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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. 

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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, 


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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,  Education,  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. 0 

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 


Department  of  Health,  Education,  and  Welfare,  1956 


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Social   Security  Administration 


81 


3,190 
12, 838 

2,108 
701 
996 

8,348 

1,105 
355 

i 

3,568 

823 

41,496 

5,532 

860 

4,843 

4,387 

2,911 

8,537 

2,015 

1,402 

3,005 

416 

856 

1,410 

298 

24 

2,267 

6,099 

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5,075 
10,  693 
2,  540 
1,282 
3,764 
13,  367 
1,449 
988 

CD 

?5 

3,941 

1,681 

40,  060 

13, 094 

934 

8.274 

6,524 

3,305 

12,  766 

20. 143 

1,568 

7,854 

789 

2.271 

1,797 

531 

101 

4,981 

5,390 

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82 


Department  of  Health,  Education,  and  Welfare,  1956 


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83 


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Ol 

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t^OO-*  b--* 

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ooo:  -H  — 1 
— 1  00(MTti 

3,987 
937 

49, 000 
5,981 
930 
5,521 
4,754 
3,169 

10,018 
2,418 

1,493 

3,301 

475 

944 

1,482 

322 

29 

2,578 

6,425 

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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. 0 

$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  0 

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  0 

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  0 

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  Health  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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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  Education }^ 

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 

0 


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 

0 

0 

79 

130 

0 

0 

1,  034 

286 

1 

3 

689 

142 

1 

3 

6 
3 

Cosmetics  and  colors  - 

0 

Caustic  poisons 

0 

*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 

0 

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 
0 
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 
0 

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 
0 

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 

0 

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 
0 

15 
0 

42 
0 

4 
0 

0 
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 

0 

476 

6,896 

-10 

113 

2,065 

+  10 

89 

1,413 

0 

202 

3,478 

-1 

170 
1,999 

+1 

104 

1,419 

0 

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