    [U.S. Department of Health, Education, and Welfare Annual Report 1962]
    [From the U.S. Government Publishing Office, www.gpo.gov]

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    Contents
    Page
    The Secretary’s Report........................................ 1
    Social Security Administration............................... 13
    Public Health Service....................................... 139
    Office of Education......................................... 235
    Food and Drug Administration................................ 311
    Office of Vocational Rehabilitation......................... 363
    Saint Elizabeths Hospital................................... 395
    American Printing House for the Blind....................... 411
    Gallaudet College........................................... 413
    Howard University........................................... 415
    (A detailed listing of the contents of this report, byl [topic headings, will be found on pages 421—433J
    vii
    Anthony J. Celebrezze of Cleveland, Ohio, was nominated by the President on July 16, 1962, as the new Secretary of Health, Education, and Welfare. He was confirmed by the Senate on July 20, 1962, and was sworn in by the President on July 31, 1962. He replaced Abraham Ribi-coff of Connecticut.
    The Secretary’s Report
    The dimensions of progress are varied and changing, and the measure of progress an intricate task. It requires looking both to the past and to the future.
    This report reflects the many dimensions of progress in the Department of Health, Education, and Welfare during the fiscal year 1962. Looking back over a year of effort, it seeks to measure advances in health, education, and welfare through the Department’s 112 programs. It tries also to assess the present and to anticipate the future— to identify shortcomings, realign perspectives, and to fix new sights.
    To Promote the General Welfare
    The responsibility of this Department—simply stated—is to help promote the general welfare of the 185 million men, women, and children who make up our national family. It is concerned with their present well-being—their hope for the future. Its constant aim is to improve the conditions of life in which we all share, to enlarge the capacity of individuals to create for themselves and their society a good—a better—life.
    This is no simple task, for the conditions of modern life are increasingly complex and the problems affecting our national well-being seldom are easily solved.
    We are living in an era of change—rapid, revolutionary change— in which the patterns of relationships between man and his environment and between man and his fellow man are in process of transformation. We are living in a time in which new concepts and new technologies are born in such swift succession that the stability of a society is no longer measured by its constancy but by its ability to move and adapt itself to the new conditions it has created.
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    Department of Health, Education, and Welfare, 1962
    The great surge forward in science and technology has not been accompanied by an equal advance in the conditions of human welfare. Social progress lags behind the achievements of our scientists and technicians.
    Science has given us powerful new tools for the conquest of disease and the further expansion of human knowledge, but it has also presented mankind with new problems and new perils. The swift advance of technology in agriculture and industry has brought new prosperity to our people—new comforts and new wealth—but the increased efficiency of machinery, which brings us better products at reduced cost, has created severe personal problems for workers whose skills are displaced or made obsolete.
    The extension of the average lifespan from 47 years at the beginning of this century to a record 70 years is a notable achievement, but the value of this progress in human terms is diminished by the fact that these added years of life do not always bring added years of happiness.
    Our population growth, the expansion of knowledge, the unleashing of nuclear power to build or to destroy, the economic and technical revolutions of the 20th century—all these are among the complicating factors which contribute to the massive problems involved in our effort to “promote the general welfare.”
    This Department’s approach to these problems is at once positive and constructive. It combines humanity and commonsense. It is rooted in the traditional American respect for independence and self-reliance. It seeks to lift the shackles that bind and handicap an individual, that prevent him from accomplishing all that he might be capable of.
    In short, we view our responsibility as guarding and conserving the human resources of this Nation—protecting the well-being of the individual citizens whose combined strength is the measure of our national strength today and in the generations to come.
    Organization for Action
    Since its establishment in 1953, the Department has exercised its responsibilities through five major operating agencies: The Public Health Service, the Office of Education, the Social Security Administration, the Food and Drug Administration, and the Office of Vocational Rehabilitation. Date in 1962 plans were announced for the establishment of a sixth major agency—the Welfare Administration—to bring together the Department’s principal welfare programs under the direction of a new Federal Commissioner of Welfare. Programs concerned with the welfare of children, the aging, and families and individuals in need had previously been attached to the Social
    The Secretary’s Report
    3
    Security Administration or to the Secretary’s immediate office. Their regrouping under a central Welfare Administration reflects the new responsibilities placed on the Federal-State welfare programs by the Public Welfare Amendments of 1962 and the need for full-time leadership and direction for both the welfare and social security programs to insure their careful administration. The old-age, survivors, and disability insurance program, which now employs nearly half the Department’s personnel, will have top-level administrative status as the primary mission of the Social Security Administration.
    The work of all these agencies involves 112 separate programs and, in 1962, accounted for a total Federal expenditure of nearly $4.5 billion. Some of these programs—such as social security and the inspection of food and drugs—are carried out directly by the Department. The majority of the Department’s programs, however, are cooperative undertakings with the States which share our responsibilities for the welfare of the people.
    Most of the Department’s money goes out across the country in the form of grants to the States, local communities, and institutions to support local projects in health, education, and welfare, and to aid in research that promises new benefits to all people. In 1962 almost 90 percent of its budget was devoted to these purposes. The largest single expenditure was in grants for public assistance.
    We do not work alone, and neither do we seek to dictate policies or to control the actions of responsible agencies—public or private— which have joined with us in this broad effort on behalf of all the American people. The fundamental philosophy underlying all the Department’s programs is one of respecting, preserving, and encouraging local initiative—for here lies the true strength of America. We provide the mechanisms for cooperative action on health, education, and welfare programs throughout the land. We respond to local needs wherever possible with money and expert technical assistance. The success of our undertakings is determined not by how many programs we administer or how much money we expend but by the degree of cooperation we achieve with States and communities and with public-spirited organizations and individuals in all walks of life.
    Past as Prologue
    The work of the Department is based on two fundamental concepts: (1) the prevention of human suffering and waste of human potential, and (2) the rehabilitation and restoration to productive capacity of individuals who have fallen victim to the age-old scourges of disease and poverty or to newer hardships born of progress.
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    Department of Health, Education, and Welfare, 1962
    Our programs of prevention and rehabilitation reach across all fields of endeavor. In the field of health this kind of activity has long been familiar to the public through the efforts of the Public Health Service to control or eliminate the agents of disease. For many years the Public Health Service has worked to help insure the physical well-being of the American people through improved sanitation, accident prevention campaigns, mass inoculations against contagious diseases, insect eradication programs, and other measures essentially preventive in character. Today these programs have been extended to meet new health hazards created by man himself— among them the contamination of our atmosphere by automobile exhaust fumes and radioactive fallout, and the pollution of our waterways by manmade chemicals which have come to plague as well as protect us.
    The Food and Drug Administration, too, has long played a protective role in guarding the Nation’s health. Its ward is the consumer; its statutory responsibility is the protection of the public against unsafe drugs and cosmetics, contaminated foods, medical quackery, and dishonest labeling of commercial products. In many ways it serves to complement and reinforce the preventive measures of its sister agency, the Public Health Service.
    The concept of rehabilitation as a public responsibility and as sound public welfare policy has been successfully pioneered by the Office of Vocational Rehabilitation in close cooperation with State agencies. This joint Federal-State program has demonstrated beyond all doubt the enormous gains in personal happiness and economic wellbeing that are possible for both the individual and the Nation when disabled or handicapped persons are given the opportunity to reduce their impairments, to learn new skills, to find useful employment, and to take their places as self-supporting, self-reliant members of society.
    Progress—1962
    In 1962 this pattern of prevention, protection, and rehabilitation was carried further into the fields of education and welfare. In this way, we have begun to knit together allied programs in separate fields, giving to each and to all greater strength and effectiveness.
    Adequate education, for example, is a concept as old as civilization itself: the idea that man must learn in childhood and adolescence to provide for himself and his family in adult life. In this modem age, an individual’s ability to work, to earn a living, and to enjoy the cultural benefits of the world around him depend in large part
    The Secretary’s Report
    5
    on formal education and training. Without the basic educational skills—reading, writing, and simple arithmetic—he cannot carry out his responsibilities as a worker, a parent, and a citizen. In today’s highly developed industrial society, individuals with educational deficiencies are the last to be hired and the first to be fired. Among their ranks is found the greatest incidence of disease, poverty, and crime. They make up the largest number of public welfare recipients.
    Our new look in welfare, then, involves preventive health measures; adequate education; rehabilitation programs for those with physical, emotional, or educational handicaps—and, undergirding all this, a new emphasis on family and community services. These efforts require a degree of cooperation within the Department and among State, local, and private welfare agencies never before attempted on such a broad scale. Actually, there is hardly a program in the Department that is not concerned in one way or another with helping to reduce dependency—helping every citizen, old and young, to achieve the sense of personal security that is the foundation of freedom.
    Building upon the past and laying new foundations for the future we have strengthened the Department’s program on many fronts and in many fields:
    —A focal point for cooperative health services was established with the creation of a new Division of Community Health Services in the Public Health Service. This new administrative unit works with local communities to help find ways to coordinate public and private health and medical services, and to improve and expand preventive, curative, and restorative services wherever they are needed. Under the Community Health Services and Facilities Act of 1961, we have been able to support widespread research on ways to improve out-ofhospital services, particularly for the aged and the chronically ill.
    —In the vast area of medical research important gains have been made in our continuing quest for deeper understanding of the complex processes of life. The partial cracking of the “genetic code” by scientists at the National Institutes of Health and elsewhere has brought us to the threshold of understanding long-hidden mysteries involved in the systematic reproduction of all living matter and bears far-reaching implications for the future health and well-being of mankind.
    —A National Institute of Child Health and Human Development was created by the Congress to provide a central facility for research on unsolved problems relating to child health, maternal health, prenatal development, and aging. At the same time the Division of General Medical Sciences was elevated to Institute status, giving added recognition to a Federal program which supports research in sciences basic to medicine and biology.
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    Department of Health, Education, and Welfare, 1962
    —In the area of environmental health, additional safeguards were established to protect the public from the growing dangers of air and water pollution.
    Amendments to the Federal Water Pollution Control Act have enabled us to increase the amount of Federal aid to States and municipalities for construction of sewage-treatment plants so that 754 projects received Federal funds in 1962, compared with 590 the previous year. The new amendments also strengthened the enforcement provisions of the act and provided for an expanded program of research to find new ways of combating this national health menace.
    New protective measures against air pollution were put into effect, and surveillance programs were intensified. An important step toward clearing the air—particularly in urban areas—was an agreement by automobile manufacturers to install blowby devices on all 1963 model cars to help reduce the amount of potentially harmful exhaust fumes from the millions of automobiles traveling the Nation’s roadways.
    The Federal-State Radiation Surveillance Network, which monitors the level of radioactive fallout throughout the country, was expanded from 45 to more than 65 stations, and, with the resumption of nuclear weapons testing by the U.S.S.R. in the fall, all stations were placed on a round-the-clock schedule.
    —Additional protection for the consumer was provided by important changes in regulations under the Food, Drug, and Cosmetic Act. Among these are requirements for more complete and accurate information on the dangers as well as the usefulness of prescription drugs, revised inspection procedures to insure their purity, and strengthened controls over testing in clinical trials. Public attention was focused on the need for these changes when a new drug, thalidomide—which may produce tragic deformities in babies when taken by mothers during pregnancy—was widely used in clinical investigations in spite of the fact that it had been withheld from the market because its safety was questioned by Dr. Frances O. Kelsey, the responsible Federal review officer. New legislation to provide more adequate authority to control the manufacture and marketing of drugs was enacted by the Congress.
    —Wider enforcement of food and drug laws covering the amount of toxic residues that may safely remain on raw foods was made possible by an increase in the FDA inspection staff and the development of improved methods of detecting and measuring agricultural poisons. Still, inspections cover only a minute fraction of the total 2^ million annual interstate shipments of fresh fruit and vegetables. Before the end of next year, by more than tripling the current number of samplings, we will bring our inspection coverage up to 1 percent
    The Secretary’s Report
    of all shipments. Appraisal of the results of this intensified program will enable us to determine whether a still further increase in the sampling and inspection coverage is necessary to assure protection of the public from unsafe residues on foods.
    —A concerted effort was made to alert the public to frauds connected with medical and nutritional quackery, which cost the American consumer an estimated $1 billion a year. New regulations have been proposed on labeling of special dietary foods to prevent exploitation of the consumer by false or misleading claims. In addition, the first National Congress on Medical Quackery was called in October and brought together representatives from private and Government agencies and the communications media to design special information projects to protect the public from hucksters of pseudomedicine.
    —Programs to alleviate the problems faced by the Nation’s 17.5 million senior citizens have been strengthened throughout the Department. The Special Staff on Aging was doubled in size and given an increased budget so that it could better coordinate our programs on aging and provide special services to State, community, and voluntary organizations working in this field. A 29-member panel of nationally known specialists was appointed to advise the Secretary on problems of the aging, and, upon the recommendation of this Department, a President’s Council on Aging was established in May 1962 to coordinate all Federal programs in this field.
    —The new amendments to our welfare laws, coupled with sweeping administrative changes in the public assistance program, have allowed us to make substantial progress in the welfare field. The newly designated Bureau of Family Services now offers a family-centered approach to welfare problems and provides a broader framework for preventive and rehabilitative services designed to help move people off the welfare rolls. Special stress has been brought to bear on meeting problems of illegitimacy, desertion, and protection of children, and on community planning responsibilities.
    —There has been broad and significant expansion of child health and welfare services. Increased appropriations for 1962 permitted States to expand and extend maternal and child health, crippled children’s, and child welfare services. For the first time, in 1962, Federal funds were made available for research and demonstration projects in child welfare. The 1960 amendments to the child health and crippled children’s provisions, to permit special project grants to be made directly to institutions of higher education, were also implemented in 1962.
    The 1962 amendments to the Social Security Act represent the most important changes in the child welfare program since 1935. These
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    Department of Health, Education, and Welfare, 1962
    changes provide for gradually doubling the amount authorized for annual appropriations from $25 million to $50 million per year; for special project grants for training personnel in the field of child welfare, including traineeships, so that insofar as it is possible there will be full geographical coverage in the child welfare services field by July 1, 1975; and for earmarking up to $10 million of Federal child welfare funds for day-care services. Since no supplemental appropriation for day-care services during fiscal 1963 was made before Congress adjourned, this latter provision has not been implemented.
    —Several important improvements were made in the old-age, survivors, and disability insurance program by the 1961 amendments to the Social Security Act. A reduction in eligibility requirements for insurance benefits brought additional thousands of elderly persons under the protective shield of social security. The new amendments increased the minimum benefits paid to retired workers in general, and increased aged widows’ benefits by 10 percent. They also lowered the retirement age for men from 65 to 62 and gave added incentive to workers to continue part-time employment after retirement.
    —In the field of education, although legislation to give much needed assistance to the States and to higher education failed, notable progress was made in our drive to stimulate new efforts toward excellence in the Nation’s schools and colleges. A stepped-up research and development program in the field of English has set the pace for a new national appraisal of instruction in this basic subject and serves to complement the very successful programs for expansion and improvement of instruction in mathematics, science, and foreign languages operating under the National Defense Education Act.
    •—The passage of the Manpower Development and Training Act in March 1962 was a singular achievement in vocational education and carries important implications for the future. Here vocational education is being supported by the Federal Government on a broad national scale in an attempt to solve the problem of unemployment and consequent dependency among workers with obsolete skills or limited educational attainment. At the same time, this legislation has stimulated new approaches to the entire field of vocational and technical training. Under this program, vocational training is being directed to specific jobs in fields where manpower is in short supply. The whole field of vocational and teclmical education and its relationship to national manpower needs was under study during the year by a special panel of national representatives from industry, labor, and education. Their recommendations for new directions in vocational education were presented near the end of the year and provide a basis for reshaping the Federal vocational acts and the programs to which they are directed.
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    —The Federal-State vocational rehabilitation program passed an important milestone this year by providing physical restoration, new skills, and economic independence to more than 100,000 disabled persons. This marks the passage of the halfway post on the road to 200,000 rehabilitations a year—a goal set for the program when the rehabilitation legislation was enacted in 1954. The Office of Vocational Rehabilitation, which administers this program, was renamed the “Vocational Rehabilitation Administration” early in 1963, and its head was given the title of “Commissioner of Vocational Rehabilitation.”
    —Efforts to prevent and cure juvenile delinquency have been stepped up during the year under the overall direction of the President’s Committee on Juvenile Delinquency and Youth Crime, which consists of the Attorney General, the Secretary of Labor, and the Secretary of Health, Education, and Welfare. Grants under the Juvenile Delinquency and Youth Offenses Control Act of 1961 have been made to support 15 community planning projects in which cities are preparing broad action programs, 26 training programs for youth workers, and a major demonstration project—the Mobilization for Youth program in New York’s lower East Side. Under the direction and coordination of the President’s Committee, Federal youth-service agencies—including those of this Department—are giving technical assistance to the communities which have received grants under the act.
    —By the end of 1962, over 155,000 Cuban refugees who had fled the Castro regime had registered at the Department’s Cuban Refugee Center in Miami and had been provided with a variety of health, welfare, educational, and employment services. As the result of an intensive campaign conducted by the Department, with the assistance of a number of volunteer agencies, more than 52,000 of these refugees have been resettled in over 1,100 communities throughout the Nation, where they have opportunities to put their skills to use, to continue their education, and to build new lives for themselves during their exile from their homeland. The urgent need for continued resettlement efforts is underlined by the fact that two out of three of the 100,000 refugees still in the Miami area require public assistance because of the limited job opportunities there.
    Tasks for Tomorrow
    Against the backdrop of the past, it can truthfully be said that the American people have never been as well served—in health, education, and welfare—as they are today. But comparison with the past is an imperfect measure of progress, for we are living in a changing 665171—63-------2
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    Department of Health, Education, and Welfare, 1962
    present and we face an uncertain future. Our efforts of today merge with our tasks for tomorrow—and with our hopes for a better life for ourselves and our posterity.
    We are not content to see the costly burden of medical care clouding the latter years of life for most of the Nation’s 17.5 million people over the age of 65. The high and still-rising costs of illness in old age present a fearful specter to our older people—and to their families—for when illness strikes the elderly it can reduce otherwise independent people to poverty almost overnight. The problem we must resolve is how to provide needed health services to all older people—how to prevent illness from forcing them into the poverty and dependency which can tarnish the “golden years” of life. This administration’s proposed solution to this problem is a program of health insurance for the aged, financed through social security—a plan which would make it possible for people to acquire paid-up health insurance at age 65 through small regular contributions during their working years. In addition, we will continue to encourage those States that have not done so to establish medical assistance plans for the aged under the Kerr-Mills Act of 1960.
    We do not accept as inevitable and insoluble the appalling waste of human lives and the incalculable cost and suffering resulting from mental retardation among some 5.4 million American children and adults. We recognize the need to concentrate greater effort on research into the causes and prevention of mental retardation, as well as the need to make better use of our present resources and present knowledge. With the report of the President’s Panel on Mental Retardation serving as a blueprint, we plan to establish a comprehensive, long-range program to prevent, treat, and alleviate this major national problem.
    We are not content with our national posture in the field of education, and we will continue to press for measures to strengthen our schools and colleges. We have long recognized our obligation to protect the public interest in matters regarding public health and the quality, safety, and effectiveness of such tangibles as foods, drugs, and cosmetics. Education—although it is not manufactured, packaged, and labeled—is no less tangible a commodity for public use and no less vital to the Nation’s well-being. If our young people are shortchanged in the quality of education they receive and if their educational opportunities are limited, the Nation as a whole suffers— in loss of talent and productive energy, in blighted hopes and wasted lives.
    Adequate education, then, is an essential corollary to preventive measures in health and welfare. It involves increased efforts to wipe out adult illiteracy and to provide the American people—young and
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    adult—with the skills and knowledge essential for independent, productive lives. It requires broad retraining opportunities for men and women whose skills are made obsolete by technological advances. It calls for measures to eliminate the financial barriers to higher education for young people of limited resources but unusual ability. It means putting an end to discriminatory practices in education. It means increased attention to the quality of education our children receive. It means assurance that adequate space is available in our schools and colleges, that the schools are staffed with a sufficient number of well-trained teachers, and that the tools of education—materials and equipment—are up to date.
    We are dissatisfied with our present efforts in accident prevention and public safety. During 1961 alone, 45 million people suffered accidental injuries—from motor vehicles, home accidents, poisoning, and other causes. Accidents are the fourth leading cause of death for Americans of all ages, following heart disease, cancer, and stroke. For persons aged 1-35, accidents are the leading cause of death. We believe that this needless source of human suffering—this appalling waste of life—can and must be prevented. Just as research and technology have provided us protection against the fatal and crippling effects of disease, so must they now seek out and define the real causes of accidents and develop new means of prevention.
    A similar program of research and prevention needs to be launched against the problems of alcoholism and drug addiction. These costly and debilitating afflictions, which strike alike at rich and poor, have for too long been shrouded with mystery and misunderstanding. Much more can and should be done by health, education, and welfare agencies to aid in their prevention and control.
    We are, in fact, not satisfied with resting on our accomplishments in any field or any program. Too many questions remain unanswered ; too many problems remain unsolved.
    How we ourselves have fulfilled the public trust is the final dimension to our measure of progress. We are acutely aware of the huge responsibility we bear to the American public for effective, efficient administration of the programs entrusted to our care. We are responsible for the investment of billions of dollars of public funds, and we bear a continuing responsibility to see that the public receives full returns on its investment. This means efficient management of our programs, careful expenditure of the tax dollar, resourceful use of our personnel, effective coordination among our agencies.
    It is not possible in this fast-moving age to stop and say we are done. We can only pause from time to time to say that we have begun—knowing that other beginnings, other tasks, await our attention tomorrow.
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    Department of Health, Education, and Welfare, 1962
    Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1962
    [On checks-issued basis]
    States	Tota	Social Security Administration	Public Health Service 1	Office of Education	Office of Vocational Rehabilitation	American Printing House for the Blind 2	White House Conference on Aging
    Total		$3,217,801,775	$2,498,729,820	$255,670,997	$397,674,578	$65,077,625	$680,000	—$31,245
    Alabama		90,078,370	72,690,489	5,565,156	9,249,636	2,560,487	12,602
    Alaska	15,089,559	2,273,273	4,032,144	8,667,002	117, 704		-564
    Arizona- __	27, 488, 912	18,027,287	2,303,172	6,592,762	559,730	5,961
    Arkansas 		50,462,654	37,466,788	5,548,279	5, 487,674	1,953,272	6,641
    California	330,628,600	266,248,284	11,732,450	49,252,341	3,333,797	61,728
    Colorado. _	56,341,752	42,477,847	2,963,365	10,160,191	734,068	6,281
    Connecticut		29,170,597	22,258,445	i; 783,150	4,721,344	393,050	15,002	-394
    Delaware			6,078, 610	3,297, 747	1,287,446	1,323,575	174,095	1,920	-6,173
    District of
    Columbia....	12,633,261	10,951,274	1,048,797	348,393	283,157	1,640
    Florida 			84,899,464	64,606,081	7,761,615	10,111,498	2,401,748	18,522
    Georgia		92,888,391	71,336,812	8,304,343	9,707,697	3,522,857	16,682
    Hawaii		18,032,719	5,434,941	2,163,912	9,978,681	452,465	2,720
    Idaho				13,883,734	9,240,087	1, 934, 579	2,481,514	230,010	1,120	-3,576
    Illinois	144,403,814	123,855,813	8,437,084	9,530,681	2, 550,552	29,684
    Indiana.	38,120,325	28,297,812	5,172,921	4,025,773	' 610,777	13,042
    Iowa		43,068,207	34,043,994	4,596,555	3,387,133	1,033,524	7; 001
    Kansas... _	_ _	40,941,438	28,334,260	3,919,323	7,862,532	817,082	8,241
    Kentucky.			64,676,368	53,919,970	6,075,229	3,884,331	792,231	7,281	-2,674
    Louisiana.	130,581,384	120, 785,880	4,508,469	3,199,848	2,075,946	11,241
    Maine			19,592,253	14,700,171	1,541,439	2,996,998	352,045	1,600
    Maryland		40,504,810	23,810,276	4,330,878	11,639,456	710,078	14,122
    Massachusetts...	98,859,859	80,327, 783	5,256,330	11,867,828	1,382,419	26,483	-984
    Michigan			97,099,575	77,806,289	7,958,318	9,671,211	1,636,747	28,124	-1,114
    Minnesota .	53,438,422	43,873, 938	5,094,442	3,195,155	1,263, 766	11,121
    Mississippi ...	51,699,232	39,824,141	6,842,519	3,881,011	1,144,840	6,721
    Missouri	105,081,945	91,722,344	5,919,687	6,148,591	1,280,402	10,921
    Montana	11,869,195	6,846,659	1,503,835	3,187,370	329,211	2,120
    Nebraska		22,491,446	15,478,274	1,958,477	4; 612,366	439,899	3,761	-1,331
    Nevada. .	7,150,762	3,141,089	1,323,068	2,599,947	85,818	840
    New Hampshire.	9,024,148	5,227,501	1,640,136	2,017,355	142,710	1,960	-5, 514
    New Jersey			50,924,167	35,643,240	5,046,480	8,931,557	1,278,607	24,283
    New Mexico		28j 265' 892	17,734,091	2,713,192	7,544.939	' 269,229	4,441
    New York	249,136,174	214,468,265	14, 735,094	14,982,889	4,888,358	61, 568
    North Carolina	83^ 293, 191	63;244,124	8,376,818	9,066,815	2,585, 752	19,682
    North Dakota	14,686,441	9,160,921	2,661,535	2,462, 995	399, 710	1,280
    Ohio.	12L 243,198	98; 027; 086	8,986,488	12, 538,008	1,659,652	31,964
    Oklahoma 		105,822,373	89; 715,142	4,238,034	10,305,571	1, 559, 545	4,081
    Oregon	29,529,064	22,660.650	2,836, 451	3,324,094	699,028	8,841
    Pennsylvania _	14L 656,989	111,600,418	13,525,561	10,950,904	5,533,700	46,406
    Rhode Island	17,350,470	12,698; 724	1,443,062	2,760,116	445,288	3,280
    South Carolina	38,037,801	24,043,689	6,032,868	6,583, 910	1,370,333	7,001
    South Dakota	15,849,441	9,659,013	L 929,610	3; 952,873	305’, 945	2,000
    Tennessee	61,232,582	46,836,688	7,067,078	5,487,145	1,829,469	12,202
    Texas	178,301,681	142, 790,014	14,164; 483	19,307,414	2,016,287	23,483
    Utah.. 		16; 522,808	11,165,007	1,384; 575	3,685,580	292.040	2,840	-7,234
    Vermont	7,417,059	5,354,638	1,077; 820	736,501	247,260	840
    Virginia	52; 871, 969	24,362,816	8,327,140	18,665,073	1,503,138	13,802
    Washington		6i; 777; 796	45’, 864,424	3,152,190	11,870,037	879,437	11,962	-254
    West Virginia..	52,076,932	45,817,432	2, 745,407	1,920,531	1,585,399	8,561	-398
    Wisconsin		46,333,301	34,905,620	5,726,305	4,558,708	1,132,416	11,001	-749
    W yoming	5,780,851	3,265,806	718,977	1, 679,842	115,066	1,160
    Canal Zone	128,491	128,411				80
    Guam	8,383,981	1,750,669	4,803, 740	1,762,498	67,074
    Puerto Rico... ..	13,381.232	9,223,612	1,401,617	L730,009	1,022,907	3,160	-73
    Virgin Islands	604,680	303,771	69,354	204,270	27,498		-213
    Undistributed	10,913,405			10,872; 405		41,000

    i Excludes $252,447 paid to water pollution interstate agencies. » Includes permanent annual appropriation of $10,000.
