, 823, 727 555, 794 15, 000 4,194 21, 433, 998 16, 299,036] 2,026, 545 2 692, 535 391, 157 15, 000 9, 725 4, 392, 609) 2, 502, 713 637, 750 1, 057, 488 181, 212 12, 200 1, 246 10, 685, 771 9, 132, 640 956, 478 347,915 232, 887 15, 000 851 80, 253, 332 62, 705, 676 6, 534,488} 9,262,718) 1,723, 567 15, 000 11, 883 85, 869, 533 68, 153,335) 7,113,633) 8,258,474] 2,318,545) 15,000} 10,546 10, 355, 045 4, 218, 072 2,010, 927 3, 884, 371 224, 851 15, 000 1, 824 12, 524, 026 7, 232, 904 2,202, 876] 2,896, 786 175, 639 15, 000 821 109, 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 O05, OOS) ooo ad oe 7,172 37, 998, 452 30, 439, 559 3, 520,957| 3, 033, 531 984, 968 15, 000 4, 437 36, 951, 262 25, 793, 666] 3,318, 554 7, 223, 855 595, 537 15, 000 4, 650 57, 735, 472 48, 243, 310 5, 174, 215 3, 760, 073 537, 586) 15, 000 5, 288 118, 134, 250 106, 120, 910 6, 544, 010 4,222,103} 1,225,024 15, 000 7, 203 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 bMiionigan <=... 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 MUINHOUTE SoCo cece 104, 146, 041 90, 545, 309 6, 680, 405 6, 016, 035 882, 606 15, 000 6, 686 MORINS_...5=...- 12, 365, 905 6, 931, 859 1, 563, 611 3, 644, 597 219, 197) 5, 000 1, 641 Webraskac?.--.- 22. 20, 315, 768 14, 500, 815 2, 261, 512 3, 188, 832 346, 995: 15, 000 2, 614 NOG GD ee a 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, 252 172, 021, 517 145, 977, 389} 10,054,368) 12,717,548) 3,213, 541 15, 000 43, 671 72, 622, 368 53, 143, 250 9, 464, 723 7, 852,948] 2,133,440 15, 000 13, 007 10, 976, 131 7, 264, 619 1, 409, 867 2, 021, 073 264, 630 15, 000 942 104, 464, 228 85, 083, 904 8,930,002} 9,237,922) 1,175, 245 15, 000 22,155 91, 941, 263 75, 748, 634 3,002, 982} 11,955,298) 1, 216, 553 15, 000 2, 796 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 2 338,305] 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 ennedses..........- 57, 682, 702 44° 015, 341 6, 822, 179 5, 317, 888] 1, 504, 149) 15, 000 8, 145 vil Se er 163, 035, 141 127, 162, 691 9,507,601} 24,697,763] 1, 638, 653 15, 000 13, 433 ie 14, 669, 990 9, 718, 679] 1, 585, 925 , 040, 395 08, 502} 15,000 1, 489 WEFMONfs..6=5 25... 6, 784, 297 5, 001, 624 974, 565 607, 691 184, 961 15, 000 456 Wo 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 , 790, 286] 1, 205, 719 15, 000 4, 680 Wisconsin....--..--- 40, 004, 855 80, 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----_---- Ol J nccteten conse bose ce 0 eS yp Te EOS oe Se - ld Les ib i rf ted sche LS ¥ ye, i ey Ma : ‘ ¥ \ Tae , wot AG Al } id> ’ ‘ A { ' an ¥ « mal t c * ® - + . 1 ’ sm , ¥ } a F . rl S t " fod are | mw . } ‘ ake The : : ’ - a a ¢ an) & ce ee | “ wee % A at va ' } a ' ' 5 > - ‘ = f je. re 7 - a 5 7 > ‘ ae + io _ « SS trie ad cnt io] “ r= a re, eS -* i pues ht ety , hy z SNe Re: a ie ord apt eh iO gay ainientc agin fl BOG 01? i CBee lla Ihe nat te pe ae 3 ‘ unt 1h ed gta te qiFs é Tee ST ic as laa tt Ab Zee) Ot hoot tah Eis wD 8 Mo Wake me Te e kt hase a> pSeret pa 1 Ane ia 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, 1960 ® 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 514 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 the 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 38 years, from 3,800 in 1955 to 23,250 in 1958. The hearing workload on July 1, 1959, was 12,445 cases, of which 9,475 were related to disability issues. During the fiscal year 18,355 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. Requests 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 internationally was reflected in a number of United States Information 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 first time, with an International Service staff member presenting ma- terials and leading discussions. During the fiscal year the Social Security Administration’s In- 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 tee 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 li ill a tl Te Ee 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 Bureaw’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 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 176,000 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 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 Social Security Administration 21 in June. About 151,000 benefits were being paid in June to dependents 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. For 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 insured workers—whose disability began before age 18. During the fiscal year 28,000 persons met the disability requirements for child’s 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. 2p, 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 a i lin aaa lth RRs Raa The Federal Disability Insurance Trust Fund was created by the Social Security Amendments of 1956. Contributions to this fund first became payable in January 1957. Benefit disbursements began in August 1957. Expenditures from the Federal Disability Insurance Trust Fund during 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 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 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 relationship was more favorable than in recent years, when staffing was undesirably tight. Asa 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 inquiries concerning the old-age, survivors, and disability insurance program. The subcommittee appointed by the Chairman of the Committee 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 Rulings,” a revised edition of the “Social Security Handbook,” and the updating and expansion of the Social Security Regulations. The first quarterly issue of “Social Security Rulings,” 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 Regula- 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 Regulations 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, 8 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 ILI-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 IlI-705 is in file reference techniques. The Model IIT 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 III-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. AI] 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. Following 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 ee 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). As a 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 know 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 waiting 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 organza- 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. NMiscellaneous.—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 asample 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 Simp lification 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 1960 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 Federal 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 ap a a Mm 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 14 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 rethedtal 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 Federal 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, 1960 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 83 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 Jjuris- 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 18 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,” * 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 needy 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 oe ea eae a ae 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, 1960 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 ce. 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) ; ce. 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 i eae Ae a EES eae 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 Bureaw’s report, JJlegitimacy 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 estab- 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.’ 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 3.83 percent, 2.2 percent, and 8.7 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 $63.87 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. 2General 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, 1960 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 a NA ah RE ee 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 cliscussion 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 a 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.’ 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.* ' 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 Hmergency 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 sR a a a A cm 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.—F ollowing 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 Joimt 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 17 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 pill 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. Hisenhower. For the next three mornings, Conference par- 60 Department of Health, Education, 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 Forums, experts presented facts and issues related to specific aspects of the life of children and youth. For three afternoons, the participants jomed 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 Zhe 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 Rico; (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 7'he 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, Z'rends—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 Your Child From One to Sia, 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 fesearch, 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 Federal 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 95.7 (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 nonwhite 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, VizZ., 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 314 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 st 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 Depariment 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. Reflecting 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 $16,698. 