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Full text of "Annual Report of the U.S. Department of Health, Education, and Welfare, 1956"

ANNUAL REPORT 





^956 



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





Digitized by the Internet Archive 

in 2010 with funding from 

Lyrasis IVIembers and Sloan Foundation 



http://www.archive.org/details/annualreportofus1956unse 




ANNUAL REPORT 



Wmm 



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



For sale by the Superintendent of Documents, U. S. Government Printing Office 
Washington 2S, D. C. Price 7S cents 



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

As of June 30, 1956 

Marion B. Folsom, Secretary 

Herold C. Hunt, Under Secretary 

OFFICE OF THE SECRETARY 



RoswELL B. Perkins . . 
Bradshaw AIintener . . 
Lowell T. Coggeshall . 

John R. MacKenzie . . . 
Terence P. Scantlebury 
Willis D. Gradison, Jr. . 
Charles F. Barrett 
Parke M. Banta . . 
RuFus E. ]Miles, Jr. . 
Chester B. Lund . . 
Harvey A. Bush . . 
Frederick H. Schmidt 



Assist'mt Secretary for Program Analysis. 
Assistant Secretary for Federal-State Relations. 
Special Assistant for Health and Medical 

Affrirs. 
Legislative Liaison Officer. 
Executive Secretary. 
Assistant to the Secretary. 
Assistant to the Secretary. 
General Counsel. 
Director of Administration. 
Director of Field Administration. 
Director of Publications and Reports. 
Director of Security. 



SOCIAL SECURITY ADMINISTRATION 

Charles I. Schottland .... Commissioner of Social Security. 

William L. Mitchell Deputy Commissioner of Social Security. 

Victor Christgau . . Director, Burraii of Old-Age and. Survivors 

I nsmymce. 

Jay L. Roney Director, Bureau of Public A.ssistance. 

J. Deane Gannon . . . Director, Bureau of Federal Credit l')iin)i.<:. 

M-vrtha M. Eliot . . . Chief, Children's Bureau. 

PUBLIC HEALTH SERVICE 

Leonard A. Scheele Surgeon General. 

W. Palmer Bearing Deputy Surgeon. General. 

Jack Masur Chief, Bureau of Medical Services. 

Charles E. BuRBRiDr;E . Superintendent, Freedmen's Hospital. 

Otis L. Anderson . . . Chief, Biireau of State Services. 

James A. Shannon . . Director. A'aliofial Institutes of Health. 

OFFICE OF EDUCATION 

Samuel M. Brownell Commissioner of Education. 

John R. Rackley Deputy Coinn:if.sioner of Education. 



FOOD AND DRUG ADMINISTRATION 

Geokue p. TjARRU.'K ...... Coiinninaioiier of Food and Druys. 

John L. H.^uvey Dcpntii Commissioner of Food and Diikjs. 

OFFICE OF VOCATIONAL REHABILITATION 

Mary E. Switzer Director of Vocational Rihabilitnlinn. 

Emory E. Ferebek Deputy Director of Vocational RehabiiUaiion. 

SAINT ELIZABETHS HOSPITAL 

Winfred Overholser Superintendent. 

Addison M. Duval Assistant Superintendent. 

FEDERALLY AIDED CORPORATIONS 

Finis Davis Superintendent, American Priniincj House for 

the Blind. 

Leonard M. Elstad President, Gallaudet College. 

MoRDECAi W. Johnson .... President, Howard University. 

REGIONAL DIRECTORS 

Lawrence J. Bresnahan . . . Region I, Boston, Mass. 

Joseph B. O'Connor Region II, New York, N. Y. 

Edmund W. Baxter Region III, Charlottesville, Va. 

Richard H. Lyle Region IV, Atlanta, Ga. 

Melville H. Hosch Region V, Chicago, III. 

James W. Doarn Region VI, Kansas City, Mo. 

James H. Bond Region VII, Dallas, Tex. 

Albert H. Rosenthal Region VIII, Denver, Colo. 

Fay W. Hunter Region IX, San Francisco, Calif. 

iil 



Letter of Transmittal 



Department of Health, Education, and Welfare, 

Washington, D. C, December 1, 1956. 

Dear Mr. President: I have the honor to submit herewith the 
annual report of the Department of Health, Education, and Welfare 
for the fiscal year ending June 30, 1956. 
Respectfully, 



kox^f^^w^ 



Secretary. 
The President, 
The White House, 
Washington, D. C. 



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Contents 

Page 

The Secretary's Report 1 

Social Security Administration 17 

Public Health Service 87 

Office of Education 159 

Food and Drug Administration 197 

Office of Vocational Rehabilitation 223 

Saint Elizabeths Hospital . • 243 

American Printing House for the Blind .... 253 

Gallaudet College 255 

Howard University 257 



I A detailed listino; of the contents of this report, by 
I topic headings, Avill be found on pages 261-268. 



The Secretary's 
Report 



America is a land of change, of sometimes sudden, dramatic growth. 

As an example, consider what happened in one 30-year period in 
our history, the years spanning 1820 to 1850 : 

Americans had needed 200 years to spread their civilization west- 
ward across one-third of the country, to the Mississippi River. Far- 
ther west were only the Indians of the Great Plains, the fur traders, 
and, a thousand miles southwest, a foreign land owned by Spain and 
forbidden to Americans. Then, almost explosively, the westward 
rush began. The "Winning of the West" — from the Mississippi to 
the Pacific Ocean, from Canada south to Mexico — required only 30 
years. 

Now let's advance a century to another 30-year period in our his- 
tory : the immediate past. 

It took only 30 years, from 1926 to 1956, for our population to in- 
crease by 50 million, and our gross national product to jump from 
$97.8 billion to $412.4 billion. During this period, American industry 
grew to vast proportions, to bring to everyday use products unheard 
of in 1926. Normal life expectancy increased more than 12 years in 
this time, and many illnesses that formerly beset us were conquered. 
High school enrollment more than doubled, and college attendance 
increased by 34 percent. Almost every employed American gained 
through social security assurance of a minimum economic founda- 
tion. In our social and economic development, we have reached our 
highest point in history. 

Today we stand at a doorway, looking into the unfamiliar rooms 
of the nuclear age, unsure of what changes the next 30 — or even the 
next few — ^years will unfold. But we know that changes will come 
and that we, with preparation, must meet them. 



Department of Health, Education, and If el fare, 1956 



The Department of Health, Education, and Welfare, youngest in 
our Government, is itself a product of our changing times, born of 
this spirited economic and social development. Our particular areas 
of service are vital — and as changing as the human needs of 167 mil- 
lion people. Human beings — Americans alive, Americans not yet 
born — give direction and meaning to our statistics and planning. As 
each individual finds better health, improved education, and stronger 
economic security, his own life is enriched and the welfare of the 
entire Nation is advanced. 

In advancing human welfare, we not only face up to today's needs, 
but we look constructively to the future. This way of thinking, this 
forward look, is the essence of our future growth — as individuals, 
communities, States, and Nation. This effort — this working in the 
present and for the futuie — represents an underlying philosophy of 
this Department as we strive to serve the people of our country, to 
help each individual realize his potential. 

As we move forward in our social and economic development, one 
of the most rewarding investments for the future lies in research. 
Expanded research in health, education, and welfare represents a 
constructive investment in human beings. But research cannot fulfill 
our bright hopes for progress unless we apply more quickly and fully 
the knowledge we obtain through research. 

Progress and Plans in Health 

In the decade since World War II, 6l^ 3^ears have been added to the 
average life span, a blessing born mainly from better control of child- 
hood infections and communicable diseases. Deaths from tuberculosis 
and pneumonia have been reduced dramatically. Surgical techniques, 
undeveloped 10 years ago. are now routine, and treatment by anti- 
biotics has progressed to a point that a decade ago would have ap- 
peared as visionary. A treatment and prevention program has been 
developed which strikes hard at rheumatic fever. Chemotherapy 
holds hope of controlling some forms of cancer and mental illness. 
The scourge of polio is on the wane. 

The progress we can total up this past year reflects the thinking, 
planning, and action of many individuals and groups : of the Presi- 
dent, the staff of this Department, and members of Congress who gave 
fresh emphasis to the enactment of important health legislation; of 
the universities, hospitals, private laboratories, and great philan- 
thropic organizations which devoted much of their effort to better 
health; of the scientists who labored to bring forth new knowledge 
and those in the medical profession who worked daily to bring the 
benefits of medical knowledge to the people; of the local and State 
governments which played their significant role in improving health. 



The Secretary's Report 



To all the people who, in one way or another, supported advances in 
health, we owe these proud gains. 

HEALTH RESEARCH PROGRAM 

Since World War II, medical-research expenditures from all sources 
have increased more than fourfold — from $60 million in 1945 to $270 
million in 1956. This may seem an impressive figure, but it represents 
only 5 percent of our total national expenditure for research and 
development. Considering the potential humanitarian and economic 
gains from medical research, this proportion is small indeed. 

Congress allocated $99 million to the National Institutes of Health, 
principal research arm of the Public Health Service, for use in the 
past fiscal year. These funds were greatly increased for the fiscal 
year 1957. Most of this sum is allocated, in turn, for medical research 
by scientists in hospitals, medical schools, and universities throughout 
the country. 

Our major aim in medical research today is to find the basic causes 
of those chronic diseases which kill and cripple so many of our people. 
The greatest killers — diseases of the heart and arteries — account for 
almost half of all deaths. Cancer claims nearly 250,000 lives each 
year. 

But death alone does not define the full tragedy of chronic diseases. 
We cannot begin to measure the hurt to each family represented in 
these statistics: diabetes, 2 million people; epilepsy, 1% million 
people; arthritis and rheumatism, 10 million people. And the trend 
in chronic disease is upward, since older people who are most suscep- 
tible account for an increasingly large proportion of our population. 

Last year a number of specific and important findings were associ- 
ated with our Institutes or with Institute-supported work. In the 
fight against cancer, the chemotherapy program was rapidly expanded. 
Our scientists report that increasing emphasis is being given to basic 
research into biochemistry of the cell. In another direction, during 
the year, final data were collected on a test for the early detection of 
uterine cancer. This test, conducted for 3 years as a pilot project in 
Memphis, Tennessee, has been undergoing trial in eight other cities, 
with a view toward full national usage and the eventual elimination 
of this form of cancer. During the coming year, the National Cancer 
Institute plans to develop application of the test to other parts of 
the body. 

The study of cerebral palsy has recently received increased emphasis. 
Last year an intensive, nationwide research program w^as initiated to 
seek out the causes and improve treatment of this disease that afflicts 
some 300,000 of our children annually. 

In the past Ave have perhaps given more emphasis to funds for 
current medical research and have attached less importance to two 



4 Department of Health, Education, and Welfare, 1956 

other requirements for progress in health : adequate medical-research 
facilities and well-trained manpower. However, we cannot afford 
to neglect any one of these three factors, for each is important in our 
total efforts toward better health. Last year the President recom- 
mended to Congress a $250 million, 5 -year program for grants to build 
facilities for medical research and for medical education to train 
more doctors. Congress subsequently authorized an annual grant 
of $90 million for a 3-year period to medical schools and universities, 
hospitals, and other nonprofit institutions to construct and modernize 
their research facilities. Congress made no provision for aid to build 
medical teaching facilities. 

HOSPITALS 

We have just completed the tenth year of operation under the local- 
State-Federal program of hospital construction. During this decade 
more than 2,000 federally aided hospitals and health centers were 
built and are now in operation, including 550 new general hospitals 
in communities where people had never had a suitable hospital before. 
An additional 800 projects are now planned or under construction, 
including 325 approved last year. As a result of this orderly planning 
on a nationwide basis, projects completed or approved as of June 30 
amounted to a grand total of more than 136,000 hospital beds and 750 
health units for outpatient care. 

The administration proposed an important new phase in our entire 
hospital program, which was approved by Congress. This was the 
extension of the program in 1954 to include Federal aid for four new 
categories: nursing homes, chronic-disease hospitals, diagnostic and 
treatment centers, and rehabilitation facilities. By June 30, 1956, 
204 such projects had been approved. They will provide 4,500 beds 
and 120 units for outpatient care. To the extent of their use, they 
will free our general hospitals to serve the more acutely ill. The first 
construction under this new program began with Federal approval in 
July 1955 of a 53-bed nursing home in Florence, Arizona. 

NURSING SERVICES 

Advances in surgery and medicine have increased the responsibili- 
ties of our nurses and enlarged their workload. This, combined with 
current shortages of trained nurses, has created a serious problem in 
providing hospital care of patients. Last year a research program 
was launched to improve nursing services, and, as a result of this study, 
the Public Health Service has demonstrated ways in which hospitals 
may make better use of their nurses and improve patient care. Al- 
ready 113 hospitals in 14 States have been helped in this phase of their 
work, and eventually these improvements will be of practical use to 
hospitals throughout the country. 



The Secretary's Report 



To ameliorate the nursing shortage, legislation was sponsored by the 
administration and enacted last year to train additional nurses in 
teacliing, administrative, and supervisory capacities. In addition, $2 
million was made available to educational institutions and individuals 
to train rehabilitation workers in such positions as nursing, physical 
therapy, and occupational therapy. At the close of the fiscal year, 
$2 million was also provided for the training of practical nurses, 
whose work will free professional nurses for their more responsible 
duties. 

POLIOMYELITIS PROGRAM 

During the fiscal year 1956 the manufacture of poliomyelitis vac- 
cine was greatly increased, and, under a voluntary priority apportion- 
ment system, administered by the Federal Government and the States, 
vaccine was used throughout the Nation on a broadening scale. The 
program was aided by a congressional appropriation of $53 million to 
help purchase vaccine. By the end of the year, enough vaccine had 
been released to provide some protection for all children under 20 and 
expectant mothers. 

Studies of the effectiveness of the vaccine were conducted in cooper- 
ation with the States and Territories. As a result, scientists decided 
that the vaccine may be given with good results in the summer and 
during epidemics, and it is now clear that, even with only one or two 
doses, the vaccine reduces the risk of paralytic poliomyelitis by about 
75 percent. 

State by State allocations under the voluntary distribution plan 
were discontinued in August 1956, when supplies of the vaccine be- 
came more plentiful. 

INDIAN HEALTH 

At the beginning of the fiscal year, the Public Health Service, by 
act of Congress, assumed responsibility for providing medical care 
and health services to some 350,000 Indians and Alaska Natives. This 
responsibility was transferred from the Bureau of Indian Affairs in 
the Department of the Interior, 

Historically, our Indians and Alaska Natives have been isolated 
both geographically and culturally from the mainstream of progress 
that brought health rewards to each succeeding generation of Ameri- 
cans. The health needs of these people are critical. Their average 
age at time of death, for example, is 39 — compared with 60 for the 
general population. 

Most of their illnesses are tragically due to causes than can be pre- 
vented. For this reason, the Public Health Service has accelerated 
its program of disease prevention. More than $4.3 million was spent 



Department of Health, Education, and Welfare, 1956 



in tliis effort during the year, and more than 500 of the 4,150 Indian 
health staff were engaged in preventive health activities. 

HEALTH SURVEY 

At the close of the fiscal year, the President signed a bill, proposed 
in his health message, authorizing the Public Health Service to conduct 
a continuing national health survey, the first such Federal survey in 
20 years. When we understand more clearly the extent of illness 
and disability in the Nation, we can with more accuracy appraise 
our needs, with more effectiveness use our medical manpower and 
facilities. These statistics, brought up to date every year, will be 
of tremendous significance to all who work in the cause of health. 

OTHER NEW AND EXPANDED PROGRAMS 

Steps were taken to help States initiate or expand health services for 
migratory labor and rural areas. Programs for study of the special 
medical problems of older people were enlarged. Plans were com- 
pleted for a special accident prevention unit which began work at the 
end of the fiscal year. Civil defense training programs for sanitary 
engineers and other public health officials were conducted in all parts 
of the Nation. 

Air pollution and water pollution constitute community health 
hazards and threaten, in varying degrees, our social and economic 
Avell-being. New legislation materially strengthened and improved 
the Federal Water Pollution Control Act, providing for expanded 
research and simplified measures for enforcement. Program grants to 
State and interstate water-pollution agencies were authorized and 
also grants to municipalities for construction of sewage-treatment 
works. 

Air-pollution research was considerably expanded during the year, 
following legislation enacted in 1955. Various aspects of this problem 
are being studied by the Public Health Service's facilities and in 
cooperation with other Government agencies. In addition, during 
the year a number of grants were made to private institutions, agencies, 
and individuals for additional research into the problem of air pol- 
lution. 

Progress and Plans in Education 

To each American his individual education is a matter of urgent 
personal importance, a foundation stone he must stand upon to reacli 
his greatest potential. In our country, our free educational system is 
basic to progress. We must strive constantly toward this goal — that 
every child has the opportunity for learning to the full extent of his 
ability. 



The Secretary's Report 



Many deficiencies in our school system today are an inheritance 
from the 20 years from 1930 to 1950. School construction ebbed dur- 
ing that first decade of economic depression and low birthrate and, be- 
cause of labor and material shortages, came to an almost complete 
halt during World War II. The problem lias been aggravated in the 
past 10 years by a 40-percent increase in school enrollment. Last fall 
40 million full-time students from kindergartens to colleges — nearly 
one-fourth of the total population — swarmed into overcrowded 
schools. By 1960 we may expect to have 48 million students. 

Since 1950, when States and communities spent about $1 billion to 
build 36,000 new classrooms, public school construction has increased 
steadily; last year an estimated 63,000 new classrooms were built at 
a cost of about $2i/2 billion. But even as the construction rate spiraled 
upward, new schools failed to meet expanding needs. While some 
progress has been made toward reducing the deficit, it will take many 
years at the current rate of construction to eliminate the classroom 
shortage. 

On the basis of reports from the States, 80,000 new classrooms were 
needed in the 1955-56 school year to accommodate about 2i/4 million 
pupils enrolled in excess of the normal capacity of the public schools. 
The Office of Education estimates an increase of more than 6 million 
children in our public schools during the next 5 years. At 30 pupils 
per room, this would require 200,000 new classrooms for the increased 
enrollment alone. In addition to these needs, many thousands of 
classrooms will need replacement. 

To help meet the needs of our children for more schools, the Presi- 
dent proposed a program of Federal aid in providing these des- 
perately needed classrooms. The President had asked for authoriza- 
tion of appropriations totaling $1.25 billion over a 5-year period in 
Federal grants to the States to build schools in needy communities. 
He had also requested authorization of $750 million for the purchase 
of school bonds in districts with marginal credit. Congress failed to 
act upon these proposals. 

We have just completed the sixth year of operation under the two 
laws providing for Federal assistance to schools and school construc- 
tion in areas where the public elementary and secondary school popu- 
lation is especially increased by Federal activity. During this fiscal 
year, $85.2 million was paid to such schools to assist in meeting annual 
operating expenses on behalf of 980,000 students. To build new 
schools in these areas, $43.4 million was approved. Over this 6-year 
period, a total of $621 million was allocated, and this new construc- 
tion now houses some 900,000 school children. 

Eecognizing the complex and pressing problems facing our schools 
today, the President initiated a nationwide citizens' study of our edu- 
cational system from elementary school through high school. Half 



Department of Health, Education, and Welfare, 1956 



a million people took part in 4,000 meetings all over the country. 
These meetings, devoted to local school needs and problems, cul- 
minated in the White House Conference on Education in the fall of 
1955. The report to the President from the 34-member Committee for 
the Conference contains 72 specific recommendations for improvement 
in elementary and secondary education — a much-needed springboard 
for the solution of school problems. The gains from a sharpened 
public interest in education are immeasurable, for ultimately it is the 
people who determine the quality and quantity of education in 
America. 

Many of the 40 million children now overflowing our elementary 
and high schools soon will be at the doors of our colleges and universi- 
ties. Action and planning are imperative now, and on a broad scale, 
to meet the educational needs not only of those who complete high 
school but also for those adults who need further educational oppor- 
tunities in the sciences and professions and in the liberal arts. For 
this reason, the President in April 1956 appointed a Committee on 
Education Beyond the High School, composed of 35 prominent lay 
leaders and educators. The committee will study and make recom- 
mendations for action to help solve the fundamental problems that 
beset higher education today — problems which will become more acute 
tomorrow unless we remedy them. 

In 1956 the administration proposed an unprecedented 100-percent 
increase in funds for the Office of Education — from $314 million to 
$6 million. Congress approved more than $51^4 million for operation 
in fiscal 1957, a 65-percent increase. As a result, many services to 
schools all over the country will be expanded and new services inaugu- 
rated. Importantly, much-needed educational research can begin. 

EDUCATIONAL RESEARCH 

One of the serious defects in our educational system in the past has 
been the lack of adequate research upon which to base our planning 
for tomorrow and our decisons today. We spend annually some $15 
billion to build and operate our schools, from kindergarten to college. 
But we have spent less than a half million dollars to make our educa- 
tional system, in its actual functioning, more efficient and responsive 
to the needs. 

In the spring of 1956 Congress appropriated a little over a million 
dollars for cooperative educational research. This money, meager 
as it is compared with the nationwide need, is eagerly sought. By 
mid- July the Commissioner of Education had received 70 preliminary 
proposals from nearly as many institutions and agencies ; by the end 
of August, 55 more proposals had been made. The Research Advisory 
Committee will evaluate proposals throughout the year. If funds 
are not available at the time a project is approved, it will be deferred 
until they become available. 



The Secretary's Report 



By October 1956, 29 projects had been recommended for support.^ 
These inckide research into the important areas of education of the 
mentally handicapped, the development of special abilities of students, 
the relationship of education to juvenile delinquency, and the prob- 
lem of why so many capable students drop out of high school and 
college. 

Progress and Plans in the Food and Drug 
Administration 

The food and drugs that we consume every day are vital to our 
life and health. The year 1956 marked the fiftieth anniversary of our 
first Federal food and drug law and brought a rededication to the 
ideal of maintaining in our food and medicines the highest degree of 
purity. 

Time has dimmed somewhat the records of deplorable conditions 
a half century ago that led to the first food and drug legislation. No 
greater tribute can be paid the work in consumer protection than that 
the public, generally, takes it for granted. 

The past two decades brought a revolution in food and drug con- 
sumption. The bulk foods of a generation or more ago have been 
replaced by packaged and frozen food and prepared mixes. The aver- 
age large market now stocks over 5,000 items, compared with about 
1,000 items carried by the general store before World War II. The 
drug industry expanded and its production methods changed as new 
drugs and medicines were developed, beginning with the sulfa drugs of 
the 1930's and continuing to the antibiotics and tranquilizing drugs 
of today. New drugs approved for safety since 1938 account for more 
than 90 percent of all prescriptions written today. 

Every year more than $60 billion worth of food and drug products 
subject to Federal inspection move in interstate commerce through 
some 100,000 factories and warehouses. This has greatly increased 
the responsibility of the Food and Drug Administration. Its limited 
staff and facilities were unable to keep pace with the changes in food 
processing or with the unparalleled progress in pharmaceutical re- 
search and development. 

Early in 1955 a Citizens Advisory Committee was established to 
study the needs of the Food and Drug Administration in meeting its 
responsibilities. Some of the recommendations included in its report, 
submitted in June 1955, are now moving toward reality. These include 
congressional approval of a new headquarters and laboratory build- 



1 By the end of December 1956, 79 cooperative educational research projects had been 
recommended by the Committee for support. 



408691—57- 



10 Department of Health, Education, and Welfare, 1956 

ing and a 15-percent increase in appropriations for 1957. Internal 
reorganization is under way to provide maximum efficiency. 

This progress will aid the Food and Drug Administration in its 
effort to catch up — and keep up — with its complex job. Further 
expansion would mean, simply, improved service to American indus- 
try and increased safety for American consumers. 

An important part of the w-ork being done to safeguard the public 
health is the constant war against worthless or illegal medicines. 
Curative claims of useless "remedies'- lead the seriously ill to turn 
av.ay from competent medical treatment. During the year, an exten- 
sive investigation was made into the sources of sale of amphetamine 
to truckdrivers, whose use of this stimulant jeopardized highway 
safety. Conditions are now improved in the South Atlantic States 
where the campaign was most active. 

As a part of its ciA'il defense activities, the Food and Drug Adminis- 
tration last year instructed approximately 2,000 people in the han- 
dling of problems inherent in an attack employing chemical, biolog- 
ical, or nuclear weapons and in procedures necessary to test products 
so exposed and to restore a safe food and drug supply. This infor- 
mation was provided through 53 5-day courses in 45 States. 

Teams of workers stand ready to go to all critical problem areas to 
assist local and State agencies. Their help was needed last August 
when Hurricane Diane lashed through the New England States, caus- 
ing serious damage to commercial stocks of food and drugs. During 
the Christmas holiday season, northern and central California suffered 
the worst flood in the State's history. As the waters receded, Food 
and Drug Administration workers were on hand to assist in protecting 
the public from contaminated food and drugs. 

Progress and Plans in Social Security 

One of the strongest intrenchments against human distress in our 
country today is the Federal system of old-age and survivors insur- 
ance. Some years must still pass before the entire impact will be felt, 
when the first full generation of Americans completes its working life 
under the provisions of the Social Security Act. 

In the i)ast year the social security system continued its steady 
growth toward maturity. By June 1956, nearly 8.4 million people 
were receiving benefits at a rate of $5.3 billion a year. Nearly 80 per- 
cent were over 65 years of age, representing three-fourths of our 
retired aged population. 

As the fiscal year closed, legislation was effected to widen the area of 
protection even further. The amendments of 1956, signed by the 
President on August 1, extended coverage to include military per- 
sonnel, lawyers, dentists, osteopaths, other self-employed persons, 



The Secretary's Report \ I 

and more farm owners and operators. Thus, more than 9 out of 10 
employed persons in the country are eligible for coverage under the 
social insurance program. The broadened program includes cash 
payments for totally disabled workers aged 50 and over and, in spe- 
cific instances, for disabled children over 18 years of age. Widows are 
now eligible for social security benefits at age 62. Other women may 
receive reduced benefits at the same age. 

PUBLIC ASSISTANCE— A CHANGED EMPHASIS 

From Federal and State funds, public assistance is now being paid 
to 5 million Americans. These are the needy aged, blind, totally dis- 
abled, and dependent children. Every State now administers Fed- 
eral funds under the Social Security Act to aid those in need. 

The Federal-State public assistance programs, established in the 
depression days of economic catastrophe, naturally and properly 
placed emphasis on providing cash income to meet immediate needs. 

Today we recognize that we have a deeper duty to those in need than 
the mere payment of cash benefits. For many, disabled to the point 
where they have little hope of supporting themselves or their families, 
we should assume the responsibility of offering services leading to self- 
care. Others receiving public assistance may be capable of future 
independence, and the best service we can provide is to help them 
build toward independence and a rich and full life. 

The administration has a firm objective to develop services leading 
to self-care, self-support, and the strengthening of family ties. This 
latter goal becomes particularly compelling when highlighted by 
statistics : 43 percent of all recipients of public assistance are in the 
aid to dependent children program, and more than half of these young- 
people are dependent because of divorce, separation, unwed parent- 
hood, or the desertion of the father. 

New legislation, proposed by the administration and directed to 
these constructive objectives, was enacted by Congress during the year 
and will become effective in July 1957. Authorizations include $5 
million to launch a progrartj of cooperative research into the causes 
of poverty and ways of overcoming them. The legislation also in- 
cludes an amendment to the Social Security Act to help States train 
more v^orkers for the public assistance program. If full advantage is 
taken of this opportunity, within 5 years an additional 5,000 to 6,000 
professionally trained social workers will be available throughout the 
country to help overcome the complex problems of dependency. 

The medical needs of the aged, the sick, and handicapped far exceed 
the facilities and services available. The new law authorizes Federal 
grants to the States on a matching basis to help make up this defi- 
ciency. This is, of course, apart from public assistance payments to 
individuals. 



12 Department of Health, Education, and Welfare, 1936 

CHILD WELFARE SERVICES 

Upon the administration's request, the 84th Congress increased from 
$10 million to $12 million the appropriation authorized to the States 
for child welfare services. 

The regular programs of the Children's Bureau, as in the past, made 
notable contributions to the physical and emotional well-being of our 
children. Major current concerns are to provide social service to 
children in all geographical areas and to aid children who are mentally 
retarded or emotionally disturbed. 

JUVENILE DELINQUENCY 

Juvenile delinquency continues as a deep concern of the Department. 
In the past 7 years, the increase of youngsters appearing in courts 
has been 4 times greater than the increase in this population group. 

Many units of the Department are at work on both the prevention 
and treatment aspects of this problem. The Division of Juvenile 
Delinquency Service, established in 1955 in the Children's Bureau, 
offers professional consultation to public and private agencies. The 
Bureau's programs for helping parents, professional workers, legal 
authorities, and others to meet their responsibilities to youngsters are 
potent forces on the side of prevention. 

The Office of Education, through its research, consultation, and 
grants, assists educators in making school years a more meaningful 
and constructive experience for boys and girls. Significant research 
into the etiology of disturbed behavior of children and diagnostic 
techniques, conducted or financed by the Public Health Service, gives 
promise of better handling of delinquent and predelinquent youth in 
the future. In still another way, the Food and Drug Administration 
works at this problem through its control of habit-forming and stimu- 
lant drugs. The underpinning to family income provided by old-age 
and survivors insurance and through the Federal- State program of 
aid to dependent children is a strong factor in the prevention of 
delinquency. 

To help States and communities make new or more vigorous efforts 
to cope with their delinquency problems, the administration supported 
bills introduced in the House and Senate which would provide a 
5 -year program of grants for planning and coordinating services, for 
training workers, and for study. These bills failed of passage. 

Progress and Plans in Vocational Rehabilitation 

For several years there was a downward trend in the annual number 
of handicapped people restored to productive jobs. Then, in 1954, 
legislation was effected to expand the Federal grants-in-aid program 
for rehabilitation. 



The Secretary's Report 13 

By 1956, $31 million became available to State rehabilitation pro- 
grams, an increase of $6.5 million over the preceding year. Under 
this broadened program, which created new opportunities for coopera- 
tion between public agencies and private groups, the downward trend 
was reversed. During the year 66,273 handicapped persons were re- 
turned to useful lives, the highest total in the history of the program 
which began in 1921. In the first year after their rehabilitation, these 
people will earn an estimated $119 million, compared with their pre- 
vious annual earnings of $17 million. 

Such monetary rewards are secondary to the humanitarian aspects — 
the increased self-respect gained by each handicapped individual as he 
advances to the dignity of self-support. As a further gain to the 
States and the Nation, during the year 3,500 rehabilitated people en- 
tered the professional fields of education, medicine, and engineering, 
where additional manpower is urgently required. More than 8,000 
now work in skilled trades, and 6,000 work on farms. 

Aware of the value of private effort in this kind of enterprise — and 
particularly at the community level — the Federal Government granted 
$1 million to voluntary groups for the expansion of rehabilitation 
facilities. This sum represents 90 percent of total Federal funds. 

During the year, $2 million was made available to educational insti- 
tutions for teaching grants in the field of vocational rehabilitation, in 
specific areas such as social work, counseling, and occupational and 
physical therapy; and 2,000 students were aided in traineeships. 
From these colleges and universities will come the professional work- 
ers we need in this understaffed field. 

An expanded research program, with a view toward the eventual 
rehabilitation of a maximum number of people, was long overdue. 
Grants totaling $1.2 million were approved for partial support of 39 
special research and demonstration projects. These nationwide stud- 
ies, though small compared with their urgency, are as varied as the 
needs of the disabled. In charting a path for this research, the 
Office of Vocational Rehabilitation is fortunate to have the benefit of 
an advisory council composed of an outstanding group of national 
leaders in medicine, education, rehabilitation, industry, and labor. 

Every year, 250,000 persons become in need of help from rehabilita- 
tion programs. Some of them are being rehabilitated through the 
Federal-State program. Other handicapped persons are rehabili- 
tated through private and voluntary efforts. Others have short-term 
impairments, die, or leave the disabled group for other causes. Yet, 
on a national annual average, 2 million people need the help vocational 
rehabilitation should be able to offer. 



14 Department of Health, Education, and Welfare, 1956 

Progress and Plans for the Aged 

Older people account for an increasingly larger percentage of the 
American poi^ulation. Today there are 14 million persons 65 years of 
age or older. By 1975 the number is expected to climb to 21 million. 
The social and economic implications of an aging population are many 
and varied, and the whole subject matter is of increasing national 
concern. 

Many of the problems of our aging population rise from basic 
changes in our economy and our society. The movement of people 
from a rural environment into cities, our greater industrialization, our 
attitudes toward the value of work by older people, even the current 
accent on youth in our culture — all these contribute to the complex 
problems of growing older. 

There must be an economic and social framework in America within 
which older people can live usefully and with a sense of purpose. 
Nothing less than this is required for each older person as a human 
being; nothing less would be consistent with the national interest. 
Among many factors, this framework must embrace employment for 
those who are able and want to work, sufficient retirement income for 
others, suitable housing, improved health, and satisfactory leisure. 
Primary responsibility for meeting these needs rests, of course, with 
the individual, his family, and his community. 

The Federal Government, however, has long carried on many activi- 
ties which bear directly or indirectly on the welfare of older persons. 
In more recent years, the Government has been giving increasing 
thought and emphasis to these activities. 

Every major unit in the Department of Health, Education, and 
"Welfare conducts some activity relating to the welfare of older people. 
The old-age and survivors insurance and old-age assistance programs 
are basic to income maintenance of older people. Various programs 
of the Office of Education and the Office of Vocational Rehabilitation 
are of special service to older persons. Expansion of the Public 
Health Service's hospital construction program places particular 
emphasis on nursing homes, geriatric clinics, and chronic-disease 
liospitals. Research in the chronic diseases, which are more preva- 
lent among older people, has been greatly expanded by the Public 
Health Service. 

To coordinate and broaden the activities of various Federal agencies 
whose responsibilities include programs relating to older persons, the 
President in April 1956 created the Federal Council on Aging. The 
Council is composed of 13 Federal departments and agencies — the 
Departments of the Treasury; Interior; Agriculture; Commerce; 
I^abor ; and Health, Education, and Welfare ; and the Office of Defense 



The Secretary's Report i5 

Mobilization; U. S. Civil Service Commission; Veterans Adminis- 
tration ; Housing and Home Finance Agency; Small Business Admin- 
istration; National Science Foundation; and Railroad Retirement 
Board. 

The Federal Council and the Council of State Governments jointly 
sponsored in June 1950 the first Federal-State conference ever held 
on the problems of the aging. The conference served to coordinate 
and provide impetus to the work being done by the Federal and State 
governments on behalf of older people. The conference provided an 
opportunity for discussing the nature and impact of the problems 
of an aging population and the experience gained from specific pro- 
grams designed to meet the needs of older people. Thus, the States 
were better equipped to develop principles for administrative, legisla- 
tive, and community action to benefit older people. 

The efforts of many individuals, of private organizations, and of 
government at all levels — Federal, State, and community — are re- 
quired to establish the climate and opportunity for older people to 
live in dignity and make their contribution to the progress of the 
Nation. But the efforts of all organizations and government units 
must, in the end, be directed to producing such a climate and oppor- 
tunity in the community. For it is in the community — his immediate 
living environment — and nowhere else that the older person will find 
personal satisfaction and impart the benefits of his experience, wis- 
dom, and skills into the mainspring of American life. 

4: 4: ^ ^ ^ ^ 

All Americans owe a debt of gratitude to those who, in their chosen 
fields of endeavor, have worked faithfully through the year in the 
cause of human betterment. That flowing tide of Americans of the 
last century who pounded across mountains and plains and won the 
wilderness country were never, in their own time, accorded such a 
resounding name as pioneers; they were simply "the movers." Nor 
do we today call our doctors, nurses, scientists, social workers, and 
teachers — pioneers. But we may acclaim them as "movers." Their 
daily contributions and plans for the future have moved our country- 
one more year ahead in a steady progress toward better health, im- 
proved education, and a deeper foundaticm for economic security. 



16 



Department of Health, Education, and Welfare, 1956 



. — Grants to States: Total grants under all Department of Health, 
Education, and Welfare programs, fiscal year 1956 

[On checks-issued basis] 



States, Territories, 
and possessions 



Total 



Social 
Security 
Administra- 
tion 



Public 
Health 
Service 



Office of 
Education 



Office of 
Vocational 
Rehabil- 
itation 



Total 

Alabama 

Arizona 

Arkansas 

California 

Colorado 

Connecticut 

Delaware 

District of Columbia-.. 

Florida 

Georgia 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New Hampshire 

New Jersey 

New Mexico 

New York 

North Carolina 

North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Rhode Island 

South Carolina 

South Dakota 

Tennessee 

Texas 

Utah. 

Vermont 

Virginia 

Washington 

West Virginia 

Wisconsin 

Wyoming 

Alaska 

Hawaii 

Puerto Rico 

Virgin Islands 

Canal Zone 

Guam 

America Samoa 



$1, 835, 819, 489 



$1, 488, 897, 227 



$104, 959, 947 



$208, 633, 760 



$33, 094, 565 



50, 826, 270 

13, 066, 000 

27, 884, 530 

202, 084, 798 

33, 288, 377 
17, 508, 205 

2, 678, 636 

5, 646, 763 

48. 245, 061 
60, 369, 378 

6, 858, 872 
74, 705, 263 

23, 727, 063 

24, 307, 685 
26, 863, 126 
35, 572, 244 
74, 546, 005 
10, 954, 095 
23, 730, 857 
55, 994, 939 

55, 693, 277 
32, 288, 768 
29, 637, 561 
81,317,654 
8, 036, 245 
13, 018, 249 

3, 814, 267 
4,821,566 

21, 343, 280 

15. 246, 841 

125, 570, 602 
41, 995, 690 

6, 616, 937 
69, 083, 592 
62, 770, 417 
14, 322, 982 
63, 349, 638 

8, 431, 464 
25, 242, 313 

8, 775, 437 

42, 089, 272 
112, 615, 158 

9, 726, 044 

4, 772, 075 

34, 578, 194 
43, 159, 989 
24, 195, 683 
27, 248, 743 

3, 545, 319 

6, 513, 670 

7, 837, 671 

8, 842, 070 

432, 231 

151 

11, 042 

17, 230 



42, 034, 093 
9, 735, 759 

23, 024, 533 
162,314,461 

27, 814, 440 

13, 341, 470 
1,983,246 

4, 644, 885 
39, 770, 274 
48, 590, 425 

5, 309, 679 
65, 492, 349 

19, 365, 699 

21, 433, 720 
19, 126, 850 
30, 420, 708 
68, 935, 053 

8, 606, 251 
11,469,840 

50, 612, 714 

43, 810, 423 
27. 333, 889 
25, 522, 264 
73, 360, 958 

5, 998, 121 

9, 713, 232 
1,610,218 
3, 435, 316 

16, 283, 950 
8, 340, 200 

109, 824, 096 
34, 108, 765 

5, 054, 897 
57, 903, 399 
52, 192, 165 
11,924,728 

51, 691, 646 

6, 517, 833 

20, 323, 842 
6, 355, 725 

33,523,104 
94, 024, 135 
6,991,217 
4, 052, 617 
13, 460, 304 
33, 773, 092 
21, 087, 007 

22, 648, 401 
2, 489, 849 

2, 015, 019 

3, 942, 956 
5, 213, 904 

343, 506 



3, 282, 676 
439, 019 

1, 633, 568 
6,741,226 

617, 795 
707, 146 
136, 179 
507, 635 

2, 835, 021 

4, 263, 980 

462, 299 

3, 023, 164 
1,486,139 
1, 160, 834 
2, 070, 170 

2, 718, 979 

3, 443, 860 
926, 282 

1, 788, 824 

2, 595, 380 

3, 336, 332 

2, 585, 095 
2, 185, 928 
3, 006, 991 

347, 456 
1, 064, 340 

522, 835 

507, 479 
1,636,717 

489, 655 

7, 595, 281 

4, 004, 351 

830, 513 

2,871,084 

1, 712, 900 
801, 306 

5, 626, 832 
425, 591 

2, 185, 893 
527, 071 

4, 475, 448 

4, 499, 252 

438, 741 

298, 765 

3, 775, 994 
870, 545 

1,513,352 

2, 548, 009 
182, 155 

397, 951 
186, 342 
2, 590, 248 
50, 896 
151 
11,042 
17, 230 



4,441,564 

2, 659, 106 

2, 575, 559 

30, 958, 570 

4, 551, 669 
3,015,738 

373, 261 

106, 999 

4, 473, 567 

5, 727, 555 

1, 009, 966 

4, 687, 295 
2, 453, 746 
1, 175, 270 

5, 289, 763 
2, 122, 618 
1, 223, 429 
1, 232, 956 

10, 128, 904 
2, 196, 372 

7, 292, 818 
1, 615, .571 
1, 485, 190 
4, 183, 467 
1, 532, 877 
1, 954, 805 

1, 648, 914 
777, 843 

2, 690, 191 

6, 266, 140 

5, 717, 475 

2, 584, 204 

553, 882 

7, 545, 160 
8, 215, 876 
1, 178, 618 
3,477,117 
1, 313, 625 
2,194,223 
1, 744, 954 

3, 198, 899 

12, 954, 224 

2, 152, 490 

279, 944 

16, 392, 764 

7, 937, 557 

808, 180 

1, 420, 260 

784, 313 

4, 018, 213 

3, 520, 764 

751, 456 

37, 829 



1, 062, 927 
230, 592 
645, 426 

2, 054, 702 
302, 046 
440, 459 
184, 861 
386, 155 

1,161,220 

1, 780, 821 

75, 901 
1,491,315 
417, 465 
533, 847 
373, 760 
306, 143 
939, 338 
188, 606 
338, 528 
580, 827 

1, 242, 564 
748, 581 
440, 165 
761, 602 
157, 013 
284, 378 
32, 300 
100, 928 
724, 549 
148, 543 

2, 415, 360 

1, 286, 763 
176, 743 
753, 618 
646, 955 

415. 343 

2, 539, 169 
174, 415 
535, 212 
146,318 

886, 500 

1, 128, 274 

142, 133 

140, 749 

943. 344 
575, 372 
783, 877 
626, 005 

89, 002 

82, 487 
187, 142 
284, 222 



Social Security 
Administration 



Social Security in 1956 



In June 1956, the programs of old-age and survivors insurance and 
public assistance were serving as a major source of income for nearly 
13 million people, with payments at an annual rate of almost $8 
billion. About 8.7 million of them were aged 65 and over ; this group 
represents three-fourths of the Nation's retired aged population. The 
research and service programs of the Children's Bureau were carried 
forward during the year. Federal credit unions continued to expand 
throughout the country. 

As the fiscal year closed, legislation was in process to effect a wide 
range of changes in old-age and survivors insurance and the public 
assistance programs. 

The amendments extend the coverage of old-age and survivors in- 
surance to about 600,000 additional farm owners or operators and 
about 200,000 self-employed lawyers, dentists, osteopaths and others. 
The only groups of self-employed professionals remaining outside 
the scope of the program are doctors of medicine and Christian Science 
practitioners. Under separate legislation, coverage on a contributory 
basis was extended to almost 3 million members of the Armed Forces. 

The old-age and survivors insurance program was amended through 
the addition of disability benefits for certain permanently and totally 
disabled workers aged 50 and over, and for adult children of deceased 
or retired workers if the children had been permanently and totally 
disabled before reaching age 18 and remained so to the date of the 
award. 

Another major change is in the provision of benefits for women 
prior to age 65. The retirement age for women is reduced to 62, with 
full benefits for widows and female dependent parents and with an 
actuarial reduction in the benefit amount for wives and women workers. 

Accompanying the provisions for payment of cash benefits to dis- 
abled workers at age 50 was a provision for an increase in the contri- 

17 



18 Department of Health, Education, and Welfare, 1956 

bution rate to finance these benefits. The additional contributions 
amounting to one-fourth percent eacli for employees and employers, 
and three-eightlis percent for the self-employed, will be automatically 
appropriated to a separate disability trust fund. 

The amendments relating to public assistance that were recom- 
mended by the Administration place new emphasis on helping needy 
people to build toward greater independence. The amendments en- 
courage the provision of appropriate social services ; to assist in making 
trained individuals available for providing more services and in in- 
creasing the eflectiveness and efRciency of public assistance adminis- 
tration, grants are made available to States for the training of welfare 
personnel. In addition to an increase in Federal matching on main- 
tenance payments, the amendments provide for separate matching 
to help States pay for more adequate medical care for assistance 
recipients. 

The authorization for grants for child welfare services was raised 
from $10 million to $12 million a year. 

Another amendment provides grants and payments under contracts 
or cooperative arrangements to States and to public or other non- 
]>rofit organizations to pay part or all of the cost of research or demon- 
stration projects, such as those related to preventing or reducing 
dependency, or for the coordination of planning between private and 
public welfare agencies, or which will help improve the administration 
and effectiveness of programs under the Social Security Act. 

These amendments obviously have important implications for the 
future as well as for the millions of people who now look to the social 
security programs for economic security and for a variety of services. 

As a result of steady growth throughout the year, the number of 
beneficiaries of old-age and survivors insurance had reached 8.3 mil- 
lion in June 1956, an increase of 11 percent during the year. Eight 
out of every 10 of the beneficiaries were aged 65 and over; the 6.6 mil- 
lion aged beneficiaries were about the same proportion of the total 
benefit rolls as in June 1955. 

While the number of aged persons receiving insurance benefits was 
rising at an average rate of almost 1 percent per month, the old-age 
assistance caseload was dropping slightly. The 1-percent decline over 
the year brought the number of recipients to 2,524,000 in June 1956. 
In relation to our growing aged population, this decline over the past 
few years has been more significant. In the autumn of 1950, when 
old-age assistance caseloads first began to drop, 23 out of every 100 
persons aged 65 and over received assistance. At the end of fiscal year 
1956, the ratio was down to 17 per 100. Over the same period, the 
ratio of aged insurance beneficiaries to the total aged population has 
risen from 19 per 100 to 45 per 100. 



Social Security Adininiatrulioii IV 

With declining old-age assistance caseloads and continuously in- 
creasing proportions of the aged population receiving insurance bene- 
fits, the supplementary role of the assistance program is becoming 
more evident. By the end of fiscal year 1956, about 1 out of every 
5 old-age assistance recif)ients was receiving assistance to supplement 
liis benefits under the insurance program — compared with 1 out of 
every 10 in September 1950. "V^Hien measured in relation to the ex- 
panding old-age and survivors insurance rolls, however, there has 
been a decrease in the proportion of insurance beneficiaries receiving 
supplementary assistance payments. The 8 percent of aged insurance 
beneficiaries who were also getting assistance in June 1956 had smaller 
benefits, on the average, than all aged beneficiaries. 

The number of families receiving aid to dependent children was 
6,600 lower in June 1956 than in the same month of 1955, but the 
number of children assisted was greater. The 614,000 families re- 
ceiving assistance in June 1956 contained 1,708,000 children, an aver- 
age of almost 2.8 per family in contrast to just over 2.7 for families 
on the rolls in June 1955. Nevada, since 1945 the only State without 
a federally aided program of aid to dependent children, established 
such a program during the year. With old-age and survivors insur- 
ance providing protection for children whose fathers have died, the aid 
to dependent children program will be almost wholly confined in the 
not too distant future to meeting need arising from causes other than 
death — for example, from the disability or absence of the father from 
the home. 

Again this year there was a significant increase — 9 percent — in the 
number of recipients of aid to the permanently and totally disabled. 
A total of 258,000 persons were receiving these payments at the end of 
the year. The establishment of programs in three States during the 
course of the year brought the number of federally aided programs for 
aid to the permanently and totally disabled to 45. 

Aid to the blind went to 106,000 persons in June 1956, some 2,000 
more than a j^ear earlier. 

Average payments under each of the federally aided programs had 
risen during the year, and the aggregate of payments made under the 
four programs in June 1956 was 3.3 percent more than in June 1955. 
Reflected in the higher expenditures for public assistance is the in- 
creased cost of medical care paid for by the States for persons on the 
rolls. 

The programs of i\\Q Children's Bureau contributed to the well- 
being of children throughout the Nation. 

Appropriations of Federal funds under title V of the act were in- 
creased by Congress by $4 million in the crippled children's program 
for fiscal 1956, by $2 million for maternal and child health for 1957, 



20 Department of Health, Education, and Welfare, 1956 

with $1 million identified for emphasis on programs for mentally re- 
tarded children. The 84th Congress increased the authorization for 
appropriations to the States for child welfare services from $10 mil- 
lion to $12 million. 

Preliminary figures from State reports indicate that a new peak 
was reached in 1955 in the number of handicapped children served 
under federally aided programs for crippled children. Some 278,000 
children were cared for during the year. Most of the children 
(221,000) were seen in clinics; about 53,000 received physicians' serv- 
ices through home or office visits. Children who were hospitalized 
numbered approximately 48,000. Convalescent-home care was given 
to the smallest group, around 3,800. Following the increase in the ap- 
propriation for crippled children's services, the Children's Bureau 
conducted a series of regional meetings to discuss new types of handi- 
capping conditions that might be included in the program and to give 
the States an opportunity to exchange ideas. 

The Children's Bureau administers the Federal grant-in-aid funds 
for child welfare services. It also develops guides, recommendations 
for practice, and informational materials in relation to the child wel- 
fare program as a whole and for specialized services, such as social 
services to children in their own homes, protective services, homemaker 
services, services to unmarried mothers, foster family and group care 
programs, and adoption services. 

A major concern of the Children's Bureau, the Bureau of Public As- 
sistance, and State public welfare agencies is the provision of appro- 
priate social services for all children in need of them in all geographical 
areas, including, for example, mentally retarded children, emotionally 
disturbed children, and financially dependent children. 

Juvenile delinquency in the United States continues to be a major 
social problem and the amount is ever increasing. Delinquency has 
been on the upswing steadily for the past 7 years, and percentagewise 
rising far faster than our juvenile population. The Division of Ju- 
venile Delinquency Service was established in the Children's Bureau 
in 1955. Consultant service is now being given to States and com- 
munities in relation to juvenile courts, probation, institutions, police 
work, personnel training and community services for the prevention 
of juvenile delinquency. 

Program research on disadvantaged children is being emphasized. 
In addition to its own studies and those conducted jointly with others, 
the Bureau has sought to stimulate research in child life by other 
agencies, by formulating the questions requiring study and develop- 
ing research methods, and has assisted agencies engaged in such 
research. 

Certain groups of children call for special attention. Among these 
are the juvenile delinquents, the children of agricultural migratory 



Social Security Administration 21 

workers, mentally retarded children, and children placed for adoption 
without legal, medical, and social protection. The Bureau placed 
emphasis upon the needs of these groups during the past year. 

Federal credit unions registered further growth during the year 
with a 12-percent increase in membership to 4.3 million. In June 1956, 
there were 8,108 operating Federal credit unions, a net gain of 546 for 
the year. Their assets of $1.4 billion were 22 percent greater than in 
June 1955. 

Program Administration in 1956 

Ever-increasing worldoads required that all of the Bureaus carry 
forward their efforts to improve procedures and organizational struc- 
ture and maintain a high level of efficiency. There was still much to 
be done to implement the 1954 amendments, and the legislative plan- 
ning and analysis in connection with the 1956 amendments spanned 
the year. 

The major contribution the social security programs are making to 
the economic security and welfare of aged persons received increased 
attention during the year. A Social Security Administration Com- 
mittee on Aging was established to provide for continuing close co- 
ordination and an integrated focus, within the Social Security 
Administration and in relation to the Departmental Committee on 
Aging. Staff participated in the planning of the Federal-State Con- 
ference on Aging, held in Washington on June 5-7, and served as 
resource persons and recorders during the sessions. 

Old-age and survivors insurance benefits taking into account the 
disability freeze were first payable in July 1955. From early in 
calendar year 1955 through the end of fiscal year 1956, nearly a 
quarter-million applications for a period of disability were processed 
to allowance or denial. A program for the collection and analysis of 
disability statistics, as a byproduct of the determinations, was put 
into operation. 

The Bureau of Old- Age and Survivors Insurance inaugurated an 
intensive study of old-age and survivors insurance provisions and their 
administration for the purpose of seeking a simpler, clearer, and more 
rational law and program. 

The Bureau's use of automation in its repetitive mass operations 
was carried forward through installation of large-scale electronic 
data-processing equipment in the earnings record operation. 

The Bureau of Public Assistance placed increased emphasis during 
the year on developmental work in improving the adequacy of services 
to needy people, and in planning for the strengthening of family life 
through increased capacity for self -care and self-support. Effort was 
also made to advance efficient and effective State administration of 



22 Department of Health, Education, and Welfare, 1956 

public assistance prograins and to strengthen Bureau administration 
and facilitating services. 

The Social Security Administration was given responsibility for 
operation in an emergency of the financial assistance and clothing 
programs of Defense Welfare Services. This is in addition to the 
planning responsibility previously assigned. The Commissioner of 
Social Security was also authorized to sign agreements with the States 
regarding Defense Welfare Services operations. By the end of the 
fiscal year, agreements had been signed with 12 States ; by the end of 
August, with 27 States. 

The Children's Bureau gave major emphasis in its technical research 
to studies of the costs and effectiveness of various programs and 
statistical reporting. One such study subject is the development of a 
method for determining unit costs in child placement and institutional 
care of children. 

The fact that Federal credit unions are increasing in size as well 
as number has important implications for the program administration 
responsibilities of the Bureau of Federal Credit Unions. During the 
year solutions to new problems were developed and trends were 
studied for the purpose of anticipating the need for changes in pro- 
cedures. To determine whether Bureau policies have kept pace with 
changing economic conditions and the growth of Federal credit unions, 
a comprehensive survey of the basic policies pertaining to chartering, 
examination, and supervision w^as undertaken. 

To carry out the operations of the growing programs, the Social 
Security Administration had 18,591 employees at the end of June, the 
vast majority of whom were in field, area, and regional offices. This 
compares with a total of 18,514 on the payroll a year earlier. 

(NTERNATIONAL ACTIVITIES 

The Social Security Administration continued to participate in 
policy development in the international social welfare field through 
representation at United Nations meetings and those of the Organiza- 
tion of American States. Meetings during the year at which staff 
served as delegates or accredited observers included the United Nations 
Children's Fund, the First United Nations Congress on the Preven- 
tion of Crime and Treatment of Offenders, the Directing Council of 
the American International Institute for the Protection of Childhood, 
and the International Social Security Association. 

An important phase of the Social Security Administration's inter- 
national activities was the preparation of materials and papers for 
Interdepartmental Committees on International Social Welfare 
Policy, on International Labor Policy, on Human Eights, and on 
Status of Women, in connection with sessions of the United Nations 



Social Security Adrninistratiuii 23 

General Assembly, Economic and Social Council, and other UN and 
OAS meetings. Information was also prepared on new developments 
in program administration and services, training, costs of social secu- 
rity, and other subjects for international studies and reports sponsored 
during the year by the United Nations and the International Labor 
Office. 

Preparations were made for the Eighth International Conference 
of Social Work in Munich, August 5-10, 1956, at the sessions of which 
Social Security Administration staft' participated in expert groups or 
commissions. 

The international aspects of social work and social welfare have 
claimed increasing attention from the national organizations in these 
fields. Social Security Administration staff has assisted this develop- 
ment through the preparation of materials and through participation 
at general meetings, workshops and panel discussions. 

The Social Security Administration continued to cooperate with the 
International Cooperation Administration in the nomination and 
technical support of experts in the fields of social welfare, social in- 
surance, and maternal and child health, as required by the agreements 
between the two organizations. At the end of the year, 19 consultants 
were assigned to overseas posts. 

The groAving consciousness of the social needs of people has been 
reflected in the applications of trainees coming to the Social Security 
Administration this past year. The requests for study make clear 
that all governments, whether with new or advanced welfare pro- 
grams, are anxious for the trainees to have a broad understanding of 
social welfare in the United States and of the interrelationship of 
social and economic needs, as well as specific knowledge in particular 
fields. 

In 1956, the swiftly expanding social welfare programs brought to 
the Social Security Administration 698 trainees, from 45 countries, 
representing all parts of the world. These included United Nations 
and World Health Organization Fellows, International Cooperation 
xidministration participants, and many experts and students financed 
through voluntary organizations or personal funds. 

Old- Age and Survivors Insurance 

During the fiscal year 1956 the old-age and survivors insurance 
I^rogram made significant progress toward providing basic security for 
the workers of the Nation. The largest single gap in coverage was 
closed by the extension of protection to members of the uniformed serv- 
ices. Coverage was also extended to all previously excluded self-em- 
ployed professional groups (except doctors of medicine), to many 



24 Department of Health, Education, and Welfare, 1956 

additional self-employed farmers, and to a number of smaller groups 
of workers. With these extensions of coverage, the number of persons 
covered by the program will be approximately 75 million during the 
calendar year 1957. Significant strides were made in effectuating the 
provision that protects the benefit rights of workers and their families 
during periods when the worker is under a long-term disability ; by 
the end of the year this provision had been applied in the case of 
134,000 disabled individuals. 

Legislatively, 1956 was a very active year. In addition to the 
extensions of the coverage of the program, mentioned earlier, Congress 
enacted many changes that introduced new concepts into the insurance 
program. These included provision of benefits at age 50 and over 
for disabled workers and a reduction to 62 in the age at which women 
may qualify for benefits, with the benefits actuarially reduced where 
working women and wives elect to receive them prior to age 65. 

The year witnessed, too, the undertaking of several projects designed 
to further program objectives and to improve administration. Plans 
were made for a project for detailed study and analysis of the old-age 
and survivors insurance program with the objective of determining 
where the program can be simplified, clarified and rationalized so that 
it will be easier to administer, explain, and understand. The Bureau 
of Old- Age and Survivors Insurance made a comprehensive study 
of the effectiveness of the 1954 amendments in providing social security 
coverage for farmers and farm workers. Based on this study and 
on other experience, the Department prepared and submitted to the 
Committee on Finance of the Senate and to the Committee on Ways 
and Means of the House of Representatives a report on the effectiveness 
of those provisions. A w^ork group on aging reviewed the many ac- 
tivities of the Bureau of Old- Age and Survivors Insurance in the field 
of aging and presented recommendations for the expansion of these 
activities. Automation in the record-keeping operation was advanced 
through the installation of large-scale electronic data-processing equip- 
ment to post earnings records and to facilitate the computation of 
benefit payments. Responsibility for preparation of the checks for 
the 1 million beneficiaries served by the Bureau's Birmingham, Ala- 
bama, area office (payment center) was transferred from the Treasury 
disbursing office to the Birmingham area office. The transfer per- 
mitted the combining of check-writing operations with accounting 
work, resulting in work simplification and savings. 

The following pages spell out in more detail the year's record of 
significant events and accomplishments. 



Social Security Administration 25 

What the Program Is Doing 

BENEFICIARIES AND BENEFIT AMOUNTS 

In June 1956, about 8.3 million individuals were getting monthly 
benefits under the program. Some 6.6 million of these beneficiaries 
were aged 65 or over — 4.7 million of them retired workers and 1.9 
million the wives and dependent husbands of retired workers and the 
widows, de]3endent widowers, and dependent parents of workers who 
had died. Of the remaining 1.7 million, some 350,000 were mothers 
and 1.3 million were children. 

In June 1956, the average insurance benefit paid to a retired worker 
who had no dependents also receiving benefits was $60.00 a month. 
When the worker and his wife both received benefits, the average for 
the family was $104.80. Families consisting of a widowed mother and 
two children received on the average $137.80. 

The benefit awards for persons who came on the rolls for the first 
time in the past fiscal year are considerably higher than those given 
above for all beneficiaries. The higher amounts reflect the more liberal 
computation provisions of the 1950 and 1954 amendments, under which 
(1) it is possible to use only earnings after 1950 in the computation 
and (2) as many as 5 years of low earnings and periods of total dis- 
ability may be dropped from the computation of the average monthly 
wage. Among beneficiaries on the rolls at the end of June 1956 whose 
benefits are based on earnings after 1950 with eligibility to omit years 
of lowest earnings, the average for a retired worker with no dependents 
receiving benefits was about $76, for an aged couple about $127, and 
for a widowed mother and two children about $181. 

THE DISABILITY FREEZE 

The disability freeze provision of the Social Security Amendments 
of 1954 became effective on July 1, 1955, although applications could 
be filed at any time after the beginning of 1955. A person under an 
extended total disability who has had both substantial and recent 
covered work before disablement may, after a waiting period of 6 
months, have his insurance rights preserved during the period in which 
total disability prevents him from performing any substantial gainful 
work. (This means that a period of total disability will not count 
against the disabled person in determining whether he or his sur- 
vivors are eligible for benefits or in calculating the amount of the 
benefits.) By the end of June 1956 a period of disability had been 
established for 134,000 disabled workers. About 110,000 applications 
for a disability freeze were denied. About 36,100 persons who al- 
ready were old-age beneficiaries had their benefits increased by the end 
of June 1956 ; the average increase was $9.93 a month. The higher ben- 

408691—57 3 



26 Department of Health, Education, and Welfare, 1956 

etits were attributable to the exclusion of a period of disability and 
also to the dropping of as many as 5 years of lowest earnings in the 
computation of the worker's average monthly wage when eligibility 
for such dropout stemmed from the disability freeze. About 13,100 
monthly benefits payable to dependents of these retired workers and 
to survivors of workers who had established a period of disability 
before death were also increased because of the freeze. For the same 
reason, lump-sum death payments based on the earnings records of 
almost 4,500 deceased workers were increased by an average amount of 
about $21.50 per worker. 

THE PROTECTION PROVIDED 

Of the popidation under age 65, 65.6 million were insured at the 
beginning of the calendar year 1956. Some 26.3 million of these 
])eople were permanently insured — that is, whether or not they con- 
tinue to work in covered jobs they will be eligible for benefits at age 
65 and their families are assured of protection in the event of their 
death. The remaining 39.3 million were insured but would have to 
continue in covered work for an additional period to make their in- 
sured status permanent. Nine out of 10 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 earner. 

Of the almost 14.4 million people aged 65 or over in the United 
States in December 1955, 54 percent were eligible for benefits under 
old-age and survivors insurance. Forty-three percent were actually 
receiving benefits, and 11 percent were working. The percentage of 
aged persons who are eligible is expected to rise to 69 percent by 1960. 

THE COVERAGE OF THE PROGRAM 

Approximately 69 million workers were covered by old-age and 
survivors insuranc-e during the couree of the calendar year 1956. An 
additional 1% million people employed in the railroad industry 
earned social insurance protection under what, in effect, amounts to 
joint coverage of the railroad retirement and old-age and survivors 
insurance progi'ams. Altogether, including State and local govern- 
ment and nonprofit employees for whom coverage is available on a 
group election basis and members of the Armed Forces, over nine- 
tenths of all persons in paid employment in the continental United 
States were covered or could have been covered by old-age and sur- 
vivors insurance in June 1956. (Members of the Armed Forces were 
covered on the basis of gratuitous wage credits of $160 a month for 
service before January 1, 1957, the effective date for regular con- 
tributory coverage for them.) 

Of the workers not eligible for coverage by old-age and sm*vivors 
insurance, about one-third were covered by other public retirement 



Social Security Administration 27 

programs — Federal, State or local. The remaining two-thirds — 6 
percent of the Nation's paid employment — were not covered by any 
public retirement program. Those without retirement protection un- 
der a public system consisted principally of self-employed persons 
whose amiual net earnings were less than $400 and of domestic and 
farm workers who did not earn sufficient wages from any one em- 
ployer to meet the minijnum coverage requirements of the law. 

INCOME AND DISBURSEMENTS 

Expenditures during the fiscal year totalled $5,485 million, of which 
$5,361 million was for benefit payments and $124 million for ad- 
ministrative expenses. Total receipts were $6,937 million, including 
$6,442 million in net contributions, $487 million in interest on in- 
vestments, and $7 million in transfers from the railroad retirement 
account. Receipts exceeded disbursements by $1,452 million, the 
amount of the increase in the trust fund during the year. At the end 
of June 1956 the fund totalled $22.6 billion. 

Total assets of the trust fund, except for $550 million held in 
casli, were invested in United States Government securities as required 
by law ; $2.6 billion were invested in public issues (identical with sim- 
ilar bonds owned by private investors) , and $19.5 billion were invested 
in special ceilificates of indebtedness bearing interest at the average 
rate paid on the total interest-bearing Federal debt at the time they 
w^ere issued. The average interest rate on all investments of the trust 
fund at the end of the fiscal year was about 2.5 percent. 

Administering the Program 

The composite measurable workload of the Bureau in fiscal year 
1956 was about 7 percent above 1955, reflecting the continuing large 
volume of work attendant upon the 1954 amendments to the program. 
Funds appropriated for Bureau operations were $91,229,000; 
$5,229,000 of this amount was a supplemental appropriation to cover 
the pay increase provided by Public Law 94, 84th Congress. Recruit- 
ment during the year was mainly to replace employees who had left 
the Bureau. Personnel on duty at the beginning of the year num- 
bered 17,651 ; at the end of the year 17,797. District offices providing 
direct service to the public increased by 7, from 532 to 539. In addi- 
tion to district offices, 41 resident stations and 3,538 contact stations 
were in operation. 

The major administrative circumstance of the year was the success- 
ful follow-through in processing heavy workloads and in establish- 
ing several new operations consequent to the 1954 amendments. 

The issuance of new and duplicate account-number cards remained 
at high levels. About 16 million employer reports of wages paid to 



28 Department of Health, Education, and Welfare, 1956 

employees were received, and about 230 million earnings items (in- 
cluding self -employment income) were posted to individual earnings 
records. Despite the inexperience of the farm groups with record 
keeping, reports were on the whole well-prepared. 

Applications for benefits remained high— about 2 million during the 
year. The time required to process these claims, which had been in- 
creased by the earlier rush of 1954 amendment work, returned to nor- 
mal during the first part of the year. However, claims receipts in 
the last quarter of the year peaked very steeply, mainly because self- 
employed farmers were becoming eligible for benefits for the first 
time, and during the last several months of the year the number of 
claims in process increased substantially. 

A new operation under the 1954 amendments was the receipt from 
beneficiaries of annual reports of earnings in excess of the amount 
permitted by the retirement test established by the 1954 amendments. 
Beneficiaries were urged to report currently during the year so that 
necessary withholding of benefits might be done currently and were 
required to make, at the end of the calendar year, an annual report 
of earnings when they earn above $1,200. Actions were taken to get 
the necessary report forms into the hands of beneficiaries, to establish 
controls to check nonreporting, and to process a concentrated load of 
report receipts and make the necessary benefit suspensions, deductions, 
and reinstatements in the space of several months. 

Under the terms of the disability freeze provision of the 1954 amend- 
ments — the provision which preserves the benefit rights of workers 
suffering from long-term total disability — disability determinations 
are made by the States except that in the case of foreign claimants 
and railroad career employees determinations are made by the Bureau 
of Old- Age and Survivors Insurance. In the early stages of the pro- 
gram, the Bureau made determinations in certain classes of cases now 
processed by the States — principally the backlog cases of applicants 
who had been disabled for long periods of time. By February 1956, 
agreements for this operation had been completed with agencies in all 
States, the District of Columbia, Alaska, Hawaii, and Puerto Rico. 
The staffs of these agencies engaged in disability freeze work were 
equivalent to more than 200 positions nationwide. From the begin- 
ning of the program early in calendar year 1955 through this fiscal 
year, nearly a quarter-million applications for establishment of a 
period of disability were processed to allowance or denial. As was 
expected, during the initial year of operation, the Bureau did all of the 
processing in 4 out of 5 cases. The cases processed by the Bureau 
represented those not covered by State agreements and were primarily 
the backlog cases. 

Total administrative costs for the old-age and survivors insurance 
program in fiscal year 1956, including Treasury Department costs, 



Social Security Administration 29 

were approximately $124,300,000. This total was less than 2 percent 
of the contributions to the trust fund. The composite measurable 
workload of the Bureau has increased by 116 percent since 1950, while 
personnel has increased by only 59 percent. This record of increased 
productivity is also reflected by lower salary costs in relation to work- 
load and it accounts in major part for the continuing low level of ad- 
ministrative costs compared to contribution receipts. 

Among the more dramatic recent actions to reduce costs was the suc- 
cessful installation during the year of large-scale electronic data- 
processing equipment in the earnings record operation. This action 
continues and advances the Bureau use of automation in its repetitive 
mass operations. The electronic equipment, by carrying earnings 
information in tape form, eliminated the need for setting up a second 
summary punch-card file for 100 million earnings accounts. The cost 
of new cards and cabinets for establishing this file in 1957 would have 
been $335,000, and maintenance of the file would have cost $250,000 
a year. Also, the use of electronic data-processing equipment to 
handle earnings information reported incorrectly will substantially 
reduce the number of items for which correct information camiot be 
determined in internal operations. When the procedure has been 
fully installed and experience has been obtained, savings of about $1 
million a year are expected. A third operation in which the equip- 
ment will be put to immediate use is the computation of benefit 
amounts. These computations will be made at the rate of 16 a second, 
compared to 60 a minute on the equipment previously used. 

Use of electronic equipment opens up the possibility for large em- 
ployers, as they make data-processing installations, to reduce costs by 
reporting employee earnings for social security purposes on magnetic 
tape instead of the present method of tabulating the reports on paper 
forms. Arrangements were completed with one large employer to 
begin this type of reporting in the last quarter of the year. 

On July 1, 1955, the writing of the benefit checks was transferred 
from the Treasury disbursing office in Birmingham to the Bureau's 
area office in that city. A reduction in processing costs is made pos- 
sible through the elimination of overlapping balancing and control 
operations, the use of addressograph plates for the preparation of 
forms that previously had to be typed, and work simplifications in 
the certification of claims and maintenance of the beneficiary rolls 
that have been made possible by combining accounting and disburs- 
ing functions. The Department has recommended, on the basis of 
this experience, the transfer of the Treasury check-writing operations 
to the other five area offices of the Bureau. 

The project of erecting a new building on the outskirts of Baltimore, 
to house all the Baltimore operations now scattered in ten different 
buildings is proceeding. The architectural firms are expected to 



30 Department of Health, Education, and Welfare, 1956 

complete the final detailed working drawings in the spring of 1957. 
After checking by the Public Buildings Service and assuming suf- 
ficient funds are available to be spent on the building, everything will 
be in readiness to solicit construction bids. It will take about 2 years 
to construct the building. 

Fact -Finding for Program Evaluation and Improvement 

SIMPLIFICATION STUDY 

At present the basic old-age and survivors insurance legislation is a 
product of 7 sets of major amendments and approximately 20 other 
less significant amendments. As this program expanded, complexi- 
ties have been introduced, making difficult not only its administration, 
but also its understanding by the public. 

An intensive study of the program has been instituted to determine 
how and where the program can be made simpler and more rational. 

A STUDY OF FARM COVERAGE 

During the last 6 months of 1955, the Bureau of Old-Age and Sur- 
vivors Insurance made an extensive study to evaluate the effectiveness 
of the agricultural coverage provisions of the Social Security Amend- 
ments of 1954. These provisions extended old-age and survivors in- 
surance coverage to self-employed farm operators for the first time and 
broadened the coverage of agricultural workers to include all who were 
paid at least $100 in cash wages during a year by a farm employer. 
Considerable interest in the experience under these provisions had been 
expressed not only in the Congress but also among many farm groups. 

The Bureau's study was designed to obtain and analyze informa- 
tion on how the agricultural coverage provisions were working out, 
and on the prospects for complete and accurate reporting of covered 
farm earnings. Special reports were obtained from all of the district 
social security offices ; farmers in 24 States were consulted about their 
coverage and the coverage of their farm workers; and contacts were 
made with crew leaders, hired farm workers, and leaders in farm 
organizations and in rural communities. The results of this special 
study, together with information drawn from the Bureau's adminis- 
trative experience with the provisions for coverage of farmers, were 
evaluated in a special report submitted to the Committee on Finance 
of the Senate and to the Committee on Ways and Means of the House 
of Representatives. 

About 3 million farmers had sufficient self-employment income to 
be covered by old-age and survivors insurance under the 1954 amend- 
ments. In spite of the previous lack of understanding of old-age and 
survivors insurance among farm people, it was clear by the end of 



Social Security Administration 3 1 

1955 that the provisions for coverage of farm operators were working 
out satisfactorily and that only relatively minor improvements in 
the coverage provisions were needed. 

Of a total of slightly more than 4 million persons employed at paid 
farm work during the course of a year, about 2.2 million were covered 
by social security. Those still excluded from coverage are mainly 
people who are not normally in the labor market — such as students, 
housewives, and children — although they do some farm work at one 
time or another during the year. About half a million farmers em- 
ployed covered workers. The study showed that the great majority 
of these employers had experienced no serious problems in fulfilling 
their social security responsibilities. About 5 out of eveiy 6 em- 
ployers apparently needed to make only minor adjustments in their 
record-keeping system and were using practicable and workable pro- 
cedures to facilitate compliance with the f arm-W'Orker coverage provi- 
sions. The remaining employere encountered difficulties of varying 
degree in obtaining and recording the information necessary to de- 
termine which of their workers were covered. 