    Social Security Administration
    Social Security in 1962
    Significant new emphases stemming from the conviction that we can and must do more to shape our public welfare programs toward the goals of preventing and reducing dependency marked developments during fiscal year 1962. That conviction and the emphases it generated found concrete expression in actions on a broad front— in legislative developments, in administrative changes, and in new directions in social welfare research.
    Achievement of a new emphasis in public welfare began with a comprehensive review of the public welfare programs of the Social Security Act. State and local welfare officials and leaders in voluntary organizations contributed to the study. This activity culminated in a number of administrative changes, detailed in subsequent sections of this report, and in the development of legislative proposals for submittal to Congress. The proposals were embodied in the Public Welfare Amendments of 1962, enacted shortly after the close of the fiscal year.
    The amendments emphasize provision of services to help families become self-sufficient. The States will be enabled to provide incentives that will contribute to reduction in the need for continued public assistance. This approach recognizes the importance of rehabilitation in helping welfare recipients better to be able to care for themselves and, wherever possible, to become self-supporting.
    The amendments also have the objective of maintaining and strengthening family life for children. In addition, emphasis is placed on training to increase the supply of adequately qualified public welfare personnel to provide some of the services that can help to reduce the need for and the cost of the public assistance programs.
    Signifying the increased emphasis on the importance of welfare services directed toward strengthening family life and the self-reliance of individuals, the name of the Bureau of Public Assistance was changed to Bureau of Family Services effective January 1,1962.
    Other action on the administrative and legislative fronts that made our social security programs better suited to serving the Nation’s
    13
    14
    Department of Health, Education, and Welfare, 1962
    social and economic needs included implementation of the Social Security Amendments of 1961. Provisions of the 1961 amendments reduced some of the hardships resulting from old age, disability, or death of the family wage-earner by liberalizing the Federal old-age, survivors, and disability insurance program and by increasing Federal sharing in State assistance payments to the aged, the blind, and the disabled. Also, under the provisions of Public Law 87-31, 15 States extended the coverage of their aid to dependent children programs to help children of unemployed parents. The Public Welfare Amendments of 1962 included a provision making Federal funds available for such aid through fiscal year 1967.
    The Juvenile Delinquency and Youth Offenses Control Act of 1961 authorized a 3-year program that provides for (1) grants to finance projects that will demonstrate and evaluate techniques and practices for the prevention and control of juvenile delinquency and youth offenses, (2) grants for the training of personnel, and (3) technical assistance services to public and private agencies working in this field. Funds were appropriated and the program was put into effect before the end of calendar year 1961.
    Although important social security legislation was passed and implemented, the President’s proposal for adding health insurance for the aged to the protection provided by the old-age, survivors, and disability insurance program was tabled in the Senate and remained a major issue. Continuing efforts were made to improve and extend the medical care available to needy aged persons through the regular old-age assistance program and the more recently enacted medical assistance for the aged program. But “social security protection, financed by payments made during the working years, supplemented by private programs and backed up by the Federal-State public assistance provisions for medical care,” said the Secretary of Health, Education, and Welfare, “is the only way to a truly effective solution of the problem.” President Kennedy announced that a bill incorporating this approach to meeting the problems arising from the costs of health care in old age would be introduced again early in the next session of Congress.
    In the Social Security Administration’s research program, emphasis on searching out the causes of dependency was continued from previous years.
    The absence of a research effort having as its main focus increased knowledge relating to the prevention or reduction of dependency was long cited by the Social Security Administration as a major gap in the total research effort in this country. The 1956 amendments to the Social Security Act provided authorization for a program of research and demonstration grants to help fill this gap. It was not until Sep-
    Social Security Administration
    15
    tember 1960, however, that funds were appropriated to implement the program. At the close of fiscal year 1962, the Social Security Administration had made thirty-nine grant awards totaling more than $1 million to educational institutions, public agencies, and other nonprofit organizations for a broad range of research of significance to social security programs and social welfare.
    Federal funds for a new program of child welfare research and demonstration grants were made available for the first time in 1962. The purpose of this grant program, which was authorized by Congress in 1960, is to provide support for (1) special research and demonstration projects in the field of child welfare that are of regional or national significance, and (2) special projects for the demonstration of new methods or facilities that show promise of substantial contribution to the advancement of child welfare. Seventeen grant awards were approved for the fiscal year.
    A new international cooperative social welfare research program of the Social Security Administration is reported on in the section on international activities.
    The intramural research activities of the Social Security Administration were strengthened during 1962 by steps taken in accordance with the recommendations of an advisory group of experts from outside Government. The major recommendation of the group in its August 1961 report to the Commissioner of Social Security was for the creation of a new unit in the Division of Program Research in the Commissioner’s Office with responsibility for long-range research, that is, research into fundamental questions relating to the nature of poverty and insecurity in modern society, the character and dimensions of poverty, and the social and other factors involving dependency and independence.
    A continuing advisory committee on research development established on the recommendation of the expert group met for the first time toward the fiscal year’s close. The purpose of the committee is to assist the Commissioner in formulating a research program for the Social Security Administration—including the work of the new long-range research unit—and in stimulating close working relationships with research personnel in universities and private research centers.
    Work was initiated on another major research project—a nationwide cross-section survey of persons 62 years and over, designed to provide information on the demographic characteristics, living arrangements, economic circumstances, and health care costs of old-age, survivors, and disability insurance beneficiaries and other aged persons. Among other uses, the survey will help meet the detailed information needs of the Statutory Advisory Council on Social Security, which will be appointed in calendar year 1963. It will, in addi
    16
    Department of Health, Education, and Welfare, 1962
    tion, provide much of the information requested by the 29-member Panel of Consultants on Aging to the Secretary of Health, Education, and Welfare. As a supplement to this study, similar information on social and economic circumstances will be obtained for a sample of mother-child beneficiaries under the old-age, survivors, and disability insurance program. Field collection and tabulation will be undertaken by the Bureau of the Census under contract with the Social Security Administration.
    At the end of fiscal year 1962, social insurance, related payments, and public assistance accounted for about 7 percent of total personal income in the United States. The social insurance and related payments portion amounted to $27.2 billion on a seasonally adjusted annual basis. The payments went to beneficiaries covered by public retirement, disability, unemployment, and veterans’ programs and included benefits for work injuries under Federal employer liability acts and cash and medical payments made under workmen’s compensation and temporary disability insurance laws. Public assistance payments in the same month, excluding vendor payments to suppliers of medical care, were made at an annual rate of $3.5 billion.
    Under old-age, survivors, and disability insurance—the largest social insurance program by far—the number of beneficiaries in current payment status increased 11 percent during the fiscal year to 17,280,-000. The monthly benefit rate increased 14 percent from $992 million in June 1961 to $1,128 million in June 1962.
    The number of disability insurance beneficiaries increased from 200,400 at the end of fiscal year 1958—the fiscal year when such benefits first became payable—to 679,300 at the end of fiscal year 1962. The provision in the Social Security Amendments of 1960 which extended benefits to disabled workers under age 50 and to their dependents, beginning November 1960, spurred the rate of increase.
    Over the 4-year period from July 1957 to June 1961, the proportion that retired workers were of total old-age and survivors insurance beneficiaries rose slightly, from 56.4 percent to 57.1 percent. At the end of fiscal year 1962, the proportion was 58.0 percent, reflecting the effect of the provision in the 1961 amendments making benefits payable to men aged 62-64. By June 30, 1962, old-age benefits had been awarded to 525,000 men aged 62-64 and wife’s or child’s benefits to 195,000 dependents of these men.
    In federally aided assistance for persons 65 and over, 2.2 million were receiving old-age assistance, and more than 102,000 received medical assistance for the aged in the 27 States that were administering such programs in June 1962. Almost 3.7 million children and their adult caretakers received aid to dependent children, including 237,000 recipients in the unemployed-parent group; 100,000 received aid to
    Social Security Administration
    17
    the blind, and 417,000 received aid to the permanently and totally disabled. In addition, 812,000 persons received general assistance financed from State and local funds. Payments for all types of public assistance for the month totaled $365 million.
    The 1962 appropriation of about $70 million for the maternal and child health, crippled children’s, and child welfare programs of the Children’s Bureau, which marked its 50th anniversary on April 9, 1962, was an increase of about $17 million over the amount available for these programs during fiscal year 1961.
    More than 1,000 new members on the average joined Federal credit unions each business day in fiscal year 1962. More than $3 billion was lent to individuals in a total membership of 6y2 million in these mutually owned institutions.
    Following the precedent set in naming his predecessor, Robert M. Ball, a career Social Security Administration official, was sworn in April 17,1962, as Commissioner of Social Security to succeed William L. Mitchell.
    The Social Security Administration had 35,304 employees on duty at the end of the fiscal year. The great majority of the employees were in the Federal program of old-age, survivors, and disability insurance.
    International Activities
    The Social Security Administration initiated new international activities during the fiscal year and cooperated in making facilities available for other programs administered by the Department of State, the United Nations, the Organization of American States, and the many voluntary agencies operating overseas exchange programs.
    The SSA planned for experts and participants coming to the United States from 92 countries, an increase of 11 countries over the last fiscal year, and 17 over fiscal year 1960. Newly independent countries are looking to the U.S. for guidance in establishing their welfare and social security programs or for training of administrative or technical personnel. A majority of the participants sponsored by governmental organizations come through the United Nations programs or the Department of State’s Cultural Exchange, with the Agency for International Development sending relatively few participants in the social welfare or social security field. The training programs planned for the participants and experts reflect new trends, both in the use of U.S. training resources and in areas of interest in social welfare. A greater number of the participants attended full-time graduate schools and remained to complete work for the degree. These persons were preparing for key posts in their own governments or to train personnel in their own universities. Other visitors, experi
    18
    Department of Health, Education, and Welfare, 1962
    enced administrators coming for a shorter period, had observation programs in the several different fields of competence of the Social Security Administration—family and child welfare, planning and administration of social insurance, prevention and treatment of juvenile delinquency, training of personnel, and credit cooperatives. Requests for programs combining several areas of the social field included social services in public housing and urban development, coordinated planning for social and industrial development, and legislative planning for social security and social services.
    The Social Security Administration began a new partnership in cooperation with other countries when an international research program using U.S.-owned local currencies under Public Law 480 was undertaken. Negotiations with the seven countries in which funds are available—Burma, India, Israel, Pakistan, Poland, UAR-Egypt, and Yugoslavia—resulted in the approval by the end of the fiscal year of projects in social services, juvenile delinquency, child care, and maternal and child health. Projects approved will contribute new knowledge to the United States. As an illustration, it is anticipated that one of the projects accepted will produce data useful in evaluating successful methods of working with young delinquents. Another project, a study of toxemia of pregnancy, will be of value as toxemia of pregnancy is the leading cause of maternal death in the U.S. and little is definitely known as yet of its cause.
    Cooperation with the Agency for International Development reflected new aspects as a result of the foreign aid legislation which underwent drastic revision during the fiscal year. With specific language in the legislation emphasizing social as well as economic aspects of development and the “development of human resources,” a base was provided for more attention to social welfare. In response to a request from the Agency for International Development Administrator, the Social Security Administration detailed a senior social welfare officer for full-time duty in the agency with a view to effective utilization of Social Security Administration resources in the foreign aid program.
    In July 1961, a member of the staff of the International Service of the Social Security Administration was appointed by the President to serve as the U.S. Representative on the Directing Council of the Inter-American Children’s Institute. This Council held its annual meeting at the Pan American Union in October 1961. One of its major achievements was the formulation of a proposed agreement with the Organization of American States. This agreement, which will have the effect of merging the administrative and fiscal organization of the Institute with that of the OAS while respecting its complete technical autonomy, was signed by the Director General of
    Social Security Administration
    19
    the Institute and the Secretary General of the OAS in Washington in May 1962.
    The 1962 conference of the International Labor Organization adopted a new convention on the subject of equality of treatment in social security. A staff member of the Division of Program Research served as advisor on the U.S. delegation.
    The International Social Security Association general meeting in Istanbul in September was attended by social security officials from every industrialized country of the world and many of the less developed as well. The U.S. delegation, headed by the Commissioner of Social Security, invited the conference to hold its next meeting in the United States in 1964. This will be the first such session ever held in this country.
    Research in social security systems to serve as a basis for providing technical assistance in this field was carried on cooperatively by the Social Security Administration and the Agency for International Development. Experts in social security financing and administration served as Social Security Administration consultants on the study.
    At the United Nations, the 14th Session of the Social Commission in April and May 1962 marked resumption of annual Commission meetings for consideration of international social questions, social policies, and technical assistance. Chief accomplishments of the Commission were the recommendations for establishment for the first time of an international committee on housing, requests for a revamped and strengthened international social welfare program, and the development of an expert report on social and economic planning with particular attention to allocation of resources. The UNICEF Executive Board Meeting approved increased requests for funds for projects in new fields such as social services, vocational training, and education as well as continuing substantial grants in the health field. The Social Security Administration provided technical advisers for the U.S. Delegations to both the Social Commission and the UNICEF Board Meetings.
    Cuban Refugee Program
    In the past 2 years, the United States has become a country of first asylum for large numbers of political refugees from Cuba. The U.S. Government has found it necessary to develop a program of help for refugees from a neighboring republic and to assume major responsibility for the health, education, and welfare needs of these unfortunate people. By June 30, 1962, about 150,000 Cubans had found political refuge in the United States.
    20
    Department of Health, Education, and Welfare, 1962
    The principal port of entry for Cuban refugees is Miami, where many remain. A number of the refugees are professionally or technically trained; they were not permitted to take any resources when they left Cuba. On reaching the United States, most need assistance of one kind or another—financial aid, employment counseling, retraining, English language instruction, or help in resettlement and adjustment to American customs.
    The severity of the Cuban refugee problems became evident near the end of 1960. President Kennedy early in 1961 expressed his concern and directed Secretary Ribicoff to undertake a study of the situation and to develop a program of assistance.
    The program as it has developed since 1961 provides:
    (1)	Financial assistance, supplemented by surplus commodities, to provide food, clothing, and shelter to needy refugees registered at the Miami Cuban Refugee Center and who are living in Florida or who resettle outside Florida with the help of voluntary agencies.
    (2)	Financial assistance in relocating refugees to homes and jobs elsewhere in the United States.
    (3)	Health services and long-term hospitalization.
    (4)	Assistance to the public schools of Dade County, Fla., in providing instruction to the refugee children as well as English instruction and vocational training to adults.
    (5)	Loans to refugee students in college and funds for English and refresher courses for lawyers, doctors, and other professional persons.
    (6)	Care of children unaccompanied by relatives.
    Administration and coordination of the program are assigned to the Commissioner of Social Security. In operating the program, the Commissioner has made full use of existing resources, as, for example, the Office of Education, the Public Health Service, the Children’s Bureau and the Bureau of Family Services within the Social Security Administration, the Bureau of Employment Security of the Department of Labor, the Dade County Board of Education, the Florida State Department of Public Welfare, and the Florida State Board of Health.
    Four voluntary agencies (National Catholic Welfare Conference, International Rescue Committee, Church World Service, and United Hebrew Immigrant Aid Society) are under contract with the Social Security Administration to handle the resettlement of Cubans to homes and jobs away from the Miami area to other parts of the country and overseas.
    During the fiscal year 1961, the program was carried out under authorities contained in the Mutual Security Act of 1954, as amended, with expenditures of nearly $5 million. During the fiscal year 1962, the program operated under authority contained in the Foreign Assist
    Social Security Administration
    21
    ance Act of 1961, with expenditures of $38,502,000. On June 28,1962, the Migration and Refugee Assistance Act of 1962 (Public Law 87-510) was enacted. This law authorizes assistance to refugees and an appropriation of $71,110,000 for providing such assistance during fiscal 1963 was made.
    Increasing emphasis is being placed on the resettlement of refugees from the Miami area to other places in the United States and overseas. New entrants from Cuba have ranged from 1,600 to 1,800 per week for the last year. By June 30, 1962, there were about 95,000 refugees living in greater Miami. Roughly 60 percent of the refugees in Florida were on assistance. Successful resettlements are essential if the refugees are to become self-supporting and the public assistance load reduced.
    Thirty-two thousand two hundred fifty-five Cuban refugees had been resettled by June 30, 1962, to over 900 communities in 49 States, Puerto Rico, the Virgin Islands, and 23 other countries. The rate of resettlement has risen in fiscal year 1962 from 1,259 persons during July 1961, to 3,454 during June 1962.
    A transition resettlement allowance averaging $80 to persons receiving assistance in Miami who resettle elsewhere was authorized in May 1962. This allowance is designed to promote resettlement by allaying the fears of the refugees over being stranded without funds in a strange city. This allowance is also intended to increase the number of sponsors; by lessening their personal financial obligations, they can be asked to place greater emphasis on providing personal services.
    The intensive efforts made to accelerate resettlements and to stimulate employment opportunities are reflected in the approximately 8,800 public assistance cases closed between January and June 1962. About 38 percent of the cases closed represented resettlements, and 31 percent represented reemployed persons.
    During the fiscal year, some 28,000 individuals, or 12,700 refugee family groups, were resettled in communities outside Florida. Relatively few of the resettled refugees (about 400 in June 1962) had to apply for assistance from local welfare agencies in the new communities; and, in most cases, the duration of assistance payments was relatively short.
    Plans were completed for the Cuban Refugee Emergency Center in Miami to move into much larger quarters on July 1, 1962. It will now be possible to step up resettlement wrork because more workers can be added by the voluntary agencies for this purpose. The Center was established in Miami as a focal point for Cuban refugee registration and resettlement activities and to coordinate the local aspects of the Federal Government’s general program of aid to Cuban refugees.
    22
    Department of Health, Education, and Welfare, 1962
    At the beginning of fiscal year 1962, 35,000 Cuban refugees had registered at the Center, and registrations were at the rate of 5,600 a month. Registrations at the end of the fiscal year were at the rate of 7,400 a month, and 90,000 refugees registered at the Center during fiscal year 1962.
    ASSISTANCE PROVIDED TO CUBAN REFUGEES
    By request of the Commissioner of Social Security, the Bureau of Family Services became an active participant in the emergency program of assistance to Cuban refugees in January 1961, when members of the Bureau’s staff made an initial reconnaissance visit to Miami. The Bureau also participated in the Department’s task force which developed basic data for a comprehensive Federal program of health, education, employment, welfare, and resettlement services for needy Cuban refugees.
    In February 1961, the Bureau was assigned operating responsibility for temporary financial assistance and related social and welfare services.
    Under an agreement with the Social Security Administration, the Florida State Department of Public Welfare administers the Bureau’s part of the program, using assistance standards similar to those established for other Florida residents in providing the basic necessities of life and hospital care.
    Other State public welfare agencies provide assistance to refugees whose resettlement plans, for a variety of reasons, are not fulfilled or who need other services.
    By the end of June 1961, approximately 8,700 cases had received assistance under the program in the Miami area. By September 1961, this number had increased to 12,600 and to 28,000 by the end of June 1962. During this 9-month period, 31,500 applications were received—an average of 715 per week. Many were emergencies. During August and September, the number of boat cases averaged 100 per week. These were persons who escaped Cuba in small craft and who needed immediate assistance and services, often medical care due to dehydration, overexposure, and injuries incurred en route.
    UNACCOMPANIED CUBAN REFUGEE CHILDREN’S PROGRAM
    By delegation from the Commissioner of Social Security, the Children’s Bureau is responsible for child welfare services, including the care and protection of unaccompanied Cuban children. These were described by the President as “the most defenseless and troubled group among the refugee population.” The Florida State Department of Public Welfare acts as agent for the Department of Health, Education, and Welfare and bears responsibility for the overall supervision and administration of the Cuban Child Welfare Pro-
    Social Security Administration
    23
    gram, implemented by contracts with voluntary agencies which accept children for placement in group care or in foster family care.
    The four voluntary agencies under contract with the Florida State Department of Public Welfare are the Catholic Welfare Bureau, Miami; Jewish Family and Children’s Service, Miami; United Hebrew Immigrant Aid Society, Inc.; and the Children’s Service Bureau of Dade County, Miami. These agencies have arranged placement for the children through cooperating child-placing agencies or institutions in the various States licensed or approved by appropriate State authorities.
    On June 30, 1962, more than 6,100 Cuban children had received either group care or been placed in foster family homes since the beginning of the program. More than 2,400 Cuban children, or about 40 percent of the total number placed had been reunited with their parents or with the family group as it was constituted in Cuba.
    Of the almost 4,000 children remaining under care on June 30,1962, 71.2 percent were in group care and 19.7 percent in foster family homes. Thirty-eight percent of the children were being cared for in the Miami area while 62 percent had been placed outside the Miami area in 38 States and 85 communities. The majority of the children under care on June 30, 1962, were adolescent boys; over 60 percent of the total number of children under care were boys, and over 85 percent were over 10 years of age.
    The large number of children arriving and the emergency nature of the program made it necessary to place over 75 percent of them in institutions or group homes until foster family homes became available or until the children could be returned to their own parents or relatives. Since it has been assumed that these children will eventually be returning to their parents who still have guardianship, the children cannot be placed for adoption.
    Old-Age, Survivors, and Disability Insurance
    The federally administered old-age, survivors, and disability insurance program plays a major role in achieving our national goal of eliminating dependency and want. It provides the base upon which almost every American builds his plans for family security in old age and in the event of his death or disablement. Under the program about 9 out of 10 gainfully employed people—self-employed as well as employees—contribute toward providing income for themselves and their families when their work income is cut off or greatly reduced by retirement or is cut off by disability or death. In the course of a year about 74 million earners contribute to the program. More than
    24
    Department of Health, Education, and Welfare, 1962
    9 out of 10 mothers and children are protected against loss of income resulting from the death of the family breadwinner.
    Eighty-seven percent of the people reaching age 65 in 1962 were eligible for retirement benefits and, based on present projections, this proportion will rise to about 95 percent by 1985. Two-thirds of the insured group under age 65—over 50 million workers—have enough credits to meet the work requirements for disability insurance benefits and this proportion will also increase each year.
    By the end of fiscal year 1962 over a billion dollars in benefits was being paid each month to about 17.3 million beneficiaries.
    These benefits make up a critical part of the income on which the retired aged, the permanently and totally disabled, and widows and orphans must rely for support. They are an especially important source of support for old people. A survey conducted by the Bureau of Old-Age and Survivors Insurance in 1957 indicated that for more than half of the aged social security beneficiaries the benefit is the only significant source of regular income, and for the great majority of the others the benefit is the major source of regular income. (Chart 1.) Of course, a survey of old-age and survivors insurance beneficiaries taken today would be expected to show that more beneficiaries
    CHART 1.—82 PERCENT OF AGED BENEFICIARIES HAD HALF OR MORE OF THEIR RETIREMENT INCOME FROM BENEFITS*
    Only 4% had less than !4 of their retirement
    ■ncom® from benefits (median income, $4500)
    18% had less than half
    of their retirement income V/.V.vX from benefits (median	XvXv.vX
    income $2310)	*•
    JRXXX 38% had all their retirement gxgglv/’
    income from benefits (median
    income, $680)	ggxSt•’
    d half to 99% of their retirement income from benefits ^zzzzzzzzy (median income, $1240)	'///////a
    *Data from a nation-wide survey of aged beneficiaries made in 1957.
    Social Security Administration
    25
    have additional sources of retirement income. The number of people getting payments under private pension plans, for example, has increased substantially in recent years. Since the number of aged old-age and survivors insurance beneficiaries has grown at about the same rate, though, the proportion of old-age and survivors insurance beneficiaries getting such income would not be very much different today than it was in 1957. And, even though vesting provisions are becoming more common in private pension plans and the coverage of such plans is growing, old-age and survivors insurance benefits will continue to be the main reliance of a majority of retired persons in the foreseeable future as it is today.
    Providing this regular social security income to many millions of families that might otherwise have been unable to provide for themselves is not only vital to their welfare, it is also important in protecting society from the many evils bred by widespread poverty. In addition, the benefits paid under the program provide an assured source of purchasing power, in bad times as well as good times, and thus have an important stabilizing effect on our economy.
    The program also reinforces the American traditions of independence and self-help. It provides the way for a person to earn his future security as he earns his living. Fie pays toward the cost of his protection out of his earnings. Since a person’s right to benefits does not depend on his current need but arises out of his past work, and since the benefit amount is related to earnings, the program is in line with our system of incentives. Furthermore, since benefits are payable regardless of the person’s financial resources, they serve as a base upon which he is encouraged to build additional income protection for himself and for his family.
    Thus, by providing a continuing income for workers and their families when earnings are cut off or greatly reduced by retirement in old age or are cut off by disability or death, the program increases the social and economic stability of our society, and it does this in a way that enhances the dignity and self-reliance of the people whose lives it touches. Because it has this tremendous social and economic impact on the American people, the program cannot be allowed to remain static. It must be responsive to the needs of the people in the face of changing social and economic conditions.
    If the program were allowed to remain static—for example, if benefits were not increased as wages, prices, and levels of living increase— it could not fulfill the role intended for it. In reporting on the bill that created the program in 1935, the Committee on Ways and Means of the House of Representatives spoke of benefits “. . . in amounts which will insure not merely subsistence but some of the comforts of
    665171—63---3
    26
    Department of Health, Education, and Welfare, 1962
    life . . and the Committee on Finance of the Senate spoke of benefits “. . . which will provide something more than merely reasonable subsistence. . . Although benefit increases and other improvements made over the years, reflecting changes in the economy and experience with the program, have gone a long way toward fulfilling this promise of security to the American people, much remains to be done.
    The Congress has recognized the need for periodic re-evaluation and improvement in the program and has given the Secretary of Health, Education, and Welfare responsibility (section 702 of the Social Security Act) for “studying and making recommendations as to the most effective methods of providing economic security through social insurance, and as to legislation and matters of administrative policy concerning old-age pensions . . . and related subjects.” The effectiveness of the Department in carrying out this statutory duty is dependent to a large degree on research designed to evaluate the effectiveness of the protection provided by the program and to identify new trends and problems. There are now under way several major studies designed to supply basic information about the adequacy of present provisions and to point up areas in which provisions need to be strengthened.
    Unmet Needs
    HEALTH INSURANCE FOR THE ELDERLY
    A serious shortcoming in the protection afforded by the present program is the failure to protect the elderly against the tragic hardships resulting from expensive illness. In 1935 the great need of the aged was for income loss protection; the great need today is for protection against the cost of health care. More people are living longer and so more people are exposed to the risk of the diseases that attack the aged. In 1935, there were 7.8 million people aged 65 and over (6.1 percent of the total population). By 1962 the aged numbered 17.4 million (9.3 percent of the population). Improved techniques and facilities for providing health care are expensive. Since 1935, hospital charges have gone up 500 percent; during the same period, the cost of living has risen 200 percent.