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 : In Federal Treasury, June 30 Appropria- Year tion Payments Amount | Percentage BOGO Se As Pade! $13, 000, 000 $12, 902, 037 $97, 963 0.8 DE aio a a al 12, 000, 000 11, 833, 299 166, 701 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 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 Federal 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 statt 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, Jn Search of Staff for Child Welfare, prepared by the Bureauw’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 a a ment. Children’s Bureau and Public Assistance staff in Regions III, IV and V report fruitful joint discussion and exploration with States i 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; (3) 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 conerete 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, 1960 An appreciable and increasing amount of staff time of the 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.R. 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 was 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 Jwenile 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 June, 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 H'xpe- 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 Food 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 leng-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 86 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 bid, EEE 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 514 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 Act? 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 2 Public 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. | Average | Average | Average Year ended Dec. | Average | Average | Average mem- shares loans mem- shares loans bership bership 2 Ae We A ae TR Eel 83 $7 (1) 376 $133 $194 1030 Seee noes eh 156 19 (1) 401 144 2 TUBG Sea eee eee 180 (1) 405 157 sy iS. eee ae 213 37 () 427 170 299 p Leek Re SEES ae 230 43 (Q) 456 185 297 1930s gestircs 2p Sie 268 51 (1) 2 209 351 1040 ee ee eee occu 302 58 () 495 236 4 ees SEE 337 69 (1) 498 259 394 1042S ee, sae oe 331 81 1 517 282 7 DEE ee ee SS 337 90 $112 539 303 479 yt) ee 344 102 118 561 324 516 1045 rire ee 324 116 130 577 348 5 1046 Soe 346 123 159 597 368 593 1 Basic data not available. By the end of 1959, average savings (shares) of Federal credit union members had risen to $368, 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 Leport 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 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 * (In thousands, data as of June 30, 1960) Funds available 2 Obligations incurred Item 1960 1959 1960 1959 2 oe eS =) ees ee. oe TRB bias aie weeds - 4 sou ese sac ascnse-s--e56-+-- $2, 274, 364 | $2,181,896 | $2,268,911 | $2,180,025 Grants to States: IPUDHC GESISLANCO. <5. 2s oo ee ns enen enn eos no === 2,037,500 | 1,957,960 | 2,033, 761 1, 957, 098 Old-age assistance....:.-.-+---.+--1--24+--.42+--|----=----+-2|---=-------- 1, 157, 523 1, 182, 194 et tad Be: DING $ sent owore sat ne teed ata eee | caetnebaneda| =n once econ 48, 824 47, 619 iid to.dependent; children. <.2.2..5-256 5+ -o-000|tosscnds—ne~|a-asensee=-- 660, 232 626, 546 Aid to the permanently and totally disabled-___]_.._.-_-_---|.----------- 167, 182 150, 739 Maternal and child health and welfare services__-.- 46, 500 45, 000 46, 218 44,728 Maternal and child health services__.--- = 17, 500 16, 500 17, 443 16, 494 Services for crippled children.-_-_- 16, 000 16, 500 15, 873 16, 401 Child welfare services_-...------ 13, 000 12, 000 12, 902 11, 833 Administrative expenses: 3____._-.------ 190, 364 - 178, 936 188, 932 178, 199 Office of the Commissioner 4_ --_---------- = 613 610 602 596 Bureau of Old-Age and Survivors Insurance 181, 600 170, 614 180, 476 170, 087 Bureau of Public Assistance--_-.---.--------- = 2, 345 2, 2, 280 2 Mente S TSUTOOU nao ccc cane nn ead wens sans 2, 300 2,172 2, 278 2, 165 White House Conference on Children and Youth-- 200 150 198 150 Bureau of Federal Credit Unions_---_-.--.--------- 3, 306 3, 226 38, 098 3, 059 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 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. § 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. 6 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 !3______-_--___--_-_--_----- $10, 830 $8, 460 $8, 193 Federal Unemployment Tax Act 3 341 324 336 State unemployment insurance laws 4 § 2,165 1, 675 1, 500 Old-age and survivors insurance trust fund: Receipts, total oe ao Se ee aa es Speen Seer ecepase—s 10, 342 8, 109 7, 824 Net appropriations and deposits-_-------------- a 9, 843 7, 565 7, 267 Net interest and profits on investments 6___ 4 500 540 557 Expenditures; total: eee sceno seen eee eee ace 11,055 9, 377 8, 041 Monthly benefits and lump-sum payments 7___--_-.-.------ 10, 270 9, 049 7, 875 Transfers under financial interchange. with railroad retire- MON ROCOUNG oe ae ee ee oe nee eas eS 583 128 5. Saeeeee Administration - 202 206 166 Assets, end Of Year a ee Eo nat eee 20, 829 21, 541 22, 813 Disability insurance trust fund: ROCOLDES: LOU ee ac cee ota erin wb ene ae 1,061 928 942 Net appropriations and deposits__..-..-...-----------_-_-_- 987 895 926 Transfers under financial interchange with railroad retire- ment Account. 288. 2. oon no nen eno sone e nese Sc euaes! 26 |-----.3..-2| eee Net interest and profit, 48 33 16 Expenditures, total_-_.--.------_--- 560 360 180 Monthly benefits_ 528 339 168 Administration_-- 32 21 12 (ASsotS; end Dfiveals. foe 6 52 a Sete an ane see 2, 167 1, 667 1,099 State accounts in unemployment trust fund: Receipts; totals. =. see neosnae enn 2,351 2, 126 1, 794 ‘Deposits te... 222. _ Sea 2,169 1, 946 1, 575 Interest 22%... .5 2 eae ee 182 179 Withdrawals for benefit payments __ 2, 366 2,797 2,926 Assetayondiol year. 2s ne ee ee oaecuee 6, 673 6, 688 7, 360 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: 244 percent each beginning Jan. 1, 1957; 2% percent each beginning Jan. 1, 1959; 3 percent each beginning Jan. 1, 1960. Contribution rate paid by self- employed: 334 percent beginning Jan. 1, 1957; 334 percent beginning Jan. 1, 1959; 444 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 es wa for full contribution if reduced by State experience rating provisions), effective rate is 0.3 percent of such wages. ‘ Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 5 Contributions and deposits by States usually differ slightly, 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. 6 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. 7 Represents checks issued. Source: Compiled from Final Statement of Receipts and Expenditures of the United States Government, other Treasury reports, and State agency reports. 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 * [In thousands, except for average benefit] December 31, 1959 November 30, 1958 ! Family classification of beneficiaries Number | Number } Average | Number | Number | Average of of monthly of of monthly families | benefi- | amount | families | benefi- | amount ciaries |per family ciaries |per family Totaletumpecessterosu.ces-cot-—-c_2 TOf11258 -|\ 13,,703859"|2. e. =-.- 9189) 5 | 12, 480c1 |_--2s-22- Retired-worker families 7,625.64 9,931.6 |_.J-5..+- 67020) 7 | 9; 147.3 ta -e Worker only , 320. 5, 320.7 $68.70 | 4,871.8 | 4,871.8 $62. 60 Malozee== A a 2, 755. 3 78.00 2, 587.3 2, 587.3 70. 70 Female 3 2, 565. 4 58.70 2, 284. 5 2, 284. 5 53, 50 Worker and aged wife___-_-.---- Ks 4, 058.8 121.60 | 1,901.5} 3,803.0 111. 20 Worker and young wife 2 -8 1.6 118. 60 ays 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 ed 109. 80 Worker, wife aged 65 or over, and 1 or TPEOTC I Ne Ee iy a 13.0 39.9 157.30 10.3 $2.5 140. 30 Worker, young wife, and 1 or more (liniles isk 5-5 le See eee oe ee 102.1 378.3 151. 70 92.0 338.7 132. 50 Worker, husband, and 1 or more PHRMTOMMmee] hoe = oS. cae .2 5 123.70 :1 + 126.70 Survivor families___.--.------ es y Se OA ee eee ee 2081, 1 |, 8,014.9 |---2e=-te— Aged widow 3 4 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 2aged dependent VO OLS ee ra .3 130. 50 (4) (4) (a Aged dependent widower_------------ 1.9 1.9 53. 40 1.6 1.6 48.90 Widower and 1 or more children__---- (5) (5) 92. 60 (5) (5) 86. 90 Widowed mother only ?_______-------- 1 Be 1 bet | 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 GRUCEOUEEP eR palit ee Suk aU 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) (*) Divorced wife and 1 or more children_ .3 9 166. 80 .3 .9 141. 40 (AG 3) ee hr re ies 282. 6 282. 6 56. 90 261.1 261.1 51. 80 Zenigren 8 s--=---- 110.4 220.8 101. 30 100.0 200.1 88. 90 Ti 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_-_---------- eye 3.3 104. 80 1.7 3.4 97.60 Disabled-worker families__..-....--------- 334. 4 ABO: 4: |_ctoceese 237.7 08. Pe eee INOS 5 a ae ar are ean ag 275.3 275.3 87.90 223. 2 223. 2 81. 70 AIO 2 Se ee eee 206.3 206.3 91.90 175.6 175.6 84.7 nC aS EASE ae Be er a ae 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 ?_______-_--_- 72 -5 133. 20 0 0 Worker and aged dependent husband_ aa .3 116. 60 (5) (5) 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 morecuiucdron.-- 2-2 e (5) ei 204. 00 (5) (5) 197.00 Worker, young wife, and 1 or more sro ogee ae a ee 30.1 121.1 185. 60 7.4 29.5 167. 