WORK GROUP ON AGING 

During the year the Bureau set up a work group to review its ac- 
tivities in the area of aging and to develop recommendations as to 
further activities that might be undertaken in this area. The work 
group's report, designed to aid administrative planning, includes a 
brief description of the numerous ways in which the Bureau's field 
organization has provided leadership and services and otherwise has 
participated in community affairs related to aging. The report also 
summarizes the Bureau's research and program-planning activities 
that have dealt with various aspects of the aging problem. 

Areas considered include : (1) Increased participation by the Bureau 
in community and regional programs relating to the problems of older 
people, particularly through a more uniform level of activity in all 
district offices; (2) continued emphasis on the Bureau's public in- 
formation activities that relate to the interests of the aged ; (3) expan- 
sion of the Bureau's research on aging through field surveys, studies 
based on the Bureau's records, and studies of the social and economic 
aspects of old age in cooperation with other governmental and non- 
governmental agencies; and (4) increased participation by the Bureau 
staff in conferences and meetings dealing with the problems of the 
aging. 

REFERRAL PRACTICES OF DISTRICT OFFICES 

The Bureau has, from the beginning of the program, assumed a 
responsibility for referring to the appropriate public or private agency 



32 Department of Health, Education, and Welfare, 1956 

people who come to district offices and ask where they can get help 
with problems not directly related to old-age and survivors insurance. 
This year there has been completed the second of two studies in differ- 
ent parts of the country of the referral service provided by district 
offices. From these studies it appears that many people come to the 
local offices for this kind of service even when they have no problems 
immediately related to old-age and survivors insurance to discuss. 
Referrals are made to a wide range of agencies with the largest pro- 
portion being made to related programs concerned with income 
maintenance — unemployment compensation, public assistance, and the 
employment services. The findings derived from these studies will 
serve as the basis for planning ways in which the Bureau offices can 
more effectively help people by referral service. 

Legislative Developments During the Year 

The fiscal year 1956 was one of intense legislative activity. The 
most important measure affecting old-age and survivors insurance was 
H. E,. 7225, a bill that was passed by the House in July 1955 and 
passed by the Senate early in fiscal 1957. The bill — known as "The 
Social Security Amendments of 1956" (P. L. 880) — was signed by 
the President on August 1. 

MAJOR PROVISIONS OF THE 1956 AMENDMENTS 

Extension of coverage. — More than 600,000 additional persons who 
have self-employment income from farming were afforded coverage 
under old-age and survivors insurance through changes made by the 
1956 legislation. One change extended coverage to certain income, 
previously excluded as rental income, derived by owners or holders of 
farm land who participate materially in the farm production under 
an arrangement with the tenant or share farmer who produces the 
commodities on the land. This provision extended coverage to about 
400,000 persons. Another change, the extension of the optional 
method of computing farm self -employment income for social security 
purposes, made coverage available to about 200,000 farm operators. 
This option is designed to preclude the need for small farmers to keep 
special records for social security purposes, and also to enable both 
large and small farmers to maintain their old-age and survivors 
insurance protection during years of low farm earnings. The new 
provision permits farm operators whose gross farm income in a year is 
at least $600 and not more than $1,800 to deem their farm net earnings 
to be two-thirds of their gross farm income ; if gross income exceeds 
$1,800 and net earnings are less than $1,200, net earnings may be 
deemed to be $1,200. The provision previously in effect was restricted 
to farmers whose gross farm income was at least $800, with half, rather 



Social Security Administration 33 

than two-thirds, of the gross farm income (up to $1,800) the maximum 
that could be reported for old-age and survivors insurance purposes 
under the option. The use of the option, which formerly was limited to 
individual farmers who reported their income on a cash basis for 
income-tax purposes, was extended to members of farm partnerships 
and to farmers who report on an accrual basis. The 1956 amendments 
also provided that share farmers are, generally speaking, self-employed 
persons for social security purposes, thus confirming an interpretation 
which had been given to previous law. 

The amendments extended coverage to more than 200,000 self- 
employed professional people, including self-employed lawyers, 
dentists, osteopaths, chiropractors, veterinarians, naturopaths, and 
optometrists. The amendments continued the exclusion of doctors 
of medicine from old-age and survivors insurance coverage. 

A number of changes in the law resulted in making coverage possible 
for several relatively small groups of employees. These groups 
include: additional employees of State and local governments and 
of nonprofit organizations, additional clergymen in foreign countries, 
and American employees of a foreign company in which an American 
corporation holds 20 percent or more (rather than 50 percent as in 
previous law) of the voting stock. Coverage was also made available 
to employees covered by the retirement systems of the Tennessee Val- 
ley Authority and the Federal Home Loan Banks. For both groups, 
coverage would be subject to approval by the Secretary of Health, 
Education, and Welfare of a plan for equitable coordination of their 
special staff retirement systems with old-age and survivors insurance. 

Changes in coverage of farm workers. — The 1956 amendments made 
three changes in the provisions for coverage of farm workers. Under 
the new coverage test, a farm worker is covered under old-age and 
survivors insurance with respect to his work for a farm employer if 
his cash pay from the employer in a year is $150 or more, or if the 
worker performs agricultural labor for the employer on 20 or more 
days during the year for cash wages computed on a time (rather than 
on a piece-rate) basis. Under the law previously in effect, a farm 
worker was covered for his work for a farm employer if his cash pay 
from the employer amounted to at least $100 a year. The amendments 
specifically designate "crew leaders" as the employers of the crews or 
workers they furnish to perform agricultural labor for other persons, 
provided the crew leader pays the workers and there is no written 
agreement specifying that the crew leader is an employee of the person 
for whom the agricultural labor is performed. A person who is a 
crew leader under this provision is deemed to be self-employed with 
respect to his services in furnishing the crew members and any work 
he performs as a member of the crew. The amendments broaden the 



34 Department of Health, Education, and Welfare, 1956 

previous exclusion from coverage of certain agricultural workers from 
Mexico and the British West Indies so that the exclusion now applies 
to the services of workers temporarily admitted from any foreign 
country to perform agricultural labor. The farm- worker coverage 
provisions as modified by these three amendments afford coverage to 
roughly the same number of farm workers as were covered under 
previous law. 

Disability insurance benefits. — The 1956 amendments to the Act 
provide a new type of benefit — payable in certain cases of disability. 
Totally disabled workers between the ages of 50 and 65 who meet 
specified work and disability standards can receive monthly benefits 
under the old-age and survivors insurance program beginning with 
July 1957. It is estimated that about 400,000 people will be eligible 
to receive benefits for that month and that about 900,000 people will be 
receiving benefits by 1970. 

To be "disabled" under the new law a worker must be unable to en- 
gage in any substantial gainful activity by reason of a medically de- 
terminable physical or mental impairment which can be expected to 
result in death or to be of long-continued and indefinite duration. A 
waiting period of 6 consecutive months of disability is required before 
benefits may be payable. In order to qualify for disability benefi-ts 
a worker must be both fully and currently insured and also must have 
had 20 quarters of coverage during the 40-quarter period ending with 
the quarter in which the disability begins. These requirements are 
intended to limit the payment of disability insurance benefits to per- 
sons who have had a suiRciently long period of coverage under the 
program to indicate that they were dependent upon their covered 
earnings over an extended period before they became disabled and who 
have had sufficient recent coverage to indicate that their withdrawal 
from covered work was probably due to their disability. 

The disability benefits program will be administered in close re- 
lationship with the vocational rehabilitation program. Applicants 
for disability insurance benefits will be referred to the vocational re- 
habilitation agency. The law contains special provisions designed to 
keep the disability benefits consistent with the objective of rehabilita- 
tion. A beneficiary who engages in remunerative work pursuant to a 
program for his rehabilitation carried on under a State-approved vo- 
cational rehabilitation plan will, up to a year after he engages in such 
a program, not be considered as able to engage in substantial gainful 
activity solely by reason of the services rendered under this rehabili- 
tation program. A rehabilitant will thus have a year to test his earn- 
ing capacity without losing his disability benefits. On the other hand, 
disability benefits will not be paid to anyone who, without good cause, 
refuses rehabilitation services which have been made available to him 
imder a State- approved vocational rehabilitation plan. For the pur- 



Social Security Administration 35 

pose of guarding against a pyramiding of certain benefits that may be 
payable to an individual under various public programs on account 
of disability, the disability benefit under old-age and survivors insur- 
ance is reduced by the amount of any other Federal benefit or work- 
men's compensation benefit that is based on the individual's disability. 

A distinctive feature of the disability provision is the separate 
financing system. Beginnng with 1957, an additional tax of i/o of 
1 percent on wages ( i/4 each from employee and employer) and % of 
1 percent on self-employment income is imposed to finance the dis- 
ability insurance program. This additional tax will be deposited in 
the newly created Federal disability insurance trust fund. Disability 
benefits and the costs of administering the disability benefits progi-am 
will be paid from this fund. 

Benefits for adult children who are disabled before attaining age 
18. — The 1956 amendments made an important change in the eligibil- 
ity requirements for child's insurance benefits. Until now, child's 
benefits could not be paid after the child attained age 18. Under the 
new law, child's insurance benefits are payable, beginning in January 
1957, to dependent children age 18 and over who become totally dis- 
abled before age 18. Also, mothers of children entitled to benefits 
under the new provision can receive mother's benefits on the same 
basis as mothers of children under 18. 

It is estimated that about 20,000 children age 18 or over will be 
added to the benefit rolls in the first year ; after the first year, annually 
about 2,500 disabled children will be either currently reaching age 
18 and continued on the benefit rolls or added to the rolls when the 
insured parent dies or becomes entitled to old-age insurance benefits. 

To qualify for these benefits a child must meet the same definition 
of disability as a disabled worker. The child's disability must have 
become total before he reached age 18 and must have continued un- 
interruptedly after age 18. The child must have been or, upon filing 
application, would have been entitled to child's benefits before he 
reached age 18 or it must be proved that the child was receiving at least 
half of his support from the worker when the child applied for bene- 
fits or when the worker died. Like benefits for disabled workers, dis- 
abled child's benefits will be adjusted if any other Federal benefit or 
workmen's compensation payment is made on the basis of the child's 
disability. A disabled adult child will be referred to the vocational 
rehabilitation agency and his benefits will be suspended if he refuses, 
without good cause, to accept offered rehabilitation services. Bene- 
fits for disabled adult dependent children and the costs of adminis- 
tering the provision for these benefits will be paid from the old-age 
and survivors insurance trust fund. 

Benefits for women at age 62. — The 1956 amendments reduced to 
62 the age at which, women may qualify for benefits. As a result, au 



36 Department of Health, Education, and Welfare, 1956 

estimated 860,000 additional women conld, if they filed a claim, draw 
benefits for November 1956, the eft'ective date of this provision. 

Widows and dependent mothers of deceased workers may receive 
full benefits at 62. Working women and wives, on the other hand, 
may draw benefits prior to 65 if they elect to receive actuarially re- 
duced benefits (in such cases the reduced benefit is payable both before 
and after age 65). As under present law, wives with child bene- 
ficiaries in their care can draw full benefits regardless of age. 

The old-age insurance benefit of a woman — that is, the retirement 
benefit payable to her on the basis of her own earnings record — is 
reduced by % of 1 percent for each month before age 65 for which she 
draws the benefit. A woman who elects to receive an old-age insur- 
ance benefit for the month in which she attains age 62 will thus have 
her benefit reduced by 20 percent. A wife's benefit is reduced by 2%^. 
of 1 percent for each month before attainment of age 65 for which she 
draws the benefit ; if the benefit starts at age 62 it will thus be reduced 
by 25 percent. 

If provision had been made for paying full-rate benefits to all 
women at age 62, the cost of the program would have been significantly 
increased. Since benefits to wives and women workers are payable 
on an actuarially reduced basis there was little increase in the cost 
of the program. 

Suspension of benefits of certain aliens. — Under the 1956 legislation 
benefit payments to certain aliens not eligible for benefits for Decem- 
ber 1956 who are outside the United States for more than 6 consecutive 
months will be suspended. Benefit payments will not be suspended if 
the alien is a citizen of a country that has a social insurance or pension 
system which is of general application in the country and which pro- 
vides for the payment of periodic benefits or their actuarial equivalent 
to otherwise eligible American citizens who leave that country. They 
will not be suspended if the individual upon whose earnings record 
the alien is receiving benefits has at least 10 years of employment under 
social security or has lived in the United States for at least 10 years, 
or if suspension would violate an existing treaty between the United 
States and another country. Time spent outside the country in the 
active military or naval service of the United States will not cause 
suspension of an alien's benefit. If an alien whose benefit is suspended 
dies outside the United States, no lump-sum death payment will be 
made. 

Conviction for subversive activities. — The amendments provide 
that courts may, at their discretion, as an additional penalty, ter- 
minate an individual's benefit rights based on earnings prior to his 
conviction for certain Federal crimes, such as espionage, sabotage, 
treason, sedition, and other subversive activities. Any wages and self - 
employment income reported after the individual's conviction will be 



Social Security Administration 37 

treated as a new earnings record, on which, if he meets all conditions 
of eligibility, he can establish new benefit rights. Benefit rights of 
other members of the individual's family who are otherwise eligible 
will not be affected by his conviction. The provision applies only to 
convictions for crimes committed after August 1, 1956, the enactment 
date of the Social Security Amendments of 1956. 

Bejnoval of certain emijloyment from coojerage. — The new law ex- 
cludes from coverage after June 30, 1956, any service in the employ 
of any organization registered (or required to register) under the 
Internal Security Act of 1950 as a Communist-action, Communist- 
front, or Communist-infiltrated organization. 

Interest rate on trust fund investments. — The interest rate on trust 
fund investments will be changed to reflect the essentially long-term 
character of the investments. The interest rate will be equal to the 
average rate of interest borne by all marketable interest-bearing obli- 
gations of the United States not due or callable until after the expira- 
tion of 5 years from the date of original issue. Under the previous 
law, the rate of interest for trust fund investments is equal to the 
average rate borne by all interest-bearing obligations of the United 
States without regard to maturities or marketability. To make it 
clear that bonds purchased by the trust fund are as much a part of the 
public debt as any other obligations of the Federal Government, they 
are designated as "public debt obligations for purchase by the Trust 
Fund" in place of the designation imder the old law, "special obliga- 
tions issued exclusively to the Trust Fund." 

Advisory Gowncil on Social Security Financing. — Provision is 
made for the establishment periodically of Advisory Councils on So- 
cial Security Financing to review the status of the Federal old-age 
and survivors insurance and disability insurance trust funds in rela- 
tion to the long-term commitments of the program. The first Coun- 
cil will be appointed after February 1957 and before January 1958. 
The Secretary of Health, Education, and Welfare will appoint its 
members. They are to represent employers and employees (as far as 
possible, in equal numbers) and self-employed persons and the public. 
The Commissioner of Social Security is to serve as Chairman of the 
Council. The Council's report will be included in the annual report 
submitted to the Congress by the Board of Trustees. 

A new Council, similarly composed and with the same functions, 
will be appointed by the Secretary not later than 2 years before each 
scheduled increase in the social security tax rate. Each Council will 
report its findings and recommendations not later than January 1 of 
the year preceding the one in which the tax increase is scheduled. 

Coverage of the uniformed services. — The major extension of cover- 
age approved by the 84th Congress resulted not from Public Law 880 



,^8 Department of Health, Education, and Welfare, 1956 

but rather from Public Law 881, a law designed, primarily to revamp 
survivor benefit progi'ams for members of the uniformed services. 
Members of the services, nmnbering nearly 3 million, were brought 
mider regular contributory old-age and survivors insm-ance cov- 
erage for the fii^t time by the new law, and the social security 
protection thus provided was made the base for a simplified and 
improved structure of militarj'^ survivor benefits. Although the old- 
age and survivors insurance coverage of servicemen is restricted to 
their basic pay and does not apply to wages in kind, in other respects 
the new provisions follow the recommendations made earlier by the 
Committee on Retirement Policy for Federal Personnel and endorsed 
by President Eisenhower, Under legislation previously enacted as 
a stop-gap measure, gratuitous old-age and survivors insurance wage 
credits of $160 a month were provided, under certain conditions, for 
service in the Armed Forces performed after September 15, 1940, and 
before April 1, 1956. Public Law 881, 8-lth Congress, extended the 
period for granting the gratuitous $160 wage credits to include mili- 
tary service after March 1956 and before January 1957, thus bridging 
the gap between the expiration date of the earlier provisions and the 
beginning date of contributory coverage. The new law also provided 
for reimbursement of the Federal old-age and survivors insurance 
trust fund for expenditures resulting from the gratuitous wage credi; 
provisions. These expenditures include approximately $200 million 
already paid out of the trust fund by the close of the fiscal year anc. 
more than $600 million in expected future disbursements. 

Proposals to cover Federal civilian employees. — Early in 1956, 
Administration-sponsored bills were introduced in the Congress which 
would have extended old-age and survivors insurance to Federal 
employees covered by the civil service retirement system. At public 
hearings before the Post Office and Civil Service Committees of 
the Senate and the House of Rrepresentatives, the Department 
and the Civil Service Commission both recommended that social 
security protection be extended to the civilian employees of the 
Federal Government. The Administration's spokesmen pointed out 
that the retirement and sm-vivor protection of Federal employees 
would be considerably improved if they, like 13 million or more 
employees in private industry, had old-age and survivors insur- 
ance coverage in addition to their staff retirement system. They 
also emphasized that this coverage would provide more equitable 
benefits to employees who shift between Federal employment and 
private industry. The measure passed by the Senate, however, liberal- 
ized the civil service retirement system without extending old-age and 
survivors insurance to employees covered under the system. The 
Plouse of Representatives later passed a bill similar to that approvei" 
by the Senate, and the legislation eventually approved (Public Law 



Social Security Administration 39 

854) contained no provisions for extending old-age and survivors 
insurance to Federal employees. The more than 2 million Federal 
civilian employees now constitute the largest group without old-age 
and survivors insurance coverage. Thus, Federal employment is 
now the only major type of employment in which a worker does not 
acquire social security coverage and may lose his previously acquired 
protection. Until an equitable plan for coordination of old-age and 
survivors insurance and Federal retirement systems is put into 
effect, many Federal employees will have less adequate retire- 
ment and survivor protection than employees in private industry who 
are covered by both social security and staff retirement systems. 

Status of the plan for combined reporting of social seetcrity and 
withholding taxes.— The Department of Health, Education, and Wel- 
fare and the Treasury Department submitted to the Congress a pro- 
posal that would make possible integrating old-age and survivors 
insurance wage reporting with annual reporting of income taxes with- 
held. Under this proposal the report of each employee's wages made 
annually on the withholding-tax form (Form W-2) would provide the 
information needed for the social security earnings records, thus mak- 
ing it possible to eliminate the present detailed quarterly wage reports 
filed by employers for old-age and survivors insurance. In 1951, the 
Hoover Commission estimated that as a result employers would save 
about $22 million a year. The workload of wage report items to be 
processed by the Government would also be reduced. Recent esti- 
mates indicate that in fiscal year 1959, the number of wage items that 
would have to be processed under the present quarterly reporting pro- 
visions by the Social Security Administration for wage record pur- 
poses would amount to about 245 million. A change to annual report- 
ing would eliminate the need for processing at least one-half this 
number of wage items. The reduction would be three-fourths if it 
were not for the fact that a substantial number of employees work 
for more than one employer in the course of a year. 

Under the proposed plan, the Bureau of Old- Age and Survivors 
Insurance would mechanically match the reports made by employers 
on Forms W-2 with those copies filed by employees with their indi- 
vidual tax returns. The purpose of this matching operation would be 
to discover errors in reporting wages under old-age and survivors 
insurance and income-tax withholding. The Government would bene- 
fit through improved tax administration. Also, employees would 
benefit because the plan would provide a comprehensive mechanical 
check each year on the accuracy of the amounts of earnings reported 
for their social security records. The employees' receipts on Form 
W-2 would be an exact copy of the employers' social security report. 
The employee could check this information against his own records 



40 Department of Health, Education, and Welfare, 1956 

raid obtain a corrected copy of the Form W-2 to attach to his income- 
tax report; automatic reconciliation of discrepancies would result. 

The plan requires that the definition of insured status and related 
provisions of old-age and survivors insurance be put on an annual 
rather than a quarterly basis. The necessary changes were included 
in the draft bill submitted to the Congress. 

Financing the Program 

With the amendments to the old-age and survivors insurance pro- 
gram which became law on August 1, 1956, Congress modified the 
schedule of contribution rates so as to continue to reflect its intent 
that the system be self-supporting from the contributions of covered 
workers and employers. The revision in the contribution schedule 
was arrived at after careful review of long-range actuarial cost esti- 
mates prepared for use by the congressional committees in their legis- 
lative considerations. As indicated previously, separate arrange- 
ments have been established for the financing of old-age and survivors 
insurance benefits and of disability insurance benefits. 

OLD-AGE AND SURVIVORS INSURANCE BENEFITS 

Since enactment of the Social Security Amendments of 1954, three 
important changes have taken place which will result in higher in- 
come to the system than was expected according to the long-range 
actuarial cost estimates on which the 1954 contribution schedule was 
based. First, the present cost estimates are based on earnings levels 
in 1955, which are about 15 percent higher than the 1951-52 earnings 
levels on which the earlier estimates were based. As earnings levels 
rise, relatively more is collected in contributions than is paid out in 
higher benefits. This is due to the fact that the benefit formula 
is weighted in favor of those with low average wages. As a result 
of this weighting, benefit amounts, expressed as a percent of a worker's 
wage, decline as his average wage increases. As earnings levels 
rise, there is a corresponding rise in contribution income and some, 
but proportionately smaller, increase in benefit outgo. 

Second, the change made in the method of determining the inter- 
est rate of securities purchased for investment by the trust funds 
will result in higher interest earnings. Accordingly, the present 
cost estimates are based on a yield of 2.6-percent interest as compared 
with the 2.4-percent rate on which the earlier estimates were based. 
Third, the extension of coverage, including that of the uniformed 
services under P. L. 881, will result in relatively more being collected 
in contributions than is paid out in benefits. This occurs because 
under limited coverage those who move in and out of covered employ- 
ment have low average monthly wages in covered employment and re- 



Social Security Administration 41 

ceive the advantage of the weighted benefit formula. Under extended 
coverage, their wages in covered employment will be greater with a 
corresponding increase in contribution income. There will be some, 
but proportionately smaller, increase in benefit outgo. Over a period 
of time the contribution income will increase more than benefit outgo. 

Expressed as a level premium percent of payroll, this additional 
income will be somewhat more than is needed to meet the larger outlays 
for old-age and survivors insurance benefits resulting from the amend- 
ments. Accordingly, the schedule of contributions that was estab- 
lished in 1954 has been retained without change. 

The level premium cost of these benefits on an intermediate basis 
is 7.43 percent of payroll. Contributions income is equivalent to 7.23 
percent of payroll on a level basis. This leaves an actuarial insuffi- 
ciency of 0.20 percent of payroll. (There was an actuarial insuffi- 
ciency of 0.38 percent of payroll when the 1954 amendments were 
adopted.) 

DISABILITY INSURANCE BENEFITS 

The level premium cost of the disability insurance benefits on an 
intermediate basis is 0.42 percent of payroll. Contribution income 
has been specifically allocated to finance these benefits; this income 
is equivalent to 0.49 percent of payroll, thereby producing an actuarial 
surplus of 0.07 percent of payroll. 

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, 
disability, or earnings had been used, different results would have 
been obtained. Accordingly, no one set of estimates shoidd be looked 
upon as final. As economic and other conditions change, the De- 
partment will continue to prepare new cost estimates reflecting the 
latest information available. 

Public Assistance 

The 1956 amendments to the Social Security Act provide for far- 
reaching and significant changes in the public assistance programs. 
The objectives of the programs have been broadened by encouraging 
the States to provide more adequate medical care and appropriate 
social services to help needy persons achieve more independent living, 
and in general, to strengthen family life. The use of Federal funds 
has been authorized to assist States in making grants to schools for 
training in order to increase the skill of public assistance persomiel. 
The amount of Federal funds available to the States for public as- 
sistance programs has also been increased. In addition, an amend- 

408691—57 4 



42 Department of Health, Education, and Welfare, 1956 

ment to another title, which has great significance for all the social 
security programs, provides for the study of the causes of dependency 
and the development of constructive methods of dealing with it. 

Legislative Developments 

THE 1956 AMENDMENTS 

Amendments relating to public assistance include the following : 

1. An increase in Federal funds in each program, (a) The Federal 
share in State assistance payments for old-age assistance, aid to the 
blind, and aid to the permanently and totally disabled was increased 
to 4^ of the first $30 (raised from $25) of a State's average monthly 
payment plus half of the balance up to the new maximum of $60 
(raised from $55) . Effective October 1, 1956, through June 30, 1959. 
(b) The Federal share in State assistance payments for aid to depend- 
ent children was increased to i%7 of the first $17 (raised from % of 
the first $15) of a State's average monthly payment plus half of the 
balance up to the new maximums of $32 for the first child and the same 
amount for the needy relative with whom the child is living (raised 
from $30) and $23 for each additional child (raised from $21). 
Effective October 1, 1956, through June 30, 1959. (c) The ceiling 
on Federal matching for Puerto Kico and the Virgin Islands was 
raised 25 percent. Effective July 1, 1956. No change was made in the 
present sj^ecial matching formula for individual payments in these 
jurisdictions. See 4 (c) below. 

2. A new provision in each program for separate Federal sharing 
in State medical care costs paid directly to suppliers of medical serv- 
ices. Effective July 1, 1957. In old-age assistance, aid to the blind, 
and aid to the permanently and totally disabled, a Federal share (on 
a 50-50 basis) of a State's expenditures for medical care in behalf of 
recipients was authorized up to a monthly maximum determined by 
multiplying $6 by the total number of recipients of cash or medical care 
under the program for the month. In aid to dependent children, the 
Federal share is one-half of such expenditures up to a monthly maxi- 
mum of $6 times the total number of needy relatives, plus $3 times 
the total number of children receiving aid for the month. This new 
provision, recommended by the Administration, is in addition to the 
one for sharing in money payments to assistance recipients. 

3. Inclusion in the statement of purpose in each of the four public 
assistance titles of the objective of furnishing appropriate public 
welfare services to help assistance recipients toward more independent 
living, (a) In aid to dependent children, the emphasis is on helping 
to maintain and strengthen family life and on assisting the needy 
relative caring for the child to attain maximum self-support or self- 



Social Security Administration 43 

care consistent with the parental role ; in old-age assistance, on achiev- 
ing increased self-care; and in aid to the blind and aid to the perma- 
ently and totally disabled, on assisting individuals toward self-support 
or self-care. Effective August 1, 1956. (b) The authority of the 
Federal Government to participate in a State's costs in providing 
agency staff services to help needy people achieve increased self-care 
or self-support was clarified. Effecti've August 1, 1956. (c) The 
States are required to outline the services, if any, provided toward 
these objectives under each of the assistance programs and, except 
in old-age assistance, the steps taken to assure maximum use of other 
agencies providing similar or related services. Effective July 1, 1957. 

4. The aid to dependent children program was broadened through : 
(a) Inclusion of additional relatives (first cousins, nephews, and 
nieces) with whom the needy child may live and receive federally aided 
assistance. Effective July i, 1957. (b) Deletion of the limitation of 
Federal sharing in assistance expenditures for children between the 
ages of 16 and 18 to those who are regularly attending school. Effec- 
tive July i, 1957. (c) Extension to Puerto Rico and the Virgin Islands 
of provisions for Federal sharing in aid to dependent children pay- 
ments with respect to the needy relative with whom the dependent 
child is living. Effective July 7, 1956. 

5. A new provision for Federal funds to train personnel for public 
assistance programs which (a) provides for allotments to States on 
the basis of population, need for trained personnel, and financial need, 
and (b) authorizes payment from the allotments of 80 percent of 
expenditures for State grants to public or other nonprofit institutions 
of higher learning for training of personnel employed or preparing 
for employment in public assistance programs, for establishing fel- 
lowships or traineeships (directly or through grants), and for provid- 
ing special short-term courses of study. Effective July i, 1957., for 
5 years. 

STATE LEGISLATIVE CHANGES 

While most of the State legislatures met during the year, the meas- 
ures enacted affecting the public assistance programs were few in 
comparison with those passed in recent years. However, some of 
this year's measures were important. 

For example, several States expanded the scope of their assistance 
programs. The establishment of a federally aided program of aid 
to dependent children in Nevada extended this potent force for 
strengthening family life into every jurisdiction in the Nation. Two 
States, Florida and Nebraska, began programs of aid to the perma- 
nently and totally disabled during the year, and Federal aid was 
approved on a retroactive basis for the Maine program which began 
in April 1955. The number of States now administering this program 



44 Department of Health, Education, and Welfare, 1956 

is 45. Kentucky also developed a plan for a new program of aid to 
the permanently and totally disabled, and Texas prepared a consti- 
tutional amendment that would empower the legislature to establish 
such a program. 

A bill to open public assistance lists to limited public inspection 
passed by the West Virginia Legislature was vetoed by the Governor. 
No additional States adopted legislation permitting similar action, 
and the previous total — 31 States — still remains. Several States 
amended their earlier provisions. 

Financing of medical care for public assistance recipients was also 
the subject of legislation in several States. Many States have already 
begun planning for legislative changes necessary to participate in the 
new provisions of the 1956 amendments to the Social Security Act. 

Trends in Caseload and Expenditures^ 

About 5.7 million persons — 3.4 percent of the total civilian popula- 
tion or approximately 1 in 19 — received some form of public assistance 
in June 1956. There was a decline of 69,000 in the total caseload from 
that of a year earlier even though the aid to the blind and aid to the 
permanently and totally disabled programs showed increases. Sea- 
sonal influences were reflected during the winter months by increases 
in the aid to dependent children and general assistance programs. The 
year's peak of 5.9 million persons reached in March was nearly 200,000 
below the total in the peak month in the preceding year. 

Expenditures for assistance payments from Federal, State, and local 
funds during fiscal 1956 amounted to $2.8 billion, representing about 
nine-tenths of one percent of personal income payments in the Nation 
during 1955. The Federal share of this expenditure was $1.4 billion. 
The 2.5 percent increase in total expenditures reflected increases in 
average payments in each of the assistance programs except general 
assistance, due in part to increasing expenditures for medical care 
through vendor payments and higher standards of assistance in some 
States. 

OLD-AGE ASSISTANCE 

Old-age assistance was received by 2,524,000 persons in June 1956, 
a decrease of about 25,000 persons, or 1.0 percent, from the number 
receiving aid in the previous June. The caseload rose slowly through 
November 1955, largely as a result of an expanded program in Ala- 
bama, and then declined throughout the remainder of the year. Only 
six States had higher caseloads at the end of the year than at the 

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



Social Security Administration 45 

beginning. The national average monthly payment for old-age 
assistance was $54.29 in June 1956 as compared with $52.30 a year 
earlier. Payments ranged from a low of $28.45 in West Virginia to 
a high of $90.18 in Connecticut. 

AID TO DEPENDENT CHILDREN 

Aid to dependent children was received by 614,000 families in June 
1956. Although the number of children receiving aid rose slightly, 
there was a decrease of about 6,600 families, or 1.1 percent from the 
preceding June. A seasonal rise began in December 1955, but the 
year's peak of 617,000 families, reached in May 1956, was 9,000 below 
the peak in fiscal 1955. More than half the States had lower caseloads 
at the end of the year than at the beginning. The national average 
payment in June 1956 was $89.27 per family ($24.35 per person) as 
compared with $86.78 per family ($24.04 per person) in June 1955. 
Average payments per family ranged from $27.69 in Mississippi to 
$144.96 in Wisconsin. 

AID TO THE BLIND 

Aid to the blind was received by 105,800 persons in June 1956, an 
increase of about 2,000 or 1.8 percent during the year. The caseload 
increased slowly but rather steadily, and at the end of the year only 
22 States had fewer recipients than in June 1955. The national aver- 
age assistance payment in June 1956 was $60.42 as compared with 
$57.41 in the previous June. Average payments ranged from $32.44 
in West Virginia to $103.27 in Massachusetts. 

AID TO THE PERMANENTLY AND TOTALLY DISABLED 

Aid to the permanently and totally disabled was received by 258,000 
persons in June 1956. The increase of 21,000 persons, or 9.1 percent, 
was due in part to the initiation of new programs in a few States, 
liberalization in policy provisions in some States, and the continuing 
growth of a relatively new program. The national average monthly 
payment was $56.72 in June 1956, as compared with $54.93 a year 
earlier. Average payments ranged from $24.59 in Mississippi to 
$118.42 in Connecticut. 

GENERAL ASSISTANCE 

About 290,000 cases received State and/or locaUy financed general 
assistance in June 1956, a decrease of 20,000 cases or 6.5 percent from 
the preceding June. A seasonal rise in the caseload began in November 
1955 and reached a peak of 336,000 cases in February ; this, however, 
was 45,000 cases lower than the peak reached in the preceding year. 
There was a decrease in the national average payment per case from 
$53.78 in June 1955 to $51.94 in June 1956, even though the average 



46 Department of Health, Education, and Welfare, 1956 

per person increased slightly. Average payments per case ranged 
from $13.95 in Arkansas to $76.20 in New York. 

OASI BENEFICIARIES RECEIVING SUPPLEMENTARY ASSISTANCE 
PAYMENTS 

About 516,000 beneficiaries of old-age and survivors insurance also 
received old-age assistance in February 1956 to supplement insurance 
benefits insufficient for their basic needs or to meet special needs. They 
represented a little more than a fifth (20.4 percent) of all old-age 
assistance recipients in February 1956, as compared with -489,000 or 
19.2 percent a year earlier. The national average old-age assistance 
payment for recipients receiving both insurance and assistance pay- 
ments was less than for those receiving only old-age assistance — $44.74 
compared with $56.39. 

In addition, about 32,600 families received both benefits under the 
old-age and survivors insurance program and assistance payments 
under the aid to dependent children program in February 1956 — 5.3 
percent compared with 5.2 percent a year earlier. About 80 percent 
of these families were receiving insurance benefits based on the wage 
record of a father who had died, 17 percent on an aged retired father's 
work record, and 3 percent on the wage record of a deceased mother. 
The national average assistance payment in February to families 
receiving both types of payments was $68.98 per family compared 
with $90.75 for families receiving only assistance. The average family 
receiving both assistance and insurance benefits included more children 
than the average family receiving only assistance payments. 

Program and Administrative Developments 

The basic objective of the Bureau of Public Assistance is to assist 
the States in the development and maintenance of a sound and efficient 
public welfare service for the people of the country. This involves 
assuring that Federal public assistance grants to States are adminis- 
tered in accordance with the provisions and intent of the Social Secu- 
rity Act ; assisting States in the application of Federal requirements 
and working with them toward improving their programs ; securing 
information on a nationwide basis about progi-am operations for re- 
porting and for use in advising officials of the Department, the Con- 
gress, and others on various aspects of the public assistance programs ; 
and cooperating with national, public, and voluntary agencies and 
other organizations in planning for the development of needed welfare 
services. 

Within this framework of responsibility, special interest during 
the year was focused on planning for the strengthening of individual 
and family life through provision of financial assistance, including 



Social Security Adtninislration 47 

costs of medical care, and through needed social services directed 
toward increased capacity for self-care and self-support, and preven- 
tion of needless physical deterioration or further personal and eco- 
nomic dependency. Special attention was given also to improving 
welfare services for the aging. In addition, activities were directed 
toward advancing efficient and effective State and local administration 
of public assistance programs and strengthening Bureau administra- 
tion and facilitating services. 

STRENGTHENING OF INDIVIDUAL AND FAMILY LIFE 

While similar problems and disabilities are found among people in 
all income groups, those of needy people are often compounded by 
their inadequate financial resources. The experience of State public 
assistance agencies has shown that, although financial help is all that 
some needy people require in order to plan and live independently, for 
many others, the provision of money alone, without other types of 
help, can be expensive both in terms of dollars and cents and in human 
frustration and misery. Without additional help, some will remain 
wholly dependent on public assistance when they might be able to 
achieve improved self-care or increased self-support. Others will con- 
tinue unnecessarily in deteriorating situations which are detrimental 
and costly not only to the individuals but to the community. 

In most instances, the need for help beyond financial assistance 
grows out of the circumstances that lead people to apply for public 
assistance, and the kinds of problems they bring with them to the 
public welfare office. For example, more than two and a half million 
people who receive assistance are over age 65. These persons, almost 
half of whom are at least 75 years of age, have a high incidence of 
chronic illness, and frequently suffer from the loss of family and 
friends and from general exclusion from employment opportunities 
irrespective of their skills or physical vigor. In addition, about 
614,000 families (including 1,708,000 children under 18) are receiv- 
ing aid to dependent children because of family breakdown, or because 
one or both parents have died, disappeared, or are disabled. Another 
258,000 persons, many of them heads of families, are permanently and 
totally disabled ; about a third of these persons are under 50 years of 
age and nearly half are under 55. Approximately 106,000 persons are 
receiving assistance because they are blind ; of this number more than 
half are less than 65. 

The additional help these people need is mainly of three types. The 
first involves a review and evaluation of their situation to determine 
the extent of their financial need and the nature of other help needed : 
how much they can do for themselves, and how much they require from 
the public assistance agency or from other community resources. In 
this, the welfare agency seeks answers to such Questions as : Can a 



48 Department of Health, Educati on, and Welfare, 1956 

parent be helped to carry his parental responsibilities so that family 
life will be strengthened and the children have the opportunity for 
healthy growth and development? Can the physical disability which 
occasioned financial need be cured or alleviated with adequate medical 
care? Can vocational training be provided to develop new skills? 
What resources are available for improved housing ? Can the aid of 
friends and relatives be enlisted to provide care at home so that an 
old person need not go to an institution ? 

The second type of help needed is assistance in locating and using 
other available resources suited to the applicant's needs. Some may be 
found in community programs or facilities and others in the person's 
own circumstances. 

The third major type of help needed is with emotional problems. 
Some people cannot make effective use of either money or other re- 
sources until they receive help in dealing with problems that have 
prevented them from using the personal and community resources 
available to them. These are often the people whose behavior both 
occasions the most community concern and requires the most skillful 
help. Frequently these problems are particularly destructive to 
family life and to the normal growth and development of the children. 
The extent to which public welfare agencies can provide the help 
needed will depend largely on the extent to which they have qualified 
social work staff, and on the availability of services from mental 
health clinics and other psychiatric and casework services in the 
community. 

Public assistance laws of most States provide statutory assumption 
of responsibility for both financial assistance and accompanying social 
services, and many State welfare programs include the provision for 
some services to public assistance applicants and recipients. The 
Bureau has long held that the availability of welfare services to 
needy neople is essential to the achievement of the purposes of the 
public assistance programs and, therefore, to their proper and efficient 
administration. The public assistance amendments of 1956 relating 
to strengthening family life, self-support, and self -care clearly indi- 
cate Federal support of the State's efforts to make available the help 
people need to achieve the maximum independence of which they are 
capable. 

In furthering this objective, work is under way within the Bureau 
on clarifying the scope and content of the social services needed by 
persons seeking or receiving public assistance, the role of the public 
welfare agency in providing these services, and criteria for Federal 
financial participation in the State's costs of such services. For ex- 
ample, interpretative materials are being developed on social services 
for the aging, including counseling, environmental adjustment, pro- 



Social Security Administration 49 

tective services, and services leading toward increased self-care. 
Effort is also being made to clarify policy and standards in relation to 
the use of homemaker services. 

Much of this work involves the participation of other agencies. For 
example, the Bureau is working with the Children's Bureau in the 
further development of homemaker services for the needy aged and 
families with children, as well as in the maximum use of both the aid 
to dependent children and the child welfare services programs in 
providing other services for needy children. In the latter, the docu- 
ment on services in the aid to dependent children program, prepared 
jointly by the Bureau of Public Assistance and the Children's Bureau, 
was discussed at several joint regional meetings held during the year; 
the progress made by States in implementing the concepts in this 
document is being evaluated. 

The continuing emphasis on the need for a wide range of welfare 
services has pointed up the necessity for adequately qualified social 
work staff. The 1956 amendment authorizing the use of Federal funds 
to assist States in meeting the cost of training personnel for public 
assistance programs will undoubtedly increase the number of ade- 
quately qualified persons available for work in public assistance 
agencies. Increasing emphasis is also being placed on the role that 
volunteers can play in extending and strengthening public welfare 
services. To encourage this participation, a new publication, "Citizen 
Participation in Public Welfare Programs, Supplementary Services 
by Volunteers," discusses the purposes of supplementary services and 
offers suggestions for developing volunteer services and for the orien- 
tation, training and supervision of volunteers. 

IMPROVING WELFARE SERVICES FOR THE AGING 

The federally aided public assistance programs are an important 
income-maintenance and social service resource of the Nation's aging 
population. About a sixth of the aged (65 years of age and over) are 
currently receiving old-age assistance. Other public assistance pro- 
grams include a large number of persons in the 55-65 age range ; nearly 
half the recipients of aid to the blind are 65 or over, most of the 
recipients of aid to the disabled are in late middle life — approximately 
a third of them at least 60 years of age — and in 7 percent of the 
families receiving assistance under the aid to dependent children pro- 
gram a grandparent is the relative caring for the child. 

Old-age assistance is available to the needy aged through State or 
local departments of public welfare in every community in the United 
States and the Territories. This program also presents significant 
pioneering opportunities in providing other needed social services, 
since the majority of the needy aged live in small communities or rural 



50 Department of Health, Education, and Welfare, 1956 

areas where almost no other organized community welfare services are 
available. 

Increasing attention and activity are being directed toward meeting 
needs of the aging at Federal, State, and local levels. 

At the national level. — The Bureau has been working with other 
Federal agencies in planning for and stimulating the development of 
needed services for the aging. It has been participating in planning 
and in joint activities carried on by a variety of national voluntary 
organizations such as the Family Service Association of America, the 
American Public Welfare Association's Committees on Aging and 
Medical Care, and the National Social Welfare Assembly's Committee 
on Aging, as well as by sectarian groups and national professional 
social work organizations. 

The Bureau also has been developing technical materials relating 
to aging. For example, material on homemaker services, with specific 
emphasis on its use for aged persons who are sick, is being prepared 
with the help and advice of other public and voluntary agencies to 
assist States in developing this important home-care resource. Con- 
sideration is being given also to other services involved in helping 
aged persons remain in their homes. For example, the possibility 
of the broader use of surplus commodities for "meals on wheels" is 
being explored jointly by the Bureau and the Department of 
Agriculture. 

Attention is being directed also to the problems of some aged persons 
requiring protection because of varying degrees of difficulty in han- 
dling their own affairs. An interbureau committee on guardianship 
within the Social Security Administration studied problems of guard- 
ianship in both the public assistance and old-age and survivors 
insurance programs. In addition, the Bureau gave special attention 
to State practice in helping aged persons secure the kind of protection 
needed, and explored difficulties experienced by States in the use of 
guardianship procedures. Also, representatives of 11 State public 
assistance agencies at a meeting in April shared their experience in 
operating under the money payment provisions of the Social Security 
Act in relation to aged persons of marginal competency. The discus- 
sion focused on effective methods of handling problems of individuals 
needing social and legal protection, and on identification of areas 
requiring further attention. 

Work undertaken or under consideration in other subject areas 
having implications for serving the aging include: developing in- 
terpretative materials on social services for the aging; helping State 
mental health services and public welfare departments expand and 
improve their teamwork in arranging for those no longer in need of 
institutional care to return to the community ; determining the types 
of institutional care needed by individual aged persons and the amount 



Social Security Administration 51 

of public assistance to be paid for such care; and exploring ways in 
which public assistance agencies can help toward the improvement 
and extension of institutional facilities under public, voluntary, and 
proprietary auspices. The report issued by the Bureau in June 1955 
on "Kecipients of Old-Age Assistance in Early 1953," containing State 
data on the social, economic, and liealth characteristics of the needy 
aged, has been used by both Federal and State agencies in legislative 
and program planning. Additional materials are being prepared on 
specific aspects of these data which describe the personal character- 
istics of recipients, the total costs of their requirements, the amount 
and types of their resources, and the responsibility that adult children 
are carrying in providing support for their aged needy parents. 

At the State and local level. — Many State and local public welfare 
agencies also are planning for and, in most instances, are providing 
some services to enable the needy aging to remain in their own homes 
as long as their health permits. For example, efforts are being made 
to provide various home-care services, such as homemaker seirvices for 
older people living alone. Some local public welfare agencies also 
provide the aging and their relatives with counseling services directed 
toward helping them with problems of social adjustment and intra- 
family relationships. In some instances, where appropriate, referral 
is made to voluntary family service counseling agencies or other com- 
munity resources for additional help in working out these and other 
problems around health, employment, living arrangements, recreation, 
and housing. In some communities, volunteers provide supplementary 
services, such as assisting the aging in participating in community 
recreational and creative activities. 

Several States are making substitute family arrangements such as 
foster home care for those aged who though no longer able to main- 
tain their own homes, do not yet require institutional care; also for 
those who are well enough to be released from mental hospitals or 
other institutions but who have no source of support and no families 
or homes to return to. There has also been increased cooperative 
planning with institutional facilities in helping older persons return 
from sheltered care as soon as possible. An example of this is the 
North Carolina State agency's special unit providing services for the 
aged ; it is preparing some persons for return to normal life outside 
the institution, and is working through local welfare offices to choose 
the community placement best suited to the needs and interests of 
the aged individual. Between 1952 and 1954 about 500 patients were 
released from State mental hospitals and placed in private living- 
arrangements, with prospects of continuing success in the placement. 
State mental health programs, too, are beginning to give special atten- 
tion to the needs of older persons for a range of community services 



52 Department of Health, Education, and Welfare, 1956 

including alternatives to placement of nonpsychotic patients in State 
hospitals. 

Many public welfare agencies are becoming the focal point for social 
services for other aged persons in addition to the needy. For example, 
some State departments of public welfare are providing social services 
to the non-needy person, and others are providing leadership in or- 
ganizing State commissions to do broad planning for all older people. 
There is also increasing public welfare representation on State and 
local commissions for the aging, community welfare councils and study 
groups. These place major emphasis on the aging by enlisting citizen 
participation, developing programs and services needed, and coordi- 
nating the activities of public and voluntary agencies. Many citizen 
boards of State and local public welfare departments are taking in- 
creasing interest in community planning for the aging, and are in- 
terpreting the needs of the group to State legislators and to others 
in the community. 

ADVANCING EFFICIENT ADMINISTRATION OF PUBLIC ASSISTANCE 
PROGRAMS 

Regional and departmental staffs have been working together in 
advancing more efficient and effective administration of public assist- 
ance programs at Federal, State, and local levels. Much of this is 
done through providing technical assistance and consultation on re- 
quest to the States, through continuing review of State and local 
administration and special study of various aspects of the program, 
and by assisting States in strengthening the administrative under- 
structure of their public assistance programs. 

For example, the Bureau provided consultation to 9 States on vari- 
ous aspects of the aid to the permanently and totally disabled program, 
to 11 States on specific phases of medical care, to 7 States on need 
and standards of assistance, and to several additional States in other 
areas such as welfare services, incapacity, disability, and legislative 
j)lanning. Consultation was also provided to 14 States on various 
aspects of staff development and training, such as the planning for 
long-term staff development in anticipation of the 1956 amendments 
to the Social Security Act relating to public assistance, the initiation 
of Statewide staff development plans, and the strengthening of the 
skills of the field representative and other supervisory positions. The 
increasing recognition by States of the significance of staff training 
in improving the quality of services to public assistance recipients was 
reflected in more requests for consultation in this area than could be 
met because of limitations on staff time. Numerous requests were also 
received for participation of Bureau consultants in national and State 
social welfare conferences and other types of professional meetings. 



Social Security Administration 53 

In addition to the help given to States with specific problems in 
program areas, much of which is revealed through the continuing 
review of State and local administration and study of specific program 
areas, a variety of steps were also taken to assist States in the study 
and control of the cost and efficiency of their administration. For 
example, at the request of State agencies, the Bureau conducted sur- 
veys in 10 States designed to provide a basis for improving organiza- 
tion, streamlining procedures, and using staff and administrative ex- 
penditures more efficiently. Following the conference on adminis- 
trative management of large urban agencies, held in Washington in 
June 1955, attention was given to problems arising in large local of- 
fices, such as State direction and supervision of large local agencies 
and the proper size of caseloads and workloads. Work is being done 
also on the analysis of administrative costs of public assistance, in- 
cluding the costs of certain broad functions in State and local agencies. 

Developmental work is continuing on the application of principles 
of statistical quality-quantity control in public assistance administra- 
tion. During the year, materials developed cooperatively by the 
Bureau and the State of Maine were presented at several regional 
meetings and at the national round-table meeting of the American 
Public Welfare iVssociation. In addition, with case recording consti- 
tuting a major and time-consuming function of local agency visitor 
staff, a Bureau committee is developing criteria and principles to guide 
States in more efficient and effective performance in this area. 

Pertinent experience of some State and local agencies in specific 
areas of staff development and administrative and fiscal management 
was made available for the use of other States through publication of 
certain of their materials. Among the reports processed for distribu- 
tion were Washington's material describing methods developed for 
induction and training of social service supervisors; Missouri's ex- 
perience in identifying staff training needs as the basis for Statewide 
planning for group meetings as a part of the on-going training pro- 
gram; California's guide for analyzing a staff training program 
within the day-by-day function of the agency ; and the experience of 
Louisiana, Missouri, Pennsylvania, and Washington in establishing 
caseload standards in local offices. The Bureau also issued a kit con- 
taining materials on the preparation of manuals and other written 
instructions for staff use. 

Work also continued in other areas in developing solutions to new 
complexities or in identifying constructive approaches to some older 
problems. For example, a "new look" was taken at some of the 
component elements of Federal- State relations, including the State 
plan, and the administrative review of State and local public assist- 
ance administration. Consideration was given to the program devel- 
opment role of the Bureau, including the establishment of a research 



54 Department of Health, Education, and Welfare, 1956 

development coinniittee to provide a continuing mechanism for con- 
sideration and evaluation of proposals for research in relation to the 
development and appraisal of program policies. Effort was made to 
devise methods for reducing Bureau work in assuring that Federal 
i-equirements for plan and practice are being met. A program of 
manpower utilization audits was initiated to aid in assuring that the 
Bureau's activities are being administered as efficiently and econom- 
ically as possible, and plans were made for the General Accounting 
Office to begin a comprehensive audit of Bureau operations. Many of 
the recommendations growing out of earlier consideration of questions 
raised about Federal requirements and the streamlining of operations 
resulting from the decentralization of certain functions to the regional 
offices Avere implemented in whole or in part. In an effort to further 
improve Bureau administration, a series of study sessions was held 
with an expert in this area. 

Several ad hoc committees of State and regional staff and other 
persons met with the Bureau during the year to advise on specific 
subject areas, for example, with a selected group of State people to 
discuss ways of dealing with the problems that arise in making money 
payments to aged persons who have difficulty in managing their affairs, 
and securing qualified and interested guardians where this appears 
necessary ; with the national family service agency in a series of meet- 
ings to discuss common interests in the development of social welfare 
services for public assistance recipients ; with selected physicians and 
State agency staff to consider the medical and social needs of the dis- 
abled, especially the group termed "completely helpless" under the 
State's progi-am ; and with State public welfare staff and representa- 
tives of voluntary agencies to consider proposals for changes in public 
assistance legislation. 

Bureau staff have also been working with the Council on Social 
"Work Education on the planning of curriculum in public social serv- 
ices; on the development of knowledges, skills, and attitudes needed 
by those administering the public assistance programs ; on the develop- 
ment of teaching materials and criteria for teaching grants and 
traineeships ; and on devising ways of strengthening recruitment to 
the field of social work. Similarly, medical social workers and assist- 
ance standards specialists in the Bureau have been working with the 
American Public Welfare Association on provisions for medical care 
services and adequate housing for the needy. 

In addition, the first meeting of the regional public assistance techni- 
cians was held in Washington in January to consider needed changes 
in technical materials for use in the administrative review and the 
development of materials on case recording. Also, the first national 
meeting since the late thirties of State research and statistics personnel 
was held in March to discuss the functions of research and statistics 



Social Security Administruliun 



units in State public assistance agencies. An interim committee was 
established with representation from each region to plan future meet- 
ings. The first meeting of State welfare department consultants on 
standards of assistance was also held in July ; these are home econo- 
mists who work on the formulation and pricing of items, such as food, 
clothing, fuel, and utilities, which make up the standard by which need 
is determined. 

Other publications issued during the year include : a preliminary 
release of data obtained from the recent study of support given by 
absent fathers to children receiving aid to dependent children ; a trend 
report consisting of a graphic presentation of data reflecting the im- 
pact on the assistance programs of social, economic, and legislative 
factors during varying periods in the past 20 years (a similar chart 
book will be issued in October of each year) ; a pamphlet describing the 
public assistance programs and explaining in general terms the respon- 
sibilities of the Federal agency and State governments under the public 
assistance titles of the Social Security Act; and a reissue of the earlier 
publications on the characteristics of State public assistance plans, 
and the characteristics of staff development provisions in State public 
assistance plans. 

DEFENSE WELFARE SERVICES 

In advancing the delegated defense welfare programs of emergency 
financial assistance and emergency clothing, the Bureau pursued the 
objective of preparedness for a civil defense emergency built into the 
Nation's established public welfare organization — Federal, State, and 
local. Thus, the experience and skill in helping people, in administra- 
tion, and in organization of community resources, which have de- 
veloped in public welfare programs, can be made immediately available 
and effective in a time of national emergency. 

To clarify the broad, general terms of the welfare delegations, a 
memorandum of understanding was signed by the Secretary of Health, 
Education, and Welfare and the Administrator of Federal Civil De- 
fense, specifying the nature and scope of the delegated program, the 
extent of authority delegated, and the basic operating and fiscal prin- 
ciples applicable to the two programs. "Emergency financial assist- 
ance" is defined as assistance in cash or in kind, including essential 
services, and "emergency clothing" as distribution in kind. The 
Federal responsibility in providing emergency financial assistance 
and clothing will be met with 100 percent Federal funds. Delegated 
responsibilities will be discharged through established State agencies 
administering public assistance. 

In March 1956, an "Interim Statement on Emergency Financial 
Assistance and Emergency Clothing" was issued to State public assist- 
ance agencies. This material is being incorporated into a manual for 



56 Department of Health, Education, and Welfare, 1956 

Federal, State, and local use in planning, organizing, and developing 
the programs, in test exercises and training activities, and in civil 
defense emergencies. Negotiations have been in process to formalize 
through written agreements the relationship between State agencies 
and the Social Security Administration in the planning, organization, 
and operation of the delegated welfare programs. Florida was the 
first State to take formal action to enter into such an agreement, and 
Connecticut and Montana next. By the end of June, 16 States had 
signed agreements ; by August the total had risen to 27. These agree- 
ments have the concurrence of the State civil defense directors and, 
in some instances, of State governors. 

The interest and participation of various groups and organizations 
have been maintained in a nmnber of ways. A regional meeting was 
held in Dallas in June with representatives of State w^elfare depart- 
ments and of Federal and State civil defense organizations. National 
private welfare agencies have been consulted regarding their part in 
the programs, and plans are under way to establish an advisory com- 
mittee in that area. Two meetings were held with clothing industry 
representatives and clothing specialists in other Government depart- 
ments and private organizations to consider the most eflS.cient and 
effective means of meeting clothing needs in a civil defense emergency. 
State and local public welfare administrators and defense welfare staff 
in 22 States met in June to take stock of developments to date and to 
advise the Bureau regarding the future course of defense welfare 
planning. 

A substantial amount of instructional material was prepared for 
Operation Alert, including a formula for estimating clothing re- 
sources. This formula was supplied to FCDA for application in the 
Milwaukee survival project. A field test of the formula has been 
arranged for fiscal 1957. 

The delegated responsibilities are being integrated into the total 
Bureau operation through use, as needed, of Bureau technical and 
administrative resources, through participation of staff from all divi- 
sions in Operation Alert, and through increased responsibility of the 
Defense Welfare Services unit in planning for continuity of regular 
assistance programs in a civil defense emergency. 

Children's Bureau 

Under the Act of Congress of 1912 which created it, the Children's 
Bureau is charged to investigate and report "upon all matters pertain- 
ing to the welfare of children and child life among all classes of our 
people." Under Title V of the Social Security Act of 1935, as 
amended, the Children's Bureau is delegated the additional responsi- 



Social Security Administration 57 

bility of assisting States in extending and improving their services for 
promoting the health and welfare of children, especially in rural areas 
and in areas of special need, through the administration of grants to 
State agencies. 

Throughout its 44 years the Children's Bureau has been concerned 
with improving the conditions of life for sick and well children. Its 
efforts in this direction were continued during 1956 through its own 
studies and reports, and through the technical consultation it pro- 
vides, on request, to public and private agencies and organizations 
serving children. 

Some Facts and Figures About Child Life 

The estimated number of live births in 1955 approached 4.1 million, 
reaching a new all-time high. The birth rate, 24.9 per 1,000 total 
population, is close to the highest in the last 30 years. 

The U. S. child population under 18 years increased from 47 million 
in 1950 to about 56 million in 1955, an 18-percent rise. Between 1955 
and 1965, the number of children under 18 years is expected to rise 
by 21 percent to a total of 67 million in 1965. In this period, the 10 
to 17 year olds will increase by about 48 percent, as the large number 
of children born in the late 1940's and early 1950's enter this age group. 
In 1952, 42 percent of the children under 18 in the United States were 
living in rural areas. 

The infant mortality rate for 1955 was 26.5 per 1,000 live births, the 
lowest so far recorded. Many of the States continue to show marked 
deviations from the national average. 

About 310,000 infants were prematurely born in 1955. Fifty-nine 
percent of neonatal deaths and 43 percent of infant deaths in 1954 
were reported as associated with prematurity. In 1954, almost 4 per- 
cent of reported pregnancies which reached 20 weeks or more of gesta- 
tion resulted in a still-born infant or death in the neonatal period. 

The maternal mortality rate in 1955 was the lowest ever recorded, 
4.8 maternal deaths per 10,000 live births. Maternal mortality has 
declined without interruption since 1929 when the rate was 69,5 per 
10,000. In 1954, over 139,000 births occurred among mothers who 
were delivered without a physician in attendance. Nineteen percent 
of births to mothers in the nonwhite group and 7 percent of births to 
mothers resident outside of metropolitan counties had no medical 
attendant at delivery. 

In 1954 accidents took the lives of 16,189 children in the age group 1 
to 19 years and accounted for 38.6 percent of the mortality of this 
age group. Mortality due to accidents was highest in the age group 
15 to 19 years, with 49.9 fatal accidents per 100,000 children. Cancer 

408691—57 5 



58 Department of Health, Education, and Welfare, 1956 

has become the leading cause of death due to disease among children 
5 to 19 years of age (6.7 deaths per 100,000 children 5 to 14 years; 
7.6 per 100,000 children 15 to 19 years) . Next in importance among 
all fatal diseases are those of the heart and acute rheumatic fever 
among children 15 to 19 years (5.1 per 100,000) ; congenital malforma- 
tions in cliildren 5 to 14 years (2.7 per 100,000) ; and influenza and 
pneumonia in the preschool group (16.1 per 100,000) . 

Large families continue to carry a disproportionate share of the 
responsibility for rearing the Nation's children. Families with 3 
or more children under 18 years of age constituted only 18 percent of 
all families but they had 54 percent of the country's children. Fami- 
lies with 4 or more children constituted only 8 percent of all families 
but they had 29 percent of the comitry's children. 

Families with large numbers of children have lower than average 
incomes. As compared with the national average family income of 
$4,173 in 1954, families with 4 children had an average income of 
$3,949 ; families with 5 children, ^3,155 ; and families with 6 or more 
children, $3,252. 

In 1954 about 2.7 million children under 18 years, or 1 in 20 of the 
Nation's children, had lost one or Ijotli parents by death. This repre- 
sents a sharp drop from the number of orphans in the country in 1920 
\vhen there were 6.5 million orphaned children, or 1 in 6 children, in 
the population. The decline in tlie number of full orphans has been 
particularly striking, from 750,000 in 1920 to about 60,000 in 1954. 

An estimated 176,600 children were born out of wedlock during 
1954 (62,700 white; 113,900 nonwhite). This number was about 10 
percent more than the estimated 160,800 children born out of wedlock 
during 1953. There were 71,100 unmarried mothers under 20 years 
of age, 40 percent of the total number. In 1954, of every 1,000 unmar- 
ried women between 15 and 44 years, 18.3 gave birth to a child out of 
wedlock. This rate was more than double that of the 1940 rate of 
7.1 per 1,000 unmarried women. 

The 1.5 million marriages in 1955 represented a 3 percent increase 
over 1954. Preliminary figures indicate that divorces were 1.6 per- 
cent lower in 1955 than the 379,000 divorces in 1954. About one-third 
of a million children have their families broken by divorce each year. 

In 1955, 61/^ million mothers with children under 18 years were 
in the labor force. This represented more than one out of every 4 
mothers in the population ; in 1940 one out of 10 mothers was in the 
labor force. 

Police arrest data reported by the FBI in its Uniform Crime 
Eeports for 1,162 cities show that the arrests of juveniles (under 18) 
increased 11.4 percent in 1955 over 1954. In 1955, juveniles repre- 
sented 62.2 percent of all persons arrested for auto theft; 52.7 percent 
for burglaries; 46.9 percent for larcenies. Data for 1955 indicate a 



Social Security Administratioti 59 

9-percent increase in juvenile delinquency court cases over 1954 — the 
seventh consecutive year of increase. The overall increase since 1948, 
when the rise first began, was 70 percent, while the overall increase in 
the child population, aged 10 through 17, was only 16 percent over 
that same period of time. In 1955, roughly one-half million children 
or about 2l^ percent are estimated to have been involved in court 
delinquency cases out of a total of about 20 million children in this age 
group. 

Children With Special Needs 

The problem of certain groups of children call for special attention. 
Among these are the adolescent in conflict with society, the children 
of migratory workers, mentally retarded children, and children in 
unprotected adoptions. 

The Nation as a whole is concerned about juvenile delinquency be- 
cause of its tragic consequences for tlie individual young person, its 
contagion among youth, and its social and economic costs for the com- 
munity. The Children's Bureau is giving particular attention to the 
problems of delinquent children through the coordinated programs of 
the Division of Juvenile Delinquency Service and the Divisions of 
Social and Health Services and the activities of the Division of 
Research. 

For the country as a whole, it has been estimated that there are 
at least 320,000 children of migrant agricultural workers. The Chil- 
dren's Bureau, working with the Office of Education, the Public 
Health Service and the Bureau of Public Assistance, continued to 
carry out a pilot project along the East Coast to assist the 10 States 
in the East Coast migrant stream to do interstate planning for serv- 
ices to migrants so that each State can more easily perform its share 
of the total job. In the health programs it has been possible to make 
special grants for demonstration projects. Florida, with such a 
grant, provided a qualified observer to move with a group of families 
up the East Coast migrant stream, and during the year developed 
plans for a service project in the area where a great many migrant 
families live. Colorado will start its third year of a special project 
which now includes 3 counties, and Idaho has a joint project with 
Oregon for a group of migi-ants in a very rural area. 

The exact number of mentally retarded children is not know-n but 
it is estimated that about 1 person in 100 is mentally defective and 
that about 750,000 children of school age are of low intelligence. As 
the birth rate goes up the number of such children increases. At 
the same time the growing complexity of our society makes their 
social and vocational adjustment ever more difficult. Parents, doc- 
tors, nurses, educators, and social workers are increasingly concerned 



60 Department of Health, Education, and Welfare, 1956 

about the health and welfare of these children. The Children's 
Bureau is placing special emphasis upon health, child welfare, and 
research programs related to mentally retarded children. 

For many years the Children's Bureau has worked with the States 
m their efforts to improve services to unmarried mothers and services 
for the placement of children, including adoptive placement. Be- 
cause of the seriousness of the situation in unprotected adoptions the 
Bureau is seeking advice from legal, medical, social work, and other 
professional groups, from adoptive parents and law enforcement 
agencies. Conferences with professional groups were begun in 1955 
and the work was more fully developed in 1956. 

Federal Interdepartmental Committee on Children 
and Youth 

The Congress places responsibility upon a number of the agencies 
of the U. S. Government for programs which contribute in varying 
degrees to the social well-being of children and youth. In 1948 the 
President requested these agencies to form an Interdepartmental 
Committee on Children and Youth to assist each other in keeping 
informed about program developments, to work together for greater 
effectiveness in program planning, and to strengthen working rela- 
tionships between the Federal Government and the States. This 
triple assignment has been carried out during fiscal 1956 by the 
regular monthly meetings of the full Committee, the work of its 
subcommittees, and an informational exchange with the State and 
Territorial Committees on Children and Youth. Thirty-two Fed- 
eral agencies are represented on the Committee which meets monthly 
from September to June. The Children's Bureau furnishes the secre- 
tariat for the Interdepartmental Committee on Children and Youth. 

The Interdepartmental Committee was a cosponsor of the Joint 
Conference on Children and Youth held in Washington, D. C, in 
December 1955 at which 200 representatives of State, national volun- 
tary, and Federal agencies jjarticipated. The theme of the confer- 
ence was "A Look Ahead for Children and Youth." 

In February, 1956, the Interdepartmental Committee, together 
with the Josiah Macy, Jr. Foundation, held a 3-day conference at 
Princeton, N, J., to discuss new directions in community planning 
for mentally retarded children. 

Programs of the Bureau 

RESEARCH IN CHILD LIFE 

The Bureau's small research staff' is helping to carry out the legis- 
lative mandate "to investigate and report upon all matters pertain- 



Social Security Administration 61 

ing to the welfare of children." Program research on disadvantaged 
children is being emphasized for the time being. In addition to its 
own studies and those conducted jointly with others, the Bureau 
has sought to stimulate research in child life by other agencies, by 
formulating the questions requiring study and developing research 
methods, and has assisted agencies engaged in such research. 

Study subjects in technical research included development of a 
method for determining unit costs in child placement, and in insti- 
tutional care of children; methods and findings of evaluative re- 
search as exemplified by studies of psychotherapy, delinquency preven- 
tion and treatment programs and school health services. Two 
cooperative field studies were launched to examine respectively the 
outcome of independent adoptions and the reasons why the natural 
mother may choose to place her child on her own, rather than through 
a social agency. Work continued on assembling information about 
programs and services for mentally retarded children. Improvement 
in hospital statistics about maternity and newborn infant care was 
stressed in the development of a joint reseai-ch study of the American 
College of Obstetricians and Gynecologists, the American Academy 
of Pediatrics and the Children's Bureau on "I'ses of Statistics on 
Maternity and Newborn Infant Services in Hospitals." 

Throughout the country juvenile delinquency was being studied 
from both psychological and sociological perspectives — the former 
focusing primarily on the inner personality dynamics of individual 
children, the latter directing attention to the effects of situational 
or environmental social and cultural factors. In an attempt to bridge 
the gap between these two approaches, the Bureau held a conference 
of experts from both fields, and is planning additional conferences. 
A report of this first conference for use by research w^orkers has been 
prepared. 

Bureau staff aided officials of Senate health departments with the 
installation of a new report on maternal and child health services. 
Reports from State welfare agencies now provide an undisputed 
count of the number of children receiving public child welfare case- 
work services annually. Data were collected during 1956 about the 
use of educational leave in the public child welfare programs and 
about the professional training of State and local child welfare staff. 
A reporting system to provide more accurate national statistics on 
juvenile court cases has been established, and one has been developed 
to provide annual data from public training schools for delinquents. 

During the year annual reports from the State crippled children's 
agencies were used as the basis for a series of tables showing trends 
in the programs since 1948. 

As part of its research interpretation activities, the Bureau sent to 
press a completely rewritten edition of Your' Child Froin One to Six. 



62 Department of Health, Education, and Welfare, 1956 

A last supplement of Research Relating to Children was issued in ac- 
cordance with the original plan of coverage and a first issue under a 
new plan was prepared for publication. This series is an inventory 
of current research to help investigators in the field of cliild life keep 
informed about studies being conducted in their areas of special 
interest. 

The research staff provided technical consultation requested by 
State health departments on studies in areas such as evaluation of 
child health conferences, health records for migrants, maternal and 
infant mortality, pregnancy, hospital care of premature infants, use 
of vital records, and fetal and neonatal wastage. State welfare de- 
jmrtments and voluntary organizations were assisted in studies on 
such problems as unit costs in child placement, independent adoptions 
of children, delinquency prevention, child-rearing practices, training 
school staff development, institutional care, research needs, and pro- 
gram evaluation. 

MATERNAL AND CHILD HEALTH SERVICES 

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

The ongoing programs of the State maternal and child health 
agencies continue to make a major contribution to the health of the 
Xation. Preliminary figures from State maternal and child health 
reports show that about 200,000 expectant mothers received health 
supervision at prenatal clinics in 1955. Public health nurses served 
some 250,000 mothers before delivery and about 300,000 in the period 
after delivery. The number of mothers served did not vary greatly 
from the previous year. 

Nearly half a million infants and close to 600,000 preschool children 
received health supervision through well-child clinics. In addition, 
health department programs provided nursing service for almost 
700,000 infants and about the same number of preschool children, in 
both instances somewhat less than in 1954. 

Almost 2,000,000 children were vaccinated for smallpox and a 
slightly larger number were immmiized for diphtheria by State and 
local health departments through grants provided by the maternal 
and child health programs. 

The following publications relating to maternal and child health 
were prepared or issued during the year : The Child Who Is Mentally 
Retarded/ Sei'^ioes for Crippled Children ; and Ding-i^o^e^ of Children 
in Crippled Children's Programs. 

To better prepare personnel for maternal and child health pro- 
grams a number of States carried out institutes and special training 
projects. A postgraduate conference on hospital care of the new- 



Social Security Administration 6S 

born infants, sponsored by the University of Colorado School of 
Medicine and the Mid-Westem Hospital Association, and planned 
especially for hospital personnel, was held in Denver in the early 
summer of 1956. The conference dealt with all aspects of medical, 
nursing and administrative practices related to the improved care 
of newborn infants. 

The Harvard School of Public Health and the Massachusetts De- 
partment of Public Health conducted an institute on the growth 
and development of children for nurses concerned with the care of 
handicapped children. A selected gi-oup of nurses from faculties 
of universities, schools of nursing, hospitals and State crippled chil- 
dren agencies was invited to attend 2 weeks of lectures, seminars, and 
related field work. Plans were made for developing more compre- 
hensive and effective staff education programs in the different regions 
of the country, and during the year such regional meetings were held 
at the University of Pittsburgh, at Vanderbilt University, and in 
Wyoming. 

Because of the increased interest in the care of the mentally re- 
tarded child, workshops on community programs for these children 
were conducted in Washington State, Denver, and Los Angeles. 
These workshops involved professional personnel in health and wel- 
fare departments as well as personnel in other community agencies 
that contribute to the care of the mentally retarded child. 

During the year a conference of medical social personnel in all 
of the four medical social ^v()rk education projects supported by ma- 
ternal and child health and crippled children's fimds was held. This 
meeting was planned in response to requests from the medical social 
workers, deans of schools of social work, aiul State agencies involved 
in the projects who washed to consider together mutually interesting 
problems and to plan for the future. This conference resulted in 
recommendations that the Children's Bureau give leadership in col- 
lecting and analyzing material to be supplied by the participants in 
order to determine what public health content should be taught in 
schools of social work and what methods might best be used. 

The conference on nutrition called by the Governor of New Jersey 
during the spring of 1956 dealt with problems relating to the nu- 
trition of specific age groups and the role of various institutions in 
the community in solving these problems. 

A multidiscipline workshop on consultation in Puerto Rico was the 
culmination of over a year of joint planning efforts. The Assistant 
Professor of Nursing Education of Teachers College, Columbia Uni- 
versity, and the Chief of the Nursing Section of the Children's Bu- 
reau, Division of Health Services, participated. Sixty-six profes- 
sional health workers in Puerto Rico attended the workshop, and 



64 Department of Health, Education, and Welfare, 1956 

among the participants were physicians, nurses, medical social work- 
ers, health educators, nutritionists, and persomiel representatives. 