    While the cash social security benefits go a long way in helping to meet regular and recurring expenses like food, clothing, and rent, the impact of health costs varies greatly from month to month and even from year to year. A person over 65 may have no appreciable health costs for several years and then in a short time have health costs running into thousands of dollars, costs that often mean financial disaster. And the problem of meeting high health care costs is one
    Social Security Administration
    27
    that confronts virtually all aged people—not just the very poor. (Chart 2.)
    Cash social security benefits, even when supplemented by other retirement income and savings, clearly cannot be expected to meet the costs of an expensive illness. Obviously, it would not be possible to increase cash social security benefits sufficiently to cover the large health care expenses that many aged people incur.
    While necessary for filling certain gaps, public assistance cannot be a good primary basis for financing the health needs of the elderly; an assistance program is designed primarily to meet the problem of dependency after it occurs. Also, public assistance is seriously handicapped in meeting the medical care needs of even the very poor because of the inadequacies of State financing. During fiscal year 1962, four high-income States accounted for about 90 percent of the payments made under the medical assistance for the aged provisions of the 1960 public assistance legislation.
    When confronted with a risk to which all are subject but which falls unevenly on those exposed, it is only natural to turn to insurance for protection. Unfortunately, the elderly have not been able to protect themselves adequately through the existing health insurance arrangements as younger people have. The biggest obstacle is simply that most older people cannot afford adequate health insurance. In
    CHART 2.—WHEN HOSPITALIZATION BECOMES NECESSARY, MEDICAL COSTS FOR THE AGED RUN HIGH
    Medical Costs	Medical costs of aged couples - husband or wife hospitalized - for 1961
    *3'000	$2f890
    2,000 --------------------------------------------------------------------------------- ----------------------------
    $1,820
    $1,220
    1,000 ------------------------------------------------------------ -------------------- ----------------------------
    $540
    0 L. ■ L,----------------------------------------------------I;;;	-----L—-*------------L—
    1-14	15-30	31-60	61 and over
    Number of days in hospital.
    Source: 1957 OASI Beneficiary Survey, adjusted for increases in medical care prices.
    28
    Department of Health, Education, and Welfare, 1962
    1960, the average income of aged couples in this country was only about $2,500—less than one-half the average income of younger couples. For aged people living alone, the average annual income was about $1,050 a year as compared with about $2,570 for younger people living alone. There are, of course, other factors that put adequate health insurance out of reach of most of the aged. Their above-average hospital use results in high health costs which tend to make health insurance much more expensive for the aged than for younger people. (Chart 3.) Also, the aged, unlike working people who can
    CHART 3.—OLD PEOPLE GO TO THE HOSPITAL MORE OFTEN AND STAY LONGER THAN YOUNGER PERSONS
    RATIO OF PERSONS HOSPITALIZED DURING A YEAR
    ■ - •
    65 OR OVER . •	: '	‘ I'' ‘‘' ' / • I
    AVERAGE DAYS IN HOSPITAL PER PATIENT
    UNDER 65	8
    65 OR OVER .______ ■ ■, ■ '	.'I 15
    get group coverage, must generally be insured on an individual basis, a form of health insurance that sometimes costs twice as much as group coverage offering the same protection. It is not surprising that only about one-half of the elderly have any health insurance, or that the insurance even this group can afford is often inadequate.
    The Administration has concluded that the social security mechanism offers the most practical solution to the problem of insuring the elderly against the cost of expensive illness. Through social security people would provide for the high health costs they will face in retirement by making contributions while they are working. Also, use of the social security mechanism would put coverage of the elderly on a group basis and avoid the high administrative costs which most elderly people must now pay under their individual enrollment policies. Similarly, the sound and proven method of financing the existing program, the work-related and dynamic character of social security benefits and the principle of paying benefits as an earned right, the practically universal coverage of the program—all these characteristics are a part of the Administration’s health insurance proposal.
    Like the present social insurance program, the proposed health in
    Social Security Administration
    29
    surance program would not provide more than basic protection. Since for the aged who need medical care the heaviest financial burden generally falls upon those needing hospitalization, it was concluded that insurance against the cost of hospital care was the proper point of concentration. As in the case of the present retirement, survivors, and disability benefits, the individual could build on his basic social insurance protection and by his own means obtain protection against the cost of physicians’ services, drugs, and other health needs that would not be covered under the proposed plan. And, like the present cash benefits program, the proposed health insurance program would depend upon public assistance to fill in the gaps that would remain. In fact, with a health insurance program for the aged, the financial problems faced by the States in their efforts to aid the aged with their medical costs would be greatly reduced; and it seems reasonable to expect that the States would be able to move toward a more effective health care program for the aged who would still need help in meeting their health care costs. Thus, the proposal would carry on the threefold attack against indigency in old age that has been so successful in the area of income maintenance—an attack carried out by social insurance, voluntary insurance, and public assistance—all working in partnership.
    KEEPING BENEFITS UP TO DATE
    Another problem now under study is that of keeping the amount of the benefits paid under the program up to date. While benefits have more than kept up with the changes in prices over the years, the program, in spite of the many improvements that have been made, has not kept up with the increased productivity of the American economy, as reflected by higher wage levels, and the consequent rise in the level of living of the American worker. (Chart 4.)
    The basic structure of the program now has built into it only a small measure of response to changing wage levels. Under present law, benefit amounts over the long run will be based on a lifetime average of the worker’s earnings in covered work. As earnings go up, the average on which the benefits are based will be held below current wage levels by the lower wages paid in the past.
    This is not a problem at present because as new groups of workers have been brought into the program, the social security law has been changed so that, in the period immediately after these extensions of the program, benefit amounts could be based on earnings over a relatively short and recent period. This was done to avoid disadvantaging the newly covered workers who reached retirement age or died shortly after they came under the program. As a result, benefits awarded over the past decade have generally been based on fairly
    30
    Department of Health, Education, and Welfare, 1962
    CHART 4.—BETWEEN 1940 AND 1961 THE PERCENTAGE INCREASE IN AVERAGE EARNINGS EXCEEDED THE PERCENTAGE INCREASE IN AVERAGE BENEFITS
    Percentage Increase 300
    280
    260
    240
    220
    200
    180
    160
    140
    120
    100
    80
    60
    40
    20 0
    lllllllll Earnings	269.0
    Benefits
    -	Bili| ||||||
    125-6
    I94'1
    I II
    I1
    ■■ KM ,
    1940 - 45	1940 - 50	1 940 - 61
    PERIOD
    current wage levels. In 1961, for example, most of the benefits awarded were related to an average of no more than the worker’s highest 5 years of earnings after 1950; benefits awarded in 1962 were typically related to no more than the highest 6 years. Unless the law is changed, though, retirement benefits will eventually be based on a person’s average earnings over virtually all of his working life and the generally higher earnings level at the time of retirement will be offset by lower earnings in earlier years.
    Social Security Administration
    31
    Various ways in which benefits reasonably related to fairly current earnings could be provided, including the costs that most such plans involve, are being studied. Providing a benefit that is based on reasonably current earnings at the time it is awarded, though, will not, in itself, ensure the adequacy of benefits as wages and prices go up. The worker who retires today may still be living—and depending primarily on his social insurance benefit—10, 20, or even 30 years hence. The adequacy of his benefit will depend on whether it keeps pace with changes in the economy after he retires. This involves more than merely adjusting his benefits so that they will retain their original purchasing value. During this period of his retirement not only the price level but also the average level of living in the United States undoubtedly will rise.
    Basic to any consideration of the problem of keeping the program in line with the changing economy is the matter of adjusting the ceiling on the amount of earnings that can be taxed and credited toward benefits under the program. Only people whose annual earnings do not exceed $4,800—the upper limitation on earnings creditable for benefits—will have their benefit amounts related to their full earnings. Unless the ceiling on the amount of earnings that can be taxed and credited toward benefits is raised as earnings levels rise, more and more people will be earning above the ceiling and fewer people will have their benefit amounts related to their total earnings. In 1938, when the ceiling was $3,000, about 94 percent of all regularly employed men had all their earnings taxed and counted toward benefits. In 1963, despite three increases in the ceiling since 1938, only about 39 percent of such workers will have all of their earnings taxed and counted toward benefits. (Chart 5.) While it is generally agreed among responsible individuals and groups who have studied the question that the ceiling does have to be raised from time to time as earnings go up, there have been differences of opinion on the amount and timing of increases.
    There is also a question of how these adjustments to keep the benefit structure of the program in line with changes in the economy should be made—that is, should automatic changes in benefits and the benefit base be provided for or should we continue to depend on periodic amendments to keep the program up to date? Some foreign systems have adopted provisions of the former kind, and the desirability and feasibility of adopting some automatic method of adjustment in this country is now under study.
    EXTENSION OF PROGRAM COVERAGE
    Also under study are the problems of extending coverage under the program to those who are still without its protection. Today about
    32
    Department of Health, Education, and Welfare, 1962
    CHART 5.—THE EARNINGS BASE COVERS THE TOTAL ANNUAL EARNINGS OF A SMALLER PERCENTAGE OF REGULARLY EMPLOYED MEN THAN IN THE PAST*
    EARNINGS BASES
    Percent 100 —
    90 _
    80 —
    70 -
    60 —
    50 —
    40 —
    30 _
    20 —
    10 -
    0
    '937	1951	1955	1959	1963 (Estimated)
    *Year shown is the first year for which the higher earnings base was effective (except 1963).
    9 out of 10 workers are covered. But there are still gaps in the coverage of the program. The desirability of extending the protection of the old-age, survivors, and disability insurance program to virtually all regular workers of the Nation and their families has been recognized ever since the establishment of the program, and coverage extension proposals have received active consideration and support by the Congress and this Department. To the extent that progress is made toward permitting everyone employed with some degree of regularity to earn protection under the program, more and more workers and their families will of course obtain the valuable protection of the old-age, survivors, and disability insurance program and can look forward to benefits that are related to the level of past earnings from practically all gainful work.
    The largest group of workers still without social security coverage are the more than 2 million civilian employees of the Federal Government who are covered under Federal staff retirement programs. (Chart 6.) Many of these Federal employees switch once or more between the Federal service and wmrk outside the Government, with the result that their retirement, survivor, and disability protection depends largely on chance. Some ultimately qualify for benefits under
    $4,800 $4,200
    $3,600
    $3,000
    Social Security Administration
    33
    CHART 6.—9 OUT OF 10 WORKERS ARE COVERED UNDER THE OASDI PROGRAM
    both a Federal staff retirement program and the old-age, survivors, and disability insurance program. Many others qualify under one program or another for benefits that reflect only part of their working lifetime and thus provide inadequate protection. Some fail to qualify under any program.
    If their employment with the Federal Government were covered by social security, people who spend part of their working lives in Federal employment would be assured of retirement, survivors, and disability insurance that would follow them as they shift from one job to another. Social security coverage for Federal employees, supplemented by coverage under a staff retirement program, would provide them with protection comparable to that afforded many workers in private industry, employees of State and local governments, and members of the uniformed services. This improved protection can be furnished without impairing in any way the independence of the Federal staff retirement programs and without undue cost to employees of the Government or the Government itself.
    Self-employed physicians are also excluded from social security coverage. Many self-employed doctors have become aware of the value of old-age, survivors, and disability insurance protection and
    — FEDERAL CIVILIAN EMPLOYEES
    -----OTHERS ♦
    0----FARM, DOMESTIC SERVICE, AND
    | NONPROFIT EMPLOYEES
    ----ARMED FORCES
    ___ STATE AND LOCAL
    GOVERNMENT EMPLOYEES
    (Covered or con be covered by state action)
    * Includes —
    Self Employed Physicians;
    Persons earning less than minimum required for coverage.
    £ NOT COVERED
    COVERED
    | EMPLOYEES IN
    I INDUSTRY
    2 AND COMMERCE
    RAILROAD EMPLOYEES_________J
    (Joint Coverage, OASDI •
    Railroad Retirement)
    FARM AND URBAN
    SELF EMPLOYED
    34
    Department of Health, Education, and Welfare, 1962
    many desire coverage. The position of their principal organization, however, continues to be opposed to social insurance coverage.
    Aside from civilian employees of the Federal Government and self-employed physicians, the great majority of workers for whom coverage is not available under the Federal law are those who are irregularly employed, or have earnings which do not meet the minimum requirements for coverage. While some of these workers will, over their working lifetimes, obtain old-age, survivors, and disability insurance protection as a result of their coverage under the program during periods of more regular employment or on the basis of the coverage of a member of their family, many will have no protection unless the law is changed to provide wider coverage of marginal workers.
    DISABILITY INSURANCE
    Continuing study is being made of the effectiveness of the protection afforded disabled workers and their families under the program. Although the provisions for disability insurance benefits are still relatively new, the program now provides a large measure of protection to workers and their families against loss of earnings due to severe long-term disability of the worker. As of June 30, 1962, over 114 million persons were receiving benefits amounting to more than $80 million a month on account of their own disabilities or that of the family earner.
    During the fiscal year definite progress was made in improving procedures and plans for obtaining more comprehensive evidence relating to the medical and vocational limitations of claimants. The Social Security Administration has also been developing more effective techniques for giving due weight to vocational and other nonmedical factors in evaluating disability. Regulations to this effect are being expanded.
    There remain several significant gaps in the protection provided by the disability provisions. For example, some workers are totally disabled over many months or even several years but cannot receive benefits for themselves or their families only because their disability is one from which they may be expected to recover.
    Another gap in the protection afforded disabled persons is represented by wives and widows who are totally disabled before reaching age 62. These disabled wives and widows cannot qualify for any benefits under the present law unless they have a child in their care, although they are, of course, in much the same position as those aged 62 and over. Benefits are payable at age 62 to wives and widows without children because it seems reasonable to assume that at age 62 a large number of persons, for health or other reasons, may no longer be able to support themselves by working.
    Social Security Administration
    35
    Under present law, in the case of applications for disability protection filed after June 30, 1962, the starting date of a period of disability can be established only as far back as 18 months before the date of application, even though the actual onset of disability occurred much earlier. As a result, where filing of application is delayed, the benefits of disabled workers and their dependents may be substantially reduced, and some workers and their families may lose all rights to social security protection. The Department has recommended elimination of the restriction in present law.
    THE RETIREMENT TEST
    There are strong pressures to liberalize, or to eliminate entirely, the provision in the law—generally called the retirement test—that is designed to assure that the funds available for the old-age, survivors, and disability insurance program are used to pay benefits only to people who meet a reasonable test of retirement from full-time work and to their dependents and survivors who do not have substantial earnings from work. In the 87th Congress more bills were introduced on the retirement test than on any other provision of the social security law. Included in the total of 629 social security bills are 32 bills to eliminate the test, 71 bills to raise the exempt amount, and 15 to change other provisions of the test.
    Under the present retirement test, $1 in benefits is withheld for each $2 of annual earnings between $1,200 and $1,700 and for each $1 above $1,700 (except that benefits are not withheld for any month in which the beneficiary neither earned wages of more than $100 nor rendered substantial services in self-employment, regardless of the amount of his annual earnings). The present test is a decided improvement over the test in effect before 1961, because it adjusts benefits in proportion to the amount of earnings above $1,200, thus reducing the deterrent to work and removing certain inequities that existed under the previous test. Under the present test, a beneficiary will always have more combined income from work plus benefits if he earns between $1,200 and $1,700 than if he earned only $1,200. However, there is no incentive, and even some deterrent, for a beneficiary to earn above $1,700 (unless he earns a good deal more than $1,700), since for every $1 in taxable earnings above $1,700 he loses $1 in tax-exempt benefits.
    It is, of course, desirable that the test be framed so as not to discourage beneficiaries from working. On the other hand, it does not seem desirable to use the limited funds of the program to provide benefits for people who have not suffered a loss of work income. An ideal retirement test for the old-age and survivors insurance program would be one that would not deter any retired person from seeking
    36
    Department of Health, Education, and Welfare, 1962
    an opportunity to do all the work he wants to do and would also prevent the payment of benefits to people who are not retired but are working full time at their regular jobs after the age at which benefits are payable. Unfortunately, it is not possible to devise a test which in all respects meets both of these criteria. A test which included an annual exempt amount of more than $1,200 would allow people to do more work and still get all of their benefits for the year, but raising the exempt amount would be relatively costly and would result in paying benefits to additional people who had not suffered any reduction in earned income. Raising to $2,400 the present $1,700 limit on the area in which the $l-for-$2 reduction applies would improve incentives for older people to work, at a considerably smaller cost. No doubt the retirement test will continue to be an important area of concern to the Department, to Congress, and to the public.
    OTHER OBJECTIVES
    Another proposal now under consideration would cover tips as wages for social security purposes. Because tips are generally not counted as wages under the program, employees who receive a sizeable part of their work income in the form of tips have only partial protection. As a result, their benefits do not reflect their true level of earnings. The Department of Health, Education, and Welfare and the Department of the Treasury have recommended a plan to provide that tips received by an employee in the course of his employment, whether paid over to the employee by his employer or received directly from a person other than the employer, be considered wages for purposes of the old-age, survivors, and disability insurance program and for income tax withholding.
    These are only some of the major projects now under way; many others are in various stages of development. In addition, numerous problems and proposed program changes of a minor and technical nature are always under study.
    What the Program Is Doing
    BENEFICIARIES AND BENEFIT AMOUNTS
    During the fiscal year ended June 30, 1962, benefits paid under the old-age, survivors, and disability insurance program totaled $13,-669 million—an increase of $1,781 million over the amount paid in the preceding fiscal year. Benefit payments to disabled workers and their dependents wTere 44 percent higher than in fiscal year 1960-61 and totaled $1,011 million. Old-age and survivors insurance monthly benefits rose 13 percent to $12,484 million and lump-sum death payments amounted to $174 million, about $7 million higher than in the previous fiscal year.
    Social Security Administration
    37
    About 3.2 million monthly benefits were awarded in fiscal year 1962, almost half a million more than the previous record number made in fiscal year 1957. New highs were set for awards of old-age benefits (1,490,000), child’s benefits (590,000), and mother’s benefits (98,000). The record number of awards stemmed largely from (1) the 525,000 old-age benefits awarded to men aged 62-64, (2) the 195,000 wife’s or child’s benefits awarded to dependents of these men, and (3) the 169,000 monthly benefit awards attributable to the liberalized insured-status provisions in the 1960 and 1961 amendments. Old-age (retired-worker) benefits accounted for almost three-fourths of the awards under the new insured-status provisions; the average monthly amount for beneficiaries who became insured only because of the change in the law was about $43 compared with $80 for all other old-age benefit awards made in the fiscal year. The 492,000 monthly benefits awarded to disabled workers and their wives, husbands, and children was only 48,000 less than the record number awarded in the preceding fiscal year.
    The 851,000 lump-sum death payments awarded in fiscal year 1962 were 26,000 more than the previous record number in fiscal year 1961. About 823,000 deceased workers were represented in the awards. The average lump-sum amount per worker was $211.43, about a dollar higher than the average for the preceding year.
    The number and amount of monthly benefits in current-payment status increased sharply during fiscal year 1962. The number of monthly benefits went up nearly 1.7 million (11 percent)—294,000 more than the increase in fiscal year 1961—and the monthly rate of payment rose $136.1 million (14 percent). The growth in the number of beneficiaries produced most of the increase in the monthly rate. Other factors were the provisions in the 1961 amendments which raised the minimum monthly benefit and increased benefits for most aged survivors. At the end of June 1962, about 17.3 million beneficiaries were receiving benefits at a monthly rate of $1,128.2 million. A year earlier, monthly benefits totaling $992.0 million were going to 15.6 million beneficiaries. (Chart 7.)
    At the end of June 1962, about 13.5 million persons aged 62 or over were receiving old-age and survivors insurance monthly benefits—1.2 million more than in June 1961. Old-age (retired-worker) benefits were going to 69 percent of the aged group, wife’s or husband’s benefits to 17 percent, widow’s or widower’s to 13 percent, and the remainder— primarily parent’s benefits—to less than one-half of 1 percent. An increase of 351,000 for the 12 months brought the number of mothers and children receiving monthly benefits to 3.1 million. Disabledworker beneficiaries under age 65 numbered 679,000, an increase of 121,000.
    38
    Department of Health, Education, and Welfare, 1962
    CHART 7.—BOTH BENEFIT PAYMENTS AND NUMBER OF BENEFICIARIES HAVE INCREASED
    RAPIDLY SINCE 1950*
    FISCAL YEARS
    ♦The 1950 amendments made major improvements in the program.
    ♦♦Payments in fiscal year. Includes a small percentage of lump-sum death payments.
    ♦♦♦Beneficiaries on the rolls at the end of the fiscal year.
    In June 1962, the average old-age benefit being paid to a retired worker who had no dependents also receiving benefits was $72.40 a month. When the worker and his wife were both receiving benefits, the average family benefit was $127.10. For families composed of a disabled worker, his young wife, and one or more children, the average was $191.70, and for families consisting of a widowed mother and two children the average benefit was $191.40. The average monthly benefit for an aged widow alone was $65.40 in June; the rise of $7.20 from the average at the end of June 1961 resulted mainly from the higher rate provided by the 1961 amendments. Among beneficiaries on the rolls at the end of June 1962 whose benefits were based on earnings after 1950, the average family benefits being paid were $79.90 for a retired worker with no dependents receiving benefits, $135.20 for an aged couple, $200.70 for a disabled worker, his young wife, and one or more children, $212.70 for a widowed mother and two children, and $76.50 for an aged widow alone. At the end of June 1962, about 73 percent of all retired-worker families were receiving benefits based on earnings after 1950.
    DISABILITY PROVISIONS
    During the fiscal year, a period of disability was established for about 245,000 workers, 25,000 more than the previous record number in fiscal year 1960-61. About 26,500 disabled persons aged 18 or over
    MILLIONS 20 ---------------
    DEPENDENTS OF DISABLED ' BENEFICIARIES
    16 ---------------
    DISABLED.____
    WORKERS “
    CHILDREN & YOUNG x.
    12 WIDOWS
    BENEFICIARIES* » *
    AIWAL FAYMENYS'* *
    AGED SURVIVORS & DEPENDENTS
    BILLIONS OF DOLLARS 20 ----------------------
    o----------------------------1__I__|__|-- LJ 0------------------1--1-------------1__I--1__L
    ’55	’60	’65	’50	’55	’60	’65
    16
    12
    8
    4
    AGED WORKERS
    Social Security Administration
    39
    who had applied for child’s monthly benefits were found to have a disability that began before they were 18 years of age; the number was about 4,500 greater than in 1960-61. Since the beginning of the program, about 1,450,000 persons have been found to meet the disability requirements under the law.
    The number of disabled workers receiving monthly benefits rose 22 percent in the fiscal year and reached 679,000 at the end of June. Almost 473,000 benefits were being paid to the wives, husbands, and children of these beneficiaries—a 39 percent increase. By the end of June 1962 child’s monthly benefits were being paid at a monthly rate of $6.2 million to 135,000 disabled persons aged 18 or over—dependent sons or daughters of deceased, disabled, or retired insured workers— whose disability began before age 18. About 15,000 women—who would not otherwise be eligible for benefits—were receiving wife’s or mother’s benefits as the mothers of disabled persons receiving child’s benefits.
    A preliminary estimate indicates that by the end of June 1962, about 150,000 persons were receiving old-age benefits that had been increased by an average of $8 a month because their social security records were frozen for periods while they were disabled before reaching retirement age. About 55,000 wives, husbands, and children of retired workers and about 85,000 widows, widowers, children, and parents of workers who had their social security records frozen before death were also receiving larger monthly benefits because of the freeze. For the same reason, lump-sum death payments in fiscal year 1962 based on the earnings records of almost 24,000 deceased workers were increased by an average of about $24 per worker.
    THE PROTECTION PROVIDED
    At the beginning of 1962, more than 89 million people had worked long enough in covered employment to be insured for benefits under the program (53 million of them permanently insured so that they could get benefits even if they had no more covered work). Of the population under age 65, an estimated 80 million were insured at the beginning of the calendar year. Some 44 million of these people were permanently insured—that is, whether or not they continue to work in covered jobs, they will be eligible for benefits when they reach retirement age, and their families are protected if they die. (Included in this total were about 1.8 million men and 1.1 million women aged 62-64 who were already eligible for old-age benefits but on a reduced basis.) The remaining 36 million were insured but must continue in covered work for an additional period to be insured permanently. Nine out of 10 mothers and young children in the Nation can count on receiving monthly survivors insurance benefits if the
    40
    Department of Health, Education, and Welfare, 1962
    family breadwinner should die. An estimated 51 million of the insured persons under age 65 also met the insured status requirements for protection against the risk of long-term and severe disability.
    Of the 17.3 million people aged 65 or over in the United States at the beginning of 1962, 76 percent were eligible for benefits under the program. (Chart 8.) Sixty-seven percent were actually receiving benefits, and 9 percent were not receiving benefits because they or their husbands were receiving substantial income from work. The percentage of eligible aged persons is expected to rise to 84 by the beginning of 1966.
    INCOME AND DISBURSEMENTS
    Expenditures from the Federal Old-Age and Survivors Insurance Trust Fund during the fiscal year totaled $13,259 million, of which $12,658 million was for benefit payments, $350 million for transfers to the railroad retirement account and $251 million, including Treasury Department costs, for administrative expenses. Total receipts were $11,985 million including $11,455 million in net contributions and $530 million in interest on investments. Disbursements exceeded re-
    CHART 8.—THE NUMBER AND PERCENTAGE OF POPULATION AGED 65 AND OVER
    Number
    (in millions)
    ELIGIBLE FOR OASDI BENEFITS ARE INCREASING*
    *Figures as of January 1.
    Population eligible for ' OASDI benefits
    { 84%
    18.6
    15.7
    Total aged population \	17.3
    16.6	p-
    15---------------------
    13.1
    12.3	0^0 /
    >1.6
    III rR
    • u ■ n
    BiB fill
    o w iw »
    1950	1960	1961	1962
    Social Security Administration
    41
    ceipts by $1,274 million, the amount of the decrease in the trust fund during the year. At the end of June 1962 this fund totaled $19.6 billion.
    Total assets of the old-age and survivors insurance trust fund, except for $1,191 million held in cash, were invested in United States Government securities as required by law; $3.4 billion was invested in public issues (identical to Treasury securities owned by private investors), and $15.1 billion was invested in securities of varying maturities issued for purchase by the trust fund. The average interest rate, figured on the coupon rate and face amount of all investments of this fund at the end of the fiscal year, was 2.87 percent.
    Expenditures from the Federal Disability Insurance Trust Fund during fiscal year 1962 totaled $1,086 million, of which $1,011 million was for benefit payments, $11 million for transfers to the railroad retirement account, and the remainder—some $64 million—for administrative expenses. Total receipts were $1,088 million, including $1,021 million in net contributions and $67 million in net interest on investments. Receipts exceeded disbursements by $2 million, the amount of increase in the fund during the year. At the end of June 1962, the fund totaled $2,507 million. (Contributions to this fund first became payable in January 1957 and benefit disbursements began in August of that year.)
    Assets of the disability insurance trust fund consisted of $2,407 million in United States Government securities and a cash balance of $101 million. The invested assets consisted of $102 million in public issues and $2,304 million in securities of varying maturities issued for purchase by the trust fund. The average interest rate, figured on the coupon rate and face amount of all investments of this fund at the end of the fiscal year, was 2.94 percent.