80 eS 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. Beet 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 ee 1958 are included in other family groups; see footnote 3. ess than 50. | iN = “ 2] wz ore ‘t 9CF ‘18 ae a 919, 9€8 ‘OF "S 96 ‘ZI 680 ‘F GPF ‘892 N gT9 ‘9 L1e ‘T £6F ‘OL ¥66 ‘9 288 ‘C 68T ‘Z0% 899 ‘2 She ‘L 862 ‘ELF 3 008 ‘OT 09¢ ‘9 #20 ‘SLE 3 $96 ‘2 QIL ‘% TPS ‘ZEST 661 ‘8 920 ‘T SIZ ‘19 : 826 ‘8 £80 ‘% 629 ‘ZOT 5 890 ‘ZI Iet ‘Z CEP ‘EST 3 C6L ‘F 666 ‘T 269 ‘9ZT 5 Tg¢ ‘9 G29 °% CFS ‘IST 3 L18 ‘81 £09 ‘F 66F ‘G6 ) $90 ‘82 TS8 ‘OT 6F8 ‘229 Q 21g ‘T 8I¢ ZL8 ‘SE 90T ‘I TZ 6 ‘ST 982 ‘ZI P19 ‘% OCF ‘TST s T@S ‘ST £12 F Og ‘Oge 3 GPL ‘T SIL T6L ‘28 © $02 ‘T oar PEL ‘8% = 662 ‘L gol ‘e STS ‘QLT ag 193 ‘g OFT ‘T £50 ‘88 ° F18 ‘6e CST ‘ST £98 ‘618 Pi SEL ‘9 296 ‘T ZOL $8 288 ‘F 0sg SIs $9 O6T | 8 Cr6 ‘E 068 ‘TT 608 ‘% 986 ‘E21 ~~ 5 H08 ‘8z9$ ZLL ‘OTS 616 ‘20T ‘O1$ ® Q squ0ur -Aed q4v0p s}gousq tia uins-duin'T ATq}UOWw eISvoO LLZ ‘16 O10 ‘er 99F ‘C8z GZ ‘28 $90 ‘TIZ 662 ‘F0S 81 ‘TOF 128 ‘GT 88h ‘TL OFS ‘SIT 126 ‘LOT GPF ‘EST TS9 ‘681 6IF ‘S18 S92 ‘999 ZOL ‘LE 662 ‘0Z 928 ‘OFT PCS ‘ESE 192 ‘Se £9L ‘FZ £86 ‘98T OSF ‘28 T830.L 096T 1804 [ROSY UT syuNMAVd JyoUNg #81 G% PLE‘ (ae ras 199 ‘2 8°91 LIT 9'T OP ‘e Geo 699 ‘g T'99 826 mas 689 ‘ZS 9 ‘FL8 199 ‘8% G"18e £0F OL ese ‘9 9 ‘ZL 992 ‘9 L'6FT Sehr 09 60 ‘LT L912 88F ‘LT L 28S £99 ‘T £02 £86 ‘68 8 989 Le9 ‘Tr T 209 881 ‘T GST 168 ‘TE Z LLY 60 ‘es LG6F £29 69 2ST ‘IT 8 ‘O8T 619 ‘IT L‘L81 Le re 899 ‘9 ‘96 $68 ‘¢ °°66 zs9g £01 629 ‘8 9 “E9T 912 ‘6 0'FLT 018 0°ST 616 ‘ZT 9 ‘OFZ 682 ‘ET 9 19% ose 8'F £89 ‘OT 6 ‘08T 0 ‘TT 8 ‘SST £0F g'g ZI ‘ST 8 0Sz STL ‘ST £99 0S6 Brat $16 ‘FZ 8 26 £98 ‘SZ b SOF £00 ‘% 1°93 1¥6 ‘ZS L°T6L 096 ‘$9 8 ‘918 16 tT £20‘ $09 ZI ‘E 8'Tg LL Tat 989 ‘T 0°82 £99 ‘T 1 6Z 068 mat 280 ‘TL Z ‘0Z 9F6 ‘TT P PSs Ee ‘T 6°11 £98 ‘LZ 6 98h L6L‘6S 8 FoF LEI yas GOL ‘S 6°Sh 268 ‘Z oly 88 Tak 096 ‘T ¥ 08 680 ‘Z 91 8I¢ £°9 168 ‘FT T 11a OTF ‘ST ¥ LIZ 68% e'¢ 000 ‘2 8 FIT 68 ‘L I '‘8IT 688 ‘Z Zoe O&T ‘69 T ‘020 ‘T 610 ‘ZL $°SOT ‘T IF 19 eer ‘2 £ OFT Po ‘L 08ST OFS oF S13 ‘F obL 616 ‘F 0°6L 1 Be ZE 9°¢ gee 8'¢ a8 9°81 StF ‘OT £012 19% ‘IT 6 “82% TL0 ‘8e$ 9 “T%o T6L ‘ISs$ 2 OFL ‘ET £98 ‘688$ 8 °19% ‘FT qunoure JoquUINny qunous JIquInNN qunoms JIquIn NT ATG UOT ATq}MOWW ATWIWOW sid sISvO 1830.1 096T ‘Og euNL ‘snqeys yUoUTABd-UOIIND UI s}youeq ATGIUOPY morse sae- eso se<=9"-a eee ldony ee euByuoyL --~""LMOSSIJT coat tiie! eras ~-1ddIssisst jy Pei er ae BOSOUUTTAL are wee UBsIOIA a ~="-==-sa49snyoesse AL oS ware Se="=9-—= nie AIG yr a ee -7--""="gUBisMoy ee ge eee et Ayonquey fae oad «sat a ai aon TIRMB FT ca Saal — a a --~""="BIZ 1084) Bploly Pers ree ““BIQUIN[OD JO JOLISIC. a ae sa OIBMBIOC. es mee oie ~--===-qnorqyOoUuU0g ieee sao ee OpBI0[oD eouepIsel Jo 93819 s,AlBloyousg 82 [spuesnoq} uy] 192019 £q “Q96T 41094 yoosif ur syuauAnd y1fauag fo yunOWwD puD 096] aunt fo pua 7D sn}0}s yuaUApd-.UIa1iNd U1 s}ifauag ApYQUOW fo JUNOWD puD Jaquiny, :aauDinsul 47271QDs1p pup ‘ss0aiains ‘asD-pj]Q—'h 2[F¥L 83 Social Security Administration “09 UBY} SSOT ¢ SIOATAINS 0} pus sjuspuedep JET} PUB soTIe}Oyoueq (1eyIOM-PelT}01) 9OUBINSUT 93-PTO *syuspuedep Jey} pure solepyg 0} puny ysnIy IS VO ey} Woy o[qeded 18 UIeIZ0Id dOURINSUT AITTIQeSIP Pue ‘SIOATAINS -900q (1dYIOM-PeqesIp) soUBINSUT ATIGesIp 0} puny 4sN1} Tq ey} Woy aiqeAed O18 ‘ade-plo 043 Jo Jaed (ISVO) eUvINSUT SIOATAINS PUB 988-PfO EY} JopuN s}yousg ¢ ureid01d 04} Jo Avd (Tq) VuUBINSUT AITIGUsIp 94} JopuN s}yousg ‘S1ay1OM Posvadop JO “poqeuiyjse 04849 Aq WOTINII4sTq 1 LS as as ae a a as ae a a a 888 ‘T 8L9 88h ‘L9 #00 ‘OL iaas 8'T STL ‘go 8°16 298 ‘9 9"€6 Tebese Tes as eae eee OLO i 619 (ord Lee ‘ST 802 ‘OT oF 9° 263 ‘T 01% gee ‘T 9 IZ ri “-""" =" SuTuI0d MA £91 ‘OT $26 ‘8 61 ‘29% 96% ‘91% eel o'6 SIT ‘2 0 SFE L¥8 ‘CS g “Lo re bes His hes ~~ UISMOOST MA. 62S ‘ZI 289 ‘T $6F ‘TIT GOL ‘ST 216 8°F1 Z8E ‘6 9 SOT $62 ‘OT F,0GIs_ aadibal oak Seek -""""="BTUTSITA 989M 618 ‘2 LIL ‘S 282 ‘BLT 818 ‘681 og¢ OL 611 ‘ST 6 ‘EZ $19 ‘ST 8 682 SSS. fe stn mo4SUTYSeM Z8P ‘ZT Tr6 ZLB ‘OST G69 ‘TLT L16 eat OST ‘ST 9 “SHS £10 ‘FT 8 560G meadienetll pcos hae ke ce BIUISITA Or fh org Le if (e) +P ey! oF Ta.) (SR ee es oe a SPUBIS] UISITA 28 ‘T 08g 698 ‘SZ 19S ‘LZ #6 rT ISI ‘% 1°98 PLZ ‘S 188 108 ‘T g9¢ GT ‘gg 06€ ‘OF ¥6 £'T EFS ‘ES (ares Lee ‘8 res SOF ‘IZ Tlz‘9 798 ‘BFE 869 ‘118 ges ‘T o 2 OCP ‘6% 1°68 166 ‘08 £°299 TS8 ‘OL 168 ‘% $66 ‘8hT GPS ‘LET 682 rat aera SCH 116 ‘21 Z‘SSa i ee Ee eae ~"gessouua J, S16 ges 086 ‘88 6h ‘OF PL jeae 982 ‘E Z'9S ge ‘8 ¥'LS $eus ~---="---g1oyBq YING TI19 ‘L 209 ‘T 189 ‘LL 06 ‘98 gag 06 Zes ‘9 o ‘Fel 280 ‘L £ SFT ee cae ae BBUSIOISO WIHOS 6FZ ‘8 S66 OFL ‘89 $86 ‘L9 ZkS oe BLE ‘¢ 918 019 ‘¢ VFS. 2 Sl soe eee ~~~ purvys] spony ZS8 a O19 ‘ee GI6 ‘98 69 6'T £90 ‘¢ 9°26 821 ‘8 o'6 ae “------ooly OJON $68 ‘eh 620 ‘ET G6L ‘FOL SIT ‘18 ZOl ‘8 LOF Teh ‘69 6 ‘816 £69 ‘29 Oe eh del eee ory eluea[Asuueg 940 ‘9 ¥eL ‘T £60 ‘E21 £28 ‘6ZT £98 9°F 188 ‘OT 0°Z9T PPL ‘OL ONO Toms obese stor setes ese et w0sa10 OIF ‘9 GPL ‘T 908 ‘TIT 8SP ‘BIT SOF o'9 LLE ‘6 €°L9T G8 ‘6 BOUT ob Rats So Sek as --"-"BOIOge [yO Ges ‘6z 620 ‘6 688 ‘P89 ESF ‘829 ZOl'S Z LZ Sie ‘6F 0°6PrL STP ‘TS ESE © l= ik 4 ane a) (0) sco ooF 198 ‘Ze 0L6 ‘88 Tg Bz OLL ‘% L°9F Tes °Z Gly ~-Bj0yBC YON gee ‘FT ZES ‘ES 182 ‘69T 198 ‘981 0+0 ‘T 691 OS ‘FT L°S8z G82 ‘ST 9 ‘ZOE woneeeersen=""-BUtOleQ TION 886 ‘29 ZS ‘BT OO ‘EST ‘T STS ‘900 ‘T PLL ‘S e°Lh TS9 ‘96 9°9TF ‘T GP ‘66 8°89 ‘T Sie. a ee YIOX MON 019 ‘T Ze G96 ‘Sz 160 ‘8% Sil $5 ZBI ‘SZ 6 IF 862 ‘3 Leh cay eee oes LOUXOTT MONT G68 ‘8T QI ‘L $28 ‘EOF G88 ‘8zr Fe ‘T 6°ST 810 ‘FE 0 °Z6F Tee ‘ce 6°L08 Sonne hadesy 7 AGbaOl, AON T6L ‘T CLL 898 ‘bh 166 ‘OF 821 EY CPL‘ ¢"6¢ 018 ‘E Z°19 2 eysdurey MONT 919 29% O8T ‘IT 890 ‘ZT oF 9° G6 oF 186 TST ETE ae tn SPOAON, 84 Department of Health, Education, and Welfare, 1960 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] Calendar year 1957 2 Employers reporting taxable Amount of taxable State wages Workers earnings ¢ Amount of July- with contribu- September} taxable tions * 1959 1 earnings 3 Total Average per worker Totalon tetas. na A eee ce es ae. 4, 140 71,000 | $181, 421,000 $2,560 | $7,968, 700 Alabama sae oe a sesess eet eae cee cease 59 1,070 2, 160, 000 2,020 95, 100 Alicka 2 oo ee eee eas 4 80 176, 000 2, 200 7, 800 ATIZONG © oot. Ate eee cease ceee 26 430 942, 000 2, 190 41, 400 PATEKADSAG. eg yee oe aoe, 36 530 900, 000 1, 700 38, 900 Galifornia ls sass 5 oh eee 368 6, 030 15, 863, 000 2, 630 696, 800 Golorado 22s. eae eee 42 690 1, 488, 000 2, 160 64, Wonnecticute---s4-s--eeee 64 1,180 3, 231, 000 2, 740 142, 800 Deldwaresce.s22 Soa 13 250 621, 000 2, 480 a District 0 31 480 1, 012, 000 2,110 45, 100 Florida 126 1,810 3, 423, 000 1, 890 149, 700 Georgia 85 1,420 2, 706, 000 1,910 119, 100 SEA Wallioecee. ae eee eee ll 200 477,000 2, 380 21, 000 Wdahiec. a se.2 2 a ee 15 260 546, 000 2, 100 23, 300 PALEY) Cer cee ee ee ae ts Se 227 4, 560 12, 169, 000 2, 670 534, 400 inGisig se nae oe ee ee 92 1, 950 5, 079, 000 2, 223, 300 TOW Hee Stee sane ee, ee 67 1,110 2, 505, 000 2, 260 105, 400 Kansas! soe. ee one, os eee nes = 61 870 1, 881, 000 2, 160 81, 100 INBIUEUCK Y Senna se cee Coe cones S 60 980 1, 994, 000 2, 030 86, 300 eonisiana Se 28-2 5 Se ee 2 64 1, 060 2, 213, 000 2,090 97, 300 Wisine 222 2ee ee eos oe ee ee a 25 400 776, 000 1, 940 34,000 MMarylatid= = -eee secs se, at Se 2 70 1, 200 2, 821, 000 2, 350 124, 500 Massachtisetts 2-2 2) 5. ee é 122 2, 270 5, 647, 000 2, 490 249, 900 INiichiganeas sia ae a= es see seese = 154 3, 310 9, 377, 000 2, 830 414, 500 Minnesota 6. eee ee ame a 73 1,310 3, 111, 000 2, 370 134, 000 Mississi ppidc seetac stones nee a 37 610 999, 000 1, 640 43, 500 Milssourits 33226 -a. wo oa eee . 108 1, 870 4, 314, 000 2, 310 188, 600 Montana:.3 ses 25. ee 3 17 280 632, 000 2, 260 27, 100 INODTASKA: Besse. sos hace epee eee 35 620 1, 232, 000 1, 990 52, 300 INSVads 2.5 = SS ee 7 130 , 000 2, 150 12, 300 INewsHamnipshire 2-3 = eo eee 17 280 590, 000 2,110 25, 900 New,J ersey..-:22- 5.2323 8 aescecads 152 2, 690 7, 085, 000 2, 630 312, 600 ING WHI OxiCo ese aes 19 300 % 1, 870 24, 500 INO Walt OCK 25, < Jeeta 2 aes ee 496 8, 210 21, 800, 000 2, 660 962, 200 North Carolina:-2.-22-4.25-22 5.228. 94 1, 650 3, 218, 000 1,950 140, 900 North Dakotao22- 2 ies re 14 240 468, 000 1,950 19, 000 Onigg <8 ee Be eS Se ee 203 4,030 10, 991, 000 2, 730 484, 700 Oklahoms -*: 32. 25.-8-0lecsces sate 52 870 1, 803, 000 2,070 78, 400 Oregon.---- fae ae eee cee 41 7 1, 760, 000 2, 380 77, 000 Pengsyivania. atc 249 4,810 12, 556, 000 2, 610 554, 000 IeMertG: AGO. =e 2 =e ee 18 452, 980 19, 800 hogs Island 229.2 ss ee 21 380 886, 000 2, 330 39, 100 South Caroling=2......3) 22% 22 46 800 1, 520, 000 1, 900 66, 900 South Dakotei..55.5... = 16 240 477, 000 1, 990 19, 600 MOnnessee 222 anno cco Sense, ooo 75 1, 270 2, 513, 000 1, 980 110, 100 PLexseits 2 teen cde oe cece 223 3, 540 7, 558, 000 2,140 330, 900 OF) 1) pe Ree ER ae 17 3 , 000 2, 160 32, 300 WWEETIONG oa scared oc eenasaee de Wh 150 314, 000 2, 090 13, 700 Virginia 223.-5.-3.. 5 2. 86 1, 380 2, 811, 000 2,040 , 600 Waroin Islands. 2-26 aco See oe 1 10 13, 000 1, 300 500 IWasbinstorie 2225s ce. dun semeann se 65 1, 160 2, 854, 000 2, 460 124, 900 Wieshs V sreinia 2o re Sansa ce sens a 37 690 1, 645, 000 2, 380 72, 700 Wisconsin ee. Sets scec sees 89 1, 580 3, 955, 000 2, 500 171, 900 Wyoming: s2sscecuetectocectecce 9 150 000 1, 990 12, 900 Moreign 225 325-2 arte aceadecss cus se- | ee 90 214, 000 2, 380 9, 500 Ocean-borns vessels. = sec eee 2h |e 140 395, 000 2, 820 17, 800 Uniformed services (on basic pay).------|---.----.__- 3, 510 5, 372, 000 1, 530 241, 700 a ee Se ee, ee 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. 2 Includes self-employment. 3 State data represent workers employed in the State at some time during the year. Workers employed in more than 1 State are counted once in each of the States in which employed. 4 et taxable earnings in the State in which workers were employed. Averages are rounded to nearest $10. 5 Contributions based on a worker’s annual taxable earnings, not more than $4,200 in 1957. Contribution rate was 24 percent each for employees and employers, and 334 percent for self-employed persons. 6 Refers to employment of United States citizens outside listed States or other areas by American employers and their foreign subsidiaries. Social Security Administration 85 ee 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 ——_ EEE 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 Number (OASI).--------------------------------- 13, 740.3 12, 820. 2 11, 704.9 Number (DI) ------------------------------------- 521.6 361.2 200. 4 Old-age (retired-worker) - --.-------------------------- 7, 813.0 7, 295.6 6, 638. 5 Disability (disabled-worker) ------.------------------- 370.8 275.2 200. 4 Wife’s or husband’s (OASI and DI 2, 279.9 2,141.8 1, 947.4 Wife’s or husband’s (OASJI) ----- 2, 223. 5 2,108. 5 1, 947. 4 Wife’s or husband’s (DI)--------------------- 56. 4 neko i ee Set eee Child’s (OASI and DI)?__--..------------------------ 1, 903.5 1, 747.7 1, 571.9 @hiid’s (OASI)2_< .2.-.-----.-.~----+------=------- 1, 809. 1 1, 694. 