The University of Michigan and the University of Minnesota 
Schools of Public Health expanded their maternal and child health 
divisions to enable them to give more specialized training in maternal 
and child health as well as to strengthen the maternal and child health 
aspects of the generalized public health training in these schools, 

A renewed interest in the prevention not only of perinatal deaths 
but of damaged infants has developed, and a number of States, in- 
cluding Georgia, Kansas, and North Carolina, are carrying on peri- 
natal mortality studies. 

As an indication of continued interest in the care of the premature 
infant, the Illinois Legislature appropriated $390,000 for last fiscal 
year for the care of premature infants. As a result of this appropria- 
tion additional centers for tlie care of premature infants have been 
established in the State. Additional centers for care of premature in- 
fants and training of physicians and nurses were established during 
the year in Indiana, New York, and Ohio. The Premature Institute 
Program conducted by the Cornell-New York Medical Center con- 
tinues to prove a popular and needed training opportunity for both 
physicians and nurses. 

There is an increasing awareness of the emotional aspects of hospi- 
talization of young children, and in a number of hospitals in the 
country more liberal arrangements have been made for parents to 
visit their children, for mothers to share in the care of their children 
with the nurses, and for the earlier discharge of children from the 
hospital. 

A survey of school health services in New York City is being con- 
ducted under the aegis of the New York City Health and Welfare 
Council in cooperation with the Department of Education, the De- 
partment of Health, and the parochial school systems. Workshops on 
the health problems of the school-age child were held in Kansas, 
Minnesota, and Missouri during the year. 

Helping translate research findings into improved practices for the 
benefit of mothers and children is an important function of the 
maternal and child health services. States have been active in meas- 
ures designed to prevent retrolental fibroplasia, especially since Janu- 
ary 1955, when a cooperative study by 18 hospitals showed that a major 
cause of retrolental fibroplasia was the exposure of premature in- 
fants to too high a concentration of oxygen. What States can ac- 
complish is illustrated by the experience in New York, where in 1949 
retrolental fibroplasia was the leading cause of blindness in children 
under five. Between 1953 and 1955, there was a 94-percent decrease 
in blindness from retrolental fibroplasia; in 1955 only 3 cases of 



Social Security Administration 65 

blindness from this cause were reported from New York State and 
New York City. 

An area of expanded activity in maternal and child health services 
includes provisions for Indian children. During the year State 
maternal and child health programs developed a number of coopera- 
tive relationships with the Indian Health Service. 

CRIPPLED CHILDREN'S SERVICES 

All of the 53 States and Territories, with the exception of Arizona, 
are participating in the crippled children's program. Though the 
State agency auspices vary, the objective is uniform, namely : to lo- 
cate children who require care, and to provide the means of physical 
restoration through diagnosis, medical and surgical treatment, and 
alleviation of unfavorable social and psychological influences which 
adversely affect the degree and duration of the disability. 

Preliminary figures from State reports indicate that a new peak 
was reached in 1955 in the number of handicapped children served 
under Federally aided programs. Some 278,000 children were cared 
for during the year. Most of the children (221,000) were seen in 
clinics; about 53,000 received physician's services through home or 
office visits. Children who were hospitalized numbered approxi- 
mately 48,000. Convalescent-home care was given to the smallest 
group, around 3,800. 

The Congress increased the appropriation for crippled children's 
services to the full authorization of $15 million during this fiscal year. 
This has enabled the State agencies not only to provide care for more 
children with diagnostic conditions already included in the program 
but to include more kinds of handicapping conditions and to experi- 
ment with new types of services. Following the increase in the appro- 
priation for crippled children's services, the Children's Bureau con- 
ducted a series of regional meetings to discuss a wide range of handi- 
capping conditions that might be included in the program and to give 
the States an opportunity to exchange program ideas. 

During the year Colorado, Pennsylvania, and West Virginia initi- 
ated services for the epileptic child. The Massachusetts Health De- 
partment and the Harvard Medical School presented a 1-day institute 
on epilepsy which focused attention on the integration of medical, 
social, economic, and emotional components in the patient's situation 
and which clarified some of the community aspects of the care of 
children with epilepsy. 

Several States, including Connecticut, Mississippi, North Carolina, 
and Tennessee, expanded their crippled children's programs to in- 
clude care of children with heart disease. A new regional congenital 
heart center was established at the University of Minnesota to provide 



66 Department of Health, Education, and Welfare, 1956 

care for children which is not provided in any of the other regional 
heart centers in the country. 

The Alabama crippled children's program, in cooperation with the 
Alabama Dental School, is developing a special project to find out 
better methods to obtain overall care of children with cleft palate 
deformities who live in rural areas, and Maryland expanded its exist- 
ing integrated Cleft Palate Clinic at Johns Hopkins to include a 
cooperative arrangement with the Baltimore College of Dental Surg- 
ery and the University of Maryland Dental School for the provision 
of dental services for children accepted under the program. 

Services for children with disorders of the brain and neurological 
system are being brought together in a special project at the newly 
established Kehabilitation Center in the Children's Hospital, Buffalo. 
It is expected that the center will serve portions of Western Pennsyl- 
vania and Eastern Ohio, as well as the Western New York area. 

Many State crippled children's agencies during the past year have 
mcreased their services to the child amputee. In some States the 
agencies maintain evaluation and training centers ; in others this serv- 
ice is purchased from evaluation and training centers established by 
other organizations and hospitals. The Michigan Child Amputee 
Center in Grand Rapids has expanded its staff and is now able to 
offer its services to children in other States. Michigan is also able 
to train a limited number of physicians, occupational and physical 
therapists and prosthetists. 

Children's Bureau specialists have been in frequent consultation 
with staff of the Office of Vocational Rehabilition during the year in 
relation to the expanded program of that agency for older children 
and for adults. Joint work has resulted in criteria for the developing 
of rehabilitation centers for adults and children. 

CHILD WELFARE SERVICES 

In its child welfare services the Bureau consultants work with State 
public and voluntary welfare agencies in planning and operating 
their child welfare programs and with the Bureau of Public Assist- 
ance, other Federal agencies, and national organizations in planning 
for better services to children. The Bureau administers the Federal 
grant-in-aid funds for child welfare services. It also develops 
guides, recommendations for practice, and informational materials in 
relation to the child welfare program as a whole and for specialized 
services, such as social services to children in their own homes, pro- 
tective services, homemaker services, services to unmarried mothers, 
foster family and group care programs, and adoption services. 

In working with State public welfare agencies in the development 
of the child welfare programs, one of the major concerns of the 
Children's Bureau is the provision of appropriate social services for 



Social Security Administration 67 

all children in need of them in all geographical areas. Particular 
attention has been given to the stimulation of new types of services 
for special gToups of children, such as mentally retarded children, 
emotionally disturbed children, and children in need of protection 
from neglect or abuse. 

States are facing the problems of how to achieve geographic cover- 
age and maintain quality of service in the face of both shortage of 
personnel and shortage of funds. This involves examining staffing 
patterns, personnel practices and coordination of services. It necessi- 
tates also stepping up programs for the training of child welfare 
personnel. 

States are seeking new ways for staff development programs. 
Connecticut, Vermont, Indiana, and Ohio have added full-time staff 
development supervisors or consultants. Michigan, Utah, and Wy- 
oming have been using staff committees in planning staff develop- 
ment activities. In Connecticut a joint plan developed by the school 
of social work, the State Department of Social Welfare, the Personnel 
Board, and a voluntary agency has made possible a work-study plan 
which would lead to full professional training of workers providing 
direct services to children. 

Persomiel continued to loom large as a purpose for which Federal 
funds were used, including salaries, in-service training, and pro- 
fessional education. States were thus able to extend and strengthen 
their services in some of the special areas of child welfare, such as 
services to unmarried mothers, adoption, homemaker services, services 
to children in their own homes, and licensing of institutions, agencies, 
and foster family homes. 

Increased emphasis throughout the country in providing services 
to children in their own homes is evidenced by the fact that most of 
the regional conferences of the American Public Welfare Association 
and the conferences of the Child Welfare League gave special at- 
tention to services to children in their own homes. State conferences 
of social work have also included specific sessions on this subject. 
An overwhelming number of requests from State agencies for consul- 
tation have been received by the Bureau. Visits to States have high- 
lighted the desire of local staff to be helpful to children and parents, 
and also the need for increased knowledge and skill and the almost 
complete lack of adequate local supervision to provide skilled service 
in this area. 

Agencies all over the comitry are expressing concern about the 
ways and means of providing services for the protection of neglected 
and abused children. The American Humane Association has re- 
activated regular meetings of representatives of national agencies 
concerned with protective services. Serious gaps in this type of 



68 Department of Health, Education, and Welfare, 1956 

service are found throughout the country. The need to develop 
special skills for this service has been of paramount interest. 

More interest is also being expressed in the development of home- 
maker services which ^YOuld preserve a family unit at times of crisis. 
To assist the Bureau in plamiing with the States in the expansion of 
homemaker service programs a group of people interested in this 
service met in Washington June 11 and 12, 1956, at the invitation of 
the Bureau. The group, which included representatives of welfare 
and health agencies — national, State and local, voluntary and public 
— recommended that a conference, planned on a broad basis to include 
homemaker service to families with children, the aged, and the chron- 
ically ill, be held in the spring of 1957 under the combined auspices of 
the Children's Bureau, the Bureau of Public Assistance, and the 
Public Health Service. 

The Division of Social Services has given special emphasis this 
year to the development of new and improved services to unmarried 
mothers. A new permanent position, Consultant on Services to Un- 
married Mothers and Unprotected Adoptions, was established and 
filled in December 1955. This consultant has been working closely 
with health services and research staff on problems related to the pro- 
vision of medical care and social services for unmarried mothers. All 
State public welfare agencies in their State and local child welfare 
programs carry some responsibility for services to unmarried mothers 
and for adoptions. Twelve States budgeted Federal child welfare 
services funds to help provide care not otherwise available for un- 
married mothers, such as the purchase of maternity home care and 
provision of foster family or group care. State and local progress in 
providing services to unmarried mothers has been slow due to limited 
funds, the lack of staff, and in some instances residence requirements. 

Adoptions and adoption practices of agencies continue to be very 
much in the limelight in social work conferences, community planning, 
press, TV, radio, and other mass media and in State legislatures. 
Many State legislatures passed social welfare legislation, especially 
adoption legislation. In Alabama legislation was passed which ex- 
tended the inheritance right of adopted children. In Florida an 
amendment to the Adoption Act was passed which provided that the 
preliminary hearing and the interlocutory degree of adoption be elimi- 
nated and that there be only one hearing which would not be held 
until the child had lived in the home of the adoptive parents under 
the supervision of an authorized child welfare agency for at least 3 
months. Several acts passed in Georgia strengthened and clarified 
the adoption laws and prohibit certain bad adoption practice which 
existed in the past, some of which received publicity during the black 
market hearings in Miami held by the Senate Subcommittee on Juve- 
nile Delinquency. 



Social Security Administration 69 

Almost 5,000 copies of the publication, Protecting Children in Adop- 
tion, reporting on the Conference on Unprotected Adoptions, called 
by the Children's Bureau in June 1955, have reached national organi- 
zations, public and private agencies, schools of social work, and inter- 
ested individuals. 

More public agencies have l)een developing adoption services and 
those which already have adoption programs are examining their cur- 
rent practices. Many agencies are reviewing practice in regard to 
foster care placements to determine whether they can make decisions 
earlier than they now do as to whether a child can be returned to his 
own home or whether permanent placement through adoption should 
be arranged. Agencies are concerned about termination of parental 
rights and are asking the Children's Bureau for help in this area. 
Agencies all over the country are beginning to put more effort into 
the placement in adoption of children who were formerly grouped 
among the "hard-to-place" children. Through foundation funds a 
project called MAKCH has been established in San Francisco for the 
recruitment of adoptive homes for children of minority groups. One 
of the most significant developments in relation to adoption services 
is the reorganization of the Edna Gladney Home in Fort Worth, Tex., 
an institution that became famous through the moving picture, "Blos- 
soms in the Dust." The program of the Home has been reorganized 
and a professionally equipped director of social services has been em- 
ployed. All adoption placements are now made by professional so- 
cial workers and social services are to be provided the unmarried 
mothers. The Gladney Auxiliary initiated a unique workshop for 
parents of adopted children on general child development and parent- 
child relationships. The major workshop focus was on constructive 
acceptance of adoption on the part of the parents, the child, relatives, 
and friends. 

Recognition of the value of the services of foster boarding parents 
has been shown in various ways. Sometimes State welfare depart- 
ments have increased boarding rates to include a fee for service. In 
Connecticut the Governor proclaimed May 27 as foster parents' day, 
and foster parents who had given service for 10 years received special 
certificates. 

Many boards of traditional institutions for dependent children, 
fully aware of the decreasing demand for residential care for these 
children are under increasing pressure to serve other groups of chil- 
dren, including those who are retarded, delinquent, and emotionally 
disturbed. 

Publications in the field of child welfare services that were pro- 
duced or prepared in 1956 include : Protecting Children in Adoption; 
Interviewing for Staff Selection in. Public Welfare; Leadership 
through Consultation; Survey Methods for Determining the Need 



70 Department of Health, Education, and if el/are, 1956 

for Services to Children of Working Mothers; Personnel in Public 
Child Welfare Programs; Children Receiving Caseioorh Services. 

JUVENILE DELINQUENCY SERVICES 

Juvenile delinquency in the United States has been on the upturn 
steadily for the past 7 years, and percentagewise it is rising far faster 
than our juvenile population. The Children's Bureau is giving con- 
sultant service to States and communities in relation to juvenile courts, 
probation institutions, police work, personnel training, and commu- 
nity services for the prevention and treatment of juvenile delinquency. 

A steady increase is noted in the number of agencies and communi- 
ties developing new programs to reach and serve predelinquent youth 
and delinquent youth in groups. This whole area of work has ex- 
panded rapidly without much formulated concurrence as to the theory 
and practice which can serve as guidelines, or as bases for evaluation - 
To begin to meet the pressing requests of planners, administrators, 
and practitioners in the area, the Bureau has collected reports on 
operating projects serving predelinquent youth in gang groups. 
These are being studied to distill out common concepts, principles, and 
standards. The common elements and program problems which 
emerge will be carefully considered with national youth serving 
agencies. 

Although several States have operated forestry camps as treatment 
facilities for the control and treatment of delinquency for a number 
of years, eight more States either established such camps in the last 
year or are now establishing them. 

During the past year several police departments have organized 
special divisions or bureaus to work with juveniles. Five new asso- 
ciations of State and local juvenile officers' associations have been 
organized either on a regional or Statewide basis. In addition, two 
local associations were formed. 

Increased interest has been shown in the States in reviewing the 
legal aspects of juvenile court work and in developing a compatible 
interweaving of legal and social work principles in the court's opera- 
tion. Eecent State legislation revising juvenile court statutes re- 
flects many of the principles outlined in the Bureau's publication, 
Standards for Specialized Courts Dealing with Children. 

A widespread desire exists to build more and better research controls 
into programs aimed at juvenile delinquency prevention. Many 
States and communities have inquired about the specific programs, 
projects, and techniques which have proved effective for delinquency 
prevention. Others are asking for help in designing appropriate re- 
search for their programs and for guidance in carrying it out. 

A paramount problem, as expressed by the field, is the lack of 
trained staff for delinquency programs. In partial response to this 



Social Security Administration 71 

need, the Bureau has been placing great emphasis on training. In 
May 1956 the Bureau's chief consultant on training in juvenile delin- 
quency was appointed. This consultant is chairman of a standing 
committee on corrections of the Council of Social Work Education. 
At the request of schools of social work, the Consultant has advised 
with the instructional staff of 13 schools which were reviewing their 
offerings in the correctional field, or which are launching a correctional 
emphasis in the education of social work students. 

A summer session project in correctional social work, planned for 
social work teachers, was offered by the University of California 
School of Social Welfare, at Berkeley, cosponsored by the Council of 
Social Work Education, the National Probation and Parole Asso- 
ciation, and the Children's Bureau. Two foundations contributed 
funds — the Kosenberg Foundation of San Francisco and the Doris 
Duke Foundation — and one anonymous donor. Twenty-four experi- 
enced faculty members and practitioners were selected from the 138 
individuals nominated throughout the country to attend the 6-week 
project. 

Evidence of the great interest of the police in training to work with 
juveniles is the fact that the Consultant on Police Services partici- 
pated in 13 training institutes during the year. These institutes varied 
in length from a day to a week and were sponsored primarily by 
educational institutions, although several were sponsored by operat- 
ing agencies or professional organizations. At the request of the 
Bureau of Indian Affairs, 4 Indian agencies were visited in New 
Mexico and Arizona to provide consultation to personnel working 
with juveniles on the reservation. A 2-day institute was sponsored 
by the Bureau of Indian Affairs for tribal law enforcement officials at 
Santa Fe. 

The Division Director attended the First United Nations Congress 
on the Prevention of Crime and the Treatment of Offenders, Geneva, 
Switzerland, August 22-September 3, 1955, and served as chairman 
of the United States delegation for the section on juvenile delinquency. 

The following publications relating to the field of delinquency were 
published during the year : Health Services and Jv/oenile Delinquency; 
Juvenile Court Statistics^ IQBJf,; Public Training Schools for Delin- 
quent Children^ a Directory ; Studies in Juvenile Delinquency — A 
Selected Bibliography. New Perspectives for Research on Juvenile 
Delinquency is in press. 

INTERNATIONAL COOPERATION 

The cooperative program with the International Cooperation Ad- 
ministration is continuing with a moderate increase in persons sent 
to this country for training by that organization and a similar in- 



72 Department of Health, Education, and Welfare, 1956 

crease in the requests for specialists from other countries. The World 
Health Organization and the United Nations continue to refer peo- 
ple from other countries to us for observation and academic training. 

During the year the Training Branch has planned and arranged 
training programs for 74 long-term trainees and observers and 156 
short-term visitors, (The trainees were in programs 12 months or 
more, the observers 2 to 6 months, and the short-term visitors a few 
hours to 2 or 3 weeks.) Of the 74 long-term trainees and observers, 53 
were in the health field, as follows : maternal and child health physi- 
cians — 21, pediatrics— 10, obstetrics — 2, nursing (pediatric, mater- 
nity, and midwifery) — 12, other — 8; 18 were in the field of child and 
youth welfare, as follows : child welfare — 9, group work — 5, juvenile 
delinquency — 4 ; 3 were in the field of medical social work. Of the 74 
trainees and observers, 48 came through the International Cooperation 
Administration, 17 through the World Health Organization, 8 through 
the United Nations, and one "on her own." The long-term trainees 
came from 31 countries, the short-termers from 51. 

The child health and welfare specialists recruited and back- 
stopped by the Bureau are contributing to programs in 6 countries. 
The pediatric nurse educator in Vellore, India, has served as teacher 
and consultant at the School of Nursing for 1 year. The medical 
social work consultant in Panama has assisted with the establishment 
of the Social Service Department as an integral part of the Santo 
Tomas Hospital and the creation of a Section of Social Services in 
the Department of Public Health. The staff in Iraq has continued 
training Iraqi personnel to eventually take over the program. The 
obstetric nursing consultant in Guatemala has assisted in the develop- 
ment of the Maternity Unit at the Koosevelt Hospital. The staff in 
Egypt have been working on the Demonstration and Training Health 
Center in the village of Shubramant and now the Center is carrying 
out its major function of the training of Egyptian personnel. 

The Chief of the Bureau attended two meetings of the Executive 
Board of the UN Children's Fund (UNICEF) as U.S. Kepresentative 
on the Board. She also attended a meeting in Geneva, Switzerland, 
of the Joint Committee on Health Policy made up of members of the 
Executive Board of WHO and of the Executive Board of UNICEF. 

Federal Credit Unions 

As of June 30, 1956, there were 8,108 operating Federal credit 
unions with aggregate assets of $1,368 million of which $946 million 
was in loans outstanding to 2 million members. These organizations 
had a combined membership of 4.3 million who owned $1,239 million 
in shares for an average of $288 per member. During the fiscal year, 



Social Security Administration 73 

the number of operating Federal credit unions increased 540 or 7.2 
percent; total assets increased $244.9 million or 21.8 percent; member- 
ship increased 465,288 or 12.1 percent; loans outstanding increased 
$178.4 million or 23.2 percent; and shares increased $225 million or 
22.2 percent. 

At the end of fiscal year 1956, Federal credit unions were operating 
in each of the 48 States and in the District of Columbia, Hawaii, 
Alaska, Canal Zone, Puerto Rico, and the Virgin Islands. xVbout 83 
percent were serving employee groups in commerce, industry, and 
government ; 15 percent were serving associational groups ; and 2 per- 
cent were serving residents of small rural communities or well-defined 
neighborhood groups in urban areas. About two-thirds (64.6 per- 
cent) of those operating on June 30 had assets of less than $100,000, 
and approximately 60 percent were chartered after January 1, 1948. 

Each Federal credit union is a separate corporation. Each is man- 
aged and operated by officials elected by and from the group it was 
organized to serve. The field of membership of each unit is specifi- 
cally defined in its charter, and the law limits its activities to provid- 
ing cooperative thrift and short-term consumer loan services for its 
members. The Federal Credit Union Act specifies the maximum 
size of the aggregate loans that may be made to a member ($200 or 
10 percent of the credit union's paid-in and unimpaired capital and 
surplus, whichever is larger) ; the maximum loan maturity (36 
months) ; and the maximum rate of interest (1 percent per month on 
the unpaid balances, inclusive of all charges incidental to making 
the loan). Although each unit is authorized to borrow from any 
source up to 50 percent of its paid-in and unimpaired capital and 
surplus, boiTOwing has not been an important source of capital for 
most Federal credit unions. Funds used to make loans to members 
are tlie accumulated savings of members in their credit union. Such 
savings are called "shares." 

The Bureau of Federal Credit Unions furnishes upon request in- 
formation concerning the organization and operation of Federal credit 
unions. Charters are granted to groups that apply when it is found 
that they are eligible under the provisions of the Federal Credit 
Union Act. During fiscal year 1956, 747 charters were granted, as 
compared with 794 in the previous year. The Bureau furnishes man- 
uals and instructional materials to newly chartered groups, and when 
necessary, provides the services of an examiner to assist with the or- 
ganization meeting and instructs the new officials. 

The Bureau provides supervisory and advisory services for estab- 
lished Federal credit unions and makes supervisory examinations on 
the average of once every year or 15 months. 

408691—57 6 



74 Department of Health, Education, and Welfare, 1956 

The operations of the Bureau are financed by fees paid by Federal 
credit unions. Fiscal year 1956 was the third year that the Bureau 
received no appropriation other than fees collected from Federal 
credit unions. 

Research and Development 

The growth in numbers and size of Federal credit unions is an im- 
portant factor in the administration of the Bureau's program re- 
sponsibilities. Solutions to new problems must be developed and 
trends must be studied in order that the probable impact of indicated 
developments can be anticipated and the necessary changes in proce- 
dures be readied for installation at the appropriate time. 

Manuals and instructional materials furnished to the officials of 
Federal credit unions are revised from time to time to keep them up to 
date and pertinent. Advice and suggestions of the operating officials, 
of the field examiners, and of the leaders of the organized credit union 
movement are solicited. This method has fostered good cooperation 
with instructions issued by the Bureau and has been of material assist- 
ance in the development of practical aids in credit union operation. 
This method of proven value is being continued. 

An integral part of each examination is the instruction of the Fed- 
eral credit union officials. Since these instructions can be and are 
geared to prevailing or anticipated conditions in the credit union con- 
cerned, the examination program is a progressive rather than a static 
influence in the development of sound credit union service in the 
Nation. The knowledge this experience gives the field examiners is a 
valuable resource in keeping the Bureau's policies and regulations up 
to date. 

During the fiscal year a supplement to the Accounting Manual for 
Federal Credit Unions was completed and sent to the printer. The 
supplement contains instructions and suggestions that are of special 
interest to credit unions with assets of $100,000 and above. Preceding 
the writing of the supplement a considerable amount of research was 
done among large credit unions to determine their special accounting 
problems and the procedures some of them had developed to meet 
these problems. 

A complete revision of the Supervisory Committee Manual for 
Credit Unions was written during the fiscal year. The new manual 
reflects the results of research into internal auditing procedures now 
used in commerce, industry, and government. By means of question- 
naires sent to the Bureau's field staflp, credit union officials, and leaders 
of the organized credit union movement, suggestions as to organization 
and content of the new manual were obtained. The first draft was 



Social Security Administration 75 

then distributed to the field staff and to others who had returned the 
questionnaires for review and comment. The first draft was revised 
to incorporate as many as possible of the comments and suggestions. 
As a result of this procedure, considerable interest has been stimu- 
lated in improving internal audits for credit unions. 

During the fiscal year, manpower utilization surveys were made in 
two divisions of the Washington office of the Bureau. In the last 
quarter of the fiscal year, the Chief of Field Operations reviewed the 
procedures and organization of the Bureau's regional offices. The sur- 
vey of the regional offices was completed and the findings summarized 
in time for discussion at the conference of the Regional Representatives 
and Associate Regional Representatives held in Washington during 
the last week of June 1956. Surveys and analj^ses of this type, which 
are essentially research in the area of management procedures, have a 
special significance to the Bureau of Federal Credit Unions. The 
Bureau's program responsibilities are increasing as the number and 
size of Federal credit unions increase. To maintain quality per- 
formance without unduly increasing costs requires continuing atten- 
tion to operating procedures and management improvement projects. 
The findings of the surveys made during fiscal year 1956 will be used 
to effect modifications and improvements during the coming year. 
Additional surveys will be made when their need is indicated. 

The economy of the Nation has changed materially since June 26, 
1934, when the Federal Credit Union Act was signed by the President. 
In this period Federal credit unions have become well established. 
In order to determine whether the policies of the Bureau have kept 
pace with changing economic conditions and the growth of Federal 
credit unions, a comprehensive survey of the basic policies pertaining 
to chartering, examination, and supervision of Federal credit unions 
was undertaken during the year. Work on this project will carry over 
into fiscal year 1957. 

The Bureau is continuing efforts to collect and maintain basic sta- 
tistical data on Federal credit unions and to encourage research in 
this field by graduate students and faculty members of colleges and 
universities. The results of these efforts will provide the means for 
detecting need for changes and for evaluating proposed legislation, 
proposed amendments to published regulations, and proposed revisions 
of manuals for Federal credit union officials. 



76 



Department of Health, Education, and Welfare, 1956 



Table 1. — Social Security Administration: Funds available and obligations 
incurred, fiscal years 1955 and 1956 ^ 

[In thousands; data as of June 30, 1956] 



Item 



Funds Available 2 



Obligations Incurred 



1956 



1955 



Total 

Grants to States 

Public assistance 

Old-age assistance 

Aid to the blind 

Aid to dependent children 

Aid to the permanently and totally disabled 

Maternal and child health and welfare services.. 

Maternal and child health services 

Services for crippled children 

Child welfare services 

Administrative expenses 3 

OfTice of the Commissioner * 

Bureau of Old-Age and Survivors Insurance '. 

Bureau of Public Assistance 

Children's Bureau ' 

Bureau of Federal Credit Unions 



$1, 608, 038 



$1, 553, 969 



$1, 576, 251 



$1, 538, 730 



511, 157 

477, 000 



1, 477, 000 

34, 157 

11,928 

15, 000 

7,229 

96, 881 

323 

91, 229 

1,636 

1,740 

1.953 



1, 468, 000 
1,438,000 

1,438,000 

30, 000 

11,928 

10, 843 

7,229 

85, 969 

309 

81,020 

1, 501 

1,629 

1,510 



1, 479, 736 

1,446,116 

922, 539 

37, 618 

395, 290 

90, 669 

33, 620 

11,922 

14, 803 

6, 895 

96. 515 

320 

91, 046 

1, 621 

1,731 

1,797 



1,453,199 

1,423.943 

920. 791 

36, 467 

385, 233 

81,452 

29, 256 

11.919 

10.614 

6, 723 

85, 531 

304 

80. 687 

1,484 

1,614 

1.442 



' 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 reimbursement items for services rendered to other Government agencies. 

* Appropriations by Congress from general revenues accounted for approximately 58 percent of the admin- 
istrative expenses of the Office of the Commissioner in 1955, and approximately 57 percent of such expenses 
in 1956; balance from old-age and survivors insurance trust fund, 

5 For administration of the old-age and survivors insurance program, which involved benefit payments of 
$4,333,000,000 m 19.55 and $5,361,000,000 in 1956. 

« 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. 

Table 2. — Financing social insurance under the Social Security Act: Contribu- 
tions collected and trust fund operations, fiscal years 1954—56 

[In millions] 



Item 



Contributions collected under — 

Federal Insurance Contributions Act ' 

Federal Unemployment Tax Act 2 

State unemployment insurance laws ^* 

Old-age and survivors insurance trust fund: 

Receipts, total 

Transfers and appropriations ' 

Interest and profits on investments ' 

Expenditures, total 

Monthly benefits and lump-sum payments ' 

Administration 

Assets, end of year 

State accounts in the unemployment trust fund: 

Receipts, total 

Deposits * 

Interest 

Withdrawal for benefit payments 

Assets, end of year... 



$6, 442 


$5, 087 


$4. 689 


325 


280 


285 


1,329 


1,142 


1,246 


6,937 


5,535 


5,040 


6,442 


5,087 


4,589 


495 


448 


4.51 


5,485 


4,436 


3, 365 


5,361 


4,333 


3,276 


124 


103 


89 


22, 593 


21,141 


20, 043 


1,520 


1,333 


1.454 


1,333 


1,146 


1.246 


187 


187 


209 


1,287 


1,760 


1,605 


' 8, 216 


7,983 


8,409 



' Contributions on earnings up to and including $3,600 a year in 1954 and ,$4,200 a year beginning Jan. 1, 
1955. Contribution rate paid by employers and employees: 2 percent each. Contribution rate paid by 
self-employed: 3 percent. Includes deposits by States under voluntary agreements for coverage of State and 
local employees. Includes deductions to adjust for reimbursement to the General Treasury of the estimated 
amount of taxes subject to refund on wages in excess of wage base. 

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

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

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

' Includes interest transferred from the railroad retirement account under the financial interchange pro- 
vision of the Railroad Retirement Act, as amended in 1951. 

' Represents checks issued. " Preliminary. 

Source: CompOed from Monthly Statement of the U. S. Treasury, other Treasury reports, and State agency 
reports. 



Social Security Administration 



77 



Table 3. — Old-age and survivors insurance : Estimated number of families and 
beneficiaries receiving benefits and average monthly benefit in current-pay- 
ment status, by family group, end of June 1956 and 1955 

[In thousands, except for average benefit; data corrected to Nov. 8, 1956] 



Family classification of beneficiaries 



June 30, 1956 



Number 

of 
families 



Number 
of bene- 
ficiaries 



Average 
monthly 
amount 

per 
family 



June 30, 1955 



Number 

of 
families 



Number 
of bene- 
ficiaries 



Average 
monthly 
amount 

per 
family 



Total 

Retired worker families 

Worker only 

M ale 

Female 

Worker and wife aged 65 or over 

Worker and wife under age 65 ' 

Worker and aged dependent husband 

Worker and 1 or more children 

Worker, wife aged 65 or over, and 1 or more 
children 

Worker, wife under age 65, and 1 or more 
children 

Survivor families 

Aged widow 

Aged dependent widower 

Widowed mother only i 

Widowed mother and 1 child. 

Widowed mother and 2 children 

Widowed mother and 3 or more children___ 
Divorced wife and 1 or more children 

1 child only 

2 children 

3 children 

4 or more children. 

1 aged dependent parent 

2 aged dependent parents 

1 Benefits of children were being withheld. 



6, 160. 2 



8, 374. 5 



5, 539. 7 



7, 563. 5 



4, 731. 9 

3, 460. 3 
2, 148. 4 
1,311.8 

1, 182. 6 
.3 

10.7 

16.6 



1.3 

60.1 

1, 428. 3 

746.3 
1.1 



128.4 

85.7 

82.4 

.3 

217.0 
90.0 
31.8 
20.2 

22.8 
1.5 



6,114.4 

3, 460. 3 
2, 148. 4 
1,311.8 

2, 365. 2 

.6 

21.4 

42.7 



4.0 

220.1 

2, 260. 1 

746.3 
1.1 



256.8 
257.2 
389.8 

.7 

217.0 
179.9 
95.3 
89.3 

22.8 
2.9 



$60. 00 
65.60 
50.70 

104. 80 
113.30 

88.20 



132. 30 



49.00 
48.20 
51.20 

108. 50 
137. 80 
136. 40 
135. 70 

48.50 
83.80 
105. 20 
112.20 

50.50 
95.30 



4, 214. 8 

3, 067. 7 
1, 962. 3 
1,105.4 

1, 066. 4 

.4 

9.2 

15.8 



1.2 

54.0 

1, 324. 9 

688.3 
1.2 
1.4 



120.8 

83.6 

75.6 

.2 

200.3 
80.9 
29.1 
19.6 

22.2 
1.7 



5, 462. 3 

3, 067. 7 
1, 962. 3 
1, 105. 4 

2, 132. 8 

.8 
18.5 

41.1 
3.6 



2, 101. 2 

688.3 
1.2 
1.4 

241.6 

250.7 

356.1 

.6 

200.3 
161.9 
87.2 
86.3 

22.2 
3.3 



$58. 10 
63.50 
48.40 

102. 20 
102. 50 
87.00 

98.10 



123. 30 

117.00 



46.60 
40.00 
48.60 

105. 10 
132. 60 
129. 90 
130. 00 

47.80 
81.60 
101.00 
105. 60 

48.10 
92.90 



78 



Department of Health, Education, and Welfare, 195b 



Table 4. — Old-age and survivors insurance: Selected data on benefits, 
employers, workers, and taxable earnings, by State, for specified periods, 
1953, 1955, and 1956 

[In thousands, except for average taxable earnings; data corrected to Nov. 9, 1956] 



State 



Monthly benefits 
in current-pay- 
ment status, end 
of fiscal year 1956 ' 



Num- 
ber 



Amount 



Benefit payments, fiscal 
year 1956 > 



Total 



Monthly 
benefits 



Lump- 
sum 
pay- 
ments 



Em- 
ployers 
report- 
ing tax- 
able 
wages, 
July- 
Sep- 
tember 
1955 2 



Calendar year 1953 



Work- 
ers with 
taxable 
earn- 
ings 3 



Amount of taxable 
e-^rnings < 



Total 



Aver- 
age pe 
worker 



Total. 



8, 374. 5 



$439, 424 



Alabama 

Alaska 

Arizona - 

Arkansas 

California --. 

Colorado 

Connecticut 

Delaware 

Dist. of Col 

Florida 

Georgia 

Hawaii 

Idaho - 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts,. - 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New Hampshire - 

New .Jersey 

New Mexico 

New York 

North Carolina.. 
North Dakota. .- 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Puerto Rico 

Rhode Island 

South Carolina.. 

South Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virgin Islands 

Virginia 

Washington 

West Virginia 

Wisconsin 

Wyoming 

Foreigna' 

Maritime ' 



121.2 

4.3 

39.3 

75.2 

670.0 

70.1 

142.0 

19.3 

31.5 

228.0 

125.5 

18.6 

28.1 

502.2 

240.2 

131.5 

94.8 

134.6 

97.0 

68.7 

116.6 

346.5 

358.7 

151.3 

63.1 

218.3 

29.6 

61.0 

8.6 

42.0 

321.3 

22.6 

938.2 

139.6 

16.9 

487.6 

93.1 

105.5 

672.3 

33.4 

58.1 

71.8 

24.3 

125.0 

288.3 

31.6 

24.0 

0.4 

141.3 

154.0 

112.1 

204.3 

11.9 

52.9 



$5, 360, 813 



$5, 245, 473 



$115,340 



3,910 



61, 000 



$136,000,000 



2,767 



62, 374 

2,449 

23,868 

38, 225 

444, 523 
43, 347 

102,715 
12, 759 
19. 883 

145,216 
64, 880 
10. 830 
16, 562 

344, 085 

153, 585 
79, 572 
56, 576 
74, 137 
52, 459 
41, 593 
74, 545 

239, 512 

248, 130 
95. 751 
30, 363 

136, 602 
18. 202 
36, 377 
5,584 
26, 834 

227.812 
11,621 

644, 577 
72,712 
9,209 

330, 621 
52, 768 
68, 450 

456, 577 
11,446 
39, 424 
36,011 
13, 899 
66, 334 

161,826 

19, 434 

14, 662 

165 

79, 902 

101,337 
65. 867 

134, 077 
7,405 
33, 139 



60, 869 

2,382 

23,369 

37, 550 
435, 233 

42, 510 

100, 579 
12,418 
19,424 

142, 805 
63, 149 
10, 622 
16, 207 

336, 024 

150, 360 
78, 058 
55, 498 
72, 496 
51,208 
40,821 
72, 565 

234, 769 

242, 620 
94, 013 
29, 654 

133, 774 

17, 767 

35, 671 

5,444 

20, 296 

222, 417 
11,358 

630, 154 
70, 931 
9,056 

323, 497 
51,620 
67, 103 

446, 773 
11,247 

38, 638 
35, 080 
13, 658 
64, 737 

157, 953 
19, 067 
14, 397 
160 
77. 891 
99, 270 
64, 700 

131,525 
7,267 
32, 819 



1,505 

67 

499 

675 

9,290 

837 

2,136 

341 

459 

2,411 

1,731 

208 

355 

8,061 

3,225 

1,514 

1,078 

1,641 

1,251 

772 

1,980 

4,743 

5,510 

1,738 

709 

2,828 

435 

706 

140 

538 

5,395 

262 

14, 423 

1,781 

153 

7,124 

1,148 

1,347 

9,804 

199 

786 

931 

241 

1,597 

3,873 

367 

265 

5 

2,011 

2,067 

1,167 

2,552 

138 

320 



(«) 



57 
3 

20 
31 

321 
40 
63 
12 
30 

100 
80 
10 
14 

234 
91 
70 
49 
50 
59 
25 
66 

121 

140 
74 
33 
99 
16 
33 
7 
16 

143 
16 

493 
81 
13 

193 
47 
45 

247 
17 
20 
42 
16 
66 

211 
15 
11 

76 
62 
35 



820 
60 
270 
410 

4,820 
510 

1,040 
180 
430 

1,130 

1,120 
170 
180 

4,090 

1,700 
770 
670 
760 
820 
3.50 
950 

2,110 

3,010 

1,020 
470 

1,580 
200 
430 
80 
220 

2,190 
200 

7.360 

1,290 
130 

3,700 
670 
620 

4,560 
340 
360 
650 
170 
990 

2,840 

260 

130 

10 

1,150 
870 
560 

1,320 
110 
60 
100 



1,501 

148, 

570, 

662, 

11,487 

1,044 

2, 648 

420 

941 

1, 949 

1,951 

362 

345 

9, 928, 

3,823 

1, 573 

1, 407 

1, 520, 

1,568 

640, 

2,075 

4, 792 

7, 755, 

2,181 

722 

3,416 

40 

830 

184, 

430 

5, 373. 

376 

17, 60 

2, 262 

226 

9,151 

1, 334 

1,425, 

10, 950 

259, 

787, 

1,150 

312 

1,826 

5,597 

557, 

249 

6, 

2, 202, 

2, 012 

1,231 

3,081 

224, 

187, 

340 



,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
.000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
.000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 
,000 



$2, 230 



1,830 
2,470 
2,110 
1,610 
2,380 
2,050 
2,550 
2,330 
2,190 
1,720 
1,740 
2,130 
1,920 
2,430 
2,250 
2,040 
2,100 
2,000 
1,910 
1,830 
2,180 
2,270 
2,580 
2,140 
1,540 
2,160 
2,010 
1,930 
2,300 
1,950 
2,450 
1,880 
2,390 
1,750 
1,740 
2,470 
1,990 
2,300 
2,400 

760 
2,190 
1,770 
1,840 
1,840 
1,970 
2,140 
1,920 

600 
1,910 
2.310 
2,200 
2,330 
2,040 
3,120 
3,400 



1 State of residence estimated. 

2 State data represent number of employers reporting taxable wages by the State of their reporting head- 
quarters. An employer is a legal entity such as a corporation, partnership, or single ownership, for which 
a single tax return is filed. Excludes agricultural employers. 

3 Preliminary estimate. Workers are shown in the State of major job — that is, the State in which the 
greatest amount of taxable wages or self-employment net earnings was received. 

* Preliminary estimate. Total annual taxable earnings are shown in the worker's State of major job. 
Averages are rounded to nearest $10. 

' Fewer than 500 employers. 

6 Benefit data relate to persons in foreign countries receiving old-age and survivors insurance benefits. 
Employment and earnings data relate to citizens ol the United States employed by American employers. 

' Relates to employment of officers and crews of American vessels. 



Social Security Admiiiistratiuii 



79 



Table 5. — Old-age and survivors insurance : Selected data on benefits, employers, 
workers, and taxable earnings for specified periods, 1954—56 

[In thousands, except for average monthly benefit and average taxable earnings; corrected to Nov. 9, 1956] 



Item 



1954 



Fiscal year 



Benefits in current-payment status (end of period) : 

Number 

Old-age 

Wife's or husband's 

Child's 

Widow's or widower's 

Mother's 

Parent's 

Total monthly amount 

Old-age 

Wife's or husband's 

Child's 

Widow's or widower's 

Mother's 

Parent's 

Average monthly amount: 

Old-age 

Wife 's or husband's _ 

Child's 

Widow's or widower's 

Mother's , 

Parent's 

Benefit payments during period: 

Monthly benefits 

Old-age 

Supplementary 

Survivor _.. 

Lump-sum payments 

Estimated number of living workers with wage credits (mid- 
point of period— Jan. 1) : ' 

Total 

Fully insured 

Currently but not fully insured 

Uninsured 

Estimated number of employers reporting taxable wages, 1st 
quarter of fiscal year 



Estimated number of workers with taxable earnings 

Estimated amount of taxable earnings __ 

Average taxable earnings ^ 



8, 374. 5 


7, 563. 5 


6, 468. 8 


4,731.9 


4, 214. 8 


3, 519. 4 


1, 255. 


1,131.3 


959.1 


1, 316. 7 


1, 220. 9 


1,111.9 


747.8 


689. 8 


586.3 


297.3 


281.2 


267.7 


25.7 


25.6 


24.4 


$439, 424 


.$384, 025 


$278, 702 


$296, 976 


$257, 230 


$182. 334 


$41, 968 


$37,011 


$26, 302 


$48, 662 


$43, 730 


■$34, 770 


$36, 648 


.$32, 150 


$24, 016 


$13, 876 


$12, 677 


$10, 249 


$1, 293 


$1,226 


$1, 030 


$62. 76 


.$61.03 


$51. 81 


$33. 44 


$32. 72 


$27. 42 


$36. 96 


$35. 82 


$31.27 


$49. 01 


$46. 61 


$40. 96 


$46. 67 


$45.08 


$38. 28 


$50. 31 


$47. 86 


$42. 26 


$5, 245, 473 


$4, 232, 609 


$3, 185, 282 


$3, 532, 910 


$2, 802, 967 


$2, 068, 404 


$531, 831 


$428, 847 


$318,614 


$1, 180, 732 


$1, 000, 795 


$798, 264 


$115, 340 


$100, 539 


$90, 175 


99, 800 


95, 200 


93, 600 


70, 100 


70, 300 


71, 000 


1,200 


600 


(2) 


28, 600 


24, 300 


22, 500 


3 3, 910 


3,715 


3,654 


Calendar year 



66. ono 

$159, 000, 000 
$2, 410 



59, 700 

$134, 000, 000 

$2, 240 



1 Estimates of insured workers have not been adjusted to reflect changfs in insurance status arising from. 
(1) provihims that coordinate the old-age and survivors insurance and railroad retirement programs and (2) 
wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of 
persons with taxable earnings reported on more than 1 account number. The effect of such duplication is 
substantially less significant for insured workers than for uninsured workers. 

2 Not possible imder the 1950 amendments until July 1, 1954. 

3 Excludes agricultural employers. 
« Not available. 

5 Rounded to nearest $10. 



80 



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81 



3,190 
12, 838 

2,108 
701 
996 

8,348 

1,105 
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5,532 

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84 



Department of Health, Education, and Welfare, 1956 



Table 8. — Maternal and child health and welfare services: Grants to States for 
maternal and child health services, services for crippled children, and child 
welfare services under the Social Security Act, by program and State, fiscal 
year 1956 ' 

[In thousands] 



State 


Maternal 

and child 

health 

services 


Crippled 

children's 

services 


Child welfare 
services 


United States 


$11,921.3 


$14, 804. 


$6, 897. 3 






Alabama ------ -- 


426.1 
84.4 
85.9 
201.3 
607.9 
209.7 
144.8 
85.5 
150.6 
286.5 

360. 1 
141.6 

92.6 
309.7 
233.6 
177.1 
136.3 
291.4 
300.0 

87.6 

328.8 

350.8 

331.4 

223. 9 

307.7 

255.4 

84.2 

99.2 

73.2 

65.2 

157.4 
123.5 
453.8 
547.8 
85.1 
374.9 
156.1 
105.9 
482.4 
308.0 

84.9 
259.7 

86.1 
379.8 
543.7 
128.0 

77.0 

68.1 
321.2 
182.8 

185.5 

201.5 

75.6 


518.1 
169.7 


218.1 


Alaska ------ -- 


39.4 




66.3 


Arkansas . - - - 


309.9 
622.1 
148.2 
211.6 
93.2 
252.0 
392.5 

554. 5 
162.6 
150.7 
458.4 
151.5 
291.2 
177.5 
494.1 
372.4 
114.7 

308.7 
212.4 
461.7 
265.3 
327.1 
410.6 
131.0 
130.6 
86.9 
28.2 

213.8 
122.5 
444.9 
557.1 
106.2 
463.2 
322.0 
139.2 
561.6 
451.6 

126.7 
390.3 
106.3 
424.6 
701.5 
197.6 
97.6 
87.1 
395.7 
215.3 

287.7 

312.7 

71.4 


160.8 




239.7 


Colorado - - - - 


76.2 




68.4 




40.9 


District of Columbia -__--- 


28.9 


Florida... - . 


141.2 




225. 1 




33.0 


Idaho ------ -- 


29.3 




194.7 




98.7 


Iowa - - - - - 


150.7 




110.9 


Kentucky - - - . . 


221.3 


Louisiana . - - - - - 


173.1 




69.3 




100.8 


Massachusetts - - - . - 


80.0 


Michigan . - - _ - - - 


225. 1 




163.3 


Mississippi . - - - -- 


202.0 




170.8 




64.0 


Nebraska -. ---------- 


51.2 




23.7 


New Hampshire 


47.9 


New Jersey - - - -- 


81.1 


New Mexico - - - - -- 


71.6 




217.5 


North Carolina --- 


319.0 


North Dakota - - - - - - -- 


61.8 


Ohio - 


260.5 


Oklahoma 


135.0 


Oregon - -_ ------- 


51.0 


Pennsylvania ------ - 


294.3 


Puerto Rico - - - - - 


204.3 


Rhode Island - ----- 


39.1 




185.2 


South Dakota - --_ - 


70.6 


Tennessee - - ------ 


217.6 


Texas 


332.6 


Utah . 


58.5 




51.1 


Virgin Islands 

Virginia - -- --- -- --- 


30.0 
214.0 


Washington - -- _ - _- 


112.6 


West Virginia ------ -_- - - 


163.9 


Wisconsin - -. . - 


170.2 




41.0 







' Based on cheeks Issued less refunds. 



Social Security Administration 



85 



Table 9. — Federal credit unions: Number of members, amount of assets, amount 
of shares, and amount of loans outstanding, Dec. 31, 1935—55 



Year 


Number of 

reporting 

credit 

unions ' 


Number of 
members 


Amount of 

assets 


Amount of 
shares 


Amount of 
loans 


1935 - 

1936 -- 

1937 

1938 

1939 


762 
1,725 
2,296 
2,753 
3,172 


118,665 
307, 651 
482, 441 
631,436 
849, 806 


$2, 368, 521 
9, 142, 943 
19, 249, 738 
29, 621, 501 
47, 796, 278 


$2, 224, 608 
8, 496, 526 
17,636,414 
26, 869, 367 
43,314,433 


$1, 830, 489 
7, 330, 248 
15, 6f<3, 676 
23, 824, 703 
37, 663, 782 


1940 

1941 

1942 

1943 

1944 


3,739 
4,144 
4,070 
3,859 
3,795 


1, 126, 222 
1, 396, 696 
1, 347, 519 
1, 302, 363 
1,303,801 


72, 500, 539 
105, 656, 839 
119,232,893 
126, 948, 085 
144, 266, 156 


65,780,063 
96, 816, 948 
109, 498, 801 
116,988.974 
133, 586, 147 


55,801,026 
69, 249, 487 
42, 886, 750 
35, 228, 153 
34, 403, 467 


1945 

1946 

1947 

1948 

1949 


3,757 
3,761 
3,845 
4,058 
4,495 


1, 216, 625 
1, 302, 132 
1, 445, 915 
1, 628, 339 
1, 819, 606 


153, 103, 120 
173, 166, 459 
210. 375, 571 
258,411,736 
316, 362, 504 


140, 613. 962 
159,718,040 
192,410,043 
235, 008, 368 
285, 000, 934 


35, 1.55, 414 
56, 800, 937 
91,372,197 
137, 642, 327 
186, 218, 022 


1950 

1951 

1952 

1953 - 


4,984 
5,398 
5,925 
6,578 
7,227 
7,806 


2, 126, 823 

2, 463, 898 
2, 853, 241 

3, 255, 422 
3, 598, 790 
4,032,220 


405, 834, 976 
504, 714. 580 
662, 408, 869 
854, 232, 007 
1,033,179,042 
1, 267, 427, 045 


361, 924, 778 
457, 402, 124 
597,374,117 
767,571,092 
931,407,456 
1, 135, 164, 876 


263, 735, 838 
299, 755, 775 
415,062,315 
573, 973, 529 


1954 


681, 970, 336 


1955 


863, 042, 049 







' In the period 1945 through 1955, the number of operating and reporting credit unions was the same, 
other years, the number of credit unioas which reported was less than the number in operation. 



Table 10. — Federal credit unions: Assets and liabilities, Dec. 31, 1955, and 

Dec. 31, 1954 



Assets and liabilities 


Amount 


Percentage 
distribution 




Dec. 31, 1955 


Dec. 31,1954 


Change 
during year 


Dec. 31, 
1955 


Dec. 31, 
1954 


Nurnber of operating Federal credit 


7,806 


7,227 


579 












Total assets - -- . - 


$1, 267, 427, 045 


$1,033,179,042 


$ 234,248,003 


100.0 


100.0 






Loans to members - . _ 


863, 042, 049 
105,361,383 

83, 896, 302 
181, 956, 756 

24, 019, 882 
9, 150, 673 


681,970,336 
97, 740, 682 
84,313,214 

143, 974, 932 
17,737,716 
7, 442, 162 


181,071,713 
7, 620, 701 
-416,912 
37, 981, 824 
6, 282, 166 
1,708,511 


68.1 
8.3 
6.6 

14.4 
1.9 
.7 


66 


Cash. 


9.5 


United States bonds 


8.2 


Savings and loan shares . . 


13 9 


Loans to other credit unions -- . 


1 7 


Other assets . 


.7 






Totalliabilities.. .-. . 


1, 267, 427, 045 


1,033,179,042 


234, 248, 003 


100.0 


100 






Notes payable _ - 


29, 098, 259 

3, 642, 212 

1,135,164,876 

39, 042, 931 

2, 468, 400 

58, 010, 367 


19, 729, 224 

2, 772, 413 

931, 407, 456 

31,134,017 
2. 273, 804 

45. 862, 128 


9, 369, 035 

869, 799 

203, 757, 420 

7, 908, 914 

194, 596 

12, 148, 239 


2.3 

.3 

89.5 

3.1 
.2 

4.6 


1 9 


Accounts payable and other liabilities... 
Shares .. 


.3 

90.2 


Regular reserve - 


3 


Special reserve for delinquent loans 

Undivided earnings 


.2 
4.4 







Public Health Service 



Health of the Nation 

The past year was one of significant progress in American health. 
Advances were made in many fields, and the Nation's health status — 
as revealed in national death rates and the continued decline of the 
acute, communicable diseases — continued to improve. 

Reseui'ch scientists probed deeper into the causes and cures 
of today's major diseases. The national network of hospitals and 
medical facilities continued to expand. Important forward steps 
were taken to increase the numbers of professional health workers. 
Many State and local health services were intensified or broadened. 

In addition, a substantial number of significant new health measures 
were requested by the President and enacted into law by the Congress. 
This included legislation to aid research, to strengthen health services 
and increase health knowledge, and to augment medical manpower. 
Althougli some of these measures did not become law mitil after the 
close of the fiscal year, the legislation was drafted, studied, and con- 
sidered during the period covered by this report. 

Among the notable developments of the year was the appropriation 
by the Congress of the largest dollar increase for medical research in 
the history of the Public Health Service. The National Institutes of 
Health, principal research arm of the Public Health Service, began 
fiscal year 1957 with a total appropriation of $183 million. This fig- 
ure compares with a total appropriation for 1956 of $99 million and 
for 1940 of less than one million dollars. Most of the additional funds 
are being used to support research projects by scientists in hospitals, 
medical schools, health agencies, and private laboratories throughout 
the Nation. 

87 



88 Department of Health, Education, and Welfare, 1956 

LEGISLATIVE HIGHLIGHTS 

The President also recommended — and the Congress enacted — a 
new program of Federal aid for the construction of medical research 
facilities. The program authorizes the expenditure of $90 million over 
a 3-year period, to be matched on a 50-50 basis, by medical schools in 
keeping with the principle of partnership among those engaged in 
forwarding health. 

Better health for the American people depends upon a sufficient 
number of well-trained professional personnel. During recent years, 
the shortages in nui*sing and in trained public health workers have been 
especially serious. In his special message, the President recommended 
several measures to aid in stretching the supply of nurses and public 
health personnel. As a result, the Congress authorized, in Public Law 
911, a program of traineeships and advanced study for various types of 
professional personnel needed in State and local health agencies, and 
for professional nurses to qualify them for supervisory, administra- 
tive, and teaching positions. In addition, a program of grants to the 
States for vocational training of practical nurses was authorized, to be 
administered by the Office of Education, These steps, combined with 
the augumented program of assistance to students and teaching scien- 
tists, should enable the Nation to make substantial inroads on the 
health manpower shortage. 

Public Law 911 also included provisions to increase the number of 
hospital and medical care facilities and to improve the care and treat- 
ment of the mentally ill. Both of these measures were enacted at 
the request of the President. Title 4 of P. L. 911 extended, for a 
2-year period, the successful local- State-Federal program of hospital 
and medical facilities construction (see p. 119) and authorized an in- 
crease in funds for the program. Title 5 authorized a program of 
Federal grants for special studies of the institutional care of the men- 
tally ill. The projects are designed to develop better methods of care 
of the mentally ill, and to improve administration and services in 
mental hospitals. 

The President also recommended several other steps to improve pub- 
lic health services and to increase knowledge of health needs and 
problems. One of the important measures enacted by the 84th Con- 
gress was authorization for the Public Health Service to conduct a 
continuing national survey of sickness and disability in the United 
State (P. L. 652). This will help provide up-to-date and compre- 
hensive information on the extent, nature, and severity of the major 
diseases and impairments in this country. By the end of the fiscal 
year, plans were already under way by the Public Health Service t^n 
set up the survey mechanism (see p. 92V 



Public Health Service 89 

To help clean up our Nation's streams and rivers, the Congress 
enacted Public Law 660, which extends and strengthens the Federal- 
State water pollution control program (see p. 142). 

This year, too, the Congress created a National Library of Medicine 
within the Public Health Service. The law (P. L. 931) provided for 
the transfer of the Armed Forces Medical Library from the Depart- 
ment of Defense and authorized the erection of a new building to re- 
place the present obsolescent structure. This Library houses the 
world's greatest collection of medical literature and is of inestimable 
value to the medical profession and the Nation. A l7-member Board 
of Regents, authorized by the legislation, will advise on a site for the 
new library building. Plans for effecting the transfer of the library 
from the Department of Defense to the Public Health Service were 
completed shortly after the end of the fiscal year. 

Other health measures enacted during the year or on which 
substantial progi'ess was made toward enactment were: P. L. 411, 
which extended the duration of financial assistance to the States for 
the purchase of poliomyelitis vaccine (see p. 131) ; P. L. 732, which 
authorized $4 million for a new building to house the laboratories of 
the National Institute of Dental Research ; P. L. 830, which authorized 
the construction of mental health facilities for the Territory of 
Alaska ; P. L. 832, which authorized a Congressional appropriation of 
$400,000 to defray the costs of holding the 11th Assembly of the World 
Health Organization in the United States in 1958; and P. L. 854, 
which provided salary increases for the Surgeon General and other 
top officials and for medical and biological scientists in the Public 
Health Service and other Federal agencies. 

Taken together, all these measures represent a broad and compre- 
hensive approach toward meeting many of the Nation's leading health 
needs. They reflect the deep desires of the American people for a 
healthier and happier life and the expressed wish of the President to 
work unceasingly toward that goal. This, then, has been a year of 
unusual activity in the field of health — by professional and voluntary 
groups and at all levels of government. America's multipartnership 
in the health cause has been strengthened and fortified, and should 
yield even greater dividends in the years to come. 

HEALTH RECORD 

As already noted, the Nation continued to enjoy good health during 
the past year. The death rate for 1955 ^ was 9.3 per 1,000 population, 
compared with the 1954 record low of 9.2 and the previous low of 9.6 
in 1950, 1952, and 1953. This was the eighth consecutive j^ear that 
the death rate has been below 10 per 1,000. 



1 An vital statistics are given for tlie calendar year. 
408691—57, 7 



90 Department of Health, Education, and Welfare, 1956 

The infant mortality rate, 26.4 deaths per 1,000 live births, remained 
practically unchanged from 1954. The maternal mortality rate con- 
tinued its descent in 1955, with 4.7 maternal deaths per 10,000 live 
births. 

The average length of life was 69.5 years for the entire population 
in 1955, the most recently published life tables for the United States. 
The average life expectancy was 67.3 years for white males, 73.6 for 
white females, 61.2 for nonwhite males, and 65.9 for nonwhite females. 

An increasing proportion of all deaths was caused by the major 
cardiovascular-renal diseases. This group accounted for 54 percent 
of the deaths in the United States during 1955, with a death rate of 
506.0 per 100,000 population. Cancer caused 16 percent of all deaths 
in 1955. The death rate was 146.5 per 100,000 population. 

The mortality trend for accidents has been generally downward 
since 1936. In 1955, the death rate was 56.9 per 100,000 population. 
In the last 10 years, there has been no definite trend in the rate for 
motor- vehicle accidents. But the rate for all other accidents dropped 
nearly a third — to 33.5 in 1955. 

Deaths from most communicable diseases continued to decrease. 
The tuberculosis death rate dropped from 10.2 per 100,000 population 
in 1954 to 9.1 in 1955. The principal diseases of childhood — scarlet 
fever and streptococcal sore throat, diphtheria, whooping cough, and 
measles — which caused about 10 deaths per 100,000 children in 1945, 
were responsible for about 1 death per 100,000 in 1955. Since 1937, 
when the sulfa drugs were introduced, the influenza-pneumonia death 
rate has been cut three-fourths, from 114.9 in 1937 to 27.1 in 1955. 

Many infectious diseases also decreased in incidence. Reduc- 
tions of 20 percent or more were reported for infectious hepatitis, 
poliomyelitis, malaria, and typhoid fever. In 1955 the total number 
of reported cases of infectious hepatitis was 31,961, as compared with 
50,093 in 1954. The incidence of poliomyelitis decreased from 38,476 
in 1954 to 28,985 in 1955. Although the incidence of diphtheria has 
been decreasing for many years, there was an increase in the nmnber 
of cases during the latter part of 1955. 

BIRTHS, MARRIAGES, AND DIVORCES 

About 4,047,300 live births occurred in 1955, slightly more than 
the total in the preceding year (4,017,362) . However, since the popu- 
lation increased nearly 2 percent between 1954 and 1955, the birth rate 
declined slightly — from 24.9 to 24.6 per 1,000 population. There was 
a continued rise in the proportion of registered births occurring in 
hospitals — 94.4 percent — and in the proportion attended by physi- 
cians — 96.8 percent. 



Public Health Service 91 

The number of marriages increased slightly. There were 1,531,000 
marriages in 1955, for a marriage rate of 9.3 per 1,000 population, 
compared with 1,490,000 marriages in 1954, and a rate of 9.2 per 1,000 
population. Figures for 1955 indicate a slight decrease in the num- 
ber of divorces. In 1954 there were 379,000 divorces, for a rate of 
2.4 per 1,000 population. 

Change in Leadership 

In April 1956, Dr. Leonard A. Scheele was reappointed Surgeon 
General of the Public Health Service for a third four-year term. 
Shortly after the close of the fiscal year. Surgeon General Scheele an- 
nounced his retirement from the Service, effective August 1. President 
Eisenhower appointed Dr. Leroy E. Burney as the eighth Surgeon 
General of the Public Health Service on August 3, 1956. A career 
officer of the Public Health Service, Dr. Burney served as Chief Deputy 
of the Bureau of State Services from 1954 to 1956 and was Commis- 
sioner of Health for the State of Indiana for 9 years. 

Funds and Personnel 

For its various programs and activities, there was a total of $485.7 
million in funds available to the Public Health Service in 1956 (see 
table 1, page 153). About $395 million of this sum was in appro- 
priations and authorizations, with the balance made up of reim- 
bursements for services rendered to other agencies and in unobligated 
balances from previous years. 

Grants to the States for health programs and for construction of 
health facilities amounted to 39.7 percent of the total funds obligated. 
Research and training grants to medical, dental, and research insti- 
tutions represented 16.2 percent of the total. 

At the close of 1956, there were 21,268 full-time employees in the 
Public Health Service (see table 2, p. 155). This number included 
1,266 members of the regular Conmiissioned Corps of the Service, 
1,698 members of the Reserve Corps on active duty, and 18,304 full- 
time Civil Service employees. 

Public Health Methods 

The Division of Public Health Methods evaluates national health 
needs and resources in a staff capacity for the Surgeon General. It 
conducts special studies, develops and applies methods for measur- 
ing the extent and nature of disability and illness, and participates 
in special cooperative projects with public and private agencies. The 
Division also edits and publishes Public Health Repoi^ts and the Pub- 



92 Department of Health, Education, and Welfare, 1956 

lie Health Monog-raphs, media for disseminating information about 
public health research, practice, and administration. 

ANALYSIS OF ILLNESS AND MORTALITY 

Legislation enacted during the year authorized the Public Health 
Service to conduct a continuing national survey and special studies of 
sickness and disability. The National Health Survey Progi'am, lo- 
cated in the Division of Public Health Methods, will consist of a con- 
tinuing sampling of the population by means of household interviews 
designed to secure data on sickness, disabilities, and the medical care 
received for these conditions. It will also include special studies to 
collect detailed morbidity information, for example, physical exam- 
inations and clinical tests of a subsample of pei*sons interviewed during 
the household survey. The purpose of the program is to provide 
statistical information that will define more clearly the extent of illness 
and disability in the Nation. 

The direction of a special survey of Indian health was made the 
responsibility of tlie Division in July. Requested by the Committee on 
Appropriations of the House of Representatives, its purpose is to de- 
termine measures needed to bring Indian health to an accepted level. 
Statistics on the Indian population were assembled and analyzed, and 
a house-to-house morbidity survey was made at selected reservations. 
Information on public health services was collected by means of a 
questionnaire, supplemented by data routinely reported to the Pub- 
lic Health Service. Information on health services provided by the 
Division of Indian Health was obtained from that Division and by 
special field studies. A study of economic and social resources avail- 
able for Indian health was carried on by contract arrangements with 
universities. A preliminary report was made to Congress at the end 
of October ; a comprehensive report will be submitted later. 

A study of surgical experience in selected areas of the United States 
was completed. In it these observations are reported : Fewer surgical 
removals of tonsils and the appendix have taken place in small cities 
and rural areas than in large cities, in nonwhite than in the white 
population, in eastern cities than in those of the far west, and in 
families with low incomes than in those with higher incomes. 

HEALTH PERSONNEL STUDIES 

Part one of a, manual, Cost Analysis for Collegiate Programs in 
Nursing, has been completed. Prepared with the assistance of the 
Division of Nursing Resources, and published by the National League 
for Nursing, it presents a method for analysis of expenditures. The 
preparation of part two of the manual continued during the year. 

A pilot study that applies cost analysis methods to medical edu- 
cation, in which the Division is cooperating with Emory University, 



Public Health Service 93 

is Hearing completion. This has required detailed study of the finan- 
cial relationships between the school of medicine and the parent uni - 
versity, the hospital, and other professional schools. The dividing 
of expenditures according to the primary functions of teaching, re- 
search, and service, and the technical problems of allocating indirect 
expenditures added to the complexities of the study. 

Another study nearing completion is that being made in collabora- 
tion with the American Hospital Association and the National Asso- 
ciation of Social Workers. This study represents the first compre- 
hensive survey in 25 years to determine the extent to which medical 
social service is a part of hospital care, 

In cooperation with the Division of Dental Eesources, a report on a 
special study of original tabulations of dentists made for the Health 
Manpower Source Book series was published this year in an article on 
the location of dentists. The location of dentists graduated in recent 
years was contrasted with the distribution by residence of students 
attending dental school within the past 12 academic years. Members 
of the Division made extensive contribution to a publication of the 
Office of Defense Mobilization released during the fiscal year that 
reviews for each category of paramedical personnel such characteris- 
tics as these : functions, education, supply, demand, aids for teaching 
and training, and recommendations for overcoming shortages. The 
Division also provided consultative service to many groups, including 
representatives from abroad, on problems associated with health and 
medical personnel. 

STUDIES OF HEALTH SERVICES 

Among the important studies completed by the Division during the 
year was one jointly sponsored by the Division of Special Health 
Services and the Commission on Chronic Illness. This was a study of 
selected home care programs, undertaken because of the interest in 
the provision of care to patients at home. Among the findings of the 
study is the observation that patients of all economic groups, espe- 
cially those with long-term illness, need coordinated services at home 
during some phase of illness ; yet comparatively few communities have 
recognized the potential of organized home care. 

During the fiscal year, the Commission on Chronic Illness began 
to terminate its activities, preparatory to eventual deactivation and to 
the transfer of its functions to other agencies and groups. Among 
the final tasks, in which the Division is participating, is the 
preparation of the report of the Commission in a four-volume series 
entitled "Chronic Illness in the United States." Volmne I, Pre- 
vention of Chronic Illness, will present the Commission's recom- 
mendations and will include a revision of 16 technical statements on 
preventing chronic disease. 



94 Depurtinent uf Health, Education, and Welfare, 1956 

National Institutes of Health 

The National Institutes of Health, the main research bureau of the 
Public Health Service, continued to conduct and support research and 
research training in the major diseases of our time. In 1956 its lab- 
oratory and clinical investigations at Bethesda, Md., as well as its 
extensive program of research grants, represented about a quarter 
of the medical research in this country. Approximately two-thirds of 
the NIH appropriation was awarded to scientists in medical schools, 
hospitals, and other non-Federal institutions (see table 3, page 157). 

Today's medical scientist, in order to make maximum progress, re- 
quires highly skilled teams of auxiliary personnel. In December 1955 
centralized services at NIH were reorganized and expanded to form 
two new Divisions — the Division of Research Services and the Divi- 
sion of Business Operations. The research services are performed by 
branches concerned with biometrics, laboratory aids, plant engineer- 
ing, research facilities planning, sanitary enginering, and scientific re- 
ports. The business operations are the responsibility of branches on 
financial management, management analysis, offices services, personnel, 
plant safety, supply management, and a Board of United States Civil 
Service Examiners. 

Another program change was an expansion of activities in the Na- 
tional Microbiological Institute, with a change of name to National 
Institute of Allergy and Infectious Diseases. NIH now comprises 
seven institutes and five divisions, including the Clinical Center. 

Clinical Center 

A total of 443 beds had been activated in the Clinical Center by the 
end of fiscal year 1956, an increase of 70 over the previous year. Pa- 
tients hospitalized for study totaled 2,112, and their average stay was 
44.5 days. The average daily census was 281. All of these figures 
represent substantial increases over the preceding year. 

One handicap to the clinical program is the continuing nation- 
wide shortages of essential professional workers, particularly gradu- 
ate nurses. In an efTort to attain maximum use of the clinical 
facilities, an intensive nationwide program of nurse recruitment was 
begun, in cooperation with other parts of the Public Health Service. 

Despite this handicap, a varied and vigorous program of clin- 
ical study, closely meshed with NIH's laboratory research, is now 
firmly established. It has already made numerous contributions, 
many of which are mentioned elsewhere in this report. 

Less tangible, but in the long run not the least of these contribu- 
tions, is the progression of young physicians who go out each year 



Public Health Service 95 

from the Clinical Center to the faculties of medical schools, to 
hospitals and other institutions, and to private practice. These physi- 
cians — designated as clinical associates — come to NIH directly from 
the first or second year of residency in leading general and special hos- 
pitals. Under the direction of senior clinical investigators, they pro- 
vide necessary medical and surgical care for the research patients 
while also taking part in the research studies. 

Many young physicians use their NIH service as qualifying experi- 
ence toward their chosen medical specialty, and all have an oppor- 
tunity to learn the techniques and traditions of research medicine. 
This program is thus enhancing the ability of hundreds of physicians 
throughout the country to do independent research and to approach 
the teaching and practice of medicine with the inquiring mind and 
sharpened skills of the research worker. 

Large numbers of physicians, nurses, dietitians, science teachers, 
and hospital administrators from every part of the Nation and many 
foreign countries continued to visit NIH, attracted by the new clinical 
program. The schedule of lectures, seminars, symposia, and clinical 
staff conferences also attracted many physicians and scientists. 

Division of Biologies Standards 

The past year has been one of substantial accomplishment for the 
Division of Biologies Standards, which was created a year ago. 
The intensified developmental research and testing required for 
poliomyelitis vaccine, as well as the background research for the 
entire program, necessitated an increase in staff from 45 to 138 
during the year. The need for additional space led to Congressional 
authority for the construction of a $3,500,000 building, planned for 
occupancy by January 1959. Meanwhile, temporary space was made 
available for immediate expansion of the Division's four programs — 
viral products, bacterial products, blood and blood products, and 
control activities. 

During the year, the Division strengthened the program concerned 
with testing the poliomyelitis vaccine. More than 80 million cubic 
centimeters of vaccine were released — 57 million cc.'s of this amount 
since January 1. 

The close cooperation of the manufacturers, the Technical Com- 
mittee on Poliomyelitis Vaccine, and Division scientists has made 
possible the development of improved measures for dealing with a 
number of technical problems affecting consistent and safe vaccine 
production. These measures involve: (1) suitably spaced filtration 
procedures to remove aggregates in which virus may be protected 
from inactivation by formaldehyde, (2) improved sampling methods 
in the tissue culture tests, and (3) increased sensitivity of the monkey 



96 Department of Health, Education, and Welfare, 1956 

safety test. This has required an intensified testing program, close 
observation of manufacturing processes, and a revision of the origi- 
nal requirements for manufacture and testing. 

Division scientists are studying human cell lines in tissue culture, 
with a view to finding one that will be even more sensitive to polio- 
myelitis virus than the monkey kidney cells now in use. Other work- 
ers are studying the possible emergence of resistant mutants or vari- 
ants to formaldehyde, ultraviolet light, and other inactivating agents ; 
and methods for improving the potency test of the vaccine. 

The Division is also concerned with such problems as the purifica- 
tion of rabies vaccine, the classihcation and isolation of influenza 
virus, the control of serum hepatitis, and methods for extending the 
storage period of blood for transfusion. A complete panel of red 
cells of known antigenic makeup has been prepared for identifica- 
tion of antibodies of unknown bloods. In addition, complete geno- 
typing of families with hei'editary abnormalities is being clone in 
a search for red cells of unusual types. 

Division of Research Grants 

Because the conquest of many diseases depends to a large extent 
on a vastly increased understanding of fundamental biological struc- 
tures and processes, the Division of Kesearch Grants placed particular 
stress on the support of basic medical research during the fiscal year. 
These biological structures and processes contain the ultimate sig- 
nals of any abnormality preceding a disease process. Many of these 
signals, however, remain so delicate and subtle that we have not yet 
been able to develop the necessary skills, apparatus, or methods 
required to establish valid criteria or baselines. 

In order to aid the numerous scientists attempting to furnish these 
criteria, the Division of Research Grants, through its recognized 
authorities composing the National Advisory Health Council and 
the various Study Sections, instituted new programs specifically 
designed to increase the number and special training of research 
scientists in the fields of biophysics, instrumentation, and pathology. 
Reward from this support was evident in the degree of progress 
made in these fields, as well as in biochemistry, histochemistry, meta- 
bolism, reproduction, endocrinology, physiology, and radiation. 