    Administering the Program
    During fiscal year 1962, the Bureau of Old-Age and Survivors Insurance faced two major administrative tasks; processing increased workloads growing out of the 1961 amendments, and continuing its program to improve administration and provide a higher quality of service to the public.
    Provisions of the 1961 amendments which added substantially to the Bureau’s growing workloads were those which permitted men to become entitled to old-age insurance benefits as early as age 62 with the benefits actuarially reduced to take account of the longer period of payment; liberalized the eligibility requirements and retirement test provisions; and raised the minimum and widows’ benefits. The application of electronic data processing to the Bureau’s operations
    665171—63
    42
    Department of Health, Education, and Welfare, 1962
    was used to special advantage in implementing the latter provisions, as the benefit rates for about 3.7 million individuals whose benefits were increased by law were converted electronically. In the limited time allowed by the legislation, it would have been impossible to accomplish the conversion without the use of electronic equipment.
    The Bureau of Old-Age and Survivors Insurance received a total of 3,438,000 applications for old-age and survivors insurance during the year, plus 659,000 claims for disability insurance benefits. Social security account numbers were established for 3,902,000 persons, and approximately 3,220,000 duplicate account number cards were issued to individuals who had lost their cards or needed new cards for one reason or another. Approximately 264,726,000 earnings items were received from employers or the self-employed for posting to the individual accounts. The district offices handled more than 14,166,000 inquiries about the old-age, survivors, and disability insurance program.
    These are massive figures and they indicate why substantial numbers of well-trained employees are necessary to administer the program properly—to pay benefits on time and in the right amount. Bureau staff on duty at the end of the year totaled 33,454, an increase of 2,482 employees during the year. Although there has been a series of significant amendments to the Social Security Act—in 7 out of the last 12 years—which have greatly increased the continuing level of Bureau work and the complexity of the job to be done, the Bureau of Old-Age and Survivors Insurance has demonstrated a capacity to do a larger and more involved job without a proportionate increase in manpower. Although Bureau workloads are more than four times as great as they were in 1950, Bureau staff required to handle these workloads is only some three times as large as in 1950. Thus, 77 employees now perform about the same amount of work as 100 did in 1950. This improvement in productivity has been achieved in spite of the increasing complexity of the program and the necessity of training large numbers of new personnel.
    Continuing efforts to improve the quality and timeliness of service to the public set the tone for all endeavors during the year. As an example of these efforts to improve public service, 17 additional district offices were opened in various sections of the country where surveys indicated the most pressing need. The new offices are located in the following cities: White Plains, Flushing, and Freeport, N.Y. ; Butler, Pa.; Glen Burnie, Md.; Goldsboro and Greenville, N.C.; Elizabethtown and Campbellsville, Ky.; Cookeville, Tenn.; LaSalle, Ill.; East Liverpool, Ohio; Mt. Pleasant, Mich.; Big Spring, Tex.; Helena, Ark.; Whittier, Calif.; and Plilo, Hawaii. At the end of the fiscal year, the program was being administered through a network of
    Social Security Administration
    43
    601 district offices, 11 regional offices, 7 payment centers, and the central headquarters in Baltimore. In addition, public service visits are made on a regular and recurring basis to more than 3,600 communities, in order to bring a personalized service to as large a share of the population as is possible.
    A special service initiated during the year was a nationwide campaign to notify through the press, radio, and television all people over 65 who were made eligible for benefits by the 1960 and 1961 amendments but who had so far failed to apply for them. In the latter part of the fiscal year, a program was begun to advise by personal letter those aged insured workers who had not claimed benefits because they were unaware of their entitlement to them. This special program, which is being continued in fiscal year 1963, resulted in the filing, during fiscal year 1962, of almost 38,000 additional claims by workers and their dependents or survivors.
    An example of the Bureau’s continuing efforts to improve its services to beneficiaries already on the rolls is the special study of beneficiaries aged 85 and over whose numbers have been increasing at a rate of about 40,000 annually. At the beginning of 1961, there were approximately 285,000 such beneficiaries. Because the Bureau’s channels of communication with them were limited, a question existed as to the situation of persons in the group. The Bureau, therefore, conducted a nationwide survey during the period from June through September 1961 to determine the extent to which benefit checks might be going to individuals who (1) were in need of a representative payee (i.e., who were incapable of managing their own funds and were in need of someone to receive and expend benefits on their behalf), or (2) had died without their deaths being reported to the Bureau. Personal contact was made with a sample of 1,937 beneficiaries over age 85. The results of the survey indicated that there was no problem of unreported deaths. Nor in any case was evidence found that benefits had been misappropriated or misused by persons responsible for the beneficiaries’ monthly checks. There were a number of cases, however, in which the beneficiaries were not capable of handling their own funds and whose inability had not been previously reported. To safeguard benefit rights and to verify the continuing eligibility of this and other groups of beneficiaries, procedures have been developed for a permanent survey program to be conducted on an annual basis.
    Late in fiscal year 1962, the Bureau of Old-Age and Survivors Insurance initiated a 14-month pilot project in the State of Maryland to test the design for a nationwide study of the representative payee procedures, under which the benefits of minor children and incapable adults are paid to another person for the beneficiary’s use. Data will
    44
    Department of Health, Education, and Welfare, 1962
    be collected concerning the management of the benefit by the payee, the current situation and needs of beneficiaries, and the availability and use of community protective services and welfare facilities. The findings will provide a basis for appraising both the policies governing the selection of representative payees and the procedures for safeguarding the interest of beneficiaries having payees. The nationwide survey is scheduled for late 1963, upon completion of the Maryland pilot project.
    During the year, the Bureau successfully completed the installation of its data communications system, which interconnects the district offices, the regional offices, the payment centers, and the central headquarters. This system has made it possible for the Bureau to processs and pay insurance claims more rapidly than would otherwise be possible and is an important part of the Bureau’s integrated data processing system for the handling of claims and related activities. The use of computers is, likewise, an integral part of this system and, during the year, the processing capabilities of the Bureau were substantially enlarged. The programs developed for these computers have simplified the process of certifying to the Treasury Disbursing Offices the payment of old-age, survivors, and disability insurance benefits, and are replacing statistical operations previously performed on electric accounting machines. The Bureau has further expanded its use of computer facilities by integrating the preparation of the award form with the certification of the earnings record in its claims operations. This process has reduced the clerical effort previously devoted to forms preparation and the manual calculation of benefit amounts, and has reduced errors stemming from manual calculations and transcriptions.
    Work to accomplish a total, Bureau-wide integration of claims processing will proceed in fiscal year 1963 with simultaneous and interrelated attention being given to further development of electronic data processing and long-range total systems planning.
    A feasibility study was completed for the Bureau of Old-Age and Survivors Insurance in February 1961 by a research team from Johns Hopkins University to determine whether operations research techniques could be profitably applied to processing and organizational problems in the long-range aspects of the Bureau’s work. The feasibility study was thoroughly considered during the first half of fiscal year 1962 and, after an analysis of the detailed proposals submitted by six research organizations, a contract was signed on January 30, 1962, with Dunlap and Associates, Inc., Stamford, Conn., for operations research assistance in the Bureau’s long-range studies of the claims process. The objectives established for the operations research program are, through use of the highly technical assistance supplied
    Social Security Administration
    45
    by the Dunlap firm, to: (1) determine the best size and number of claims review points and the best organizational structuring for claims development, adjudication and review; (2) supplement the Bureau’s studies of those aspects of the claims process requiring exercise of sound judgment; and (3) develop within the Bureau a staff capable of employing operations research techniques on a long-range basis. For purposes of the third objective, the Bureau selected five employees to form the nucleus of the internal operations research group. Detailed plans for on-the-job and academic training for the group were developed and initiated. In addition, the trainees are working as research assistants on the project.
    Early in fiscal year 1962, the Bureau established a Foreign Claims Branch as a component of the Division of Claims Control, with responsibility for the centralized administration of the old-age, survivors, and disability insurance program abroad. The establishment of this new Branch was prompted by numerous considerations, the most important of which were: (1) the increasing number of beneficiaries who reside abroad; and (2) a number of special problems in this area which have come to the Bureau’s attention in recent years. Many areas have been defined in which additional effort to improve Bureau operations abroad is required and in fiscal year 1963 the Bureau will be engaged in the solution of these problems.
    The Form SS-5 file of account number applications, record changes, and indicators of claims actions now contains approximately 175 million forms and is growing at the rate of 7,772,000 forms annually. The file now occupies about 40,000 square feet of floor space. Attempts to find a method for converting this file to a more efficient system were continued and, during fiscal year 1962, the Bureau collaborated with systems engineers from seven companies in the development of a film-medium substitute for the Form SS-5 file. Schemes developed by these companies range from sophisticated microfilm systems to video tape processes, with a considerable degree of automation of updating and reference operations. Serious consideration is now being given to each of the proposals for converting the file and it is expected that one system will be adopted if it can be shown conclusively that any increase in cost would be offset by increased efficiency in updating and reference operations.
    By agreement between the Department of Health, Education, and Welfare and the Treasury Department, the Bureau of Old-Age and Survivors Insurance has incurred a substantial new workload in the issuance of social security account numbers for Internal Revenue Service identification purposes. This enumeration project for Internal Revenue Service involves the Bureau in four distinct phases. The first phase was concluded on March 30, 1962, and resulted in the proc
    46
    Department of Health, Education, and Welfare, 1962
    essing of 116,312 applications for account numbers that had been filled out by Federal Civil Service employees. The second phase, started near the end of the fiscal year, will involve the processing of applications for account numbers to be completed by approximately 2 million people who filed 1961 and who will file 1962 income tax returns. The third phase will start in the second quarter of fiscal year 1963 and will involve the processing of approximately 2,750,000 applications for account numbers to be completed by the recipients of dividends, interest, and other income subject to income tax reporting. The last phase of this enumeration project is expected to start in the first half of fiscal year 1964 and will involve those taxpayers and recipients of dividends, interest, etc., who did not obtain account numbers in the earlier phases. Details of this entire project are being developed jointly by the Internal Revenue Service and the Bureau.
    In continuing its efforts for greater operating economy and efficiency, the Bureau implemented new and revised procedures and obtained new and improved equipment for its earnings record activities. Two of the Bureau’s older computers were replaced by newer models with greater speed and capacity. Experience with this new equipment is extremely gratifying. Under the improved system, a number of programs have been combined to save processing time, to produce the end product at an earlier date, and to take advantage of the greater memory capacity of the newer model. Further improvements in the operations of these new computers were achieved when the newer high speed tape units, which record data at a density of 800 characters to the inch, wTere placed in operation during the fourth quarter of the fiscal year.
    During the year, there was an increase in employers’ use of magnetic tape reporting of employees’ earnings. By the end of fiscal year 1962, over 4 million employee earnings items per quarter from 28 private companies, 6 State and local governments, and 4 military organizations were being reported on magnetic tape. This method of reporting employee earnings saves time and money both for the Government and for the employers who make use of it.
    A total of 258 employers, each having 10,000 or more employees, are currently participating in the Bureau’s direct submittal plan (reporting employees’ earnings direct to the Social Security Administration rather than through the Internal Revenue Service). As a result, 7,600,000 earnings items are being received early each quarter, thereby enabling the Bureau to get a correspondingly early start on updating individual earnings accounts.
    Both the magnetic tape reporting and direct submittal plans have been used only by employers reporting 10,000 or more employees. In fiscal year 1963, the Bureau is planning to extend each of these plans to employers who have between 5,000 and 10,000 employees.
    Social Security Administration
    47
    An electronic data processing system for payroll and leave accounting for central office personnel was implemented during the year. The transition to the new system was accomplished in the latter half of fiscal year 1962 in a series of steps, beginning with a data verification and clean-up project, and concluding with a period of parallel operations to verify the accuracy of the new system before discontinuing the old procedures.
    Adequate space for Bureau personnel and equipment continues to be a problem, although alleviated somewhat in Baltimore by construction of an Annex (largely completed during the fiscal year) to the Social Security Building. The Annex was ready for occupancy in August 1962 and most of the Bureau personnel located in downtown Baltimore buildings have been moved into the new space. Plans are now being developed to construct a 5-bay enlargement of the Annex, to alleviate further crowded conditions in the Social Security Building and to meet additional space needs. Lack of adequate space for district offices and payment centers remains a serious problem.
    Research Activities
    In cooperation with the Division of Program Research of the Social Security Administration and the Bureau of the Census, the Bureau of Old-Age and Survivors Insurance participated in the planning and preparatory work for a survey of all persons 62 years of age and over and a companion study of mother-child old-age and survivors insurance beneficiaries. The Bureau of Old-Age and Survivors Insurance is also participating with the Bureau of Family Services in planning or carrying out a number of studies designed to determine: (a) why a significant number of public assistance recipients are not qualifying for old-age, survivors, and disability insurance benefits, and (b) why old-age, survivors, and disability insurance beneficiaries require public assistance.
    The Bureau also advanced preparations for a longitudinal study of aged beneficiaries, which is now scheduled to be launched with an initial survey in the spring of 1964. During the year the Bureau released additional analyses based on data from the 1957 cross-section survey of beneficiaries. Data from the 1960 survey of disability beneficiaries and of disabled workers who were awarded a period of disability for benefit computation purposes in the eight largest metropolitan areas were tabulated in preparation for analysis and release of the survey findings.
    The Bureau published a monograph on average and aggregate paid manhours of employment of wage workers in covered employment, by industry division.
    48
    Department of Health, Education, and Welfare, 1962
    During the year the Bureau also made progress in its continuing survey of applicants for old-age benefits designed to provide data on, among other things, the factors affecting the worker’s decision to apply for benefits.
    A study of persons who failed to meet the requirements for a period of disability or disability benefits in 1957, 1958, and 1959 was continued. Reports of findings from this study will be prepared during the coming fiscal year comparing the characteristics and subsequent experience of workers who were denied a period of disability in these years.
    The Bureau, in cooperation with the Office of Vocational Rehabilitation, continued its study of the rehabilitation experience of 2,100 disabled persons who were referred by the Bureau to State rehabilitation agencies and who were reported as rehabilitated in 1957-58. A report is scheduled for completion in fiscal 1963.
    The Bureau published an analysis of provisions for survivor benefits in private pension plans. Work advanced on an analysis of findings from the Bureau’s survey of State and local retirement systems. During the coming fiscal year the Bureau, jointly with the Bureau of Labor Statistics, will continue to develop a program of studies in the private pension and welfare field.
    Work on other socio-economic research studies was advanced during the year, including studies of the taxation of income of the aged, and a cohort study of 61,000 men and women wage earners with earnings in 1957 that shows changes in the cumulative employment and cumulative wage credits of these wage earners as they aged from 1937 to 1957.
    Financing the Program
    The old-age, survivors, and disability insurance system has an estimated benefit cost that is very closely in balance with contribution income. In enacting the 1961 amendments Congress again made clear its intent that the program continue to be self-supporting from contributions of covered workers and employers. Careful review was given to intermediate-range and long-range actuarial cost estimates prepared for use of the congressional committees in their legislative considerations. The program as amended continues to be financed on an actuarially sound basis, both for the next 15 to 20 years and for the distant future.
    The difficulties involved in making exact predictions of the actuarial status of a program that reaches into the distant future are widely recognized. If different assumptions as to, say, interest, mortality, retirement, disability, or earnings had been used, different results would have been obtained. Accordingly, no one set of estimates should be looked upon as final, in view of the fact that future experi-
    Social Security Administration
    49
    en.ce may vary from the actuarial assumptions. Nonetheless, the intent that the system be actuarially sound can be expressed in law by a contribution schedule that, according to the intermediate-cost estimate, results in the system being substantially in balance. The Department, in carrying out its policy of continually reexamining the cost estimates of the program, is now conducting a complete review of its cost estimates in the light of the latest information available.
    OLD-AGE AND SURVIVORS INSURANCE BENEFITS
    The level-premium cost of old-age and survivors insurance benefits after 1961, on an intermediate basis, assuming interest of 3.02 percent and earnings at about the levels that prevailed during 1959, is estimated at 8.79 percent of payroll (after adjustments to allow for administrative expenses and interest earnings on the existing trust fund). The level contribution rate, equivalent to the graduated rates in the law, is estimated at 8.55 percent of payroll, leaving a small actuarial insufficiency of 0.24 percent of payroll. In view of the very long range over which these projections are made, and the many variable factors included, the insufficiency is so small that the system may be considered in actuarial balance.
    DISABILITY INSURANCE BENEFITS
    The Social Security Amendments of 1956 established a system for financing disability benefits which is entirely separate from the financing of old-age and survivors insurance benefits. The estimated level-premium cost of the disability benefits (adjusted to allow for administrative expenses and interest earnings on the existing trust fund) on an intermediate basis is 0.56 percent of payroll. Contribution income has been specifically allocated to finance these benefits; this income is equivalent to 0.50 percent of payroll, leaving a small actuarial insufficiency of 0.06 percent of payroll. Future experience with this program will be studied carefully to determine whether the actuarial cost factors used are appropriate or if the financing basis needs to be modified.
    Summary and Conclusions
    The old-age, survivors, and disability insurance program is a major institution in the economic and social life of the Nation. Over the years, this “social utility” has proven to be an effective and efficient method of preventing widespread dependency and want that is in every way consistent with the principles of our free society. If it is to fully realize its potential contribution toward eliminating poverty in our society, though, it can not be allowed to remain static. It must respond to changing conditions and emerging problems. The Depart
    50
    Department of Health, Education, and Welfare, 1962
    ment of Health, Education, and Welfare will continue carefully to evaluate the effectiveness of the present program and to plan for its improvement. The legislative history of the program gives us every reason to believe that the program will be kept effective and responsive to changing needs and by efficient administration that it will be able to fulfill its promise of security to the American people.
    Bureau of Hearings and Appeals
    Prior to 1939, when the Bureau of Old-Age and Survivors Insurance denied an application for social security benefits, the determination was final. Recognizing that a claimant who disagreed with such determination was entitled to an opportunity to protect his rights, Congress in that year amended the Social Security Act so as to provide for administrative hearings and judicial review on claims for benefits. To implement that provision there was established within the Social Security Administration an office which was charged with responsibility of conducting quasi-judicial proceedings and issuing decisions which would be subject to review by the courts.
    These adjudicative responsibilities are carried out through hearing examiners stationed in the various States and certain territories, and through the Appeals Council sitting in Washington, D.C. The hearing examiners conduct hearings during which the claimant has the right to a representative of his own choosing. Sworn testimony is recorded verbatim by a reporter, documentary evidence is admissible, and oral and written arguments may be presented. After a full record has been made, the hearing examiner issues a written decision which may affirm, reverse or modify the determination of the Bureau of Old-Age and Survivors Insurance. Such decision is subject to full review by the Appeals Council at its option. If the Council decides to review a case it then issues a written decision. Thereafter, a claimant who continues to feel aggrieved may appeal to the courts.
    Following enactment of the disability provisions of the Social Security Act, the number of requests for hearings filed by claimants increased sharply until a high of 23,450 was reached in fiscal 1959— an increase of 500 percent over 1955. The number declined in 1960 and 1961; but statutory amendments in those years resulted in 21,400 requests for hearings in fiscal 1962, an increase of 52 percent over the preceding fiscal year (Chart 9). The goal is to afford each claimant a prompt hearing and a decision by the hearing examiner within 90 days thereafter. Efforts to achieve that goal have been made through a substantial increase in the size of the hearing examiner corps, the maintenance of a continuing program of technical training, and the use of such devices as overtime and reassignment of cases.
    Social Security Administration
    51
    CHART 9—HEARING REQUESTS: TOTAL RECEIVED, CLEARED, AND PENDING
    HEARING EXAMINERS ON DUTY
    200	I200
    Aug. 1954 - Disability Freeze Amendments	Aug. 1958 - Liberalized Disability 1960 & 1961 Liberalized	A	/
    Oct. 1956 - Cash Disability Amendments	Earnings Requirements	Requirements; Male	/ \ j
    Thou.onJ.__________________________________________________R.tir.m.n. ot 62	_________/	___________100
    24--------------------------------------Z -3L----------------------------0 ------------------------------- 0
    /	»	1956 1957 1958 1959 I 960 > 961 1962 1963 1964
    N k	*	E- E«.
    20--------------------------------f---------\-----A j----------------X	----------------------x
    71\	//>_______________________
    16--------------------------------1----------------------------'I /----------------------------------14
    TOTAL RECEIVED—
    12----------------—7-----J--------------— ------------------------------------------------------------12
    •-------------f f^\-------------------------~V-------------------------------------------------------’
    /	f TOTAL CLEARED	\
    I TOTAL PENDING
    0---------------------1--------------------------------------------------------------------------------
    1956	1957	1958	1959	1960	1961	1962	1963(EST.)	1964(EST.)
    52
    Department of Health, Education, and Welfare, 1962
    The tremendous increase in hearing requests has also brought about concomitant increase in the workload of the Appeals Council (Chart 10). Thus, wdiereas 970 requests for review of hearing examiners’ decisions were filed in 1956, the number rose to 7,300 in 1960. After a decline in 1961, new statutory amendments contributed in part to an increase in requests for review to 6,400 in 1962. It is estimated that over 9,000 such requests will be filed in fiscal 1963 and a comparable number in fiscal 1964. In addition, the greatly increased volume of litigation has added special burdens (Chart 11).
    The drastic increase in workload has created major problems in maintaining our goal of avoiding “delayed” justice, while continuing to render proper and fair decisions. In addition to the staff increase, and step-up in technical training, other innovations have been made. For example, in order to obtain as complete a record as possible in disability cases, plans have been made to facilitate the appearance of physicians and vocational specialists as witnesses at hearings. Their expert testimony should contribute greatly to the decisional process.
    In 1960, a Subcommittee of the House Ways and Means Committee issued a preliminary report on the social security disability program, in which some of the problem areas which had arisen in the appeals process were considered. The Commissioner thereupon selected an outstanding law firm experienced in administrative law to survey the operation of the Office of Hearings and Appeals. The report of this study, submitted to the Commissioner in December 1960, while making recommendations for certain changes and reorganization, stated in its conclusions: “We are impressed, moreover, with the efforts now being made further to reduce the time required to dispose of claims.”
    The culmination of the reviews of the appeals process was the Secretary’s action during the past year in creating the Bureau of Hearings and Appeals to replace and assume the functions of the Office of Hearings and Appeals. The Secretary stated that elevation of the appeals organization to Bureau status would “emphasize its importance and its independence from the initial adjudicating body, the Bureau of Old-Age and Survivors Insurance,” and would “give increased emphasis to the management needs of what has become a large organization by providing the framework for full management staffing.” The important changes in internal organization during the year were the establishment of the position of Deputy Director, who also serves as Deputy Chairman of the Appeals Council, in order to relieve the Director and Chairman of many responsibilities of administration; the separation of general administrative functions from those relating to field operations, through the creation of the Division of Administration and the Field Division with increased responsibilities; and the expansion of the Program Division.
    Social Security Administration
    53
    CHART 10.—REVIEWS BEFORE APPEALS COUNCIL: RECEIPTS, DISPOSALS, AND PENDING
    Thousands ”1-----------------------------------------------------------------------------------------         I'4
    12--------------------------------------------------------------------------------------------------12
    10-----------------------------------------------------------------------------------------------------
    8----------------------------------------------------------------------------------------------------  8
    --------------------------------------/_/------------JL______________________________________________b
    TOTAL RECEIVED.-----------------------'
    f	CLE ARED
    2	------------------------------------------------------2
    PENDING *\ «•—>s
    ---------'f-----------------------------	I __________________________________	__ _^_____ 0 >2S4	1957	1958	1959	I 960	1961-1962	1963_1964
    (Em.)	(E.t.)
    4
    54
    Department of Health, Education, and Welfare, 1962
    CHART 11.—CUMULATIVE CIVIL ACTIONS FILED, DECIDED, AND PENDING, DECEMBER 1957
    THROUGH JUNE 1962
    1400 ------------------------------------
    1200 --------------------X^______________
    CIVIL ACTIONS FILED. 7
    3x
    1000 ------------------------------------
    800 _____________________________________
    ./XPENDING COURT ACTION
    600	---^X-------------
    400 -------------------------------------
    FINAL COURT X
    ACTI ON 200 -------------------------------------
    oi-------------------------------------
    Dec.	Dec.	Dec. June
    1959	1960	1961 1962
    REGULAR
    18001-------------------------------------
    1600 -------------------------------------
    1400 -------------------------------------
    1200 -------------------------------------
    1000 -------------------------------------
    CIVIL ACTIONS FILED _ __~
    .800	-----— -----
    600 -------------------------------------
    FINAL COURT
    ACTjffM,—*** 400 -------------------------------------
    PENDING COURJ ACTION 20°	------—TT" /	;----
    TOTAL
    3200 -----------------------'----------------------------------
    3000 ----------------------------------------------------------
    2800 ----------------------------------------------------------
    2600 ----------------------------------------------------------
    2400 ----------------------------------------------------------
    2200 ---------------------------------------------- £----------
    2000 -----------------------------------------f-— ————
    1800 -----------------------------------f----------------------
    civil Actions piled^ '
    1600 ----------------------------------------------------------
    1400 ----------------------------------------------yZ----------
    1200 -------------------------------------------/?-— ————
    ....	^INAL ACTIONS BY COURTs"/^
    1000 ----------------------------------f-----------------------
    800 ---------------------------....---------------------------
    600 —---------------------------------------------------------
    400 _^Z^ENPINC FINAL ACTION N COURTS__________________________
    200 ——--------------------------------------------------------
    o------------------------1-----------------------------------
    Dec.	Dec.	Dec.	Dec.	Dec.	June
    1957	1958	1959	1960	1961	1962
    Social Security Administration
    55
    Public Assistance
    Public assistance is intended to help individuals and families meet their essential needs when they are unable to do so themselves, and other resources, including social insurance, are not adequate or available to them.
    Federal governmental aid, first provided in the early 1930’s to meet emergency financial need due to unemployment, was replaced by long-range preventive measures under the Social Security Act passed in 1935 and subsequently amended. By 1950 the measures included (1) social insurance against the risks of unemployment, old-age, and dependency of widows and children because of the death of the wage earner; and (2) federally aided State public assistance to help meet basic unmet needs of certain dependent persons—the needy aged, blind, or disabled, and needy children deprived of parental care or support because of the death, incapacity, or absence of a parent.
    Through subsequent legislative changes, the scope and coverage of the Federal-State public assistance programs were broadened, and the amount of Federal financial participation increased to enable States to raise assistance payments to keep pace more fully with rising costs of living. In 1950, the permanently and totally disabled were included, and measures were added to extend and improve medical care for the needy. In 1956, clarification was made of the availability of Federal financial participation in the costs of providing services to help needy persons increase their capacity for more independent living. Federal funds were also authorized, but not appropriated, for training to upgrade the qualifications of public welfare personnel. In 1960, a separate program of medical assistance for the aged was established, and in 1961, the aid to dependent children program (ADC) was temporarily broadened to provide assistance to needy children in families with an unemployed parent, and to pay for foster family care for certain ADC children.
    Legislative changes made during the past quarter century to meet more adequately the needs of a growing population (especially the aged and children) in a period of rising prices contributed to increased welfare caseloads and expenditures. (See chart 12.)