8 1, 571.9 Child’s (DI)22__-<-2-=.----.-..--.--------<-=----<- 94.4 52:38 (ieee aes Widow sor widowér’s_.<...---2=-.----.6--2-5----5-5- 1, 471.3 1, 322.0 1,172.8 WMother’s sods ss ce soo o-oo 2 one se nsw cowensessece---- 387.9 366. 5 344.9 Maron 6 seetee saa - ~ 2555 oS eos ase eee -- s 35.5 32.7 Fe 29.4 Total monthly amount (OASI and DI). ------------------ $889, 863 $805, 545 $659, 684 Total monthly amount (OASI)_------------------ $851, 791 $778, 404 $644, 773 Total monthly amount (DI) $38, 071 $27, 141 $14, 911 Old-age (retired-workecr) ---------- $575, 295 $526, 701 $436, 244 Disability (disabled-worker) --.-.--------------------- $33, 123 $24, 324 $14, 911 Wife’s or husoand’s (OASI and DI)------------------ $87, 701 $81, 295 $67, 821 Wife’s or husband’s (OASI)--.------------------- $85, 676 $80, 096 $67, 821 Waite sor nusband’s (DI). 2-...----..<5-s-=,- 5 $2, 025 $1,199 |. eRe Child’s (OAST and DI)?.-....---~---.-----=------ e $84, 789 76, 209 $61, 471 RORGA OAS)? = 2 henen s3a2oon-- sae \ $81, 865 $74, 591 $61, 471 CONG So COD RS ere bp ana aR Palen ae dean *. $2, 924 $1) 618]. geneween = Widow’s or widower’s----------------.---------- 2 $84, 229 $74, 359 $60, 457 INO REI ao cee teirs snc ne aco ne nse me ewenesesnue 2 $22, 609 $20, 760 $17, 241 Parent Ose es oe os saat cceec nag etesuess seas = $2, 117 $1, 896 $1, 538 Average monthly amount: Old-age (retired-worker) - ------------------- 3 $73. 63 $72.19 $65. 71 Disability (disabled-worker) ---------------- g $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)--------------- a $35. 92 $36. 09° |4=-2- 5-52 ee Onild’s (OAST and DI)3__---_-222---=---- 2 $44. 54 $43. 61 $39. 11 Ginides (O AS])4 22° 255 ss 52 --4e-- _ $45. 25 $44. 01 $39. 11 Mnpld's(D1)?.....=. E $30. 98 $30.62: 2. oxo decaes= Widow’s or widower Su $57.25 $56. 25 $51. 55 WMiOGhOMNS= <= =222---2- - $58. 29 $56. 65 $49. 99 Paraniis Meise sics.cssee ae sese Seon esos ees nbhenee~see=- $59. 67 $58. 02 $52. 34 Benefit payments during period: Monthly henefits (OASI and DI).------------------------ Monthly benefits (OASI)------------------------- $10, 632, 223 $9, 238, 753 $7, 900, 638 $10, 103, 919 $8, 899, 522 $7, 732, 218 Monthly. benefits (DI)__..------=--=-------------- $528, 304 $339, 231 $168, 420 Old-are: @atired-worker),..-_-<--..---.=----=.---------- $6, 803, 466 $6, 041, 417 $5, 245, 777 Disability (disabled-worker) -------------------------- $450, 114 $311, 105 $168, 420 Supplementary (OASI and DI)----------------------- $1, 183, 515 $1, 007, 142 $860, 488 Supplementary (OASI)_-------------------------- $1, 105, 325 $979, 016 $860, 488 Supplementary (D1)-.---------------------------- $78, 190 $28° 196) {4.2¢---256 <—= Lp GC ee Ee Re ee ee ee $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): Mei IISUTG0 ee Sa encom ecco ade oa onan t Seen = | eee ne emen | spose conn en ees [ase See Currently but not fully insured . -.....------.---------=----|--------------|--------------|--- 2-7-2900 0 > Estimated number of employers reporting taxable wages, Ist quarter of fiscal year-_-------------------------------------- 44,140 44,090 44,060 Calendar vear « Estimated number of workers with taxable earnings _---_------ 75, 000 73, 000 70, 000 Estimated amount of taxable earnings------------------------ $213, 000, 000 | $202, 000, 000 $181, 000, 000 Average taxable earnings 5_____.-.---------------------------- $2, 840 $2, 770 $2, 590 1 Benefits under the old-age and survivors insurance (O AST) parts of the old-age, survivors, and disability insurance program are pavable from the OASI trust fund to old-age insurance (retired-worker) beneficiaries and their dependents and to survivors of deceased workers. Benefits under the disability insurance (DI) part of the program are payable from the DI trust fund to disability insurance (disabled-worker) beneficiaries and their dependents. 2 Includes benefits payable to disabled persons aged 18 or over—dependent children of disabled, deceased, or retired workers—whose disability began hefore age 18. 3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from: (1) provisions that coordinate the old-age, survivors, and disability insurance and railroad retirement pro- grams and (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported on more than 1 account number. 4 Excludes agricultural employers. $ Rounded to nearest $10. 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OLE 916 268 ‘T OCF) Chem Mit Gros tes. 6, SpBaoNn £°89 19 ‘T 9°89 216 ¥ GL 890 ‘“F 8°99 82L ‘ET £20 ‘T s19 @o8 ‘% 669 ‘8 LOO SR Mis ieee br ts Ae 5. ByselgoN 06g FOE ‘T Z'89 798 8°19 080 ‘¢ a!) 08 ‘¢ $08 c0z 9F8 ‘T Gol ‘E S10; Othe skal lite aie Sa oe a os ob koe? BuEuO YL 9°99 eh0 ‘ZT | 049 098 QSL 092 ‘08 £99 6LL ‘98 p86 ‘2 1g % GEG ‘TS | - 260 129 ORF GSN Soto a ae eee = Jmosst Al 8°oL 928 ‘F ZG 290‘ L°8L STL ‘OL o'8L LS¥ ‘0 gee ‘8 ste ‘% L¥S ‘8 £60 ‘FZ 60 oe els ee ae TddIsstss} 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 *? {In thousands] Maternal and} Crippled |Child welfare State child health | children’s services services services United States. = 22 .0- o.sS.cccunabe~ebhcogecn sboareeeee 371.6 416.3 310.8 Wirrintieiands s. e202 tora on Sonera bo eae aeaen og cee epee 93.0 89.0 45.1 1 On checks issued basis. 2 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 a __ a Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1959, and Dec. 31, 1958 Amount Percentage distribution Assets and liabilities Change Dec. 31, | Dec. 31, Dec. 31, 1959 | Dec. 31, 1958 during 1959 1958 year Number of operating Federal credit dabei ee es 9, 447 9, 030 by AN ere es [Ee Eee igtal Se6eINe = 26-~<.--+.-t--=- $2, 352, 813, 400 | $2, 034, 865, 575 | $317, 947, 825 100.0 100.0 We ee 1, 666, 525, 512 | 1,379,723,727 | 286, 801, 785 70.9 67.8 ia ee ee sae oak 137, 677, 971 154, 257, 791 | —16, 579, 820 5.8 7.6 United States bonds-_----- 110, 328, 752 94, 897, 483 15, 431, 269 4.7 4.7 Savings and loan shares 363, 003, 574 347, 411, 329 15, 592, 245 15.5 i by ie | Loans to other credit unions_-------- 50, 217, 364 35, 073, 948 15, 148, 416 2.1 APY Pandas pulldines.-.=.----.__--_... 7, 778, 138 6, 084, 555 1, 693, 583 3 .3 SPT es | ee 17, 282, 089 17, 416. 742 —134, 653 ae .8 otal Na biies.->------~---=-== 2, 352, 813,400 | 2,034, 865,575 | 317, 947, 825 100.0 100.0 Mntos PAvaD is. =—- =. .--~s==c.<-~---- 58, 427, 188 37, 481, 165 20, 946, 023 2.5 1.8 Pinvedeeee ates anno 52-3 ~se5.-5- 2,075, 055,019 | 1, 812,017,273 | 263,037, 746 88.2 89.1 Regular reserve 91, 733, 369 75, 810, 826 15, 962, 543 3.9 3.7 Special reserve for delinquent loans-_- 4, 674, 782 4, 579, 416 95, 366 2 .2 St har reserves). -.---5.----2----~. 4, 629, 088 3, 881, 182 747, 906 2 .2 Undivided earnings 106, 259, 883 93, 922, 039 12, 337, 844 4.5 4.6 Raner lig hilties..-.=-.---=.-~--2--=-- 11, 994, 071 7, 178, 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 * Number of operating | Number of Loans out- Year Federal members Assets Shares standing credit unions 39 3, 240 $23, 300 $23, 100 $15, 400 772 119, 420 2, 372, 100 2, 228, 400 1, 834, 200 1,751 309, 700 9, 158, 100 © 510, 900 7, 343, 800 2, 313 483, 920 19, 264, 700 17, 649, 700 15, 695, 300 2, 760 632, 050 29, 629, 000 26, 876, 100 23, 830, 100 3, 182 850, 770 47, 810, 600 43, 326, 900 37, 673, 000 3. 756 1, 127, 940 72, 530, 200 65, 805, 800 55, 818, 300 4, 228 1, 408, 880 106, 052, 400 97, 208 900 69. 484, 700 4, 145 1, 356, 940 119, 591, 400 109, 822, 200 43, 052. 500 3, 938 1, 311, 620 127, 329, 200 117, 339 100 35, 376, 200 3, 815 1, 306, 000 144, 365, 400 133, 677, 400 34, 438. 400 3, 757 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 3 761 1, 302, 132 173, 166, 459 159, 718, 040 56, 800, 937 3, 845 1, 445, 915 210, 375, 571 192, 410, 043 91, 372, 197 4, 058 1, 628, 339 258, 411. 736 235, 008, 368 137, 642. 327 4, 495 1, 819, 606 316, 362. 504 285, 000, 934 186, 218, 022 4. 984 2, 126, 823 405, 834. 976 361, 924, 778 263, 735, 838 5, 398 2, 463, 898 504, 714, 580 457, 402, 124 299, 755, 775 5, 925 2, 853, 241 662, 408, 869 597, 374, 117 415, 062, 315 6, 578 3, 255, 422 854, 232, 007 767, 571, 092 573, 973, 529 7, 227 3, 598, 790 | 1, 033, 179, 042 931, 407. 456 681, 970, 336 7, 806 4, 032, 220 | 1, 267,427,045 | 1, 135, 164, 876 “4 863, 042, 049 8, 350 4,502,210 | 1,529. 201.927 | 1,366, 258, 073 1, 049, 188, 549 8, 735 4, 897, 689 | 1, 788, 768,332 | 1, 589, 190, 585 1, 257, 319, 328 9, 030 5, 209,912 | 2,084, 865,575 | 1,812, 017, 273 i 379, 723, 727 9, 447 5, 643, 248 | 2, 352,813,400 | 2, 075, 055, 019 + 666, 525, §12 1 Data for 1934-44 on membership, assets, shares, and loans outstanding are partly estimated. 3 First charter approved October 1, 1934. ‘ALT, ie (eet -DBy- ide Oe | see ak aw "tan Loe iT 8 Peep OMe: | a Sey ee . | 36 208 20k! oe Ste Wwe Te IS GF AF bane wes ae soe en are Y wont ? 4 a 7 ROH eh i ’ et | Sib 8 ee “2~4.. = tip Riser “ie ce bh {" ne te 53, ee S, eC er UNE Tee ee ¢ pT tub 2d foot 3th aw i ta ii i bat i GK 184.0 L- e " 1 |) ae grees i =, wa i “ 3 4 wo = ar ne UH A BAe q 4H: * nS eu S or 126". t pa , a3! me | {> ‘? ; vi oe 2 oe ‘ ‘ it b ae | Ss } las ' ve an “ar go Tee 20 : *; 1a. 1% pa - ; Sees : “bs — uo oe —. ‘ ae : cm)! wil eo wetes fal rape hn 2 r " “ tego Lo incomes aydeeaum lo. so-dbng i crreiase hers ne -RE-FECT NE orofk Lomihntteies adool \o theonw bee sede +? na —— an a - _= -_ ' ay tee 7 eS ie : (to wocheenagye : sti 270.1 vetites 4 quite ae Stowe ; try aga tg Pst 4 + &tediperc iomiete -: 4 } thats * A t waving’ i af “ “my t x ee on - i Cay ow KEP roe | be ae Ske nae IG FER, al Be > At Bri —_ = = REE mt 5.9 OT at Ce ies SR wn MR et ton 4) tu Le ne a par de ie UO SK? * ier oy, hy og Tae a mMe.T -aet-gae Peat oq a pe Pte 2a of a £° } eu 09 (7 at ROT PAP BH. Me £0 a re ABA Veer cre tet) a8. et eee Se) me en SY erg” (h2 i F =% on 2% It. Gud E2784 ff Oo TH GBI MS J ras 00 a> de * Oe 45 SBI + AM, OF 2 om > ore Sy ZAL a 29 et ee ; OF Ale sd ay ey LARP Es . rf Gab A085 TB} YOR 2 wr r HO Are a 7 ces sod , satan vw ieee alee tate on $i anioglngl at] reeae) ben (=? i= = 3 aa i te vite bete gee fete Covehebe ee dn ede 8 ay Jeuekuae aaees Public Health Service Health of the Nation Tue weavru 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 would 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 + 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 80.7 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 4 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 8.0 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, 1960 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 June 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 Jndew Medicus. 