Especially conspicuous was the advance made in obtaining more 
highly purified ribonucleic compounds for study. These compomids, 
predominant in the genes, control the development of the individual as 
well as the heredity of unborn generations. Hence, the effects of radi- 
ation and numerous deleterious chemical substances have been in- 
tensively explored. 



Public Health Service 97 

Significant progress was also made in understanding how certain 
metals, serving as part of an enzyme system, react within the body as 
a "claw" that reaches out and fastens itself to certain proteins. The 
year was further marked by a more widespread use of techniques pri- 
marily designed for the physical sciences. On one grant-supported 
project, the emission spectroscope revealed previously unidentified 
inorganic material in the biological sample. 

Institute of Allergy and Infectious Diseases 

A major development at NIH during the year was the delegation 
to the National Microbiological Institute of responsibility for a broad 
program of fundamental research on allergy. Authorization was 
made by the Surgeon General and became effective December 29, 1955. 

It was also decided to change the Institute's name to the National 
Institute of Allergy and Infectious Diseases. The new name not only 
reflects the importance attached to the program ; it also emphasizes the 
close relation of allergy to the study of infectious diseases, particularly 
those concerned with immunology. 

The decision to initiate an expanded research program in allergy 
was the outgrowth of a series of conferences at the National Institutes 
of Health, attended by some of the Nation's leading authorities in 
allergy and immunology. It was decided that major emphasis should 
be placed on grant-supported studies to encourage scientists in schools 
and hospitals to investigate problems in this long-neglected field. 

An estimated 10 percent of the population in this country suffers 
from some form of allergy, with asthma victims alone numbering be- 
tween one and two million. Despite the widespread prevalence of 
these disorders, present knowledge of allergy is meager. This is par- 
ticularly true concerning the underlying mechanisms of the allergic 
response. 

One of the most notable areas of progress in infectious disease re- 
search in the past year was the field of common respiratory diseases. 
An experimental vaccine developed by scientists of the Institute 
against one type of APC virus was tried out in prisoner volunteers 
and was shown to provide substantial protection against induced in- 
fection. On the basis of these results, a field trial in cooperation with 
the Navy was initiated in January 1956 to evaluate an APC vaccine 
made from three strains of virus which are an important cause of res- 
piratory disease in military recruits. This group of viruses, recently 
renamed adenoviruses, produce grippe-like illnesses. They are not 
the cause of nonfeverish illnesses commonly termed colds. The 
vaccine effected a significant reduction in the occurrence of acute 
respiratory disease due to the APC virus prevalent during the period of 
observation. 



98 Department of Health, Education, and Welfare, 1956 

Institute scientists succeeded in crystallizing Coxsackie virus for 
the first time. Isolation of a human virus in crystal form was first 
achieved in 1955 by University of California scientists working with 
poliomyelitis virus grown in tissue culture. The NIAID studies repre- 
sent the first time any virus has been obtained in pure crystal form 
directly from animals. Purification of viruses opens new opportuni- 
ties to study their chemical makeup and immunological reactions. 

New advances were reported in tissue culture studies aimed at de- 
fining the minimal nutritional requirements of various cell lines. Thus 
far, Institute scientists have shown 27 factors to be essential for survi- 
val and growth of cells in the test tube. Among these are 13 amino 
acids and 8 vitamins, including inositol, one of the least understood 
of the vitamins and one for which there is no evidence of a require- 
ment in man. 

In studies of the nutritional requirements of certain parasitic 
worms, Institute scientists have succeeded in cultivating in the test 
tube for the first time a nematode parasite of a vertebrate through 
its entire life cycle. As a result, studies can now be made with para- 
sites exposed to a predetermined environment uncomplicated by the 
bacteria normally found in the intestinal tract of laboratory animals. 

During the past year, scientists of this Institute reported isolation of 
type 1 poliomyelitis virus from an infant born at the time his mother 
was in a respirator suffering from acute poliomyelitis. This is be- 
lieved to be the first time a subclinical infection with poliomyelitis has 
been demonstrated in a newborn infant. The child's growth and de- 
velopment have been normal. 

RESEARCH GRANT STUDIES 

Grant-supported studies in the Nation's universities and other re- 
search institutions produced a nmnber of significant results. A 
University of Chicago scientist, for example, demonstrated that an 
outbreak of the pulmonary fungus disease, histoplasmosis, was caused 
by inhalation of spores while spreading infectious chicken manure 
compost on garden soil. Another study at Iowa State College showed 
a marked reduction in the number of trichinae, the microscopic para- 
sites causing trichinosis, in bulk and untreated-link sausage over the 
nmnber found 10 years earlier. This reduction is probably due to 
sterilization of the garbage fed to hogs or to elimination of garbage 
feeding. Tests carried out on smoked and heat-treated link sausage 
yielded no trichinae. 

Institute of Arthritis and Metabolic Diseases 

Research conducted and supported by this Institute during the 
year yielded a number of important developments. Progress has 



Public Health Service 99 

been notable both in basic studies directed toward development of 
fundamental knowledge of the complex metabolic processes and in 
clinical investigations seeking improved methods of treatment. 

PROGRESS IN RESEARCH 

Higlilighted in this report last year was the fact that NIAMD had 
conducted the first clinical trials of two new steroid compounds, 
prednisone and prednisolone. These chemical cousins of cortisone 
were reported to be several times as potent as the older steroid in the 
treatment of rheumatoid arthritis, yet safer to use because they did 
not cause certain untoward side effects. During the past year these 
new drugs have, in everyday use, borne out the preliminary findings 
of the scientists. They are now rapidly replacing cortisone and 
hydrocortisone in the treatment of rheiunatoid arthritis and several 
other diseases. Meanwhile, the search for even better antirheumatic 
drugs continues. 

Research in the field of metabolism yielded a discovery which can 
result in saving the lives of many children suffering from a usually 
fatal hereditary disease of infants — galactosemia. Institute scien- 
tists found in the blood of normal persons a new enzyme which makes 
it possible for the body to convert one of the sugars in milk, galactose, 
into glucose (blood sugar), which produces energy. Searching 
further, they found that children suffering from galactosemia lacked 
this enzyme. Now that the basic cause is known, a relatively simple 
diagnostic test is made possible. This is important because early diag- 
nosis and treatment are vital. Treatment of the disease, when diag- 
nosed, is simple : removal of milk from the diet. 

Another promising compomid, 9-alpha-flourohydrocortisone, was 
studied intensively last year as a part of the Institute's continuing 
search for improved antiarthritis drugs. It was found to be 20 to 
40 times more potent than cortisone in its antirheumatic action, but 
unfortunately, it caused serious side effects which will prevent its use 
in the treatment of arthritis. 

It is a noteworthy event when pain-relieving power similar to that 
of morphine is demonstrated in a new chemical type. Chemists at 
the Institute have produced such a compound. Preliminary tests in- 
dicate that the new drug has low addiction liability. 

Institute scientists have foimd that a well-known chemical steri- 
lizer, ethylene oxide, destroys essential vitamins in food products, 
even though thoroughly removed from the products before marketing. 
It is employed in industry to sterilize food items when steam or other 
conventional methods cannot be used. 

One of the principal hormones secreted by the pituitary gland con- 
trols the activity of the thyroid gland. NIAMD investigators have 
developed a sensitive, accurate, and rapid method by which this hor- 



100 Department of Health, Education, and Welfare, 1956 

mone may be assayed. The method is being used to guide efforts to 
isolate and purify the hormone in the laboratory. 

Searching for new raw material sources for the synthesis of anti- 
arthritis drugs, chemists at the Institute have extracted from the 
dried leaves of a shrub which grows wild in Paraguay the sweetest 
natural product yet Iniown, a substance called stevioside, which is 
300 times sweeter than table sugar (sucrose) . 

During episodes of acidosis, which lead to coma and death, dia- 
betics often are unresponsive to insulin. Institute scientists have 
shown that the plasma of patients with diabetic acidosis contains a 
material which suppresses or abolishes the effect of insulin. Search 
for the source of this insulin inhibitor is continuing. 

PROGRESS IN GRANTS 

Through its extramural programs, NIAMD supports research pro- 
jects in non-Federal institutions throughout the country, provides 
grants to medical schools for graduate training programs, provides 
research fellowships for medical students, and awards training sti- 
pends which enable physicians to develop specialized skills in the rheu- 
matic and metabolic diseases. Research grants recommended by the 
National Advisory Arthritis and Metabolic Diseases Council yielded 
such results as the following. 

Although degenerative joint disease (osteoarthritis) is considered 
to be largely due to wear, tear, and irritation of the joints, grantees at 
Washington University, St. Louis, have found that laboratory ani- 
mals fed a high-calorie, high-fat diet are more likely to develop this 
disorder than animals that are underfed. 

At Yale University, grantees have developed a technique by which 
high-frequency sound waves are used to break up urinary calculi — 
stones found in the kidney, bladder, and ureter. 

At the Boston Children's Hospital, grantees have developed a new 
diagnostic test for mucoviscidosis, also known as fibrocystic disease of 
the pancreas, which is nearly always fatal if not found at an early 
stage. The new test, 98 percent accurate, is based upon analysis of 
sweat and is much more simple than the test previously used. 

At Johns Hopkins University grantees have found that one of the 
complications of diabetes, diabetic retinopathy, a disease of the retina 
of the eye, is linked to an apparent inability of the affected individuals 
to utilize vitamin B12. 

Cancer Institute 

The age-adjusted cancer mortality rate for women continued to 
decline slowly, following a trend which began about 1935. By 1954, 
the rate dropped to the level which prevailed in 1910. In contrast to 



Public Health Service 101 

this trend, the age-adjusted death rate for males is steadily increasing, 
and there is no indication of a slackening in the immediate future. 
Between 1950 and 1954, the respiratory system accounted for two- 
thirds of the rise in male mortality rates for all sites. 

The Third National Cancer Conference was held under joint spon- 
sorship of the Institute and the American Cancer Society. Arrange- 
ments were completed for the Journal of the National Cancer Institute 
to be issued monthly, beginning July 1, 1956, after 16 years as a 
bimonthly publication. 

NATIONAL CHEMOTHERAPY PROGRAM 

The Cancer Chemotherapy National Service Center, headquarters 
for the national voluntary program of cooperative research and 
development in chemotherapy of cancer, completed its first year of 
operation. Under the guidance of advisory groups, steps were taken 
to stimulate, support, and assist research in cancer chemotherapj". 
Approximately 6,800 chemical compounds were procured for the 
screening program. These came principally from educational insti- 
tutions, government installations, and industrial firms. Financial 
support was given for the synthesis of new chemical agents and for 
the procurement of relatively large amounts of chemical agents that 
warrant extended investigation. Contracts for screening chemicals 
were let to five laboratories, providing a total capacity for amiual 
evaluation of between 5,000 and 10,000 compounds against three mouse- 
tumor systems. 

Preclinical pharmacological testing on five drugs was begun at the 
Food and Drug Administration under an arrangement whereby the 
FDA will provide the Center with a rather complete preclinical 
workup of compounds, at the rate of one or two a month. 

LABORATORY AND CLINICAL STUDIES 

The wide range of research activities at the Institute produced 
significant accomplisliments in both laboratory and clinical studies. 
New advances in cancer knowledge were reported by Institute scien- 
tists working in the fields of biology, biochemistry, chemical phar- 
macology, physiology, endocrinology, radiation, and surgery. 

Studies at the cellular level were assisted by the development of 
techniques for growing massive, long-term tissue cultures outside the 
body. Cells were grown freely suspended in a rapidly shaking nu- 
trient fluid. By this method cultures can be grown weighing as much 
as 21 grams, whereas conventional methods permitted the growth of 
cultures weighing only 20-50 mgs. 

The remarkable power of the amino acid arginine to reduce lethal 
toxicity of amino acid mixtures such as those used for intravenous 
feedings was reported by Institute scientists. It was later found that 



102 Department of Health, Education, and Welfare, 1956 

administration of arginine at the appropriate time will permit sur- 
vival of all rats receiving a lethal dose of ammonium ion. This ob- 
servation emphasizes the need for studying metabolism of ammonia, 
or ammonium compounds formed by molecular rearrangements within 
the body, as a practical problem in feeding by vein the patient who 
cannot eat. 

A new synthetic, water-soluble, complete diet has been developed 
and used successfully by Institute scientists in growing rats from the 
weanling stage through maturity. 

A new drug, Amphenone, developed by Institute scientists, was used 
successfully to suppress the functions of the adrenal glands. Hor- 
mones produced by the adrenals apparently play a role in the growth 
and development of some cancers. Drugs like Amphenone may be- 
come effective substitutes for surgical removal of the adrenal glands 
in patients with breast cancer for whom adrenal surgery has a pallia- 
tive effect. It has also brought adrenal overactivity under control in 
other patients who suffer from cancer of the adrenal glands or adrenal 
overgrowth. 

Studies in radiation therapy have shown that both tumor response 
and normal-tissue tolerance may be improved if effective doses of 
ionizing radiations are administered over prolonged periods of time 
rather than in shorter periods as generally practiced. 

Institute scientists have reported that the cause of hypoalbuminemia 
in cancer patients appears to be a defect in the rate of production of 
albumin in the body. Hypoalbuminemia is a decreased concentration 
of circulating albumin, a blood plasma protein. This observation was 
made in the course of a study of the distribution and metabolism of 
blood proteins of cancer patients. 

STUDIES SUPPORTED BY GRANTS 

Activity of scientists working under grants covered all phases of 
research on the cancer problem: the cancer-producing process, im- 
provements in diagnostic and therapeutic procedures, and host-tumor 
relationships. In the search for drugs to block certain chemical path- 
ways necessary for the growth of cancer, grant-supported scientists 
found that selenium cystine produced temporary remissions in a few 
leukemia patients. In one patient this drug appeared to neutralize 
the resistance that he had acquired to another drug, 6-mercaptopurine. 
The occurrence of disagreeable side effects indicates the need for 
further study. 

A grantee has observed that bile may carry a substance that produces 
cancer specifically in the biliary system. Subcutaneous injection of 
bile from individuals with cancer of the bile duct into hamsters and 
mice produced cancer of the bile duct in some of the animals and 
cancer of the liver in others. In sharp contrast, hamsters tested with 



Public Health Service 103 

bile from normal individuals and from those suffering from benign 
biliary tract disease showed only sloughing of the skin at injection sites. 
Some light was shed on duplicating biologic systems by a study in 
which living virus was separated into its major components — a protein 
and a nucleic acid — and was then caused to reconstitute itself through 
proper mixing. The reconstituted virus regained the attributes of 
life : it infects other cells and reproduces. This study has an impor- 
tant potential for extending knowledge of viruses that cause cancers 
or destroy them and of the growth and multiplication of cancer cells. 

BIOSTATISTICAL AND FIELD INVESTIGATION STUDIES 

"Morbidity from Cancer in the United States, Part I," a definitive 
work on the occurrence of cancer in 10 metropolitan areas, was pub- 
lished. Results of a survey on the distribution of smoking patterns in 
the country, taken by the Bureau of the Census for the Institute, were 
tested on the relation between smoking and lung cancer. The study 
indicated that the risk of lung cancer for the total population of the 
United States appears to correspond to that found in earlier studies 
of selected groups of smokers and nonsmokers. 

Analysis of recorded mortality among Navajo Indians has confirmed 
the presumed deficit of cancer and cardiovascular-renal disease in this 
population group. 

Studies of the cell examination techniques for early detection of 
uterine cancer, initiated 3 years ago in Memphis, Tenn., were widened 
by establishment of field projects in eight different areas of the coun- 
try. The new centers will provide comparative data for the estab- 
lishment of true incidence rates and more information on the natural 
history of carcinoma in situ. One objective is to demonstrate that 
eventual widespread application of this screening teclinique will help 
eradicate cervical cancer. 

The results on 75,000 patients with cancer during a 17-year experi- 
ence were analyzed in a collaborative study with the Connecticut State 
Department of Health. There has been a significant improvement 
in survival rates, not attributable to earlier diagnosis, and referable 
particularly to specific sites of the rectum, colon, and uterus. 

CANCER CONTROL AND RESEARCH TRAINING 

Grants in the amount of $2,250,000 were made to health agencies 
in 47 States and 4 Territories for the support of cancer programs. 
These are directed toward expansion and wider use of cancer diagnos- 
tic and treatment services. 

Manpower resources in the cancer field were augmented under the 
Institute's three specialized training programs: teaching grants to 
medical, dental, and osteopathic schools; support of physicians in 
clinical traineeships ; and support of research fellowships to promis- 



104 Department of Health, Education, and Welfare, 1956 

ing young scientists. The latter two programs have been in opera- 
tion for 18 years. 

Institute of Mental Health 

The challenge of the national mental health problem resulted in 
important forward strides in 1956. These included measures of Fed- 
eral and State legislatures, development of more effective research 
tools and treatment techniques, increasing nvmibers of trained scien- 
tific and professional personnel, and greater interest and participa- 
tion in mental health activities by citizens and private organizations. 

Early in the fiscal year, Congress enacted the Mental Health Study 
Act (P. L. 182) , which provided for a thorough review and evaluation 
of current Iniowledge concerning resources, methods, and practices for 
dealing with mental illness. The study is expected to produce rec- 
ommendations on how to extend psychiatric knowledge and how to 
make more effective use of professional personnel and facilities, both in 
short supply. Under the terms of the act, the National Institute of 
Mental Health awarded a grant to the Joint Commission on Mental 
Illness and Health, Inc., to conduct a nationwide analysis and evalua- 
tion of the human and economic aspects of mental illness. The Com- 
mission's membership includes representatives of the American Med- 
ical Association, the American Psychiatric Association, and 19 other 
national organizations having a major interest in the social, legal, 
scientific, clinical, and psychological aspects of mental illness. 

In every State during 1956, there was an accelerated effort to meet 
mental health needs. There were increasing requests for technical 
and consultative services in State hospitals and institutions, in pro- 
fessional and community education programs, and in clinic and re- 
habilitative services. Consultants in special areas such as drug addic- 
tion were added, and work was extended on alcoholism, school mental 
health, and inpatient services for emotionally disturbed children. 

The Institute also worked with the States on two other major mental 
health problems — juvenile delinquency and mental retardation. 
Grants to support a wide range of basic and applied research were in- 
creased in both of these areas. In addition to expanded research, the 
Institute made available the services of specialized staff to State and 
private organizations and to other Federal agencies planning and 
evaluating remedial action. 

The States also focused attention on extending community 
mental health services. Such services contribute to mental health gen- 
erally, help prevent admissions to hospitals, and increase the num- 
bers of persons who can be discharged from mental hospitals. Sev- 
eral States enacted legislation providing for matching local coimiiunity 
mental health expenditures on a 50-50 basis. 



Public Health Service 105 

Regional cooperation by States in the field of mental health con- 
tinued to grow. Pooling of mental health resources has enabled each 
participating State to benefit from the facilities of a total area, rather 
than from its own facilities alone. The most recent of these inter- 
State compacts for mental health — and the second to be supported by 
an Institute grant — was undertaken by the Western Interstate Com- 
mission for Higher Education. 

ADVANCES IN TRAINING 

During the past year. Institute grants supported graduate training 
in clinical psychology, psychiatric nursing, psychiatric social work, 
public mental health, and psychiatry. Other grants were awarded 
to medical schools to improve psychiatric instruction. 

In addition to extending the training opportunities for personnel 
associated with the mental health professions, grants were made to 
support various pilot projects in evaluating teaching methods and 
training procedures. A grant awarded to the College of Nursing at 
Wayne University has among its objectives the determination of the 
value of an investment in preservice education for psychiatric aides. 
Scheduled for intensive study are the effects of such training on 
patient care, the proper content and teaching methods for a preservice 
program, and the identification of those areas of supervision and 
administration which can be safely assumed by the trained aide in 
caring for the psychiatric patient. 

Attention was also given to providing mental health training courses 
for lawyers, teachers, ministers, and others who deal with human 
problems. One current grant to the Law School of the University of 
Pennsylvania is to develop the curriculum content and methods for 
training law students in the behavioral sciences. Nine grants were 
awarded in support of institutes for general practitioners, pediatric- 
ians, psychologists, and other professional personnel to acquaint them 
with recent advances in research on mental retardation and techniques 
for counseling parents of retarded children. 

DEVELOPMENTS IN MENTAL HEALTH RESEARCH 

Both the intramural and extramural research programs of the 
Institute benefited from the intensified application of techniques de- 
rived from a wide range of scientific disciplines. A strong stimulus 
to research came from statistical studies. The collection and eval- 
uation of data from mental health clinics and hospitals and the devel- 
opment of unified reporting systems on a nationwide basis have raised 
a host of questions concerning etiology, treatment, and types of com- 
munity services that can and should be provided. 

In the research grants program of the Institute, increased research 
potential has made possible a growth in large, multidisciplined, pro- 

408691—57 8 



106 Department of Health, Education, and Welfare, 1956 

gram-type projects as well as expanded efforts in clinical psychology 
and psychiatry and basic physiological, psychological, and sociologi- 
cal investigations. 

The several grants made to finance conferences were an indication 
of the Institute's concern for certain special areas of research. Grant 
support was given to the American Psychological Association's Na- 
tional Conference for Planning Research on the Psychological Aspects 
of Aging. Another was made for the Symposium on Interdiscipli- 
nary Research in the Behavioral, Biological, and Biochemical Sciences 
held at the University of Wisconsin. In such conferences, leaders in 
relevant research fields met to synthesize their collective knowledge 
and to determine the direction of their future efforts. 

A psychopharmacological conference, cosponsored w^ith the Na- 
tional Research Council and planned for the fall of 1956, has aroused 
much interest because of the widespread use of tranquilizing drugs in 
the treatment of mental disorders. It is expected that the conference 
will take up the many ways that drugs act upon mental state and 
mental disease. The relation observed between certain drugs and 
normal body substances poses the challenging possibility that chem- 
ical imbalances may be a factor in the development of some mental 
diseases. The identification made this year of the chemical disturb- 
ance in phenylpyruvic oligophrenia (a disorder associated with mental 
retardation) has led to its prevention and treatment. 

Institute of Dental Research 

The National Institute of Dental Research continued its search for 
further evidence of the cause of tooth decay and disease of the oral 
tissues. The Institute continued to demonstrate the inhibitory effects 
of fluoridated drinking water on dental caries. 

Greater emphasis was placed on the study of periodontal diseases, 
which are often seen among older persons. Preliminary findings sug- 
gest that, to be effective, efforts at prevention of periodontal disease 
must begin early in life. 

There is continuing evidence that the heat processing of certain 
protein foods may bring about nutritive changes which become a 
factor in dental caries. Proteins are thus being seriously considered 
in nutritional studies on dental disease. 

In continuing research on dental metabolism, the evidence sug- 
gests that the physiological activity of the dental enamel may be of 
major importance in determining susceptibility to dental caries. 

A histochemical technique has been developed for diagnosing tissue 
disease through detection of the proteolytic enzyme peptidase. In a 
study of tumor tissue, the technique reveals changes that cannot be 



Public Health Service 107 

seen with routine staining methods. The investigation may, there- 
fore, prove of value in fields other than dental research. 

Hereditary defects in tooth structure were studied in 63,000 school 
children in Michigan. Part of the study involves a comparison with 
a group of about 4,500 isolated people, found along the Atlantic sea- 
board. Two dental conditions were identified. 

Studies on the etiology of dental caries and periodontal disease 
in laboratory animals are going on. Bacteriological studies in- 
clude the effects of various antibiotics and their relation to prevention 
of decay. The periodontal tissues and the salivary secretions are 
being studied for biochemical and enzymatic properties related to 
oral diseases. 

New and improved techniques for preparation of specimens for 
electron microscopy and diffraction are being developed. Research 
in the biologic effects of ultrasound on human tissues other than teeth 
are also under way. Particularly to be determined is the kind of 
radiation set up by ultrasonic equipment. 

Institute of Neurological Diseases and Blindness 

The Institute's expanded research program in neurological and 
sensory disorders has resulted in several advances in the diagnosis, 
treatment, and prevention of many chronic and crippling conditions. 
Intramural investigations were coordinated with research grant proj- 
ects on the development, activity, and function of the brain and 
nervous system. 

Studies on the embryology, pathology, cytology, histochemistry, 
and biochemistry of nerve cells and fibers of the brain and spinal cord 
are under way. Other studies concern the experimental production 
of cerebral palsy by means of anoxia, birth injury, anesthesia, and 
cerebral vascular damage. 

Investigation of the microstructure of nerve cells, fibers, junctions, 
and terminals with the electron microscope and micrograph, and 
studies on the nerve impulse and rapid ion movements, have provided 
new leads in nerve-muscle research. 

Experimental studies of thermoregulatory mechanisms of the auto- 
nomic nervous system and research on the effects of drugs and irradia- 
tion on the brain centers that regulate body heat, water balance, 
sleep, visceral activities, and endocrine secretions have resulted in 
better understanding of many neurologic disorders. 

Studies on the development, regeneration, vascular supply, and 
functional restitution in the central nervous system have led to further 
investigations of the fever-producing mechanisms which facilitate 
nerve regeneration. 



108 Department of Health, Education, and Welfare, 1956 

Valuable information on sensory disorders has been found in studies 
of the auditor}^ and vestibular tracts, the sensory mechanism of the 
inner ear, taste bud degeneration and regeneration, and effects of 
anesthetic agents in relief of pain and toxic change. 

Other projects included investigation of cerebral hemodynamics; 
studies on nutritional, metabolic, enzymatic, and endocrinal aspects 
of neurological disorders ; and production of Parkinsonism in mon- 
keys by reserpine and other drugs. 

CLINICAL PROGRESS 

Significant progress was made in the field of neuromuscular dis- 
orders. New drugs and electronic techniques provided valuable 
knowledge of the biochemistry and electrophysiology of muscle and 
neuromuscular function. Biochemical studies of blood and urine, 
using radioactive tracer techniques, and protein metabolism studies 
in patients with muscular dystrophy and related diseases, have yielded 
important data. 

A new approach to the causes and course of multiple sclerosis in- 
volves the production of experimental demyelination. Electro- 
phoretic studies and biochemical analysis of gamma globulin in 
multiple sclerosis patients provided new leads to differential diagnosis 
and prognosis. 

Experimental studies on control of respiration and blood flow by 
the central nervous system show that the anterior spinal artery may 
carry enough blood to sustain medullary respiratory and vasomotor 
center function. Studies on effects of temperature on the myoneural 
junction show that relatively low frequencies of electrical stimulation 
initiate tetanus in the hamster at low temperatures. 

Neurosurgery studies contributed to the knowledge of focal epilepsy, 
localization of motor and perceptual functions, speech, memory and 
consciousness; and surgical relief from pain has been progres- 
sively successful. 

In collaboration with NIAID, the therapeutic effects of pyrime- 
thamine on patients with toxoplasmic uveitis and of metacortin and 
other drugs on inflaimiiatory eye diseases were evaluated. Studies 
of adenopharyngeal conjunctivitis have determined the viral cause 
and course of the disease. Tissue culture studies have shown that the 
APC virus, type 8, is immunologically similar to the virus causing 
epidemic keratoconjmictivitis. 

Studies on glaucoma show that eye pressure changes elicited by 
central stimulation are secondary to coexisting changes in the systemic 
blood pressure and independent of striate muscular activity in the 
orbit. Other investigations show that ionizing radiation, nutritional 
deficiencies, metabolic agents, and drugs can produce cataractous 
changes. Electroretinographic studies have resulted in evaluation of 



Public Health Service 109 



photopic and scotopic responses in patients with hereditary retinal 
degeneration. Because histological and serological studies indicate 
that 20-25 percent of all granulomatous uveitis may be due to infection 
with Toxoplasma gondii, a more accurate diagnostic test for presump- 
tive ocular toxoplasmosis, an agar-diff usion technique, has been devised 
to replace the so-called toxoplasma dye test. 

Radioisotope studies with malignant tissue of the eye indicate that 
the beta-emitting P^^ uptake of ocular melanomas is often too slight 
to assure detection by external counting. 

The glutamine-asparagine studies have led to greater emphasis on 
the investigation of gamma amino butyric acid, which is of vital im- 
portance in the metabolic processes of the brain. A dramatic corol- 
lary of this work has been the relief from seizures in cases of total or 
partial removal of the temporal lobe. 

RESEARCH GRANT ACCOMPLISHMENTS 

Several compounds called hydroxylamine derivatives, which seem 
to act as true antidotes for the nerve gases, have been synthesized. 

Preliminary studies suggest that migraine headaches may be 
promptly terminated by intravenous injection of norepinephrine, a 
blood vessel constrictor. 

Studies on barbiturate poisoning and insulin coma show that elec- 
trical stimulation to the head provides a beneficial restorative effect. 
Peripheral electrical stimulation was found to be as effective as 
cranial stimulation. 

Studies on the origin of childhood convulsions show that Nissl stain 
may provide a histochemical means of assessing protein metabolism 
in the brain. 

In the studies on epilepsy, scientists found that the anticonvulsant 
action of Diamox is unrelated to its inhibitory effect on enzymes con- 
trolling kidney excretion and the resultant acidosis, and that ammo- 
nium chloride influences the anticonvulsant action of Diamox, inde- 
pendently of enzyme inhibition. 

The final report on retrolental fibroplasia reaffirms that oxygen in 
high concentrations given routinely to premature infants is a major 
contributing factor of this disease. The report also validates earlier 
findings that the use of oxygen can be limited to clinical emergencies 
without affecting the survival rate of premature babies. 

Heart Institute 

More than half of the Nation's deaths and much of the physical 
disability of its population are attributable to heart disease. The 
problem is complex, embracing over a score of cardiovascular dis- 
orders. To meet it, new knowledge must be gained through research 



110 Department of Health, Education, and Welfare, 1956 

and applied widely. The programs of the National Heart Institute 
are focused on these goals. 

Substantial progress was achieved in 1956. In research conducted 
by the Institute, important findings increased fundamental and clini- 
cal knowledge of the underlying disease processes affecting the heart 
and circulatory system. Significant advances also resulted from grant- 
supported research in miiversities and hospitals. Training activities 
aimed at increasing the supply of persons qualified in research and 
clinical aspects of cardiovascular disease were extended. In coopera- 
tion with the Bureau of State Services, the control of heart disease 
was fostered, and States and localities were assisted in developing com- 
munity heart programs. 

PROGRESS IN HEART RESEARCH 

The process which underlies atherosclerosis, the most common form 
of hardening of the arteries, is an accumulation of fatty materials in 
the lining of blood vesels. Because this may be due to an abnormal 
handling of fatty substances in the body, a major part of NHI research 
is concerned with the study of mechanisms involved in the absorption, 
distribution, and utilization of fats and fatty substances. Just as 
detergents are required to make fatty substances soluble in water, 
special chemical entities are necessary for transporting fat in the 
watery fluid of the blood. In the blood plasma the fats are carried 
attached, in complex arrangements, to the plasma proteins. The 
attachment of fat to protein does not, in general, occur spontaneously, 
but requires the mediation of certain enzyme systems. The operation 
of those systems has been under intensive study, and some of their 
components have been clarified by Institute investigators. 

One facet of the problem, previously puzzling, is now open to solu- 
tion. It has been known for some time that injection of the anticlotting 
drug, heparin, causes the enzyme system to appear in the circulating 
blood. This system can break down large fatty aggregates believed 
to be directly related to atherosclerosis, but whether the heparin merely 
causes activation of the enzyme system or is an integral part of it has 
not been known. A definitive answer to this question will be made 
possible through the Institute's recent development of a strain of 
bacteria by which heparin is specifically destroyed. 

The drug, reserpine, derived from Indian snake root and now used 
widely in the treatment of hypertension and mental disorders, con- 
tinued to be the subject of investigation. NHI studies have shown that 
the effect of reserpine is due to its property of causing the release of 
serotonin, a substance previously thought to play a role in the regula- 
tion of the blood pressure through a direct effect on blood vessels. It 
now appears that the pertinent effect of serotonin is probably in the 
central nervous system, where it may be involved in the transmission 



Public Health Service 111 

of nerve impulses within the brain centers. Particular interest lies 
in that center concerned with the control of blood pressure. The 
implications of this finding and its various facets — relevant not only 
to heart problems but to nervous and mental fmictions as well — are 
being extensively explored. 

The essential discovery in this area and the entire present exploration 
have been made possible by a new analytical instrument, the spectro- 
photofluorometer. This instrument, devised in NHI laboratories, 
makes possible the identification and quantitative measurement of 
minute amounts of a wide variety of substances by means of the 
characteristics of the light they emit when excited with ultraviolet 
light of particular wave lengths. The notable and unforeseen applica- 
tions of the instrument are an excellent example of the way in which 
fundamental developments contribute to scientific progress in 
directions which cannot be anticipated. 

Wlien the heart muscle can no longer carry the load imposed 
upon it, a characteristic complex of derangements and symptoms 
ensues. Breathlessness and swelling of the ankles and legs are the 
most commonly observed features. These symptoms are those of con- 
gestive heart failure and, in general, are directly attributable to reten- 
tion in the body of excessive amounts of salt and water. The secretion 
by the adrenal gland of excessive amounts of the hormone aldosterone 
has been shown in previous Institute work to be the immediate cause 
of most of this retention. Studies aimed at determining the normal 
stimulus for secretion of this hormone are progressing and may provide 
the key to identification of the source of abnormal stimuli in cardiac 
failure. 

Studies are also in progress in evaluating the various factors which 
make up the workload of the heart muscle and determine its require- 
ments for oxygen and oxidizable foodstuffs. It has been found that 
the oxygen used by the heart muscle of the experimental animal is 
directly proportional to the pressure against which the heart must 
pump the blood and to the frequency of the heart beat. Surprisingly, 
there appears to be no relation of oxygen requirements to the volume 
of blood expelled with each beat. If these findings are confirmed in 
more extensive experiments, they will have an important bearmg on 
the handling of patients, since it is when the demands of heart muscle 
for oxygen exceed supply that angina pectoris results. It is probable 
that the significant workload leading to enlargement of the heart and 
congestive failure is that which increases the demand for oxygen. 

In surgical studies, the further development and evaluation of 
diagnostic techniques is continuing, and the application of low tem- 
peratures to surgical approaches to the interior of the heart has been 
furthered. Considerable effort has been devoted to the problem of 
artificial heart and luns: devices for the maintenance of vital circula- 



112 Department of Health. Education, and Welfare, 1956 

tion during open heart surgery. Studies of the use of plastics to 
substitute for blood vessel segments and for the possible replacement 
of damaged valves are also being pursued. Of particular interest is a 
procedure and device for the complete bj^pass of aortic heart valves 
by rerouting the main course of outflow from the heart at the end 
of the left ventricle opposite from the normal egress through a 
valve-containing plastic tube directly into the aorta, the body's main 
arterial trunk. The flaws in this procedure have now been virtually 
eliminated, and animals so treated have shown remarkable health 
and exercise-tolerance. 

ACCOMPLISHMENTS THROUGH RESEARCH GRANTS 

Grants made by the Institute resulted in notable advances in many 
areas of research. In arteriosclerosis, a number of projects dealt 
with the possible influences of dietary factors in producing condi- 
tions favorable for the increase of the fatty substance, cholesterol, 
in the blood and in the walls of arteries. One investigator reported 
studies of high and low cholesterol diets in several groups of men 
in the United States and in two groups on the Island of Sardinia, 
where the type of diet differs considerabh' from that in this country. 
The results, in all groups, indicated that the serum level of cholesterol 
is essentially independent of cholesterol intake in the diet. Other 
researchers produced findings showing that the amounts of fats con- 
sumed influenced cholesterol levels and that different types of fats 
apparently produce varying effects. 

Important contributions to understanding the causes and mecha- 
nisms of blood clotting were made. One team of investigators pre- 
pared a purified prothrombin, one of the substances involved in the 
early stages of clot formation, and was thus able to determine more 
exactly its characteristics and how it becomes converted to thrombin 
in the development of a blood clot. Another group succeeded in puri- 
fying accelerator globulin, a substance in blood which is recognized 
as the agent that facilitates the conversion of prothrombin to throm- 
bin. Use of these purified substances should clarify much that is 
yet unknown concerning the process of clot formation. 

Progress continued to be made in heart and blood vessel surgery. 
A difficulty encountered in grafts for the repair of blood vessel 
injuries is incompatibility between the transplanted and host tissues 
and the consequent failure of incorporation of the graft. An investi- 
gation completed in 1956 indicates that controlled chemical treatment 
(with ethylene carbonate) of blood vessel segments to be used as 
grafts may offer a solution to this problem. 

A remarkable surgical development reported during the year was 
the origination of a simple, inexpensive oxygenator-pump, composed 
chiefly of plastic tubing, which can substitute temporarilj'- for the 



Public Health Service 113 

heart and lungs of patients undergoing heart surgery. The apparatus 
has been used successfully in many operations on the interior of the 
heart. 

Bureau of Medical Services 

The Bureau of Medical Services administers the programs of the 
Public Health Service which relate to care and protection of the in- 
dividual; the health program for American Indians; aid in the con- 
struction of community hospitals and health facilities ; development 
of the Nation's nursing and dental resources; and foreign quarantine. 
It operates the hospital and outpatient facilities of the Service and 
gives professional supervision to members of the Service staff assigned 
to other Federal agencies to direct their health programs. 

Hospitals and Outpatient Facilities 

The Division of Hospitals conducts the medical care program for 
American seamen and other legal beneficiaries of the Public Health 
Service. Beneficiaries include otiicers and enlisted men of the U. S. 
Coast Guard, commissioned officers of the Public Health Service, 
Civil Service employees of the Federal Government injured or taken 
ill in the course of their work, and several smaller groups. Patients 
with leprosy and j^ersons addicted to narcotic drugs as defined by 
statute are treated in special hospitals. 

The Division also administers the Federal employee health pro- 
gram. Federal departments, at their request, receive consultative 
help in establishing or improving health activities for their employees ; 
22 health units are conducted on a reimbursable basis. 

In 1956, the Division maintained 16 hospitals, 25 outpatient clinics, 
and 96 outpatient offices; in addition, 58 physicians served active 
Coast Guard and Coast and Goedetic Survey persomiel. Of the hos- 
pitals, 12 provide general medical and surgical services, 1 is ex- 
clusively for patients with tuberculosis, 2 treat narcotic addiction and 
neuropsychiatric disorders, and the combination hospital-community 
at Carville, La., cares for persons with leprosy. Most of the hospitals 
are in major port cities, including Boston, New York, Baltimore, New 
Orleans, San Francisco, and Seattle. The outpatient clinics are 
staffed by full-time personnel and provide a range of medical, dental, 
and allied health services. The outpatient offices are conducted by 
local physicians in their private offices on a part-time basis, as needed. 

During the ye-ar, action was taken to integrate more of the out- 
patient clinics with hospitals in the same geographic areas. The 
outpatient clinic in Portland, Maine, became a miit of the Boston 
hospital; the clinic in St. Louis, Mo., was merged with the Chicago 



114 Department of Health, Education, and Welfare, 1956 

hospital; and the outpatient clinic in New York City was made a 
section of the outpatient service of the hospital on Staten Island. 

VOLUME OF SERVICES 

Inpatient admissions in all the hospitals rose 6 percent — from 45,- 
852 in 1955 to 48,627 in 1956. The average daily census remained 
approximately the same, at 5,412. The average length of stay per 
patient dropped 21^ days. The number of outpatient visits went up 
4 percent to a total of 1,042,000. 

The general hospitals admitted 43,399 patients in 1956, compared 
with 41,379 in 1955. The daily nmnber of patients averaged 2,765, 
about the same as the previous year. 

Tuberculosis. — The tuberculosis hospital, at Manhattan Beach, 
Brooklyn, N. Y., operated at its 325-bed capacity, a decrease of 14 
patients from 1955. All the accepted newer drugs for treating pul- 
monary tubercidosis are used, as indicated, and the staff keeps abreast 
of the status of experimental drugs and therapeutic procedures 
for other chest diseases. Cardiopulmonary function facilities were 
expanded to include cardiac catheterization procedures on patients in 
need of them. A special education progi*am for patients nearing dis- 
charge was begmi, and training conferences for tuberculosis patients 
who also have diabetes were continued. 

Lefrosy. — The Public Health Service Hospital at Carville, La., is 
devoted entirely to care and treatment of persons with leprosy. 
Patients receive complete medical care and full maintenance. Serv- 
ices include not only the special medical, surgical, and dental therapy 
necessary to treat the disease, but also general medical care. Since 
the course of treatment at Carville usually spans a period of years, 
the hospital conducts social service and community activities pro- 
grams with diversified recreational and educational opportunities. 

The sulfone drugs still constitute the "treatment of choice" at 
Carville. All workers in the field of leprosy agree that these drugs 
offer a comparatively effective form of therapy. Most sulfone-treat- 
ed patients enjoy greatly improved general health. In the majority 
of cases, the irreparable ravages of long-standing leprosy can be 
avoided if treatment is begun early. Like the onset of the disease, the 
sulfone drugs work slowly. Therefore, the search for more efficient 
and quicker- acting specific therapy for leprosy continues. 

Admissions to the Carville hospital totaled 59 in 1956, compared 
with 57 the year before. The average daily census declined from 319 
to 313 as patients with "closed" cases left the hospital. Leprosy 
parallels tuberculosis in that a stage of apparent arrest may be 
reached, and the patient may enjoy long periods relatively free from 
disease activity. 



Public Health Service 115 

Narcotic Addiction. — The hospitals in Lexington, Ky., and Fort 
Worth, Tex., treat narcotic addicts as defined by Federal law. They 
also receive mentally ill patients entitled to care as beneficiaries of the 
Federal Government. 

In 1956, the two hospitals admitted 4,767 patients, an increase of 
18.5 percent; the average daily census remained virtually changed at 
2,010. Most of the patients admitted were narcotic addicts who en- 
tered voluntarily. The stability of the average daily census while 
admissions increased indicates the addicts' weakened capacity for self- 
control in relationship to narcotics. About 25 percent of voluntary 
addicts who enter the hospital leave M^thin a week after admission; 
by the end of a fortnight, 50 percent are gone. This period of hospi- 
talization is hardly long enough for recovery from the acute absti- 
nence syndrome. On the other hand, addict patients sentenced by 
Federal courts usually stay a year or more. The need persists for a 
way to require addicts to remain in the hospital until they achieve 
reasonable recovery from physical dependence on narcotic drugs. 

TRAINING MEDICAL CARE PERSONNEL 

More than 250 physicians, dentists, pharmacists, and dietitians 
served internships and residencies in Public Health Service hospitals 
during the year. Eight of the hospitals had approval for the post- 
graduate training of physicians granted by the American Medical 
Association. The American Dental Association approved eight hos- 
pitals for dental internships. 

Through affiliation with colleges and technical schools, about 100 
undergraduates received practical experience and hospital instruc- 
tion in physical therapy, occupational therapy, vocational therapy, 
social service, practical nursing, and medical laboratory technology. 
The Baltimore hospital trained 10 new medical record librarians. 
The hospital on Staten Island provided the clinical nursing portion 
of the hospital corpsmen course offered by the U. S. Coast Guard. 

CLINICAL INVESTIGATIONS 

Twenty formal clinical investigation projects were started under 
the auspices of a new clinical investigations committee in the Division. 
In cooperation with a pharmaceutical firm, one hospital began a cost- 
accounting study of expenses of administering frequently used in- 
jectables by the conventional method; this will be followed by an 
investigation of those costs using the single-dose closed system. In 
collaboration with the Food and Drug Administration and the Ameri- 
can Association of Medical Record Librarians, the Division partici- 
pated in a study of methods of recording and reporting adverse re- 
action to drugs. 



116 Department of Health, Education, and Welfare, 1956 

At Car vi lie, the first conference on leprosy investigations was 
held to discuss leprosy studies from the standpoints of bacteriology, 
pathology, immunology, biochemistry, metabolism and nutrition, 
chemotherapy, epidemiology, and clinical management. Conducted 
by a Public Health Service interbureau committee, the meeting 
brought to Louisiana nearly all scientists in the United States en- 
gaged in research on leprosy. 

FREEDMEN'S HOSPITAL 

Freedmen's Hospital, Washington, D. C, is a general hospital with 
provision for chronic chest diseases. It serves as the clinical teaching 
arm of the College of Medicine of Howard University. The hospital 
has a capacity of 320 general medical and surgical beds, 50 bassinets, 
and 150 beds in the annex for chronic chest diseases. 

In 1956, the hospital admitted 11,638 inpatients, an increase over 
1955; daily average census was 366, compared with 378 in 1955. The 
outpatient service, consisting of 36 organized clinics and including the 
emergency I'oom recorded an aggregate of 79,430 visits, an increase 
over 1955, 

The School of Nursing had 106 students, and 33 graduates. The 
hospital was affiliated with the M. M. Washington Vocational School 
for the training of practical nurses. An inservice training program 
for professional and nonprofessional nursing personnel was begun. 

The hospital provided graduate training for 42 medical residents, 
18 medical interns, 4 medical externs, 2 dental interns, and 8 clinical 
research fellows. To broaden the scope of the program in medical 
education, an affiliation was established with the Chelsea Soldiers 
Home in Massachusetts, and plans were made to extend this program 
to Norfolk Community Hospital in Virginia, and to Denmar Sana- 
torium, Beard, W. Va. 

Ten dietetic interns completed requirements for certification by the 
American Dietetic Association, which reviewed the program during 
the year and extended continued accrediation. Sixteen persons par- 
ticipated in training progi'ams in medical technology, pharmacy, hos- 
pital administration and social service. 

In 1955 a study commission, appointed by the Secretary of Health, 
Education, and Welfare, surveyed Freedmen's Hospital to determine 
its future role. The commission recommended transfer to Howard 
University and the construction of a new general hospital building. 
Efforts were made in 1956 to implement the commission's recom- 
mendations and at the recommendation of the Department, legisla- 
tion was introduced in Congress to bring; about the transfer. 



Public Health Service 117 

Foreign Quarantine 

In spite of smallpox being epidemic in many countries of South 
America, Asia, and Africa, the United States was free of it for the 
third consecutive year. This achievement may be attributed in part to 
llie fact that the United States requires persons arriving at ports of 
entry to present evidence of smallpox vaccination within 3 years. 

The northward sweep of yellow fever in Central America continued. 
In fiscal year 1955 the disease reached the area near San Pedro Sula 
in northwestern Honduras, not far from the Atlantic coast. While 
no human cases were reported in Central America in fiscal 1956, infec- 
tion in monkeys occurred again in Honduras, and the disease crossed 
the border into Guatemala where infected monkeys were found south- 
east of Lake Izabal. Bolivia reported 5 cases of yellow fever, with 
4 deaths in Caranovi, about 75 miles northeast of La Paz. The last 
preceding report of cases from this area was in 1947. There was some 
yellow fever, including fatal cases, in locations in Brazil, Venezuela, 
and Colombia. 

Cholera was quiescent in the Far East until spring, when an epi- 
demic occurred in Calcutta. Case and mortality rates were the high- 
est since 1953 ; by the end of June the epidemic had tapered off. Only 
five ports were infected with cholera during the year, a figure com- 
parable to the small number infected in recent years. 

For the first time since 1951 a case of human plague was reported 
in the United States. It occurred in California, where the disease 
has been endemic in wild rodents. There was an outbreak of pneu- 
monic plague during January in Amherst, Burma, which was checked 
within the month. An outbreak of plague in Bolivia was associated 
with a population movement from the highlands to the more produc- 
tive areas of the lowlands. 

INTERNATIONAL TRAFFIC VOLUME 

International traffic subject to Public Health Service requirements 
increased again, as follows: airplanes inspected for quarantine or 
immigration-medical purposes from 54,759 in 1955 to 56,891 this 
year; ships inspected from 27,551 to 30,126; arriving persons subject 
to foreign quarantine regulations from 42,861,862 to 46,993,370 ; small- 
pox vaccinations by quarantine officers from 481,190 to 485,967. The 
number of persons released subject to further medical examination at 
destination decreased from 17,831 to 9,670; persons detained in isola- 
tion at ports decreased from 229 to 3. 

MEDICAL EXAMINATIONS 

In the Eefugee Relief Program of immigration, medical examina- 
tion services were provided in Austria, Belgium, Denmark, Egypt, 



1X3 Department of Health, Education, and Welfare, 1956 

England, France, Germany, Greece, Iran, Italy, Jordan, Kuwait, 
Lebanon, The Netherlands, Norway, Sweden, Turkey, and the Far 
East. The number of persons examined abroad increased from 38,928 
in 1955 to 92,519 this year. The number of those examined in this 
country increased from 26,882 to 72,382. There were 1,619 refugees 
certified, abroad and in the United States, for diseases excludable 
under the immigration law. 

The number of aliens other than refugees examined abroad by 
Service officers increased from 158,074 in 1955 to 194,736 in 1956. 
Those examined in this country increased from 1,861,787 to 2,111,237. 
Most of those examined abroad were prospective immigrants. The 
majority examined in this country were crew members and temporary 
visitors; arriving aliens usually receive a brief inspection, with fur- 
ther examination when indicated. There were 4,263 aliens certified, 
abroad and in the United States, for diseases excludable under the 
immigration law. 

In the farm placement program of recruiting agricultural workers 
from Mexico, 415,210 laborers were examined, with 10,057 rejections, 
at 4 migratory centers in Mexico; and 435,332 examinations were 
made, with 5,757 rejections, at 5 reception centers in California, 
Arizona, and Texas. 

OTHER QUARANTINE ACTIVITIES 

Control measures were applied to more than 30,000 aircraft and 
numerous sliips and land vehicles arriving from other countries to 
kill mosquitoes and related carriers of disease. 

Because of the northward movement of the yellow fever virus, 
the Division and other interested units of the Service considered plans 
for controlling Aedes aegypti, the yellow fever mosquito prevalent in 
the southern part of the United States. 

In two instances larvae of Culex qidnquefasciatus Say mosquitoes, 
chiefly a pest form, were found alive in water in old tires brought to 
Miami, Fla., from South America in cargo planes, illustrating how 
insects that may transmit disease can be introduced unless preventive 
measures are taken. 

Nearly 580,000 copies of the International Certificates of Vaccina- 
tion form were issued to clerks of court, passport agencies, and health 
departments; this was an increase of 33 percent over the number 
issued in 1955. In addition, 968,013 copies were sold by the Superin- 
tendent of Documents — double the sales for the previous year. 

Foreign quarantine regulations were amended to apply the rabies 
immunization requirement to dogs brought in from Canada, and the 
physical inspection requirement to both dogs and cats brought in 
from Canada. This change was made because of the presence of 
rabies in animals in Canada. 



Public He alth Service 11^ 

During the year, a technical advisory committee to the Division 
of Foreign Quarantine was established. Composed of leaders in 
public health and medicine, this group will help insure that the most 
effective means are used to prevent introduction of disease by the 
increasing volume of international traffic. A subcommittee on tuber- 
culosis will assist in determining when prospective immigrants with 
a history of confirmed or suspected tuberculosis may be considered 
free of the disease under the immigration law, which denies admission 
to aliens with tuberculosis in any form. 

Hospital and Medical Facilities 

The Division of Hospital and Medical Facilities administers the 
Hospital and Medical Facilities Survey and Construction program. 
The legislation of 1946 authorizing this program was amended in 1954 
to include earmarked Federal aid for the construction of hospitals 
for the chronically ill and impaired ; nursing homes ; diagnostic cen- 
ters or diagnostic and treatment centers ; and rehabilitation facilities. 
The appropriation for construction grants of all types in 1956 was 
$96 million, including $21 million for the new phase of the program. 
Shortly after the close of the fiscal year. Congress extended the pro- 
gram for an additional 2-year period. 

The first hospital to be built under this program was completed 
and opened in October 1948. As of June 1956, 3,047 hospitals, health 
centers, and related facilities were approved for construction. Of 
these, 2,050 were completed and rendering community service, and 
806 were under construction. The remainder were in the planning and 
preconstruction stages. Federal aid for these projects amoimted to 
$781,421,267. 

The 3,047 projects will add 133,239 hospital beds, 2,259 nursing 
home beds, 748 health units, and many related medical facilities to 
the Nation's resources. Of the beds, 108,955 are in general hospitals ; 
11,403 are in mental hospitals; 7,010 are in tuberculosis facilities; and 
5,871 are in chronic disease facilities. The total cost of these projects 
is $2,467 million, toward which the Federal Government contributed 
$781 million, and State and local sources $1,686 million. Two dollars 
in State and local funds are being spent for every Federal dollar. 

Of the 1,031 new general hospitals being built under the program, 
549 are in communities that had no hospitals before the program was 
begun, and 236 are in communities where the only hospital was obso- 
lete or unsuitable. Fifty-four percent of the new facilities are lo- 
cated in communities of less than 5,000 population, and only 12 percent 
are in cities of more than 50,000. 

Fifty-seven percent of the new hospitals have fewer than 50 beds 
and only 21 percent have 100 beds or more. Among the larger proj- 



120 Department of Health, Education, and Welfare, 1956 

ects are teaching hospitals approved for intern and residency train- 
ing. Thus, in addition to meeting rural needs, the program is serving 
the training needs of larger institutions. 

The hos]ntal bed deficit in the Nation is still large. Although this 
program in 10 years has provided almost 136.000 beds, and nearly 
twice that amount of hospital construction has been done during the 
same period Avithout Federal aid, the need for hospital beds is ac- 
centuated by an annual population increase exceeding 2,5 million. 
Also, every year large numbers of hospital beds become obsolete or 
in need of modernization. 

Additional facilities for early diagnosis and treatment of ambula- 
tory patients would reduce the demand for general hospital beds. 
The aging of the population has intensified the need for facilities for 
the chronically ill. Twice the average number of hospital care daj'S 
are required for persons 65 and over. Many patients now in general 
hospitals could be cared for in nursing homes and chronic disease 
hospitals at less cost than is possible in the general hospital. 

The amendments of 1954 are designed to help meet these needs. 
By June 30, 1956, all the States had revised and supplemented their 
State hospital construction plans to include nursing homes, diagnostic 
centers or diagnostic and treatment centers, chronic disease facilities, 
and rehabilitation centers; 204 of these projects had been approved 
at a total estimated cost of $24,482,910. A 53-bed nursing home in 
Florence, Ariz., was the first project approved — in July 1955. 

Grants for research, experiments, and demonstrations relating to 
the effective development and utilization of hospital facilities, services 
and resources were authorized by Congress in 1949. The 1956 appro- 
priation was the first to include funds to implement this research 
program, in the amount of $1.2 million. Twenty-seven research 
grants for hospital services were approved during the fiscal year. 

Health Services for Indians 

Fiscal year 1956 was the first year the Public Health Service had 
complete responsibility for the Federal Government's Indian health 
program. Personnel and facilities were expanded to meet more fully 
the backlog of accumulated needs of the increasing Indian popula- 
tion. The Division of Indian Health administers this program. 

The Public Health Service provides medical care and preventive 
health services for some 315,000 Indians living mainly on reserva- 
tions, and 35,000 Indians, Aleuts, and Eskimos in the native villages 
of Alaska. Most of these groups are thinly spread over vast sparsely 
settled areas, generally lacking adequate facilities for transportation 
and communication. This dispersion and isolation, and the absence 



Public Health Service 121 

of well developed community health resources, are major obstacles 
in providing health services for Indians and Alaska Natives. 

Although the health of the Indians has been undergoing gradual 
improvement in recent years, it still contrasts sharply with that of 
the general population. The average age at time of death among 
Indians is only 39, compared with 60 for the population as a whole. 
A third of the deaths among Indians occur before the fifth year of 
life, whereas only 8 percent of the deaths in the general population 
are in this age group. The Indian death rate from influenza and 
pneumonia is nearly 4 times that of the general population. The 
death rate from tuberculosis is 5 times greater, and from enteric 
diseases 10 times greater, than corresponding death rates in the popu- 
lation as a whole. 

In carrying out its responsibilities for Indian health, the Public 
Health Service encourages self-reliance and independence on the part 
of the Indian people, and seeks their participation in planning health 
activities. It endeavors to give full consideration to the customs and 
traditions of each tribe or group. The Indians are assisted in making 
use of State and local services of health, vocational rehabilitation, 
and crippled children's agencies. 

In fiscal 1956, in accordance with a request by the Committee on 
Appropriations of the House of Representatives, the Public Health 
Service began a comprehensive survey of Indian health needs and 
facilities (see p. 92). 

To enable the Public Health Service to obtain the judgment of 
authorities on Indian affairs, the Surgeon General early in May 
named an Advisory Committee on Indian Health. This committee, 
with members representing medicine, science, law, education, journal- 
ism, and the Indian peoples, is aiding in the development of policies 
to improve health services to the Indians. 

The health program provides both curative medical care through 
hospital and clinic services, and public health services to promote 
health and prevent disease. The two major phases of the program 
are equal in importance and, for the most part, fully integrated. 
Preventive activities are provided in all Indian health facilities, and 
treatment is administered at many field installations. Increases in 
the number of professional personnel permitted an expansion of serv- 
ices during the fiscal year. The number of physicians on duty with 
the program, for example, was increased from 121 to 190, and the 
number of dentists from 46 to 64. 

HOSPITAL SERVICES 

Hospital services are provided at 48 Public Health Service Indian 
hospitals and at 8 Alaska Native Health Service hospitals, as well 

408691—57 9 



122 Department of Health, Education, and Welfare, 1956 

as at more than 160 non-Federal hospitals under contract to the 
Public Health Service. The latter include community general hos- 
pitals, State and county tuberculosis sanatoriums, and State mental 
hospitals. 

The 56 Public Health Service hospitals operated for Indians and 
Alaska Natives have a bed capacity of approximately 3,800, Except 
for 9 large facilities with 100 or more beds, the majority of these 
hospitals are general facilities of 25 to 35 beds. There are provisions 
for 1,800 beds m the contract hospitals, two-thirds of which are for 
Datients with tuberculosis. 

Patient loads in all hospitals increased. The average daily patient 
census in the 48 Indian hospitals increased by 4 percent, and that of 
the Alaska Native Health Service hospitals increased by more than 7 
percent. The average daily patient census in contract general hos- 
pitals within the United States was almost twice that of 1955. 

The combined daily patient census for all hospitals — ^both Public 
Health Service and contract — was approximately 4,200. Of these 
patients, about 1,300 are Alaska Natives. 

Therapeutic and preventive services are provided at outpatient 
clinics in all Indian hospitals. Outpatient treatments and preventive 
services at Indian and Alaska Native Health Service hospitals in- 
creased by 15 percent dm-ing the year. 

The most significant development in the Indian hospitals was the 
increase in their medical and supporting staffs. Nearly all the smaller 
hospitals now have at least two medical officers. Food service, 
maintenance, administration, and other f mictions were also improved. 
Another significant development was the inauguration of a system 
whereby the larger medical centers provide supportive services for 
the smaller outlying hospitals. Higher standards and greater effici- 
ency are being achieved through centralizing some of the functions 
of the pharmacy, medical records, and dietetic services. 

FIELD HEALTH SERVICES 

More than half of the deatlis and most of the illness among Indians 
are caused by diseases that can be prevented or controlled. These 
facts suggest that preventive health services are the key to the great- 
est improvement in Indian health. Consequently, the Public Health 
Service is intensifying efforts to work with Indians in their own 
commimities to help apply modern knowledge of sanitation, diet, 
health habits, and other aspects of disease prevention. 

Health education is a major part of this effort. Professional staff 
members carry on educational work in their day-to-day relations 
with Indian patients, families, schoolchildren, and community leaders. 
Health education activities are coordinated by a small staff of health 



Public Health Service 123 

educators, assisted by a number of college-trained community work- 
ers — most of whom are Indians. 

It long has been apparent that much illness results from polluted 
drinking water, insufficient quantities of water available, unsafe prac- 
tices in the disposal of wastes, improper handling of food, high levels 
of infestation by insect carriers of disease, and inadequate housing. 
Empasis was given to increasing the services of Indian sanitarian 
aides on reservations and in Indian conununities. Working under the 
sanitary engineering staff in the field, these aides are fostering wider 
knowledge of sanitation among the Indian people. 

One new feature of the Indian health program begun in the South- 
west during the year was an extensive effort to control rabies by in- 
oculating dogs on reservations. 

Public health nursing services were substantially increased in 1956, 
and home visits were devoted to health problems of entire families 
rather than to acute illnesses of individuals. A similar shift of em- 
phasis in public health nursing also occurred at clinics, where greater 
demands for preventive health services and better acceptance were 
evident. 

Field health services are provided from the Indian and Alaska 
Native Health Service hospitals, and through a system of some 100 
health centers and field clinic installations at more than 100 other 
locations. Staff's at field health facilities supplement the work of 
the hospitals by diagnosing, treating minor illnesses, referring cases 
to hospitals, following up on discharged patients, and conducting 
case-finding programs. Clinic staffs provide prenatal, maternity and 
infant, and preschool services ; mothers receive instructions and chil- 
dren are immunized and treated for common infections. 

Wherever it is advantageous to Indian beneficiaries and the Gov- 
ernment, and where the necessary facilities are available, health serv- 
ices are provided by State agencies and private physicians or clinics 
under contracts monitored by the Division of Indian Health. The 
Public Health Service now has in effect contracts for such services 
with about 30 State or local health departments and numerous physi- 
cians and dentists. A total of $7.6 million was spent for contract 
patient care in 1956, compared with $5.8 million spent for this purpose 
in 1955. 

DENTAL AND SOCIAL SERVICES 

Dental services are provided in hospitals and at other locations in 
the field. Since 1950, dental services have included preventive and 
control measures as well as treatment. Preventive dentistry now is 
provided at about 230 locations, with particular attention to school 
age children. 



124 Department of Health, Education, and Welfare, 1956 

During 1956, greater emphasis was placed on restorative dentistry, 
but extractions continued to constitute a substantial portion of the 
total dental services rendered. Topical fluoride treatment was 
brought to additional communities, and to larger numbers of school 
children than ever before. 

A total of 118 man-years was devoted to the dental health program 
in hospitals and field installations. The dental staff comprised an 
average of 60 dental officers, 44 dental assistants, 4 dental laboratory 
technicians, and 10 persons engaged in dental educational and preven- 
tive activities. Dental officers were increased by 20 and auxiliary 
dental personnel by 26 over 1955. 

Medical social work services to Indians were nearly doubled during 
1956, with the addition of 10 medical social workers to the staff. 
In 1955, nearly all of the medical social workers in the Indian health 
program were stationed at tuberculosis hospitals. During 1956, how- 
ever, medical social service was extended to general patients. Since 
the assignment of medical social workers to the six Indian health area 
offices, consultative services have been provided to contract hospitals 
and additional services obtained for Indians through arrangements 
with community social agencies. 

TUBERCULOSIS CONTROL 

Control of tuberculosis among Indians and Alaska Natives is an 
effort that concerns both the hospital and the field health staffs. The 
Indian death rate from this disease is 5 times that of the United 
States population as a whole. The tuberculosis problem is particu- 
larly serious in Alaska, where the mortality rate is 5 times that of the 
rate for Indians within the continental limits of the United States. 

A chemotherapy program to control tuberculosis in Alaska w^as 
begun in 1954, and was substantially expanded in 1956. Ten chemo- 
therapy nurses now cover more than 70 native villages in western 
Alaska. These nurses dispense medications, train chemotherapy 
aides to assist them in the village clinics, visit patients, follow up with 
tuberculin testing, and find new cases. This program has nearly elim- 
inated the backlog of tuberculous patients awaiting hospitalization. 

Contracts are in effect with several State agencies for tuberculosis 
case-finding, treatment, and followup activities. This is in keeping 
with Public Health Service policy to work closely with State health 
departments on Indian health matters, and to use State and local re- 
sources whenever possible. 

In research, Cornell University is conducting a study for the Public 
Health Service to determine clinical effects of new chemotherapeutic 
agents used in controlling tuberculosis among Indian patients. The 
University of Pennsylvania is conducting research among the United 



Public Health Service 1^5 

Pueblo Indians to determine the effectiveness of using antibiotic 
drugs to prevent development of tuberculosis in children. 

TRAINING OF INDIANS 

To meet the needs in Indian and Alaska Health Service hospitals 
for practical nurses, the Public Health Service operates practical 
nurse schools at Albuquerque, N. Mex., and Mount Edgecumbe, Alaska. 
Sanitarian aides are given special orientation training courses con- 
ducted at Phoenix, Ariz., and in Alaska, after which they return to 
their reservations or villages. Dental assistants and dental techni- 
cians are being trained and employed, and plans were made in 1956 
to establish another training facility for dental technicians beginning 
in 1957. Community health workers receive on-the-job training 
supervised by schools of public health under contract. Approxi- 
mately 90 Indians were trained by the Public Health Service during 
the year for employment in these occupations in the Indian health 
program. 

CONSTRUCTION AND RENOVATION 

Congress appropriated $5 million for the construction and renova- 
tion of Indian health facilities in 1956. Four new general hospitals 
were authorized, and nearly $2 million of the funds was allocated for 
the construction of one facility and the planning of the other tliree. 
A site was selected for a 75-bed hospital at Shiprock, N. Mex., and 
preliminary plans were drawn up. Sites were under consideration 
for 50-bed hospitals at Sells, Ariz., and at Kotzebue, Alaska. Pre- 
liminary plans were drawn for a 200-bed medical center at Gallup, 
N. Mex., which will be a referral hospital for some 80,000 Navajos 
and other Indians in that area. 

Preliminary plans were made for the conversion and renovation 
of 4 existing clinics on the Navajo reservation, and bids were received 
for the construction of 5 new ones. A site was selected for the con- 
struction of the Santa Rosa clinic to serve the Papagos in Arizona. In 
the Aberdeen, S. Dak., area, program plans were completed for the 
construction of 6 health stations and clinics. Major alteration proj- 
ects were started at the Phoenix, Ariz., medical center and at the 
Tuba City, Ariz., hospital. 

To overcome a serious housing shortage for health personnel, more 
than $2 million was used for construction of permanent housing in 
Alaska at Bethel, Barrow, and Tanana, and for the relocation of some 
325 surplus Government housing units in the United States. By the 
end of the year, 250 housing units from Camp Pickett, Va., had been 
dismantled, and about 200 had been moved to locations in the South- 



126 Department of Health, Education, and Welfare, 1956 

west. Kelocated in the Northwest and North Central States were 50 
housmg units and 25 trailers. 

Dental Resources 

Major program emphasis of the Division of Dental Eesources con- 
tinued to be in the field of dental manpower. Studies of supply, 
utilization, and distribution of dentists and dental auxiliary personnel 
were the principal activities. The Division was also active in studies 
relating to voluntary prepayment dental care. 

DENTAL MANPOWER 

A study of the characteristics, finances, and practice plans of dental 
and dental hygiene students, begun in 1954 by the Division and the 
American Dental Association, was completed. It provides compre- 
hensive information on the expenditures of dental students as well 
as facts on the personal and family characteristics of students and 
their plans for location of practice. 

A study of dental manpower requirements in the 11 Western States, 
Alaska and Hawaii, initiated in 1955 in cooperation with the Western 
Interstate Commission for Higher Education, was carried on with 
the assistance of the American Dental Association and the W. K. 
Kellogg Foundation. Its primary purpose was to determine needs for 
additional dental training facilities in the West. The collection of 
data was completed, an analysis was made, and arrangements were 
made for publication in fiscal 1957. 

The cooperative study by the Division and the American Dental 
Hygienists' Association of supply, characteristics and distribution 
of dental hygienists, begun in 1954, was continued. This will be pub- 
lished as "Health Manpower Source Book, Section 8 : Dental Hygien- 
ists," providing a source of information not previously available, 

PREPAYMENT DENTAL CARE 

Two projects relating to prepayment for dental services were com- 
pleted. The first was an evaluation of the predictability of dental 
treatment needs in adults by developing data collected in an earlier 
study of time and service requirements in a group service program. 
The second was an assessment of some of the possible effects of com- 
munity water fluoridation on a dental care prepayment program for 
children by applying a fixed fee schedule to services rendered in se- 
lected counties that have fluoridation and counties that do not have it. 

Information on all existing dental prepayment programs was cata- 
logued. A comprehensive study of one of these programs, that of the 
St. Louis Labor Health Institute, was begun. 



Public Health Service 127 

Nursing Resources 

The Division of Nursing Kesources is a focal point in national 
efforts to augment the nurse supply. The Division assists States, 
hospitals and local groups to analyze problems of nursing services 
and to take action to improve the nursing care given patients. The 
work of the Division was expanded in fiscal year 1956. 

NEW RESEARCH GRANTS PROGRAM 

For the first time Public Health Service aid for medical and scien- 
tific studies included grants and fellowships specifically for nursing 
research. The new program was carried on cooperatively by the 
Division of Nursing Kesources and the National Institutes of Health. 
An appropriation of $625,000 was made for the year. The National 
Advisory Health Council approved 20 grants, totaling $496,176, for 
studies in problems of nursing service and the needs of patients, the 
selection of nursing as a career, the development of leadership quali- 
ties in nurses, and refinement of the basic curriculum in schools of 
nursing. In addition, $124,578 was awarded to nurses for graduate 
training in research methods. This amount provided 27 full-time 
fellowships and 62 part-time fellowships in 16 schools of nursing. 

STATE SURVEYS OF NURSING NEEDS 

The Division published "Design for Statewide Nursing Surveys: 
A Basis for Action," a manual to help States and institutions analyze 
and improve their nursing resources. In the past 7 years the Di- 
vision has assisted 38 States in surveying nurse supply and planning 
remedial programs. States that have made changes on the basis 
of these surveys are reporting success in improving nursing services 
and in providing more care for patients. These surveys have in- 
creased in scope. Special studies, such as nurse utilization and job 
satisfaction, are now being undertaken in addition to general ap- 
praisal of needs. 

BETTER METHODS OF PATIENT CARE 

As part of an extensive program to determine how best to utilize 
the present supply of nursing personnel, the Division, in cooperation 
with the American Hospital Association, conducted a study of patient 
care in 60 hospitals in 7 States. The study was designed to find 
out to what extent satisfaction with nursing care is related to the 
number of hours of care provided. The procedures and question- 
naires used were developed following an experimental study in hos- 
pitals in Cleveland, Ohio. Preliminary findings indicate that the 
shortage of nurses may be related to other factors, as well as numbers. 



128 Department of Health, Education, and Welfare, 1956 

The Division has developed methods to aid hospitals in better 
utilization of nursing personnel. To date 113 hospitals in 14 differ- 
ent States have been helped through self-improvement demonstra- 
tions. More than a million and a half patients will benefit in a 
single year from the changes being made in management and person- 
nel policies, including relieving nurses of jobs other types of personnel 
can do, streamlining recordkeeping systems and methods of dispens- 
ing drugs, and revising ward routines. 

The Division works closely with organizations such as the Ameri- 
can Nurses' Association, the National League for Nursing, and the 
American Hospital Association in developing programs concerned 
with recruitment and utilization of nurses. One program is the 
training of nursing aides, carried on jointly with the League and the 
American Hospital Association. In 2 years, more than 75,000 nurs- 
ing aides in 1,350 institutions, including nursing homes, have received 
this training. 

Medical Services for Federal Agencies 

The Public Health Service is responsible for providing medical 
services to certain other Federal agencies. Through the Bureau of 
Medical Services, medical, dental psychiatric, nursing, and other per- 
sonnel are assigned on a reimbursable basis to agencies that request 
assistance in operating their medical programs. 

OFFICE OF VOCATIONAL REHABILITATION 

During the past year, 7 coimnissioned officers (3 physicians, a den- 
tist, nurse, physical therapist, and sanitarian) were detailed by the 
Service to the Office of Vocational Rehabilitation. These officers 
had important roles in various phases of the State-Federal rehabili- 
tation program. Their responsibilities included technical assistance 
to State vocational rehabilitation agencies; administration of an ex- 
panded training program for physicians, nurses, physical therapists, 
and occupational therapists; consultation to voluntary agencies and 
medical schools on the design of research and demonstration programs, 
as well as on the development and expansion of rehabilitation services. 
Details regarding these activities may be found in the section of this 
report devoted to the Office of Vocational Rehabilitation. 

BUREAU OF EMPLOYEES' COMPENSATION, DEPARTMENT OF LABOR 

Medical care, compensation for wage loss, and rehabilitation serv- 
ices are provided to Federal civilian employees by the Bureau of 
Employees' Compensation for injuries in performance of duty and 
diseases attributable to conditions of employment. Facilities of the 
Public Health Service are utilized for the medical care program 



Public Health Service 129 

where possible; facilities of other Federal establisliments are also 
utilized where available. In addition, approximately 3,000 physi- 
cians in private practice are designated by the Bureau to furnish 
medical care under the Federal Employees' Compensation Act. 