    In recent years, public concern about welfare expenditures and dependency of welfare recipients has been reflected in widespread publicity about individual instances of fraud, unmarried parenthood, desertion, and other social problems. But there has also been an increasing recognition that the economic need of some groups is a consequence of a healthy, growing industrial society in which technological change and automation have produced economic and social problems with which some individuals, families, and even communities, can no longer cope.
    56
    Department of Health, Education, and Welfare, 1962
    CHART 12.—WHY INCREASED PUBLIC ASSISTANCE EXPENDITURES?
    I949-IS6I J/
    (AMOUNTS IN MILLIONS)
    1 Represents 131 percent increase over 1949.
    2 Includes $199 million vendor medical payments in OAA, ADC, and AB; $166 million in APTD; $142 million for the adult caretaker in ADC; $31 million in MAA; $8 million for Guam, Puerto Rico, and the Virgin Islands; $7 million for additional State plans; and $3 million for children of unemployed parents
    Public concern over rising welfare costs, as well as wide interest in welfare methods and goals, led in 1961 to a concerted departmental effort to find new and better ways of dealing with dependency. Soon after taking office, Secretary Ribicoff announced that improvement of welfare programs would be one of his principal objectives. Early in the year, he sought and received advice and reports from several groups of experts in welfare and related fields on how welfare programs could be more effectively used as a constructive force in preventing and alleviating dependency and other related social problems.
    According to Secretary Ribicoff: “What has emerged from this review is a clear recognition of the fact that today in 1961 the outlook of 1935 is not up to date. Born of depression emergencies, the original Federal welfare legislation well met the problems of that time. But the quarter of a century that has passed has taught us many new things. We are not satisfied with our welfare programs, and we know there is much that can be done to improve them. We must move toward two objectives: eliminating whatever abuses have crept into these programs and developing more constructive approaches to get people off assistance and back into useful roles in society.”
    To accomplish these goals, there was general agreement of the need for: (1) greater emphasis on rehabilitation and family-centered social services; (2) more adequate protection and support of needy children; (3) an administrative structure more helpful to the States in achieving
    NEW PROGRAMS OR SERVICES ADDED BY FEDERAL LEGISLATION &
    INCREASE IN
    -—NUMBER OF RECIPIENTS
    ^«73 J
    % 46% £
    %S544
    • 48% ::$542
    FEDERAL SHARE OF ASSISTANCE PAYMENTS-----
    INCREASED BY FEDERAL LEGISLATION
    Social Security Administration
    57
    these objectives, including better qualified public welfare personnel, and methods of dealing more effectively with fraud and location of deserting parents; and (4) increased development and utilization of community resources in dealing with social welfare problems.
    Administrative Actions in Fiscal 1962
    A substantial start in modifying the public assistance program was made under existing legislative authority in December 1961 when Secretary Ribicoff directed the Commissioner of Social Security to:
    change the name of the Bureau of Public Assistance to the Bureau of Family-Services to reflect the increased emphasis on family-centered welfare services;
    establish a new Division of Welfare Services (absorbing the functions of the former Division of Program Standards and Development) to implement the welfare services emphasis, to assist the States in the development of their services programs, and to study work and training activities and other incentives to employment;
    modify existing Federal policy to permit and encourage the States to allow income of children to be conserved for appropriate future needs (such as the costs of education, and training for employment) without deduction from the public assistance payment; and
    require State agencies to:
    identify needy families with problems such as unmarried parenthood, desertion, and children in other hazardous home situations; and assign such cases to qualified staff for the provision of services, including frequent home visits, and close coordination to assure maximum use of the child welfare staff for consultation and services;
    improve staff training and development programs through an assessment of personnel and training needs to carry out the objectives of the proposed family-welfare-service-oriented program;
    establish a special unit responsible for locating deserting parents of needy children, assisting law enforcement officers and others in their efforts to require effective discharge of family responsibilities, reuniting families whenever feasible, and obtaining support; and
    include in the State plan pertinent points relating to methods, procedures, and placement of responsibility for dealing with instances of suspected fraud, and submittal of periodic reports on the nature and extent of this problem.
    Ill January 1962, Secretary Ribicoff announced the following additional administrative actions:
    extension of the earlier policy change allowing conservation of income of ADC children for future educational and training purposes to permit the income of the ADC mother also to be used for this purpose, and identification
    665171—63----5
    58
    Department of Health, Education, and Welfare, 1962
    of specific steps to be taken by the States to assure that ADC children obtain the full educational opportunities available to them ;
    organization of a work group to assist the Department in simplifying and improving welfare forms and procedures, and in eliminating unnecessary paperwork to allow more staff time for work with recipients;
    establishment of a work group to develop further informaton on the causes of illegitimacy and the most effective methods of dealing with it, to review existing programs to see where further study is needed, to highlight promising areas of research, and to develop programs that will help combat illegitimacy and the economic dependency of children; and
    expansion in the Social Security Administration’s research facilities to assure continuing attention to developing and carrying out studies in the broad field of human resources and social welfare, and appointment of a continuing committee to advise on the Department’s research planning responsibilities, especially in finding ways to reduce dependency and to stimulate self-care and self-support.
    Cooperative effort was also encouraged with the following newly established groups:
    the Children’s Bureau’s special Youth Development Unit, to help local communities plan for improved coordination of welfare services to meet special problems of youth, particularly those on ADC ;
    the Office of Education's Youth Development Section, to promote better coordination between school authorities and welfare agencies in working on school problems of children, especially those on welfare rolls, and on the school drop-out problem;
    the Office of Vocational Rehabilitation’s task force established to determine what administrative steps can be taken under present law to expand and improve vocational rehabilitation services for disabled persons on welfare rolls; and
    the special committee of deans of schools of social work, to increase the supply of adequately trained personnel for public welfare.
    A further policy change announced by the Secretary in March was designed to help mental patients return to community living by permitting Federal financial participation in assistance payments to them or on their behalf on their conditional release from a mental institution, if the patient goes to his own home, the home of a relative, a boarding home, or to a nursing home not specifically established for psychiatric care.
    STATE AGENCY REACTION TO ADMINISTRATIVE CHANGES
    State agency administrators meeting in Washington the latter part of January to discuss the implications of the earlier administrative
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    actions and to plan for their implementation at the State and local level reported “basic agreement between the two levels of government, an eagerness to move forward on a broad front in improving and strengthening public welfare programs, and satisfaction in the far-reaching progressive leadership given by Secretary Ribicoff, Wilbur Cohen, and other members of the Department.”
    They pointed up areas needing further clarification; asked for help in developing in-service training programs, in preparing plan material, and in case classification; and urged the Department to give strong leadership in helping social work gain increased recognition. They also asked for guide materials in planning for social services on a statewide basis, recognizing the lack of community resources in remote areas and the differences in staff capabilities. They cautioned that a sound service program must be based upon adequate financial assistance and expressed concern that an increased emphasis on services to children not result in diminished services for the aged, blind, and disabled.
    While there was unanimous support for the goals and objectives of both the administrative directives and the overall legislative proposals, the State administrators pointed out that “such changes take much time ... we will of necessity be slow in implementation of many of the facets; we will not promptly reduce the caseloads or costs, and there are many factors which indicate we will always have high, and perhaps higher, caseloads and increased costs. ...”
    Some of the Secretary’s directives and many of the recommendations made by the State administrators and other groups, including the White House Conference on Aging, were subsequently reflected in amendments to the Social Security Act passed in 1962.
    Public Welfare Amendments of 1962
    Public Law 87-543, approved July 25, 1962, provides a legislative base for implementing the Administration’s goals to help needy persons attain or retain capability for self-care and self-support, and to maintain and strengthen family life for children.
    Through new financial incentives, the States were urged to provide welfare services that are likely to prevent or reduce dependency, and to develop training programs to increase the number and skill of workers providing such services. Increased Federal funds were allocated for the adult assistance programs to enable the States to increase payments to recipients. In aid to families with dependent children (AFDC formerly ADC), Federal financial participation was authorized in expenditures for work performed by adult relatives under community work and training programs that provide opportunities
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    for conserving and developing work skills. Special protection for the child was provided in the event his parent or other relative does not spend the assistance money for the benefit of the child. Several new provisions also were directed toward more effective administration of the welfare programs.
    In approving the Public Welfare Amendments of 1962, President Kennedy said, “the new legislation marks a real turning point in the Nation’s effort to cope realistically and helpfully with pressing welfare problems.”
    The major provisions of the law, directed to certain objectives, are outlined below.
    To Promote Self-Reliance
    Federal participation in the State’s administrative costs of providing prescribed or specified services in all the assistance programs was increased to encourage States to provide social services to alleviate economic or personal dependency or contribute to its prevention. Services to persons formerly but not now receiving assistance, or considered likely to become dependent within a specified time, however, are to be provided only upon request.
    In the period September 1, 1962, through June 30, 1963, 75-percent matching is available for certain services designated by the Secretary. Beginning July 1, 1963, the Secretary is authorized to prescribe these minimum services. If the minimum prescribed services are provided, 75-percent matching is available in the costs of such services and also in other specified, but optional, services that may prevent or reduce dependency. If a State does not provide the prescribed minimum services, Federal participation will be 50 percent, as before.
    As previously, in all programs, the choice remains with the State agency as to whether services are to be provided, but the State plan must include a description of any services that are made available and steps to assure maximum use of related agencies. Beginning July 1, 1963, in the aid to families with dependent children program (AFDC) the State plan must also provide for the development and application of such welfare and related services as may be necessary because of home conditions and the specific needs of each child, and for the coordination of services provided under the public assistance program with those provided by the State’s child welfare program.
    Services generally are to be provided by public assistance staff. If the State public assistance agency determines, within the limits prescribed by the Secretary, that it cannot offer welfare and related services economically or efficiently and such services are not reasonably available otherwise to persons in need of them, these services may be purchased, by agreement, from other State agencies. There is further provision concerning vocational rehabilitation services (as defined in the Vocational Rehabilitation Act, e.g., counseling, training, and placement for the physically or mentally handicapped) available through the State vocational rehabilitation agency, or which this agency is willing to provide pursuant to agreement.
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    To Upgrade Staff Skill in Providing Services
    A major objective of the new legislation—to help people move from dependency toward self-reliance—is largely dependent upon personnel capable of providing necessary services. To upgrade staff skill, Federal participation was increased from 50 to 75 percent in a State’s expenditures for training personnel employed or preparing for employment in public assistance. This applies to the administrative costs of in-service training programs, training grants for prospective employees, and stipends to welfare staff on educational leave, effective September 1, 1962, for States with an approved staff development plan. Beginning July 1, 1963, the 75-percent matching of a State’s costs for staff development will be available only to those States which also provide the minimum prescribed services to recipients.
    Funds were also authorized for other training to be administered by the Department directly or through grants to or contracts with institutions of higher learning without State financial participation, but no appropriation was made under this authority in 1962.
    To Provide Work Incentives and Encourage Efforts To Achieve Self-Support
    To encourage States to provide useful work experience and constructive training for adults receiving assistance under aid to families with dependent children, Federal participation was provided in the form of payments for work by those employed on community work and training projects that meet prescribed working conditions and safeguards.
    All specified requirements became effective October 1, 1962. However, States were permitted to claim Federal matching for work payments in any period beginning July 1, 1961, through September 30, 1962, if specified conditions, with certain exceptions, were met. This program was authorized for a temporary period, ending June 30,1967.
    Other work incentives were afforded through provisions that (1) require taking into account necessary expenses that can reasonably be attributed to the earning of income in determining need under all the federally aided assistance programs; (2) permit exemption of some earned income in determining need under the old-age assistance program; (3) require disregarding, for not more than 12 months, income and resources in determining need for an aid to the blind recipient who has a plan for achieving self-support in addition to the amount of earned income otherwise exempt; and (4) permit States to set aside earned or other income of an AFDC family for future identifiable needs.
    Thus, in determining need and the amount of an old-age assistance payment, States are permitted to disregard the first $10 of earned income plus one-half the remainder of the first $50, effective January 1, 1963.
    In the aid to the blind program, in addition to the provision of a 1960 amendment, effective July 1, 1962, which requires disregarding the first $85 per month of earned income plus one-half of earned income in excess of $85, further provision was made to disregard additional amounts of other income and resources for a period not to exceed 12 months to enable a blind individual to fulfill a State-agency-approved plan for achieving self-support.
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    To Extend the Adequacy and Scope of Public Assistance
    The formula for determining the amount of Federal participation in State public assistance payments to the aged, blind, and disabled was liberalized, effective October 1, 1962. The Federal share of the average monthly assistance payment in old-age assistance, aid to the blind, and aid to the permanently and totally disabled was raised from % of the first $31 to 2%s of the first $35, and the average maximum was increased from $66 to $70.
    In approving the 1962 amendments, President Kennedy pointed out that, “The reports of both the Ways and Means Committee of the House of Representatives and of the Committee on Finance of the Senate make it clear that the States are expected to pass these additional funds on to the recipients under these programs. It would truly be a miscarriage of justice and a frustration of the legislative intent if these new Federal funds merely replaced existing State funds, and those for whom the increase was intended were denied the full benefit.”
    Assistance to dependent children of unemployed parents, authorized in 1961 for a 14-month period ending June 30, 1962, was extended for 5 years, to June 30, 1967. Also, the aid to families with dependent children program was broadened to include both parents as eligible recipients when deprivation of parental care or support is due to incapacity or unemployment.
    To assure that an assistance payment made on behalf of a child is spent in his best interests, in instances where there is evidence that the money is being used in ways that are detrimental to or threaten the well-being of the child, the State agency may take any of the following actions. It may provide counseling and guidance services to the relative payee on the proper use of such payment; it may advise the relative that continued failure to use the payment for the benefit of the child may result in court appointment of a legal representative or guardian, or in criminal or civil penalties imposed by a court of competent jurisdiction; or under specified conditions, it may make a “protective payment” without loss of Federal funds.
    A “protective payment” is a money payment to a substitute payee—a third party, such as a relative, friend, or individual who is a member- of a church, community service group, or public or voluntary agency who is interested in the welfare of the family. When such payments are made, safeguards are included to assure that (1) consideration is given in the selection of a substitute payee to qualifications for assuming this responsibility and acceptability of the individual to the family, the needs, and problems in the home and the nature of tbe difficulties that led to the present need for help in money management; and (2) special efforts or services are directed toward helping the relative payee develop his ability to manage funds, since the purpose of the protective payment is to strengthen the child’s own family rather than to provide care for the child in a foster home.
    The State may receive full Federal financial participation in protective payments made to a limited number of recipients (not exceeding 5 percent of the number of other AFDC recipients in the State for such month) during the period October 1, 1962, through June 30, 1967.
    To increase resources for the care of children removed from the home, the following actions were taken.
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    (1)	The 1961 amendment, which temporarily provided Federal financial participation in State expenditures for a dependent child in a foster family home, was made permanent.
    (2)	The limitation that responsibility for placement and care be only in the State or local agency administering AFDC was modified until June 30, 1963, to include responsibility for placement and care by other public agencies. However, a current interagency agreement must assure the development of a plan for the children that will accomplish the objectives of the AFDC program. Before March 1963, the Secretary is to report on the effectiveness of this provision and recommend further action.
    (3)	Federal participation was also temporarily authorized in State AFDC payments in the form of foster care for children who must be removed from their home and placed in a licensed or approved private nonprofit child-care institution (from October 1, 1962, through September 30, 1964). Payments for maintenance, such as board and room, clothing, medical care, and other needs—but not overhead costs of the institution—may be made to the institution.
    The program of assistance to Americans repatriated to the United States from abroad was extended from June 30, 1962, through June 30, 1964. This program was authorized by Congress in 1961 because of the need for emergency aid that might result from international crises or severe personal problems which befall the increasing number of Americans living or traveling abroad.
    To Assure More Effective Administration
    A move toward a noncategorical approach was reflected in title XVI added to the Social Security Act to permit replacing the present separate State plans with a single plan consolidating all adult programs, effective October 1, 1962. (In States which have a separate agency for the blind under title X, that agency may be designated to administer or supervise as a separate plan the portion of the State plan under title XVI which relates to blind individuals.)
    The new title does not, in most instances, modify existing provisions in titles I, X, and XIV, but to the extent that eligibility conditions are the same for aged, blind, or disabled persons, the new program under a single State plan permits simplification. The single State plan would have a common standard for determining need and payment, except for the disregard of earned income of those in the aged and blind groups; and assistance payments for the aged, blind, or disabled would be averaged in computing the amount of Federal financial participation under the new program. Also, the separate and additional Federal financial participation for medical care authorized under title I will be available under title XVI for medical care for the blind or disabled, as well as the aged. Medical care for the first 42 days of an aged individual’s stay in a general medical institution as a result of a diagnosis of psychosis or tuberculosis is also extended to blind or disabled persons.
    To stimulate experimental projects to test new ideas and ways of dealing with public welfare problems, the Secretary is permitted to waive State plan requirements that may interfere with such demonstrations, such as the requirement that a plan must be in effect throughout the State, since such projects usually are not statewide. The law also authorizes use of not more than $2 million
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    a year, for 5 years, of funds appropriated for public assistance to assist in paying that portion of the costs of projects not otherwise subject to Federal participation.
    A 12-member Advisory Council on Public Welfare is to be appointed in 1964. This group, representing the general public and various interests concerned with public and voluntary welfare programs, is to review and make recommendations on the Federal-State public assistance and child welfare services programs; and to study the relationship between the public assistance and the old-age, survivors, and disability insurance programs. The first Advisory Council is to submit a report to the Secretary by July 1, 1966. Subsequent similar councils are also authorized.
    Trends in Caseloads and Expenditures
    In June 1962 assistance was available in all 54 jurisdictions of the country (including the District of Columbia, Guam, Puerto Rico, and the Virgin Islands) under federally aided programs of old-age assistance (OAA), aid to the blind (AB), and aid to families with dependent children (AFDC).
    Fifteen jurisdictions administering AFDC also made payments to unemployed-parent families, compared with 6 in June 1961, and 13 jurisdictions made payments for the foster-family care of children, compared with 1 in June 1961.
    Federally aided programs for the permanently and totally disabled were administered by 50 jurisdictions, and an additional APTD program was started in Arizona on July 1,1962.
    Twenty-seven jurisdictions, compared with 10 in June 1961, had a program of medical assistance for the aged, now in its second year.
    General assistance (wholly State and/or locally financed), in some form for some persons, was available in all 54 jurisdictions.
    CASELOADS
    About 7.3 million persons were receiving aid in June 1962 under the six public assistance programs—old-age assistance, medical assistance for the aged, aid to families with dependent children, aid to the permanently and totally disabled, aid to the blind, and general assistance. With increases in MAA, AFDC, and APTD more than offsetting decreases in OAA, AB, and GA, the net increase in June 1962 over June 1961 was 180,000 recipients (or 2.5 percent)—considerably less than the 432,000 (or 6.3 percent) increase in June 1961 over June 1960.
    There were 101,600 recipients of MAA in the 27 States with such programs in June 1962 compared with 46,000 receiving such assistance in June 1961, when only 10 States had such programs. The MAA program was initiated in October 1960 under an amendment passed in September 1960.
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    Ill AFDC, the 3,692,600 recipients (including 2,853,400 children in 944,000 families) assisted in June 1962 represents an increase of 310,000 over June 1961. This 9.2-percent increase is attributable in part to the increase of 125,000 recipients in unemployed-parent families, and also reflects the continuing growth in child population.
    The 417,000 persons receiving APTD in June 1962 represents an increase of 8.7 percent over the 384,000 aided a year earlier. The increase in 1962, slightly higher than the 5.8-percent increase in June 1961 over June 1960, is a continuation of the gradual but steady increase in the number aided under this program since its initiation in 1950.
    The 2.2 million recipients of old-age assistance in June 1962 represents a 59,000 (or 2.6 percent) decrease from June 1961, due largely to liberalizations in eligibility requirements for the old-age, survivors, and disability insurance program (OASDI) and transfers of aged persons in medical institutions and/or nursing homes to newly established programs of MAA. A similar 2.6-percent decline in OAA recipients in June 1961 from June 1960 is part of the slow but steady decline in the number receiving OAA since 1951.
    However, the 34 percent of OAA recipients receiving both public assistance and social insurance in June 1962 because their insurance benefits and other resources were insufficient to meet their basic needs, such as medical care, is a continuation of the steady increase in concurrent receipt of assistance and insurance. Since 1950 when OAA and OASDI were concurrently received by less than one-tenth of the total OAA caseload, the number receiving both has steadily grown until they represented slightly more than one-third of all OAA recipients in 1962.
    The 100,400 recipients of aid to the blind in June 1962 represents a 4.9-percent decline from the 106,000 aided in June 1961. The June-to-June decline in 1962 is greater than the 2.2-percent decrease for the same period between 1961 and 1960.
    The 812,000 persons in 340,000 cases receiving general assistance in June 1962 represents a 16-percent decrease from the 1,040,000 persons in 405,000 cases receiving general assistance a year earlier.
    One in 25 persons in the total population was a recipient of public assistance in June 1962. The recipient rate varied widely by program. One out of every 8 aged persons received old-age assistance; only 1 out of every 24 children received AFDC.
    The recipient rate also varied by State, due in part to variations in per capita income. States with relatively high per capita income are likely to have a relatively small proportion of their population in need; conversely, States with low per capita income usually have a high incidence of need.
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    Although a majority of persons applying for assistance do not receive OASDI benefits (e.g., voluntary reports from 29 States indicate that of the cases approved January-June 1961, 97 percent in AFDC, 97 percent in GA, 90 percent in APTD, 86 percent in AB, and 53 percent in OAA were not receiving OASDI benefits), a State’s assistance recipient rate is usually inversely related to the proportion of persons in the State who do receive OASDI benefits. In general, in States where more persons receive OASDI benefits, the proportion of the aged receiving OAA is lower than in States with smaller numbers of OASDI beneficiaries.
    Voluntary reports from 29 States also indicate that one out of every six applicants for whom old-age assistance was approved during the last 6 months of fiscal 1961 found it necessary to apply for assistance because of increased need for medical care or because of exhaustion or reduction of assets to meet medical care expenses during the 6 months preceding application. For persons who have been receiving OASDI benefits and have found it necessary to ask for old-age assistance, the proportion for whom medical care is the immediate reason was more than twice as high (29.3 percent) as that for persons approved for assistance who are not receiving OASDI benefits (12.2 percent).
    EXPENDITURES
    Total assistance expenditures, including vendor payments for medical care, for all six programs for the fiscal year 1962 were $4,269 million—an 8.4-percent increase over expenditures in 1961. Total expenditures in June 1962 compared with a year earlier reflect both increases of $220 million or 19.6 percent in AFDC, $153 million or 357.2 percent in MAA, and $33 million or 11.0 percent in APTD; and decreases of $16 million or 0.8 percent in OAA, $1 million or 1.2 percent in AB, and $58 million or 12.4 percent in GA programs in 52 States. Assistance payments during 1962 represented about a cent per dollar of total personal income in the Nation during 1961. The cost per person in the United States was $22.92.
    In aid to families with dependent children, the national average monthly payment was $31.48 per recipient in June 1962, compared with $30.30 a year earlier. Average payments per recipient ranged from $9.15 in Mississippi (except for $3.76 in Puerto Rico) to $47.52 in New Jersey.
    In old-age assistance, the average payment was $72.55 per recipient in June 1962, compared with $67.85 in June 1961—an increase of nearly $5. Average payments ranged from $36.03 in Mississippi (except for $9.05 in Puerto Rico and $33.89 in the Virgin Islands) to $103.42 in California. For all States, the average medical care vendor
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    payment per recipient of old-age assistance increased from $11.12 per recipient in June 1961 to $14.49 in June 1962.
    In medical assistance for the aged, the average vendor payment per recipient, as reported by 26 of the 27 States with programs in June 1962, was $171.36, compared with $201.33 per recipient in the 9 States making payments in June 1961. Average MAA payments ranged from $18.40 in Kentucky (except for $18.10 in the Virgin Islands x) to $394.15 in Louisiana.
    In aid to the permanently and totally disabled, the average payment per recipient was $72 in June 1962, compared with $68.21 a year earlier. The nearly $4 increase was centered largely in vendor payments. Average payments ranged from $34.44 in Mississippi (except for $8.75 in Puerto Rico, $24.85 in Guam, and $34.08 in the Virgin Islands) to $131.77 in Massachusetts.
    In aid to the blind, the average payment per recipient was $77.47 in June 1962, compared with $73.36 a year earlier. Average payments ranged from $38.13 in Mississippi (except for $8.33 in Puerto Rico i 2) to $121.72 in California.
    In State and/or locally financed general assistance programs, the average payment per case excluding medical care vendor payments, was $65.78 in June 1962, compared with $65.13 in June 1961 for 52 jurisdictions (Idaho and Indiana excluded). Average payments per case ranged from $12.65 in Alabama (except for $8.31 in Puerto Rico3) to $123.94 in New Jersey. Thirty-seven percent of all cases were family cases, including an average of 4.4 persons per family.
    The wide variation in average monthly payments between States is closely related to per capita income and willingness to support public assistance programs.
    States with relatively high per capita income usually have a relatively small proportion of their population in need, but a relatively greater fiscal capacity to meet needs that occur. States with relatively high per capita income, thus, usually make relatively higher payments than States with low per capita income in which there is both a high incidence of need and low fiscal capacity.
    Some States with low per capita income make a strong effort to finance public assistance, and as a result, their expenditures per inhabitant are larger than other States with similar per capita income. In general, however, States with low per capita income provide smaller average amounts of assistance. Therefore, matching formulas for Federal participation in State expenditures for public assistance
    i Too few recipients In Guam and New Hampshire to compute a reliable average payment.
    2 Too few recipients in Guam and the Virgin Islands to compute a reliable average payment.
    3 Too few recipients in Guam to compute a reliable average payment.
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    have been designed to be of relatively greatest help financially to low-income States.
    Factors contributing to increased expenditures in 1962 include: the increase of 125,000 persons in the unemployed segment of the AFDC program, growth in existing MAA programs and initiation of new programs in 17 States, initiation of vendor payments in OAA for certain types of medical care in 6 States, an increase in rates for vendor medical services in several States due to the rising cost of medical care, and an increase in the level of money payments to meet the rising cost of living.
    Higher level of payments in several States resulted from actions taken to utilize additional Federal funds made available for OAA, AB, and APTD under the 1961 amendments to the Social Security Act. Cost standards used in determining eligibility for and the amount of assistance payments, for example, were also increased in one or more programs in about a fourth of the States, a few States raised their maximums on individual monthly payments, and some States removed or lessened percentage reductions in need met.
    SOURCE OF FUNDS FOR PUBLIC ASSISTANCE PAYMENTS
    Of $4,269 million expended for the six public assistance programs in fiscal 1962, about 54.0 percent, or $2,304 million, came from Federal funds; 34.7 percent, or $1,482 million, from the States; and 11.3 percent, or $483 million, from the localities.
    For the five special types of public assistance, the Federal share of total costs was 59.7 percent; the State share, 32.7 percent; and the local share, 7.7 percent.
    Program Developments
    In addition to the new program provisions provided through administrative action or legislative change during the year, significant developments have occurred in several program areas.