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 Janu- ary 1960 issue, the old Current List of Medical Literature became the new /ndex Medicus. In 1961, the Index Medicus 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 meet 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 Biologics 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 7” ed- eral Support of Medical Research. An NIH task force studied the impact of NIH grant programs on medical schools. Forces 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 Biologics 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 Research. 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 U.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 NIH 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. p 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 were 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 sufli- 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 vewans 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, 1960 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 found 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-carbon 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 anticancer 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 thelung. 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, 1960 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 germfree 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 idl: 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, 1960 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, Jamaica, Japan, 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 Minnesota 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 pr ogram also str Bee 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), chlorpromazine (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 Federal, 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 Retardation, and other Neurological and Sensory Disorders of Infancy and Childhood completed its first year of study in January 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 Federal 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 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 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 1.8 per- cent higher than in 1959. Kighty-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 87 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 at ane menrmed 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, 1960 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 has 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 Service 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. . Tn 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. Allemployees served by the 82 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 Rocky 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 Freedmen’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 traflic 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 Foreign Quarantine personnel. Smallpox continued to challenge international quarantine control +n 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 Far 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 nin a i ee 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 sylvatic 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 ee 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 Depariment 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 ia ts 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 Jamaica 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 well 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 emergency 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 upward 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 was made. There was a gain of 102 professional nurses. Eighty-eight were 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 were 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, and Welfare, 1960 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 Keams 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 ee —E—————— 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, such as welfare agencies, rehabilitation and home care services. In 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 Tn 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 a afl ml a aa SR ree 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 18,054 beds; and 16 percent were public health centers and State health laboratories; 7 percent, diag- nostic centers; and 8 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. -|-<-~---—=-|---2=----=|oneant sane [Ar oro 236 147 Farm labor supply revolving fund, Bu- reau of Employment Security, (trans- feria PES). .2--52--+---------|--2---2-=-|=--9-2-=-~| -=senbanna| =n nse an n= 585 549 General Administrative expenses, Sec- tion 411, Mutual Security Act, execu- tive, (transfer to HEW) - --.-----------|----------|----------|------- 000 [oo- 007 35 33 Technical cooperation, general executive, (transfer to HEW) (annual) -----------|----------|-------5--|----- 00700 |omon 1, 964 1,951 Technical cooperation, general executive, (transfer to HEW) (no year)_-_----.----|----------|-------7--|---- 2-7-0 ooo 2, 296 1, 586 Defense support, general executive, ; (transfer to HE W)---------------------|---------- ee ed eo BOE SE 206 184 Special assistance, general, executive, (iransten tonEDEW)=.-4-----.2=----=----]-=----5-~-|-------=22|--“--2-nne)-noe eae 246 233 President’s Contingency Fund, execu- tive, (transfer to HEW) - _-------------|----------|----------|=--n00r ro forn 27 27 Salaries and expenses, Office of Civil and Defense Mobilization, (transfer to HEW, Office of Secretary) ----------]----------|----------|-2---=-===|00 === 1, 023 1, 023 Gift funds donated for general and specific purposes- ---------------- SU1857 eo -2e- oa | anaes ee $174.0 292. 7 208.3 Patients’ benefit fund, Public Health nm o 3 Sb fo} a Ss SA oo 2 an h \ \ 1 ‘ ‘ H \ I i 1 \ ' \ ' 1 \ ‘ 1 ' \ oo =) o i ‘ ' \ \ 1 i ' \ i H ' ' ' \ \ ' ' ' to S on on © or wo gift fund-.--...------------------------ 28.7 57.8 86.5 =a et areal Om Ww Special Statistical Work, Vital Statistics_ 10.0 Public Health Service conditional gift te ye 0 aa ae ee 136.7 97 Department of Health, Education, and Welfare, 1960 174 01% GL S8e 88h 06T 829 bre €Z LIP id LI co OFT OZT 99% 9 &T I 6LE 6E SIF z g 4 6 aretD ees ee 8& 8E LT g¢ _—* Or ss) HOE ro oe hee com LE LIT Z For €& S2T 96 $9G (ai gee ‘S 660 ‘T OFF ‘E $00 ‘T IS ‘F } ~~ Rey hi ee aga T PSP eein: me 6F1 IL O9T 961 9g eo Re aa ar ek eee ae a ay | RE add a OR Ck cE ce €I 8F gg €1 €8 SPA + wile se ee £12 ‘F raui oe 'b LOP 26L ‘F GZ ea eee CW aS ee ea S08 aaa ieee RGD Take aS ¢08 £01 1% SEZ 6S¢ rai 066 ‘F FIZ 91Z ‘g 140 'T £92 ‘9 oe oer ieee ia Ta ae a 6 6 Sw oe ee LE TOT ZOL L 60T 61 9 SI OF 19 89F €& 899 cP &19 Te eee 2 ee ee eee EV TUR dian Wake CA le cee ae 0€ 0€ IT lr 5! 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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 Conimittee 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 |” fos a nc, ean Aaa 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.* 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 toa 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, 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 total 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 IIT 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 workers 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. Recent publications of various national educational organizations reflect re- newed interest in the potentialities of the school library for strength- ening elementary and secondary schools. Llementary 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 all 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 1958-99 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 o f 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 June 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 1 | | 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. For 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 schoo] 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 schoo] 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 Jead 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 rT 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, 5) 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 Area 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-—V ocational 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 TOUR ee ee ee ees ee en eee ee 860, 814 Blind 222250 Mise eee Se ae Se Se See 2, 742 Partially: seeing) hose ees oes. Joe eee oe asso eee 8, 266 Deaf: 2. 62 to fea SS eee eo ee ee 6, 162 Hard ot hearing. i= 25. 25 ee eee 138, 037 Speech” impaired -=-—__2=_. ss Se OS ee 474, 643 Crippledesit:s Yes soe FAS eee aoe ees See eee eee 28, 355 Special health. :problemsz2... £22... 2b ao) 2 8 eee 21, 714 Socially and emotionally maladjusted2. 222-223 eee 27, 447 Gifted) a2) = ek ee ee oe 52, 005 Mentally retarded (upper range) ~~ 22-2 eee 196, 785 Mentally retarded ‘(middletrange)'- 222_2_ 2022 22-23 See _ eee 16, 617 Other? a3 ae ee Ae pitas Ss a ee et eee ey eee 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 17714 fellowships, at an average individual cost of about $5,600 and a total cost of about $994,800. Of these, 8414 were used by 19 institutions of higher learning (under sec. 1), and 9314 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 July 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 @ 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, Zhe 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 Survey 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 euidance 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 Nation2 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 2The Library Services Act was extended by President Bisenhower’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 of 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. Related 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 seleetion. 