Medical officers of the Public Health Service administer the medi- 
cal care program and serve as techincal advisors to the Bureau. They 
also assist in the rehabilitation program, staff educational activities- 
identification of special problems in industrial health, and liaison 
with employing establishments in the safety program. 

Special studies are made of conditions of obscure etiology and con- 
ditions suspected to have occupational origin. In 1956 special at- 
tention was given to hearing loss at a military proving ground and 
to cases of tuberculosis among employees of Federal hospitals. Re- 
habilitation of injured employees through vocational rehabilitation 
agencies was extended during the year. Many patients were cared 
for through cooperative arrangements with State vocational rehabili- 
tation agencies. 

MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE 

The Public Health Service assisted the Office of Seamen's Services 
with the review and release of clinical information from the medical 
records in custody of the Maritime Administration and supplied 
medical and dental staff for outpatient and inpatient care at the Patten 
Hospital, U. S. Merchant Marine Academy, Kings Point, N. Y. The 
Service staff at Kings Point consisted of the chief medical officer of 
the Academy and three dentists. 

UNITED STATES COAST GUARD, TREASURY DEPARTMENT 

Ninety-two Public Health Service officers were on duty with the 
Coast Guard at the close of the year. There were 37 medical officers, 
45 dental officers, 8 nurses, a sanitary engineer, and a scientist. Medi- 
cal officers were assigned to ocean vessels ; both a medical officer and 
a dental officer were assigned to the vessel engaged in the Bering Sea 
Patrol. 

Considerable progress was made in improving dental facilities 
within the Coast Guard and obtaining new equipment, thus making 
possible an increase in dental services given. The sanitary engineer- 
ing program, begun in 1954, was maintained with good results. 

FOREIGN SERVICE, DEPARTMENT OF STATE 

Existing health units in New Delhi, India; Baghdad, Iraq; and 
Kabul, Afghanistan, were expanded by the addition of a doctor. Po- 
sitions were established and doctors have been selected for Vientiane, 
Laos. New health units with nurses in charge were approved for 
Seoul, Korea; Rio de Janeiro, Brazil; and Amman, Jordan; and 



130 Department of Health, Education, and Welfare, 1956 

La Paz, Bolivia. A new unit with a physician in charge was estab- 
lished in Katmandu, Nepal. 

The Medical Director visited 20 countries and 23 posts during the 
year ; in general, the medical as well as the sanitary and living condi- 
tions have improved gTeatly during the last 5 years. 

Poliomyelitis vaccine was distributed to all Foreign Service posts 
which do not receive medical services from the Department of 
Defense. All children of eligible ages and pregnant women were 
given injections. Arrangements were made for Foreign Service posts 
to pay emergency medical expenses of local employees injured in per- 
formance of duty; reimbursement is then obtained from the Bureau 
of Employees' Compensation. 

The Foreign Service Act of 1946 was amended to authorize medical 
care for dependents, with certain limitations; medical travel when 
local medical facilities are inadequate ; examination of dependents of 
applicants ; and increased medical facilities at Foreign Service posts. 
This program will be implemented in fiscal year 1957. 

BUREAU OF PRISONS, DEPARTMENT OF JUSTICE 

The Public Health Service has provided medical and related serv- 
ices for prisoners in Federal penal and correctional institutions for 26 
years. Today, the medical staffs not onl}^ provide general medical 
care, but also participate in rehabilitating prisoners to return to 
society. Medical personnel serve as instructors in correctional officer 
programs; participate in classification meetings where programs are 
developed ; advise on disciplinary problems, especially where neurotic 
or emotional problems exist; and participate in other aspects of 
administration. 

In 1956 over 41,000 persons in 28 institutions in 23 States were pro- 
vided with care. There were 13,818 admissions to the hospitals for a 
total of 439,608 hospital relief days ; 953 major and 4,910 minor opera- 
tions were performed. Outpatient departments provided 818,176 
treatments and performed 25,991 routine physical examinations. 

A number of research projects were conducted at various penal 
institutions. These included: development of new psychological 
tests ; study to learn how and why youthful delinquents form cliques 
or gangs; experimental work with d-lysergic acid and possible anti- 
dotes ; chloriquinized salt in malaria control ; rates of absorption and 
excretion of DDT ; study of an attenuated vaccine for poliomyelitis ; 
and a study of effects of industrial noises on hearing. 

BUREAU OF OLD-AGE AND SURVIVORS INSURANCE, 
SOCIAL SECURITY ADMINISTRATION 

A Public Health Service officer served as chief medical consultant 
to the Division of Disability Operations of the Bureau. His work 



Public Health Service 131 

included advising on development of medical policies and guides to 
determination of disability; conduct of a medical training program 
for central and field office personnel, including the referees of the 
Appeals Council ; and the recruitment, training, and supervision of a 
medical staff for evaluation of medical impairments. He attended 
several medical conferences to familiarize physicians with the admin- 
istration of the disability insurance program. 

BUREAU OF PUBLIC ASSISTANCE, 
SOCIAL SECURITY ADMINISTRATION 

A Public Health Service officer served as the Bureau's medical 
consultant. Much of his work was in connection with the program 
of aid to the permanently and totally disabled in which 45 States are 
providing assistance. In field consultations on medical aspects of this 
program, attention was given to strengthening the working relation- 
ships between public assistance agencies and State health departments. 

Bureau of State Services 

The Bureau of State Services is the principal unit through which 
the Public Health Service carries out its programs in disease control 
and in the improvement of public health services. It provides assist- 
ance to State and Territorial health agencies and administers the 
health aspects of international programs involving the United States. 
The Bureau also cooperates with voluntary health agencies and pro- 
fessional organizations in encouraging widespread application of 
existing knowledge about the prevention and control of disease. 

General Health Services 

The programs administered by the Division of General Health 
Services are : State grants, program development, public health edu- 
cation, public health nursing, the National Office of Vital Statistics, 
the Arctic Health Research Center, and emergency health services 
(civil defense). One of the major activities of fiscal year 1956 was 
the administration of the poliomyelitis vaccine program. 

POLIOMYELITIS VACCINE PROGRAM 

To assure an equitable distribution of poliomyelitis vaccine while 
it was in short supply, States and manufacturers cooperated with the 
Public Health Service in an allocation program which allowed each 
State a proportion of each new supply of vaccine corresponding to the 
proportion of persons in the priority groups which were set by the 
National Advisory Committee on Poliomyelitis Vaccine. Initially, 



132 Department of Health, Education, and Welfare, 1956 

priority was limited to children 5-9 years of age, but the group was 
gradually expanded until it included all children under 20 and preg- 
nant women. The Division administered the allocation system, 
notifying the manufacturers of the distribution among the States of 
each lot of new vaccine released and notifying each State of its 
allotment. 

On August 12, 1955, Congress enacted the Poliomyelitis Vaccination 
Assistance Act — patterned after legislation recommended by the ad- 
ministration — authorizing Federal grants-in-aid for the purchase of 
poliomyelitis vaccine and the administration of vaccination programs. 
In February 1956, the act was extended to June 30, 1957, and addi- 
tional funds were appropriated. All States and Territories applied 
for grants and submitted plans which were approved after they were 
reviewed for conformity with the requirements of the Federal law 
and regulations. 

Policies for export of vaccine, for limited purposes, w^ere worked 
out in cooperation with the Department of Commerce and the De- 
partment of State. Cooperation was also given to the National Foun- 
dation for Infantile Paralysis in its program of promoting widespread 
domestic use of the vaccine. 

STATE GRANTS 

Federal funds available for grants-in-aid to States for health pro- 
grams totaled $194,538,000 in fiscal year 1956. This amount included 
$109,800,000 for hospital and medical facilities construction and $53,- 
600,000 for poliomyelitis vaccination programs. The following break- 
down shows amounts and purposes for which actual payments were 
made: 

General health services ^$13,332,038 

Venereal disease special projects -1,187,906 

Tuberculosis control 4, 488, 026 

Mental health activities 2,980,547 

Cancer control 2, 217, 825 

Heart disease control 1,088,061 

Medical facilities survey and planning 287, 064 

Construction of community facilities 647, 240 

Hospital construction 54,372, 562 

Poliomyelitis vaccine assistance 24, 358. 678 

1 Includes $3,607,160 earmarked for distribution and use of poliomyelitis vaccine. 

2 Includes !f 195,347 in services and supplies furnished in lieu of cash. 

Table 4, page 158, shows the distribution of these sums by State. 

State appropriations available to health departments, exclusive 
of those for the operation of sanatoriums and general hospitals and 
construction, amounted to $134,542,853. This was an increase of about 
10 percent over the preceding year. 



Public Health Service 133 

A comparative study of 1955 and 1950 expenditures by full-time 
local health units was initiated during the year ; the purpose was to 
determine current trends in different areas and in different types of 
units. Teclinical assistance and consultation were given to States on 
budgeting, accounting, and other management and fiscal problems by 
specialists in the Division. 

PROGRAM DEVELOPMENT 

A special branch was established in the Division to explore and 
make preliminary plans relating to new public health programs. 
This first year, it served as a focal point for Service activities in migra- 
tory labor, rural health, and school health. 

In cooperation with the Children's Bureau and other units of the 
Department, a uniform health record for migrant families has been 
developed for testing and eventual use in States where large numbers 
of migrant workers are employed. Two guides to health services 
for migrants were developed and distributed, one for 10 East Coast 
States, and one for 12 Western States. Work also progressed on the 
development of uniform standards for farm labor camps, on a sug- 
gested State code for the transportation of migrant workers, and 
on a summary of tax advantages which accrue to employers when 
health, education, and welfare services are made available to migrants. 

Reports were prepared on the relationships of public health agencies 
to the rural development program of the Department of Agriculture. 
In cooperation with the Office of Education, Children's Bureau and 
other units of the Department, State plans for school health programs 
were reviewed and analyzed. 

PUBLIC HEALTH EDUCATION 

Through research, training, and consultation, the health education 
staff assists other units of the Public Health Service, State health de- 
partments, educational institutions, and other organizations in devel- 
oping health education programs that will influence health habits. 

Research included a study of health improvements that resulted 
from having a professional health educator on the staff of a teacher 
education institution ; an evaluation of a public health fair which is 
held amiually in a large city ; a study of the health education aspects 
of a community's reaction to a flood disaster. In cooperation with 
other programs in the Bureau, the research staff identified behavioral 
factors which are significant in planning tuberculosis, heart disease, 
and other control programs. 

Training activities in the health education field included work with 
schools of public health in improving curricula; lectures in schools 
of medicine ; and assistance in training health educators for service in 
foreign countries. 



134 Department of Health, Education, and Welfare, 1956 

Consultation was given to 14 States and to 6 foreign countries. In 
addition, health education consultants stationed in 4 regional offices 
gave continuing consultation and technical assistance to States in 
their areas, 

PUBLIC HEALTH NURSING 

With the trend toward home care programs for the chronically ill, 
health agencies are placing increasing emphasis on the development 
of sound public health nursing programs. This is reflected in the 
extensive consultation work carried on by the PHS nurses this year. 
Aid was given to the California Health Department in developing a 
base for determining the number of nurses needed in local health de- 
partments and in designing studies of public health nursing services 
in special programs. The North Carolina Health Department was 
assisted in planning a 4-day workshop on consultation. Washington, 
Texas, Maryland, New York, Michigan, and Florida were also aided 
through special training programs. 

A field study designed to establish a baseline for measuring the 
utilization of public health nursing services to patients was conducted 
in 8 local health departments. A formula for determining public 
health nurse staffing patterns and units of work is being developed 
to provide a simplified method of interpreting budget needs and to 
guide appropriating bodies, management firms and other surveyors 
in their attempts to quantitate health department services. 

An annual census of nurses employed in public health activities dur- 
ing 1955 was compiled. It revealed that, of the 27,112 nurses em- 
ployed by public health agencies and boards of education, 37 percent 
had completed one or more years of academic study in public health 
nursing. Forty-four percent of the more than 27,000 were employed 
by local official health agencies, practically the same number as in 1950. 
The number of nurses employed by boards of education for school 
nursing increased by more than 30 percent during the same period. 

VITAL STATISTICS 

The National Office of Vital Statistics works closely with State 
health agencies to compile the national statistics on births, deaths, 
marriages, divorces, and communicable diseases. This includes rou- 
tine reporting of the numbers of new cases and epidemiologic infor- 
mation on unusual occurrences of diseases. Such data provide a 
current basis for planning programs in public health, social welfare, 
education, defense, business and market analysis, and in medical 
and demographic research. The Office also cooperates with the World 
Health Organization and its member countries to develop comparable 
international statistics. 



Public Health Service ^^^ 

Coordination and improvement of the vital statistics system are 
effected mainly through the Public Health Conference on Kecords 
and Statistics. The year's achievements included: completion of a 
draft of the Model State Vital Statistics Law; final criteria for 
admitting States to proposed marriage and divorce registration areas ; 
a standard form of reporting adoptions and a standard form to permit 
movement of a body for burial ; a recommended definition of prenatal 
mortality rates; and a guide for using service statistics in home 
accident programs. 

The National Office consulted with and gave direct assistance to 
several States in surveying statistical operations, developing new or 
improved procedures, and clearing up backlogs of unprocessed rec- 
ords. It also conducted regional institutes for State personnel. 

The most notable achievement in processing vital statistics was 
the publication of the NOVS annual statistical report for 1954 ahead 
of schedule. Besides the routine weekly, monthly, and annual pub- 
lications, NOVS issued many special reports, including 48 State 
reports on life expectancy, a study of economic characteristics of 
recently married persons, the first 12 of 31 reports on selected causes 
of death during 1900-53, and a study of the relation of birth weight 
to causes of death in the neonatal period. 

Revisions of the Standard Certificates of Live Birth and of Death 
were distributed and recommended for State adoption. 

ARCTIC HEALTH RESEARCH CENTER 

Epidemiologic studies constitute an important part of the pro- 
gram of this Center. House-to-house surveys in several native vil- 
lages have been made in connection with enteric disease studies. New 
evidence has been acquired indicating that small mammals may be 
an important factor in the epidemiology of trichinosis in Alaska. 
Three additional species of fish tapeworm have been discovered and 
other data offering valuable clues to the control of this health prob- 
lem have been compiled. 

A study of diabetes in Alaskan Eskimos was completed. The di- 
sease is extremely rare among Eskimos, but it is not yet known 
whether this is due to heredity or to nutritional factors. If it is the 
latter, increased prevalence can be expected due to the increasing 
use of nonnative foods. 

Home treatment for tuberculosis was begun for over 1,200 Alaskans 
in 66 villages, and mass X-ray surveys of villages are in progress. 

With the help of villagers. Center staff constructed the first experi- 
mental well ever developed in a permafrost area. This was part of 
an experimental sanitation program carried out in a few isolated 
villages to demonstrate and test the practicability of developing water 



136 Department of Healthy Education, and Welfare, 1956 

supply and sewage disposal systems in permafrost areas. Winter 
operations are being carefully watched to determine needed modifi- 
cations of design or operation. 

EMERGENCY HEALTH SERVICES 

The emergency health services staff coordinates Bureau activities 
in civil defense and disaster relief and gives leadership in the develop- 
ment, improvement, and continuity of regional. State, and local pub- 
lic health civil defense plans and organizations. The staff developed 
the Bureau emergency plan which was adopted for use during Oper- 
ation Alert 1956. 

The general inadequacy of existing civil defense programs in the 
States is a matter of serious concern. During the year, information 
covering the activities and organizational responsibilities of the States 
for civil defense was analyzed and distributed to health officers and 
others concerned. Consultation and training were provided by head- 
quarters and regional staff and the PHS field centers. 

Disaster relief functions during the year were concerned primarily 
with damages caused by hurricanes in the East and floods in Oregon, 
Washington, and California. A critique covering Public Health 
Service emergency operations following the disasters was prepared, 
and recommendations were made concerning the development and im- 
provement of memoranda of understanding with other national 
agencies, a personnel readiness program, a PHS disaster aid plan, 
and a PHS regional disaster plan. 

Division of Special Health Services 

The Division of Special Health Services is concerned with the 
problems of personal health maintenance and the development and 
application of improved health maintenance and preventive tech- 
niques. Through demonstration, training, research, and consultation, 
the Division works closely with health agencies at all levels and assists 
in the establishment and extension of programs in adult health serv- 
ices, and chronic disease, heart disease, occupational health, medical 
aspects of air pollution, tuberculosis, and venereal disease. 

CHRONIC DISEASE PROGRAM 

This unit conducts continuous studies to establish and maintain 
current estimates of the size and characteristics of the chronic disease 
problem in terms of incidence and prevalence of disability, death from 
various chronic diseases, and needs for service by the chronically ill. 
These studies indicate that there are now about 2.5 million persons 
with long term disabilities who are not amenable to vocational 
rehabilitation. 



Public Health Service 137 

To help States meet some of the health needs of this group, the 
Chronic Disease Program, in cooperation with the State and Terri- 
torial Health Officers Association, sponsored a seminar in September, 
1955. The meeting brought together for the first time representatives 
from all State health departments to exchange ideas, and establish 
principles and patterns for State and local activities in chronic disease 
prevention and control. 

The need for more emphasis on chronic disease in the curricula of 
schools of public health was recognized and consultations were held 
with faculty members of the major schools. Members of the program 
staff also served as guest lecturers. 

Six training courses in public health diabetes programs were given 
for regional, State, and local public health staffs. 

Three basic studies are under way to determine the social and med- 
ical needs of the chronically ill. One is a nursing home study, in 
St. Louis, Mo. ; one is a study of rehabilitation services for the aged, 
in the New York City hospital system; and the third is a study on 
patient education, at Denver General Hospital. 

Special emphasis continued to be given to the problems of diabetes 
prevention, detection, and control. A long range study is in progress 
to determine whether insulin given during pregnancy will prevent 
or delay the occurrence of the disease in diabetes-prone mothers and 
their offspring. Numerous studies, designed to develop increasingly 
effective mass screening techniques for the early detection of diabetes, 
are also in progress. At present, it is estimated that at least half the 
persons suffering from diabetes do not know they have the disease and 
are receiving no treatment. 

In cooperation with the National Society for the Prevention of 
Blindness, the Chronic Disease Program is working on the develop- 
ment of effective mass screening techniques for the early detection of 
glaucoma. 

HEART DISEASE CONTROL PROGRAM 

To assist States in reducing deaths and illness from heart disease, 
the Heart Disease Control Program carries on three major activities : 
operational research, training programs, and consultative activities. 

A study by the California State Health Department with the sup- 
port of the Heart Program provided data on the mortality experience 
of 577 elderly persons whose nutritional status was assessed by history 
and laboratory methods 5 years previously. Findings indicated that 
the serum cholesterol was not prognostic of coronary diseases in this 
group. There was, however, an association of vitamin C deficiency 
by history and low serum vitamin levels with increased mortality from 
subsequent coronary disease. 

408691—57 10 



138 Department of Health, Education, and Welfare, 1956 

Other studies of the relationship of animal fat in the diet as related 
to serum cholesterol levels were carried on in a group in Boston. A 
study was also initiated in the Washington, D. C, area to assess the 
severity of atherosclerosis in a group whose diet is largely vegetarian. 

The relationship of obesity as contrasted with overweight due to 
body build was studied to determine which of these is a more important 
factor in the excess mortality from heart disease. 

The use of the mass X-ray programs for detection of heart disease 
was studied further. Findings to date indicate that with appropriate 
criteria the X-ray chest films should be able to detect approximately 
20 percent of all diagnosable heart disease. 

Geographic patterns in mortality in the United States and various 
parts of the world are being studied. Mortality rates for coronary 
heart disease were twice as high in some areas of this countiy as in 
others. Differences among States appear to be as large and real as 
differences observed among countries. 

An epidemiological study of census tract mortality data conducted 
in Chicago has yielded the following preliminary observations : la- 
borers have more coronary disease than executives ; low income fam- 
ilies more than high income families ; housewives more than working 
women. Further study will be necessary before these findings can 
be confirmed. 

A pilot center was established at the University of Minnesota School 
of Public Health to provide 3 months of intensive training in cardio- 
vascular disease to nurse consultants, supervisors, and instructors from 
all fields of nursing. Plans for a similar training center at another 
university are in progress. 

Several State health departments have set up training programs, 
either in cooperation with existing courses in schools and universities, 
or as on-the-job training. Extensive training activities were also 
conducted among social workers, many of whom deal with heart dis- 
ease patients in welfare agencies and in hospitals. 

Consultative services were given by physicians, nurses, social work- 
ers, and nutritionists to State and local health departments and to 
voluntary agencies and professional groups. Cooperation of health 
departments in the "Stop Rheumatic Fever" campaign of the Ameri- 
can Heart Association was encouraged and supplementary material 
on the campaign was prepared for physicians and the public. 

OCCUPATIONAL HEALTH PROGRAM 

The continuing efforts of medical, engineering, and other occupa- 
tional health specialists to protect and improve the health of the 
Nation's working force achieved new scope during the year. 



Public Health Service 139 

With the establisliment of a pilot program in agricultural pre- 
ventive medicine, a first step was taken to apply to agricultural 
workers the protective measures available to industrial workers. The 
project is being conducted cooperatively with the South Dakota De- 
partment of Health and is designed to develop basic information 
that can be applied by other health departments. 

A beginning was also made toward the development of critically 
needed information on the long-term effects of low-level exposures 
of workers to radioactive substances. Lack of such knowledge has 
been the principal deterrent to the use of atomic energy for peaceful 
purposes. To develop the necessary clinical data, a radiological 
health research program was instituted during the year. 

In the area of adult health maintenance, a study was made of the 
attitudes of industrial executives toward preventive health services 
for employees. The results will be used in demonstration projects 
to encourage the expansion of privately financed preventive services 
in industry. 

A new experimental approach in preventive industrial toxicology 
holds promise for the development of new tests for overexposure or 
early diagnosis of occupational disease before the exposed individual 
has any signs or symptoms. Other research conducted during the 
year involved studies of pneumoconiosis in the diatomite-producing 
industry ; the prevalence of silicosis in the United States ; industrial 
toxicology ; effects of noise and vibration ; and various other industrial 
health problems, including the control of radon and radon daughters 
in uranium mines. 

AIR POLLUTION MEDICAL PROGRAM 

This unit conducts and helps support studies designed to discover 
more about the relationship between air pollution and human health. 
Studies initiated during the year include analyses of geographical 
patterns of causes of death; possible relationship of different types 
and degrees of air pollution to the medical impairments of persons 
breatliing such air; studies of the toxic effects of air pollutants on 
laboratory animals ; and various analyses of the toxicology of common 
air pollutants upon human blood tissues and enzyme systems. Lim- 
ited consultative services were provided to help State and local health 
departments appraise and cope with air pollution as a health problem. 

TUBERCULOSIS PROGRAM 

The principal objectives of the Tuberculosis Program are: (a) the 
removal of tuberculosis as a cause of death; (b) the prevention of 
illness from tuberculosis; and (c) the prevention of the spread of 
tubercle bacilli from infected to uninfected persons. To achieve 
these objectives, the following activities are carried on: (1) re- 



140 Department of Health, Education, and Welfare, 1956 

search, (2) promotion of casefmding among population groups at 
high risk, (3) establishment of standards for home care and case 
management, (4) measurement of the extent of the tuberculosis prob- 
lem, (5) provision of tecluiical information and health education 
services and (6) financial assistance to States to strengthen State and 
local programs. 

National data on the tuberculosis problem reveal a continued de- 
cline in morbidity and mortality rates. In 1954, the morbidity rate 
for the continental United States was 48.8 per 100,000 as compared 
to 46.4 for 1955 ; and the mortality rate dropped from 10.2 per 100,000 
persons in 1954 to 9.1 in 1955. 

A study of nonhospitalized tuberculosis patients was undertaken to 
ascertain facts which would be helpful in planning future control pro- 
grams, since, with modern drugs, a considerable number of tubercu- 
losis patients are being treated at home rather than in sanatoriums. 
The study was based on a sample census of the number and status of 
nonhospitalized tuberculosis cases for the United States as a whole. 
It was found that 56 percent of the tuberculosis patients are in hos- 
pitals ; 44 percent are at home. Of those at home, half are 45 years 
of age and older ; there are twice as many males as females ; 87 per- 
cent are in advanced stages of disease; almost half left the hospital 
against medical advice ; a third are under care of private physicians ; 
the sputum status of almost half is unknown ; 40 percent of the active 
cases have had neither drugs nor bedrest recommended. 

Studies continued on the use of isoniazid as a preventive, and pre- 
liminary plans for trials in human beings were explored. The pos- 
sible value of isoniazid in preventing meningitis and other complica- 
tions in tuberculous children was the theme of another significant 
study. Other research dealt with evaluation of drug therapy, and 
additional projects designed to yield more knowledge about prevention 
and control. 

Cooperative clinical investigations with 26 hospitals throughout the 
country have gone forward in determining the most elfective drug 
combinations in the treatment of tuberculosis. A study of the char- 
acteristics of patients in these hospitals was also completed. 

Direct assistance to State and local programs included the loan of 
more than 40 pieces of X-ray equipment ; assistance to hospitals in im- 
proving nursing practices to prevent the spread of tuberculosis ; con- 
sultation services; and review and evaluation of several State and 
county programs. 

VENEREAL DISEASE CONTROL PROGRAM 

For the first time since 1947, the number of cases of primary and 
secondary syphilis reported by State and Territorial health depart- 
ments in 1956 was greater than in the previous year. This increase 



Public Health Service 141 

indicates a significant upward departure from the trend previously 
established. The increase is not due to a sudden resurgence in a few 
areas; it represents a slowly growing national trend which is not 
limited by race, sex, or geographic area. 

More than 150 interviewers and investigators from the Venereal 
Disease Program were assigned to State and local health departments 
this year to assist in venereal disease control programs. Almost 2 mil- 
lion people were examined in clinics and about 16 percent were found 
to be infected. In addition, over 350,000 people, living in areas or 
belonging to groups where the incidence of venereal disease is high, 
w^ere tested in house-to-house campaigns and public testing stations; 
30,000 of them were found to be infected. 

The problem of venereal disease among migrant workers received 
increasing attention. During the year, more than 65,000 migrant 
workers w^ere tested, with 7,300 identified as potentially in need of 
treatment for syphilis. 

In venereal disease research, the most important achievement was 
the development of the Treponema 'palliduin complement fixation test 
(TPCF). This technique — w^hich uses a reacting substance made 
from the organisms that cause syphilis — makes it possible for State 
and other laboratories to test blood serum more accurately and at 
about one tenth of the cost of any previously known method. Other 
research projects included continued studies of syphilis immunology, 
gonorrhea studies, chancroid studies, and numerous long-term sero- 
logic studies. 

An outstanding educational project of the year was the Interna- 
tional Symposium on Venereal Diseases and the Treponematoses, 
held in Washington, D. C, May 28-June 1, under the cosponsorship 
of the Public Health Service and the World Health Organization. 
Over 800 physicians, scientists, nurses, and other health workers from 
54 countries attended. 

Training courses were conducted for laboratory personnel, epidemi- 
ologists, nurses, and physicians. 

Sanitary Engineering Services 

The Division of Sanitary Engineering Services cooperates with 
State and local health departments and other groups on environmental 
problems associated with water, food, air, and housing. 

ROBERT A. TAFT SANITARY ENGINEERING CENTER 

A cooperative training program with the Federal Civil Defense 
Administration was given to Commissioned Keserve Officers. It in- 
cluded courses on radiological health protection, chemical warfare 
defense, nuclear weapons defense, and water supply and water poUu- 



142 Department of Health, Education, and Welfare, 1956 

tion decontamination tecliniques. A highlight of the year was the 
first organized training presentation on the Division's air-pollution 
abatement program. 

The Center's Chemical Analytical Reference Service provided a 
comprehensive mechanism for evaluating chemical laboratory meth- 
ods and raising standards of test performance in its own and other 
sanitation laboratories. 

ENGINEERING RESOURCES 

Recruitment of inactive reserve officers in preparation for civil de- 
fense emergency was continued. There are now 580 reserve environ- 
mental health officers recruited toward an ultimate goal of 1,000. 

A total of 14 Commissioned Reserve engineering personnel were 
mobiled for disaster relief activities in connection with the hurri- 
canes which struck the northeastern part of the country in Augaist, 
1955, and with the California floods of January 1956. 

Five training courses covering various phases of disaster relief 
were conducted and were attended by about 80 reserve officers. 

MILK AND FOOD SANITATION 

Research during the year on the effect of pasteurization on the 
Q-fever organism showed a need to raise the temperature from 143° 
to 145° F. for 30 minutes by the vat pasteurization method. State 
milk authorities and the milk industry were notified of this finding. 

Trends in public buying habits have promoted increased emphasis 
on the sanitation aspects of processing, storing, and distributing pre- 
cooked and frozen foods. Regulatory measures applicable to auto- 
matic vending machines are being developed with the cooperation of 
the National Automatic Merchandizing Association. 

Field work in con j miction with several States on sanitation rating 
methods should develop standard evaluation procedures which will 
more accurately reflect the effectiveness of State and local food con- 
trol programs. Studies are in progress to determine any correlation 
between the training of food-service personnel and the sanitary rat- 
ings of food establishments. 

In conjunction with the American Dry Milk Institute and the 
Universities of Wisconsin and Minnesota, plans were initiated for re- 
search on the factors involved in the formation of toxins in dry milk. 

WATER SUPPLY AND WATER POLLUTION CONTROL 

During the year, the Congress enacted new legislation (P. L. 660) 
to extend and broaden the water pollution control program. The 
legislation authorized an expanded program of research and tech- 
nical assistance, basic data collection, simplified enforcement pro- 
cedure, grants to State and interstate water pollution control agencies 



Public Health Service 143 

(provisions recommended by the President), and construction grants 
for sewage treatment works. 

It has been estimated that current annual expenditures of approxi- 
mately $230 million for municipal sewage treatment plant construc- 
tion need to be doubled for each of the next 10 years to eliminate the 
existing backlog, and provide for obsolescence and expected population 
growth. A study of municipal pollution trends indicates that to 
attain a desired level of municipal sewage control, by 1985 all munici- 
pal wastes will require secondary treatment, and present techniques 
will have reached the upper limits of practical treatment. 

The President's Committee on Water Resources Policy endorsed 
the established policy of primary State responsibility for controlling 
pollution at its source. It recommended that the Federal Government 
aid the States through research, investigation, and technical assistance. 
In addition to Federal enforcement of interstate pollution abatement, 
the Commission recommended that the Federal Government prescribe 
basic criteria and participate in the planning of long-range programs 
for pollution abatement. 

A compilation of industrial waste research projects in progress 
during 1955 was made available to interstate agencies. 

A study of ground water supplies will help to provide a pattern 
for similar surveys in large metropolitan areas since miderground 
supplies are not vulnerable to contamination by radioactive fall-out 
resulting from thermonuclear warfare. This source would provide 
safe drinking water to evacuated populations. 

The Interagency Report of Studies of the Arkansas-Wliite-Red 
River Basins and the New York-New England Area Survey of Water 
and Land Resources were transmitted to the Congress. These studies 
will provide an overall view of the developed and undeveloped 
resources of the regions covered, for use by Congress and govern- 
mental agencies in specific program development. 

A Water Facilities Inventory of 570 communities of 25,000 popula- 
tion and over was completed and sent to State health authorities and 
others for water development planning purposes. 

AIR POLLUTION CONTROL ACTIVITIES 

Public Law 159, 84th Congress, authorized a comprehensive pro- 
gram of community air pollution research and technical assistance to 
States, communities, and other organizations. 

To date, over 250 requests for technical assistance have been 
received. Included were requests for surveys, technical information, 
assistance in developing legislation, and plant studies. All requests 
were met within the limits of available resources. 

Personnel were assigned to the Connecticut State Health Depart- 
ment to help evaluate statewide air pollution problems, and to the 



144 Department of Health, Education, and Welfare, 1956 

Los Angeles Air Pollution Control District to assist in the conduct of a 
specialized aerometric survey and oil refinery studies. Another 
cooperative study was initiated in January 1956, in Louisville- Jeffer- 
son County, Kentuclvy, on the source and character of air pollutants 
in that area. 

A total of 29 research projects were undertaken at the Sanitary 
Engineering Center. Of these, 11 have been completed, including a 
revised plan for the operation of the National Air Sampling Network, 
initial installation and operation of a pilot plant for testing air clean- 
ing apparatus, and field trials of newly designed stack-sampling 
devices. 

RADIOLOGICAL HEALTH 

At the request of the Atomic Energy Commission, the Public 
Health Service set up and equipped a nationwide radiation-surveil- 
lance network. At present, 33 stations are recording increases, over 
normal radiation background, which result from nuclear weapons 
testing in the United States and other countries. This network pro- 
vides State health oiRcers with on-the-spot information on local 
radiation intensities. 

During the spring Pacific test series of nuclear devices, PHS officers 
performed off-site functions for the protection of people located near 
the Pacific Proving Grounds. At the Nevada test site, personnel 
supervised radiological safety in connection with nonnuclear tests. 

Public health implications of the nuclear power industry were 
studied, as well as the contemplated widespread industrial use of 
nuclear energy. Waste disposal, radiation-control techniques, and 
the development of radiation-protection standards were given atten- 
tion, in cooperation with several States. Training programs, appli- 
cable to civil defense needs at the local level, were provided for physi- 
cians and other groups. Requests by State and city health depart- 
ments for control of radioactive water pollution increased markedly 
during this period. 

GENERAL ENGINEERING ACTIVITIES 

Three major shipping companies received the Public Health Serv- 
ice special citation for having attained a Certificate of Sanitation for 
each of their operating units. 

The Public Health Service collaborated with the American Public 
Works Association in the collection and development of basic data and 
information in the field of refuse sanitation. 

Decontamination procedures were carried out after leakage of live 
poliomyelitis virus in an air shipment. An amendment to the Inter- 
state Quarantine Regulations is being developed in cooperation with 



Public Health Service 145 

other interested government agencies, covering tlie shipment of 
etiological agents. 

Staff personnel helped formulate a resolution, adopted by the Sixth 
Inter-American Travel Congress, to develop minimum sanitation 
standards for tourist accommodations throughout the Americas. 

As recommended and issued by the President's Committee, min- 
imum standards of housing and environmental sanitation were 
developed to assist State and local health authorities. Staff consul- 
tation was also given on sanitation aspects of mass evacuation, munic- 
ipal and rural sanitation problems, sanitation in aircraft and the new 
lightweight trains. 

ACCIDENT PREVENTION AND HYGIENE OF HOUSING 

Plans are now under way to broaden the accident prevention activi- 
ties of the Public Health Service. One of the purposes is to apply the 
public health techniques which have been found effective in home 
accident prevention to the total accident problem. 

There was an increased number of requests for technical assistance 
on basic definitions, relationships between physical and psychological 
limitations and accidents, and methodology for recognition, treat- 
ment, and susceptibility to, and occurrence of, accidents. 

Poison information centers increased in number among the States. 
Fifteen centers are now in operation and 12 others are in advanced 
planning stages. The American Public Health Association provides 
consultation to health departments and medical societies in the initial 
development of these centers. The feasibility of a National PoiFon 
Information Center received consideration. 

In cooperation with the National Office of Vital Statistics, a survey 
was made of the accident-prevention activities sponsored by State 
and local health departments. The data reflected increased interfst 
and activity and a greater demand for technical services. 

Public Health Service activities in hygiene of housing were re- 
viewed during the year. Considerable attention was given to housing 
rehabilitation and to increased emphasis on research associated with 
technological developments in housing. 

Communicable Disease Center 

This Division, with headquarters in Atlanta, Ga., maintains labora- 
tories and field stations in various parts of the United States. It 
assists States in preventing and controlling outbreaks of communicable 
diseases through direct aid in epidemics and disasters; continuing 
field studies on the epidemiology of diseases; laboratory investiga- 
tions for more rapid, accurate, and economical diagnostic techniques ; 
development of more effective disease control materials and methods ; 



146 Department of Health, Education, and Welfare, 1956 

consultations and demonstrations; and training of public health 
personnel. 

During the year, the Congress approved the construction of a 
new building for the Communicable Disease Center, which has been 
housed in temporary quarters at widely scattered locations. It will 
be built on land donated by and adjacent to Emory University, 
Atlanta, Georgia. 

EPIDEMIC AND DISASTER AID 

An important part of the Communicable Disease Center (CDC) 
program is providing aid in epidemic and disaster situations which 
tax or exceed State health resources. Thirty-five requests for epi- 
demic aid came from 30 State and Territorial health departments, 
and units of the Armed Forces. About 20 separate diseases or con- 
ditions were involved, and they required the services of physicians, 
veterinarians, statisticians, nurses, bacteriologists, mycologists, engi- 
neers, and entomologists. These personnel helped identify the out- 
breaks and their sources, and assisted public health workers in 
applying effective control methods. 

Emergency assistance was given on 13 occasions where natural 
disasters such as floods, tornadoes, hurricanes, or droughts created 
vector control or water supply problems. In these instances, CDC 
furnished manpower, special equipment, and materials as needed, 

SURVEILLANCE AND INVESTIGATION OF DISEASES 

The purpose of the CDC surveillance program is to prevent the 
reintroduction or resurgence of diseases now rare or absent in this 
country, and to accelerate the decline of others. CDC also serves as 
a clearinghouse for information on diseases of national importance. 
Although major emphasis was given to poliomyelitis this year, small- 
pox, leprosy, diphtheria, malaria and other vector-borne diseases 
also came under surveillance, with special attention directed to the 
arthropod-borne encephalitides. 

CDC's Poliomyelitis Surveillance Unit, in cooperation with States, 
evaluated the safety and effectiveness of the poliomyelitis vaccine. 
In addition, CDC supported State and other non-Federal programs 
for the laboratory diagnosis and confirmation of poliomyelitis and 
poliomyelitis-like diseases. It also contracted with reference labora- 
tories for special investigations concerned with the typing of viruses 
that produce poliomyelitis-like syndromes. Laboratory evaluation of 
over 10,000 cases reported as poliomyelitis indicated that a significant 
proportion of nonparalytic cases were due to causes other than the 
poliomyelitis viruses. An outbreak of poliomyelitis-like disease in 
Marshalltown, Iowa, involving about 1,000 persons, was investigated 
and found to be caused by an ECHO virus. This was the first time 



Public Health Service 147 

a so-called "orphan" virus was related to a specilic disease outbreak 
involving a sizable community. 

The year 1955 was marked, generally, by low incidence of the viral 
encephalitides. Eastern equine encephalitis occurred sporadically in 
human beings but widely in horses and pheasants throughout the 
Atlantic and Gulf States. St. Louis encephalitis was seen in epidemic 
form in two areas of the country — the lower Ohio River Valley and 
Nevada. CDC aided in investigating the encephalitis outbreaks and 
stimulating more complete reporting of this disease. 

The steep downward trend in incidence of diphtheria showed a 
reversal during the past 18 months. However, the mortality rate, 
which has never declined significantly, remained at about 6 to 7 per- 
cent. Hence, this disease again became a threat, calling for intensified 
immunization programs and surveillance in particular localities and 
population groups. 

A sharply defined outbreak of viral hepatitis, involving 232 cases 
in Pennsylvania, was traced to a contaminated municipal water supi^ly. 
A followup study of an earlier outbreak in Kentucky, with emphasis 
on detecting residual effects of the infection, revealed that approxi- 
mately 30 percent of the cases evidenced chronic liver disease. 

The majority of psittacosis cases were attributed to contact with 
parakeets and other psittacine birds. However, the most serious out- 
break involved 60 persons in Oregon who had contact with infected 
turkeys on farms and in rendering plants. 

The incidence of rabies among dogs continued to decline as a result 
of immunization programs, but the known incidence in wild animals 
increased. Approximately 20 percent of the human cases in this 
country during the past 4 years have been attributed to exposures to 
rabid wild animals, pointing up the need for more intensive studies 
of the disease in nature. 

Sylvan animals, particularly rodents, were found to be a possible 
source of leptospiral infections in domestic animals and man. A re- 
view of 35 human cases of the disease showed that 32 of the patients 
had known association with animals or with their contaminated 
environments. 

LABORATORY SERVICES AND NEW TECHNIQUES 

During the year CDC performed the following laboratory services : 
(1) processed 27,762 reference diagnostic specimens received from 
State health departments, from other Federal agencies, and from 
foreign countries; (2) prepared and stocked 32 types of antigens and 
antisera, which are not available commercially, for use by State lab- 
oratories; (3) served as a referee for intrastate laboratory programs, 
evaluated the parasitology diagnosis for six States and bacteriology 



148 Department of Health, Education, and Welfare, 1956 

diagnosis for seven, and evaluated the vector control program in 
Puerto Rico. 

A fluorescent antibody staining procedure has been worked out for 
the detection of Vibrio comma^ Brucella sp., Pasturella pestis, Bac- 
terium tularense^ and two species of Malleomyces. Low concentra- 
tions of Malleomyces pseudomallei can be detected rapidly even in 
heavily contaminated materials, and it is believed that other agents 
can be stained under similar circumstances. This time-saving tech- 
nique would be vitally important in the event of a national emergency. 

An apparently specific diagnostic test for myoglobulinuria using 
paper electrophoresis has been developed. A new procedure for read- 
ing stained patterns in paper electrophoresis studies indicates that the 
change in gamma globulin reflects, within limits, the trend and degree 
of nonspecific abnormality of all serum proteins. 

In airborne pathogens studies, an impinger which collects micro- 
scopic particles and is capable of sampling large volumes of air at 
high velocity was designed and fabricated. 

VECTOR CONTROL 

Investigations were continued to develop increasingly safe and 
effective methods of controlling flies, mosquitoes, rodents, and other 
disease vectors. The fact that mosquitoes create problems to health 
and comfort other than transmission of disease has led to further 
control efforts. 

In field experiments in the Milk River Valley, Mont., residuals 
from preflood treatments with dieldrin and heptachlor larvicides for 
the control of mosquitoes (principally Aedes vexans and Aedes dor- 
salis) in irrigated areas were completely effective throughout the 1955 
season. On experimental plots of fertilized irrigated land in tlie 
jMilk River Valley of northern Montana, mosquito production was 
eliminated and yields of western wheat grass were increased fivefold. 
In all, approximately 100 Federal water resources development proj- 
ects were studied, and recommendations were made on the incorpora- 
tion of vector control mto planning, construction, and operation. 

In studies on the toxicity of insecticides, investigation was made 
of the adverse effects suffered by fruit thinners in parathion-sprayed 
orchards. Respiratory exposure appeared to be negligible, but sig- 
nificant dermal contamination indicated the validity of a 48-hour 
waiting period before entering sprayed orchards. 

Experiments in high-rate mechanical composting of municipal 
refuse to eliminate or minimize vector breeding and feeding demon- 
strated that the addition of 20 and possibly 25 percent of raw garbage 
to composting refuse does not interfere with the normal process. 
When composting is kept on a continuous basis, the breakdown proc- 
ess can be completed in 4 or 5 days. At Phoenix, Ariz., a "high 



Public Health Service 149 

grade" compost no longer attractive to flies was produced outdoors 
in 6 weeks when raw refuse was ground and piled in windrows. 

Vector control demonstration projects were conducted at Laredo, 
Tex. ; Cedar Rapids, Iowa ; Gadsden, Ala. ; and Boise, Idaho. They 
were designed to assist the States with such problems as refuse hand- 
ling and disposal, elimination of insanitary privies, rodent control, 
proper maintenance of animal shelters, and control of mosquito pro- 
duction in manmade breeding places such as irrigated lands and log 
ponds. 

TRAINING 

During the year, 73 organized training courses were presented on 
approximately 250 separate occasions. They were attended by more 
than 5,000 people, including employees of State and local health de- 
partments, other Federal agencies, and industries, and health workers 
from foreign countries. Individual instruction was given to an ad- 
ditional 100 people. Courses were held in Atlanta, in CDC field sta- 
tions, and in various States. CDC also distributed more than 100,000 
items of training material, including audiovisual aids and literature. 

To extend the benefits of laboratory training services, qualified in- 
dividuals and State laboratories were supplied with specimens for 
review and practice in diagnosis. More than 4,000 parasitology, 
mycology, pulmonary mycology, and tuberculosis specimens were 
distributed. 

Dental Public Health 

The Division of Dental Public Health works toward better dental 
health for every citizen. To this end, the Division develops public 
health methods for reducing the prevalence of dental disease, and 
aids States and communities in applying these methods. 

PROGRAM SERVICES 

During the year, four additional States initiated dental public 
health programs, making a total of 50 States and Territories that 
now have such organized programs. The dental health program 
guide, developed by the Division in 1954, was widely used by State 
dental health directors in planning their activities. 

States continued to request and receive consultative services from 
the Division. Several States were helped in developing various ele- 
ments of their programs; and several conomunities were assisted in 
conducting various types of dental surveys. 

A recruitment program was conducted for State and local dental 
programs. This program included talks to student dentists and dental 
hygienists, courses and lectures on dental public health presented in 



150 Department of Health, Education, and Welfare, 1956 

schools of dentistry, and consultation with personnel of State health 
departments on methods of recruiting, examining, and evaluating 
applicants for dental public health positions. Aid was also provided 
in the orientation and training of dental personnel in State and local 
health work. 

OPERATIONAL RESEARCH 

The Division of Dental Public Health also conducts a program of 
operational and developmental research. Significant research in 
progress this year includes : 

1. Development of a model chemical feeder which makes it possible 
to use calcium fluoride in the fluoridation of water supplies. This 
product is plentiful and is more economical to use than the fluoridating 
agents now employed. 

2. Testing of home fluoridators which can be used to fluoridate 
individual water supplies. 

3. Examinations and analysis of the 11th year experience of the 
Grand Rapids, Mich., water fluoridation project. 

4. Completion of three-fourths of the second round of examina- 
tions and treatment of 4,000 children participating in the Gainesville, 
Fla., dental study program representing 90-percent participation of 
the school population ; and completion of the second series of exami- 
nations and treatment of 2,000 children participating in the Cam- 
bridge, Mel., dental study program representing 88 percent of the 
school population. 

5. Preliminary work which indicates that aqueous methyl red may 
be an effective device for indicating caries activity and predicting 
where new caries will occur. 

6. Analysis of data which will lead to development of a method 
of determining the appropriate fluoride concentration in water sup- 
plies under varying climatic conditions. 

7. Study of dental care problems in a chronic disease institution 
to determine dental needs and evolve effective and economical measures 
for meeting them. 

8. Collection of data on fluoridation. By the Spring of 1956, over 
26 million people living in 1,300 communities were served by fluori- 
dated water supply systems. Major cities which began fluoridation 
during the year included St. Louis, Toledo, Cleveland, and Chicago. 

Division of International Health 

Through the Division of International Health, the Public Health 
Service maintains active relationships with the World Health Or- 
ganization (WPIO), the Pan American Sanitary Organization, and 



Public Health Service ISl 

other health agencies. The Division is also the primary source of 
assistance to the Department of State in international affairs related 
to health, and to the International Cooperation Administration (ICA) 
of the Department of State for staffing and technical aid to United 
States Operations Missions abroad. 

During the year the chief and other officials of the Division served 
on United States delegations to five major international conferences. 
These included the Ninth World Health Assembly, which met in 
Geneva, Switzerland, the Directing Council of the Pan American 
Sanitary Organization, which met in Washington; the meeting of the 
Regional Committee of the World Health Organization for the West- 
ern Pacific, which met in Singapore ; the Third South Pacific Confer- 
ence; and the Fifteenth Session of the South Pacific Commission in 
Suva, Fiji Islands. In addition, members of the Division served as 
the United States members at two meetings of the Executive Board of 
the World Health Organization, and represented the United States 
at three meetings of the Executive Committee of the Pan American 
Sanitary Organization. 

TRAINEES AND VISITORS 

The Public Health Service aided health personnel of 72 countries 
who visited or studied in the United States during 1956. Training 
programs were arranged for 886 foreign trainees, of whom 634 were 
sent to the United States by ICA Missions in 47 countries, and 252 
were sponsored by WHO and other United Nations agencies, foreign 
governments, and private foundations and organizations. The larg- 
est number, 356, came from the Far East, 286 from Latin America, 
72 from Europe, and 172 from the countries in the Near East, Africa, 
and South Asia. 

Fifty academic and 20 clinical institutions and 19 other organiza- 
tions such as State health departments were used for the training of 
these foreign health workers. 

Among the visitors to the United States was a delegation of four 
medical scientists from the Union of Soviet Socialist Republics, the 
first official health delegation from that country to visit the United 
States since World War 11. The Division made arrangements for 
their visits to laboratories and other facilities associated with the de- 
velopment and production of poliomyelitis vaccine. Arrangements 
were made by the Division for a reciprocal exchange visit in May of 
five American microbiologists to the U. S. S. R. 

FOREIGN MISSIONS 

The Division of International Health provided personnel and tech- 
nical support to the United States bilateral technical assistance pro- 



152 Department of Health, Education, and Welfare, 1956 

grams under the terms of the Department of Health, Education, and 
Welfare-International Cooperation Administration agreement. The 
Division recruited and assigned to ICA 186 public health workers. It 
reviewed and evaluated 299 proposals for the initiation, continuation, 
or expansion of health projects in 44 countries. 

Public Health Service specialists in tuberculosis control, schisto- 
somiasis control, sanitary engineering, nursing, health education, and 
medical technology consulted with U. S. Operations Missions in 
10 countries in Asia, the Near East, and Africa and in 5 countries in 
Latin America. 

The Division provided staff assistance to the International Develop- 
ment Advisory Board in preparing a report recommending intensified 
United States support of the WHO malaria eradication program. 

INTEEINATIONAL EPIDEMIOLOGY 

Material relating to the world distribution of disease, the status of 
national health organization, and the development of health facilities 
in foreign countries was collected and classified by the Division. This 
was made available to orientate personnel receiving foreign assign- 
ments, to answer inquiries, and to advise research workers in a number 
of fields. 



Public Health Service 



153 



Table 1. — Statement of appropriations, authorizations, obligations, and 
balances, fiscal year 1956 



[In thousands] 



Appropriations 



Funds available for obligation 



Appropri- 
ations 
and au- 
thoriza- 
tions 



Net 
transfers 
between 
appro- 
priations 



Repay 
ments for 
services 



Prior year 
xmobli- 



balances 



Total 

funds 

available 



Amounts 
obligated 



Balances 



Total 



$395, 508 



Appropriations, Public 
Health Service 

Control of tuberculosis 

Control of venereal diseases 

Assistance to States, general 

Control of communicable dis- 
eases 

Disease and sanitation investi- 
gations and control, Alaska __ 

Sanitary engineering activities. 

Foreign quarantine service 

Hospitals and medical care 

Salaries and expenses, hospital 
construction services 

Indian health activities 

Construction of Indian health 
facilities 

Grants for hospital construc- 
tion 

Construction of housing facOi- 
ties for animals 

Surveys and planning for hos- 
pital construction 

Patients' benefit fund. Public 
Health Service hospitals 

Operating expenses, National 
Institutes of Health 

Salaries, expenses, and grants, 
National Cancer Institute 

Mental health activities 

Salaries, expenses, and grants. 
National Heart Institute 

Dental health activities 

Buildings and facilities, Cin- 
cinnati, Ohio 

Arthritis and metabolic dis- 
ease activities 

Microbiology activities 

Neurology and blindness ac- 
tivities 

Gorgas Memorial Laboratoiy.. 

Construction of Biologies 
Standards Laboratory Build- 
ing 

Grants to States for poliomye- 
litis vaccination 

Construction of research facili- 
ties 

Retired pay of commissioned 
officers (annual) 

Retired pay of commissioned 
officers (no year) 

Salaries and expenses 



395, 
6, 
3, 

18, 



Appropriations, special 
project fimds made 
available by other 
agencies 

Salaries and expenses, Bureau 
of Prisons (allocated working 
fund to HEW, PHS) 

American Sections, Interna- 
tional Commissions, State 
(allocated working fund to 
HEW, PHS) 

Refugee Relief, Executive 
(transfers to HEW, PHS)___. 



462 
062 
616 
387 

,451 

,139 
,880 
,170 
,665 

,290 
,990 

,000 

,000 

600 



21 

,929 

,978 
,001 

,808 
,176 

415 



3,190 

57, 800 



1,355 
'2,'9i6" 



$535 $16, 931 



535 
10 
10 



-174 
535 



310 
-45 
-310 



$485, 709 



16, 931 

7 

15 

127 

289 

14 
163 



12, 947 



20 



$361, 272 



64, 071 



61, 204 



1,827 
15 



1,417 



476, 999 
6,079 
3,641 

18, 514 

5,740 

1,159 

5,043 

3,170 

38, 435 

1,299 
34, 956 

5,535 

172, 204 

510 

1,827 

36 

18, 876 

24, 978 
18, 021 

18, 898 
2,176 

420 

10, 840 

7,775 

9,861 
147 



3,500 

57, 755 

1,107 

1,355 

6 
3,136 



8,561 
1,491 



74 
557 



353, 686 
6,053 
3,624 
17, 577 

5,723 

1,158 

4,996 

3,154 

38, 351 

1,282 
34, 690 

1,947 

93, 187 

506 

269 

16 

18, 655 

24, 830 
17, 978 

18, 838 
2,168 

392 

10, 821 

7,744 

9,668 
147 



130 

24, 359 

970 

1,333 



3,120 



7,562 
1,486 



72 
506 



See footnotes at end of table. 



$124, 437 



123, 313 

26 

17 

937 

17 

1 

47 
16 



17 
266 

2 3, 588 

3 79, 017 

4 

2 1,558 

2 20 

221 

148 
43 

60 



193 



2 3, 370 

33,396 

2 137 

22 

26 
16 



408691—57- 



-11 



154 



Department of Health, Education, and Welfare, 1956 



Table 1. — Statement of appropriations, authorizations, 
balances, fiscal year 1956 — Continued 

[In thousands] 



obligations, and 



Appropriations 



Appropri- 
ations 
and au- 
thoriza- 
tions 



Operations, Federal Civil De- 
fense Administration (allo- 
cated working fund to HEW, 
PHS) 

Atomic Energy Commission 
(allocated working fund to 
HEW, PHS) 

Research and development, 
isavv (allocated working 
fund" to HEW, PHS) 

Naval working fund (allocated 
working fund to HEW, 
PHS). 

Research and development, 
Armv (allocated working 
fund'to HEW, PHS) 

Research and development, 
Air Force (allocated working 
fund to HEW, PHS) 

Army, industrial fund (allo- 
cated working fund to HEW, 
PHS) 

Farm labor supply revolving 
fimd. Bureau of Employ- 
ment Security (allocated 
working fund to HEW, 
PHS) 

Technical Assistance to Ameri- 
can Republics and Non- 
Self-Governlng Territories of 
the Western Hemisphere, 
Executive (transfers to 
HEW) 

Technical Assistance, U. S. 
Dollars Advanced from For- 
eign Governments, I. C. A. 
(transfers to HEW) 

Plant and equipment, Atomic 
Energy Commission (allo- 
cated working fund to HEW, 
PHS) 

Defense support, Europe, Ex- 
ecutive (transfers to HEW).. 

Administrative expenses. Sec- 
tion 411, Mutual Security 
Agency Act, Executive 
(transferred to HEW) 

Technical cooperation, general. 
Executive (transfers to 
HEW) (no year) 

Technical cooperation, general. 
Executive (transfers to 
HEW) (annual) 

Salaries and expenses, civil 
defense functions of Federal 
agencies, Federal Civil De- 
fense Administration (allo- 
cated working fund to HEW) . 

Defense support, Asia, Execu- 
tive (transfers to H E W) 



Gift funds donated for 
general and specific 
purposes 



Public Health Service imcon- 
ditional gift fund 

Public Health Service condi- 
tional gift fund 



Funds available for obligation 



12.6 
33.5 



Net 
transfers 
between 
appro- 
priations 



Repay- 
ments for 
services 



Prior year 
unobli- 
gated 
balances 



103.2 



77.1 
26.1 



Total 

funds 

available 



154 
86 
93 
36 

191 
65 
25 



144 



807 
153 



149.3 



89.7 
59.6 



Amounts 
obligated 



152 
71 
72 
27 

172 
17 
12 



15 


3 


18 


17 


114 


110 


1,322 


1,141 


2,893 


2,594 



703 
146 



24.3 



Balances 



23.6 



' Liquidation of contract authorizations obligated in 1955 fiscal year. 
2 Available for obligation in subsequent years. 
, * $78,602 available for obligation in subsequent years. 



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158 



Department of Health, Education, and Welfare, 1956 



Table 4:.'— Payments to States, fiscal year 1956 

[In thousands! 

















Polio- 


Medi- 


Hospi- 






Vene- 












myeli- 


cal fa- 


tal and 


Com- 


State 


real 


Tuber- 


General 


Mental 


Cancer 


Heart 


tis vac- 


cilities 


medical 


munity 




disease 


culosis 


health 


health 


control 


disease 


cination 


survey 


facili- 


facili- 




special 


control 








control 


assist- 


and 


ties con- 


ties 




projects 












ance 


plan- 
ning 


struc- 
tion 




Total 


1 $1,188 


$4, 488 


2 $13,332 


$2, 981 


.$2, 218 


$1, 088 


$24, 359 


$287 


$54, 373 


$647 


Alabama 


34 


109 


420 


65 


54 


30 


847 


2 


1,722 






28 
29 


55 
81 


99 
225 


19 
40 


17 
37 


1 
21 


150 
400 


2 

1 


68 
799 




Arkansas 




California. - 


14 


270 


801 


182 


143 


50 


1, 396 


31 


3,855 








34 

49 


145 
119 


25 
36 


24 
28 


16 
16 


291 
346 


6 


83 
106 




Connecticut- _- . 


2 




Delaware- 


( 


16 


24 


19 


5 


11 


29 




26 




Dist. of Columbia. - 


45 


42 


50 


19 


10 


13 


101 




228 




Florida 


83 


81 


331 


63 


50 


25 


777 




1,392 


34 


Georgia 


113 


112 


369 


72 


57 


31 


894 


10 


2, 557 


49 


Idaho 


6 


17 


86 


19 


13 


13 


95 


2 






Illinois 


18 


230 


491 


145 


117 


38 


1,194 


9 


556 


225 


Indiana.. .- -.. 




88 
38 
39 


215 
159 
192 


57 
44 
36 


54 
40 
30 


25 
21 
17 


218 

84 
456 


24 
8 
10 


804 

767 

1,074 










Kansas.— 


2 


214 


Kentucky 


27 


129 


346 


60 


51 


27 


690 


3 


1,386 




Louisiana.. 


32 


92 


271 


56 


44 


22 


665 


6 


2,256 




Maine 




23 

86 


107 
185 


19 
42 


18 
25 


14 
17 


177 
190 


2 


567 
1,129 




Maryland--. . .. - 


6 


108 


Massachusetts ._ 




118 
147 


356 

475 


84 
117 


70 
84 


28 
33 


960 
1,008 


19 
23 


959 
1,414 




Michigan ... . 


36 




Minnesota 




51 

80 


274 
363 


53 
51 


45 
47 


23 

27 


876 
574 


5 


1, 258 
1,002 




Mississippi 


42 






25 


110 

20 

25 

12 

9 


341 
78 

122 
36 
53 


73 
19 
22 
19 
19 


61 
13 
16 
6 


27 
13 
13 
10 
10 


182 
85 

112 
12 

113 


t 
5 
2 


2,186 
112 
744 
421 
303 




Montana . 






5 
2 




Nevada 


4 


New Hampshire 




New Jersey 


44 


125 


338 


86 


65 


25 


852 


9 


84 


8 


New Me.xico .. 


19 


33 


106 


19 


15 


14 


154 


6 


122 




New York 


100 

83 


385 
109 


940 

465 


248 
83 


189 
65 


46 
29 


2,110 

678 


12 
14 


3.566 
2,478 




North Carolina 




North Dakota.- .-. 




23 
187 
64 
34 
282 


91 
438 
224 
150 

744 


19 
142 
42 
26 
184 


14 
108 
36 
21 
129 


13 
38 
21 
13 
49 


234 
618 
259 
80 
600 


3 

2" 

10 

1 


432 
1,286 
1,056 

468 
3, 589 




Ohio 


55 
10 








Oregon 




Pennsylvania 


48 




Rhode Island 




25 
75 


63 

286 


19 
46 


12 
37 


10 
24 


167 
701 


4^ 


130 
950 




South Carolina 


62 




South Dakota 


1 


15 


79 


19 


15 


13 


207 


2 


176 




Tennessee 


61 
91 


127 
211 
17 
16 
HI 
50 


373 
660 
85 
46 
310 
188 


67 
151 
19 
19 
67 
39 


45 
111 
13 
8 
43 
32 


29 
39 
13 

3 12 

9 
19 


727 
465 
224 
79 
968 
200 


5 
7 
2 

7" 


3,042 

2,764 

66 

118 
2,236 

336 




Texas. 




Utah 










Virginia 


24 

1 




Washington 


5 


West Virginia 


1 


60 


203 


35 


31 


18 


289 


5 


873 








51 
3 


281 
54 


57 
12 


43 
8 


16 

1 


911 
11 




1,188 
91 




Wyoming 


2 








43 
31 
242 


63 

51 

354 


19 
19 
50 


7 
12 


6 
13 
25 


22 

57 

785 


2 
8 
6 


242 










Puerto Rico 


23 


1,094 




Virgin Islands 


7 


6 


7 


19 




1 


11 




















11 

17 


















































1 















1 Includes $195,000 in services and supplies furnished in lieu of cash. 

2 Includes $3,607,000 earmarked for poliomyelitis vaccine distribution and use. 

3 Vermont allotment paid to Vermcnt Heart Association. 

4 An additional payment of $638,000 was made to Alaska for disease and sanitation investigation and 
control activities. 



Office of Education 



/. Introduction 

Fiscal Year 1956 was unusually significant for American education 
and for the Office of Education. Throughout the country there was 
unprecedented recognition of the contribution of the schools to the 
national welfare — recognition that what the schools contribute to an 
individual they contribute to the strength of the Nation. The empha- 
sis was on citizen-educator cooperation, on getting the facts, on action 
to improve the schools. At local. State, and National levels educators 
and laymen organized to appraise the accomplishments of schools, 
to identify and look squarely at the problems facing schools. They 
found much to be done. 

At the local level, in rural communities, small towns, and cities, 
parents and other citizens displayed an increased interest in their 
schools; they served on curriculum and other planning committees, 
assisted with the school-lunch program, and worked on the school 
playgromid. Ten million members of parent-teacher associations 
discussed school programs, problems, and policies. They all asked 
for facts. 

State departments of education sought solutions to old and new 
problems and better methods of serving the schools. They too asked 
for facts. In many States legislatures provided for greater financial 
support for schools, improved provisions for teacher welfare, and 
studied various methods of providing for a better education for their 
children. 

State and local interest and activity, as well as official recognition 
of the severity of the educational problems, were reflected in action 
at the Federal level : In the "Wliite House Conference on Education, 
in the President's Conference on the Fitness of American Youth, in 

159 



160 Department of Health, Education, and Welfare, 1956 

the President's appointment of a committee on education beyond the 
high school, in the volume of legislative activity, and in increased 
demands on the Office of Education. 

The Office of Education, as the agency of the Federal Government 
established "to promote the cause of education," was vitally concerned 
in all tliis educational ferment. Its functions, as defined by the organi- 
zation act of 1867, are to collect such statistics and facts as shall show 
the condition and progress of education, to diffuse such information 
as shall aid the people of the United States in the establishment and 
maintenance of efficient school systems, and otherwise promote the 
cause of education. 

The Office's primary means of discharging its responsibilities for 
these functions is through the collection, interpretation, and publica- 
tion of statistics ; through research and publication of its findings ; and 
through rendering consultive and advisory services. From time to 
time administrative functions have been added to Office responsibili- 
ties, and in 1956 the Office administered Federal funds under three 
programs: for vocational education of less than college grade, for 
land-grant colleges and universities, and for school assistance in fed- 
erally affected areas. Thus it will be seen that the Office is authorized 
to work primarily in three areas : Research, services, and the adminis- 
tration of grants. Some of its major accomplishments in each area 
will be summarized in this report. 

For many years the Office has cooperated with other Federal 
agencies in educational and related programs, some in voluntary asso- 
ciation and some in response to legislative mandate. The Office 
continued such cooperation in 1956. 

White House Conference on Education 

THE CONFERENCE 

The Eighty-Third Congress, in response to the President's request, 
authorized and appropriated funds for use of the States and Terri- 
tories for local, regional, and State conferences leading to a White 
House Conference on Education. In December 1954, President Eisen- 
hower named a 34-member Committee for the White House Conference 
on Education to plan and conduct an overall study of the Nation's 
elementary and secondary school needs. More than 4,000 local, 
regional, and State conferences on education were held during 1955, 
involving more than a half-million citizens. Under the American 
system of local school control, each State and Territory evolved its 
own program without direction from the President's Committee. The 
year's activity was the most thorough, widespread, and intensive 
study the American people have ever made of their educational system. 

Tlie White House Conference, held November 28 to December 1, 1955, 



Office of Education 161 

in Washington, D. C, climaxed the series of State and Territorial 
Conferences. More than 1,800 persons within the States and Ter- 
ritories, including representatives of national organizations, took part 
in the discussion of the six topical questions posed at the conference. 

There has been widespread agreement that the White House Confer- 
ence emphasized the importance of education to the well-being of the 
Nation and the individual, made available to many interested citizens 
information on needs of education and the existing resources, and 
stimulated interest in education. In his Special Message to the Con- 
gress, January 12, 1956, the President commented on the conference : 

Benefits are already apparent. About half a million people across the 
Nation, representing all segments of life, came to grips with the problems 
of education. The status of American education — where it is ; the future 
of American education — where it should and can go — have been illumi- 
nated as never before. Most important of all, there has been a reawakening 
of broad public interest in our schools * * * no more potent force can 
be devised for assailing a problem than the common will to do the job. 
For the improvement of our educational system, the people themselves 
have laid the foundation in understanding and willingness to do the job. 

REPORT TO THE PRESIDENT 

In April 1956 the Committee for the White House Conference on 
Education presented its report to the President. The 126-page report 
is in three parts: (1) The committee's statements and recommenda- 
tions, (2) the Keport of the White House Conference on Education, and 
(3) a summary of the State conference reports. 

THE COMMITTEE REPORT 

The committee report contains 79 specific recommendations for the 
improvement of schools in the 6 areas of elementary and secondary 
education the conference was asked to study. From its own studies and 
results of State and Territorial conferences and the White House 
Conference, the 34-member committee concludes that the schools now 
affect the welfare of the Nation more than ever before in history. 

The report embraces the traditional concept of education in a 
democracy : Schools free men to rise to the level of their abilities ; they 
stand as the chief expression of the American tradition of fair play 
for every one and a fresh start for each generation. The committee 
also accepts the broadened functions of education: To improve the 
child's health ; to provide vocational training ; and to do anything else 
within its power to help bring the child up to the starting line as nearly 
even with his contemporaries as his native skills will permit. 

The committee report recognizes the progress that has been made 
in American education, but points out that schools have fallen far 
behind the aspirations and the capabilities of the American people. 
To help close the gap between educational ideals and realities, the com- 



162 Department of Health, Education, and Welfare, 1956 

mittee makes a number of recommendations. Some of them are smn- 
marized below. 

1. That school authorities emphasize priorities in education, that school chil- 
dren be given first things first. 

2. That American people deny funds, other than local, to districts which do 
not organize on an efficient basis. 

3. That local boards quiclily assess their school building needs, give the in- 
formation to chief State school officers, who in turn can relay it to the Office 
of Education ; That State and local communities do all they can to construct 
new buildings and that where necessity is shown to exist, Federal funds be used 
in such emergencies as the present. 

4. That greater inducement be offered to attract and retain good teachers and 
that, while the shortage exists, greater effort be made to use teacher services 
more efficiently. 

5. That a new look be taken at the question of how much money the Nation 
should spend on education. (A doubling of present expenditure during the next 
decade would be an accurate reflection of the importance of education to society. 
Funds must come from all levels of government. Good schools are admittedly 
expensive, but not nearly so expensive in the long run as poor ones.) 

6. That every possible step be taken to encoiirage the interest and activity of 
citizens in school affairs. 

7. That a White House Ck)nference on higher education similar to the one on 
elementary and secondary education be held promptly. 

CONFERENCE REPORT 

Part 2 of the report to the President — the official report on the White 
House Conference — presents the six summary conclusions reached by 
the discussion groups on the six questions participants had been asked 
to consider. A few significant conclusions are quoted below. 

What Should Our Schools Accomplish? 

It is the consensus of these groups that the schools should continue to 
develop : 

1. The fundamental skills of communication — reading, writing, spelling 
as well as other elements of effective oral and written expression ; the 
arithmetical and mathematical skills, including problem solving. While 
schools are doing the best job in their history in teaching these skills, 
continuous improvement is desirable and necessary. 

ISew Challenges in Education 

Consideration must be given to the need for continuing growth and 
development in education at all levels in amount and scope, to keep up 
with the economic, social, and moral implications resulting from the ad- 
vances in technology and science. 

What Are Our School Building Needs? 

It appears that under present plans only 2 or 3 States have been quoted 
as stating that they can meet their building needs for the next 5 years. 

We have taken the question exactly as stated. Under the present plans 
and time limitations stipulated, it seems to be virtually impossible for 
most of the States to meet school building needs. 



Office of Education 163 

The general consensus was this : No State represented has a demon- 
strated financial incapacity to build the schools it will need during the 
next 5 years. But, with the exception of a few States, none of the States 
presently has plans which indicate a political determination powerful 
enough to overcome all of the obstacles. 

Some Territories and a few States may need outside financial assistance. 

How Can We Get Enough Good Teachers — And Keep Them? 

We believe that, to increase the supply of good teachers from any source, 
three basic considerations must be kept in mind : 

1. The prestige and status of teaching must be comparable to other 
professions within the community. 

2. The salary structure must be high enough and flexible enough to com- 
pete effectively with other fields bidding for quality manpower. 

3. The teacher's job must be so defined as to challenge and attract the 
interest of talented people. 

How Can We Finance Our Schools — Build and Operate Them? 

The participants approved by a ratio of more than 2 to 1 the proposition 
that the Federal Government should Increase its financial participation 
in public education. Of those favoring such increase, the overwhelming 
majority approved an increase in Federal funds for school building con- 
struction. On the issue of Federal funds to the States for local school 
operation, the participants divided almost evenly. A very small minority 
was opposed to Federal aid for education in any form. 

How Can We Obtain a Continuing Public Interest in Education? 

We agreed that the energy, intellectual effort, and investment of money 
on the White House Conference on Education will be futile unless specific 
and positive actions are undertaken at the local, county. State, and 
National levels to meet the existing crisis in education and plan for future 
needs. 

Five of the six conference reports commented, on tlie role of the 
Office of Education in the current effort to improve the Nation's 
schools. Among the recommendations on the Office were the follow- 
ing : That the Office be further strengthened to perform the functions 
it is now performing in making reports, in carrying on research, and in 
providing promptly statistical information needed; that the Office 
make a studj^ of certification standards and establish a basis for re- 
ciprocity in certification among the States. 

The official report also recommended that a White House Conference 
on Education be held periodically at national. State, and local levels. 

STATE AND TERRITORIAL SUMMARIES 

Part 3 of the report, a summary of State and Territorial reports, 
made a number of recommendations and suggestions on the Office and 
Office activities. Among them were the following: That the Office 
increase its staff in adult education; disseminate its findings more 



164 Department of Health, Education, and Welfare, 1956 

widely ; and expand its services to include regular communications on 
research in school building construction. 

FOLLOWUP 

Many States and national organizations are following up the White 
House Conferences in a variety of ways. Missouri is planning 6 
followup conferences; Oregon has held 32 foUowup meetings; and 
other States have organized planning committees. National Organ- 
izations are working on topics of the White House Conference, teacher 
recruitment, school financing, organization of citizen committees, and 
others. 

In the Office of Education an Advisory Committee of National 
Organizations composed of lay and educational organizations advises 
and makes recommendations to the Commissioner and his staff "to 
promote the cause of education throughout the country." It also ad- 
vises on Conference followup work. 

The Report of the White House Conference Committee is available 
from the Superintendent of Documents, U. S. Government Printing 
Office, Washington 25, D. C. 

President's Conference on Fitness of American Youth 

Because of his concern that we "do more than we are now doing 
to help our young people become physically fit and therefore better 
qualified, in all respects, to face the requirements of modern life," 
President Eisenhower called a Conference on Fitness of American 
Youth. This conference was held at the U. S. Naval Academy, An- 
napolis, Md., on June 18-19, 1956. The Office of Education assisted 
the White House and Vice President Richard M. Nixon, who served 
as conference chairman, in the planning, conduct, and followup of this 
important meeting. 