    DEVELOPMENTS IN MEDICAL CARE
    By 1960, more than four-fifths of the Nation’s jurisdictions had some provision in their public assistance programs to pay for medical care directly to the suppliers of such services, commonly known as the vendor payment, and many of the jurisdictions provided for some items of medical care in the money payment to recipients. However, the majority of the States are not yet providing the broad scope of services needed by most sick people.
    In September 1960, two additional medical care provisions for the aged were authorized by Congress under Public Law 86-778, popularly known as the Kerr-Mills legislation. These included: (1) a new
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    Federal-State program of medical assistance for the aged with Federal funds to help the States pay for medical care for older persons whose income and other resources are above the financial level of eligibility for old-age assistance, but not sufficient to meet the costs of their medical care needs; and (2) increased Federal funds to enable the States to improve medical care services in their existing old-age assistance programs, or to develop such medical care services.
    The 1960 provisions augmented the amount of medical care_that could be made available previously under federally aided public assistance programs. As a result, payments by States to suppliers of medical care under the federally aided public assistance programs, including medical assistance for the aged, have increased from less than $400 million in fiscal 1960 to about $712 million in fiscal 1962. About $195 million of the 1962 expenditures are attributable to the new medical assistance for the aged program.
    Medical Assistance for the Aged (MAA)
    The Federal provisions of the MAA program are liberal and flexible. The Federal Government shares with the States in the total cost of the program without any limitation on the individual payment or on total State expenditures. The amount of Federal participation ranges from 50 to 80 percent of medical care expenditures paid to suppliers of medical care in behalf of eligible recipients, the higher percentages going to the States with lowest per capita income.
    Under this new program States may make available a broad scope of medical services: inpatient hospital services; skilled nursing-home services; physicians’ services; outpatient hospital or clinic services; home health care services; private-duty nursing services; physical therapy and related services; dental services; laboratory and X-ray services; prescribed drugs; eyeglasses, dentures, and prosthetic devices; diagnostic, screening, and preventive services; and any other medical or remedial care recognized under State law.
    Although the law specifies a broad scope of care and services that may be provided as medical assistance for the aged, the States determine the kinds and extent of services for which costs will be assumed and the conditions of eligibility for such services. Relatively few conditions are imposed by the Federal act: the State must include both institutional and noninstitutional care; a durational residence requirement is not permitted; a lien may not be placed against the property of any individual prior to his death on account of medical assistance properly paid in his behalf, and recovery of such assistance cannot be made except from his estate after the death of the surviving spouse, if any; no charge, such as an enrollment fee or premium, is permitted as a condition of eligibility; and disclosure of information
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    concerning applicants and recipients is restricted to purposes directly connected with the administration of the program.
    State implementation of the MAA program.—By August 31, 1962, half the States and 3 other jurisdictions had MAA programs in operation ; the number had doubled from 14 States in August 1961 to 28 States4 in August 1962. The number of recipients under this program nearly doubled during the year, from 59,100 in August 1961 to 108,900 in August 1962. About a third of the recipients for whom MAA was authorized since it began came from other assistance programs primarily in States that paid for nursing-home care, and whose average payments under O A A exceeded the maximum amounts in which F ed-eral financial participation is available.
    There is considerable range among the participating States both in the number and proportion of persons receiving medical care under MAA and in the average payment per recipient. For example, in August 1962, the number aided ranged from 20 in New Hampshire to 30,503 in New York, and 2 States made no payments during the month. Nearly two-thirds of the recipients were in three States. Average MAA payments ranged from $20.86 in Kentucky to $418.47 in Illinois. The average payment for all States was $215.61.
    The States, in most instances, began on a conservative basis. Of the 28 States (25 States and 3 other jurisdictions) operating medical assistance for the aged programs in August 1962, 3 provided for comprehensive care in each of the 5 major areas of medical services (hospitalization, nursing-home care, physicians’ services, prescribed drugs, and dental care). Four additional States gave some care in each of the major areas but with significant limitations on the condition for which care would be provided or the extent of such care. Six States provided only two services, one institutional and one non-institutional, the minimum required by law.
    All 28 jurisdictions provided for hospitalization on some basis, but with varying limitations as to the number of days of hospital care and the nature of the medical need, e.g., emergency or life-endangering conditions.
    Nursing-home care was included in 18 of the State programs. In four of these States, care was restricted to post-hospital care. In the other 14 States, restrictions related largely to rates of payment.
    Twenty-six States provided physicians’ services but in two of these States, such services were available only as outpatient clinic services. In 17 programs,
    4 Alabama, Arkansas, California, Connecticut, Guam, Hawaii, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New York, North Dakota, Oklahoma, Oregon, Pennsylvania, Puerto Rico, South Carolina, Tennessee, Utah, Vermont, Virgin Islands, Washington, and West Virginia.
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    physicians’ services were limited as to the number of visits during a given period or the nature of the illness or condition covered.
    Prescribed drugs were included in 16 States, and were available without narrow limitations in 8 of these States. Dental care was covered in 11 States but with restrictions; most of the States did not provide for dentures.
    Five of the 28 States provided for more medical services in MAA than in OAA; 13 provided substantially the same breadth of service as was available in old-age assistance through vendor-payment provisions; 8 provided for less service than for OAA recipients, usually omitting dental care, prescribed drugs, or nursing-home care; and in 2, the variations prevented classifications under any of the above headings.
    The extent to which States are reaching into the group of medically indigent through this program is limited. The basis on which eligibility for MAA is determined by the different States is only slightly higher than that used for old-age assistance, as evidenced by the consideration given by the States to income and other resources, such as personal property, life insurance, and real property in determining eligibility. In addition, in more than half the 28 States, persons otherwise eligible can receive help under MAA only after health insurance or such other potential resource has been utilized. Eight States also include a deductible feature—an amount, such as $50 or $100, which must have been obligated by an individual in a year for medical care before he can be eligible for participation in the program.
    Consideration of income.—Generally, the States with MAA programs use a specified level of income in determining financial eligibility. In most States, a person with income in excess of a specified amount is ineligible. In six States, the income figure represents the amount considered as needed for living expenses, and income or available assets beyond that amount are evaluated against the probable cost of medical care needed by the individual. The most liberal annual income figure used by a State is $2,000 for a single person. The most common amount is $1,500, and the next most common amount is $1,200, with two States below this figure. The most common figure of $1,500 approximates the highest figure—$1,587—in a Stale OAA program (excluding Alaska) for a single person living alone for essential maintenance costs, in January 1961.
    Consideration of life insurance—Twenty-six of the 28 States exempt life insurance under specified conditions, such as: 1 State, a reasonable cash surrender value; 15 States, within a dollar maximum ranging from $500 to $2,000, with $1,000 the most usual limit; and 10 States, within the dollar maximum for all personal property. The other two
    72
    Department of Health, Education, and Welfare, 1962
    States provide for full utilization of any cash resource available from the insurance.
    C onsideration of other personal property.—All 28 States take into account the availability of other personal property to meet medical care costs. In 26 States, there are dollar limits on the amount that may be held without affecting eligibility. These range from $50 to $2,800, with most between $1,000 and $2,500. Nine include both real and personal property within the stated limit.
    Consideration of real property.—All States exempt the property used as a home but six States require that equity in the home not exceed a stated amount. With respect to real property other than that used as a home, five States do not allow holding such property, and four States set limits on the value of such property that can be held but require it to be income-producing. Of the other States, some require the value of such property in excess of certain limits to be applied to medical costs, and others specify limits on the value of such property which may be held.
    In general, States have been more liberal in the limits set for real and personal property which an individual may retain and remain eligible for medical assistance for the aged than is true for old-age assistance. However, with but 28 of the 54 jurisdictions utilizing Federal aid available for MAA, the limited scope of medical services being provided, and limitations imposed on income and resources, the benefits of the MAA program are reaching a relatively small segment of the elderly of the Nation, and the potential of the Federal legislation is not yet being realized. With more experience in this area, some States will probably expand their MAA programs, and others will establish programs, but the cost factor could continue to be a deterrent to expansion.
    The Secretary of Health, Education, and Welfare, in transmitting to the House Ways and Means Committee the “Report on Medical Care Under Public Assistance” covering the first year’s experience under the Kerr-Mills legislation (October 1960-October 1961), concluded that “to rely on existing public assistance legislation alone as a means of meeting the medical-care needs of aged persons would not only fail to cover many aged people in need, but would also be very costly in general revenues. The legislation could, and in my judgment should, be a supplement to the type of protection which would be afforded under the administration’s proposals for health insurance for the aged through social security.”
    Increased Medical Care Provisions Under Old-Age Assistance (OAA)
    The 1960 legislation provided for a substantial expansion in Federal participation in payments to suppliers of medical care for old-age
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    assistance recipients. In addition to the usual share in assistance payments, the Federal Government provided an additional amount based on expenditures for payments to suppliers of medical care up to a monthly maximum of $12 per recipient (raised to $15 in 1961). The additional funds were intended to enable States to improve or to initiate medical care services in old-age assistance programs.
    Between October 1,1960, (the effective date of the new legislation) and August 31,1962, of the 43 States which were already making some vendor payments for medical care costs of old-fige assistance recipients, 25 expanded or improved the coverage or content of medical care services, 4 broadened the scope by including persons only in need of medical care, and 14 continued the level of services previously offered. Ten of the other 11 jurisdictions provided medical care services for the first time through vendor payments, and 1 secured legislative authority for vendor payments for old-age assistance recipients.
    Scope of medical care provided.—Of the 53 jurisdictions making vendor payments for medical care services for OAA recipients in August 1962, 22 were providing a relatively comprehensive scope of services—15 made vendor payments in each of the five major kinds of medical care (hospital care, nursing-home care, physicians’ services, dental care, and prescribed drugs) ; and 7 used the vendor-payment method for all of these services except nursing-home care (for which payment was made through the money payment to the recipient).
    Of the other 31 States providing vendor-medical care payments, 11 provided 4 of the major services (2 of them used the money payment for nursing-home care) ; 5 provided hospital and nursing-home care plus other physicians’ services or prescribed drugs; and 15 provided 1 or 2 of the major services, usually hospitalization.
    Content of medical care provided.—Hospitalization, the kind of care most frequently provided through the vendor payment, was available in 47 States, although usually limited as to the nature of illness or duration of care needed. (One State used the money payment for hospital care.)
    Nursing-home care was provided through the vendor payment by 36 States (14 used the money payment for this—in 4 of these States, the maximum on the individual money payment was $100 or less per month, and in the others, the limitations were related to rates for specified kinds of care).
    Payments to physicians, the service next most frequently provided through the vendor payment, was available in 38 States (6 used the money payment for physicians’ services), although usually restricted the number of physicians’ visits.
    665171—63----6
    74
    Department of Health, Education, and Welfare, 1962
    Dental services were provided by 30 States through the vendor payment (9 used the money payment), but frequently were limited to relief of pain or necessary extractions; some States which include dentures limited the circumstances under which such services may be authorized.
    Prescribed drugs were provided by 31 States primarily through the vendor payment (9 used the money payment).
    Many States also provided for other medical services through the vendor payment, such as special nursing care in the patient’s own home, transportation to receive medical care, or rehabilitative services (physical or speech therapy, outpatient laboratory and diagnostic services, and prosthetic appliances or special equipment).
    States with high average vendor payments presumably provide a more adequate level of medical care to aged recipients. Chart 13 shows that in June 1962 States having high average vendor payments per recipient under the MAA program were widely scattered throughout the country. For OAA, States with relatively high average vendor payments for medical care were largely concentrated in the Northeast, the North-central, and the Pacific Northwest areas. Averages were generally low in the South.
    As indicated in chart 14 the amount of expenditures for medical services provided to recipients of the different federally aided assistance programs varies greatly. This is clearly evident in the wide
    CHART 13.—MEDICAL ASSISTANCE FOR THE AGED: AVERAGE PAYMENT PER RECIPIENT FOR VENDOR PAYMENTS FOR MEDICAL CARE, JUNE 1962
    T «
    WOrI' WeXp
    GU4“
    SmwWwSSkII	HAWAII
    v ha. A \\ w	11.j—।
    \\ \
    v \	PR
    VI
    199 9* *9R<	/’’t
    Social Security Administration
    75
    CHART 14.—VENDOR PAYMENTS FOR MEDICAL CARE
    AVERAGE PAYMENT PER RECIPIENT JUNE 1962 Jy
    PAYMENTS, FISCAL YEAR 1962 IN MILLIONS-TOTAL $712
    1 Except for MAA, averages based on cases receiving money payments, vendor payments for medical care,or both.
    range in the average monthly medical vendor payment per recipient in June 1962—from $2.29 in aid to families with dependent children to $171.36 in medical assistance for the aged. These averages, however, not only reflect differences in medical care available under the programs, but also differences in utilization of services, availability of treatment through other sources, and relative costs of similar care for different types of cases.
    Efforts To Improve Medical Care Programs
    High priority was given to consideration of major policy issues under the 1960 medical care provisions, development of instructional material for State use in improving the scope and quality of their medical services, and issuance of interpretative materials. Consultation was provided to State agencies on the development of necessary State legislation and plans to put the new medical care provisions into effect. State officials also met with Bureau staff in Washington to consider specific State situations.
    The Bureau released to the States a statement entitled “Financial Eligibility: Medical Assistance for the Aged,” summarizing the criteria and methods governing financial eligibility requirements developed by the first 10 States to begin MAA programs. “Casework Services in Public Assistance Medical Care,” issued by the Bureau in May 1962 as a guide for the use of State agencies, discusses the skills and services frequently necessary to enable those requiring medical attention to obtain early treatment, to use the opportunity fully, and to maintain the benefits of such care. This publication, available from the U.S. Government Printing Office, is now in its second printing.
    AB $9
    PROGRAM	AMOUNT	------
    MAA	$171.65	ApTD I	\
    /	\ $68 I	\
    APTD	15.56	/ AFDC \ I	\
    /________*91 V	OAA	\
    -A	$350
    OAA	14 49	I	/
    \	MAA	/
    \	$195	/
    AB	8.08	\	/
    AFDC	2.29	-------L__—
    76
    Department of Health, Education, and Welfare, 1962
    Work continued, with the help of the medical advisory group appointed in 1961, on developing the content for guides and recommended standards in the provision of medical care by public assistance agencies.
    Policy was also developed to implement the administrative actions taken by the Secretary on March 5, 1962, liberalizing the interpretation governing Federal financial participation in assistance to or on behalf of persons on conditional release from institutions for mental illness. A modification in the definition of “inmate” permits Federal financial participation in assistance payments to or on behalf of persons who are on conditional release from mental institutions without regard to the kind of control still exercised by the institution. After October 1, 1962, the State public assistance agency must develop an agreement with the State agency or agencies responsible for the care of the mentally ill.
    A report of a study of selected content of State provisions for the blind in four States was prepared as a basis for strengthening services for this group of recipients. Work materials were also developed for a review of State practice in the administration of medical care provisions on a comparable base throughout the Nation.
    Discussions of mutual benefit were undertaken with State supervising ophthalmologists associated with aid to the blind programs to exchange ideas about their role in this category of public assistance; and with an ad hoc committee of the American Hospital Association to discuss plans for a study of hospital utilization by aged assistance recipients. Joint field visits were made with the Community Health Services Division of the Public Health Service to four States and two other jurisdictions to study relationships between State health and welfare departments that have contracts or agreements for the provision or purchase of medical care for public assistance recipients.
    Information was supplied in 1961 for the report, “Medical Resources Available to Meet the Needs of Public Assistance Recipients.” A subsequent report, “Medical Care Under Public Assistance,” covering the first year of operation under the 1960 amendments (October 1960-October 1961) was prepared and submitted to Congress in March 1962. Both reports were published by the House Ways and Means Committee. “Characteristics of State Public Assistance Plans Under the Social Security Act: Provisions for Medical and Remedial Care,” Public Assistance Report No. 49, was issued in March 1962.
    To promote better public understanding, a pamphlet on “Medical Aid for Older Persons Through Public Assistance,” was prepared; and medical care in public assistance, as provided by the two Federal-State assistance programs for the aged, was the theme of an exhibit, “Public Assistance Helps the Elderly To Meet Their Needs,” first
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    shown at the White House Conference on Aging in January 1961, and subsequently requested for use in various parts of the country.
    Since enactment of the Kerr-Mills legislation, requests for information about medical care under public assistance have come from individuals seeking guidance for themselves, their families, and acquaintances ; from editors, reporters, and writers; from a wide range of government and private organizations; and from schools. Efforts have been made to obtain up-to-date information on State developments as changes occurred. The constant stream of requests from national organizations, congressional committees, and the press for reports on the progress of the medical care program is evidence of the great public interest in providing help and services for the medically needy.
    FROM WORK RELIEF TO WORK AND TRAINING
    Work relief—a form of governmental assistance in which needy unemployed persons earn all or part of the assistance payment through employment—was widely used during the thirties to maintain work habits and morale. In the sixties, its objective shifted to rehabilitation through work, education, and training.
    When Federal funds became available in May 1961 for assistance to children in families with unemployed parents, States transferred some needy families from their general assistance programs to the amended ADC program. Of the 13 States that provided aid to families with unemployed parents during September 1961,12 included work relief projects in their general assistance program. In 7 of these 12 States, employable ADC fathers were assigned to work relief projects to earn the State and/or locally financed portion of their assistance payment which was above the maximum amount for which Federal financial participation was available.
    A nationwide inquiry into the nature and extent of work relief was made by the Bureau in September 1961. According to the published report of this study, “Work Relief—A Current Look,” work relief projects in 438 local jurisdictions in 27 States employed some 30,400 persons. Of those assigned to work relief projects, 86 percent were concentrated in seven States—California, Illinois, Michigan, Ohio, Pennsylvania, West Virginia, and Wisconsin. Work relief recipients represented only a small proportion of the general assistance caseload in these States.
    Projects ranged from brush-cutting along remote country roads to training-oriented projects in big-city hospitals. The most prevalent projects, in the order named, were maintenance of streets and roads, custodial work in public buildings, care of park and recreation facili
    78
    Department of Health, Education, and Welfare, 1962
    ties, and distribution of surplus food commodities. Urban areas offered a greater variety of work than rural areas.
    The average monthly amount credited toward the assistance payment of those on work relief was about $92, and most recipients—92 percent—received their remuneration in the form of an assistance payment; the remaining 8 percent received wages, usually limited by the family’s needs as budgeted by the welfare agency- The value of the assistance worked for and wages paid on all work relief projects was about 12 percent of the total spent for general assistance and comparable programs in the 27 States with work relief programs.
    The cost of providing work relief beyond assistance was estimated by the Bureau, in the absence of other available data, at $15 a month per employed recipient to cover expense of transportation, extra food, and clothing; and about $4 a month per recipient for coordinating the program and assigning recipients to projects. Other costs—materials, tools, and supervision—were usually borne by project sponsors.
    Even though relatively few ADC parents were assigned to work relief projects, several States asked that Federal participation be extended to assistance in the form of wages earned under work relief by unemployed parents with dependent children.
    A subsequent provision was, therefore, made in the Public Welfare Amendments of 1962 for community work and training programs, for a temporary period ending June 30, 1967, to encourage the education, employment, reemployment, retraining, conservation of work skills, and the development of new skills for potentially employable recipients of the federally aided program of aid to families with dependent children.
    The new legislation also provides safeguards, many of which were suggested from earlier experience with work relief. Provision must be made for adequate protection of the health and safety of workers, and appropriate arrangements must be made for the care and protection of children during the absence of parents doing such work. Payment for work done must be at rates not less than those for similar work in the community, and in determining need, consideration must be given to reasonable expenses attributed to such work. Work performed must serve a useful purpose and not interfere with or displace regular employees. Opportunity must be given the worker to seek regular employment and to secure available training. Cooperative arrangements must also be established and maintained with State employment and vocational and adult education agencies for maximum utilization of their resources to improve opportunities of such recipients for regular employment.
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    EFFECT OF FEDERAL AID TO THE UNEMPLOYED
    A temporary measure effective May 1961, for a 14-month period, extended the aid to dependent children program to include families of needy unemployed persons. To determine the extent to which this provision was meeting needs and helping the unemployed parent use community resources to regain employment, a study of its first 7 months’ operation was also undertaken by the Bureau. In addition to reviewing State plan provisions and statistical information reported by the States, a review and evaluation of practice was made in 45 localities in the 13 States 5 making payments under this provision from May through November 1961.
    During this period assistance had been granted to 66,100 of the 86,300 unemployed parents who applied in 12 of the 13 States making such payments; nearly half (46 percent) had been transferred from State or local general assistance programs operative in 12 of the States. Unemployment insurance benefits were much less frequently a resource for this group of recipients. Only 12 percent of the families were receiving unemployment compensation at the time of approval of their application for assistance. An additional 19 percent had received such benefits during the 6 months prior to the approval of their application, and 20 percent of the applicants had filed a claim which was pending at the time of approval of the application.
    In November 1961, under this new provision, $6.7 million reached 43,200 unemployed-parent families with 157,000 children; 95 percent of these families lived in 6 States (Connecticut, Illinois, New York, Pennsylvania, Washington, and West Virginia). The average payment per family was $155, the average payment per recipient, $34. The average payment per recipient ranged from $18 in Delaware to $48 in Illinois. Most of the States aiding unemployed-parent families made higher payments per recipient to families receiving assistance for reasons other than unemployment than because of the unemployment of a parent.
    Nearly 40 percent of the cases approved for assistance during the period of the study were closed by the end of the seventh month of operation of the program usually because of employment. About a third of these parents returned to a former job and about two-thirds found work on their own initiative or with the help of friends or relatives; only 3 percent obtained employment through a public employment service referral. The small number who obtained work through such referral highlights the difficulties unemployed persons
    8 Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, New York. Oklahoma, Pennsylvania, Rhode Island, Utah, Washington, and West Virginia. (Subsequently, North Carolina and Oregon initiated such payments. On June 30, 1062. Dela ware and Washington discontinued them )
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    Department of Health, Education, and Welfare, 1962
    with low education and limited or no skill undoubtedly have in competing with other job applicants. A few welfare agencies in the communities studied established their own employment divisions. Nearly all the 13 States also gave training courses for practical nursing, supervision of food preparation and handling, machine operation, sewing, and typing.
    From a review of 1,800 case records of unemployed-parent families in the communities included in the study, it appeared that at the end of September 1961, the unemployed parents aided could be broadly classified into three major groups: (1) unskilled laborers with physical, mental, or emotional handicaps in addition to little education and poor work experience, whose reemployment opportunities seem limited; (2) fathers unemployed less than 3 months, mainly under 45 years of age, with stable work records (many were steel, construction, or seasonal workers) who were already moving toward reemployment on their own initiative; and (3) a larger number of unemployed fathers whose chances of returning to work could probably be improved with training, retraining, or other special services— this group included school “drop outs” and young persons recently discharged from military service with no previous work experience or skills; young workers with several children, limited education, and no skills who had moved from one short-term job to another, with no vocational goal; and older men, generally with large families, education below the eighth-grade level, and, with little, if any, skill transferable to other jobs.
    The provision of financial aid under this program undoubtedly prevented family breakup and sharpened public awareness of the needs of families affected by unemployment. But it also made clearly evident the urgent need for more effective mobilization or development of training and other community resources, if significant inroads are to be made on the basic and underlying difficulties facing this segment of the unemployed today-
    ASSISTANCE TO U.S. CITIZENS RETURNED FROM FOREIGN COUNTRIES
    Americans who become stranded, ill, or destitute in foreign countries are helped to re-establish themselves in the United States through a year-old Federal program. Under this program, assistance and other services are provided for Americans and their dependents identified by the Department of State as having been returned to the United States because of destitution, illness, or international crisis. In cooperation with State and local welfare departments and voluntary welfare agencies, arrangements are made for reception and transportation, temporary financial aid, and necessary social services or medical care.
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    The first year’s operation provided assistance and services to 505 cases of U.S. citizens returned from foreign countries: 153 cases (236 people), including 55 mentally ill persons, referred by the Department of State; 291 cases of U.S. citizens repatriated from Cuba; and 61 mentally ill persons receiving care at St. Elizabeths Hospital. Information or service was provided to 11 additional cases. A total of $501,000 was expended; $195,301 for mentally ill persons, and most of the rest for citizens returned from Cuba. (See pp. 19-23 for information on assistance provided to Cuban refugees.)
    Policies and procedures for administering this program were developed, and an informational leaflet prepared describing services available to destitute or ill repatriates, and their responsibilities, including repayment for assistance provided, when warranted. Agreement forms were devised for use with cooperating State agencies. Agreements were also made with the Medical Division of the Department of State to facilitate necessary care and treatment of their employees who become mentally ill in foreign countries and are returned to the United States.
    The earlier ad hoc Committee on Reception and Processing of U.S. Citizens Returned from Foreign Countries in a National Emergency was reconstituted as the Interdepartmental Committee on Services to U.S. Citizens Returned from Foreign Countries in Emergencies. This committee included, for the first time, representatives from the Office of the Assistant Secretary of Defense (Manpower), the Office of the Assistant Secretary of Defense (Civil Defense), and the Office of Emergency Planning.
    The New York regional office continued to carry the major portion of cases referred by the Department of State, since New York is the port of entry of the majority of such repatriated persons. The Atlanta regional office carried primary responsibility for U.S. citizens returned from Cuba. The Atlanta, Chicago, and San Francisco regional offices provided continuing assistance and services to an increasing number of these cases. A number of referrals were also initiated by regional offices and State or local agencies following a returnee’s arrival, or at the request of a relative or friend regarding the circumstances of a potential returnee who may not have contacted the Department of State. These situations were brought to the attention of the Department of State.
    The Bureau, which receives all referrals initially, continued to arrange for services as needed in individual cases through the regional offices acting under the general coordination and direction of the central office. Services were provided by both public and voluntary agencies. The Division of Hospitals of the U.S. Public Health Serv
    82
    Department of Health, Education, and Welfare, 1962
    ice continued to provide medical care and services at the ports of entry, and the Division of Foreign Quarantine of the U.S. Public Health Service was involved in providing medical services under P.L. 86-571 at United States Consulates overseas and at ports of entry in the United States. The Bureau’s relationships with the Office of Special Consular Services, Department of State, and the Children’s Bureau in providing services under these programs were continued and expanded.
    CIVIL DEFENSE EMERGENCY WELFARE SERVICES
    Emergency preparedness functions were assigned to the Department under Executive Order 11001 on February 16, 1962, with additional responsibilities added for “refuge in shelters.” Such functions relating to the welfare field were delegated by the Secretary to the Commissioner of Social Security for administration by the Bureau of Family Services working with the Children’s Bureau. This followed the conversion of the Office of Civil and Defense Mobilization to the Office of Emergency Planning, and the assignment of certain civil defense activities to the Office of Civil Defense in the Department of Defense (OCD-DoD).
    During the fiscal year, 38 States entered into agreements with the Bureau of Family Services to provide a full range of welfare services in a war-caused emergency. Additional Memoranda of Understanding completed with national voluntary welfare organizations and related national professional and business organizations brought the total to 16.
    Under an agreement with OCD-DoD, plans were initiated and questionnaires prepared for a preliminary field review which was conducted in eight cities to determine community readiness to provide emergency welfare services, especially in connection with community fallout shelters.