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 schoo] 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-fourth 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 dollais-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. Facilities 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- ET e. 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, andin 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 1998; 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 * Jevel, 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) 20 18 HISTORICAL DATA PROJECTED DATA 16 1939 and 1946-59 1960-70 14 lai 10s oe eee. eee Population aged 18-21 8 7 = 6 = 5 = 4 gL Degree-credit students 7 2 1939 1945 1950 1955 1960 1965 1970 Fall of year for enrollment - July 1 for population 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 huridred 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 ot 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 195%, 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) $3.8 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 COST FOR { === RESIDENTIAL COST FOR LEGEND: ADDITIONAL REPLACEMENT BILLIONS STUDENTS INSTRUCTIONAL REHABILITATION $25 RESIDENTIAL MEDICAL DENTAL INSTRUCTIONAL RESEARCH 2.0 210 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 8. 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 anda 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 $1214 billion in 1970. For the bene- Chart 3.—ANNUAL NEED FOR PHYSICAL PLANT EXPENDITURES COMPARED WITH PROJECTED INSTITUTIONAL EXPENDITURES, 1960-70 LEGEND: Eg TOTAL ANNUAL NEED BILLIONS INSTITUTIONAL FINANCING $25 1960 6l ‘62 ‘63 ‘64 "65 ‘66 ‘67 ‘68 ‘69 1970 Chart 4.—CUMULATIVE NEED FOR PHYSICAL PLANT, HIGHER EDUCATION, 1960-70 BILLIONS $20 i6 $5.2 BILLION CUMULATIVE TOTAL ANNUAL NEED Ma ae , 2S Office of Education a4 |y | 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 1 “tde- water Area of Virginia (completed in 1960), and Higher Education im 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 stafling 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 staft 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 stafling the Nation’s colleges and began the difli- 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.* 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.* 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.” 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- 8 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 Jess 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,° 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 ® 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 Research 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 47.5 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 he 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 873 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? Hlementary 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 yoca- 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? at 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 ? ——————— ee 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.Y 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 has 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 ee 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 & 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 yearsago. Ina 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 1 i, (j 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. Tn 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 who 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 +n 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 Bast and Africa area, from 182 to 830, 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 448, 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 ( :k Lhe a nn, Le eeEREnne 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 IBH’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—tin 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. III, Secondary and Vocational 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 Haperience 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 Offite- of Bdlication 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 were 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 Foreign 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). iD 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: 2 Public school system (regular full-time)_-.._.--.._._--.-------------- 26, 700, 000 27, 800, 000 Nonpublic schools (regular full-time) 5, 000, 000 5, 400, 000 Otherschoolsi) 92224 Cee 326 1 os TS Oe as fat bese oe ee 180, 000 180, 000 Total, kindergarten through grade 8.-.--__-.-_--.------.--..------ 31, 880, 000 33, 380, 000 Grades 9 through 12: Public school system (regular full-time) _......-_.__-_.--------------- 8, 300, 000 8, 400, 000 Nonpublic schools (regular full-time) 1, 000, 000 1, 100, 000 ‘Other schodis l222 22-520 3S -S Say 2s. 26 5 oe ee eee ens 90, 000 90, 000 Total, erades S:throuphil 2252 28 oa oe se enon oa eee es oe ee 9, 390, 000 9, 590, 000 Kindergarten through grade 12: Public school system (regular full-time) __..._-------.--.------------- 35, 000, 000 36, 200, 000 Nonpublic schools (regular full-time) -...-.._.---------.------------- 6, 000, 000 6, 500, 000 Other schools S }. zeit 32 fe he ee as eee Oe 270,000 270, 000 Total, kindergarten through grade 12____1...__..--------------.--- 41, 270, 000 42, 970, 000 Higher education: Universities, colleges, professional schools, junior col- q leges, normal schools, and teachers colleges (degree-credit enrollment) -_ 3, 600, 000 3, 750, 000 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] Elemen- Elemen- Item tary and Item tary and secondary secondary Supply Demand Total classroom teachers 1958-59_________ 1, 493, 000 || Total classroom teachers 1958-59_________ 1, 493, 000 Less teachers with substandard creden- Total classroom teachers needed to meet tials in publie schools preceding year enrollment increases in 1959-60_______- 70, 000 (Hallia958) oes. Sao see Sere 92, 300 ——— —_—_——— || Total classroom teachers needed 1959-60__| 1, 563, 000 Qualified classroom teachers, preceding Less qualified teachers from regular VeGT ts neice co Pe a ee ee 1, 400, 700 sources in classroom service, 1959-60__} 1, 368, 000 Less qualified teachers not returning to a classroom service in 1959-60 !___._____- 152,700 || Supply needed from other sources, a 1950-600. = 25 Sue eee ees i 2 lee 195, 000 Qualified teachers of the preceding year To be met by the re-entrance of former returning to classroom service in teachers into the profession, employ- 1GGO-O0LEs ACESECET, SULLA ASL 1, 248, 000 ment of teachers with substandard Newly trained teachers entering class- credentials, further overcrowding of POONT service 422.08 251 Ps FSS 97, 000 classes, or curtailment of curriculum. Teachers with substandard credentials (The corresponding figure for 1958-59, becoming fully certificated *.__...____- 23, 000 ogy the same dropout rate, is 182,- [panna eed 000 !). 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 Report, 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 rr aan, Table 3.—Grants and other financial assistance to States, Colleges States and outlying | for agri- parts of the culture United States and the mechanic arts ee ee Se Total 2___-----|5, 051, 500 Alabama. -=-----=--- 100, 541 71, 283 77,477 89, 047 California ----------- 175, 599 @olorado_---..------ 83, 218 Connecticut -_-------- 90, 022 Welaware.._--------- 73, 172 District of Columbia-|--------- PLOT Soe ee 97, 644 Georgia_..-----------| 104, 360 OS a 74, 985 Wanhge. -2s-e--2——.- 75, 871 Tiinois:.==2--=- 156, 905 Indiana 109, 244 Jowas+=.----- 96, 145 Kansas 89, 005 Kentucky 99, 374 Louisiana 96, 768 Maine...<-=--«------ 79, 115 Maryland----------- 93, 371 Massachusetts.------| 116, 788 Michigan.--.--------] 133, 559 Minnesota----------- 99, 750 Mississippi---------- 91, 735 Missouri —- <---=+--- 109, 448 Montana 75, 895 Nebraska 83, 222 Nevada 71, 596 New Hampshire----- 75, 319 New Jersey---------- 118, 233 New Mexico-- 76, 794 Now .0rk.----=---- 217, 933 North Carolina------ 110, 518 North Dakota------- 76, 180 (Gint 2. ee, 149, 269 Oklahoma.---------- 92, 278 Oregon 2-44 === -=5~- 85, 175 Pennsylvania__--.---| 174, 719 Rhode Island-_------- 77, 899 South Carolina South Dakota------- Tennessee----------- Virginia. .=----- Washington -_-------- West Virginia- ------ ‘Wisconsin. ---------- Guam Puerto Rico--------- Office of Education, Mainte- Coopera- | nance and School Defense | Men- tive operation | construc- Library |educational| tall Total vocational] of schools tion services | activities |retarded education| (Public (Public Law 874) | Law 815) 39, 140, 434|3 166, 660, 734/70, 553, 170}7, 036, 729|4 68, 506, 824] 71, 327/357, 020, 719 1,063,459] 4, 134, 169) 1, 178, 556 207, 576) 1, 924, 249)-------. 8, 608, 552 85,978| 4, 937,070] 2,273,264) 46, 657 ; S20 eae 7, 492, 973 204, 863} 3, 910, 640] 3,360,417) _72, 485 139, 691 7, 765, 576 780, 559 953, 655 660, 185| 164, 544 883, 240 3, 531, 233 2, 083, 982] 26, 023, 090 12, 396,011} 239, 322 1, 869, 372 42, 789, 412 340, 791 4, 657, 958] 1, 482, 603 88, 084} 1, 162, 940 7, $23, 726 352, 160 1, 504, 810 360, 626 67, 807 317, 107 2, 692, 535 185, 836 RAL O28 (aa eee 48, 391 109, 059) - 1, 057, 488 117, 625)_a2n==2—22 --|---==-—--=|===-—- === 230, 289 347, 914 641, 558| 4, 765, 332] 1,577,909] 146, 259 2,025,014] 9.000) 9, 262, 718 1,094,212} 4, 650, 651) 1, 364, 942 223, 578 B20) 725 }eoean=== 8, 258, 473 180, 891 958, 511} 2, 330, 961 55, 087 983;,9383}_ == «=2=~ 3, 884, 370 231, 670 1, 313, 116) 602, 442 85, 934 587, 7611 ." ° ae « 7 ae wy , ~ ; x ip . ‘ ch 1 ae a a ae Te ¢ e@ P ’ eB ePaper 'ty: set josacbinulin } settagabhel yee) pCyria Astwid “oy » sie ane aa ae fits il 4y?