The 150 participants included representatives of local, State, and 
Federal Governments; professional education, health, medical, and 
recreation organizations; child and youth-serving agencies; civic 
groups ; the motion picture industry ; radio and television networks ; 
amateur and professional athletics and sports; and newspaper and 
magazine editors and publishers ; sportscasters and sportswriters. 

The conference discussion resulted in a number of important find- 
ings and recommendations. Among these were the following: 

1. A fitness program should provide for development of the total 
person — physical, spiritual, mental, emotional, social, cultural — and 
should recognize the interrelationship of all personality factors. 

2. Research is needed to determine the full nature and dimensions 
of the youth fitness problem and to supply the facts essential in formu- 
lating new policies, plans, and programs, and in improving old ones. 



Office of Education I^ 

3. Schools, community recreation agencies, youth organizations, and 
other groups should take steps to expand and improve programs of 
health, physical education, recreation, sports, and other aspects of 
youth fitness by providing necessary leadership, programs, and fa- 
cilities to meet the needs of all the Nation's boys and girls. 

4. Within the community, and on regional, State, and national levels 
as well, full coordination and cooperation among public and private 
agencies and organizations and interested citizens are needed to insure 
wise planning and efficient use of fitness resources. 

5. Although a regimented national youth program is to be avoided, 
a nlimber of Federal agencies do provide appropriate services relating 
to youth fitness. Therefore, the President should provide for exten- 
sion and improved coordination of Federal services and should estab- 
lish a citizens' advisory group to lend assistance toward this end. 

In response to the last recommendation, President Eisenhower, 
through an Executive order issued on July 16, 1956, established a 
President's Council on Youth Fitness and a President's Citizens' Ad- 
visory Committee on the Fitness of American Youth. The council 
is composed of the Vice President of the United States, who serves as 
chairman, and the heads of departments that are concerned with the 
activities of young people — the Departments of Health, Education, 
and Welfare ; Agriculture ; Interior ; Justice ; and Labor. The crea- 
tion of a council at cabinet level should provide for better coordina- 
tion of the activities of some 30 Federal agencies that touch the lives 
of children and should stimulate and improve existing programs. 

The Citizens Advisory Committee will be appointed because the 
conference recommended and the President agreed that the American 
people need to be made freshly aware of the importance of physical 
and other recreational activity. The President points out the need for 
a comprehensive study and reevaluation of all government and non- 
government activities relating to the fitness of American youth. 

Through the work of the council and the committee, American 
citizens in general should benefit from the findings and recom- 
mendations. 

The Office of Education will cooperate with the council and the 
committee. 

The Report to the President of the U. S. on the Annapolis Con- 
ference is available in booklet form from the Superintendent of Docu- 
ments, U. S. Government Printing Office. 

President's Committee on Education Beyond the 
High School 

In his special message to the Congress on January 12, 1956, Presi- 
dent Eisenhower expressed concern about the growing problems in 



l66 Department of Health, Education, and Welfare, 1956 

the field of education beyond the high school and his belief that imme- 
diate action on the problem was needed. He said : 

Shortages now exist in medicine, teaching, nursing, science, engineering, 
and in other fields of knowledge which require education beyond the 
level of the secondary school. Changing times and conditions create new 
opportunities and challenges. There are now possibilities for older per- 
sons, properly trained, to lead more productive and rewarding lives. The 
tide of increasing school enrollment will soon reach higher educational 
institutions. Within 10 years we may expect 3 students in our colleges 
and universities for every 2 who are there now. 

Higher education is and must remain the responsibility of the States, 
localities and private groups and institutions. But to lay before us all 
the problems of education beyond high school, and to encourage active 
and systematic attack on them, I shall appoint a distinguished group of 
educators and citizens to develop this year, through studies and confer- 
ences, proposals in this educational field. Through the leadership and 
counsel of this group, beneficial results can be expected to flow to educa- 
tion and to the Nation, in the years ahead. 

The President's concern for this area of education was shared by 
the Committee for the White House Conference on Education and by 
interested citizens generally. 

In April 1956, President Eisenhower appointed a committee of 
33 prominent lay leaders and educators to undertake a large-scale 
study of post high school education. 

At the first meeting the committee agreed on basic objectives : First, 
to collect, assemble, and disseminate information for the purpose 
of increasing public awareness of the problems which lie ahead in 
the field of education beyond the high school; second, to encourage 
the planning and action that should be undertaken by institutions and 
groups of institutions, locally and nationally, publicly and privately, 
to meet the impending demands ; and third, to advise the President on 
the proper role of the Federal Government in this field. 

In considering these objectives at its first and second meetings, the 
committee discussed a wide range of problems on which facts were 
needed and on which planning and action should be forthcoming. 
For example, the following questions presented themselves : 

What aims should guide the provision of education beyond the high 
school ? What should be done to supph^ the quantity and quality of 
persons for science, industry, government, and education? to meet 
other educational needs of persons with a wide range of abilities and 
ijiterests before, during, and after their work careers? to staff the 
schools and colleges with qualified teachers? How can phj-sical 
facilities — classrooms, laboratories, libraries, dormitories — be pro- 
vided for the 5 to 7 million students who will be ready for college by 
1970 ? What will be the annual cost of educating, or of failing to edu- 
cate, the number of persons necessary to serve the vocational and other 



Office of Education 167 

needs of an increasing population ? What adjustments may be needed 
in existing institutions ? What, if any, changes in the role of the Fed- 
eral Government in this field should be made ? What implications are 
tliere for higher education in the international and defense activities 
of the United States ? 

The committee has reached general agreement upon the most effec- 
tive method of working. 

The President's committee, assisted by a small staff and by con- 
sultants, will collect, compile, and organize statistics and other infor- 
mation needed to shed light upon the true dimensions of the problem 
areas mentioned above, and will publish a series of reports. States 
will be asked to organize State committees, made up of educators and 
lay leaders to study the State conditions and stimulate interest and 
action at the institutional, local, and State levels. During the spring 
of 1957 the President's committee will sponsor a series of perhaps five 
regional conferences to emphasize current problems and to assist the 
States in framing the basic issues for consideration at the local and 
State levels. 

States will then develop their own studies, and conferences will be 
held to clarify and crystallize public views on such questions as those 
suggested above, and to encourage institutional, local, and State activ- 
ity to accomplish agreed-upon objectives. 

During this process the President's committee will have a good 
opportunity to decide whether it should call a national meeting. If 
such a conference is held its purpose will be to have representative 
Americans, well grounded by their State and regional studies, gather 
to discuss these problems from a national perspective and to advise the 
President's Committee on pertinent matters. 

Legislation 

Fiscal year 1956 was a period of increased legislative activity. Al- 
though the number of public laws enacted by the United States Con- 
gress affecting education was relatively small, the scope and variety of 
education bills introduced and considered indicate a growing concern 
with the Nation's educational system. Some of the bills introduced 
proposed scholarships and fellowships, veterans' educational benefits, 
loans for college housing, assistance for medical school construction, 
graduate and undergraduate traineeships, tax deductions or exemp- 
tions for tuition payments, international exchanges of students, gen- 
eral aid for school construction, aid for federally affected areas, nurse 
training, and fine arts. 

The area of greatest activity consisted of proposals for general 
Federal aid to school construction. During the 84th Congress the Ad- 
ministration's legislative program included recommendations for the 
enactment of such legislation, and the President, on February 8, 1955, 



168 Department of Health, Education, and Welfare, 1956 

and again on January 12, 1956, submitted to the Congress special mes- 
sages on this subject. A general school construction aid bill was re- 
ported to the House of Kepresentatives in 1956 and debated, but failed 
to pass. 

Among the measures enacted by the Congress during 1956, 6 are of 
direct interest to education : Public Laws 204, 221, 345, 382, 597, and 
634. 

Public Law 345, approved August 11, 1955, amends Title IV of the 
Housing Act of 1950 by increasing the amount of college housing loans 
that may be outstanding at any one time, from $300 million to $500 
million. It also expands the program to permit loans on additional 
types of self -liquidating education facilities (dining halls, student 
centers, infirmaries, etc.), provides for a decreased interest rate for 
borrowers, and lengthens the maximum maturity on loans from 40 to 
50 years. The added funds will help colleges build to meet expanded 
enrollments. 

Several amendments to legislation providing assistance for schools 
in federally affected areas (Public Laws 815 and 874, as amended) 
were enacted during the year. 

Public Law 204, approved August 1, 1955, which amends Public 
Law 874, provides for the continued operation of a limited number of 
schools on military installations. Under the amendment the responsi- 
bility for determining whether the free public educational facilities 
available to children residing on military installations are "suitable," 
within the meaning of Public Law 874, will be exercised jointly by the 
Commissioner of Education and the Secretary of the military depart- 
ment concerned, after consultation with the appropriate State school 
agency. 

Public Law 221, makes Oak Kidge, Tenn., and Kichland, Wash., 
atomic energy installations, eligible for payment under the provisions 
of Public Law 874. 

Public Law 382 amends Public Laws 874 and 815, as amended, by 
extending for 1 additional year assistance to local agencies in areas 
affected by Federal activities ; liberalizes the formula for calculating- 
payments ; postpones for 1 more year the 3-percent absorption require- 
ment ; provides for the transfer of title to certain federally constructed 
school facilities to local educational agencies and improves the admin- 
istrative machinery for certain "unhoused" and Indian children. 

Public Law 597 approved June 19, 1956, established a 5-year, Fed- 
eral grant-in-aid program to the States to assist in extending public 
library services to rural areas. The act authorizes Federal appropria- 
tions of $71/^ million annually for the fiscal year 1957 and each of the 
next 4 fiscal years for payments to States whose plans for the further 
extension of public library services to rural areas without such services, 



Office of Education ^ 169 

or with inadequate services, have been approved by the Commissioner 
of Education. 

The act provides for a minimum allotment of $40,000 annually to 
each of the States ($10,000 to the Virgin Islands) plus an allotment 
from the remainder of the appropriation based upon each State's rural 
population in relation to the rural population of the United States as 
a vrhole. The allotment for each State must be matched by the State 
on the basis of a formula which takes into account the relative financial 
ability of the States. 

Public Law 634, approved June 29, 1956, establishes an educational 
assistance program for children of servicemen who died as a result of 
a disability or disease incurred in line of duty during World Wars I 
and II or the Korean conflict. Approximately 156,000 war orphans, 
average present age 10 to 14 years, will be entitled to 36 months of 
education and training under the act. 

During the year the Office of Education further developed its serv- 
ices in the field of school law, particularly by providing information 
on State legislation to educators and laymen who are working to im- 
prove the nation's school system. 

Progress and Problems 

President Eisenhower in his special education message to the Con- 
gress, January 12, 1956, said : 

Signs of heartening progress have come to light. Among these are 
classroom construction at a higher rate than ever before; teachers' sal- 
aries increased in many communities ; the number of small, uneconomical 
school districts reduced ; substantially more young people preparing for 
the teaching profession ; private gifts to higher education at new heights ; 
support of education at all levels greater than ever before. 

Encouraging as these advances are, they are not enough to meet our 
expanding educational needs. Action on a broader scale and at a more 
rapid rate is clearly imperative. 

We still do not have enough good classrooms for our children. There 
is insufficient emphasis on both short-range and long-term research into 
the core of educational problems. We need examination and study, from 
a broad viewpoint, of the increasing needs of higher education. These 
lacks are magnified by an ever-increasing stream of student enrollment 
and the increasing complexity of modern society. 

In his message the President called for action on some of the most 
pressing problems in education : Federal aid to relieve the classroom 
shortage, a vigorous program of educational research to be conducted 
by the Office of Education, State and local attention to the need for 
good teachers, and for a commission study of education beyond the 
high school. 

408691 — 57 12 



170 Department of Health, Education, and Welfare, 1956 

ENROLLMENT 

A few figures will indicate the size of some of these problems. 
Total enrollment in public and nonpublic schools, including higher 
institutions, in 1955-56 was estimated by the Office of Education at 
39,798,700, an increase of 1,670,200 over 1954-55. (See table 1.) 
Total estimated population in the United States was 165,271,000 at the 
beginning of fiscal year 1956. Total estimated enrollments therefore 
represented 24.1 percent of total population. 

The estimated enrollment in elementary and secondary schools was 
1,101,300 higher than the total in 1954-55, an increase of 3.1 percent. 
Elementary schools enrolled an estimated 776,200 more pupils in 
1955-56, an increase of 2.8 percent over 1954-55, and secondary schools 
an estimated 325,100 more, an increase of 4.4 percent. 

A total of 2,996,000 students enrolled in colleges and universities, the 
largest in our history and the fourth year of consecutive increases, 
with each of the last 2 years adding about one-fourth of a million 
students. This increase was the result of larger high school gradu- 
ating classes and a larger percentage of students going on to college. 

TEACHER SHORTAGE 

The teacher shortage continued. When schools opened in the fall 
of 1955, they faced a shortage of 141,300 qualified elementary and sec- 
ondary teachers. (See table 2.) The shortage had to be met by 
additional emergency teachers, by the reentrance of former teachers 
into the profession, and by further overcrowding of the classrooms. 
In the computation of the total shortage the additional teachers needed 
to reduce the present overcrowding or to enrich the curriculmii were 
not taken into account. 

CLASSROOMS 

A record 62,600 classrooms and related facilities for elementary 
and secondary schools were constructed during the 1955-56 school year 
at an estimated cost of $2.4 billion. Even with this large construction 
total, the gap between the number needed and the number of class- 
rooms available remains wide. 

MIGRANT CHILDREN 

The Office continued its efforts to improve the educational oppor- 
tunities of children of agricultural migrant laborers, estimated at 
600,000 children in the United States in 1956. During the year Office 
staff members worked with two interagency groups devoted to the 
problem : The subcommittee of the President's Interdepartmental 
Committee on Children and Youth (now the Subcommittee on Chil- 
dren of Agricultural Migrants) and the Committee on Migratory 
Labor. The Office also periodically distributes packets of materials 



Office of Education 171 

on the education of migrants, inventories of State and Federal re- 
sources, and analyses of problems. 

SCHOOL DROPOUT PROBLEM 

The dropout problem continued to be serious. Of the 4I/2 million 
IG-to-lT-year-olds in this country, over a million were not in school, 
and of these only a few more than half were employed. Some progress 
has been made, however, according to Office studies. A larger per- 
centage of high school youth (age 14 to 17 years) in public and private 
schools is enrolling in high school — 85 percent enrolled in grades 9 to 
12 in the fall of 1955, as compared with 62 percent 10 years ago, and a 
larger percentage of those who enter is staying to graduate, 63 percent 
in 1954 as compared with 47 percent 10 years ago. The Office, in coop- 
eration with the Department of Labor, conducted a Back-to-School 
Campaign during the summer of 1956. 

MANPOWER SHORTAGE 

Few developments in recent years have had such vast implications 
for American education as the growing public concern over existing 
shortages of teclmically trained manpower. Public concern, inten- 
sified by reports that the U. S. S. K. was producing increasing numbers 
of scientists and engineers, stimulated interest in scientific and tech- 
nical training programs in U. S. colleges and universities. 

Central to any consideration of this manpower problem is education, 
and the chief factor in the expansion of trained manpower is the 
capacity for training — the facilities for education, the need to improve 
teacher qualifications, curriculums, methods of instruction, facilities, 
and equipment, all are part of the problem. For this reason the 
responsibility falls on education to consider the needs created by 
technical and scientific advances. The Office of Education worked 
closely with the National Science Foundation, scientific organizations. 
Federal defense agencies, professional education and teacher-pre- 
paring organizations to coordinate efforts to increase the supply and 
improve the quality of trained scientists, engineers, and teachers in 
these fields. 

SIGNS OF PROGRESS 

There were other signs of progress in education, among them the 
following: More than 9 million pupils, or 31 percent of the total, 
were transported to and from school daily. Expenditure per pupil in 
average daily attendance increased from $351 in 1953-54 to $380 in 
1955-56. The movement toward teaching foreign language in elemen- 
tary schools gained momentum ; 15 years ago fewer than 15,000 pupils 
were getting foreign language instruction in elementary schools, but 
in the school year 1955-56, nearly 300,000 were. There was increasing 



172 Department of Health, Education, and Welfare, 1956 

cooperation between local schools and State departments of education 
and between State departments and the Office of Education. 

At every level plans were being made. In the Office of Education 
plans provided for a broader program of research and for expanded 
service to education. 

The Office of Education has made an effort to improve these phases 
of education all along the line. Specialists in science and mathematics 
have made a number of research studies, written reports of their find- 
ings, and served in consultive and representative capacities with 
professional associations and groups to improve the status of education 
in these fields. During the year the Commissioner organized an 
informal Office task force to keep abreast of rapid developments in the 
scientific manpower field and to publicize these developments in the 
interest of better coordination of all activities related to the field. 
Office specialists organized and disseminated data on educational de- 
velopments pertaining to the shortage and with possible solutions. 
Continuing studies were made of earned degrees and offerings and 
enrollments in science and engineering. 

Three Office specialists worked with the National Committee on 
the Development of Scientists and Engineers on methods and pro- 
cedures of improving mathematics and science education in elementary 
and secondary schools. 

Through its periodicals, School Life and Higher Education, the 
Office made information available on scholarships and grants offered 
for science study and digests of studies. 

Research 

Authoritative information is being sought about education at every 
level. Federal agencies, national associations in commerce, industry, 
and the professions, State departments of education, and local groups — 
all are demanding more facts. Probably at no time in history has 
there been greater need for factual information on education nor a 
greater audience for it than in the last few years. 

In his special education message to the Congress the President 
said: "Basic to all endeavors in improving education is a vigorous 
and f arsighted program of educational research." 

In 1956 the Office of Education took major forward steps to provide 
an expanded and strengthened research program. Under the ex- 
panded program Office research is conducted under cooperative agree- 
ments with agencies outside the Federal Government, by the Office 
Research and Statistical Services, and by Office specialists. Although 
the cooperative phase of the program was emphasized in 1956, each 
phase of the program is important, each phase supplements the other, 



Office of Education 173 

and each contributes to the strength of the overall program. The 
intent and. scope of the program were indicated by Secretary Folsom 
in October 1955. He said : 

In the educational field, as we have already seen in health, one of the 
most basic needs is more research. We are working now on plans for an 
expanded program of educational research, which we hope to submit to the 
next Congress. The purpose is to help our Office of Education render a 
still more significant and effective service in leading the way for better 
education of all our children. We plan to study such specific problems as 
educating the retarded child, so he can lead a normal productive life. We 
also plan more research into the problems of educating the child with 
special abilities, so the Nation may utilize these abilities more fully. We 
plan research into the chronic problems of school housing, teacher staffing, 
and school financing. We hope to bring some light to unanswered ques- 
tions that have handicapped our educational program for many years. In 
a related field, we hope to make vast improvements in our educational 
statistics, so we may specify more definitely just what and where our 
problems are and what needs to be done about them. 

Some of the plans described by Secretary Folsom were put into op- 
eration in 1956. Details on the recently developed and the continuing 
programs are reported in the following sections of this chapter. 

COOPERATIVE RESEARCH PROGRAM 

The Office of Education operates three types of research programs : 

(1) Research studies conducted by Office of Education specialists, 

(2) statistical studies conducted by the Research and Statistical Serv- 
ices Branch, and (3) cooperative research with colleges, universities, 
and State educational agencies. All three programs are important, 
but cooperative research is the newest and is therefore given the most 
attention in this report. 

Under Public Law 531, 83d Congress, the Commissioner of Educa- 
tion is authorized to "enter into contracts or jointly financed coopera- 
tive arrangements with universities and colleges and State educational 
agencies for the conduct of research, surveys, and demonstrations in 
the field of education." As a first step in initiating a research program 
under this law, the Commissioner asked specialists on the Office staff 
to identify a number of the most pressing problems in education. 
Then, with the advice of several leaders in education and research who 
served the Office as consultants, these problems were reviewed and 
ten of them were selected as particularly appropriate for concentration 
of efforts in the beginning phases of this program. 

In developing the program the Office had the advice of an ad hoc 
committee of five outstanding research specialists in the field of edu- 
cation. Later the Commissioner appointed a permanent, nine-member 
committee which included the five members of the ad hoc committee 
and research specialists representing the social sciences, medicine, and 
the physical sciences. 



174 Department of Health, Education, and Welfare, 1956 

The program emphasizes three broad areas of interest — the con- 
servation and development of human resources, the staffing and housing 
of our Nation's schools, and the educational implications of our 
expanding technology and economy. In the human resources area 
there are included such problems as the education of the mentally 
retarded, the development of special abilities of students, the educa- 
tional aspects of juvenile delinquency, and the retention and continu- 
ation of students. In the second area attention is focused on the 
problems of staffing the Nation's schools and colleges and the planning 
and costs of school construction, with special emphasis on institutions 
of higher education. In the third area there are such problems as the 
implications of expanding technology for vocational education, the 
educational problems resulting from population mobility, the educa- 
tional needs of low-income, rural families, and the educational uses of 
television. 

A general proposal for an attack through research was prepared 
on each of these ten problems. The proposals were reviewed by the 
ad hoc research advisory committee and by outstanding specialists 
in certain areas who served the Office as consultants. 

Because of current public concern with the education of mentally 
retarded children, a special staff was set up to plan for research in 
this area and an ad hoc advisory committee on the education of the 
mentally retarded was appointed. With the advice and guidance of 
the committee, the Office prepared an extensive statement on the major 
research needs in this area and the facilities in institutions of higher 
education and in the State educational agencies which may be suitable 
and available for research. 

The research advisory committee established the following criteria 
to be used in selecting proposals suitable for support by the Office : 
A project should (1) promise to have a value within a reasonable 
time, (2) attack a problem in which progress has been delayed by 
wide gaps in knowledge, (3) have significance for the country as a 
whole, and (4) give preference to new projects or to those in which 
duplication would be desirable as a scientific check on earlier conclu- 
sions. In recommending projects to be carried out in the cooperative 
research program, the committee will also consider (1) the competence 
of the person who will direct the project, (2) the research resources 
of the institution or State department of education under whose aegis 
it will be directed, (3) the scientific merit of the project, (4) the extent 
to which the project will help to develop research personnel, and 
(5) the need for research in the area proposed in terms of the total 
educational research picture. 

Development of this program was a major activity of the Office 
during the year. By the end of June the Office had received 70 pre- 



Office of Education 175 

liminary proposals for research, and the number seemed likely to in- 
crease rapidly after information on the availability of fmids became 
laiown. 

RESEARCH AND STATISTICAL SERVICES 
Reference Service 

The work of the research and statistical reference service of the 
Office continued to expand throughout the year. New procedures 
for making current statistics available were instituted. In response 
to demands from governmental agencies, educational associations, 
and private industry, annual projections to 19G5 were prepared for 
public and private elementary and secondary enrollments; projec- 
tions to 1970 were prepared for total enrollments, fall enrollments, 
and first-time enrollments in institutions of higher education; and 
number of degrees to be conferred, by level, and by sex were projected 
to 1970. In addition, annual projections to 1965 were made for degrees 
to be conferred in six major fields of study (biological sciences, engi- 
neering, healing arts, physical sciences, social sciences, and "all other") . 

A 31 -page set of National and State statistical tables on education 
was prepared for the Statistical Abstract of the United States (a 
Department of Commerce publication), UNESCO was furnished 
a 33-page report on educational statistics for the period 1950-54, 
inclusive, and on the attitude of the government toward the stand- 
ardization of educational statistics for use at the Geneva UNESCO 
Conference. 

Prompt publication of summaries of recent statistical studies was 
obtained through articles in School Life and Higher Education. 

Research Consultation 

Consultive services and appropriate statistics were provided to 
the President's Commission on Veterans Pensions, to an ODM sub- 
committee on specialized personnel, and to the Subcommittee on Low- 
Income Families of the Joint Committee on the Economic Report. 

RESEARCH STUDIES BY OFFICE SPECIALISTS 

Office specialists in the various subject matter fields and levels of 
education made a number of research studies in 1956. Some of the 
studies were made at the request of professional agencies and organi- 
zations; for instance three projects were carried out at the request 
of the Council of Chief State School Officers. Other studies dealt 
with problems widely recognized as urgent by educators, Federal offi- 
cials, or laymen, such as Supervision in Rural Schools. Studies made 
under this phase of the research program are discussed under the 
appropriate subject heads in this report. Published reports of the 



176 Department of Healthy Education, and Welfare, 1956 

specialists' findings, interpretations, and suggested applications are 
listed under Publications. 

Services to Education 

One of the ways in which the Office has traditionally promoted 
the cause of education is through service to State and local school 
systems. In rendering this service the Office provides information, 
consultation, and advice on education at the different levels and in 
fields. 

ADMINISTRATION 

One of the most significant educational developments in the 20th 
century is the continued rise in leadership of State departments of 
education. This movement has been accentuated in the past few years 
and is reflected in the growing stature of the professional staffs of these 
departments, the higher level of salaries attached to the positions, 
and the recognition by local school officials, by college and university 
staffs, and by the public in general of the expanding program of 
services which the departments are now giving. No small part of 
this increase in leadership has been due to the efforts of the departments 
themselves. The Office of Education has assisted them by making 
nationwide surveys and studies which define the role of State agencies 
in the educational scheme and delineate the responsibilities of per- 
sonnel in the departments in the various areas of service. 

During the 1956 fiscal year the Office of Education engaged in 
several nationwide cooperative studies which have bearing on policy 
and good practices in State school administration. Studies dealing 
with the responsibilities of the State departments of education for 
school plant services and for pupil transportation were published 
during the year. 

During the year the Office, in cooperation with the American As- 
sociation of School Administrators, the Association of School Busi- 
ness Officials of the United States and Canada, the Council of Chief 
State School Officers, the Department of Rural Education, the Na- 
tional Education Association, and National School Boards Association, 
completed a study entitled, "Financial Accounting for Local and State 
School Systems." Nearly 200 representatives of the cooperating or- 
ganizations participated in 2 national and 8 regional conferences 
which shaped the financial accounting handbook. The handbook will 
be the basic guide in the United States for financial accounting for 
local and State school systems. To reflect accurately the condition 
and progress of education at local, State, and national levels, educa- 
tional data must be a matter of record at its source and must be recorded 
in terminology that means the same thing from place to place. This 



Office of Education 1* ' 

handbook will serve education everywhere as the guide for recording 
financial data so that it will have the same meaning to all. It will 
greatly improve the basis for educational research, the comparability 
of educational information, and the reliability of State and national 
summaries. 

ORGANIZATION 

The establishment of soundly organized local school districts con- 
tinued to be a major problem in American education — in 1955 there 
were over 59,000 school districts in the Nation; of the total number 
nearly two-thirds had fewer than 10 teachers, over half were organized 
for elementary school purposes only, and more than 1 of every 7 did 
not operate a school of any kind. Practicable approaches to dealing 
with this problem effectively were the concern of a special Office project 
which was virtually completed during the year, with publication of 
the report scheduled in fiscal year 1957. This project is the first major 
school district reorganization study undertaken by the Office of Edu- 
cation since completion of the Local School Units Project in the late 
1930's. 

Coincident with carrying on the project, the Office rendered con- 
sultive services to legislative councils, special commissions. State de- 
partments of education, and other agencies in a number of States where 
efforts were being made to develop more effective reorganization 
programs. 

The rapid growth of the National School Boards Association and 
of State associations and an increasing recognition of the importance 
of effective school board stewardship have emphasized the need for 
research on statutory provisions governing local school boards and the 
procedures employed by them in carrying out their responsibilities. 
To meet this need a series of studies was launched ; the first in the series 
was largely completed in 1956, and a report of the study is scheduled 
for publication in fiscal 1957. 

SCHOOL FINANCE 

Throughout the year the Office provided service and information 
on financing the schools. More and more difficulties of financing the 
programs of education became evident. To help finance the schools 
the State legislatures have been approving larger appropriations and 
enacting laws which provide improved methods of allocating State 
funds to the schools. Local boards of education have also been ap- 
proving larger budgets, securing larger amounts from the general 
property tax, and seeking new sources of local revenue for the public 
schools. Increases in enrollments, demands for additional school 
services, and the need for the new school buildings indicate that the 



178 Department of Health, Education, and Welfare, 1956 

methods of financing the schools will continue to require more atten- 
tion in the months ahead. 

SCHOOL HOUSING 

The Nation is continuing to spend more than $2 billion a year for 
public elementary and secondary school construction. This annual 
expenditure, however, is not sufficient to erase the existing deficit of 
classrooms, to house the increasing enrollment, and to replace the 
schools that become obsolete each year. 

Activity within the States indicates a trend toward improving the 
pattern of financing school construction, through such measures as 
district mergers, increasing legal bonding limits, and State financial 
assistance through grants and loans. 

The Office of Education promoted and participated in cooperative 
planning by educators, architects, and lay groups to improve the edu- 
cational adequacy of new facilities. 

One of the major school plant problems, which is still only partly 
solved, is the acquisition of adequate and properly located sites to ac- 
commodate the ever-increasing requirements for new schools to serve 
a growing and mobile school population. 

A recent Office study of State school plant services revealed a trend 
toward the provision of more and better school plant services and in- 
creased leadership by State departments of education. 

ELEMENTARY EDUCATION 

The Office has continued to give leadership to professional and lay 
organizations concerned with education at the elementary level, to 
elementary staff members in State departments of education, to super- 
visors in county schools, and to individuals and groups in local com- 
munities through in-service activities in town or city, or sponsored by 
colleges and universities. This leadership has been concerned with 
rounding up sources of information as well as specific items of informa- 
tion on many problems, and interpreting school problems and pro- 
grams to parents and to teachers needing such help. 

One of the important ways of identifying major problems and of 
working on these problems has been the Annual Conference on Ele- 
mentary Education held this year with 62 national professional and 
lay organizations represented. The theme of the conference was 
"Working Together for Children in 1956." 

Research was used in such studies as Status of Physical Education 
for Children of Elementary School Age in City School Systems; 
and what some States have been doing about the recruitment of 
teachers. Reports of these studies are scheduled for publication in 
fiscal 1957. 



Office of Education 17^ 

SECONDARY EDUCATION 

During fiscal year 1956 the Office devoted considerable time and at- 
tention to the pressing manpower problems in such professional fields 
as science, mathematics, and teaching. Office of Education specialists 
in mathematics and science worked closely with such voluntary pro- 
fessional organizations and government agencies as the American 
Association for the Advancement of Science, the National Science 
Teachers Association, the National Science Foundation, and the Pres- 
ident's Committee on Science and Engineering. Recommendations 
were made for the guidance of action programs to obtain more quali- 
fied persons in the shortage areas through cooperative efforts to im- 
prove the quality of instruction programs and to increase the number 
of teachers in secondary schools. Studies were made of science and 
mathematics in public high schools. In addition, plans were made 
for a survey of the teaching loads and the preparation of science and 
mathematics teachers, to be made by the Office in cooperation with 
State departments of education and the National Science Foundation. 

In conjunction with the Interdepartmental Committee on Children 
and Youth, the Office of Education, the Department of Labor, and the 
Employment Service studied various problems associated with the 
transition of youth from school to work. An Office bulletin offers 
advice useful to school administrators interested in initiating and im- 
proving work experience education programs in the high schools. 

At the request of the Comicil of Chief State School Officers, the 
Office made a study of the curriculum responsibilities of State depart- 
ments of education. This study will be carefully analyzed by the 
study commission of the council in an effort to improve leadership 
responsibilities of State education departments and relationships with 
local schools. The study was a joint undertaking of the Elementary 
and Secondary Sections. 

To find ways of effectively coping with the pressing problems in 
secondary schools the Office called a conference of selected State 
directors of instruction to discuss (1) current developments in second- 
ary education, (2) ways of improving secondary school programs, 

(3) research being carried on by State education departments, and 

(4) the program of the Office of Education and ways in which the 
Office can more effectively assist State education officials. 

ADULT EDUCATION 

During the year Office staff members worked with national organi- 
zations and State and regional groups on the role of adult educa- 
tion in promoting better health, improved human relations, and vo- 
cational efficiency and adjustment, including such organizations as the 
National Association for Practical Nurse Education, the Virginia 



180 Department of Health, Education, and Welfare, 1956 

Joint Conference of Vocational and Industrial Arts Services, and 
Alpha Kappa Mu Honorary Society. The Office continued to coop- 
erate with the Section on Fundamental and Literacy Education of the 
Adult Education Association on a variety of activities in developing 
a national commission on literacy, and with the National Council on 
Naturalization and Citizenship on the education of the foreign born. 
The Office assumed responsibility for organizing and conducting 
the Group and Work Sessions on Education of the Federal State Con- 
ference on Aging, and for writing the conference report. 

INTERGROUP EDUCATION 

The Office of Education continued to cooperate with the National 
Educational Association and the American Teachers Association in 
promoting the use of the kit and packet of materials on intergroup 
education. Staff members participated in several conferences on 
planning the extension of intergroup education. 

In addition, consultive services were rendered to the Council 
of National Organizations, National Congress of Colored Parents 
and Teachers, Advisory Committee on Parent Education of the Na- 
tional Council of Churches of Christ in the USA, and to the Steering 
Committee of the Tuskegee Institute Self-Study. 

EXCEPTIONAL CHILDREN 

Progi^ams for the education of exceptional children in the United 
States have been increasing rapidly, but their expansion is retarded 
by such factors as lack of qualified teaching personnel and the need 
of more knowledge about these children and their deviations. Within 
the last year the Office of Education has done something about botli 
of these problems. 

For several years the Office has been giving leadership to a nation- 
wide study, "Qualification and Preparation of Teachers of Excep- 
tional Children." The general purpose of the study is to aid in se- 
curing for the Nation's schools the necessaiy number of teachers and 
teachers with the best possible qualifications. Specifically it is hoped 
that the findings will contribute to a better miderstanding of ( 1) com- 
petencies needed by teachers and other special education personnel 
and (2) the kind of experiences and professional preparation believed 
to contribute to effective work with the various types of exceptional 
children. To this Office-directed project more than 2,000 leading 
educators have contributed either through membership on one of 15 
committees or by providing information through inquiry forms. 

During the year a national spotlight was turned on the problems 
of educating the mentally retarded. The Office is now giving leader- 
ship to the solving of some of these problems, not only through tlie 



Office of Education 181 

special project on teacher preparation but also through cooperative 
research on various aspects of mental retardation, mentioned earlier. 

AUDIOVISUAL EDUCATION 

The use of audiovisual educational materials continued to expand 
during the year with attention being given experimentally to the use of 
these materials, particularly sound motion pictures, in alleviating the 
shortage of qualified teachers. During the year a trend toward a closer 
integration of audiovisual and printed materials with school cur- 
riculums became apparent. 

The Office of Education continued to provide services relating to 
the audiovisual materials of the Federal Government. It cataloged 
tlie 5,098th Government film for Library of Congress catalog cards 
and issued a 650-page catalog, Government Films for Public Educa- 
tional Use. 

As part of its program to strengthen State and local educational 
resources, the Office prepared its 5th edition of a directory of State and 
local sources of educational films, which identifies and describes the 
resources and services of 3,300 16mm film libraries. 

In line with its overall policy of making fact-finding comparative 
studies of the functions, responsibilities, and services of the various 
State departments of education, the Office took preliminary steps 
(including the preparation of a questionnaire) toward such a study 
of audiovisual education in the various State governments. The study 
will be completed and published in fiscal year 1957. 

The Office of Education, with a complete file of all Government films, 
continued to provide a central reference service on the films of all 
agencies; and, in addition, to answer miscellaneous inquiries (weekly 
average 150) for audiovisual information. 

RADIO-TELEVISION 

Throughout the Nation there was convincing evidence of interest 
in the educational uses of radio and television in the increase in number 
of stations and number of courses offered on the air. The number of 
radio stations owned and operated by colleges, universities, and school 
systems increased from 160 in 1955 to 176 in 1956, and the number of 
noncommercial educational TV stations, from 15 in 1955 to 26 in 1956. 
Some of the TV stations were supported by public funds; others 
either totally or in part by foundations and subventions of funds; 
and still others by local communities. There was also a general in- 
crease in the number of courses offered and the number of students 
enrolled. At 60 institutions 400 courses were available for university 
credit. At a single Junior College of the Air 4,000 students were 
registered for evening courses. 



182 Department of Health, Education, and Welfare, 1956 

The Office served educational institutions, public and private, with 
materials, information, and advice on conducting their programs. 
Office cooperation with the Department of Defense, Department of 
Treasury, Department of State, United States Information Agency, 
Bureau of Standards, Library of Congress, International Coopera- 
tion Agency, and similar government agencies has brought about a 
successful relationship in dealing with common problems by combined 
effort in educational matters affecting these various services. 

International radio and television received increased attention. 
The United Nations, UNESCO, individual foreign broadcasting sys- 
tems in Europe, the Near and Middle East, Africa, Australia, South 
America, and the Far East regularly exchange educational ideas and 
program offerings with the Office. 

CIVIL DEFENSE EDUCATION 

The most significant activities of the Civil Defense Education Proj- 
ect carried on in the Office have been built around formal agreements 
with State departments of education in Connecticut, Michigan, and 
California for the operation of civil defense education pilot centers. 
These centers have developed instruction materials for use by ele- 
mentary and secondary school teachers. The materials listed below 
were prepared by teachers, supervisors, administrators, and ciu-- 
riculum specialists in accordance with established procedures and 
policies of each State : 

Connecticut : 

(1) Education for Natural and Wartime Emergencies 

(2) Curriculum Guide for Emergency Education 
Michigan : 

(1) Civil Defense in the Classroom 

(2) Film strip for civil defense in schools 
California : 

(1) Civil Defense for Personal and Family Survival 

(2) Some Suggestions for Introducing Civil Defense Into the Curriculum 

Materials developed in the three States were reviewed in a 5-day 
conference sponsored by the Office of Education in cooperation with 
the Federal Civil Defense Administration in Battle Creek, Mich. The 
conference was attended by representatives of the States and larger 
city school systems. Recommendations and suggestions of this group 
have been incorporated in a handbook on civil defense for schools. It 
contains information and suggestions for school administrators and 
teachers planning protective measures in school civil defense. 

GUIDANCE AND STUDENT PERSONNEL SERVICES 

On July 1, 1955, the Office of Education expanded its guidance and 
student personnel services to (1) assist local and State authorities 



Office of Ed ucation }^ 

in initiating or expanding services suitable to their needs, (2) coop- 
erate with interested public and private schools and agencies, (3) 
serve as a clearinghouse for information especially adapted to school 
use, and (4) prepare and issue professional materials. 

During the year the Office prepared and distributed pamphlets and 
leaflets on occupations, guidance programs, lists of guidance officials, 
State certification requirements, and testing programs. Staff mem- 
bers carried on continuing research in such selected guidance areas 
as the problem of "dropouts," building needs for guidance services, 
and summer and academic-year offerings at colleges and universities 
in the preparation of guidance workers. 

The Office also worked with agencies and groups, both private and 
governmental, concerned with improving services in this field. For 
instance, staff members cooperated with the Department of Labor in 
developing studies and providing information ; with the Departmental 
Committee on Juvenile Delinquency, a subcommittee of the Inter- 
Departmental Committee on Children and Youth ; and with the rep- 
resentatives of the Atomic Energy Commission, the American Medical 
Association, the American Personnel and Guidance Association, the 
National Education Association, the National Association of Chiropo- 
dists, and the American Pharmaceutical Association in developing 
occupational information material for later publication. 

SERVICES TO LIBRARIES 

In cooperation with the State library agencies, the Office of Educa- 
tion made a nationwide survey of the structure and control of publicly 
supported library services at the State level. The basis of the study 
was an analysis of the State laws as of January 1, 1956, supplemented 
by fundamental information from political science, educational ad- 
ministration, and library science. 

The Office also provided library data and consultive services to the 
Coordinating Committee on the Revision of Public Library Standards 
of the American Library Association. This undertaking should result 
in extended and better public library service for the people of the 
United States since the new standards emphasize the performance of 
libraries rather than per capita costs and quality of service rather 
than quantity. The committee foresees a network of public library 
services which will reach every person in the United States. These 
services will be found at the community outlets in village, town, and 
rural areas, backed up by the large central library of city or county, 
and with the State library at the apes of the cooperative system. 
Larger units of library administration are called for in the interest 
of economy and efficiency of operation. 



184 Department of Health, Education, and Welfare, 1956 

VOCATIONAL EDUCATION 

In fiscal year 1956 the Office of Education administered grant-in-aid 
programs providing more than $33 million for vocational education 
in the States and Territories under the Smith-Hughes, George-Barden, 
and supplementary acts. This total is an increase over the amount 
available in 1955. Most of the increase, $2i^ million provided under 
the George-Barden Act, was used to extend vocational education to 
communities that had not previously had programs. Table 3, col- 
umn 4, page 195, shows the distribution of funds for vocational 
education, by States, in fiscal year 1956. 

The Office of Education issues an annual digest of the statistical 
and financial reports made by the State boards of vocational educa- 
tion to the Office covering the program provided for by the Smith- 
Hughes and George-Barden Acts. The digest of State reports, which 
shows expenditures made and work done in vocational education for 
the previous year ending June 30, is ordinarily available in March of 
the succeeding year. The digest of State reports for fiscal 1956 is 
in preparation. 

The Office continued its cooperative working relationships with the 
States in the further development and improvement of vocational 
education. Federal-State attention focused principally on means of 
alleviating the teacher shortage, on the preparation of teachers; im- 
provement of supervisory practices ; and on making instruction more 
effective. Two phases of program development were of particular 
concern to the Office : The contribution that vocational education can 
make to the solution of special problems of low-income families ; and 
the significance of technological, economic, and social changes to 
vocational training. 

A revision of the Statement of Policies for the Administration of 
Vocational Education based on experience and interpretations of the 
current acts and policies was undertaken during 1956, and a prelimi- 
nary draft was submitted to State officials for review. The policy 
statement will also be reviewed by a special committee of State direc- 
tors of vocational education and executive officers of State boards for 
vocational education before it is approved by the Commissioner of 
Education. 

Program specialists in agriculture, distributive occupations, home 
economics, and trade and industry made official visits to the States to 
review vocational problems and assist with the solution of problems 
as requested. 

During the year consultants were invited to work with staff mem- 
bers on a number of studies designed to improve vocational education. 
The studies dealt with the training needs of persons employed in out- 
side selling; problems of small businesses, and the training needs of 



Office of Eilucation 185 

employers and managers of such enterprises (distributive education) ; 
related instruction and supervisory training in trade and industrial 
education ; and agricultural education for out-of -school young farmers. 
Published reports of these studies are intended to improve school 
offerings and to expand vocational education services. 

Continued emphasis was given to the professional improvement of 
administrative and supervisory personnel and to the emerging prob- 
lem areas in the States in regional conferences for State personnel. 
Separate conferences were conducted for workers in agricultural, 
distributive, home economics, and trade and industrial education. 
Through discussion of questions relating to the operation, expansion, 
and improvement of the program these conferences developed a con- 
tinuing awareness among leaders of responsibilities and improved 
practices in program supervision and administration. 

Recognizing the need for trained workers for the rapidly growing 
labor force in distributive occupations and the contribution that voca- 
tional education can make in preparing people for these occupations, 
many groups and individuals sought information about the Federal- 
State program of distributive education. As a result of this increased 
interest and the desire of business to cooperate in expanding and de- 
veloping this program, program specialists in distributive education 
worked with trade and business groups and individuals concerned 
with the business of distribution. A 3-day teacher-training clinic 
in textile fibers for teachers-coordinators in distributive education was 
conducted in the Central region. 

Staff specialists in home economics education worked individually 
and in conferences with teachers, supervising teachers, teacher train- 
ers, city and State supervisors, and teacher training institutions on 
means of increasing the supply of home economics teachers, of helping 
former teachers who return to the field, on improving student-teacher 
experiences, and on other ways of strengthening the program. 

Specialist in home economics education met with a representative 
group of college teachers of foods and nutrition and administrators to 
consider means of strengthening and improving the teaching of foods 
and nutrition. This was a followup of a conference of this same 
group held the previous year. Followup conferences were also held 
in the several regions for college teachers in foods and nutrition to 
consider course offerings in foods and nutrition in relation to the 
changes in problems of family living and in the production and dis- 
tribution of foods, and the significance of these changes to food and 
nutrition programs and educational procedures. 

A report of the project, Experiences With Infants in the Prepara- 
tion of Home Economists, begun in 1955 was issued jointly by the 
Home Economics Education Branch and the Children's Bureau. The 

408691—57 13 



186 Department of Health, Education, and Welfare, 1956 

report represents a first step toward better understanding of common 
problems in the preparation of professional workers who offer services 
to children and their families. 

To provide training for potential leaders and give participants an 
opportunity to identify and evaluate basic concepts of leadership, the 
Office organized a Leadership Training Conference in Trade and In- 
dustrial Education which was attended by more than 60 persons from 
the States, Puerto Kico, Hawaii, the Virgin Islands, and Alaska. A 
report of the conference was distributed to the States. 

A group of persons engaged in trade and industrial supervisory 
development programs were brought together by the Office to study 
means of developing supervisory personnel. The findings of the group 
on the nature and structure of successful programs should be helpful 
to others in solving similar problems. A report of the conference was 
distributed to the States. 

A systematic followup of the work conference on "Eesearch and 
Studies in Trade and Industrial Education" was made to collect data 
on research in trade and industrial education. A report "Eesearch 
and Studies in Trade and Industrial Education" was developed to 
assist the States in research essential to developing programs of trade 
and industrial education capable of keeping pace with technological 
advances in our continually expanding economy. 

Since farming is becoming more highly mechanized, the farmer 
needs to have special training in the operation and maintenance of his 
equipment. Instruction in this important area was given special 
attention in departments of vocational agriculture. Members of the 
agricultural education staff during the year assisted States in plan- 
ning and conducting special workshops for teachers of agriculture to 
assist them in the further development and improvement of the in- 
struction in farm mechanics that is offered in local schools. 

HIGHER EDUCATION 
Research 

Five research studies in higher education were carried on during 
the year : (1) The costs incurred by students in attending college ; (2) 
the extent and causes of the withdrawal of students from college be- 
fore completing their programs of studies; (3) the status of planning 
in the area of college and university facilities; (4) staffing the Na- 
tion's schools; and (5) student financial assistance. 

The study of what it costs students to attend college was based on 
the expenditures of 15,500 students in 110 colleges and universities. 
The study of student attrition was based on the experiences of 13,000 
students who entered the freshman class in 1950 in 147 institutions. 
Eeports on these studies will be published in fiscal year 1957. 



Office of Education 187 

Three of the projects were initiated in fiscal year 1956 as a part 
of the expanding research program of the Office. The study of col- 
lege and university facilities sought answers to three major questions : 
(1) What are the extent and the character of the additional enroll- 
ment that can be accommodated with existing facilities? (2) what 
facilities have been constructed within the past 5 years and how were 
they financed? and (3) what additional facilities are planned for 
construction before 1970 ? All colleges and universities listed in the 
Higher Education Directory were asked to respond to the questions. 
The project is scheduled for completion in fiscal year 1957. 

A pilot project was undertaken to explore appropriate research 
targets and techniques to be employed in studies of problems relating 
to the staffing of the Nation's schools and colleges. The project 
developed plans in anticipation of a major research effort to study 
the teacher personnel of the Nation, and it also developed and tried 
out procedures and instruments to be used in such a research effort. 
Further activity in this area will depend on the future development 
of the extended research program of the Office. 

The student financial assistance project is concerned primarily with 
institutional assistance resources and their utilization. The study 
also deals with such topics as sources of funds for undergraduate 
scholarships and graduate fellowships, size of grants, distribution of 
graduate fellowships by fields of study, availability and use of student 
loans, loan fund practices, student employment, and the relationships 
between the size of scholarship grants, tuition fees and living costs, 
and the number of students who received grants. This study will 
also provide the basic materials for new directories of undergraduate 
scholarships and graduate fellowships and for a comprehensive study 
of student assistance. The results of the study will be of interest 
and value to many groups interested in higher education, such as 
college administrative officers, business groups. State and Federal 
officers interested in scholarship programs, parents, prospective college 
students, and high school counselors. 

Services and Studies 

In addition to instituting and carrying on the research projects in 
higher education, described under Research, the Office completed and 
published a comprehensive study of education for the professions. 
It was the first such report to be issued in the United States since 1900. 
The Office also reviewed and analyzed the present status of statewide 
and regional interinstitutional studies of higher education and pub- 
lished the report of the study in the March 1956 issue of the periodical. 
Higher Education. A new issue of Accredited Higher Institutions 
was prepared and is scheduled for publication in 1957. The Educa- 
tion Directory, 1955-1956, Part 3, Higher Education, and the periodi- 
cal, Higher Education, were also published. 



188 Department of Health, Education, and Welfare, 1956 

The Office gave consultive service to State higher education surveys 
and planning in Mississippi, Louisiana, Nevada, and Florida, and 
advisory service to higher education institutes, conferences, and asso- 
ciations in the development of their program and activities. 

The Office also discharged its legal responsibility for the annual 
inspection of Howard University; rendered advisory service to the 
Department of Justice, Immigration and Naturalization Service, on 
the approval of schools which foreigners on student visas may attend ; 
advised the Housing and Home Finance Agency on whether applicants 
for college housing loans met the legal requirement for loans; and 
added the American Association of Nurse Anesthetists to the Com- 
missioner's list of 30 nationally recognized accrediting agencies and 
associations which he is required to publish. 

Administration of Grants 

For the year ending June 30, 1956, the Office administered a total of 
$5,051,500 to land-grant colleges and universities. The Office responsi- 
bility in this program is to certify that each State and Territory is 
entitled to receive its share of the annual a]3propriation and the amount 
it is entitled to receive. See table 3, column 3, for distribution of funds 
by States. 

INTERNATIONAL EDUCATION 

American education has an increasingly important function in in- 
ternational affairs. The Office has received enthusiastic support from 
the profession in recruiting educators for assignments overseas and 
in placing and training foreign educators in the United States. It is 
being requested to cooperate with public and private agencies in an 
increasing number and variety of international educational activities. 

One of the recent developments in international education is a rap- 
idly increasing interest in revising the American curriculum at all 
levels to introduce Americans to all the peoples of the world, for it is 
estimated that at any one time between 2 and 3 million Americans are 
living, working, or traveling abroad, in every country in the world. 
Our schools and colleges are calling on the Office for help in develojv 
ing techniques for training Americans to live on this new American 
frontier. 

International Educational Relations 

The Office has a statutory responsibility for studying, interpreting, 
and reporting on developments in education abroad. This is one of 
the oldest activities of the Office, and today is growing rapidly be- 
cause of the new importance of education as an instrument of foreign 
policy, and also because of the new role of the United States as a 
world leader. 



Office of Education 189 

During the year comparative educational research and specialized 
educational services in the Office provided authoritative information 
for the public and contributed to the development of international 
understanding. Stress was laid on research and services which States, 
groups, or individuals would find difficult, if not impossible to carry 
out. 

Studies were made of education in other countries, including Taiwan 
and Mexico. Basic work was completed on the first edition of a new 
International Education Yearbook, entitled "Education for Better 
Living," to be published in fiscal 1957. Important research was 
launched on education under Communism, and the manuscript, "Edu- 
cation in the Soviet Union," is now ready for publication. One staff 
member visited ministries of education in Germany to obtain basic 
information on a study to be published in 1957. Studies of educational 
terminology used in the U. S. A., in Haiti, in Brazil, and in Spanish 
America were prepared. Work in this field sparked the idea for 
glossaries in the World Survey of Education published by UNESCO. 
Teaching aids for developing international understanding to meet 
the increasing demands from schools and libraries in the United States 
as well as from foreign countries were issued. 

University and college registrars. State boards of licensure, the 
United States Civil Service Commission, and other Federal agencies 
called upon the Office to evaluate the credentials of 2,828 foreign stu- 
dents. This information was essential to the matriculation of these 
students in United States universities and colleges. 

The Office advised with the Veterans Administration on the ap- 
plications of some 100 foreign educational institutions for approval 
to train veterans under the provision of the Veterans Readjustment 
Assistance Act of 1952 (P. L. 550, 82d Congress) . 

The Educational Materials Laboratory, which was developed with 
the cooperation of members of the American Textbook Publishers In- 
stitute, added 591 books to its collection as well as pamphlets, bulletins, 
and materials developed in educational missions of the International 
Cooperation Administration. During the year the laboratory enabled 
some 600 visitors to examine representative textbooks and materials 
used in United States schools. The visitors included foreign embassy 
staff, other foreign visitors. United States personnel preparing to work 
in technical assistance programs abroad, and United States educators 
and laymen. 

The Clearinghouse, established at the request of the Department of 
State, maintains a file of persons entering and leaving the United 
States under the various Federal Government-sponsored exchange 
programs. At the end of the fiscal year a total of 36,000 names were 



190 Department of Health, Education, and Welfare, 1956 

on file, an increase of 15,000 over the 1955 total. The Clearinghouse 
met requests from the Department of State for approximately 190 
statistical tables with these data. In addition, the Clearinghouse be- 
gan a file of American Dependents Schools abroad containing approxi- 
mately 1,000 listings. 

The Office coordinated the preparation of reports on educational 
subjects required by United States participation in international or- 
ganizations. These reports concerned decisions taken by governments 
with respect to education and provided background data for technical 
groups at international conferences. Examples of such reports and 
background data were : "Elementary Education in the United States" 
for UNESCO's World Survey of Education ; "Vocational Training 
in Agricultm-e" for the use of the International Labor Conference in 
preparing an international recommendation on this subject; andj 
"School Inspection (Supervision)" for the UNESCO — International 
Bureau of Education Conference on Public Education. Office spe- 
cialists also served on U. S. delegations to international conferences. 

Educational Exchange and Training 

Under the Teacher Education Program, which the Office conducts 
in cooperation with the International Educational Exchange Service 
of the Department of State, Office staff arranged programs for the 
training of 262 foreign teachers in the methods and techniques of 
American education. Approximately 80 percent of them were con- 
cerned with elementary, secondary, and vocational education, and 
English as a second language ; 20 percent participated in an American 
civilization project. A workshop was held at the University of Puerto 
Eico for 47 educators from Carribean countries. 

Under the Teacher Exchange Program school authorities in 46 
States, 3 Territories, and the District of Columbia cooperated with 
the Office in the placement of 502 American and foreign teachers for 
506 available teaching opportunities : 156 Americans exchanged jobs 
with 156 foreigners; 104 Americans w^ere recruited for specific teach- 
ing vacancies; 71 Americans attended summer seminars in France, 
Germany, and Italy; 15 teachers from other lands were assigned to 
teaching positions in the United States. 

The Technical Training Program provided for specific training of 
teachers and other educators from underdeveloped areas to support 
educational projects in their own countries. These projects were de- 
veloped by American teclmicians to assist cooperating foreign gov- 
ernments in obtaining economic and social progress through improve- 
ment of education, health, and agriculture. Cooperating with the 
International Cooperation Administration, the Office arranged tech- 
nical training for the academic year for 600 educators from 39 coun- 



Office of Education 191 

tries. In this program particular emphasis was placed on practical 
training and experience. 

Educational Missions Abroad 

United States Technical Assistance programs were aided by the 
Office in the recruitment of 85 education specialists for assignments 
in overseas missions of the International Cooperation Administration. 
The Office furnished essential technical support to these educators by 
providing packets of educational publications, appraising lists of in- 
structional materials and equipment, and rendering professional ad- 
vice on specialized problems. 

The staff of the Office participated in on-the-spot surveys of educa- 
tional programs overseas, took part in international conferences, and 
consulted with the education officials of many other countries on pro- 
fessional matters of common interest. 

SCHOOL ASSISTANCE IN FEDERALLY AFFECTED AREAS 

One of the major functions of the Office of Education is the admin- 
istration of two laws that provide Federal aid to education in districts 
that have been affected by Federal activity. They are Public Laws 
874 and 815, both passed by the Eighty-first Congress in September 
1950. 

For fiscal year 1956 the Congress appropriated, under Public Law 
815, a total of $33,900,000, which was added to the continuing appro- 
priation, and under Public Law 874, a total of $90,000,000. Columns 
5 and 6, table 3, page 195, show the distribution of funds to States 
made under both laws during the year. 

Public Law 874 authorizes Federal contributions toward the oper- 
ating costs of public elementary and secondary schools in districts 
that feel the Federal presence in one or more of these ways : As a loss 
of revenue through the tax-exempt status of Federal properties; or 
as added school costs either (1) because of the attendance of children 
who live on Federal property or whose parents are employed on such 
property or (2) because of a sudden and substantial increase in school 
enrollment growing out of Federal-contract activities. 

Public Law 815, as amended, authorizes financial assistance for 
building schools in areas affected by Federal activity, for the con- 
struction of temporary schools in certain situations, and for construc- 
tion of schools on Federal bases where necessary to house school 
children. 

With the completion of the sixth year of Federal assistance to schools 
in federally affected areas under these two laws the number of school 
districts participating has increased to 2,860. 



192 Department of Health, Education, and Welfare, 1956 

Annual payments to federally affected districts to aid in meeting 
current operating expenses for the fiscal year amounted to approxi- 
mately $86 million. Payments were made on behalf of some 980,000 
federally connected pupils claimed by school districts which had a 
total attendance of about 6,200,000 students. The affected districts 
educate approximately one-fifth of all the Nation's public school 
children. 

The number of school construction projects which had been ap- 
proved by the close of fiscal year 1956 had passed the 3,000 mark. A 
total of $609 million in Federal funds had been allocated to some 
3,100 school construction projects approved by June 30. These funds 
together with approximately $260 million in local funds which had 
been added to the projects will be sufficient to house some Y00,000 
schoolchildren. 

In the spring of the year the President made recommendations 
to the Congress for an extension of the program for school construc- 
tion in federally affected areas. This extension in time was made 
essential principally by the substantial program of military housing 
which had been enacted by the Congress and which will create a 
demand for additional classroom space in federally affected areas. 

A separate report was made to the Congress, as required by law, 
covering the administration of this program and providing detailed 
information on receipts and disbursements of Federal funds, school 
districts participating, and other phases of operation. 

Major Publications Off the Press in Fiscal Year 1956 

Clerical and Custodial Staff in Public Secondary Day Schools 

Course Offerings in Guidance 

Current Expenditures per Pupil in Public School Systems — Large 

Cities, 1954-55 
Current Expenditures per Pupil in Public School Systems — Small and 

Medium-Sized Cities, 1954-55 
Digest of Reports of State Boards of Vocational Education 
Earned Degrees Conferred by Higher Educational Institutions, 

1954-55 
Educational Directory, 1955-56 

Federal Government and States, Part I 
Counties and Cities, Part II 
Higher Education, Part III 
Education for the Professions 
Education in Mexico 
Engineering Enrollments and Degrees, 1955 



Office of Education 193 

Enrollment (Opening Fall) in Higher Education Institutions, 1955 
Enrollment, Teachers, and Schoolhousing — Fall Statistics, 1955 — 

Full-Time Public Elementary and Secondary Day Schools 
Fifth Annual Report of the Commissioner of Education Concerning 

the Administration of Public Laws 874 and 815, June 30, 1955 
Guide for Part-Time Instructors — Distributive Education for Adults 
National Leadership Development Conference — Trade and Industrial 

Education, 1956 
Offerings and Enrollments in Science and Mathematics in the Public 

High Schools 
Public Vocational Education Programs — Characteristics of Programs 

Under Provisions of the Federal Vocational Education Acts 
Kadio and Television Bibliography 
Report to the President by the Committee for the White House 

Conference 
Resident, Extension, and Adult Education Enrollment in Institutions 

of Higher Education 
School Facilities Survey^ — Report of the Long-Range Planning Phase 
Selected References on School Finance 

Selection and Training of Part-Time Instructors — Distributive Edu- 
cation for Adults 
State Policies and Regulations Affecting Junior High Schools 
The State and Publicly Supported Libraries 
State School Plan Services 

Supervision in Rural Schools — A Report of Beliefs and Practices 
Teachers of Children Who Are Deaf 
Training for Quantity Food Preparation 

Work Experience Laboratories — Distributive Education for Youth 
Periodicals 

Higher Education (9 issues, September 1955-May 1956) 
School Life (9 issues, October 1955-June 1956) 



194 



Department of Health, Education, and Welfare, 1956 



Table 1. — School enrollments in the continental United States, 1954—55 and 

1955-56 

[Office of Education estimates] 



School 



1954-55 



Kindergarten through Grade 8: 

Public school system 

Private and parochial schools 

Residential schools for exceptional children 

Model and practice schools in teacher training institutions 

Federal schools for Indians 

Federal schools under Public Law 874 

Total elementary 

Grades 9-12: 

Public school system 

Private and parochial schools 

Residential schools for exceptional children 

Model and practice schools in teacher training institutions and preparatory 

departments of colleges 

Federal schools for Indians 

Federal schools under Public Law 874 

Total secondary 

Total elementary and secondary 

Higher education: 

Universities, colleges, professional schools, including junior colleges and 
normal schools 

Total higher education 

Other schools: 

Private commercial schools (day and evening) 

Nurse training schools (not affiliated with colleges and universities) 

Total other schools 

Grand total 



24, 588. 000 
3, 768. 000 
71, 500 
38, 500 
32, 200 
16, 000 



28, 514, 200 



6, 860, 000 

823, 200 

12, 200 

41, 000 
9,800 



39, 798, 700 



24, 091, 500 
3, 506, 200 
65, 000 
38, 300 
27, 400 
9,600 



27, 738, 000 



6, 582, 300 
774, 800 
11,100 

40, 500 
12, 300 



900 


1,000 


7, 747, 100 


7, 422, 000 


36, 261, 300 


35, 160. 000 


2, 996, 000 


2, 755, 000 


2, 996, 000 


2, 755, 000 


450, 000 
91, 400 


144, 000 
69, 500 


541, 400 


213, 500 



38, 128, 500 



Table 2. — Supply and demand for elementary and secondary public and 
nonpublic school teachers, 1955—56 



Item 



Elementary 

and 
secondary 



Supply 

Total teachers 1954-55 i 

Less emergency teachers 1954-55 

Total qualified teachers 1954-55 

Less 7.5 percent turnover 

Qualified teachers returning for 1955-56 

Emergency teachers qualifying for 1955-56 

New supply of qualffied teachers (79 percent of elementary and 56 percent of high school 
teachers trained in 1954-55) 

Total qualified supply 1955-56 

Demand 
Total teachers 1954-55 

Teachers needed to meet increase m enrollment m 1955-56 i 

Total demand 1955-56 

Shortage of qualified supply (see note below) 



1, 201, 800 
91, 200 



1, 110, 600 
83, 300 



1, 027, 300 
25, 000 



1,201.800 
55, 200 



1, 257, 000 



141, 300 



1 The number of elementary and secondary school teachers in public schools, in the fall of 1954, was 
1,065,803 (Office of Education Circular No. 417, Revised). To this must be added the number in nonpublic 
schools (private and parochial), in model and practice schools of colleges and universities, in residential 
schools for exceptional children, and in schools operated under Federal auspices. The number of teachers 
in this group of schools was estimated as 136,000, on the basis of 1 teacher to every 33 pupils— the ratio pre- 
vailing in the Roman Catholic schools which enroll 88 percent of the pupils in this group. 



Office of Education 



195 



Table 3. — Grants to States: Office of Education, fiscal year 1956 ^ 



States, or Territories and 
possessions 



Total 



Colleges of 
agriculture 
and the me- 
chanic arts 



Cooperative 
vocational 
education 



School 

construction 

(P. L. 815) 



Maintenance 

and operation 

of schools 

(P. L. 874) 



Total__- 

Alabama 

Arizona 

Arkansas 

California 

Colorado 

Connecticut 

Delaware 

Florida 

Georgia --- 

Idaho 

Illinois- 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts 

Michigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New Hampshire 

New Jersey 

New Mexico 

New York 

North Carolina 

North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Rhode Island 

South Carolina 

South Dakota 

Teimessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West Virginia 

Wisconsin 

Wyoming 

District of Columbia 

Alaska 

Hawaii 

Puerto Rico 

Virgin Islands 



$208, 633, 750 



$5, 051, 500 



$33, 199, 226 



9, 176, 815 



3 $81, 206, 209 



4,441 
2, 659; 
2, 575, 
30, 958: 
4,551 
3, 015 
373: 
4, 473 
5, 727, 

1, 009, 
4, 687, 
2, 453, 
1, 175 
5, 289: 
2, 122, 
1, 223 
1, 232: 
10, 128' 
2, 196, 

7, 292, 
1, 615 
1, 485, 
4, 183 

1, 532 
1, 954; 
1, 

777, 
2, 690, 

6, 266, 

5, 717 

2, 584: 
553' 

7, 545; 
8, 215, 
1, 178, 
3, 477; 
1,313 
2, 194; 
1, 744, 

3, 198, 

12, 954, 

2, 152: 

279: 

16, 392; 

7, 937, 

808; 

1,420 

784; 

106 
4, 018; 
3, 520, 

751; 
37 



100, 541 
77, 477 
89, 048 

175, 599 
83, 218 
90, 023 
73, 173 
97, 644 

104, 360 

75, 872 
156, 905 
109, 245 
96, 146 
89, 006 
99, 375 
96, 769 
79, 115 
93, 372 
116, 789 

133, 559 
99, 751 
91, 735 

109, 448 
75, 896 
83, 222 
71, 597 
75,319 

118, 233 
76, 795 

217, 934 
110, 518 
76, 181 
149. 269 

92, 278 
85, 176 

174, 720 
77, 899 
91,118 
76, 511 

102, 835 
146, 921 
76, 871 
73, 768 
103, 104 

93, 731 
90, 006 

104, 260 
72, 898 



71,283 
74, 986 
50, 000 



898, 437 
180, 844 
657,340 
1, 620, 978 
284, 221 
315,367 
165, 000 
514,850 
964, 335 

187, 580 
1, 460, 900 
871, 495 
741, 157 
484, 204 
911,771 
652, 621 
189, 789 
397, 919 
637, 684 

1, 181, 820 
762, 446 
826, 110 
929, 047 
189, 168 
379, 037 
141, 440 
160, 088 
643, 742 
189, 715 

2, 070, 072 

1, 288, 053 
256, 940 

1, 477, 593 
582, 057 
344, 590 

1, 807, 730 
126, 458 
656, 029 
253, 114 

958, 503 
1, 671, 308 
172, 225 
164, 761 
857, 026 
474, 773 
546, 818 
819,313 
159, 443 

106, 999 
43, 378 
166, 202 
618, 907 
37, 829 



2, 424, 208 
1, 494, 698 
1, 190, 397 
14,817,260 
2, 031, 178 
1, 413, 804 
92, 098 
2, 098, 100 
2, 994, 183 

304, 253 
1, 081, 100 

720, 916 

92, 793 

1, 349, 928 

363, 039 
92, 936 

329, 948 
6, 256, 533 

177, 806 

5, 338, 495 
634, 342 
137, 195 

1, 981, 037 

1,019,371 
531, 019 
827, 537 
135, 199 
508, 546 

4, 569, 489 

1, 257, 018 
681, 809 

27, 691 

2, 788, 373 
4, 394, 929 

116, 378 
185, 714 
323, 508 
592, 384 
587, 185 

1, 075, 163 
5, 913, 353 
1, 157, 385 



8, 410, 911 

3, 265, 362 

91, 505 

157, 772 

287, 586 



741, 162 

2, 031, 670 

82, 549 



1, 018, 378 

906, 087 

638, 774 

14, 344, 733 

2, 153, 052 

1, 196, 544 

42, 990 

1, 762, 973 

1, 664, 677 

442, 261 
1, 988, 390 

752, 090 

245, 174 
3, 366, 625 

748, 433 

381. 103 

634. 104 
3, 381, 080 
1, 264, 093 

638, 944 

119, 032 

430, 150 

1,163,935 

248,442 

961, 527 

60S, 340 

407, 237 

1, 419, 670 

1, 430, 141 

2, 172, 451 
503, 824 
193, 070 

3, 129, 925 

3, 146, 612 
632, 474 

1, 308, 953 
785, 760 
854, 692 
828,144 

1, 062, 398 

5, 222, 642 

746, 008 

41, 415 

7, 021, 723 

4, 103, 691 

79, 851 

338, 915 

264, 386 



3, 162, 390 
1, 247, 906 



1 On a checks-issued basis. Does not necessarily agree with allotments or expenditures for a given fiscal 
year. 

2 Does not include $7,525,000 paid to Housing and Home Finance Agency. 

3 Does not include $735,255 paid to Air Force, $2,677,462 to Army, $11,587 to Commerce, $4,291 to Interior, 
$831, 254 to Navy, and $6,767 to Veterans Administration. 



Food and Drug 
Administration 



Fifty Years of Progress 

The tear 1956 is the Golden Jubilee of Federal food and drug con- 
trol. Nationwide commemorations by consumer, industry, and scien- 
tific organizations; and local. State, and Federal control groups have 
focused attention on progress since President Theodore Roosevelt 
signed the Food and Drugs Act on June 30, 1906. They have also 
brought consideration of problems the future may bring, and resolu- 
tion to solve them to best protect public welfare. 

The transition from the corner grocery, with a few hmidred bulk 
items to be scooped or ladled from unprotected bins and barrels, to the 
supermarket of today, with about 5,000 largely prepackaged food 
items, has been surpassed in public benefit only by medical progress. 
The average life expectancy has increased more in this 50-year period 
than in the previous 24 centuries. Not only new disease treatments, 
but also food sanitation and nutritional improvements have 
contributed. 

Dr. Harvey W. Wiley, who, more than any other, was responsible 
for the enactment of the 1906 law, came to the Department of Agri- 
culture as Chief Chemist in 1883. It was only after 23 years of scien- 
tific research under his direction, culminating in a popular crusade, 
that the law to protect consumers was passed. 

This research included studies into the composition of food in a 
period of transition of food processing from the home or local com- 
munity to factories often in far-off areas. His investigations 
included reports by State officials of the scope of adulterated foods in 
their own areas, and the enforcement problems that could not be met 
locally. It included studies into the chemical preservatives being- 
employed to aid mass production, and the effect such chemicals had 

197 



198 Department of Health, Education, and Welfare, 1956 

on the health of human guinea pigs — his "poison squad" of young men 
who volunteered to eat only the foods served them at his "hygienic 
table" and to let the scientists test the results. 

When the law was finally enacted, new ground had to be broken 
to administer it. Federal controls over industrial practices were 
new to all concerned. The industries needed education; the Gov- 
ernment needed better scientific data for wise enforcement. Inspectors 
had to be recruited and trained by persons inexperienced in making 
inspections. Court actions were specified in the law, but there were 
no judicial decisions to serve as guide lines. 

Industry had many readjustments to make. Most constructive for 
the years to come was the formation of associations to learn to live 
with the law and to pool resources to employ technicians who could 
guide them in improving their products. As the Chief Chemist stated 
in the 1917 report : 

The act has been one of the influences which has helped to draw competitors 
together into associations Kke the guilds of Middle Ages, associations shorn 
of the special privileges which the ancient guilds often enjoyed. These associa- 
tions have come to understand the value of constructive work and some of them 
devote considerable sums annually to experimental research designed to solve 
the technical problems with which the industry is confronted. Thus, there is 
made available to the small manufacturer scientific assistance which would 
ordinarily be obtainable only by large corporations maintaining their own stafE 
of investigators. Since the Bureau of Chemistry has always regarded it as its 
duty not merely to report violations of the law but also to prevent violations by 
constructive work intended to improve methods of manufacture, it cooperates 
actively with such associations of manufacturers. Such cooperation by the 
various Government agencies is bound to exert the profoundest influence on the 
country's industrial and social development. 

Despite controversies within the Department of Agriculture as to 
how the new legislation was to be enforced, and pressures from some 
commercial interests to nullify the provisions they had opposed, a 
critical observer of more than 50 years has commented that more 
was done in the first 5 years to correct the abuses the law was designed 
to control than in any subsequent period in its history. The gross 
adulterations and misbrandings were largely stopped; it was for the 
future to cope with the more refined cheats, and with new processes 
and new, often untested, ingredients developed to meet the growing 
demand for factory-processed commodities. 

The population has not quite doubled in the past 50 years, but 
traffic in canned foods has shown an 1,100-percent increase. Bulk 
staples changed to package staples, which in turn are rapidly being 
replaced by premixed, precooked, and frozen items. More and more 
fresh vegetables, meats, and other uncooked foods are found in the 
retail markets — cleaned, weighed out, and packed as convenience foods. 
These have reduced the housewife's time in the kitchen to about 25 
percent of that of her grandmother. 