    Information was provided OCD-DoD on welfare resources throughout the country, and data on resources and requirements were provided to the Office of Emergency Planning. Other resources evaluation and damage assessment activities were conducted.
    Administrative Developments
    Bureau activity during the year was concentrated on developing policy, procedure, and informational materials to implement the Secretary’s administrative directives and on planning for proposed legislative changes. Work also continued in implementing measures passed in 1961, and in carrying responsibility for the ongoing public assistance programs.
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    WELFARE SERVICES
    The change in name from the Bureau of Public Assistance to the Bureau of Family Services and the establishment of a Division of Welfare Services reflects the nature of much of the work undertaken during the year in implementing the welfare services emphasis.
    Policy framework and interpretative materials were initiated or developed to help States implement measures directed toward providing services to unmarried parents, dealing with family disruption because of desertion, locating absent parents, assuring protection of needy children, assisting families with special problems arising from financial mismanagement or mental or physical inadequacy, initiating work and training programs, and assuming other community planning responsibilities. Work also was undertaken in developing policies and guide materials in problem areas such as residence, earned income in aid to the blind, parental neglect, and institutional care needs of the aged and disabled.
    Advisory groups of State representatives helped in the development of policy on foster care and social services, including the identification of services for which increased Federal matching funds would be available and methods of determining the cost of such services. Draft policy materials were prepared and discussed with an ad hoc advisory committee and with State administrators. Methods for a review of State practice in providing services were substantially completed, and planning initiated for State reporting on the services provided. A compilation was also made of State projects on services.
    A publication, “Improving Home and Family Living Among Low-Income Families,” developed jointly with the Office of Education as a guide for State use in developing projects to increase the housekeeping skills of mothers dependent on public assistance, was sent to State departments of education and State welfare departments. Another publication, “Unmarried Parents—A Guide for the Development of Services in Public Welfare,” distributed to State public assistance and child welfare agencies in October 1961 and put on sale by the U.S. Government Printing Office, is now in its second printing. This pamphlet was used as the basis for a joint public assistance and child welfare regional meeting. “Homemaker Service in Public Welfare, the North Carolina Experience,” another report in the “How They Do It” series, was issued in December.
    Cooperative work also continued with other public and voluntary agencies. Bureau staff participated with the American Public Welfare Association’s Project on Aging in their institute on “Planning Improved Services for the Aging Through Public Welfare;” and, in cooperation with other national agencies, in planning and imple-
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    Department of Health, Education, and Welfare, 1962
    meriting two seminars on community planning on behalf of older persons. One of the seminars was held at Brandeis University in August 1961, and dealt with local community planning; and the other at Arden House, Harriman, New York, in March 1962, was on community planning at the State level. Joint consideration was given also by the Office of Vocational Rehabilitation and the Bureau to ways the vocational rehabilitation and public assistance programs can be more effectively utilized in combating dependency of handicapped persons.
    ADMINISTRATIVE AND FISCAL STANDARDS
    Policy and guide materials were developed for State use in prevention and control of fraud, including procedures and methods of investigation consistent with the legal rights of individuals. To implement the objective of reducing the number of forms in use and eliminating unnecessary paperwork, a group of State and local staff assisted in considering areas in which simplification of forms and paperwork might be possible, and proposed methods for doing this-
    Developmental work also continued on workload standards, case recording, auxiliary staff to the caseworker, single State agency, State field services, caseload classification, and the best use of the caseworker’s time. A digest of the Bureau’s resource material on the organizational, management, and administrative aspects of the public assistance programs was issued under the title, “Selected References for Public Assistance Administration.”
    A survey made in Milwaukee focused on finding ways to eliminate nonprofessional functions performed by caseworkers, and to make maximum effective use of professional staff time. A survey of three jurisdictions in Maryland evaluated utilization of professional and clerical staff, as well as the effect of State agency requirements on local agencies. Institutes for county superintendents were held in three States around principles of administration, and the responsibility and practical management of the administrator’s job. A statement for the use of county board members was prepared as a result of one of these sessions. Another in the series of conferences of large urban agencies was held in San Francisco in May 1962 to consider various aspects of administration in large cities, including organization, workload standards, caseload management, and procedures by which policy is put into effect. Consultation was also provided on request to several States on machine operations and/or electronic data processing as effective timesaving devices.
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    STAFF DEVELOPMENT
    With expansion in the scope of public assistance programs and the accent on preventive and rehabilitative services, the complex demands of the public welfare job continue to outstrip efforts to prepare staff to carry that job most effectively. According to the 1960 manpower study, only about 1 percent of the casework group and 13 percent of the supervisory group had a graduate social work degree, 89 percent of the caseworkers had no study in any graduate school of social work, and about a third of those in social work positions did not complete college. Although each caseworker authorizes an average expenditure of $150,000 a year in assistance payments and the welfare of hundreds of dependent persons is affected by her skill and experience, there was only one caseworker with a graduate social work degree for every 23,000 assistance recipients.
    Equally serious is the relatively low salary of those working in public assistance. In 1960, the median salary for caseworkers was $4,338, and for supervisors, $5,798. Comparison with other jobs with relative responsibilities, as indicated in chart 15, vividly points up the need for raising salary levels if qualified staff are to accept and remain in public assistance jobs.
    Realistically facing the dearth of social work personnel throughout the country, the Bureau’s present goal is a third of staff with professional education for leadership positions and casework services to families with serious social problems, and two-thirds of staff with an undergraduate college degree plus agency in-service training to pro-
    CHART 15.—SALARY, PUBLIC ASSISTANCE CASEWORKER AND OTHER SELECTED POSITIONS, JULY 1962 MEDIAN MINIMUM SALARY	RANGE
    OASDI Claims	$5,885—3 6,875
    Representat i ve	::
    Vocational Rehabil-	5,400— 6,660
    tion Counselor	:
    Employment	4,183— 5,220
    Interviewer
    Clerk-Typist GS-4	4,040— 4,670
    (Fed. Govt.)
    PUBLIC ASSISTANCE	s
    CASEWORKER	3,980- 5,208
    Class A _L/ 	1	1	I	1	1	I 0_________________________________________________________$2,000_$4,000_$6,000
    1 Function: Establish eligibility and extent of need and explain laws, regulations and eligibility requirements. (Class B—range $4,680 to $6,000—also includes providing social services to clients; usually requires graduate training in social work, but in some States experience may be substituted. However, according to the 1960 Manpower Study, there is only 1 public assistance caseworker with full graduate social work training for every 23,000 assistance recipients.)
    Source: Department of Health, Education, and Welfare, Office of Field Administration, Division of State Merit Systems; and U.S. Civil Service Commission.
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    Department of Health, Education, and Welfare, 1962
    vide services relating to less serious social problems. Provisions in the Secretary’s administrative actions and in the Public Welfare Amendments of 1962 were directed toward making this goal more feasible.
    The Secretary’s directive in December 1961 required States to have a continuous statewide staff development program fully developed by July 1, 1967. Starting with minimum requirements effective July 1, 1962, flexibility was provided in effecting on a progressive basis an organized staff development program appropriate to the circumstances in individual States. Effective October 1962, States were required to establish a unit responsible for a statewide staff development program headed by a qualified full-time director of staff development, and to have training personnel carry major teaching responsibility to supplement line supervision in order to deepen and broaden knowledge and skill of staff at every level. The 1962 amendments authorized use of Federal funds for the training and professional education of persons employed or preparing for employment in public assistance programs, and provided for increased Federal financial participation in expenditures for training by States providing minimum prescribed services.
    During the year, Bureau staff assisted States in the development and implementation of their staff development programs. Guide materials were developed and work initiated in preparing teaching materials directed toward the needs of the new worker and the county director; in identifying and adapting casework concepts appropriate for use by staff without professional education, and in developing criteria for selection of staff for educational leave. Work also continued on the Educational Standards Project in determining functions that can best be performed by staff with a professional education, a college degree, or technical training. Following a meeting of State staff development personnel in Washington in September 1961, a statement was prepared on standards of staff development common to the Children’s Bureau and the Bureau of Family Services. A second meeting of State staff development personnel was planned for the fall of 1962. Planning was also initiated for regional seminars and nationwide training sessions if and when Federal funds for direct administration of training, authorized but not yet appropriated, are made available.
    An advisory committee representing schools and agencies assisted the Bureau in considering the many proposals made by professional organizations, schools of social work, and individuals for academic and professional education, inservice training, and the most effective use of staff. A committee of deans of schools of social work also advised the Department on ways of increasing the supply of adequately trained personnel for public welfare. Bureau staff partic-
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    87
    ipated in the American Public Welfare Association’s Committee on Social Work Education and Personnel, and in various committees of the Council of Social Work Education.
    About 42 States now have full-time staff development directors, and the majority of the remainder are in the process of filling this position. There are other evidences in the States that planning for achieving sound staff development programs by 1967 is well on the way, although its ultimate success will depend largely on the availability of necessary State funds for this purpose.
    PROGRAM INTERPRETATION
    Public interest in the assistance programs continued at an all-time high, as reflected in the greatly increased number of telephone inquiries, personal visits, requests for press information service, and incoming mail.
    Requests for information were concentrated largely on the aid to families with dependent children program, and developments in specific States under the Kerr-Mills legislation and under provisions of the 1961 amendments. Other areas of great interest were: work relief, Cuban refugees, crisis situations in particular communities, Federal participation in assistance payments to patients on conditional release from mental institutions and other provisions included in the Secretary’s directives, and legislative proposals subsequently incorporated in the Public Welfare Amendments of 1962. Keen interest was also expressed, largely by professional groups, in the studies about public welfare made for the Secretary.
    The number of letters received directly by the Bureau was 16 percent greater than a year earlier, and congressional inquiries forwarded to the Bureau amounted to twice as many as in the previous year. Incoming mail averaged about 2,200 letters a month—1,600 more than the normal monthly load prior to the spring of 1961.
    Press releases reported progress in many program areas. Informational materials, special statements, and reports were also prepared to help meet requests for more specific information in certain problem areas.
    A position of Public Information Officer was established within the Office of the Director of the Bureau to develop a program of public information on the programs for which the Bureau carries responsibility.
    International Activities
    Bureau staff participated in three meetings of the Committee on International Social Welfare of the National Social Welfare Assem bly; in the Fourth Pan American Conference of Social Service held
    88
    Department of Health, Education, and Welfare, 1962
    in Costa Rica; and in the community-wide conference on social welfare planning held in Panama.
    In cooperation with the International Service in the Office of the Commissioner, consultation was provided to UN fellows and AID participants, and leaders and specialists under the Department of State’s Educational and Cultural Exchange program. With the cooperation of regional offices, training programs were also provided for international visitors, including arranging contacts to supplement academic and field work programs of those attending graduate schools of social work, providing for observation in various public and private agencies, and arranging intern-like placements.
    A section on developments in public assistance and other social services was prepared for the United Nations Biennial Report on Developments in Family, Youth and Child Welfare for 1960-61; and social welfare documents developed by the United Nations Social Commission were reviewed. Research projects proposed by foreign countries were also reviewed, and projects of interest to the Bureau were submitted for consideration under Public Law 480. Review was also made of UNICEF’s social service projects dealing primarily with social work education and training, urban development, and family welfare.
    Children’s Bureau
    On April 9, 1962, the Children’s Bureau was 50 years old. This anniversary gave the Bureau an opportunity to evaluate what had been accomplished for children during this half century—and to look ahead to determine goals for the next decade.
    The pervasive interest in the fiftieth anniversary did not dwarf the very important changes which came about during the year, especially in relation to the new emphasis in the Bureau, the Department, and the Administration on expanding and improving health and welfare services to help children develop to their full potential and families become more self-reliant and self-sustaining. During fiscal 1962, many gains were made for children.
    The legal base of the Children’s Bureau for serving the children of the United States is contained in two acts. Under its basic act of 1912, the Bureau is charged with investigating and reporting “upon all matters pertaining to the welfare of children and child life among all classes of our people.” The Bureau studies many types of conditions affecting the lives of children, makes recommendations to improve practices in child health and child w’elfare programs, and helps establish standards for the care of children.
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    Under Title V of the Social Security Act, as amended, the Bureau administers grants to States for three programs: (1) maternal and child health services; (2) crippled children’s services; and (3) child welfare services.
    A program of grants for research and demonstration in the field of child welfare was authorized under Title V, part 3, of the Act in 1960. Funds for these grants were appropriated for fiscal year 1962, and the first grants were made in the spring of that year. In 1961, the child health and crippled children’s provisions were broadened to permit special project grants to be made directly to institutions of higher learning. Real progress was made during fiscal 1962 in implementing these provisions.
    These then are the present purposes of the Children’s Bureau today:
    to assemble facts needed to keep the country informed about children and matters adversely affecting their well-being;
    to recommend measures that will advance the wholesome development of children, and in preventing and treating the ill effects of adverse conditions;
    to give technical assistance to public and voluntary agencies and to citizens groups in improving the conditions of childhood; and
    to administer the grants appropriated each year under Title V of the Social Security Act to aid in building the health and welfare of children.
    The Bureau’s approach to the problems of children proceeds from a concern for the child with his family or wherever else he may live. The interrelationship between the physical, emotional, and social factors in child growth, child health, and child welfare permeates all that the Bureau does, and that it stimulates others to do, in research and action for children.
    From many sources, the Children’s Bureau gathers all the facts and figures that will help children’s workers and citizens in the United States know the size of their wealth in children, the extent of conditions that are adverse to them, and the trends in our society affecting child life.
    The population of the United States is increasing at an extraordinary rate for a country which has attained such a high level of development. The annual rate of increase since 1953 is 1.7 percent (1.0 in Japan, 0.05 percent in Great Britain). The rate of increase is close to that of India (1.9 percent), the same as that reported by U.S.S.R., and higher than European countries except Albania, Iceland, and Poland.
    This phenomenon of rapid population growth in the United States is not due to immigration (271,350 in 1961), but to some increase in the size of the family and to a lengthening of the life span. The third and later children in the family make up nearly one-half of all of
    665171—63---7
    90
    Department of Health, Education, and Welfare, 1962
    CHART 16.—INCREASING CHILD POPULATION
    125 ------------
    VI	I	I	I	I	I	I	I	'
    1940	1950	1960	1970	1980
    annual births as contrasted with only two-fifths of these births in 1940. The expectation of life at birth is now 69.7 years as against 65.9 in 1945. Even if there is no further reduction in mortality below current levels, nearly one-half of the newborn today will live to at least 75 years of age and nearly a fifth to at least 85.
    The estimated number of children under 18 in the resident population of the United States in 1961 was 65,854,000 or 36.4 percent of the total population.
    Estimated birth figures for the United States counties and metropolitan areas in 1960 highlight the increasing urban character of the Nation. The national total was 4,282,000. One-third of these were born to residents of the 24 metropolitan areas with a million or more inhabitants.
    Infant mortality in the United States declined in 1961 for the third successive year. The provisional 1961 rate, 25.3 per 1,000 live births, set a record low, about 2 percent under the rate for 1960, the previous low (25.7), compared with 26.4 for 1959.
    There were 221,000 births out of wedlock in the United States in 1959—the highest number on record. This represents an increase of nearly 12,000 over 1958. One out of every 20 babies (52 out of every 1,000 live births) in the United States is born out of wedlock—the highest ratio of births out of wedlock on record.
    : 18-20 years
    | 10-17 years
    H 5-9
    = years
    I under
    | years
    i actual । estimated । r
    100 -
    a
    I ~
    o
    g
    o
    S 50 -
    a
    25 -
    0 -
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    CHART 17.—BIRTHS OUT OF WEDLOCK ARE INCREASING
    births out of wedlock
    60 ——-------------------------
    50------------------------------------
    per 1,000 live births
    20 ———————
    10 ______per 1,000 unmarried_
    women aged 15-44 years
    0 -I-1-1—I--1-1-1—I—I—I—I—I—I
    1947	49	51	53	55	57	59
    age of mother
    /	20-24 years	/ \
    /	31%	/	\
    / 25-29 years \
    /	14%	|
    \	, -	\\	30 years /
    \	15-19 years \\	/
    \	\\ and over /
    \	38%	\\	15%	/
    under 15 years 2%
    About 40 percent (89,000) of all mothers reported as bearing children out of wedlock in a year are teenagers, and 22 percent (48,000) under 18 years of age. Of all unmarried girls aged 15-19 years, 1.5 percent bear children out of wedlock in a year, compared with a 3 percent rate for unmarried women between 20 and 30 years of age. The illegitimacy for teenagers doubled between 1940 and 1955 but has barely changed since.
    Families continue to grow larger—having risen in average size from 3.54 in 1950 to 3.71 in 1961.
    On the average, families have gained in real income throughout the past decade. But in 1960, there were still 12.5 million children living in families with less than $3,000 annual income.
    For the first time in 13 years, the number of juvenile delinquency cases coming before juvenile courts showed a slight drop in 1961 (1 percent) when the child population was increasing by 3 percent.
    One of the most significant social changes in this century is the great increase in the number of married women in the labor force. About 3 million mothers with children under 6 and about 5 million mothers with children over 6 are now working. Economic necessity probably is the major reason why most mothers work. The lower the father’s income, the larger the proportion of children whose mother is employed. Twenty-seven percent of all children under 18 in husbandwife families whose fathers are not employed or earn less than $2,000 a year have employed mothers; for children whose fathers earn between $6,000 and $10,000 a year, 18 percent.
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    Department of Health, Education, and Welfare, 1962
    CHART 18.—TRENDS IN JUVENILE COURT DELINQUENCY CASES AND CHILD POPULATION 10 TO 17 YEARS OF AGE, 1940-60
    800—1---------------------------------------------------
    700 --
    600 -----------------------------------------------X-----------
    500 --	/
    § 400	________________________________________________delinquency cases
    g	delinquency cases (including traffic)	(excluding traffic)
    5	/	s
    s r \	/	s
    300 --	/	.X	4 30,000 o
    3	/	S
    . voluntary
    in own homes agencies	agencies
    in foster family homes
    I"'" ....."" [
    in institutions	7;~ 4
    in adoptive Mjill...
    homes
    I	ill	I	I	I
    0	100,000	200,000	300,000	400,000	500,000
    by physicians and certain hospital administrative personnel of cases of suspected physical abuse of children by adults. The proposed statute would relieve such an individual reporting from civil liability.
    The long-term goal for child welfare continues to be the maintenance of adequate family life for every child. During the past 6 months, State public welfare agencies have been actively engaged in assessing how they could best make use of special Federal funds for day care, one of the ways to maintain family life for children in today’s society. Through these funds, every State would be able to begin immediately to develop a variety of these- services—not only for the care and protection of children whose mothers work, but also as a preventive to full-time placement. A broadly representative Ad Hoc advisory committee was called together by the Children’s Bureau in May 1962 to explore the new’ proposals for day care.
    Requests for technical consultation to assist States in this planning have intensified. The report of the National Conference on Day Care for Children held in Washington in November 1960—Day Care Services: Form and Substance, jointly sponsored by the Children’s Bureau and the Department of Labor—has proved very helpful in this connection. It has been widely distributed and the demand for it continues to be brisk.
    States are reporting a mounting number of children coming into care as the result of family disruption. Although millions of dollars are invested annually in the care of children outside of their own homes, no uniform cos) accounting methods have been developed or
    112
    Department of Health, Education, and Welfare, 1962
    accepted for use in the purchase of care, comparisons of costs of foster care, budgeting and internal program planning.
    The Children’s Bureau has employed a consultant on a temporary basis to stimulate use of cost analysis methods in child care institutions, using several models originally tested in about 21 institutions. The Bureau and the Child Welfare League of America are cooperating in this venture.
    During December 1961, Children’s Bureau Publication No. 394, Legislative Guides for the Termination of Parental Rights and Responsibilities and the Adoption of Children, was distributed to a wide range of agencies and organizations, including deans of law schools, The American Bar Association, the Council of State Governments, public welfare agencies (with additional copies for legal counsel, advisers, and staff development people), and national voluntary agencies. Response to the guide material has been excellent. Both Connecticut and West Virginia used the document in studies on needed welfare revisions.
    Efforts to follow through on the findings of studies of irregular adoptions, as well as improvement of adoption laws generally, continued to be very much in the foreground among States on the west coast. The adoption program of the New York City Department of Welfare, financed by Federal child welfare services funds, completed its first full year of operation in December 1961, involving consideration of some 1,500 adoptive situations.
    Two Federal developments during the year coalesced to accelerate the expansion of social services for mentally retarded children and their families: hearings held in various communities by the President’s Panel on Mental Retardation to study the Nation’s needs and make recommendations in local, State, and Federal action, and the announcement of grants for research and demonstration projects in child welfare.
    Special interest was shown in setting up demonstration projects for mentally retarded children in the areas of foster family care, day care, development of the capacities of such children, and group therapy under the new grant program.
    Public responsibility for the administration and support of day care centers for retarded children was extended to several additional States during the year (California, Connecticut, Maryland, Minnesota). Some eight States now make such provisions. Voluntary national agencies are also exploring the possibilities of this type of service for retarded children.
    As the program for Cuban refugee children has moved into a more regularized phase and as the characteristics of the children arriving have changed, new aspects in planning have had to be considered. By
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    the end of May, 3,773 children were being cared for in 34 States. They resemble more closely now the children in the regular child welfare caseloads of public agencies over the country. Some have physical, mental, and emotional handicaps. Because of the large number of children arriving, over 75 percent have had to be placed in institutions, until foster homes can be made available for those needing such care.
    The past 6 months brought greatly increased pressure upon the Children’s Bureau with regard to the demands of this program, both in terms of policy decisions and in handling the flood of inquiries from the public and the Congress. The Florida State Department of Public Welfare and the voluntary agencies have been and are continuing to carry heavy responsibilities for the program.
    The Bureau’s child welfare specialist in civil defense planning has continued to cooperate with the Bureau of Family Services in planning and implementing the Emergency Welfare Services Program. Among the significant activities was: participation in a review made by an Ad Hoc Committee of the draft of Welfare Institutions: A Civil Defense Guide for Fallout Protection of Population and Staff; preparation of guides used by a survey team for a preliminary review of Community Readiness to Provide Emergency Welfare Services in eight selected cities, and assisting in consideration of the roles and interrelationships of public and voluntary agencies in the new national civil defense program.
    Child welfare programs in 1961 fell far short of reaching all of the children with emotional and social problems with which social workers could help. Few States had programs geared to give the range and competence of service required to meet the needs of children. But the pending Federal legislation provides the opportunity for States to work realistically toward the goal of more well-trained workers and the richer variety of services so greatly needed.
    JUVENILE DELINQUENCY SERVICE
    Juvenile delinquency continues to be of great public concern. Our increasingly complex society intensifies the need for well-coordinated programs in this area.
    The national concern about this problem has stimulated requests coming to the Bureau for various types of technical consultation, survey work, and guide material. The urgency of the juvenile delinquency problem in States and communities is pressing on State and local agency administrators and their personnel, as well as the general public, to seek effective techniques to alleviate the situation. A greater number, as well as variety, of requests have been received by the Bureau during fiscal 1962.
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    Department of Health, Education, and Welfare, 1962
    1.	State legislative commissions have asked for standard setting material on training schools, detention centers, courts and law enforcement agencies, community organization and training. They have also asked the Bureau for on-the-spot consultation on services for delinquent children and for help with surveys of statewide services for these youth.
    2.	State departments responsible for delinquency control have asked the Bureau for similar types of assistance. Individual training schools, police departments, and detention programs have requested more specific types of help, such as suggestions of appropriate inservice training programs and how to implement such training; how to organize an institution or department to cope with the increasing number of children brought to their attention.
    3.	Communities experiencing a high incidence of problems with adolescents have turned to the Bureau for help on developing more effective leisure time programs, and exploring the various ramifications of school dropouts and employment and work programs for youth.
    4.	Schools of social work have requested consultation on delinquency problems and their implications for curriculum development.
    5.	The President’s Committee on Juvenile Delinquency and Youth Crime has requested various types of help from the Bureau as the Committee established criteria to implement the Juvenile Delinquency and Youth Offenses Control Act. Their requests related to the Bureau’s Division of Juvenile Delinquency Service staff making site field visits to appraise the degree of community commitment to planning a comprehensive delinquency prevention program; to their readiness to receive a planning grant; analysis of projects received by the President’s Committee; technical assistance to schools of social work, agencies and communities requesting grants; and consultation relative to the knowledge and experience required by the Juvenile Delinquency Division Service staff since its establishment.
    6.	Many requests have come to the Bureau from foreign visitors and agencies for orientation and interpretation of this country’s juvenile delinquency control programs.
    The Children’s Bureau met 1,043 requests for consultation on juvenile delinquency during fiscal year 1962. Of these requests, 568 were made from the field. The remaining 475 were through office consultation or by letter. In addition, the staff of the Division participated as speakers, leaders, or panel participants in workshop groups at national, State, and local meetings throughout the country. Requests for surveys and consultation far exceeded the Bureau’s resources to meet them.
    The past year saw the completion of a pioneer standard setting document in the law enforcement field—Police Work with Children:
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    Perspectives and Principles. This publication was developed in cooperation with the International Juvenile Officers Association, the International Association of Women Police, the National Council on Crime and Delinquency, the National Police Officers Association of America, and the National Sheriff's Association.
    In the institutional field, the standard setting document, Institutions Serving Delinquent Children: Guides and Goals, was revised with the participation of the National Association of Training Schools and Juvenile Agencies. A Theoretical Study of the Cottage Parent Position and Cottage Work Situations was published in the Bureau series Juvenile Delinquency: Facts and Facets.
    An annotated and classified compilation of Children’s Bureau publications on juvenile delinquency was published. A training publication, Training for Juvenile Prohation Officers: The Report of a Workshop, is in press. A community organization publication, Community Planning to Prevent Juvenile Deliquency, is underway.
    INTERNATIONAL ACTIVITIES
    International Research (Foreign Currency Program)
    Under section 104(k) of P.L. 83-480, The Agricultural Trade Development and Assistance Act of 1954, as amended, funds were made available for research in health and other fields in specified countries. For fiscal year 1962, the Social Security Administration appropriation for international research was $1,607,000 of which $992,000 was for maternal and child health; $7,000 for medical care for the aged; and $608,000 for social welfare. The latter sum includes child welfare and juvenile delinquency. These funds were made available in August 1961, to be used in six countries—Israel, India, Pakistan, Poland, United Arab Republic, and Yugoslavia. Funds were approved in August 1961 and made available for use in the countries in December 1961.
    The Bureau participated in the development of a manual, Guide and Instructions for the P.L. J80 International Research Program In Social Welfare a,nd Maternal and Child Health, issued by the Social Security Administration in December 1961. Program areas were described, instructions given for submitting research proposals, and general requirements of the grant program stated.
    Visits were made to five of the six countries by representatives of the Children’s Bureau and the Social Security Administration to explain the program, meet with representatives of governmental, voluntary health and social agencies, and of medical schools, schools of public health, and schools of social work. These visits provided the staff with an opportunity to see something of these countries, their problems and programs, to meet and talk with outstanding national
    116
    Department of Health, Education, and Welfare, 1962
    and international workers as to research interest and possibilities for cooperative research undertakings.