/ Dicey samper Pop won) m MITHPKO PY aet { ‘ | eden oy) jhe ai te } oils %) [chewy inten B t aps. { Wet) Faw» } Tb Jae aX Re Ve Fae * ey Ue OS ea ef i Be 4 ! co « Fak, 1 Tan | ¢ ; : J r : t ce } waving s iF fi ae hey ear i ; te vb fT, Gite f hi 5 RRS Fe 1008 4 jee r te : , Hf ; oc as § Ve o00 f w | «ee Ree ZY? “ iW) Ape as N e Loe, eo 4 we Te’ G0 2 in! bred ak 2a % anal th 66 Fhe “in é | ont Ses Le i 7 ar } iiss oun : PES tte a aS GO 8G it ; Toor ciue * ‘s SPL SUAS “eG ee” iee AS) ae} { iM PAE Deo. Le CMOS Ce eT Sa L ae, Me NES pe a) tere - jw AD © oiky Go eee Pte eta -pon ghE OU 0A, ‘ ’ a AR Sa! tae! if va - I +s 2 = : > rq de nh aliay A Food and Drug Administration Tue roop and Drug 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 whose 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. Sea eee ee 327, 495 6, 893 334, 388 OMe oss ee ee eee 87,177 Jasccenosasnonc 87,177 Potion Go le a 389, 990 8, 816 398, 806 ERTS MI t Re ek co dwobawalslsodaeaenoone=sns 62; 544: \scoccweweeeeae 52, 544 Pe ERT RE eet oe eC cee no enc caeteaaseaceceneauee 60, 511s | Scewencsncene 60, 511 Pee METRE ares a oo a te ada neestoueeeesca 56, 213 1,172 57, 385 Siete PO en oo cc nconkeusensececbeeteccssaaus 380; 5463 zccucsscaesoss 330, 546 USGL. 2. ee ee ee ee 286, 792 10, 206 296, 998 3h, 450 eceecee eee ee 31, 450 86, S80n(esere voce ae 86, 880 87, 72d Wace eawaceoees 87, 724 97, 818 3,000 100, 818 573826—61——20 Vs a eble Saint Elizabeths Hospital DuRING THE YEAR just closed, problems of understafling 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 1s 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 ne 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. 18 |< |& ras ee | coe: ; & |s S win le ia is {8 @ ig (8 |& 1B jo |s IE |& Ig |e 5 B |Z js |g (6 Is 2 Bw le fe) a |a ge ig g 2 - {Eola Bie by 5 3, 5 if 5 g Ss ie {8 B 5 ale = Z 3 ty > S 5 = ~ & |B la |2 18 |s me 1a le de leo {- B is |B le Bit iF iB 2 =] se a B 8 2 Oo 5 ei 2 Ls} ies] q i g g y = |5 BE io |2 {= = 8 g d g g a Ste ta & |B - =a I -~ ot 3 g m |Z |B om bd 3 a ° Q f=4 ay i] B 5 S 8 ie q & |= |B S = |g 3 = 5 le m |= 2 ¢ | a. 8 squejed 91qesinquiteru0 Ny squeryed 9[qesimqurtey 0961 4004 yoosf ‘uonvo1fisspj9 LQ ‘sjuaiwd fo yuawaaow fo yuawew4Is pajppyosu07y—Z CLA F Saint Elizabeths Hospital th ur ia hed ge apace Linge Gaubarataa a slr herein acon is ah, i, NAA St Pe OR oe Sp es gal seraeen’ aE Cy ane wed American Printing House for the Blind As TH orricraL 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 roe es errs belle ‘s | f ‘Ser 3S ee sto toc ia CHEE 08 f E I s —_ +. = *; ~~ . 7, Boal iad a em . > Bee a G BKW Sanots (lot keninoages A * deen que * 7 : e at c Gallaudet College GALLAUDET CoLLEGE is devoted to the education of deaf persons who because of their handicap would have difficulty in schools and colleges for hearing students. The college, located in Washington, D.C., is the world’s only college for the deaf, It was accredited in May 1957 by the Middle States Association of Colleges and Secondary Schools. In addition to education, it conducts research into the educational problems of deafness. It consists of the Kendall School and the college proper. KENDALL SCHOOL Primary and secondary schooling is provided for deaf children in the Kendall School, which also serves as a laboratory school for teach- ers training in the college. The oral method of instruction is used for all pupils except those who make no progress under it. Enroll- ment last year was 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 ee ae os re . * > ez " Pedy eee aap OF J os é : y4 he ai le if A nee, I- - * i : + ao ‘ : " > “ a ) 9 4 *, = se » —¥ - ce . : gealloo tobuehem as pete ous B is. SUB Re Ae! od baiovalsei et fine 720 Blaow cas eis rwcrrian WY ni Tag “H suelion: oft +s 'esbyde ‘ge Wel vee, . bes Pitre HA 3k. Aeeh si ao} egalten ‘eam A “% ic bite amasiloD To woBeposné ¢ 5 ; i : vi pe : iin, 3} paces pee ot 4 pe ee le febnayl efx 4 3 2 218 TEND : ro t ‘ a Lae; f is Di 1 4) Butigond a Yt riorsl nls ec vavege ule Hatley a} AL at Tomded to ticdldeue fare ony raAlios with: ie + i mig ‘ A ] bitty ssateory, Da esheptt- aula sage 1ySaxKs, ath to Joist orld imott aia oo Apidae 900 auive tee ~~, sO LIOD Saf Y at #03 TPO). Be resicy..} ee Toe ¥d $08) ai parte ihdotens oR thc Zz itt ol oxtush eaoladied ee Iie ethine to grasy & talta Bor quk fh) Oylaier { ROOST at] Ctotetiger aft | BADINLOe bes 24 £ i te eortde of a!laeg aoa adtw adhabaria vot food we gid ig Ae h Ee top sored atay barre) wT. Aneb odtaoit loosen We 91 MME L noes) Ort A fern oomgah dvatnasn a § se hide ae, ed LITO ETT Ee aretha | isis " tte ai eo harde! fea Tsah a ‘ Hntoeh 6.6ciprr of oh y Give wirvbeutuoo, Leotiascr 03 exitags A int dee sail pie Lat coals § igob. te gaih Aiden li) Eh siinaleh out eins Wb mend yr dite 388 _tepemat neg bits goltpeemg, $i a0 Obae gmt | idnte wed 19% § ablirie 7 = Bios ly 2 oe idis@isteb wil} io tt Harty att as bubaig auroral fe i rey ee iit “<3 fants: 4 cr. le es meth es Mi Sn = adi To. nuldgtiyat adi ae jn? batoured oF oak Ric ait fe cuGi, y pale tarist'S Vuln i wi rT - DE att to 2990 7anh onli ‘ohals ereatie ‘eo P batted, itide * vi, coy 30 irae, {Pats sil: ts ae? gids fick > Gitte jor Bast “118 landiacotoag | bi fa 1 ls By OYFIO wi r4 polbiest 4p Mesa 2 iene - : ? Matrits arinwel there, the ‘Asibbage banat tia re Ppa tg The Sits Sa ¥ ee 5 st 12 DOs APOE IT Pb. *t fk) to, (PUL TRO LY to BAO KE ‘Nid tiie taeda. det) to.aiootio live -hooy hi tn, lousiniga ad thee ve RIP votinler “uedh fn alacant: TOL RA, 18: ne oe ons. to dein. ot. 97: 194 ARs “aphg 9g ‘ rhal i > a» ees ¥ by ‘ j fan'es ‘ + Sf “2 > | Lit _ ’ rials ‘ : tin i he ee 2 ‘ ’ - _ i orl. mf : ,; Sat irk 41 = + Og , i? . > = byprerds § " P arent, wa “Sot Thart I Ol Toe rers of % ch) itd 4 ae . Wier tw ot cite Sth o¢ Tis Nena: tae tt: ins ccscungit wniaok ig Opegaeiames : aie “2 = Ly AST WizcAV a, Che heus < was. thy Hay ua Nm CA HOSE Corigis rt DV ener.-— A wibmheradt the + 4 beh Es ven sheet rel OTF LI Sait ket. iy, wig % ta Batam rates ree Meus Law, fx gin wih 3 rile Sid orcoehinacetal eaten a neler Ribale! a7 ‘ > . my hs ® ee ~~ > «@ bes 4h eS Detailed Contents OFFICE OF THE SECRETARY Orricr or AssisTaNT Secretary (Security, Civit Derenss, INTERNA- Diente ane OTUVETIES ogo oe ea I EE ero tee delete So OFFicE oF ASSISTANT SECRETARY (FoR LEGISLATION)__..-------------- unten OF GENDRALICOUNSDL- geciucess- busi rei Jes deeele nce ls Spectral ASSISTANT TO THE SECRETARY (HEALTH AND MEDICAL AFFAIRS)_ OrFicEe or ASSISTANT TO THE SECRETARY (FOR PROGRAM ANALYSIS)_-__ ~~ DEnierOurA DMINISTRATION 22 fui. 25 bee soe oe oe ae eee lee rwien OF EIELD ADMINISTRATION..........--.<---.-------~s62-- 28055. Pougualn AMBION A GING: <224. “eb Utlysi: ba5_ susds cee. Lose 2-22 ASSISTANT TO THE SECRETARY (FoR PUBLIC AFFAIRS)_-.----------_---- Orrich or PUBLIC INTORMATIONG2E su cbowee ect bees s el lect ells Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1960_ _.-.___.--------- SOCIAL SECURITY ADMINISTRATION OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE_.----_-- ree PE ROGEA MITA LOING..--c<-.c—-=0ccccmon bee lee eet le Specran Stupy REQUESTED BY THE CONGRESS_._.-------.-------.---- SuRVEYS OF THE Status oF BENEFICIARIES UNDER THE OLD-AGE, Survivors, AND DisaBILITy INSURANCE PROGRAMS-_---------------- ROG AML SIMPTANI CAE ONG towie Soha Se outs eter. oops ee! se bus PEOtARTDR CUONTURY. IN jRETROSPECT»....-..-..--.-- #25LL Le Sa. Memmi sine hangesiss sadoess: t, Sednn Vo edu Sw sobs. = bk. Increasing Acceptance of Public Welfare Measures_____---_------------ Areas Identified as Needing Further Consideration__________----------- CONSIDERATIONS FOR TTHES Hurunm 2) 4 OLE. ek Fs. ~~. SREELEIO ENN TSN LO OU See ee eee Rane ee Loe ae ee ot OS Rime risiatilOnes we = eater. Se SS oo ee re ae See ee te at Blrends 1n-Caseloads and: hxpenditurées... 042-4. -254---6e----4s-- 265 Program and Administrative Developments___.._..--.----------------- rhe ORE INGO he Dike EA Usenet on ee Se en oo ed ee 1960 Wuitte Hovusrt CONFERENCE ON CHILDREN AND YOUTH----------- FEDERAL INTERDEPARTMENTAL COMMITTEE ON CHILDREN AND YOUTH--- ROC AMSEOMTTHEM DURE A Us oe 2k Soe eee oon oan a oo ae = eee by 5 ONNTA ATR WWH FO © 308 Department of Health, Education, and Welfare, 1960 Crippled Children’s Seryicess.% ¢e<. _ et ees Se EB ee Child "Welfare Services 24... 2. S20) eee eee = See ee eee ee Juvenile; Delinquency Services 225-2, = oe ec ot oe oe eee International Cooperation S4is2+i 0) Abbe. 2h! Sheed eee eee FEDERAL CRE DELSUINIONS 3250256. see nso eee TaBLE 1.—Social Security Administration: Funds available and obliga- tions Incurred, fiscal years, 1960%and 1959002 eee ee ee TaBie 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 1958-43 e ea ee See Sn en a ee TaBLeE 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____ TasiEe 5.—Old-age, survivors, and disability insurance: Selected data on employers, taxable earnings, and contributions, by State, for specified periods 2h. =. ssa oe ae oo et oes ae ee ee TaBLE 6.—Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 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 1o recipients, by program and State; fiscal year.19602..23-= 3. oe 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. 196022. oh ae ce nce ee Se EE Ue es eee Tas LE 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 year1960_._ 2-22 --_--. e e e Taste 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1959, and Dec.31, 1958.28.23 24, sSoa5- Fe a, RE RECT SS. 2 eee TaBLE 11.—Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding, Dec. 31, 1934—-59__ PUBLIC HEALTH SERVICE OAT LH SOlS AE HSIN ALTO Nee sees so ne ee a eee EVER CIRC COL oe ae etre re ae oe Pe Se re ee ee ee Births arriapes and Divorces. ss. ce cok ane ae eee MOUNDS AND EE MRSONN Ble. woe Sale ees ose ee ne ae ee ee Board ior Regents sate nse ae we eae eee ee eee ee ee eee PDE ANC W DULL Sr eee ct Nee acs ara we eS ee ee EN GEZIDE OCT VICOS . cee et we een ee et ee Organizational ‘Chanves sacck =< — ne oe sae a ae ae ee intersInbrarveloansse cess. oo eee nee ee eee A aed) Aer Fasc y > 81 82 84 85 86 88 Detailed Contents 309 Page BEBO US ME SUA DIS ICS 5 rs ess etl = Se ak a at ine we I noel 97 See TERE Ronny VLOTH ODS 22.2 5 ei ara wr ee BEAL et es 97 MERCORMC OCA Ola DY SICIANS soe cre eee a ee 97 REM LLC OLGH po ULV. Viren aS aoa Soe em st eS Oe Ce 98 Smeraraninantalealth Studyesomcac- ne See oe. ees eee eee + a8 98 PEROT CHNERE GE SO TUN COR Losi Bg Sis ais 2 ai ha arg lcs mr ape wae 98 Ree CIRO WOU US 25 hae ee ea SS wth a rere ee SE ES 98 DOL OMBELOP TOSS © 52 2.4 Wei N. eather n ee S eS 99 Mirena eLONAL ENS LIT OULES. OPV HBA Hs 222 222802 22 Ze ese 99 PiImislonmot DIOLOGICS, STANDARDS =... 