Food and Drug Administration 199 

At the same time she has, in effect, largely delegated control over 
sanitation and ingredients used in foods to the food manufacturer 
and the food control official. The present law, however, provides the 
sanitary controls that will protect her, if the added manpower these 
new conditions superimpose on the FDA staff is provided. Control 
of new ingi-edients clearly needs improvement, as discussed later. 

In drugs, the transition was slower, but it was on the horizon when 
the 1938 law was enacted to bring controls up to commercial progress 
and to remedy defects revealed by judicial decisions. Some advances 
had been made in the first decade, particularly in the encouragement 
of basic research to improve manufacturing controls, and in an amend- 
ment designed to curb fraudulent claims. Material strides in con- 
sumer drug protection came under the 1938 act, which provided for 
the establishment of the safety of new drugs before marketing, and 
for better control over the labeling of medicines for safe and effective 
use. 

Expanded medical and pharmaceutical research resulted in the de- 
velopment of the many drugs that have been introduced in the last 
18 years, which are incorporated in 90 percent of physicians' prescrip- 
tions today. The safety requirements imposed under the 1938 act 
and its certification amendments have contributed materially to this 
startling advancement in medicine during that period. 

Pharmacology, in 1938 a relatively minor science in terms of gradu- 
ates and their employment, mushroomed as both manufacturers and 
control officials needed more and more evidence of safety, through 
studies on animals instead of primary testing on man. 

The labeling provisions of the 1938 act, strengthened by judicial 
decisions tending to thwart subterfuge in accompanying labeling, have 
given the public more protection than ever before against being victim- 
ized by directly false claims. However, there remains the serious 
problem of cleverly worded promotional material which, by indi- 
rection and innuendo, creates a misleading impression as to the thera- 
peutic usefulness of the article. 

This summary does not permit detailed review of the many other 
developments during the past 50 years. A few cannot be ignored, 
even if listed only by title : 

The evolution of the science of nutrition, with the word "vita- 
min" coined only in 1911, and recognition of foods for special 
dietary purposes first given in the 1938 act. 

The change from arsenic and lead for agricultural crop control 
to new pesticides developed during and after World War II, with 
full legal control over "poisonous residues" effective only after the 
end of the 1956 fiscal year. 

Cosmetics which were not even mentioned in the 1906 law and 
fell into some disrepute through injuries from a few types of 



200 Department of Health, Education, and Welfare, 1956 

products. The 1938 law brought them under control, and cos- 
metics now enjoy full public confidence. 

Therapeutic devices, which also were not controlled by the 1906 
act and presented many problems. Under the 1938 act, they have 
been brought under regulatory control in much the same manner 
as drugs. 

The change from the old-type drugs, usually administered 
orally or topically, to new, potent preparations, often injections 
requiring sterility and absence of irritating impurities. 

Control over illegal sales of prescription drugs, which has be- 
come an increasing problem since 1938. 

Certification of insulin in 1941, and a number of antibiotic 
drugs developed during and after World War II. 

Use only of certified coal-tar colors, provided by the 1938 act. 
Newly developed methods are being employed to reevaluate the 
safety of some colors long accepted as eligible to the certification 
list. 

Official food standards, the country's most important cookbook, 

which specify the ingredients of a fair share of staple foods, and 

provide uniform factors for their enrichment when it is found 

in the consumer's interest. 

These all still present problems requiring the most constructive 

work of government and industry alike to advance consumer welfare. 

The 50th Anniversary commemoration ended with a high resolve to 

continue the "50 years of progress" through future protection of the 

public's food, drug, and cosmetic supplies. 

Industry and consumer groups have both hailed the Citizens Ad- 
visory Committee recommendations to provide for FDA's future 
ability to fulfill such obligations. The 1955 report outlined the 
recommendations of this Conmiittee, appointed by the Secretary of 
Health, Education, and Welfare, to study the Food and Drug Ad- 
ministration's obligations and responsibilities and its facilities to 
fulfill them. 

The Committee's recommendation for a 3- to 4-fold expansion in 
the next 5 to 10 years, the first year to be from 10 to 20 percent, was 
met by Congress in appropriating about a million dollar increase for 
fiscal year 1957 over that of 1956, which will provide a staff increase 
from 872 to 1,017. 

Its recommendation for a new headquarters building in Wasliing- 
ton to consolidate administrative and scientific personnel has pro- 
gressed to the stage of approval by the House and Senate Public 
Works Committees under the Lease- Purchase Act. 

An internal reorganization calculated to provide for more efficient 
operations and to set up an expansible framework to absorb a bigger, 
more complex organization has been put into effect. 



Food and Drug Administration 201 

Many of the other recommendations of the Committee must await 
increased funds in the future. 

Educational efforts for better compliance and benefit through more 
understanding of the law have been paramount to its administration 
from the inception of Federal food and drug control. Soon after 
the original act was passed, experts in sanitary controls went into the 
factories to teach processors how to prepare foods without preserva- 
tives to prevent spoilage. FDA inspections and improvement rec- 
ommendations, as well as administrative conferences, have also been 
constructive factors in education of industry toward more and more 
effective compliance. 

Consumers have had many exhibits, programs, and other 50th anni- 
versary observances to remind them of their benefits under the food 
and drug laws and their part in full participation. If they are to 
continue an interest in this essential provision for their welfare, how- 
ever, the recommendations of the Citizens Advisory Committee will 
require more educational efforts directly sponsored by the Food and 
Drug Administration. 

"Each generation needs to learn anew^ the why and wherefore of 
its institutions and blessings; otherwise they are taken for granted. 
Today, the right of the public to pure foods, effective drugs, safe 
cosmetics, and truthful labels has become generally accepted. It was 
not always so. We need to be reminded of Dr. Wiley and his 23-year 
struggle to obtain our first Federal pure food and drug law. It helps 
us understand and appreciate the value of the protective laws we now 
have, and the truly wonderful progress made by our food, drug, and 
cosmetic industries in this half century. It also helps us understand 
our problems of today and our obligation to insure that food and drug 
products of today and tomorrow will continue to be the best in the 
world." ^ 

Food, Drug, and Cosmetic Act 

DISASTER AND DEFENSE ACTIVITIES 

Two major natural disasters required supervision of damaged foods 
and drugs to prevent use of polluted goods in the stricken areas or 
shipments to other places. 

Hurricane Diane in August 1955 affected 22 primary areas in New 
England, Northeastern Pennsylvania, and New Jersey. Prompt proc- 
lamations by the Governors of the regions inundated by contami- 
nated waters closed flooded food and drug establishments until 
sanitation could be restored and flooded stocks removed for destruc- 



1 Larrick, George P. : Public Health Keports 71 : 557 (1956). 
508691—57 14 



202 Department of Health, Education, and Welfare, 1956 

tion or salvage under official supervision. Thirty-nine FDA men 
drove 18,673 miles to assist State and local officials control the dam- 
aged merchandise and establishments. No poisoning attributed to 
flood-contaminated products was reported. Loss of foods and drugs 
in New England alone approached $18 million and $2 million more 
from October floods. 

In California, the Governor proclaimed a state of emergency on 
December 22, because of serious floods in the northern and central 
areas. FDA inspectors were alerted and a number spent Christmas 
week assisting State and local control officials. A harbor flood in 
Los Angeles also required surveillance. 

While embargoed goods offer many segregation and disposal prob- 
lems, the situation becomes even more serious when merchandise is 
swept downstream. In New England, drums of toxic chemicals were 
lost from a manufacturing plant and a public alert was sounded to 
prevent injury to salvagers. In California, 2,000 barrels of olives 
with loose bungs and substantial quantities of beer and wine, flooded 
out of storage areas, were retrieved by the owners who planned to 
handle them as usual until State quarantines were imposed. 

The FDA civil defense training program for State and local food 
and drug officials, designed to help equip them to safeguard the food 
and drug supplies of the Nation in case of enemy attack, was con- 
ducted in 53 courses in 45 States. Nearly 2,000 people, including some 
representatives of other Departments and industry, attended 5-day 
courses on problems that might be engendered by attacks employing 
chemical, biological, or nuclear weapons, and procedures necessary to 
test exposed products and to restore production facilities for a safe 
food and drug supply. 

Investigations were continued into the safety and nutritive value 
of foods exposed to atomic explosion in 1955, and an interim report 
has been released. The vulnerability of packaged foods to bac- 
teriological attack and satisfactory decontamination procedures were 
also under active investigation during the year and plans were pre- 
pared for extending the scope of the program. Again in 1956, Pa- 
cific tuna monitoring was conducted to check on radiological contami- 
nation from weapons tests. Examination of tuna from 17 vessels 
on a cross-section sampling basis gave negative findings. 

ON THE FOOD FRONT 

Potential Health Hazards 

Agricultural poisons. — The establishment of pesticidal residue tol- 
erances for agricultural crops is discussed under "Regulations." 
With publication of established tolerances, there has been increased 
interest by growers, commercial dusters and sprayers, and the chem- 



Food and Drug Administration 203 

ical industry in tlie proper and timely application of insecticides, and 
better appreciation of tlie significance of toxicity determinations. 

FDA Washington and field staff members responded to many in- 
vitations from such groups to address meetings and discuss the new 
regulations and how to comply with them. Inspectors surveyed 
growers' practices, often in cooperation with State and county offi- 
cials, and warned against potential misuse. 

In one area, reports were received that growers intended to apply 
Endrin to a cabbage crop just before harvest, contrary to recom- 
mended use, which would have resulted in dangerous and illegal 
lesidues. An experienced inspector went into the area and prevented 
the applications, by use of press, radio, and television warnings,, plus 
personal interviews with individual growers, shippers, pesticide deal- 
ers, aerial applicators, packing plants, county agents, and others. 
Inspectors making later visits found that his warnings had been 
continued locally and that the whole area was well informed about 
hazardous use of pesticides. No violative residues were encountered 
there. 

The first enforcement actions under the new regulations were re- 
quired when growers employed Endrin for lettuce, for which no 
tolerance had been proposed or set. Two carloads from a field 
sprayed 2 weeks before harvest were shipped across the continent 
and seized on arrival in the East. Other seizures removed from 
consumer use 4,500 cases of frozen spinach prepared from spinach 
that had been sprayed with DDT only 7 days from harvest. Custom- 
ary washing and blanching at the freezing plant removed about three- 
fourths of the spray remaining on the harvested crop, but the frozen 
product still contained more DDT than is permitted on the fresh 
vegetable. The first import detentions under this amendment in- 
volved 75 lots of pears and 3 of apples which bore lead residues in 
excess of the tolerance. Other actions against nonpermitted uses of 
pesticides on raw agricultural crops included seizures involving more 
than 550 tons of grains treated for seed use with mercurial compounds 
and later diverted to food use. 

Imports of one variety of Canadian wheat in demand for seed 
because of its resistance to rust, increased the treated seed problem. 
Unless certified, such wheat had to be treated with a fimgicide before 
admission. Since some of these fungicides are colorless, sampling 
and analysis of the colorless seed wheat was undertaken and 75 lots 
were detained. One was reexported and the others distinctively 
colored to prevent diversion into food grains. 

Complete disregard for kbel warnings on a poisonous rodenticide 
agauist use directly on food by three California bean warehouses 
was observed during FDA inspections. Thousands of bags of beans 



204 Department of Health, Education, and Welfare, 1956 

had been dusted, heavily with the poison and the contents were danger- 
ously containiiitated. The State placed blanket embargoes on remain- 
ing lots and a countrywide foUowup led to Federal seizure of 150 
tons and various State seizures of 500 tons. An estimated 5,000 tons 
are being treated to remove the pesticide. 

Other careless pesticide use in the New Orleans area brought 
Federal seizure of 52 tons of lElour and 3I/2 tons of green coffee beans, 
and city seizure, pending removal of a poisonous insecticide, of 2,330 
tons of rice. 

Food poisoning. — Two outbreaks of illness resulted from popcorn 
intensely colored with coal-tar dyes which were subsequently with- 
drawn from the list of certifiable food colors. The first involved 
Hallowe'en "cats" so heavily colored with FD&C Orange No. 1 that 
some contained eight or more times the cathartic dose for an adult. 
Outstanding lots were recalled. In the second case, plastic Christmas 
stockings filled with popcorn colored with FD&C Eed No. 32 caused 
178 illnesses following an industrial firm-s Christmas party for its 
employees and their families. The firm recalled other lots, which 
had been distributed only locally. 

FDA investigators traced 44 other outbreaks of food poisoning 
reported during the year. In 18, staphylococcus was the causative 
agent, with inadequate or complete lack of refrigeration contributing 
to the growth of toxic organisms. Others were caused by locally 
prepared wieners containing excessive nitrates, wild mushrooms, and 
salmonella contamination of chicken. Five outbreaks of botulism, 
involving 15 individuals of whom 4 died, were traced to home-canned 
foods. Twelve became ill after eating an imported fishery product; 
remaining stocks contained many defective cans which were removed 
from the market. 

Inadequately processed canned mushrooms and canned goats' milk 
and a canned baby food in defective containers were recalled from 
the market because of active spoilage. No illnesses were reported. 
Other recalls that may have prevented illnesses involved crabmeat 
contaminated with E. coli. 

To Keep Food Clean 

Food seized because it was filthy or decomposed totaled nearly 2,600 
tons and accounted for 86 percent of the food seizures. Of the 79 
criminal cases filed in the food field, 71 were based on filth charges. 
Educational programs were pursued as far as FDA facilities would 
permit, and with the active assistance of industry and agricultural 
groups. 

The improvement of the sanitary storage of grain — the key to the 
success of the entire clean grain program^ — was brought to the at- 
tention of farmers and elevator operators by intensive educational 



Food and Drug Administration 



205 



work, with the active participation of the U. S. Department of Agri- 
culture, county agents. State agricultural colleges, farm youth or- 
ganizations, farm publications, and the grain trade. This better 
knowledge of how to keep grain clean was reflected in the fact that 
fewer carload lots of contaminated grain were seized in the entire 
fiscal year 1956, than in the 6 months of the previous fiscal year when 
the reactivated program was in effect. Actionable levels of con- 
tamination were reduced, effective July 1, 1956. 

Every hatchery received, through industry association letters, 
FDA's warning against diversion of decomposed incubator rejects 
into edible egg channels. Hatcherymen, visited by inspectors in the 
spring of 1956, all remembered the warning and some told of pre- 
cautions they had taken to avoid unsuitable disposition of their re- 
jects. A major outlet for incubator and candling room rejects went 
out of business, following a second prosecution within a year. 



Table 1. — Actions on foods during the fiscal year 1956 



Projects 



Total 

Beverages and beverage materials 

Bakery, ready to eat cereal, and macaroni products 
Cereals and grain products: 

Human use 

Animal use 

Chocolates, sugars, and related products 

Dairy products: 

Butter and churning cream 

Cheese and other dairy products 

Eggs and egg products 

Flavors, spices, and condiments 

Fruits and fruit products 

Meat products and poultry 

Nuts and nut products 

Oils, fats, and oleomargarine 

Seafood 

Vegetables and vegetable products 

Miscellaneous foods (mixed lots) 

Food for special dietary uses 

Violative serving of oleomargarine 



Seizures 



131 
1 

15 

15 

5 

15 

36 

66 

39 

49 

2 

71 

134 

25 

41 





Criminal 
prosecu- 
tions in- 
stituted 



Injunction 
petitions 



Eight thousand raisin growers and farm driers were presented 
individually with educational materials outlining their responsibil- 
ities under Federal and State laws to employ sanitary handling and 
drying procedures. For over a full season processors have inspected 
incoming stocks, with only a few failing to join the general movement 
toward industry-wide compliance. One firm was enjoined from in- 
troducing into interstate commerce raisins produced under insanitary 
conditions and another was prosecuted. 

Public interest in the wholesomeness of dressed poultry increased 
during the year, after numerous press items pointed to lack of Federal 
controls similar to those provided for meat. Since Federal poultry 



206 Department of Health, Education, and Welfare, 1956 

inspection is a voluntary U. S. Department of Agriculture service, the 
only legal controls now rest with the Food and Drug Administration 
which must divide its limited inspection staff among all food, drug, 
and cosmetic industries. 

Educational efforts are progressing through joint efforts of the 
Food and Drug Administration and the Public Health Service to 
further improve the wholesomeness of poultry and poultry products. 

Mass production has brought new problems, including a high dis- 
ease rate in concentrated broods, desire for rapid handling in process- 
ing lines, increased marketing of cut-up birds, freezing, pre-cooked 
items, and long-distance hauls. Seizures of unfit poultry in 1956 
were directed against diseased, f ecally contaminated, and decomposed 
birds. Spoilage resulted largely because of de-icing during trucking 
from South Central States to the West coast. Of the 38 shipments 
of unfit poidtry seized, 13 contained diseased birds, in comparison 
with 32 seizures, 21 because of disease, in the previous year. Three 
packers were enjoined from shipping filthy poultry packed under 
insanitary conditions. 

Growing demand for ready-to-eat foods presented problems in 
storage of raw foodstuffs by bakers and other manufacturers. Some 
have attempted to increase production without facilities to protect 
ingredients from infestation and spoilage. Other storage problems 
arose in warehouses which reduced clean-up operations because of 
increased labor cost. 

Increased labor cost, in comparison with raw material prices, was 
reflected also in a quality decline in some parts of the New England 
fish industry. Many educational meetings of industry and enforce- 
ment officials were held and more are scheduled. One constructive 
result was the formation of a cooperative of firms controlling more 
than 40 percent of the fish landed in Boston. This group has set 
up a compulsory, industry-run inspection service for its members. 

The trend toward use of floating canneries and freezing ships in 
remote areas of Alaskan waters is presenting an inspection problem. 
While the pack is examined, insofar as possible, when it is brought 
into ports in the States, detection of contamination of crabmeat and 
other seafoods particularly subject to pollution is more efficient 
through factory inspections. 

The percentage of time devoted to tomato products each year is 
governed by crop conditions. After a good early crop in the East, 
hurricanes and other adverse weather caused rot and insect infesta- 
tion which required unusual precautions on the part of packers and 
inspectors to prevent the processing of unfit material. Heaviest 
seizures were of pizza sauce and puree packed by one firm, and sur- 
veillance over future shipments must be maintained. 



Food and Drug Administration 207 

Thirty-four carloads of Mexican tomato catsup, of 37 offered for 
entry on a large contract, were detained because of pinworm infesta- 
tion. Thirty-four additional carloads prepared to fill the same con- 
tract may not be offered for entry as a result. 

Occasionally abnormalities in canned goods develop during storage 
and the affected goods are usually destroyed. However, one packer 
sorted out as "normal" two carloads of canned tomatoes from a large 
stock in which decomposition had developed. An inspector discovered 
them on the dock awaiting shipment and collected samples which con- 
firmed decomposition. Both carloads were seized before they could 
reach consumers and the corporation was prosecuted and fined. 

Pocketbook Protection 

Although regulatory work was predominantly in the field of health, 
filth, and decomposition, flagrant cheats received regulatory attention. 
A Maryland oyster packer who persisted in "watering" his pack, con- 
trary to the accepted practices of the industry as a whole, was enjoined 
from interstate shipments after heavy seizures. A Rhode Island 
retail butcher who sold, as beef, horsemeat steaks and hamburger, was 
jailed. 

Among seizures were cocoa powder adulterated with ground cocoa 
shells and with cottonseed flour, olive oil labeled as pure but containing 
a substantial portion of cottonseed oil, and a butter and cheese additive 
not permitted by standards. 

Continued violations of food standards were noted during the year, 
such as green beans containing tips and cuts without label declara- 
tion, "pitted" cherries containing pits, improperly labeled sirup con- 
centrations in canned fruits, low-fat butter and cheese, and deviations 
from standards by new names, such as "oyster stew base" with more 
water than permitted for canned oysters. Increased appropriations 
for the next fiscal year are intended, in part, to supply inspectional 
time to curtail such violative practices. 

Seafood Inspection Service 

Shrimp processors and oyster canners who meet Government re- 
quirements for sanitation and controls, may apply voluntarily for 
FDA seafood inspection which is financed by inspected packers' fees. 
Seven firms took the service, but inspection was withdrawn from two 
because of violation of the regulations. Under the inspection service, 
6,978,848 poimds of whole shrimp and 29,753 pounds of headless 
shrimp were processed, and 32,088 cases of oysters were canned. 

PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE 

Recent court cases involving misleading claims of benefit for the 
use of vitamin and mineral preparations have served to call attention 



208 Department of Health, Education, and Welfare, 1956 

to the many media by which the consumer is misinformed about nutri- 
tion. He is continually bombarded by a repetition of exaggerated 
claims based on half-truths and scare techniques. 

Education of the consumer in the facts of nutrition has not kept 
pace with scientific developments in this field. Since World War II, 
medical discoveries have been so spectacular that the layman now 
finds it difficult to differentiate between fact and fiction. He is vul- 
nerable to misrepresentations not only about "wonder drugs"' but also 
about the value of the foods he eats each day. For example, he is 
told that soils have been so depleted by cropping and erosion that ordi- 
nary foods cannot be relied upon to supply even the bare necessities of 
essential nutrients; that food processing destroys vitamins and min- 
erals; and that his diet is so inadequate as to lead to malnutrition. 
The simple remedy, he is told, is to take a tablet or capsule that con- 
tains vitamins and minerals that will reinforce his faulty diet. Such 
misinformation should be combatted with a program of sound nutri- 
tion education. 

A sizeable number of vitamin-mineral preparations are now mar- 
keted by organized house-to-house sales persons who in the privacy 
of homes talk not only about soil depletion and inadequate nutritional 
qualities of ordinary foods, but also make outright claims for the treat- 
ment of serious diseases. 

The development of actions against individual salesmen is time- 
consuming, but a number of prosecution cases have been successfully 
terminated. To date the firms distributing the products sold by such 
house-to-house canvassers have, in each instance, repudiated the sales- 
men's claims as being unauthorized, and evidence to show the firms' 
responsibility for the individuals' actions was not available. There- 
fore, the criminal actions were brought only against the individuals, 
who were fined and placed on probation. 

Late in May, a "health food" lecturer who had been found guilty 
by a jury in 1955 of misbranding his wares, received a sentence of a 
year and a day in jail, which he is appealing. One of the pioneers in 
the field of selling herbs and natural foods to heal diabetes, tubercu- 
losis, epilepsy, and other serious diseases, his broadest claim was that 
his products would "put off death to the very last minute." 

During the year, the vitamin content of 890 samples Avas tested by 
2,721 assays in which chemical, biological, microbiological, fluoro- 
metric, spectrophotometric, radioactive tracers, thiochrome, and other 
methods were employed. Forty- four shipments were seized because 
they contained less vitamins than declared on their labels. 

With the emphasis on education of packers of products purporting 
to be of low-sodium content, compliance with the low-sodiimi regu- 
lations in the 21 months since their effective date has been pro- 



Food and Drug Administration 209 

grossing satisfactorily. Only three seizures were made in 105G of 
so-called low-sodium foods failing to bear the mandatory labeling in 
respect to their sodium content. 

DRUGS AND DEVICES 

For some time, FDA has been concerned with the problem of acci- 
dental poisoning among young children who eat aspirin tablets ob- 
tained from packages left carelessly within their reach. An advisory 
ruling, designed to help protect children against such accidental 
poisoning resulting from swallowing large amounts of aspirin and 
other salicylate drugs, was issued in October. Drug manufacturers 
were asked to use conspicuous package warnings that such drugs 
should be kept out of the reach of children. This followed a medical 
advisory panel recommendation and was a part of a joint educational 
program to promote the safe use of drugs. 

The industry has taken commendable steps by adoption of such 
warnings and other means to warn the public that all drugs should be 
kept in a safe place and out of the reach of children. It has given 
widespread distribution to reprints of an FDA leaflet entitled "Pro- 
tect Your Family Against Poisoning," wdiich covers drugs and house- 
hold poisons that may cause accidental poisoning. 

Salh polio vaccine. — Since the great demand for Salk vaccine for 
poliomyelitis might precipitate a black market, the Department re- 
quested Congress to make a, special appropriation to the Food and 
Drug Administration to maintain surveillance over national distri- 
bution and to initiate regulatory action should abuses develop. 

During the period from August 1955 to June 1956, inspections were 
made of manufacturers, wholesalers, and retailers to audit and verify 
distribution records. These inspections were further augmented by 
visits to physicians, hospitals, health agencies, and individuals. In 
all, a total of 33,000 such inspections and visits were made. No major 
abnormalities in the distribution of the vaccine developed. As supply 
and demand came into better balance, it became evident that further 
funds for a special program would not be required for the 1957 fiscal 
year. Surveillance during the coming year will be maintained by all 
districts as part of normal drug operations. 

Recalls. — Twenty drug recalls were supervised by FDA during the 
year. Ten of the products involved were below the labeled potency 
or strength, and one, a digitalis preparation, was excessive in potency. 
Two injectables and an eye medicine were not sterile. Two other 
injectables were pyrogenic, which would have caused a temperature 
rise in patients. Two products were recalled for corrections in dosage 
directions and the expiration date. Another had developed a danger- 
ous pressure in the bottles after shipment. In volume, the largest 
recall involved an anti-con vulsant the manufacturer voluntarily with- 



210 Department of Health, Education, and Welfare, 1956 

drew from tlie market because its recent toxicity study showed damage 
to small laboratory animals not revealed in earlier studies. 

Illegal Sales 

Problems of illegal sales of dangerous drugs remain serious and 
require a major segment of the available regulatory time for drugs. 
Barbiturates (for sleep) and amphetamines (stimulants) are the 
drugs most commonly encountered. Fewer complaints have been re- 
ceived of drugstore violations, but channels unauthorized to sell such 
drugs are active in bootleg operations. 

Criminal prosecutions were filed against 114 drugstores, pharma- 
cists, lunch counter and tavern operators and employees, filling sta- 
tion men, and peddlers. Twenty-two of the actions, involving 42 
defendants, developed out of complaints that truck drivers were ob- 
taining "stay awake" pills illegally at roadside stops and their mis- 
use was jeopardizing highway safety. FDA inspectors spent many 
months in undercover investigations of the sources of their supplies. 

Publicity given to these cases by the National Safety Council, 
trucking associations, labor unions, and others has made not only 
truck drivers but also other drivers conscious of the dangers of using 
drugs to stimulate them to continue driving after normal fatigue 
has set in. On the whole, conditions in the areas covered have im- 
proved materially but the warnings have prompted additional com- 
plaints that will require a heavy drain on inspection time there and 
in other sections not yet covered. 

Misbranded Drugs and Devices 

Each report is another chapter in the continuing war against 
worthless medicines, which reappear year after year in new or con- 
tinued attempts to victimize the public. 

The 1955 report outlined a diabetes remedy case lost in district 
court on the ground that a 1923 patent established the validity of 
current claims of efficacy for the treatment of diabetes. The Gov- 
ernment appealed the case to prevent the public from being exploited 
by a worthless remedy when there are effective measures available to 
control the disease. The appellate court reversed the district court. 

An injunction to restrain misbranded drug shipments from a Texas 
cancer clinic has been discussed in a number of previous reports, 
and last year seizures from its new Pennsylvania branch were re- 
ported. The trial date for court contest of these seizures was post- 
poned until the fall of 1956. Since people who have or fear they 
have cancer are still being encouraged to go to the two "clinics" for 
treatment and to depend upon the worthless medicines, FDA issued 
a public warning in March 1956, Avhich has brought heavy corre- 



Food and Drug Administration 211 

spondence with people who fear that reLatives and friends may be 
the next victims. 

The 1954 and 1955 reports outlined an injunction case to ban ship- 
ments of an inert glandular product misbranded with sex rejuvenation 
claims. It involved a fraudulent sales promotion scheme, includ- 
ing false foreign invention and manufacturing claims. A permanent 
injunction was granted in November 1954, less than 2 weeks after 
actual distribution began. In September 1955, the two brothers 
who operated the mail-order business were fined and given 5-year 
probationary terms, and their firms were fined. 

An injunction against shipments of "orgone energy" devices and 
misbranding literature was reported in 1954. The manufacturer not 
only did not destroy the literature and recall the products then on 
lease in other States, as ordered by the court, but he continued inter- 
state distribution of both the devices and literature with the aid of 
armed assistants. Criminal contempt proceedings against the manu- 
facturer, his "Foundation," and his principal distributor were insti- 
tuted after FDA inspectors had collected evidence of violation of 
the order over a 2-year period. First declining to appear for trial, 
the two individuals finally arrived under Federal arrest, and then 
insisted that they had continued the traffic contrary to the injunc- 
tion order. A 2-year jail sentence for the manufacturer, a 1-year 
jail sentence for the distributor, and a $10,000 fine for the firm are now 
under appeal. Meanwhile, they are under bond, belatedly trying 
to comply with the order. 

The printed material ordered to be recalled and destroyed consti- 
tuted accompanying labeling as defined by the law and judicial 
interpretations. The fact that some of the false and misleading 
representations used in promoting the sale and rental of the devices 
were contained in books with hard covers did not change the status 
of this literature as "accompanying labeling." 

A long-delayed case against a mineral water, with collateral liter- 
ature claims for treatment of kidney disorders and arthritis, was 
brought to trial in the spring of 1956. The Government charged 
that this drinking water would not be efficacious for these conditions, 
but the jury did not confirm the Government's charges. 

In September 1953, the contested seizure of an antacid advertised 
as stopping acid pain of diagnosed stomach ulcers was decided in 
favor of the Government, and multiple seizures followed when the 
advertising was not withdrawn. A criminal action based on ship- 
ments made after the seizure contest brought a fine of $5,500 to 
the corporation and 3 years' probation to two of its officers in June 
1956. Despite the blatant claims in full-page newspaper ads, the 
label of the drug merely stated that the product was "for the tem- 
porary relief of excess gastric acidity." 



212 Department of Health, Education, and Welfare, 1956 

Another ulcer "remedy" that received attention during the year 
was an imported product, promoted through popular magazine pub- 
licity wliich created great demands for entries from Demnark and 
Canada. Since no new-drug application had become effective, sev- 
eral hmidred mail-order shipments to individuals were detained at 
entry points. At the end of the year, some lots were being released 
to doctors for investigational use. 

Among the 51 medicines seized for false and misleading claims 
were articles composed of dried alfalfa, cereal grass, apple derivatives, 
buckwheat flowers, powdered pumice, phosphates, sulfates, papaya, 
royal jelly (said to be the special bee food for productive and long- 
living queen bees) , or a mixture of one or more of these and vitamins 
and minerals. They bore claims for the treatment or prevention of 
almost every disease. 

Seizures of uranium ore pads, blankets, artificial tunnels, and other 
containers of slightly radioactive ore and sand, completely worthless 
to alleviate arthritis as claimed, were mentioned in the 1955 report. 
Additional shipments of such materials were seized in 1956, and a 
local warning was given to a southwest dairy farmer who was charg- 
ing admission for visitors to cover acliing feet with his "Uranium Ease 
Foot Powder" farm dirt, and selling them the dirt in 25-pound bags. 
One firm was enjoined in March 1956 from further shipments of mis- 
branded radioactive pads, monazite sand, and similar items. 

Veterinary Drugs 

Commercial feeds have long been of major concern to State feed 
officials who enforce statutes controlling protein content and label- 
ing. When such feeds became a major market for drugs, such as 
hormone-like substances and antibiotics, feed manufacturers became 
drug manufacturers, confronted with the new responsibility of com- 
pliance with both the safety and labeling requirements of the Federal 
law. In January, a symposium on problems being encountered was 
attended by approximately 400 drug suppliers, feed manufacturers, 
livestock and poultry feeders, and control and public health officials 
from all parts of the country. This meeting did much to solve many 
questions that have arisen in this fast-moving, highly technical field. 

Twelve veterinary medicinals were seized for false and misleading 
therapeutic claims, failure to meet labeled composition or bear re- 
quired labeling, and violation of the new-drug and antibiotic-certi- 
fication requirements. One contested seizure was upheld by a district 
court which confirmed the Government's charge that cannibalism in 
poultry flocks is a disease, and that no drug product presently known 
to medical science is an effective control. 

A permanent injunction in June 1956 banned shipments of a min- 
eral compound that had been the subject of litigation for the past 



Food and Drug Administration ^13 

decade. It was originally called "Stop-Bloat," but after the Govern- 
ment was upheld in a contested seizure trial, the name of the product 
was changed; illustrations and representations in the labeling con- 
tinued to represent it for bloat. Additional seizures were made and 
the Government was upheld in another contest, but the manufacturer 
persisted in misbranding the product. 

New Drugs 

During the fiscal year, 520 new-drug applications were submitted 
to the Food and Drug Administration. Of these, 407 were allowed 
to become effective, 346 for human and 61 for veterinary purposes. 
The number of supplemental applications has continued to increase. 
Twenty-four hundred and ninety-two went into effect during the 
year, half for veterinary preparations. No order was issued refusing 
to permit an application to become effective, but the effectiveness of 
one application was suspended. 

From year to year new trends in therapy are reflected by submission 
of applications for drugs usually developed as a result of advances in 
basic medical research. Some of the drugs considered during the year 
were tranquilizing agents, a central nervous system stimulant for the 
restoration of depressed physical and mental activity, an anti-halluci- 
natory drug, two general anesthetics administered by intravenous in- 
jection, some nonbarbiturate hypnotics and sedatives, an antibiotic 
useful in staphylococcic and proteus infections resistant to other 
agents, a skeletal muscle relaxant, a new alkaloid from Rauwolfia, a 
steroid which promotes protein anabolism, two ganglionic blocking 
agents for the treatment of high blood pressure, a radio-isotopic prep- 
aration for the determination of red-cell volume and useful in studies 
of red-cell survival and loss, and anticoagulant solutions packaged in 
plastic containers for the collection of blood. 

COSMETICS AND COLORS 

There were no seizures or criminal actions in 1956 based on violation 
of cosmetic requirements. A coal-tar color originally consigned to 
a soft drink manufacturer was seized because it had not been certified. 

CHANGES IN THE LAW AND REGULATIONS 

While FDA representatives testified at numerous hearings in the 
2d session of the 84th Congress, only three bills were enacted in addi- 
tion to the appropriation bills. All were essentially noncontroversial. 

Congress amended its own statutory name for dried skim milk by 
changing it from "nonfat dry milk solids" or "defatted milk solids" 
to "nonfat dried milk." 

A law was enacted which permitted the continued use of FD&C 
Red No. 32 for coloring the skin of oranges not intended for process- 



214 ' Department of Health, Education, and Welfare, 1956 

ing. A 3-year time limit was set, unless a more suitable color is 
developed in the meanwhile. This legislation arose over the fact that 
the Secretary delisted and discontinued certification for food use of 
this and two orange coal-tar dyes because of conclusive evidence that 
they are not harmless. This evidence did not include specific findings 
of toxic results from use in coloring oranges, but the law does not 
give the Secretary authority to specify the foods which may contain 
certified colors or limit the amount of color that may be used. He is 
directed to certify colors as "harmless and suitable for use" in food 
generally. The Secretary's order delisting these colors was appealed 
in three circuit courts. One of the circuit courts upheld the Secre- 
tary's action after the close of the fiscal year. 

The third amendment was procedural legislation which extended 
the beneficial provisions formerly applicable only to food standards 
to other rule making in the absence of controversies. This legislation 
was strongly supported by the Food, Drug, and Cosmetic Sectio^i of 
the New York State Bar Association, which had sponsored the earlier 
amendment to simplify the establishment and amendment of food 
standards. 

Among the numerous hearings at which FDA presented the views 
of the Department, but no laws were passed, were those on chemical 
additives for food, and compulsory poultry inspection. 

Eleven bills were introduced in the 84th Congress to require the 
testing of chemical additives for safety before they are put into foods. 
There was general agreement by Government and industry that new 
legislation is needed in this field. Three principal areas of differing 
opinions about the form such legislation should take were: 

(1) What should be done about chemicals already being used when 
the law is passed ? 

(2) Should there be evidence that a chemical is useful before it is 
permitted in food ? 

(3) How should controversies between industry and Government be 
settled? 

None of the bills was enacted, but there is so much interest in this 
field that new legislation probably will be proposed in the next ses- 
sion of Congress. 

At hearings on compulsory poultry inspection bills, FDA testified 
as favoring such legislation but believing that it would be a mistake 
for this organization to undertake a routine in-plant type of inspec- 
tion of such magnitude, at a time when its staff and facilities are so 
occupied with the important problems of expansion and development 
of an organization adequate to deal with the entire food, drug, and 
cosmetic supply. It was urged that efficient operations under the 
Meat Inspection Act for the past 50 years have equipped the U. S. 



Food and Drug Administration 215 

Department of Agi-iculture with the pattern and principles to operate 
an effective poultry inspection service. 

Regulations 

The removal of three coal-tar colors from the list permitted for food 
use is discussed in connection with the legislation enacted concerning 
FD&C Red No. 32. This red color and FD&C Orange No. 1 and No. 2 
were removed from eligibility for certification as FD&C colors on 
November 16, 1955, and added to the list of colors for external drug 
and cosmetic use only. 

New drugs. — Proposed revisions in the new-drug regulations were 
published in the Federal Register on September 8, 1955, and May 30, 
1956. Although the Commissioner of Food and Drugs has the 
authority to publish such regulations without furnishing interested 
persons an opportunity to state their views, drug manufacturers' rep- 
resentatives were given full opportunity to participate in their devel- 
opment. The final order was published after the close of 
the fiscal year (Federal Register July 25, 1956). 

Major changes in these regulations include: (1) The establishment 
of procedures for the conduct of hearings prior to the refusal or sus- 
pension of an application for a new drug. 

(2) Provision for the "filing" of new-drug applications refused as 
incomplete by the New-Drug Branch, to furnish applicants an oppor- 
tunity for administrative and judicial appeal from any arbitrary 
refusal to file an application. 

(3) A revised application form containing more detailed informa- 
tion to assist the applicant in completing a sound application with 
less individual, time-consuming correspondence. 

(4) Increased emphasis on the responsibility of an applicant to 
adhere to the provisions in an application, with broader grounds for 
suspension if they are violated or if the application contains untrue 
statements or significant omissions of material facts. 

It is expected that the revised regulations will promote better appli- 
cations, more careful observance of the conditions necessary to assure 
the safety of new drugs, and more efficient, faster processing of new- 
drug applications. 

Food standards. — A number of amendments were made to stand- 
ards for various cheeses. The most important of these makes sorbic 
acid and sodium and calcium propionates optional ingredients of 
several cheeses, process cheeses, cheese foods, and cheese spreads. 
Sorbic acid and the sodium and calcium propionates retard mold 
growth and are now widely used on packages of sliced cheeses. 

One public hearing was called because of objections to an order bj^ 
the Commissioner of Food and Drugs declining to adopt a definition 
and standard of identity for a food to be known as partially creamed 



216 Department of Health, Education, and Welfare, 1956 

cottage cheese. No order based on evidence taken at this hearing 
was issued during the fiscal year. 

Definitions and standards of identity and standards of quality for 
canned pineapple and pineapple juice and a fill of container standard 
for camied pineapple juice were adopted. The standards involving 
pineapple are based on evidence at a hearing held prior to the passage 
by Congress of the Hale Amendment. 

A definition and standard of identity for canned prune juice^ — ^i 
water extract of dried prunes — was adopted. 

Pesticide chemicals. — The Pesticide Chemicals Amendment was 
scheduled to become fully efiective in July 1955, with provision for 
limited extension of the effective date for specific chemicals. To 
prevent a hardship on agriculture it was extended for a number of 
chemicals to take accomit of the growing season. It became fully 
operative for all chemicals on July 22, 1956, shortly after the close 
of the fiscal year. 

Fifty-nine petitions for tolerances or exemptions were submitted 
during the year. Fifty petitions were filed and the following actions 
were taken : 40 petitions resulted in the establislunent of permanent 
tolerances ; 1 petition resulted in the establishment of permanent ex- 
emptions ; and 5 petitions resulted in the establishment of temporary 
tolerances. Since the Pesticide Chemicals Amendment was enacted, 
over 1,200 tolerances or exemptions have been set for 82 different 
pesticide chemicals. 

The Pesticide Chemicals Amendment provides that an advisory 
conuTiittee composed of experts selected by the National Academy 
of Sciences may be formed to consider difficult questions of science 
raised in a petition for a tolerance. One such committee was formed 
at the request of a petitioner and an appropriate tolerance was estab- 
lished for the pesticide chemical involved, based upon the report and 
recommendations of the committee. 

A tolerance was established for residues of the antibiotic clilor- 
tetracycline in uncooked poultry. Evidence presented by the manu- 
facturer of the antibiotic demonstrated that when poultry containing 
the tolerance level of the chemical is cooked, no significant amount of 
antibiotic remains ; it is destroyed by heating. The dat-a also showed 
that the dip is effective only when applied to clean, freshly killed 
birds. No evidence has been submitted that established the safety 
and usefulness of antibiotic application to other foods. 

CERTIFICATION SERVICES 

Coal-tar colors.- — -All coal-tar colors used in foods, drugs, and cos- 
metics (except hair dyes) must be from batches certified as harmless 
by FDA. In 1956, 4,776 batches, representing 5,296,414 pomids, were 
certified, and 29 batches, representing 47,765 pomids, rejected. 



Food and Drug Administration 217 

Insulin. — The act provides for predistributiou testing and certi- 
ficatioii of all batches of insulin marketed. Examination of 338 
samples resulted in the certification of 295 batches of insulin and 42 
batches of materials for use in making insulin-containing drugs. One 
trial batch of Lente insulin was not approved because it did not meet 
hydrogen ion requirements. 

Antibiotics. — The predistribution testing and certification of cer- 
tain antibiotics is also provided by amendments to the act. Exami- 
nations were made of 18,256 batches of penicillin, chlortetracycline, 
bacitracin, chloramphenicol, dihydrostreptomycin, streptomycin, tet- 
racycline, neomycin, nystatin, polymyxin, oxytetracycline, and car- 
bomycin during the fiscal year. The last 5 antibiotics are not included 
in the certification amendments, but are tested when they are mixed 
with those requiring certification. Seventy-three batches were re- 
jected for failing to meet the following standards: Potency (18), 
sterility (37), pyrogens (12), and moisture (6). In addition, manu- 
facturers withdrew their requests for certification of 45 batches be- 
cause they failed to meet sterility and other standards. During this 
period, 359 amendments and 45 new monographs were added to the 
antibiotics regulations. 

Enforcement of Other Acts 

A total of 104,013,962 pounds of tea was examined under the Tea 
Importation Act, in contrast with totals of approximately 97 million 
in the fiscal year 1955 and 124 million in 1954. Kejections for failure 
to measure up to the standards set by the U. S. Board of Tea Experts 
totaled 94,372 pounds, or 0.09 percent. Six rejections were appealed 
to the U. S. Board of Tea Appeals, which upheld the decision of the 
FDA examiner in three cases, and in some portions of two others. 
The appeal was sustained in other portions of these two and in the 
remaining case. 

Three caustic poisons were seized for failure to bear the labeling 
required to warn users of their potential danger if misused. Included 
were aluminum and concrete etchers and a soldering acid. 

No permits were issued for importations of milk from Canada. 

No legal actions were instituted under the Filled Milk Act. 

New Court Interpretations 

The Supreme Court did not review any cases under the Federal 
Food, Drug, and Cosmetic Act during the fiscal year 1956. 

An appeal from an injunction restraining the shipment of a drug 
product because it was dangerous and falsely represented, was based 

408691 — 57 15 



218 Department of Health, Education, and Welfare, 1956 

on tlie defendants' contention that experts who testified for the Gov- 
ernment had not nsed the product. The Seventh Circuit Court of 
Appeals upheld the district court without a written opinion. This 
is another decision admitting expert testimony without actual tests 
of a drug. 

In the first case decided under the Federal Food, Drug, and Cos- 
metic Act on the question of whether the Federal court has power 
to order restitution in an injunction proceeding, a district court 
judge held that he did not have such powers. He concluded that 
there is no indication in Congressional history that supports any other 
sanction, or specifically, the power to order restitution under this 
act. The Government appealed, and after the close of the fiscal year 
the Ninth Circuit Court of Appeals upheld the district court's decision. 

In a seizure of tomato paste, all libels charged preparation under 
insanitary conditions, and two also charged the presence of rot and 
filth. The lower court held that the Government failed to prove 
the charges except in the case of rot in a. few codes in one libel. The 
Government appealed on the grounds that the trial court's findings 
of fact were clearly erroneous. The U. S. Court of Appeals for the 
Seventh Circuit reversed the lower court with respect to all codes 
that showed a mold count of over 40, and ordered these codes con- 
demned. The appellate court agreed with the district court that 
none of the paste was packed rmder insanitary conditions. 

A druggist defendant in an illegal sales prosecution case filed 
a motion to suppress evidence gained during inspection of his drug- 
store, and to dismiss the information on the grounds that inspection 
authority under the act applies only to factories and warehouses. He 
also argued that section 703 of the act granted him immunity. The 
district court judge, however, held that drugstores are subject to 
inspection under the "Factory Inspection" section of the act, and that 
records may be examined and copied by Government agents conduct- 
ing an inspection, if permission to inspect the record is given by 
an authorized person. 

A judge in a New York district court granted the Government's 
motion to dismiss the plaintiff's suit against the Government under 
the Tort Claims Act, seeking to recover damages resulting from 
importations of tomato paste that were allowed entry into this coun- 
try but later seized. The motion was based on the grounds that the 
actions involved discretionary functions of the Government and are 
not subject to the Tort Claims Act. 

In 1948 a seizure was made of a macaroni product containing 20 
percent protein, because it failed to comply with the standard which 
limits the protein content to 13 percent when gluten is used as an in- 
gredient. Through discovery procedures all questions were settled 



Food and Drug Administration 219 

except whether the product "purports to be or is represented ;is spa- 
ghetti." The Government's motion for summary judgment was 
granted by the district court judge, and the Court of Appeals for the 
Third Circuit affirmed the judgment of the district court. TMs 
opinion again upholds the integrity of food standards. From a 
procedural standpoint, it exemplifies the use of discovery in narrow- 
ing the issues, and decreasing the cost of trial. 

When prosecuted on charges of illegally dispensing amphetamines 
and other dangerous drugs, a licensed M. D. pleaded not guilty and 
filed a motion to dismiss on the grounds that the act does not apply 
to licensed M. D.'s. The judge of the district court overruled his 
motion on the grounds that he was selling the drugs promiscuously, 
without examinations. Later he fined the physician $3,000 and placed 
him on probation for 3 years. 

SCIENTIFIC INVESTIGATIONS 

All of FDA's research and scientific studies are aimed toward better 
public protection in areas in which the consumer camiot protect him- 
self. The contrast between the comparatively few and simple meth- 
ods and tools available when the 1906 law was enacted and the com- 
plex physical and biological methods and apparatus in use in FDA 
and industry laboratories today is paralleled only by contrast in the 
commodities under control at the beginning and end of this half- 
century span. 

Official and industrial chemists have collaborated during the years 
through groups such as the Association of Official Agricultural Chem- 
ists and the United States Pharmacopeia Revision Committee to de- 
velop methods for the detection and measurement of constituents 
that would bring comparable results in the hands of all qualified 
analysts. 

By thus combining forces in a purely scientific environment, meth- 
ods have been developed that meet the needs of industry chemists 
in compounding and labeling products and of regulatory chemists 
in checking the accuracy of label declarations. This eliminates the 
need for argument over methods in the courtroom, which would tend 
to confuse lay juries and judges. 

Particularly since 1938, collaborative pharmacological and experi- 
mental medical studies have brought similar benefits in establishing 
the safety and efficacy of the vast number of new medical and vet- 
erinary preparations that have been developed. 

Discussion of the scientific work required to solve some of the 
problems presented by new products will indicate the complexity of 
the factors involved in FDA's scientific work. Other work on meth- 
ods of analysis and studies on the efficacy and safety of products 



220 Department of Health, Education, and Welfare, 1956 

regulated by the Food, Drug, aud Cosmetic Act are continuously in 
progress. They include laboratory and clinical studies of antibiotics 
and other new drugs; developing better methods for the rapid de- 
tection of food poisoning agents; analysis of cosmetic ingredients; 
toxicity studies of coal-tar colors, and new ingredients of foods, 
drugs, and cosmetics; and studies of the nutritional eilects of new 
processes and components. 

A substantial amount of time was spent in chemical studies of spray 
residue data submitted by applicants for tolerances on raw agricultural 
commodities, and in pharmacological evaluation of the safety of the 
proposed tolerances. The chemical investigations included studies 
of the reliability of the applicant's method of measurement of the 
residue left, and the need and practicability of the tolerance. The 
pharmacologists studied the data submitted by applicants for tol- 
erances and FDA chemists' evaluations in determining whether 
residues would be safe, and, if so, the amount that should be permitted 
in consideration of chemicals being ingested from other sources. 

Decisions could not be reached without fundamental background 
data. For example, before it was determined that no tolerance was 
needed for the residues of four chemical fumigants for grain, exten- 
sive investigations were required. Studies were made of fumigant 
residues in wheat and milled wheat products in a pilot-scale mill 
and in commercially fumigated grain. The rate of dissipation of 
fumigant residue and the effect of cooking and baking on residues 
were measured. These investigations showed that high residues pri- 
marily left on grains when these fumigants are used drop sharply with 
aeration, are further reduced during the milling process, and are 
completely destroyed by cooking. 

Since ethylene dichloride was the most persistent of the fumigants 
studied, an investigation was made of the possibility of its being- 
carried from feed into milk. No residues appeared in milk of cows 
fed high levels for 22 days. Similar results were obtained with 
parathion and several other organic phosphate insecticides. Traces 
of them showed up in the milk only when exceedingly high levels 
were fed. 

The chlorinated hydrocarbons, on the other hand, are appearing 
in market milk, according to a survey still under way. Analysis 
was made of 800 samples of milk collected from retail channels by 
the 16 field districts. The samples were screened by a bio-assay 
test using flies, and when toxic residues were found they were iden- 
tified, if possible, by paper chromatography and measured. About 
62 percent of the samples were found to contain chlorinated hydro- 
carbons ranging from a trace to as high as 1.5 parts per million of 
DDT or related products, including benzene hesachloride, lindane, 



Food and Dru^ Administration 221 

rhothane, metlioxychlor, and othc.rs. Some samples contained as 
many as four of these insecticides. 

Pharmacological studies of the safety of residues from agricul- 
tural pesticides included the metabolism of chlorinated insecticides — • 
where the metabolites are excreted, whether they are toxic, and the 
effect of solvent or spreader substances combined with them as in- 
hibitors of excretion. 

The toxicity of various organic phosphate insecticides was deter- 
mined on animals and these findings were applied to human sensi- 
tivity through the use of volunteers. Dietary levels that will cause 
blood cholinesterase inhibition were established. It was further 
found that when two or more organic phosphates are given together, 
a synergistic action frequently occurs in which the combination is 
more toxic than would be expected from the quantities of the in- 
dividual insecticides alone. 

The incorporation of drugs into animal feeds, to control certain 
diseases and to help the animal make more efficient use of food, re- 
quires close control of the amount being added. Chemical methods 
for quantitative determination of two hormone-like substances — di- 
ethylstilbestrol added to cattle feed and dienestrol diacetate added to 
poultry feed — have been studied intensively during the year. Phar- 
macological assays of tissues from stilbestrol-fed cattle indicate that 
steers fed 10 milligrams a day for 150 days have no detectable added 
estrogenic activity. Meat, fat, liver, kidney, and portions of the 
intestinal tract were examined. 

Another market milk survey^ — the third of a series — was made 
to determine the presence and extent of antibiotics in milk. Low 
antibiotic concentrations, principally penicillin, were found in 6 per- 
cent of the 1,706 samples collected from the 48 States and the Dis- 
trict of Columbia. A poll of authorities in the fields of antibotic 
therapy, allergy, and pediatrics showed that a majority did not 
consider the concentrations of antibiotics found high enough to affect 
the population as a whole, but there was concern about adverse re- 
actions in those people who are particularly sensitive to penicillin. It 
w^as obvious that some farmers are not heeding the required labeling 
warning on antibiotics for mastitis therapy to withhold milk from 
food use for 3 days after the last treatment. 

Enforcement Statistics 

The 16,287 establishment inspections conducted by FDA were 
divided into 12,575 for foods, 3,215 for drugs and devices, 376 for 
cosmetics and colors, and 121 for miscellaneous products and items 
covered by other acts. Of 17,675 domestic samples collected, 9,578 



222 



Department of Health, Education, and Welfare, 1956 



represented foods, 7,822 drugs and devices, 206 cosmetics, and 69 
miscellaneous. Import samples collected totaled 11,973. 

In the 249 criminal actions terminated (or terminated for some 
defendants) in the Federal courts during 1956, the fines paid or 
assessed in cases pending on appeal totaled $197,067.80. The heaviest 
tine in a single case was $12,000. In 66 actions the fines were $1,000 
or more. Jail sentences were imposed in 54 cases involving 68 in- 
dividual defendants. The sentences ranged from 1 month to 6 years, 
and averaged 12 months and 3 days. Twenty-four individuals were 
required to serve the imposed sentences, and for 44 individuals the 
jail sentences were suspended on condition that violative practices 
be discontinued. 

Records of actions terminated in the Federal courts were published 
in 1,240 notices of judgment issued during the year. 

Table 2. — Number of samples on which criminal prosecutions and seizures icere 
based and number of court actions instituted during the fiscal year 1956 



Item 


Total 


Criminal prosecu- 
tions instituted 


Seizures accom- 
plished 


Injunc- 




Violative 
samples* 


Actions 


Violative 
samples 


Actions 


Violative 
samples 


Actions 


tions re- 
quested 


Total 


2,214 


1,053 


890 


209 


1,324 


835 


9 


Foods 

Drugs and devices - -. 


1,305 

905 

1 

3 


774 

275 

1 

3 


271 

619 






79 

130 






1, 034 

286 

1 

3 


689 

142 

1 

3 


6 
3 


Cosmetics and colors - 





Caustic poisons 






*The number of samples on which the actions are based always exceeds the number of actions; in seizures 
a variety of articles may be contained in a single shipment, while in criminal actions each sample usually 
represents a single shipment which forms one count of the action. 



Table 3. — Import inspections and detentions during the fiscal year 1956 



Item 


Total 


Inspected 

and refused 

entry 


Inspected 

and 
released 


Total 


31,602 


5,234 


26, 368 






Foods - 


28,018 

3,429 

155 


2,790 

2,409 

35 


25 228 


Drugs and devices _ . _...^... . ... 


1,020 


Cosmetics, colors, and miscellaneous _ ._ ... .. 


120 







Office of 

Vocational Rehabilitation 



Community Enterprise Plays Key Role 
in Nationwide Rehabilitation Program 

Working iisr partnership with the Federal Office of Vocational Reha- 
bilitation, State rehabilitation agencies and cooperating public and 
private community groups intensified the dramatic assault against 
disability during fiscal 1956.^^ A record number of 66,273 handicapped 
persons Avere prepared for and placed in jobs through the public 
program.- This was 14.3 percent above the 57,981 rehabilitated in 
1955. 

The sizeable increase in the number of persons rehabilitated through 
the public program last year was an indication of the mounting local 
interest in the problems of the handicapped — of the fact that in many 
areas coordinated activity on behalf of the handicapped was taking 
on the characteristics of a genuine community enterprise. The in- 
crease reflected greater awareness of the disabled as individuals with 
a basic right to the same opportunity for living a full life as our 
democratic society provides those without disability. 

This growing grassroots concern with the handicapped and with 
their problems was in no little measure due to the enactment of Public 
Law 565, the Vocational Rehabilitation Amendments of 1954. This 
broad-gaged legislation greatly expanded the Federal grants-in-aid 
program for rehabilitation purposes, created new opportunities for 
public agency-private group cooperation, and provided for a multitude 



1 Unless otherwise inflicated, all subsequent references to 1956 will be to the fiscal year — 
that is, to the period between July 1, 1955, and June 30, 1956. 

- This total includes 05,640 persons rehabilitated by the State-Federal rehabilitation 
program as well as 633 established in employment through projects developed jointly by 
community groups and State rehabilitation agencies and financed, in part, by Federal 
grants. 

223 



224 Department of Health, Education, and Welfare, 1956 

of tools for strengtliening State rehabilitation agency programs. The 
law started an all-ont assault against disability in all its facets. 

During 1956, there were many signs that America was beginning to 
harvest some of the fruits of the 1954 legislation. 

Considerable progress was made in attacking problems relating both 
to the administration of the State-Federal rehabilitation program and 
to the social, economic and psychological aspects of the rehabilitation 
effort. Impressive strides were taken in the areas of rehabilitation 
research, in the development of facilities and techniques dedicated to 
the prevention and elimination of economic distress among the 
disabled, and in the training of urgently-needed rehabilitation workers. 

During the year, public and private organizations across the nation 
linked arms in the expansion, establishment and operation of rehabili- 
tation facilities dedicated to restoring the severely disabled to produc- 
tive lives. Federal grants helped foster and finance 80 rehabilitation 
facilities and about 60 sheltered workshops in which severely disabled 
persons could begin their return to economic self-sufficiency. 

Increased Federal funds made available by Congress in 1956 for 
basic support of State rehabilitation programs saw the States reacting 
in a positive fashion as State legislatures substantially increased their 
appropriations for rehabilitation purposes. 

Cooperation between State rehabilitation agencies and voluntary 
groups at the community level was fully consistent with relationships 
existing between the Federal Office and the major national groups 
directly concerned with the rehabilitation of the handicapped. Good- 
will Industries, the American Hearing Society, the American Founda- 
tion for the Blind, the National Society for Crippled Children and 
Adults, the United Cerebral Palsy Associations — these were among 
the many national organizations with which the Office maintained the 
closest possible working relations. 

These cooperative efforts and the record number of rehabilitations 
achieved through the public program during 1956 notwithstanding, 
there remained a great gap between the number of handicapped per- 
sons restored to useful and productive lives and the number still in 
need of rehabilitation services. 

Today, an estimated 2,000,000 Americans could be prepared for and 
placed in jobs if they had access to vocational rehabilitation. Each 
year, an estimated 250,000 persons disabled by accident, disease or 
congenital conditions come to need vocational rehabilitation. 

In moving ahead against the massive disability problem in 1956, 
the Federal Office, the State rehabilitation agencies, and cooperating 
public and private groups have demonstrated their awareness of the 
need for a broad educational and informational effort. This effort 
has sought to foster acceptance of the handicapped by all segments of 
the community, to stimulate appreciation of their abilities, and to 



Office of Vocational Rehabilitation 225 

generate a communitywide sense of responsibility for helping the 
handicapped to help themselves. 

HIGHLIGHTS OF 1956 

A record number of 66,273 handicapped persons was established in 
employment through the State-Federal rehabilitation program. This 
was 14.3 percent above the nmnber rehabilitated in 1955, and the 
highest total since the State-Federal program's inception in 1921. 

Funds appropriated by the States for rehabilitation purposes totaled 
$18.5 million, an increase of 27 percent from the preceding year and 
of almost 50 percent over 1954. 

In the first year after their rehabilitation, the 65,640 individuals 
placed in jobs by the State agencies will earn an estimated $127.3 
million, as compared to $17.5 million before the rehabilitation process 
began. It is estimated that these rehabilitants will pay Federal in- 
come taxes at an annual rate of $10.5 million. At this rate, it is 
estimated that within 3 years they will repay more than the entire 
amount expended by the Federal Government for the basic support 
program in 1956. 

About 3,300 of these rehabilitants entered professional fields such 
as education, medicine, and engineering. About 8,100 went uito 
skilled trades, and 5,600 into agriculture. 

The Office of Vocational Rehabilitation granted $1.2 million for 29 
research and demonstration projects being conducted by public or 
private nonprofit organizations to help solve rehabilitation problems 
of nationwide concern. 

The Office awarded 154 grants totaling $1.1 million to 80 institu- 
tions of learning for the teaching of rehabilitation subjects. Reha- 
bilitation students received 2,070 traineeships totaling $1 million. 

Working in conjunction with the Public Health Service, the Office 
approved Federal grants totaling $5.3 million for the development of 
42 comprehensive rehabilitation facilities in 35 States. These grants, 
made under terms of Public Law 482, were matched by an estimated 
$23.4 million allocated by the recipient organizations. 

REHABILITANTS: FURTHER FACTS 

Almost every type of disabling condition was represented among 
the 65,640 men and women rehabilitated by the State-Federal voca- 
tional rehabilitation agencies in 1956. Chart I, page 227, divides those 
rehabilitated into eight broad disability categories. 

Forty percent (26,300) of the 65,640 persons rehabilitated were dis- 
abled because of orthopedic impairments — amputations or other crip- 
pling conditions. Approximately three-fifths of the group of 26,300 
rehabilitants were injured in accidents, and about one-fifth were 
handicapped as the result of poliomyelitis, osteomyelitis, or arthritis. 



226 Department of Health, Education, and Welfare, 1956 

The occupations in which the rehabilitants were placed also are 
shown in Chart I. This vocational distribution has remained substan- 
tially the same for several years. It is noteworthy that only 7 percent 
of those rehabilitated in 1956 went into unskilled trades. 

jNIajor sources of referrals for rehabilitation were physicians, health 
agencies and hospitals. They referred for services 33 percent of the 
disabled persons established in gainful employment in 1956. 

Fifteen percent of the total number of individuals rehabilitated were 
referred by public welfare agencies, and 7 percent by State employment 
offices. About 12 percent applied for services on their own initiative. 

Almost half of the rehabilitants of 1956 had dependents, and 65 
percent were men. The average age at the time of disablement was 
25, whereas that at the time the rehabilitation process began was 35. 

Developments during 1956 again demonstrated the economic values 
of vocational rehabilitation. About 49,000 of the 65,6-10 rehabili- 
tants were unemployed Avhen their rehabilitation began. An esti- 
mated 13,000 received public assistance payments at some time during 
the rehabilitation process. These assistance payments were at an 
estimated rate of $11.1 million a year. The total cost of restoring 
these 13,000 persons to productive employment was about $9.6 million. 

The handicapped persons placed in jobs through the public voca- 
tional rehabilitation program last year will pay — during their working 
lives — an estimated $10 in Federal income taxes for every Federal 
dollar invested in their rehabilitation. The estimated rate of annual 
earnmgs of the rehabilitants increased to about $127.3 million as com- 
pared to $17.5 million prior to their rehabilitation. 

PROGRAM DEVELOPMENTS AT THE GRASSROOTS 

The major emphasis of Office eii'orts during 1956 was upon helping 
the State rehabilitation agencies to strengthen and broaden their pro- 
grams and upon creating a pattern for maximum community coopera- 
tion on behalf of the disabled. Very important in this respect were 
administrative surveys conducted by Office teams in Georgia and 
Minnesota, respectively. These surveys, requested by the States, re- 
viewed past accomplishments of the State agencies concerned, assessed 
current strengths, and made specific recommendations directed to the 
most effective development and expansion of the State programs. 

Office personnel also conducted five Vocational Eehabilitation 
Accounting Workshops which were attended by more than 125 State 
agency statf members. The Workshops, held in Chicago, San Fran- 
cisco, New York City, New Orleans, and Charlottesville, were dedi- 
cated to discussion of fiscal and accounting procedures under Public 
Law 565 and to delineation of State agency fiscal responsibilities 
in the disbursement of Federal grant funds. 



Office of Vocational Rehabilitation 



227 




228 Department of Health, Education, and Welfare, 1956 

These and other Office operations in the administrative field played 
an important role in helping the State agencies to improve their pro- 
grams as well as to strengthen their relationships Avith cooperating 
public and volmitary organizations. 

State Plans 

Under Public Law 565, States and Territories were called upon 
to submit new Plans for the approval of the Office. The State 
Plan sets forth the organization of the State rehabilitation program 
and the major policies and procedures to be adhered to in its operation. 
By the beginning of 1956, such Plans had been approved for 88 agen- 
cies in the 48 States, the District of Columbia, Alaska, Hawaii, and 
Puerto Rico. 

Consistent with the objectives of Public Law 565, there was a gen- 
eral broadening of State Plans as compared to those of previous years. 
By the end of 1956, 39 of the State agencies had provided for the 
establishment of rehabilitation facilities and 36 had provided for the 
establishment of sheltered workshops. In 43 States, Plans provided 
for State agency-managed business enterprise programs for the blind 
or for those with other types of severe disability. 

Basic Support of State Programs 

The Federal Government made $30 million available for basic sup- 
port of State rehabilitation programs in 1956, an increase of $6 mil- 
lion over the preceding year and of $7 million over 1954. The States 
matched the Federal funds available for basic support of their pro- 
grams with $18.1 million of their own money. This was an increase 
of 26 percent over the preceding year, and of 46 percent over 1954. In 
20 States, total State funds for rehabilitation jumped by one-third 
over the 1955 figure. 

Expansion Grants 

Federal grants totaling $1,065,511 were made to public and to pri- 
vate, nonprofit groups in 1956 for the expansion of rehabilitation 
facilities and services. These grants were made for partial support 
of 102 projects in 41 States or Territories. Eleven of the awards 
went to State rehabilitation agencies, the balance (91) going to other 
public organizations and to voluntary groups. Eighty-five of the 
grants were made to foster the establishment or enlargement of re- 
habilitation facilities and sheltered workshops. 

Extension and Improvement Projects 

During 1956, the Federal Office made 104 grants totaling $1 million 
to State rehabilitation agencies in partial support of projects dedi- 



Office of V ocational Rehahilitulion 229 

catecl to extension and improvement of facilities or services for the 
handicapped. Fourteen of these projects involve new and vigorous 
programs in the mental health field, nine of them being concerned 
with the mentally ill, and the remainder with the mentally retarded. 
Also among the lOi projects are 18 designed to serve the blind, 
13 concerned with the development of sheltered workshops for the 
severely handicapped, and 7 designed to serve those with speech and 
hearing defects. Otlier projects provide specialized services to the 
tuberculous, the epileptic, and to persons with heart conditions. Still 
others are for the improvement of medical consultation and super- 
visorj." methods and techniques and the development of organized 
programs to demonstrate the employment potential of the disabled. 

Cooperation in Administering the "Disability Freeze" 

The "disability freeze" provisions of the social security legislation 
of 1954 brought about a close working relationship between State re- 
habilitation agencies and Bureau of Old-Age and Survivors Insurance 
Offices. These provisions were designed to protect the rights of 
persons covered by the social security law whose disability is so severe 
as to preclude them from engaging in substantial gainful employment. 
Under agreements existing in 46 States or Territories, BOASI offices 
refer applicants for the "disability freeze" to rehabilitation agencies 
for determining whether such applicants are disabled within the defi- 
nition set down by the 1954 social security legislation. 

During 1956, the State agencies had more than 94,000 "freeze" ap- 
plicants referred to them for disability determinations. The agencies 
made 58,000 determinations during the year, screened 75,000 of the 
applicants for rehabilitation potential, and accepted 15,000 of these 
people for fiu'ther consideration for i-ehabilitation services. 

PROGRESS IN REHABILITATION RESEARCH 

During 1956, the Office of Vocational Eehabilitation approved 
grants in partial support of 29 new special research and demonstra- 
tion projects, 11 more than were approved in 1955. The grants 
totaled $925,000. This sum was in addition to $255,720 granted 
for the continuation of 10 projects initiated in 1955. 

The new projects, all of which show promise of contributing to 
solution of a vocational rehabilitation problem of nationwide con- 
cern, w^ere approved upon the recommendation of the 12-member Na- 
tional Advisoiy Council on Vocational Eehabilitation wliich reviews 
all special project grant applications. Office Director Mary E. Swit- 
zer is chairman of the Comicil, which is made up of nationally known 
leaders with an interest in the problems of the disabled. 



230 Department of Health, Education, and Welfare, 1956 

Following is a listing of the organizations which received research, 
and/or demonstration grants dnring 1956 with a brief description 
of each of the projects for which grants were awarded : 

Highland View Hospital, Cleveland, Ohio, $38,395 to demonstrate 
that rehabilitation is possible for long-term hospital patients dis- 
abled by severe cln-onic diseases ; New York Tnberculosis and Health 
Association, Inc., New York, IST. Y., $10,000 to devise and provide 
appropriate nonmedical rehabilitation services to unhospitalized ]3a- 
tients being treated for tuberculosis; Boston Psychopathic Hospital. 
Boston, Mass., $47,265 to demonstrate the effectiveness of coordinated 
efforts of hospital, expatients, patient groups, and community agencies 
in the rehabilitation of the mentally ill. 

Mount Zion Plospital, San Francisco, Calif., $17,856 to demonstrate 
the role of rehabilitation as part of a community home-care program 
for the chronically ill ; California Bureau of Vocational Rehabilita- 
tion, Sacramento, Calif., $24,692 to determine the effectiveness of a 
rehabilitation program for injured workmen covered by workmen's 
compensation ; Institute of Physical Medicine and Rehabilitation, New 
York, N. Y., $9,525 to explore problems involved in the rehabilitation 
of disabled Puerto Ricans living in the U. S. 

George Washington University Hospital, Washington, D. C, $6,614 
to develop effective methods of dealing with the psychological and 
vocational adjustment problems of individuals with multiple sclerosis ; 
Montefiore Hospital, New York, N. Y., $27,940 to demonstrate eco- 
nomic and psychological benefits of rehabilitation for permanently 
shut-in, chronically ill persons; Illinois Public Aid Commission, 
Chicago, 111., $44,500 to determine the extent to which disabled persons 
confined to public and private nursing homes can be rehabilitated; 
Alabama Society for Crippled Children and Adults, Montgomery, 
Ala., $27,800 to demonstrate that an organized marketing program can 
increase employment opportunities for the home-bound disabled ; Epi- 
Hab, Incorporated, Los Angeles, Calif., $27,041 for a workshop to 
demonstrate that epileptics can effectively perform mau}^ kinds of jobs 
from which they have been previously excluded. 

National Jewish Hospital, Denver, Colo., $36,591 to develop im- 
proved methods for use within a hospital in the rehabilitation of those 
undergoing extended treatment for chronic tuberculosis; American 
Hearing Society, Washington, D. C, $15,869 to develop standards and 
guides for use by communities in the establishment of speech and 
hearing rehabilitation facilities ; Site, Inc., Topeka, Kansas, $10,600 for 
research into the possibility^ of developing — through electronic and 
other means — practical sight substitutes for the blind. 

Davis Memorial Goodwill Industries, Washington, D. C, $92,056 to 
demonstrate that more severely disabled persons can be rehabilitated 



Office of Vocational Rehabilitation 231 

through establishing- a complete rehabilitation center in close connec- 
tion with a sheltered workshop program ; Medical Society of the Dis- 
trict of Columbia, Washington, D. C, $18,576 to analyze the role of a 
medical society in total community rehabilitation planning ; "Western 
Pennsylvania Heart Association, Pittsburgh, Pa., $18,960 to evaluate 
the effect of employment on 1,000 cardiac patients whose work tolerance 
was prescribed by a cardiac work classification unit. 

Cleveland Hearing and Speech Center, Cleveland, Ohio, $7,932 to 
improve hearing tests commonly used in evaluating speech discrimina- 
tion in certain types of deafness in order to make more effective job 
selections ; Industrial Home for the Blind, Brooklyn, N. Y., $20,000 to 
define successful methods used in the rehabilitation of the deaf -blind, 
and to develop a manual which can be used nationally in setting up 
rehabilitation services and identifying job opportunities for them; 
ISTational Health Council, New York, IST. Y., $5,000 to identify person- 
nel needs in fields related to the rehabilitation program, and to develop 
projects to increase the supply of trained personnel. 

National Association of the Deaf, Berkeley, Calif., $17,200 to inven- 
tory the types of jobs performed by deaf persons throughout the Na- 
tion, and to evaluate factors associated with occupational success or 
failure; New York University-Bellevue Medical Center, New York, 
N. Y., $11,340 to determine the extent to which a rehabilitation team 
can return homebound disabled persons to employment outside the 
home; Washburn University of Topeka, Topeka, Kansas., $31,877 to 
study the responsibilities, knowledge, and skills required of the ad- 
ministrator of the several therapies used in mental hospitals with a 
view to increasing the effectiveness of those services in rehabilitating 
the mentally ill. 

MacDonald Training Center Foundation, Inc., Tampa, Fla., $40,000 
to evaluate the potentials for rehabilitation of mentally retarded youths 
with muscular, orthopedic, and emotional impairments ; Robert Breck 
Brigham Hospital, Boston, Mass., $38,138 to develop pre-employment 
evaluation and work-hardening techniques for use with rheumatoid 
arthritic patients as a basis for their return to remunerative employ- 
ment ; Our Lady of Fatima Hospital, North Providence, R. I., $30,000 
to determine and demonstrate the services needed for rehabilitation of 
chronically ill and disabled workers 45 years of age and older; ]Min- 
neapolis Society for the Blind, Minneapolis, Minn., $142,365 to estab- 
lish a regional facility to provide adjustment, training, and workshop 
services to blind persons from a number of States ; Crotched Mountain 
Foundation, Greenfield, N. H., $22,913 to demonstrate the value of 
the social group work method in the rehabilitation of severely disabled 
persons in a rehabilitation center ; Anderson Orthopedic Hospital and 
Rehabilitation Center, Arlington, Va., $83,000 to develop a rehabili- 



232 Department of Health, Education, and Welfare, 1956 

tation center in the Washington metropolitan area as a guide for 
rehabilitation centers established in other areas. 