0. «2. ee oe 26 1 eee See ete 101 DIVISION TOR GHNERAL J EDICAL. SCIBNCES....-....-<=s08.. 28assle S255 102 Pere rn CIN CS LCSCAT CD aS. 2. h es i See Eee 104 Pg TONSOMSRMSHARCH GRANTS. 2.5 .<—nas0-25uoseeeu. 26 SSS. Ste 104 PT SONPORAR SEARCH SHR VICHS... ee. eee. =e) ee 132 Improved. Therapeutic Services..<.-...-...--1. 3). eee 133 Improved. Preventive Health Services_.2.._._.-.. --§ “5505 25es.- eee 134 Dental Services: 242... [ane oes oe a eee 135 Environmental Sanitation2.. =. —ci2el2u a eee 135 Progress Toward New and Improved Health Facilities. _.._._._.....--_- 136 Cooperation With States and Communities-_-.....-_----.-.---------- 136 Hosprran AnD. MEpicaL FACILITIES» SoS ee eee eee eee 137 Progressive Patient.Cares.¢ S224 tle ee ee eee 137 Medical School Study 4 2222-2. Sor ee eee eee 138 Modernization Needs of Hospitals.....-....-.-2222--2c.ud.ees den 138 Pallout-Protected Hospitalios-_..2__.. 22. een ee ee 138 Changing Needs and Emphasis of Program____-...-_.--..----.------- 138 Scale of Operations 2.2220. 20.208 seav ge eeu eee ee 139 Dunrat Resovromss..222c2. Ja ceeds J. eke eae eee 139 Assessing Manpower Requirements =< -..-.248- 52 2222-4. S225 2SaL eee 139 Increasing Utilization of Auxiliary Personnel___._.____.-__.------------ 140 Financing Dental Caressacsicceslsacese espe et cuteeu sch oe eee 140 TeehnologicaliActivities. 2-2 Jo. ol eased we ese ae 141 NURSING RESOURCES... 52222. 5.225. 2e2 re ee ee eee eee 141 Seope of Division. Activities.......c<...-<>.-c<-----2 easel. Se eee 141 Assessment of Nursing Needs. = . 22.0 suet /icdoeede sl ocweeth See 142 Part-Time’ Nurses. 200s 1c 220. ee ei a See 142 Emotional Needs of Expectant Mothers__-....--.-------------------- 143 Other Studies in, Progress: -- =~ -< /...2--s-- 2 1 oi i en eae 143 Research Grants and Fellowships..-....22. iu sculls esos eee 143 Professional Nurse Traineeships. 2-522 230520. 4 ee eee 144 Mepicau SERVICES FOR FEDERAL AGENCIES. -._---_---_-----1-.---21 144 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... 2 <2) 2 ee eee ee 147 Division or GENERAL Heauta SERVICES.____-_-_-----/.------_---LL 148 State Grants 2.2.2 .22.....0.-+.-~- eka ae ee 148 Arctic Health Research Center_-_._.-2......2.s..2225 22 abe 149 National Office of Vital Statistics. 2. oS 24. 52250 lti.2 a. eee 149 Program, Development... .2<~- oc. S25. 22cussecsneo Se. jee 150 Public Health Education’ 222-5228 2 a ee eee 151 TUT AIN Os Sot sre gs SA re oe oe nt ae a 151 International Education and Exchange Branch_____._____-_-_--_--_-_- 151 Drviston of Hmaura MOBILIZATION. ..<225.2-<-.254.5 262 eee 151 Division or Pusiic, Hwatts NURSING _-- 2-2-2 sinpesbeeu eee 152 DIvIston oF SprciaL.HmartH SPRVICHS._.- 2422-222 LUSsil soso yee 153 @ancer, ControlsProgramia= =e no. a= oe = See ee 153 Heart: DiseaseiControl: Propram=<= .- 2-2 5-on ao eas one ee eee 154 @hronic.Disease ‘Control, Program.--=__ .-.=----.- . -Baee ee ee eee 155 Program SerVvicess. =. 2250s 8c cee ee ne ee eee 155 Operational, Research. 322. =.=. 246. 92-52 ee ee 156 MiberculosissControl Program... .2o2- 52-52 225. eee Se 156 Occupational Health Program___--- doin oGn nese tasencae staan ete 157 Detailed Contents 311 Page Smee uion Viedical Program... Soenahs -cagee ce! 2 Ghe$s—hwrne ences 158 Pueniehts Of the years Propross--~ ~~ 0 seetip eee? Sele 158 Pe rumrovoniod "PrOeTam. .-. o- ©... = Supaeee - 26 eR uevsedll Usnes 159 BerOC CHIT (A Chl VL bt Ce eee OE IEGOE: haart PE he ee ad Ss a! 159 Beate ano Tock Developmentss. > o- 2-22 .o 525 Ss2 bn cep eens 159 Pimento A DIOLOGICAL UO BALTE 26 ell s4- ses an > ensciea kins sens bee 160 Peri ONIOe UNGINDERING SERVICHS...+--=Hebwe suet 13s cewedh Sete s 161 Robert A, Taft Sanitary Engineering Center_...-.......-.-.--------- 161 Hroineoring mesources and Training. 20222424 4+ daseares oe mdeee- 161 Orman CIneering ropa ~ <5. se oe on 2 lous aa eeaed Soe es deus 162 St Ree NOOR Sanitation FrOpTam-.2.---2-+—-2.---sssvn sg th we43se55 162 Erecouuuon. “ngineering Propram23. 05 js.es.2- se e-uoect Sct dencis 163 Other Highlights of the Year’s Progress....--.-+-++-i2+4-«-+- 164 Division oF WATER SuPPLY AND PoLLUTION CoNTROL...-------------- 164 MOUMUNTCABIE DOISMASH CHNTHR o-oo sas dnsehthSodawendhdacesw 165 Scr, ISAS, Aldiess = tisidore © Se web tonda b asad} eldt Soe wees 165 Representative Field and Laboratory Studies_____-----..------------- 165 ce Oren NOLEN | veh Oth Sse e Awe Beg el ost Span deensg sok 168 Laboratory Services and New Techniques-.---.---.-.--------------.- 168 ee oie OOperatiONts 4,125 seus oes Sg ewes hu ba wash een Senge 169 Sipe nar ci erenen Sat FLEA eh de gt sa ch nonewies duadee aa hin 169 Sinton an ONTAL PUBLIC HWALTH..\s2-.s2-.55--22222--2--5--fe- 169 UM ame SOE Rete as ee Sel oe Ses Se pega se 169 a nn Seas) PS eee SES 5 2 3 Di age lang ge) saa ss esas: s oes oe ad sek ses 260 OFFICE OF VOCATIONAL REHABILITATION ADVANCES IN RESEARCH, TRAINING, CENTERS, AND WORKSHOPS GIVE EOUANGN © W «INCHNTIVES. >. 4.--225-—-.-.---~--2->-- = neko eouse 261 PrernS Le 1 OGQescce et ete ce ek et ee eee eee 262 PmenrEmvenuerOr UNO. LORTamn=--- 1s. -- ee ae ea eee 264 ReSuAecH tT ROJDCTS ont Now RECORD = UoW L222 eso 264 Paecneamimemonstrawonus in 19602. —-0 2 oo ee nee nen n 265 Dette AL Oeae. ee eee eae Sk hee an oe ona geccm mee meee 266 Menten eersonalivy Disorders=o~ ~~~ oUt LL Li oot che 266 eres meee ee meee en Fee en cae confor 267 rn eee ee ee ee ae ee ee me eh onetencheescae ste 267 Coie tS ahh, VEDI Rie = 2 papain abe alec Bb = gare Sete pea ge pa apes Rare anfefis Apt Ney. 268 rE on Meeitte ReSCArCh = «os 2 eo on en one oan bee oe cone aoee 268 TRAINING EXPANDED To CovER SPECIALISTS IN SEVERAL FIBLDS____-- 269 Lake Orla. 2 eda eat sae es sg lk cea lee ce he te a eS ah SRE Ev 270 PERL TGTE COUNRC IND a ee cae on eae eon ee ee eae 270 Pepe eA uOLOrY ald AUGIOIOSY once o-oo Senne ce emee nen eae aoa 270 Sn MEISE TCT OFrENOLICS se oe sane gene one n ae ete tesc aac ceades accu 271 Sree iecsion ale Wiclis so 6 oats ee ee on we Se eee 271 Peemmiltswom othe Blind. 22s. 2.2.5 3-2 0 2223..29. fu Fi 2.283 271 Mentalvlil and the Mentally Retardeds2-c:-...-.-.-..--.-s.---=--- 272 eer eS ee oe ee ne ne Re ee a a oe cco bade Doeae eee 272 SPECIALIZED FACILITIES IN DEMAND FOR TREATMENT OF SEVERELY Dt1s- PIR Ty eee Te etme eee eo toe be ew bE ONS Se DES eee eee 272 Pera EOTT COEF ACHIVICS = eee ete. on bal ee ee ee ee 272 Sreranon ang User Macilitiess 2-5... 2. 2623.4... 3.5.2.0 2-2 o eee 273 Encouraging New Methods and Techniques____...-_------------------ 273 EDUCATIONAL OPPORTUNITIES FOR MENTALLY RETARDED ACCELERATED. 274 Ti FL LINERS SYS SRA Sp AR a Sal i aR Se SE ae res Ney PE TE AS 275 Services EXPANDED ror THOSE WitH COMMUNICATIVE DIsORDERS_... 276 are NeTO? TH+ ul ND = ee ere rete be oe ahs a eo Cao ae 277 Menaimosvands forthe Bindtess =-tase eo eteee. FEO ES. ue ok. 277 SERVICHS FoR ELDERLY DISABLED EXPANDED__.-_...........-..---.. 278 Mepicant ASPECTS OF PROGRAM ARE EXPANDED_._.-.---------------- 278 PROC OLED USINESSoee.cc ch cube arn s ee OU eee See Tg CE a iets 279 EH PONDITURES FOR STATM .PROGRAMS.....--2---- coon. one eee tk 279 EXTENSION AND IMPROVEMENT GRANTS__._-...-----.---.------------ 280 I ANGE ee ek oie eee ee ee ee eee ieee mack cone 280 PAS DISABILITY. DETHRMINATIONS. o.-<--cos-_--- ~~. See eset eee 280 Rehabilitation and Labor Health Service_.................----------- 281 PTO RNATIONAL «ACTIVITINS...cascac couvecsatak eens eLearn Jes 281 ROEC gumeL reINeCsae nae ee < Oee eee atm oe oe ee eae 281 Taste 1.—Number of referrals and cases, by agency, fiscal year 1960... 282 TaBLE 2.—Vocational rehabilitation grants, 1960, State divisions of voca- HONATonAitationsen sees tee ee eee Neen fockw sn e ae emeee nae 284 314 Department of Health, Education, and Welfare, 1960 Page TaBLE 3.—Vocational rehabilitation grants, 1960, State commissions or agencies for the. blind + Sah loss ets Soe A BS ea ae eee 285 Cuart 1.—Disabilities and major occupational groups_-____..--------- 263 SAINT ELIZABETHS HOSPITAL Division. OF }OLINICALSSORVICHB {2s 50- 22-78 2 ee ie oe ee a ee 290 Clinical “Branches ="SS-50 2 Peo See en cae eo ee Oe 290 Medicaljand Surgical Branch -==225 ee ea oe 291 Nursing Branch 22222 eee co al ae eo ee eee 291 Peychotherapy -pranen: 2eco2 se) one eee eee eas ee ee 291 Psychology Branch oe e tate eee ise cae ee 291 Recreational therapy Branch’ 2s. one. eo es a eee 291 Occupational -lherapy + branch 220 soa col ues. Seu oe ee ee 292 Volunteer Services branch? 3! 22a. tees oe 292 Dbocial" Services Branch esse eee a oe ee ee ee 292 Chaplam‘ Service: branch 20022 22. Seu beet a Sa ee 292 Medical"Records:Brancheenia.ee oe owen nee ee se oe eee eee 293 Labrary Services: 28s. Se Bhe_ DAL Soc oes Soe ee ee ee 293 Laboratory Branch____-.-_-_- JiheoSeL Ube ses 2a ere eee 293 DIVISION -OF GA DMENTS TRATION oo se ie oe ie a er 293 NEEDS-OF THE! HOSPITAL SD SIU 3: SI Se ee ae ee ee ee 294 TaBLe 1.—Movement of patient population, fiscal year 1960___._------- 294 TaBLE 2.—Consolidated statement of movement of patients, by classifica- tion, fiscal years 1900 ees Soe oe Soe SSek SE Ss eee ee 295 AMERICAN PRINTING HOUSE FOR THE BLIND Services to Schools and Classes for the Blind___..._._-.-.---.-.-------- 297 GALLAUDET COLLEGE FON CAL SCHOOL ee ee ee eee a ee ee ee ee 299 Gallaudet. College. 22-24" Sa- ees ind Seen Tene es ee eee are ee 299 HOWARD{UNIVERSITY Enrollment of Students__- .__. ,eea2asaet eas See See cee ee 301 Géoeraphical Distribution, of Students=-----<- --..--c2 6-22 eee eee 302 Weterans, 2) 265 ooo So nn Sie oe wc ny oe ee, a eee 302 Atiny. and Air Force. ROTC... aa ae ee ee ee eee 802 RS hacultyige ets te cas bec ue phe eee ee ee ee ee ee 303 (He Building; Program 2.5. ~-s~->~ -<=<-s -RaOTEs eee eee ee 303 G¥iduates. 6222422525022 a BR ee ee ee see 303 Séetvice.in, Foreign Countries... 22. socee cobs sae eee ee 304 U.S, GOVERNMENT PRINTING OFFICE: 1960