TRAINING OF REHABILITATION PERSONNEL 

The Office's training program, which completed its second year as of 
June 1956, experienced considerable growth. The program is de- 
signed to help overcome the shortage of professional personnel in the 
rehabilitation field, improve the knowledge and skills of those already 
in rehabilitation work and increase the awareness of rehabilitation 
techniques, methods, and objectives among workers in related fields. 

During the year, the Office made available to educational institutions 
and individuals for training purposes, more than double the amount 
granted in 1955. Of the total amount granted, $1.1 million went into 
154 grants for teaching in such areas as rehabilitation counseling, re- 
habilitation aspects of medicine, social work, occupational therapy and 
physical therapy. The remainder went for traineeships to 2,070 stu- 
dents in these and other areas. 

In administering the training program, the Office has been aided by 
an Advisory Committee on Training Policy. Composed of leaders in 
the rehabilitation and education fields, it consults with and advises the 
Office in the development of long-range training policies. 

In addition, six acl hoc technical panels — composed of professional 
personnel in the fields of medicine, rehabilitation counseling, nursing, 
social work, occupational therapy and physical therapy — cooperated 
with the Office in reviewing the individual teaching and traineeship 
applications. These panels materially assisted the Office in achieving 
the most equitable and adequate geogi'aphical distribution of grants 
within the overall framework of long-range training needs and 
policies. 

The Office greatly strengthened its liaison and informational ac- 
tivities vis-a-vis cooperating educational institutions. A compre- 
hensive informational bulletin, containing backgi'ound data on the 
training program along with specific details on grants and instruc- 
tions for the preparation and submission of grant applications, was 
distributed to these institutions and other interested organizations. 

GUIDANCE AND SETTING OF REHABILITATION STANDARDS 

During 1956, the Federal Office greatly emphasized guidance and 
consultative services to State rehabilitation agencies and working 
closely with State personnel in the solution of common problems. 
The Ninth Annual Guidance, Training and Placement Workshop, 
held in Wasliington, D. C, early in June, was among the major 
Federal-State cooperative efforts in the guidance and standards fields. 

The Workshop saw committees of State agency personnel, assisted by 



Office of Vocational Rehabilitation 233 

Office consultants, develop reports and reconnnendatioiis in sucIl ureas 
as counselor service utilization, use of occupational information, and 
tlie use of community resources. Eighty-one representatives of 58 
State agencies participated in the Workshop. 

Among other significant developments in standards and procedures 
was Office sponsorship of orientation training for 405 newly employed 
State counselors through 17 regional institutes. The orientation pro- 
gram was based upon a syllabus prepared by OVR in cooperation 
with the States' Vocational Rehabilitation Council. 

Among the many specialized consultative efforts during the year 
was one in which Federal Office personnel served in resource and con- 
sultant capacities in a pioneering workshop conducted by the Amer- 
ican Foundation for the Blind on competitive, sheltered, and home- 
bound employment of sightless persons with hearing impairments. 

Cooperative Relationships 

In 1956, the Office effected an agreement with the Veterans Ad- 
ministration for i-ef erral of disabled veterans from VA field stations 
to State rehabilitation agencies. This cooperative agreement was 
fully in keeping with a reconxinendation made by the President's 
Commission on Veterans' Pensions that extended use be made of the 
State-Federal program in the rehabilitation of handicapped veterans 
with peace-time service or with non-service-connected disabilities. 

Among other cooperative ventures in the guidance and standards 
areas during the year was the Office's participation in a conference 
concerned with community planning for mental retardation and 
jointly sponsored by several Federal Departments and the Josiah 
Macy, Jr., Foundation, Princeton, N. J. As of the year's end, the 
Foundation was preparing a report on the conference which is ex- 
pected to prove of considerable value to rehabilitation personnel and 
other groups concerned with the problems of mental retardation. 

During the year, the Federal Office cooperated with the American 
Foundation for the Blind in sponsoring a 5-day seminar on Rehabili- 
tation Centers for the Blind. The seminar, held in New Orleans, was 
attended by representatives of full-time rehabilitation centers and 
was directed to the development of principles and standards for the 
operation of such centers. A report on the seminar, in process of 
publication at year's end, is expected to have Avide circulation. 

Still another cooperative venture in 1956 was the joint development 
and issuance by the Federal Office and the Bureau of Public Assistance 
of a publication entitled "Working Together to Rehabilitate the 
Needy Disabled." The booklet is designed to foster State Rehabilita- 
tion-Public Assistance agency cooperation at the communitj^ level in 
rehabilitating persons on the public assistance rolls. 

408691—57 16 



234 Department of Health, Education, and Welfare, 1956 

STIMULATING EMPLOYMENT FOR THE DISABLED 

The Office during 1956 stepped up its mawj direct activities de- 
signed to stimulate employment of the handicapped. In doing so, it 
encouraged research into such diverse areas as employer attitudes 
toward the handicapped and the experience of college-level deaf per- 
sons in taking examinations for Federal employment. 

An employer attitudes survey is being conducted in the Boston area 
and preliminary results are scheduled to be announced during fiscal 
1957. The project involving the deaf is actually a pioneering or pilot 
effort which was conducted by the Civil Service Commission in cooper- 
ation with the Federal Office, the National Association of the Deaf, 
and Gallaudet College. 

Tentative recommendations based upon evaluation of the experience 
of deaf examinees on civil service tests are expected to improve the 
opportunities of the deaf for various types of Government jobs. An 
important byproduct of the pilot project has been the revision of an- 
nouncement language for many civil service examinations so that 
more deaf persons will be encouraged to apply for Federal posts. 

Among specific placement activities of the Office during 1956 were 
the issuance of two releases to Federal employing officers to encourage 
Federal agency employment of the handicapx^ed and the collection and 
distribution to State rehabilitation agencies of data on employment 
opportunities open to handicapped clients both in nationwide busi- 
nesses such as Sears Eoebuck and Company, and in public agencies 
such as the U. S. Public Health Service. The release of these data and 
follow-up efforts have resulted in the development of many jobs for 
the handicapped in the Sears and U. S. PHS organizations. 

The Vending Stand Program for the Blind 

Considerable progress was made in fostering the employment of 
blind persons through the Vending Stand Program for the Blind. 
Administered by State agencies in partnership with the Federal Of- 
fice, it was brought into being by the Randolph-Sheppard Act of 1936 
and was strengthened by legislative amendments in 195-1. 

A record number of 1,804 blind vending stand operators was in 
business under the program as of June 30, 1956. This figure com- 
pares with the 1,721 operators as of the same period in 1955. The net 
average income of the operators during 1956 was $2,532, an increase of 
$232 over the preceding year. 

The total earnings of the operators and their blind emploj^ees Avas 
$5.1 million as compared to $4.5 million in 1955. Gross vending stand 
sales totaled $25.9 million as compared to $23.5 million in 1955. 



Office of Vocational Rehabilitation 235 

The Eanclolpli-Sheppard amendments of 1954 iui<;niL'iited the op- 
portunities for the blind by providing for preference to blind individ- 
uals in the operation of vending stands on Federal property and 
stipulating that each agency having jurisdiction over such property 
must prescribe regulations to assure such preference. Previously, 
preference had been assured for blind persons in the operation of 
stands in Federal buildings only. 

As of June 30, 1956, preference regulations had been established, 
after detailed consultation between Office specialists and the various 
Agencies concerned, in eight major establishments. These are the 
Departments of Health, Education, and Welfare; Treasury, Defense, 
Commerce, and Post Office; and General Services Administration, 
Atomic Energy Commission and Tennessee Valley Authority. 

DEVELOPMENTS IN MEDICINE AND PHYSICAL RESTORATION 

In 1956, significant advances were made both in developing of 
medical techniques and treatment methods for rehabilitating the 
severely disabled and in plamiing facilities to serve them. The/ 
pioneering element, so basic to the research projects for which Federal 
grants were made, was especially evident in the area of rehabilitation 
medicine. Particularly was this the case in the field of mental health. 

Rehabilitation Facility Construction 

Cooperative efforts of the Office of Vocational Rehabilitation, the 
U. S. Public Health Service and various State, and community groups 
made possible the development of plans for construction of compre- 
hensive rehabilitation centers for the severely handicapped. This 
cooperative progress was made imder the provisions of the Medical 
Facilities Survey and Construction Act of 1954 (Public Law 482). 

At the year's end, the Office and the Public Health Service jointly 
had approved the granting of Federal funds totaling $5,333,803 in 
support of 42 comprehensive centers in 35 States. These grants were 
being matched with more than $20 million from the State and com- 
munity groups organizing and constructing the Centers. 

Of the 42 projects, five will provide services to persons, all of whom 
have the same type of disability. Thus, one project will concern itself 
only w^ith psychiatric cases, two with speech and hearing disorders, 
one with dental problems, and one with cerebral palsy. 

Mental Health: Plans and Progress 

Rehabilitation of persons with mental handicaps received major 
emphasis in 1956. In furtherance of a plan initiated during 1955, 3 
regional conferences were held and attended by State Hospital and 



236 Department of Health, Education, and Welfare, 1956 

State rehabilitation agency personnel working with the mentally 
handicapped. The meetings, jointly sponsored by the Federal Office 
of Vocational Rehabilitation, the National Institute of Mental Health, 
and a university in each of the areas involved, helped lay a broad 
foundation for the rehabilitation of mental patients in need of vo- 
cational adjustment when ready for discharge from the hospital. 

Aided by Federal funds, 12 State agencies increased their staffs 
and strengthened their programs of services to the mentally ill during 
the year. As of the year's end, 22 States had one or more rehabilita- 
tion counselors assigned to work exclusively with the mentally ill. 

During the year, Federal funds totaling $450,000 went to 
State agencies and other public or private, nonprofit groups for the 
development of specific projects concerned with the rehabilitation 
of the mentally disturbed or the mentally deficient. Among the States 
in which these projects are located are Maine, Vermont, New Hamp- 
shire, Massachusetts, Connecticut, New York, New Jersey, Pennsyl- 
vania, Tennessee, Florida, Kansas, Missouri, Wisconsin, Illinois, 
South Dakota, Nebraska, Colorado, Texas, and Puerto Rico. 

Very encouraging progress in helping the mentally retarded was 
made during 1956 at a work adjustment center operated jointly by the 
State rehabilitation agency and the Council of Jewish Women in 
Milwaukee, Wisconsin. Of 41 mentally retarded persons with IQ's 
ranging from 25 to 76 assisted at the Center in its first year of opera- 
tion, 21 were returned to productive employment. 

INFORMATIONAL AND EDUCATIONAL ACTIVITIES 

In keeping with the mandate laid down by Public Law 565, the 
Office greatly stepped up its efforts to inform the public as to the voca- 
tional rehabilitation program and the problems of the disabled. The 
Office Director delivered numerous addresses to national and statewide 
audiences. Numerous special reports, publications and releases bear- 
ing on specific rehabilitation developments were issued, among them 
an illustrated pamphlet explaining the provisions of Public Law 565 
in lay language and a flier designed to inform disability freeze appli- 
cants of the nature and scope of vocational rehabilitation services. 

During the year, the Office concentrated upon helping State rehabil- 
itation agencies to develop sound public information progTams and to 
deal with specific informational problems. The Office prepared a com- 
prehensive Public Information "how-to-do-it" kit for use of State 
agency personnel, the kit containing botli instructional materials and 
samples of the various types of informational tools. 



Office of Vocational Rehabilitation 237 

Office Information Specialists also conducted three public informa- 
tion training institutes for State agency personnel. The institutes, 
held in Washington, D. C, were attended by State Agency Direct<3rs, 
Informational Specialists and other personnel charged with infor- 
mational or public relations responsibilities. Well over half the State 
agencies had representatives at one or more of the sessions. 

The year also saw the development of a number of cooperative ven- 
tures in the public relations area involving both public and private 
agencies. The Office, which cooperates with the Veterans' Administra- 
tion and the President's Committee on Employment of the Physically 
Handicapped on a year-round basis in promoting the employment and 
rehabilitation of the handicapped, linked arms wdth these two agencies 
and with a private, nonprofit foundation (The Morgenstern Founda- 
tion of New York) in sponsoring the first nationwide contest for 
handicapped amateur artists. Drawing more than 1,000 entries it 
served to focus the Nation's attention upon the creative abilities of the 
handicapped and to illustrate their overall rehabilitation potential. 

INTERNATIONAL COOPERATIVE EFFORTS 

During 1956, the Office participated in the training of 107 persons 
from abroad who had come to the United States to observe the rehabil- 
itation program or to study rehabilitation subjects at educational 
institutions. The persons who received such training — nearly 50 per- 
cent more than were trained in 1955- — came from 30 difi'erent nations, 
many of them in miderdeveloped areas of the world. 

In working w^tli these people from abroad, Office persomiel 
cooperated with the International Cooperation Administration of the 
Department of State, the United Nations, various other Federal De- 
partments, and numerous American institutions of learning. Office 
personnel also provided rehabilitation specialists in Mexico and India 
with consultation and advice directed to the development of rehabil- 
itation counselor training courses within these two countries. 

The Office also helped to recruit American rehabilitation specialists 
for service abroad in such countries as Brazil and Egypt and dis- 
tributed informational materials bearing on rehabilitation develop- 
ments to more than 50 countries on a regular basis. 



238 



Department of Health, Education, and Welfare, 1956 



Table 1. — Number of referrals and cases, by agency, fiscal year 1956 

[Corrected to September 30, 1956] 





Referrals 


Cases 




During fiscal 


year 


Re- 
main- 
ing at 
end of 
year s 


During fiscal year 




Agency i 


Total 


Ac- 
cepted 
'or serv- 
ices 


Not ac- 
cepted 

for serv- 
ices 3 


Total 
active 
load 
(receiv- 
ing 
serv- 
ices) 


Closed from active load 


Re- 
main- 




Reha- 
bili- 
tated 


After 
rehabil- 
itation 
plan in- 
itiated -1 


Before 
rehabU- 

tation 
plan in- 
itiated 5 


ing at 
end of 
year * 


United States, total... 


290, 398 


93,917 


95, 705 


100, 776 


221,518 


65, 640 


6,178 


14, 881 


134,819 




7,252 
719 

1,706 

102 

3,954 

16, 390 

2,114 
261 

3,079 
186 

1,273 

58 
2,248 

8,373 
3,050 
19, 627 

764 
26 

1,382 

39 

11,054 

2,749 
276 

4,801 
135 

3,404 

286 

6,034 

4, 605 
601 

2,275 

176 

4,105 

3,710 
308 

8,334 
316 

5,029 
329 

2,816 
708 

3,240 
616 

1,464 
177 

1,234 
199 
610 


2,599 
123 

493 

39 

1,526 

3,220 

882 
49 

1,492 
66 

511 
30 
642 

2,747 

299 

5,337 

176 
6 

224 

11 

5,417 

1,519 
90 

1,658 
24 

737 

61 

932 

2,261 
167 

379 

48 

1,873 

1,215 
90 

3,441 
180 

1,101 
114 

992 
329 

1,702 
219 

426 
16 

816 
81 
95 


929 
164 

501 

24 

1,247 

10, 471 

586 

87 

828 
83 

508 
20 
802 

3,042 
1,653 
5,782 

348 
10 

576 

12 

2,768 

621 
83 

1,177 
38 

1,235 

91 

2,550 

875 
188 

955 
78 
822 

1,147 
49 

1,779 
71 

1,270 
91 

774 
251 

764 
157 

470 
124 

(i8 

78 
395 


3,724 
432 

712 

39 

1,181 

2,699 

646 
125 

759 
37 

254 

8 

804 

2,584 
1,098 
8,508 

240 
10 

582 

16 

2,869 

609 
103 

1,966 
73 

1,432 
134 

2,552 

1,469 
246 

941 

50 

1,410 

1,348 
169 

3,114 
65 

2,658 
124 

1,050 
128 

774 
240 

568 
37 

350 
40 
120 


7,011 
185 

896 

118 

3,590 

8,541 

1,784 
177 

3,605 
168 

1,202 

08 

1,423 

5,907 

810 

11,393 

563 

76 

501 

32 

12, 126 

4,222 
268 

3,484 
63 

1,879 

177 

2,441 

5,419 
518 

995 

88 

4,507 

2,776 
283 

8,498 
420 

3,677 
373 

2,728 
868 

3, 288 
514 

1,086 
50 

1, S17 
140 
173 


1,956 
33 

289 

28 

1,350 

1,724 

570 
44 

927 
50 

480 

23 

320 

1,837 

250 

5,093 

183 

5 

156 

5 

4,139 

1,067 
45 

1,105 
11 

440 

41 

551 

1,400 
105 

215 

17 

1,174 

794 
54 

2,938 
130 

679 
65 

841 
255 

1,331 
135 

369 
18 

584 
58 
54 


219 
2 

46 

5 

95 

640 

213 

4 

170 
17 

24 

9 

111 

172 
46 
213 

29 
4 

12 

5 
359 

109 
24 

75 

1 

54 
9 
97 

69 
16 

21 
11 

98 

72 
5 

295 
24 

43 
33 

61 
34 

44 
20 

12 

1 

17 
1 
3 


372 
15 

13 

11 

244 

1,258 

97 
30 

312 
6 

97 

9 

142 

510 
39 
508 

11 

5 

9 



636 

380 
32 

178 
2 

147 

15 

209 

273 

76 

3 

415 

163 

23 

189 
33 

89 
34 

175 
17 

162 
IS 

39 
1 

11 

3 


4, 464 


Alaska 


135 


Arizona: 

General 

Blind 


548 
74 




1,901 


California 

Colorado: 

General 

Blind 


4,919 

904 
99 


Connecticut: 

General 

Blind 


2,196 
95 


Delaware: 


601 


Blind 


27 


District of Columbia 

Florida: 
General 


850 
3,388 


Blind- 


475 


Georgia 


5,579 


Hawaii: 

General 


340 


Blind. 


62 


Idabo: 

General 


324 


Blind 


22 




6,992 


Indiana: 


2,666 


Blind 


167 


Iowa: 

General 


2, 126 


Blind. 


49 


Kansas: 


1,238 


Blind 


112 




1,584 


Louisiana: 


3,677 


Blind 


390 


Maine: 
General 


683 


Blind. 


57 


Maryland 


2,820 


Massachusetts: 
General 


1,747 


Blind. 


201 


Michigan: 

General. _.- 


5,076 


Blind 


233 


Minnesota: 
General 


2, 866 


Blind 


241 


Mississippi: 
General . 


1,651 


Blind. 


562 


Missouri: 

General _. 


1,751 


Blind 


341 


Montana: 
General.. 


666 


Blind 


30 


Nebiaska: 
General 


1, 205 


Blind 


81 


Nevada 


113 



See footnotes at end of table. 



Office of Vocational Rehabilitation 



239 



Table 1. — Number of referrals and cases, by agency, fiscal year 1956 — Con. 

[Corrected to September 30, 1950] 





Referrals 


Cases 




During fiscal year 


Re- 
main- 
ing at 
end of 

year s 


During fiscal year 




Agency ' 


Total 


Ac- 
cepted 
for serv- 
ices 


Not ac- 
cepted 
for serv- 
ices 2 


Total 
active 
load 
(receiv- 
ing 
serv- 
ices) 


Closed from active load 


Re- 
main- 




Reha- 
bili- 
tated 


After 
rehabil- 
itation 
plan in- 
itiated < 


Before 
rehabil- 
itation 
plan in- 
itiated 5 


ing at 
end of 

year 8 


New Hampshire: 


539 
56 

3,301 
600 

1,089 
179 

19, 209 
956 

7,770 
1,224 
1,273 

5,510 

434 

5,619 

5,133 
191 

21, 081 
3,059 
5,168 

894 
58 

5,734 
379 

909 
117 

5,329 

797 

10, 154 
1,290 
1,295 

907 
56 

11, 259 
493 

6,251 

184 

13, 143 

5,432 
148 
984 


234 

45 

984 
106 

257 
39 

6,512 
312 

4,509 
466 
353 

1,553 

194 

2,314 

1,024 
46 

7,587 

339 

1,152 

305 

57 

1,942 
121 

287 
22 

2,145 
185 

2,719 
364 
372 

265 
25 

3,193 
119 

1,433 

60 

3,861 

1,682 

72 
207 


170 

7 

992 
196 

476 
57 

7,403 
192 

1,915 
473 
225 

1,692 

74 

2,296 

2,139 

87 

6, 914 

1,534 

802 

204 


1,664 
176 

91 

56 

1,025 
135 

2,623 
475 
374 

525 
16 

4,738 
150 

2.654 

74 

3,711 

2,274 

45 

409 


135 
4 

1,325 
298 

350 
83 

5,294 
452 

1,346 
285 
695 

2,265 

166 

1,009 

1,970 
58 

6,580 
1,186 
3,214 

385 
1 

2,128 
82 

531 
39 

2,159 

477 

4,812 
451 
549 

117 
15 

3,328 
224 

2,164 

50 

5,571 

1,476 
31 
368 


480 
92 

2,460 
423 

604 
93 

13, 302 
764 

8,961 

1,454 

747 

3,659 

676 

6,697 

2,820 
149 

14, 707 
1,176 
2,887 

802 
192 

4,687 
248 

828 
55 

4,672 
589 

9,135 

784 
1,147 

642 
67 

6,974 
227 

3, 591 

157 

8,190 

4,789 
193 
470 


105 
18 

574 
99 

242 
22 

4,099 
212 

2,730 
367 
200 

1,309 

159 

1,327 

760 
38 

4,200 
244 
816 

315 
30 

1,512 

95 

169 
14 

1,852 
150 

2,182 
299 
347 

159 
16 

2,250 
88 

942 

27 

2,078 

1,450 
60 
146 


22 
9 

98 
6 

34 
6 

377 
29 

118 

27 

5 

70 
20 
71 

96 
4 

397 
72 
52 

25 

7 

65 

7 

12 
2 

120 
8 

90 
17 
45 

37 

7 

100 
14 

210 

8 
59 

143 
18 
27 


90 
8 

231 
10 

18 
6 

1,103 
66 

525 
89 
21 

226 
34 
762 

289 
6 

980 
120 
132 

11 

8 

224 
19 

22 
2 

182 
8 

594 
29 
24 

50 
4 

765 
5 

298 
29 
779 

90 
4 



203 


Blind 


57 


New Jersey: 

General.. .... . _ .. 


1,557 


Blind 


308 


New Mexico: 

General . 


310 


Blind 


59 


New York: 

General— ... 


7,723 


Blind 


457 


North Carolina: 
General 


5,588 


Blind 


971 


North Dakota.- . . . . 


521 


Ohio: 


2,054 


Blind 


463 


Oklahoma 


4, 537 


Oregon: 
General 


1,675 


Blind 


101 


Pennsylvania: 
General 


9,130 


Blind 


740 


Puerto Rico . . . 


1,887 


Rhode Island: 
General 


451 


Blind 


147 


South Carolina: 

General . _ . ... 


2,886 


Blind 


127 


South Dakota: 

General.. . . - 


625 


Blind 


37 


Tennessee: 
General 


2.518 


Blind 


423 


Texas: 

General . . 


0, 269 


Blind.. 


439 


Utah 


731 


Vermont: 

General . .. .. 


396 


Blind 


40 


Virginia: 
General 


3,859 


Bhnd- 


120 


Washington: 

General . .. 


2,141 


Blind 


93 


West Virginia . . .. 


5,274 


Wisconsin: 


3.106 


Bhnd 


111 


Wyoming ._. 


297 







1 In States which have 2 agencies, the agency under the State board of vocational educati'^n is designated 
as "general," and the agency under the State commission or other agency for the blind is designated as 
"blind." 

2 Services declined, services not needed, individual not eligible, individual needing services other than 
vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc. 

3 Eligibility for rehabilitation not yet determined. 

> Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabili- 
tation service but never reached the point of employment because of personal factors, illness, aggravated 
disability, etc. 

5 Closed prior to initiation of rehabilitation plan, because of indifference of individual; probable increase 
In degree of disability; loss of contact, etc. 

• In process of rehabilitation on June 30, 1956. 



240 



Department of Health, Education, and Welfare, 1956 



Table 2. — Vocational rehabilitation grants, 1956, State divisions of vocational 

rehabilitation 



State or Territory 



Support 
grants 



Extension 
and improve- 
ment grants 



Expansion 
grants i 



Total 



Total 

Alabama 

Arizona 

Arkansas 

California- 

Colorado 

Connecticut 

Delaware 

Florida 

Georgia 

Idaho 

Illinois 

Indiana 

Iowa 

Kansas 

Kentucky 

Louisiana 

Maine 

Maryland 

Massachusetts 

Mighigan 

Minnesota 

Mississippi 

Missouri 

Montana 

Nebraska 

Nevada 

New Hampshire. . 

New Jersey 

New Mexico 

New York 

North Carolina. . . 

North Dakota 

Ohio 

Oklahoma 

Oregon 

Pennsylvania 

Rhode Island 

South Carolina 

South Dakota 

Tennessee 

Texas 

Utah 

Vermont 

Virginia 

Washington 

West Virginia 

Wisconsin 

Wyoming 

Alaska 

Hawaii 

Puerto Rico 

Dist. of Columbia 



$2G, 250, 052 



962, 134 
185, 640 
601, 369 

780, 220 
196, 979 
317, 053 
137, 588 
756, 156 
750, 735 

66, 355 
359, 118 
360, 738 
463, 703 
225, 199 
261, 482 

781, 648 
137, 649 
333, 028 
353. 006 
049, 513 
478, 453 
265, 432 
501, 734 
128, 230 
182, 357 

30, 584 
48, 240 
550, 564 
110, 961 
762, 447 
763, 640 
168, 272 
460, 677 
633, 941 
331, 756 
055, 081 
112, 761 
478, 943 
105, 422 
613, 344 
816, 523 
135, 294 
115, 507 
757, 168 
494, 420 
752, 869 
502, 057 
89. 002 
76, 340 
151, 072 
249, 439 
248, 209 



28. 196 
2,097 

17, 255 

113,418 

6,512 

16. 038 



17, 870 
17, 324 



18, 060 



21, 000 
9,336 
25, 893 



37, 439 
30, 506 
22, 341 



8,411 



5,384 

1,716 

5,000 

47. 430 

7,056 

57,811 

38, 396 

4,211 

56, 737 

20, 490 

11,886 

40, 378 

3,718 

12, 000 

2,696 

9,600 

23, 480 

6,839 



31,077 
10, 292 
17. 590 
23, 369 



5,000 

3,000 

20, 065 

6,319 



.$997,812 



44, 797 
6,133 
26, 802 
91, 476 
24. 005 
47, 307 



28,309 
12, 762 



69, 637 
5, 954 
21, 870 



18, 768 

19, 586 
5. 533 
5,500 

23, 897 
52,017 
48, 000 



58, 607 
"33,'284" 



3,563 



15,920 

28, 467 

4,260 



13,014 
15, 652 
101,816 



500 
4,100 
17, 000 

52, 225 



22, 366 

17,014 
13, 040 
22, 800 



1,147 
2,027 
12, 889 
5,768 



$28, 118, 822 



1, 035, 
193, 
645, 

1, 985, 
227, 
380 
137 
802, 

1, 780 
66, 

1, 446 
366, 
506, 
234, 
306, 
801 
150 
338, 
414, 

1, 132, 
548, 
265, 
568, 
128, 
221 
32, 
56, 
597, 
118. 

1, 836 
830, 
176, 
517 
667 
359 

2, 197 
116, 
49i: 
112, 
639 
892, 
142, 
115 
810, 
521 
783, 
548, 
89, 
82, 
156 
282, 
260 



127 

870 
426 
114 
496 
398 
588 
335 
821 
355 
815 
692 
573 
535 
143 
234 
904 
528 
342 
036 
794 
432 
752 
230 
025 
300 
803 
994 
017 
178 
503 
743 
414 
445 
294 
275 
479 
443 
218 
944 
228 
133 
507 
611 
726 
499 
226 
002 
487 
099 
393 
296 



1 Includes grants to non-profit agencies for projects developed in cooperation with State Divisions of 
Vocational Rehabilitation. 



Office of Vocational Rehabilitation 



241 



Table 3. — Vocational rehabilitation grants, 1956, State commissions or agencies 

for the blind 



State or Territory- 


Support grants 


Extension and 

improvement 

grants 


Expansion 
grants i 


Total 


Total . . 


$3, 749, 948 


$132, 153 


$67, 699 


$3, 949, 800 








36, 722 

37,959 

51,061 

42, 273 

286, 786 

9,546 

49, 273 

24, 949 

87, 736 

138, 104 

37, 702 

75,881 

110, 528 

124, 787 

174, 733 

192, 850 

28, 649 

59, 062 

21,212 

140, 140 

30, 487 

270, 576 

450,370 

163, 645 

49, 462 

284, 478 

27, 936 

41, 719 

33, 019 

241, 555 

212,068 

18, 237 

49, 123 

41, 571 

74, 706 

31,043 






36, 722 








37, 959 


Connpntifint. 






51,061 




5,000 




47, 273 


Florida . .. 


10, 708 


297, 494 


Idaho 




9,546 




1,500 
2,325 
4,189 




50,773 


Iowa 




27, 274 


Kansas .- . . . 




91, 925 






138, 104 


Maine 






37, 702 


Massachusetts . 


600 


4,600 


81,081 


Michigan 


110.528 








124, 787 








174, 733 


Missouri 






192, 850 








28,649 


Nebraska 


4,291 




63, 353 


New Hampshire 




21,212 








140, 140 








30, 487 




72, 464 




343, 040 






450, 370 


Ohio 




23, 930 


187, 575 


Oregon 


2,920 


52, 382 




21, 456 


305, 934 






27, 936 








41,719 


South Dakota 


1,081 




34, 100 


Tennessee --- - -_- - ..- 


5,000 


246, 555 


Texas 


23, 978 


236, 046 




2,005 


20, 242 






49, 123 




12, 075 
1,730 




53, 646 






76, 436 






31, 043 











> Includes grants to non-profit agencies for projects developed in cooperation with State Commissions or 
Agencies for the Blind. 



Saint Elizabeths Hospital 



The year just closed lias been one of change and development. As 
for the physical plant, two new buildings, the Dorothea Lynde Dix 
Pavilion and the new Saint Elizabeths Chapel have been opened, 
while plans have been proceeding apace for the new Maximum Se- 
curity Building. The Men's Receiving Building has become the 
William A. White Building and its function will be that of an inter- 
mediate treatment building. The former Women's Receiving Build- 
ing, renamed the Charles H. Nichols Building, has become a part of 
the Geriatric Service. The Oaks Building, formerly used for women, 
has been vacated and will be demolished in the near future. 

Perhaps even more important than the new buildings is the de- 
velopment of new programs for the treatment and care of patients. 
Throughout the hospital the use of administrative discussion groups 
and an increasing degree of permissiveness allowed to the patient has 
been developed. This program has been aided by the services of a 
social scientist. In the Dix Pavilion the new development of non- 
stratification of patients has taken place. The building is particularly 
suitable for this, having no large dormitories, and the plan of ad- 
mitting patients to the same ward whether they be disturbed, suicidal 
or quiet has worked out very satisfactorily. The program of self- 
government carried out in the Maximum Security Section has been 
further developed and a considerable additional number of outside 
groups of volunteer visitors have come to the hospital. These are but 
a few of the changes of a progressive nature which have taken place 
during the year. 

The most significant event of the year was the dedication on 
April 13 of the Dorothea Lynde Dix Pavilion by the Vice President 
of the United States, The Honorable Richard M. Nixon. The hospital 
was greatly honored on this occasion by the presence of Vice President 

243 



244 Department of Health, Education, and Welfare, 1956 

Nixon, the Secretary of Health, Education, and. Welfare, and a large 
number of other distinguished citizens. Earlier, on December 5, the 
date stone of the Chapel was set, in ceremonies participated in by 
Chaplains of the three major faiths, the Superintendent, and two 
patients — perhaps the first occasion on which patients (for whose 
benefit the hospital is operated) took an official part in such a 
ceremony. 

The use of the tranquillizing drugs, noted in last year's report, has 
been extended with greatly beneficial effects in the general atmosphere 
of the hospital and the comfort of the patients. The use of these 
drugs has permitted the granting of ground privileges to a much 
larger number of patients, and has to a very substantial extent in- 
creased the return of patients to the community. The number of 
patients in the hospital has shown an actual decrease during the 
current year. The average number of patients in the hospital during 
June 1955, for example, was T,2T7, but one year later this number had 
dropped to 7,010, a decline of 267. Careful studies are being made 
by the hospital's statistician to determine how histing are the effects 
of the drugs on the discharge rate. 

Note should be made of the publication of "Centennial Papers", 
a volume made up of the addresses given at the Centennial Celebra- 
tion of the hospital in 1955. During the year the hospital was honored 
by the visits of physicians and others from 26 countries. 

Division of Medical Services 

CLINICAL BRANCHES 

The psychiatric care of the patients is assigned to the three clinical 
branches. The Medicine and Surgery Branch operates the Medical 
and Surgical Building and the Tuberculosis Service, where the pa- 
tients who are acutely physically ill are cared for. All of the other 
activities of the hospital, such as Laboratory, Occupational Therapy, 
Volunteer Services, Maintenance and Construction, are auxiliary to 
the work of these four branches. 

Once again emphasis is placed upon the ever present problem of 
overcrowding. Even in spite of the fall in population the excess of 
patients over proper bed capacity is 556 or approximately 8% percent. 
It should be noted that the buildings which have been added in the 
last 10 years have been replacements and have not resulted in any 
increase of bed capacity. There are some indications that the popula- 
tion may stabilize at the present level rather than showing a further 
drop. 

It still remains necessary to maintain a waiting list for prisoner 
patients to be admitted to Howard Hall. So pressing has this matter 



Saint Elizabeths Hospital 245 

become that it has appeared necessary to make plans for remodeling 
the so-called Pine Ward in the Center Building as a medium security 
unit to accommodate the increasing number of prisoners. There is no 
reason to think that the demands on the hospital for this type of ac- 
commodations will decrease. With the increasing recognition by the 
courts of the psychiatric factors in criminal behavior, indeed, it is 
likely that the number of patients of this sort will increase. Even- 
tually the new Howard Hall will remedy the problem, but that build- 
ing is still several years in the offing. 

Attention has been called repeatedly to the difficulty in filling senior 
staff positions in the hospital. One great difficulty which operates 
against us is that another agency of the Government is permitted to 
pay a premium of 25 percent of salary to physicians who are diplo- 
mates of specialty boards. 

There is no change to report in the matter of the elderly patient. 
Approximately 40 percent of the patients admitted are 60 years of age 
or over. The program of admitting the patients over 64 years of 
age to the Geriatric Building is working effectively, and an attempt 
is being made constantly to return these elderly patients to their homes 
or to other places (such as the District of Columbia Village) where 
they may be adequately cared for. 

In the line of treatment the so-called tranquillizing drugs appear to 
be working very well. The hospital, as always in the past, attempts to 
follow an eclectic approach to treatment. An active program of in- 
dividual and group psychotherapy is carried on. Treatment and dis- 
cussion groups of one sort or another are now widespread in the hos- 
pital. The District of Columbia Rehabilitation Service and the 
Board of Education have been very helpful. Recreational therapy 
has been very considerably extended, while in selected cases electro- 
shock, subshock insulin and hydrotherapy continue to be used. With 
the new drugs, however, all of these methods, particularly electro- 
shock, are showing a substantial drop. Hydrotherapy continues to 
have a useful place. Prefrontal leucotomy, never done with any fre- 
quency in this hospital, has not been performed at all during the 
past year. 

The activity of the patients in asking for writs of habeas corpus 
has shown some increase. For example, there were 46 orders to show 
cause why such a writ should not issue, as against only 15 in the pre- 
ceding year. Thirty-seven of these orders, however, were dismissed. 
The number of writs showed a slight decrease, only 20 being issued, 
and only three of these resulting in the dismissal of the patient. 

During the year 1,327 patients were admitted, while 884, or 66.61 
percent, were discharged. This is the liighest discharge rate since 
1946, when acutely ill patients from the Navy were still being treated. 



246 Department of Health, Education, and Welfare, 1956 

MEDICINE AND SURGERY BRANCH 

The services of the Branch are available to the patients of the Iios- 
pital who are in need of medical or surgical attention of a specialized 
nature and to those employees who become ill or in j ured while on duty. 
During the year 2,762 patients were admitted to the wards of the 
Branch and a total of 45,066 patients made visits to the clinics. 

PSYCHOTHERAPY BRANCH 

Psychodrama has continued active, with 345 sessions for patients 
and 103 conferences. Dance therapy has been considerably expanded, 
and several individuals have come to the hospital for training in this 
new and promising field of therapy. The art therapy has also been 
carried on successfidly, 

PSYCHOLOGY BRANCH 

During the year the psychological activities, formerly carried on a 
section basis, have been placed in the status of a branch. During 
the year 2,785 tests were given to 807 subjects. Many of these sub- 
jects were employees of the hospital in various grades. During the 
year the Branch has been approved by the American Psychological 
Association as an approved training center for clinical psychology. 
It is one of the few centers to receive such approval. A very active 
teaching program is carried on. Individual psychotherapy, appro- 
priately supervised, has been carried on by members of the Branch, 
together with supervision of therapeutic reading and vocational 
advisement. 

LABORATORY BRANCH 

The heavy load of the Laboratory has been dealt with very effec- 
tively, and in addition an increasingly close relationship between the 
Laboratory and the Medicine and Surgery Branch has been developed. 
The improvement of the laboratory facilities continues. During the 
year 315 autopsies were performed, or 52.6 percent of the 600 deaths 
which occurred in the Hospital. Four research activities are under 
v/ay in the biochemical division and the neuropathology research sup- 
ported by private funds is likewise being carried on. 

NURSING BRANCH 

The Nursing Branch, in addition to having the general responsi- 
bility for the nursing care on the various wards of the hospital, car- 
ries on an active educational program. Sixteen schools of nursing- 
affiliate at the present time at the hospital and 310 affiliate nurses were 
under training during the year. In addition an orientation course for 
new employees, 355 in number, was carried on, each group of new 
employees being given instruction in the general activities of the hospi- 



Saint Elizabeths Hospital 247 

tal. Programs for nursing assistants are now under way. In addi- 
tion, during the year 61 postgraduate students and 25 Navy corpsmen 
were given instruction and field experience. 

OCCUPATIONAL THERAPY BRANCH 

The impact of the new tranquillizing drugs upon the occupational 
therapy activities has been notable. As a result of the increased privi- 
leges which may be given to patients, occupational therapy has been 
shifting toward a closer integration with the rehabilitation activities. 
A preindustrial occupational therapy clinic has been set up. 

SOCIAL SERVICE BRANCH 

During the year 1,208 patients were served, with a total of 7,230 
interviews, these latter being held both with patients and with others. 
The Branch has worked closely with the Rehabilitation Service of the 
District of Columbia, the Public Assistance Division of the Depart- 
ment of Welfare, and the Board of Education. Conferences like- 
wise have been held with the Health Department of the District of 
Columbia with a view to coordinating the after-discharge care given 
to patients in the community. For the first time this year educa- 
tional instruction has been offered 5 days a week to the somewhat grow- 
ing number of 'teenage and juvenile patients. Nine students, three 
from Howard University and six from Catholic University, have 
been given opportunities for field work during the year. The Branch 
has been provided with expanded quarters in the E Building. 

CHAPLAIN SERVICES BRANCH 

The most important item to note in this connection is the opening 
of the splendid new Saint Elizabeths Chapel. This building, which 
was originally proposed by the hospital 60 years ago, has finally be- 
come a reality. Unfortunately the appropriation was insufficient to 
provide a suitable organ and it is hoped that voluntary contributions 
may be received which will enable this final step in the completion of 
the chapel. Services are held in various other parts of the hospital, 
such as the Geriatric Building and Howard Hall, and plans are being 
extended for further such services. The Roman Catholic chaplain 
has been aided by a part-time priest and by a number of seminarians. 
He is making plans for a clinical training course for Roman Catholic 
chaplains. The Protestant chaplain is in charge of the general train- 
ing program for Protestant theological students and ordained clergy- 
men, and of services for the Protestant patients. 

LIBRARY SERVICES 

The Medical Library is operated primarily for the benefit of the 
medical staff. There are also several library collections in other 



248 Department of Health , Education, and Welfare, 1956 

offices. During the year there were 420 accessions, bringing the total 
number of vohunes in the Medical Library to 17,598. In addition 
there are somewhat over 15,000 miscellaneous pamphlets. Further 
sjDace has now been made available to the library in the Administration 
Building. 

The Patients' Library is in charge of one employee, who is assisted 
by about 27 patients. During the year the accessions numbered 3,366, 
many of them by gift. The total number of volmnes is now 44,677. 
A very active circulation is maintained among the wards and small 
deposits of books, changed from time to time, are kept in the day- 
rooms of many of the wards. Numerous book review sessions are 
held at the library and in addition a French class and a refresher 
course in typewriting have been added. 

SPECIAL SERVICES BRAISCH 

The Branch has continued to function most effectively and has been 
constantly in close touch with the District of Columbia Chapter of 
the American Ked Cross and with a vast number of other community 
agencies, such as the American Legion and the St. Vincent de Paul 
Society. These organizations and individuals have been most gener- 
ous in donating their services, food and other material for the benefit 
of the patients. Particularly are thanks due to the Motor Corps, 
the Canteen Service, Production and Supply Service and the Gray 
Ladies of the American Red Cross. Weekly dances have been held. 
Motion pictures have been shown, both in Hitchcock Hall and on the 
wards, and various sports activities have been organized. The Branch 
supervises the production of a weekly journal, known as The Eliza- 
bethan, which is edited and written entirely by the patients at the 
hospital. 

VOLUNTEER SERVICES BRANCH 

Under the auspices of this relatively new Branch a very gratifying 
increase in response from the various individuals in the community 
has been noted. We now have volunteers working throughout the 
hospital as ward visitors, and receptionists. During the year 102 
volunteers gave a total of 8,420 hours of service. 

TEACHING ACTIVITIES 

The primary purpose of any hospital is the care of patients. Next 
to this and almost of equal importance are the related duties of teach- 
ing and research. The program of training and teaching carried on 
in previous years has been continued and expanded. The hospital is 
approved for training in psychiatry during three years of residency 
required by the American Board of Psychiatry and Neurology, and 



Saint Elizabeths Hospital 249 

this program is in charge of a well trained psychiatrist. The hospital 
is likewise approved for rotating internship, affiliation being provided 
at the District of Columbia General Hospital for the interns. An 
affiliation for psychiatric residents has been continued with the George 
Washington University Hospital, and affiliation likewise is in force 
with the Washington Institute of Mental Hygiene and with the Child 
Center of Catholic University. Medical students from all three of 
the medical schools are given instruction at the hospital. Dental 
interns and residents in surgery are also serving. Field work is pro- 
vided by the Social Service Branch for the Schools of Social Service 
of Catholic University and Howard University, and students of oc- 
cupational therapy are received from time to time. Interns and resi- 
dents are trained in the field of clinical psychology. Afiiliation for 
undergraduate nurses and postgraduate nurses is carried on, and a 
course for training nursing assistants and psychiatric aides is under 
way. The value of these training activities is great, both to the re- 
cipients, to the fields involved, and particularly to the patients in 
the hospital. It results always in a direct stimulation of the care of 
the patient. A substantial number of scientific articles have been 
published by members of the staff. 

Some of the projects under way have already been mentioned. It 
should be likewise pointed out that during the year discussions have 
been had with the National Institute of Mental Health and it is hoped 
that during the coming year a much closer relationship between the 
hospital and that institution can be developed in the field of research. 
It is planned that the William A, White Building may be set apart as 
a special research section of the hospital in cooperation with the Na- 
tional Institute of Mental Health. It is an ironic fact that while 
millions are being provided for the National Institute of Mental 
Health, that organization may not make grants to Saint Elizabeths 
Hospital, nor is any fund in the hospital appropriation earmarked for 
research. It is to be hoped that by another year this situation may be 
remedied. Certainly there exists hardly anywhere else such a mine 
of clinical material which may be utilized profitably for research. 

General Administration 

The very important functions of general administration fall under 
two headings, one administrative and one maintenance. All these 
various nonmedical functions actually enter importantly into the care 
and treatment of the patient. The sections have all operated 
smoothly, efficiently, and with a minimum of personnel. The Per- 
sonnel Section continues to find the recruitment for most of the pro- 

408691 — 57 17 



250 Department of Health, Education, and Welfare, 1956 

f essional positions, such particularly as medical officers, psychologists, 
dental officers and nurses, difficult. During the year under the Wage 
Board Conversion Program 788 employees were affected. Nearly 68 
percent of all of these employees were placed in "saved" rates at the 
time of conversion, which is to say that the rate which they were re- 
ceiving before the conversion was greater than it would have worked 
out under the hourly Wage Board plan. There has been general dis- 
satisfaction among the employees with the operation of the Wage 
Board Program. The Incentive Awards Program has been carried 
on successfully. Under the Administrative Services Branch civilian 
defense drills have been held regularly at least once a month, and the 
beginning of a new statistical system has been made with the appoint- 
ment of a statistician. Various aspects of the population dynamics 
of the hospital are now under study and some preliminary cohort 
studies are being made. 

The maintenance groups have functioned very efficiently during the 
year. There are many problems connected with a plant of the size of 
this hospital, particularly since many of the buildings are old. Dur- 
ing the year an extensive rehabilitation of the power plant has been 
under way with particular reference to coal handling. This has 
caused much inconvenience in the line of deliveries of coal and of oil, 
but the task when completed will result in much greater efficiency. 

The farm has continued to function with reasonable efficiency. The 
hennery has been closed during the year, but the growth of vegetables 
has been very satisfactory and has provided fresh foods for the 
kitchens. For example, nearly 70,000 ears of sweet corn were raised 
during the year. The farm furnishes a useful occupation for about 
50 patients, these patients being some who are not able to function in 
other capacities. It seems desirable certainly for the present that the 
use of the farm be continued. 

Needs of the Hospital 

A cafeteria for Continued Treatment Buildings 7 and 8 is still 
urgently needed, as is a new building to replace the so-called Dawes 
Section of the Center Building, a section which is particularly poorly 
planned. Consideration should be given to expanding at least to 
some extent the size of the hospital. There is no assurance that the 
present reduction in population, apparently due to the tranquillizing 
drugs, will continue, but it seems quite likely that the increase in the 
admissions of elderly patients will. It should be pointed out that the 
use of the tranquillizing drugs, far from making the load on the em- 
ployees lighter, actually causes an increase in demands for service. 
Thus the present understaffing becomes even more noticeable. The 



Saint Elizabeths Hospital 



251 



staffing at the present time is far under the standards set as desirable 
by the American Psychiatric Association. Additional personnel, 
especially physicians, nurses and other ward types, is urgently needed 
if the high standards of the hospital are to be maintained. Another 
urgent need, already mentioned, is provision for marked expansion of 
research activities. 

Table 1. — Movement of patient population, fiscal year 1956 





Total 




Male 






Female 






White 


Colored 


Total 


White 


Colored 


Total 


Total number under care and treatment, 
fiscal year 1956 . 


8,856 


2,655 


1,757 


4,412 


2,676 


1,768 


4, '144 






Remaining on rolls June 30, 1965 


7,529 
1,327 


2,284 
371 


1,463 
294 


3,747 
665 


2,248 
428 


1,534 
234 


3,782 
662 






Total discharged and died 


1,484 


467 


265 


732 


506 


246 


752 








884 


273 


164 


437 


289 


158 


447 






Discharged as: 


89 

333 

268 

147 



46 

1 


24 
66 
98 
58 


36 
48 
41 
24 


60 
114 
139 

82 


20 
134 

82 
48 


9 
85 
47 
17 


29 




219 




129 




65 








27 



15 



42 



4 




1 


4 




1 






Died -- 


600 


194 


101 


295 


217 


88 


305 






Remaining on rolls, June 30. 1956 


7,372 


2,178 


1,502 


3,680 


2,169 


1,523 


3,692 


Change in color 

On visit and elopement 




476 

6,896 


-10 

113 

2,065 


+ 10 

89 

1,413 




202 

3,478 


-1 

170 
1,999 


+1 

104 

1,419 




274 




3,418 







252 



Department of Health, Education, and Welfare, 1956 



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American Printing 
House for the Blind 



As THE OFFICIAL sclioolbook priiitery for the blind, in the United 
States, one of the principal functions of the American Printing House 
for the Blind, in Louisville, Kentucky, is the provision of special 
educational books and supplies for the blind school children through- 
out 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. Alloca- 
tions 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. Talk- 
ing Books, recorded tapes. Braille music publications, large-type texts, 
and tangible apparatus. A rich collection of educational material is 
thereby provided for the kindergarten through the high school grades. 
A total of 7,520 blind pupils was enrolled in the residential and public 
school classes for the blind being served by the Printing House for 
the fiscal year ending June 30, 1956. 

During the 1956 fiscal year. Braille books, educational periodicals, 
and music made up approximately 48 percent of the materials required 
by the schools ; Braille slates, Braillewriters, maps, and other mechan- 
ical devices about 18 percent ; Talking Books about 5 percent ; recorded 
educational tapes about 2 percent ; and large-type books about 22 per- 
cent. Approximately 5 percent was used for miscellaneous items. 

253 

408691—57 18 



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. In addition to education, it 
conducts research into the educational problems of deafness. It con- 
sists 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 
teachers training in the college. The oral method of instruction is 
used for all pupils except those who make no progress under it. En- 
rollment last year was 75, of which 63 came from the District of 
Columbia. 

GALLAUDET COLLEGE 

The college, established in 1864 by act of Congress, offers the associ- 
ate's degree after 2 years of study, and a bachelor's degree in the liberal 
arts and sciences. The Preparatory Department provides the senior 
year of high school for students who are unable to obtain it in the 
State schools for the deaf. The Graduate Department of Education 
offers a master's degree and a professional diploma in the education 
of the deaf to students with normal hearing, and offers a four- week 
training course to vocational counselors who wish to acquire a deeper 
understanding of deaf persons. Total enrollment in the college last 
year was 324 with students from 42 States, Hawaii, the District of 
Columbia, and 7 foreign countries. 

255 



Howard University 



Howard University was chartered by the act of Congress on March 2, 
1867. Located in the District of Columbia, the university operates an 
undergraduate college, a graduate school offering the master's degree 
in fifteen departments and the degree of doctor of philosophy in one 
department, and eight professional schools as follows : medicine, den- 
tistry, pharmacy, engineering and architecture, music, social work, 
law, and religion. ( Religion receives no support from Federal funds. ) 
The university also conducts a summer and an evening school which 
offers work in adult education. 

ENROLLMENT OF STUDENTS 

During the school year 1955-56 the university served a total of 
5,570 students, as follows: 3,985 during the regular academic year, 
1,260 in the summer session, and 325 in the adult evening classes. 
The net total enrollment, excluding all duplications, was 5,055, of 
whom 325 were in the evening school and 4,730 in the ten regular 
schools and colleges as follows: liberal arts, 2,184; graduate school, 
457; engineering and architecture, 544; music, 241; social work, 96; 
medicine, 288 ; dentistry, 665 ; pharmacy, 128 ; law, 95 ; and religion, 32. 

GEOGRAPHICAL DISTRIBUTION OF STUDENTS 

Of the net total of 4,730 students enrolled in the ten regular schools 
and colleges in 1955-56, 3,915 students were registered for degrees. 
Of these students, 3,536, or 90.3 percent, came from 39 States and the 
District of Columbia, while 379 students, or approximately 9.7 percent, 
came from outside the continental United States, including 36 foreign 
countries, the British West Indies, and 4 possessions of the United 
States. 

257 



258 Department of Health, Education, and Welfare, 1956 

The 3,536 students who came from the United States were dis- 
tributed as follows : New England States, 73 ; Middle Atlantic States, 
548; East North Central States, 197; West North Central States, 60; 
South Atlantic States, 2,101 ; East South Central States, 268 ; West 
South Central States, 261 ; Momitain States, 7 ; and Pacific States, 21. 

The 379 students from outside the continental United States came 
from diverse areas in Africa, Asia, Europe, and North and South 
America. Forty-six students came from seven countries in Africa — 
Egypt, Ethiopia, Gold Coast, Liberia, Nigeria, Sierra Leone, and 
Uganda. Twenty-two students came from seven countries in Asia — 
China, India, Indonesia, Iran, Iraq, Malaya, and Syria. Two students 
came from Canada. Twenty-one students came from six countries 
in Central America — -British Honduras, Cuba, Haiti, Panama, Span- 
ish Honduras, and the Dominican Republic. Twenty-four students 
came from twelve countries in Europe — England, Germany, Greece, 
Italy, Poland, the Soviet Union, Spain, Switzerland, Latvia, Bulgaria, 
Turkey, and Yugoslavia. Fifty-four students came from three coun- 
tries in South America — Brazil, British Guiana, and Venezuela. 
One hundred seventy-eight students came from Bermuda and the 
British West Indies — Barbados, Bahamas, Grenada, Jamaica, Nevis, 
St. Vincent, Tobago, and Trinidad. Thirty-two students came from 
the Canal Zone, Hawaii, Puerto Rico, and the Virgin Islands. 

VETERANS 

There was a total of 796 veterans enrolled at the University during 
the school year 1955-56. These 796 veterans were distributed among 
the 10 schools and colleges as follows : 361 in liberal arts, 160 in 
engineering and architecture, 17 in music, 67 in the graduate school, 9 
in social work, 47 in dentistry, 43 in medicine, 40 in law, 45 
in pharmacy, and 7 in religion. 

The enrollment of veterans in 1956 represented an increase of 170 
above the veteran enrollment for the previous year. 

There were 55 veterans among the 554 graduates in all schools and 
colleges, representing an increase of 11 above the group of veteran 
graduates in 1955. 

ARMY AND AIR FORCE ROTC 

Army ROTC. — Two hundred and six students were enrolled in 
Army ROTC during the 1955-56 school year of whom 172 were in 
the first and second year basic courses. Eighteen students completed 
all phases of the required work and were commissioned in the following 
branches of the service: Adjutant General Corps, Armor, Artillery, 
Chemical Corps, Infantry, and the Medical Service Corps. 

Air Force ROTO. — A total of two hundred and eighty students 
were enrolled in Air Force ROTC during: 1955-56. Two hundred 



Howard University 259 

and thirty-one (231) of these were in the first and second year courses. 
Eighteen students received reserve commissions in the Air Force at 
the end of the school year. 

IHE FACULTY 

During the school year 1955-56, there were 486 teachers serving 
the university. Of this number 272 were teaching on a full-time basis, 
while 214 were engaged in part-time capacities. The full-time equiva- 
lent of the entire teaching force was 319.5 persons. Of this number 
285 were teaching in the ranks of instructor and above as follows: 
professors, 6Y; associate professors, 72; assistant professors, 67; in- 
structors, 79. Seventy-two of the 214 part-time teachers were serving 
the university without compensation. 

THE BUILDING PROGRAM 

In September 1955, the College of Pharmacy moved into its new 
building. This building is a four-story brick structure with a usable 
basement. It was built and equipped at a cost of $970,000 made avail- 
able by an appropriation of Congress. 

During the year 1955-56 work neared completion on the new Law 
Building and the Biology Building, both of which were scheduled 
to be occupied at the beginning of the fall term in 1956. In addition, 
the new Administration Building was nearly completed and was being 
readied for occupancy sometime during the first semester of 1956-57. 

Construction continued on the new preclinical medical building, 
with its completion expected to be in May 1957. By the end of the 
1955-56 year, the plans and specifications for the Auditorium-Fine 
Arts Building and the new Men's Dormitory were virtually completed, 
with the expectancy of being placed on the market for bids in the fall 
of 1956. 

GRADUATES 

During the school year 1955-56 there were 554 graduates, as com- 
pared with 514 in the preceding year. These 554 persons came from 33 
States, the District of Columbia, the Virgin Islands, Puerto Rico, from 
Africa, Asia, Europe, North, Central, and South America. They were 
distributed among the ten schools and colleges as follows : liberal arts, 
253 ; engineering and architecture, 21 ; music, 16 ; graduate school, 48 ; 
social work, 30 ; medicine, 68 ; dentistry, 47 ; dental hygiene, 8 ; phar- 
macy, 28 ; law, 30 ; and religion, 5. The university also awarded three 
honorary degrees. 

During the years since its origin in 1867, Howard University has 
graduated 19,263 persons. By far the largest number of these grad- 
uates have entered the field of teaching, primarily engaged in the 



260 Department of Health, Education, and Welfare, 1956 

building of the system of education in the former slave States. Two 
thousand eight hundred and one (2,801) have entered the practice 
of medicine; 2,306 have entered the practice of dentistry and dental 
hygiene; 1,579 have entered the practice of law; 763 have entered the 
ministry ; 807 the practice of pharmacy ; 542 the field of engineering ; 
and 329, the field of social work. 

These graduates are at work in 43 States, and 27 foreign countries. 
In every population center in the United States they constitute a cross 
section of the leadership of the Negro people. Together, these grad- 
uates constitute the largest and most diversified group of trained 
Negro public servants related to any single institution in the world. In 
the eight professions of medicine, dentistry, pharmacy, engineering, 
architecture, music, law, and social work, they include a body of Negro 
professional graduates larger than the output of all other universities 
of public and private support combined in all the Southern States. 

SERVICE IN FOREIGN COUNTRIES 

Howard University students and teachers have associated daily with 
teachers and students representative of every race and color and many 
of the major creeds of the world. They have learned by experience 
that the common country of the trustable human heart crosses and 
transcends all these boundaries of external differences, and they are 
habituated to a friendly interest in human beings everywhere. In 
recent years many of those students and teachers, as individuals and 
in groups, have traveled on missions to many countries in Europe, 
Asia, and Africa ; as now in India, Iraq, Indonesia. Wherever they 
have gone, they have imparted good will and friendship and they have 
found good will and friendship in return. 

Again and again the responsible leaders in Government and the 
friends of America have acknowledged their services as being of the 
greatest value to their country and to the cause of democracy in the 
world. 

Just now the Professor and the Head of the Department of Classics 
is returning to Howard University from a 2-year period of service as 
Cultural Attache of the United States Embassy in Italy. The univer- 
sity has received a letter from Government officers which speaks of his 
service in the highest terms of appreciation. 



Detailed Contents 

THE SECRETARY'S REPORT 

Page 

Progress and Plans in Health 2 

Health Research Program 3 

Hospitals 4 

Nursing Services 4 

Poliomyelitis Program 5 

Indian Health 5 

Health Survey 6 

Other Nevi^ and Expanded Programs 6 

Progress and Plans in Education 6 

Educational Research 8 

Progress and Plans in the Food and Drug Administration 9 

Progress and Plans in Social Security 10 

Public Assistance — ^A Changed Emphasis 11 

Child Welfare Services 12 

Juvenile Delinquency 12 

Progress and Plans in Vocational Rehabilitation 12 

Progress and Plans for the Aged 14 

Table 1. — Grants to States: Total grants under all Department of Health, 

Education, and Welfare programs, fiscal year 1956 16 

SOCIAL SECURITY ADMINISTRATION 

SOCIAL SECURITY IN 1956 17 

Program Administration in 1956 21 

International Activities 22 

OLD-AGE AND SURVIVORS INSURANCE 23 

What the Program Is Doing 25 

Beneficiaries and Benefit Amounts 25 

The Disability Freeze 25 

The Protection Provided 26 

The Coverage of the Program 26 

Income and Disbursements 27 

Administering the Program 27 

Fact-Findinq for Program Evaluation and Improvement 30 

Simplification Study 30 

A Study of Farm Coverage 30 

Work Group on Aging 31 

Referral Practices of District Offices 31 

Legislative Developments During the Year 32 

261 



262 Department of Health, Education, and Welfare, 1956 

Fage 

Major Provisions of the 1956 Amendments 32 

Financing the Program 40 

Old- Age and Survivors Insurance Benefits 40 

Disability Insurance Benefits 41 

PUBLIC ASSISTANCE 41 

Legislative Developments 42 

Tlie 1956 Amendments 42 

State Legislative Changes 43 

Trends in Caseload and Expenditures 44 

Old-age Assistance 44 

Aid to Dependent Children 45 

Aid to the Blind 45 

Aid to the Permanently and Totally Disabled 45 

General Assistance 45 

OASI Beneficiaries Receiving Supplementary Assistance Payments 46 

Program and Administrative Developments 46 

Strengthening of Individual and Family Life 47 

Improving Welfare Services for the Aging 49 

Advancing Efficient Administration of Public Assistance Programs 52 

Defense Welfare Services 55 

CHILDREN'S BUREAU 56 

Some Facts and Figures About Child Life 57 

Children With Special Needs 59 

Federal Interdepartmental Committee on Children and Youth.- 60 

Programs of the Bureau 60 

Research in Child Life 60 

Maternal and Child Health Services 62 

Crippled Children's Services 65 

Child Welfare Services 66 

Juvenile Delinquency Services 70 

International Cooperation 71 

FEDERAL CREDIT UNIONS 72 

Research and Development 74 

Table 1. — Social Security Administration: Funds available and obliga- 
tions incurred, fiscal years 1955 and 1956 76 

Table 2. — Financing social insurance under the Social Security Act: 

Contributions collected and trust fund operations, fiscal years 1954-56_ 76 

Table 3. — Old-age and survivors insurance: Estimated number of families 
and beneficiaries receiving benefits and average monthly benefit in cur- 
rent-payment status, by family group, end of June 1956 and 1955 77 

Table 4. — Old-age and survivors insurance: Selected data on benefits, 
employers, workers, and taxable earnings, by State, for specified periods, 

1953, 1955, and 1956 78 

Table 5. — Old-age and survivors insurance: Selected data on benefits, 

employers, workers, and taxable earnings for specified periods, 1954-56_ 79 



Detailed Contents 263 

Page 

Table 6. — Special types of public assistance under plans approved by the 
Social Security Administration: Number of recipients and average pay- 
ment, June 1956, and total payments to recipients, by program and 

State, fiscal year 1956 80 

Table 7. — 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 1956 82 

Table 8. — Maternal and child health and welfare services: Grants to 
States for maternal and child health services, services for crippled chil- 
dren, and child v^^elf are services under the Social Security Act, by program 

and State, fiscal year 1956 84 

Table 9. — Federal credit unions: Number of members, amount of assets, 

amount of shares, and amount of loans outstanding Dec. 31, 1935-55- _ 85 

Table 10. — Federal credit unions: Assets and liabilities, Dec. 31, 1955, 

and Dec. 31, 1954 85 

PUBLIC HEALTH SERVICE 

HEALTH OF THE NATION 87 

Legislative Highlights 88 

Health Record 89 

Births, Marriages, and Divorces 90 

Change in Leadership 91 

Funds and Personnel 91 

Public Health Methods 91 

Analysis of Illness and Mortality 92 

Health Personnel Studies 92 

Studies of Health Services 93 

NATIONAL INSTITUTES OF HEALTH 94 

Clinical Center 94 

Division of Biologics Standards 95 

Division op Research Grants 96 

Institute of Allergy and Infectious Diseases 97 

Research Grant Studies 98 

Institute of Arthritis and Metabolic Diseases 98 

Progress in Research 99 

Progress in Grants 100 

Cancer Institute 100 

National Chemotherapy Program 101 

Laboratory and Clinical Studies 101 

Studies Supported by Grants 102 

Biostatistical and Field Investigation Studies 103 

Cancer Control and Research Training 103 

Institute of Mental Health 104 

Advances in Training 105 

Developments in Mental Health Research 105 

Institute of Dental Research 106 

Institute of Neurological Diseases and Blindness 107 



264 Department of Health, Education, and Welfare, 1956 

Page 

Clinical Progress 108 

Research Grant Accomplishments 109 

Heart Institute 109 

Progress in Heart Research 110 

Accomplishments Through Research Grants 112 

BUREAU OF MEDICAL SERVICES 113 

Hospitals and Outpatient Facilities 113 

Volume of Services 11-4 

Training Medical Care Personnel 115 

Clinical Investigations 115 

Freedmen's Hospital 116 

Foreign Quarantine 117 

International Traffic Volume 117 

Medical Examinations 117 

Other Quarantine Activities 118 

Hospital and Medical Facilities 119 

Health Services for Indians 120 

Hospital Services 121 

Field Health Services 122 

Dental and Social Services 123 

Tuberculosis Control 124 

Training of Indians 125 

Construction and Renovation 125 

Dental Resources 126 

Dental Manpower 126 

Prepayment Dental Care 126 

Nursing Resources 127 

New Research Grants Program 127 

State Surveys of Nursing Needs 127 

Better Methods of Patient Care 127 

Medical Services for Federal Agencies 128 

Office of Vocational Rehabilitation 128 

Bureau of Employees' Compensation, Department of Labor 128 

Maritime Administration, Department of Commerce 129 

United States C oast Guard, Treasury Department 129 

Foreign Service, Department of State 129 

Bureau of Prisons, Department of Justice 130 

Bureau of Old-Age and Survivors Insurance, Social Security Administra- 
tion 130 

Bureau of Public Assistance, Social Security Administration 131 

BUREAU OF STATE SERVICES 131 

General Health Services 131 

Poliomyelitis Vaccine Program 131 

State Grants 132 

Program Development 133 

Public Health Education 133 

Public Health Nursing 134 

Vital Statistics 134 

Arctic Health Research Center 135 



Detailed Contents 265 

Page 

Emergency Health Services 136 

Division of Special Health Services 136 

Chronic Disease Program 136 

Heart Disease Control Program 137 

Occupational Health Program 138 

Air Pollution Medical Program 139 

Tuberculosis Program 139 

Venereal Disease Control Program 140 

Sanitary Engineering Services 141 

Robert A. Taft Sanitary Engineering Center 141 

Engineering Resources 142 

Milk and Food Sanitation 142 

Water Supply and Water Pollution Control 142 

Air Pollution Control Activities 143 

Radiological Health 144 

General Engineering Activities 144 

Accident Prevention and Hygiene of Housing 145 

Communicable Disease Center 145 

Epidemic and Disaster Aid 146 

Surveillance and Investigation of Diseases 146 

Laboratory Services and Nevi^ Techniques 147 

Vector Control 148 

Training 149 

Dental Public Health 149 

Program Services 149 

Operational Research 150 

Division of International Health 150 

Trainees and Visitors 151 

Foreign Missions 151 

International Epidemiology 152 

Table 1. — Statement of appropriations, authorizations, obligations, 

and balances, fiscal year 1956 153 

Table 2.— Commissioned officers and civil service personnel as of June 

30, 1956 155 

Table 3. — Research grants and awards, fiscal year 1956 157 

Table 4. — Payments to States, fiscal year 1956 158 

OFFICE OF EDUCATION 

Introduction 159 

White House Conference on Education 160 

The Conference 160 

Report to the President 161 

The Committee Report 161 

Conference Report 162 

What Should Our Schools Accomplish? 162 

Nevir Challenges in Education 162 

What Are Our School Building Needs? 162 

How Can We Get Enough Good Teachers— And Keep Them? 163 

How Can We Finance Our Schools — Build and Operate Them? 163 

How Can We Obtain a Continuing Public Interest in Education? 163 



266 Department of Health, Education, and Welfare, 1956 

Page 

State and Territorial Summaries 163 

Followup 164 

Pkesident's Conference on Fitness of American Youth 164 

President's Committee on Education Beyond the High School 165 

Legislation 167 

Progress and Problems 169 

Enrollment 170 

Teacher Shortage 170 

Classrooms 170 

Migrant Children 170 

School Dropout Problem 171 

Manpower Shortage 171 

Signs of Progress 171 

Re search 172 

Cooperative Research Program 173 

Research and Statistical Services 175 

Reference Service 175 

Research Consultation 175 

Research Studies by Office Specialists 175 

Services to Education 176 

Administration 176 

Organization 177 

School Finance 177 

School Housing 178 

Elementary Education 178 

Secondary Education 179 

Adult Education 179 

Intergroup Education 180 

Exceptional Children 180 

Audiovisual Education 181 

Radio-Television 181 

Civil Defense Education 182 

Guidance and Student Personnel Services 182 

Services to Libraries 183 

Vocational Education 184 

Higher Education 186 

Research 186 

Services and Studies 187 

Administration of Grants 188 

International Education 188 

International Educational Relations 188 

Educational Exchange and Training 190 

Educational Missions Abroad 191 

School Assistance in Federally Affected Areas 191 

Major Publications Off the Press in Fiscal Year 1956 192 

Table 1. — School enrollments in the continental United States, 1954-55 

and 1955-56 194 

Table 2. — Supply and demand for elementary and secondary public and 

nonpublic school teachers, 1955-56 194 

Table 3.^ — Grants to States: Office of Education, fiscal year 1956 195 



Detailed Contents 267 

FOOD AND DRUG ADMINISTRATION 

Page 

Fifty Years of Progress 197 

Food, Drug, and Cosmetic Act 201 

Disaster and Defense Activities 201 

On the Food Front 202 

Potential Health Hazards 202 

To Keep Food Clean 204 

Pocketbook Protection 207 

Seafood Inspection Service 207 

Products of Special Dietary Significance 207 

Drugs and Devices 209 

Illegal Sales 210 

Misbranded Drugs and Devices 210 

Veterinary Drugs 212 

New Drugs 213 

Cosmetics and Colors 213 

Changes in the Law and Regulations 213 

Regulations 215 

Certification Services 2 16 

Enforcement of Other Acts 217 

New Court Interpretations 217 

Scientific Investigations 219 

Enforcement Statistics 221 

Table 1. — Actions on foods during the fiscal year 1956 205 

Table 2. — Number of samples on which criminal prosecutions and seizures 
were based and number of court actions instituted during the fiscal year 

1956 222 

Table 3.— Import inspections and detentions during the fiscal year 1956- _ 222 

OFFICE OF VOCATIONAL REHABILITATION 

Community Enterprise Plays Key Role in Nationwide Rehabilita- 
tion Program 223 

Highlights of 1956 225 

Rehabilitants: Further Facts 225 

Program Developments at the Grassroots 226 

State Plans - 228 

Basic Support of State Programs 228 

Expansion Grants 228 

Extension and Improvement Projects 228 

Cooperation in Administering the "Disability Freeze" 229 

Progress in Rehabilitation Research 229 

Training of Rehabilitation Personnel 232 

Guidance and Setting of Rehabilitation Standards 232 

Cooperative Relationships 233 

Stimulating Employment for the Disabled 234 

The Vending Stand Program for the Blind 234 

Developments in Medicine and Physical Restoration 235 

Rehabilitation Facility Construction 235 

Mental Health: Plans and Progress 235 



268 Department of Health, Education, and Welfare, 1956 

Page 

Informational and Educational Activities 236 

International Cooperative Efforts 237 

Table 1. — Number of referrals and cases, by agency, fiscal year 1956 238 

Table 2.— Vocational rehabilitation grants, 1956, State divisions of 

vocational rehabilitation 240 

Table 3. — Vocational rehabilitation grants, 1956, State commissions or 

agencies for the blind 241 

Chart 1 . — Disabilities and major occupational groups 227 

SAINT ELIZABETHS HOSPITAL 

Division of Medical Services 244 

Clinical Branches 244 

Medicine and Surgery' Branch 246 

Psychotherapy Branch 246 

Psychology Branch 246 

Laboratory Branch 246 

Nursing Branch 246 

Occupational Therapy Branch 247 

Social Service Branch 247 

Chaplain Services Branch 247 

Library Services 247 

Special Services Branch 248 

Volunteer Services Branch 248 

Teaching Activities 248 

General Administration 249 

Needs of the Hospital 250 

Table 1. — Movement of patient population, fiscal year 1956 251 

Table 2.— Consolidated statement of movement of patients, bj^ classifi- 
cation, fiscal year 1956 252 

AMERICAN PRINTING HOUSE FOR THE BLIND 

Services to Schools and Classes for the Blind 253 

GALLAUDET COLLEGE 

Kendall School 255 

Gallaudet College 255 

HOWARD UNIVERSITY 

Enrollment of Students 257 

Geographical Distribution of Students 257 

Veterans 258 

Army and Air Force ROTC 258 

The Faculty 259 

The Building Program 259 

Graduates 259 

Service in Foreign Countries 260 

U. S. SOVERNMENT PRINTINS OFFICE: U57