    The response in the number of research proposals submitted has been good. Eight proposals were received from Israel in maternal and child health and one from Pakistan during fiscal year 1962. Of these, the Bureau has approved three: A Survey of Diarrheal Diseases in Pakistani Children, Socioethnological Factors in the Etiology of Toxemia of Pregnancy, and A Longitudinal Study of Growth and Development of Children from Various Social Strata and Ethnic Groups in Israel.
    Most of the fiscal year 1962 funds from Israel and Pakistan have been reserved for these projects, which will absorb about 25 percent of the year’s total maternal and child health funds. Research proposals from Poland, Egypt, and India are under advisement.
    During fiscal year 1962, one project in child welfare, Institutionalization of Children, and one in juvenile delinquency, Forces Acting in “Street Corner Groups” were approved for Israel. Six proposals dealing with juvenile delinquency or related fields and two in child welfare have been received. A total of 9 projects in maternal and child health and 17 in social welfare were received during fiscal year 1962.
    The lack of trained personnel, research experience, and facilities in some of the countries limits the amount and type of cooperative research that can be developed. Also, the lack of dollar currency for administrative purposes, for providing materials and equipment for research which are not available with local currencies in the countries, for training of personnel in research outside of their country—in the United States or in other countries—also limits the research which is feasible under the program.
    The Congress did not appropriate funds to the Social Security Administration for fiscal year 1963, thereby limiting the development of the program for the next fiscal year to the six countries and the funds available under the 1962 program.
    International Training
    Long-term trainees.1—The number of programs developed and implemented for foreign professional students for whose training in the United States the Bureau carries program responsibility increased markedly in fiscal 1962. Programs were developed for 75 specialists from 32 countries. Thirty-eight of these were physicians, 12 were nurses, and 4 students were in other health fields: a physical therapist, an occupational therapist, an X-ray technician, and a staff mem
    1 Foreign, visitors for whom the Bureau plans and carries out programs of 2 weeks or more are classified as long-term.
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    117
    bet of a ministry of health and welfare whose major interest was the administrative and management aspects of programs for handicapped children. Of the 21 other students, 8 were studying child welfare, 1 was a medical social worker, and 12 were studying juvenile delinquency. Thirty-seven were new arrivals during the year.
    Consistent with the pattern of recent years, the largest group of students was sponsored by the Agency for International Development. Of the 58 AID participants, 34 were physicians.
    For a number of reasons, such as the duration of the educational grant, insufficient academic preparation in the home country, or the purpose of the training, many students attend our universities or medical schools as nondegree candidates. A few, however, successfully complete the degree requirements. For example, two physicians received master’s degrees in public health; a nurse from India received her master’s degree from Wayne State University; another nurse from India, her bachelor’s from Columbia; a social work student from Ethiopia received a master of social work from the University of Denver; a Vietnamese physician successfully passed the written examination of the American Board of Pediatrics in January and will take her orals before she leaves the United States.
    The majority of participants sponsored by the Agency for International Development are sent to the United States for a year. In some instances, however, particularly with respect to medical education in a specialty, grants are extended for 2 or 3 years. Of the 75 students in long-term training status during fiscal year 1962, 26 had programs which lasted 12 months, and 17 were following programs extending beyond a single year. For 15 of the long-term students, the Bureau carried program responsibility for less than 6 months. At the end of the year, 25 students were continuing their programs into the new year.
    Short-term visitors.—The number of foreign visitors who came to the Bureau for programs which ranged from conferences of an hour or two to programs which lasted a week or 10 days decreased. One hundred and thirty-six visitors from 47 countries visited during the fiscal year. The comparable figure for 1961 was 170 visitors from 70 countries. Slightly more than half of the visitors were referred by international or Federal agencies. Nearly half of the visitors came on their own.
    Of the 136 visitors, 15 had a major interest in child welfare and 32 were primarily interested in juvenile delinquency. Maternal and child health and services for handicapped children were of major interest to 19.
    A 5-year picture.—A look at the record of the training program for the past 5 years shows no discernible trend in the numbers of either
    118
    Department of Health, Education, and Welfare, 1962
    long-term students or visitors. One factor is constant—the high proportion of trainees in the health professions. Each year, more than 65 percent of the long-term students were physicians, nurses, or other health personnel. In 1962, the percentage was 72.
    Assistance to Other Training Agencies
    Other agencies, both Federal and voluntary, engaged in program planning for international visitors, turn to the Bureau for guidance in selecting appropriate resources to which to send visitors. Whenever possible, this is done only following a conference with the visitor, but in instances where a conferences is not practical, the Bureau suggests resources throughout the country which fit the training objectives of the program. All plans and arrangements are made by the responsible agency. Typical of agencies requesting such advice are the American Council on Education, the Governmental Affairs Institute, and the Office of Education.
    Summary
    In fiscal 1962, the Children’s Bureau has had a new sense of direction and purpose based on the perspectives of the past and the promise of the future. This year, as the Bureau prepared for and celebrated its own 50th anniversary, the accent was on moving ahead. Far-reaching amendments to Title V of the Social Security Act will make it possible for the Bureau to expand its services to children substantially and to increase the pool of trained workers for children’s services in the years ahead.
    Growing concern with children’s services in States and communities v as on the upswing. Greater Federal support was in the offing.
    Countrywide coverage by the Bureau’s three grant-in-aid programs was stil] far from complete, either in variety of services or geographically. But steady advances were being made in these programs and in the Bureau’s reporting and investigating activities. The demand for consultation on children’s programs by public and voluntary agencies far outstripped the Bureau's capacity to meet them.
    Fiscal 1962 was a year of ferment and steady progress for the Children’s Bureau and its programs.
    Bureau of Federal Credit Unions
    The Bureau of Federal Credit Unions supervises more than 10,500 Federal credit unions under provisions of the Federal Credit Union Act of 1934, as amended. These privately operated cooperative associations are presently serving some 61/G million families located in
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    119
    every State, in the District of Columbia, the Canal Zone, Guam, Puerto Rico, and the Virgin Islands.
    Stated broadly, the Bureau’s mission is to:
    1.	Promote self-help security through privately-owned and democratically-controlled Federal credit unions.
    2.	Stimulate systematic savings to provide capital and cash reserves for credit union members.
    3.	Make available to people of small means credit for provident purposes at reasonable rates of interest through a national system of cooperative thrift and credit.
    4.	Help stabilize the economy of the United States by developing sound thrift, credit, and personal financial management practices.
    To achieve these objectives, the Bureau encourages and actively participates in the organization of Federal credit unions: periodically examines all Federal credit unions for financial soundness and to ensure compliance with the laws and bylaws; and exercises general supervision over these groups. Manuals and other informational material and instructions are prepared for the guidance of the credit union officials.
    Since 1953, the Bureau has not received appropriations from general funds but has operated entirely on the charter, supervision, and examination fees collected from Federal credit unions.
    Federal credit unions do not serve the general public, but are limited to dealing with their members. Membership is based on a common bond of occupation or association, or to residence in a well-defined community. Membership in Federal credit unions increased 7^2 percent in 1961 to 6,543,000, representing a net increase of 455,000 for the year. Membership participation edged up to 55 percent of the potential membership, from 54 percent a year earlier. The vast majority—83 percent at the end of 1961—serve workers in the huge complex of American industry, from the pineapple plantations in Hawaii to the steel mills in Pittsburgh. Fifteen percent of the Federal credit unions are organized among associational groups—cooperatives, fraternal and professional groups, churches, and labor unions—and 2 percent serve the members of closely knit urban or rural areas.
    Two important milestones in credit union operations were passed mid-way in the fiscal year when the number of operating groups passed the 10,000 mark, and total assets of these groups exceeded $3 billion for the first time. Later in the fiscal year—in May 1962—a third important event took place when credit union services were extended to Guam, bringing the number of jurisdictions served by Federal credit unions to 55.
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    Department of Health, Education, and Welfare, 1962
    Consumer Protection
    Increased emphasis has been given to the role of credit unions in protecting consumers against credit grantors who fail to disclose the true cost of credit. Federal credit unions are making progress on this front through the use of better financial counseling and educational programs. Credit union representatives and departmental officials have testified in favor of legislation to require extenders of credit to disclose its true cost on a uniform basis to enable consumers to make more informed decisions about where and how to obtain credit. (S. 1740, 87th Congress, second session, “Truth in Lending Bill.”)
    The need for more and better preventive counseling and consumer education by credit unions requires leadership and encouragement by the Bureau and cooperation with social service agencies. A beginning has been made in some of the larger cities but much more needs to be done to make social service agencies generally aware of the services of credit unions and credit unions aware of social services in their respective communities.
    Student Loans for Higher Education
    The Bureau recognized the desire and need of Federal credit unions to make a greater contribution toward helping students gain a higher education. An amendment to the Rules and Regulations for Federal Credit Unions liberalized repayment terms of loans to students for higher education. This action will enable Federal credit unions to participate more widely in State-guaranteed loan plans. It will also broaden their opportunities for service to members in the effort to make it possible for students to gain a higher education.
    Manpower Utilization
    Emphasis continued to be placed on the Bureau's examination program. Improved operations were accomplished through a continuing training program for Bureau examiners, and measurable results were achieved. Productivity of the examiners has steadily increased. Measured in terms of man-days required to perform the examination program in fiscal year 1962, the aggregate saving in time compared to fiscal years 1959, 1960, and 1961 was 4,748 man-days. Throughout this period, there has been no increase in fees charged the credit unions for examinations, and on the basis of the saving in man-days required to complete the program, Federal credit unions saved about $227,900 while an additional $71,600 accrued to the Bureau in terms of higher average fees per examination day.
    Social Security Administration
    121
    Strengthening Research and Statistics
    Another important area in which noteworthy improvement took place during the past fiscal year was in the Bureau’s statistical program. A completely new classification system for Federal credit unions, by type-of-membership, was set up, involving reclassification of more than 10,000 active groups. The new system was patterned after the Standard Industrial Classification, and will permit greater utilization of the data on Federal credit unions. This is an important step toward filling the need for more adequate research in depth.
    Expansion and improvement of the Bureau’s research program is a major area of emphasis. It will be essential to have more complete knowledge about many aspects of credit unions and their members to provide sound bases for decisions on proposed legislation and policies which will more effectively carry out the Bureau’s mission.
    International Activities
    The Bureau’s role in international activities took on added stature during fiscal year 1962, when the Assistant to the Director participated in the First International Conference of Cooperatives at Bogota, Colombia, and the Bureau provided technical assistance to the InterAmerican Development Bank in connection with a loan to the Central Credit Union of Peru, which, in turn, will make loans to Peruvians of low income for building homes, for improving the use of the land and for potable water and sanitation projects. Bureau staff also participated in training several foreign visitors and learned from these contacts of the vast need for credit union literature in the language of the countries concerned. To fill this void, at least partially, during fiscal year 1962, the Bureau published the Federal Credit Union Act, the Standard Bylaws, and a general informational leaflet about credit unions, in Spanish.
    The Bureau is continuing its efforts to enlist the cooperation of AID and USIA in meeting the urgent, unmet need for translation, publication, and distribution of technical operating and accounting manuals in the languages of developing countries.
    The Assistant to the Director represented the Department of Health, Education, and Welfare on a work group which evaluated International Cooperation Administration assistance to cooperatives in other countries. Recommendations were made to the Advisory Committee on Cooperatives for implementing and accelerating technical and financial assistance for establishing cooperatives in developing countries. Some of these recommendations are now being implemented by AID. Whenever requested, the Bureau cooperates with
    665171—63----9
    122
    Department of Health, Education, and Welfare, 1962
    AID in planning and providing training for participants seeking to widen their knowledge and skills in connection with credit unions. The much-publicized program of assistance to cooperatives as yet has hardly gotten off the ground with respect to credit unions. These basic cooperatives are most effective in enabling people of low income to mobilize and control their meager savings while learning the fundamentals of democratic procedures. This potential for effective aid which strengthens the dignity of people with very modest expenditures of money should be developed more rapidly. In keeping with the objectives of encouraging self-help in the foreign aid programs overseas, credit union development should be speeded up.
    Extending Coverage to Low-Income Groups
    Extension of coverage to all who need and want credit union services is the ultimate goal, which can best be achieved through a program of consumer education in conjunction with a realistic chartering policy. Credit unions are voluntary associations of people, and the organization of a credit union originates with the group, not with the Bureau. The fact that new groups generally do not pay the full cost of supervision and examination during the first year or two need not act as a deterrent in chartering. This is especially true for low-income groups, who have the most need for credit union and other services and yet may experience a slower and more difficult growth. The enormous social values evolving from coverage of these groups should receive full weight, in relation to the financial considerations. The practice has been accepted that established credit unions help the smaller groups. It is generally known that many low income groups still do not have credit union service available. Overcoming the administrative and other difficulties inherent in extension of coverage to large segments of the low income population would be a major achievement in Bureau operations.
    There were no amendments to the Federal Credit Union Act during the fiscal year.
    Social Security Administration
    123
    Table 1.—Social Security Administration: Funds available and obligations incurred, fiscal years 1962 and 1961 1
    [In thousands, data as of June 30,1962]
    	Funds available1 * 3		Obligations incurred
    	1962	1961	1962	1961
    Total	   -				$2, 751,996	$2, 471,014	$2,811, 631	$2,470,676
    Grants to States						2,470,300	2,228,833	2.535,323	2.231, 990
    Public assistance 3		2. 401,200	2,177,000	2,466,974	2,180, 466
    Old-age assistance				1,256,388	1, 211, 709
    Aid to the blind				47,483 853,685	48, 517
    Aid to families with dependent children					704,108
    Aid to the permanently and totally disabled				199,552	182. 625
    Medical assistance for the aged		69,100	51,833	109,866	33, 507
    Maternal and child health and welfare services				68,349	51, 524
    Maternal and child health services		25,000	18,167	24,844	18.114
    Services for crippled children		25,000	20,000	24,638 18,648	19. 797
    Child welfare services		18,750	13,666		13, 613
    Research or demonstration projects in child			219
    welfare				350
    Assistance for repatriated United States nationals		764		517
    Cooperative research and demonstration projects		700	350	695	347
    Research and training (special foreign currency pro-	1,607		353
    gram)					241,831		238. 339
    Administrative expenses4		278,625		274,743
    Office of the Commissioner 5 * *		912	669	787	659
    Bureau of Old-Age and Survivors Insurance 8		267,570	232,200	264,289	228,909
    Bureau of Hearings and Appeals 8				3,442	2,727	3,210	2.677
    Bureau of Family Services
    Children’s Bureau ’				2,668	2,494	2,630	2,486
    White House Conference on Children and Youth..		150		146
    Bureau of Federal Credit Unions		4,033	3,591	3,827	3.462
    1 Funds available and obligations reported by administrative agencies.
    5 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered.
    3 Obligations for 1961 include $3,465,750 used from 1962 appropriation to complete 1961 requirements; obligations for 1962 exclude the aforementioned $3,465,750 and include $69,240,142 used from 1963 appropriation to complete 1962 requirements.
    4 Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and all other objects of expenditure.
    ’Appropriations by Congress from general revenues accounted for approximately 50 percent of the administrative expenses of the Office of the Commissioner in 1961 and 1962; balance from old-age and survivors insurance trust fund.
    ’Administrative costs of the old-age, survivors, and disability insurance program, which involved benefit payments of $11,884,000,000 in 1961 and $13,579,000,000 in 1962; does not include construction costs of new buildings as follows: Funds available: 1961, $5,179,585; 1962, $966,893. Obligations incurred,: 1961, $4,212,692;
    1962, $568,334. Also includes expenses for the Bureau of Hearings and Appeals as follows: Funds available: 1961, $4,436,602; 1962, $6,457,114. Obligations incurred: 1961, $4,248,625; 1962, $5,733,309.
    ’Includes expenses for investigating and reporting on matters pertaining to the welfare of children uthorized by the Act of 1912, as well as expenses for administration of grants to States.
    124
    Department of Health, Education, and Welfare, 1962
    [In millions, independently rounded]
    Table 2.—Financing social insurance under the Social Security Act: Contributions collected and trust fund operations, fiscal years 1960—62
    Item	1962	1961	1960
    Contributions collected under—
    Federal Insurance Contributions Act12		$12,475	$12,315	$10,830
    Federal Unemployment Tax Acti 2 3 *		458	345	341
    State unemployment insurance laws 48		2,709	2,361	2,165
    Old-age and survivors insurance trust fund:
    Receipts, total			 _ __ _ __	- -	-	11,985	11,814	10, 342
    Net appropriations and deposits		11,454	11, 293	9,843
    Net interest and profits on investments		530	522	500
    Expenditures, total		13, 259	11,743	11,055
    Monthly benefits and lump-sum payments		12, 657	11,185	10,270
    Transfer under financial interchange with railroad retirement account 6_	350	322	583
    Administration	_	_	_ _			 _ _ _	__			251	236	202
    Assets, end of year 		 			-				19,626	20,900	20,829
    Disability insurance trust fund:
    Receipts, total	_ 	 - -	_	_ _ 			1,088	1,082	1,061
    Net appropriations and deposits	 Transfers from railroad retirement account6 ____________	1,021	1,022	987 26
    Net interest and profit		67	60	48
    Expenditures, total		1,086	745	560
    Monthly benefits		1, on	704	528
    Transfers to railroad retirement account 6_ _		_ 	 		11	5
    Administration _ _ _	_______	_	_ - - - - - -	63	36	32
    Assets end of year	_	_	_ _	 _ _ - -- -	- -	 -	2,507	2,504	2,167
    State accounts in unemployment trust fund:
    Receipts, total		 -	- - - -	2,932	2,614	2,351
    Deposits5	___-- 		 _____	_	_	— _	-	2,767	2,417	2,169
    Interest			 		165	196	182
    Withdrawals for benefit payments		2,857	3,558	2,366
    Assets end of year			 -- --	5,805	3,729	6,673

    i Contributions on earnings up to and including $4,800 a year beginning Jan. 1, 1959. Contribution rate paid by employers and employees: 2jt£ percent each beginning Jan. 1,1959; 3 percent each beginning Jan. 1, 1960. Contribution rate paid by self-employed: 3% percent beginning Jan. 1, 1959; 4^ percent beginning Jan. 1,1960. Includes deposits bv States under voluntary agreements for coverage of State and local employees. Includes deductions to adjust for reimbursements to general funds of the Treasury of the estimated amount of employee taxes subject to refund on wages in excess of wage base.
    2 Includes old-age and survivors insurance and, beginning Jan. 1,1957, disability insurance contributions.
    s Prior to 1957 tax could be paid in quarterly installments by employers of 8 or more; beginning Jan. 31, 1957, tax payable annually on preceding year’s wages by employers of 4 or more. Rate is 3 percent (beginning Jan. 1, 1961,3.1 percent) on first $3,000 a year of wages paid to each employee by subject employer. Because of credit offset, permitted for contributions paid under State unemployment insurance laws (or for full contribution if reduced by State experience rating provisions), effective rate of 0.3 percent (beginning Jan. 1, 1961, 0.4 percent) of such wages.
    i Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies.	,	, r	.
    5 Contributions and deposits by States usually differ slightly, because of time lag in making deposits. Deposits in the State accounts also include loans from the Federal unemployment account of the unemployment trust fund.	,	, , x x. .
    a Under the financial interchange with the railroad retirement account the two social security trust funds are to be placed in the financial position in which they would have been had railroad employment always been covered under the Social Security Act.
    Source: Compiled from Final Statement of Receipts and Expenditures of the United States Government, other Treasury reports, and State agency reports.
    Social Security Administration
    125
    Table 3.—Old-age, survivors, and disability insurance: Number of families and beneficiaries receiving benefits and average monthly benefit in currentpayment status, by family group, end of December 1961 and December 1960 [In thousands, except for average benefit]
    Family classification of beneficiaries	Dec. 31,1961			Dec. 31, 1960
    	Number of families	Number of beneficiaries	Average monthly amount per family	Number of families	Number of beneficiaries	Average monthly amount per family
    Total	_ ___	12,173.6	16,494.8		10,959.6	14,844. 6

    Retired-worker families			8,924.8	11,655.2		8,061.5	10,599.0
    Worker only					6,470.2	6, 470.2	$71.90	5,741.8	5, 741.8	$69.90
    Male	_		 		3,335.9	3,335.9	81.20	2,921.7	2,921.7	79. 90
    Female..					3,134.3	3,134.3	62.00	2,820.2	2,820.2	59.60
    Worker and aged wife 1			2,213.6	4, 427.1	126.60	2,122. 0	4,243.9	123.90
    Worker and young wife 23	. 		.9	1.9	108- 50	1.0	2.0	111.00
    Worker and aged dependent husband...	13.6	27.2	107. 50	14.3	28.6	105.50
    Worker and 1 or more children		62.6	141.2	120- 90	50.2	113.4	119.40
    Worker, aged wife,i and 1 or more
    children 			25.2	77.4	159. 20	22.0	67.4	157.60
    Worker, young wife,1 2 and 1 or more
    children	. _		 		138.6	509.7	149.20	109.9	401.2	152.30
    Worker, husband, and 1 or more
    children 			 .	.1	.4	123.30	.2	.6	115. 70
    Survivor families		 		2,630.7	3,812. 5		2,442.8	3, 558.1
    Aged widow		_ 	 			1,677. 4	1,677. 4	64.90	1, 527. 3	1, 527. 3	57.70
    Aged widow and 1 or more children		17.3	35.4	122.90	14.2	29.2	112.90
    Aged widow and 1 or 2 aged dependent
    parents			 				.3	• 5	153. 80	.3	.6	131.00
    Aged dependent widower..			2.3	2.3	62.10	2.0	2.0	54.10
    Widower and 1 or more childern			.1	.1	91.30		.1	84.40
    Widowed mother only 3 _ 			1.1	1.1	61.50	1.4	1.4	64. 20
    Widowed mother3 and 1 aged de-
    pendent parent-.	. ..		0	0	0	(«)	(0	173.70
    Widowed mother and 1 child		 .	184.6	369.2	135.00	171.9	343.9	131.70
    Widowed mother and 2 children	 _ _	120.3	361.0	189.30	113.4	340.1	188.00
    Widowed mother and 3 or more children.	121.3	587.5	182.80	113.8	547.6	181.70
    Widowed mother, 1 or more children,
    and 1 or 2 aged dependent parents..	.4	1.4	231.00	.5	1.8	214.70
    Widowed mother, divorced wife, and
    children .		 			.1	247. 90	0	0	0
    Divorced wife and 1 or more children...	.4	1.0	170.10	.4	1.0	163.40
    1 child only	_ 						302.2	302.2	60.70	296.4	296.4	58. 50
    2 children. 	 		104.6	209.2	124.60	106.6	213.2	122. 50
    3 children			40.8	122.5	160.10	38.3	115.0	155. 00
    4 or more children		 		23.1	104.8	168.30	22.6	102.5	157.20
    1 or more children and 1 or 2 aged de-
    pendent parents. 		 		.5	1.1	145. 30	.7	1.5	137.60
    1 aged dependent parent			32.5	32.5	68.10	31.6	31.6	60. 90
    2 aged dependent parents		1.5	3.1	111. 00	1.5	3.0	107.90
    Disabled-worker families	618.1	1,027.1		455.4	687.5
    Worker only			459.3	459.3	87. 70	356.8	356. 8	87. 90
    Male 	 ..	332.0	332.0	91.50	261.3	261. 3	91.90
    Female			127.3	127.3	77.70	95.5	95.5	76. 90
    Worker and aged wife i_. 		24.5	48.9	136. 50	21.7	43.5	135.60
    Worker and young wife 2 3_				.1	.1	156. 90	.2	.4	143.20
    Worker and aged dependent husband...	.3	.6	115. 80	.2	.4	120.70
    Worker and 1 or more children		 .	40.6	106.4	154.90	22.0	55.8	154.40
    Worker, aged wife/ and 1 or more
    children _ . .._	_.					.2	.6	186.60	.1	.3	186. 20
    Worker, young wife,2 and 1 or more
    children		93.2	411.2	191.10	54.4	230.3	189.10
    1 Wife aged 65 or over or wife aged 62-64 with no entitled children in her care.
    2 Wife under age 65 with 1 or more entitled children in her care.
    3 Benefits to children were being withheld.
    i Less than 50.
    126
    Department of Health, Education, and Welfare, 1962
    Table 4.—Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end. of June 1962 and amount of benefit payments in fiscal year 1962, by State
    [In thousands]
    Monthly benefits in current-payment status, June 30,1962	Benefit payments in fiscal year 1962 ’
    Total	OASI i	DI i	OASI »
    Beneficiary’s State of residence	___,______________________________________	________________
    Total	DI i
    Monthly	Monthly	Monthly	Monthly Lump-sum
    Number amount Number amount Number amount	benefits death
    payments
    Total_______________________ 17,280.4	$1,128,166	16,128.5	$1,053,102	1,151.8	$75,064	$13,669,212	$12,483,747	$174,089	$1,011,376
    Alabama ________________________ 290.9	15,369	259.8	13,624	31.1	1,745	186,195	160,250	2,517	23,428
    Alaska__________________________ 7.1	429	6.7	403	. 4	26	5,251	4,834	84	333
    American Samoa__________________ .1	2	.1	20	0	19	19	0	0
    Arizona___________________________ 107.0	7,004	96.9	6,309	10.1	695	84,181	73,978	1,040	9,163
    Arkansas________________________ 197.3	10,175	181.8	9,319	15.5	856	121,588	108,827	1,460	11,301
    California______________________ 1,348.6	92,884	1,269.9	87,005	78.6	5,878	1,122,706	1,029,821	14,273	78,612
    Colorado__________________________ 144.8	9,294	136.4	8,738	8.4	557	112,284	103,570	1,413	7,301
    Connecticut_______________________ 250.6	18,741	238.3	17,816	12.3	925	228,281	212,702	2,839	12,740
    Delaware________________________ 38.2	2,606	35.7	2,432	2.5	174	31,577	28,783	450	2,344
    District of Columbia_______________ 57.2	3,598	53.1	3,321	4.2	276	44,240	39,791	788	3,661
    Florida_________________________ 595.8	39,771	555.1	37,080	40.8	2,691	474,241	433,802	4,624	35,815
    Georgia_________________________ 313.7	16,655	277.3	14,670	36.4	1,985	200,870	171,926	2,854	26,090
    Guam____________________________ .2	5	.2	5	(3)	(4)	69	68	0	1
    Hawaii__________________________ 36.2	2,210	33.7	2,043	2.6	167	26,644	24,008	348	2,288
    Idaho___________________________ 61.6	3,915	58.4	3,708	3.2	207	47,663	44,228	650	2,785
    Illinois__________________________ 957.2	67,810	903.4	63,868	53.8	3,941	823,548	759,514	11,158	52,876
    Indiana___________________________ 473.9	31,944	446.0	30,049	27.9	1,895	387,080	356,569	4,716	25,795
    Iowa______________________________ 301.0	19,428	288.9	18,637	12.1	791	235,178	221,684	2,676	10,818
    Kansas____________________________ 219.3	13,775	208.7	13,086	10.6	689	167,236	155,650	2,046	9,540
    Kentucky__________________________ 330.6	18,099	294.2	16,214	36.4	1,885	218,856	191,463	2,444	24,949
    Louisiana_________________________ 236.6	13,116	211.1	11,700	25.5	1,416	157,640	136,587	2,407	18,646
    Maine___________________________ 113.0	7,079	106.5	6.684	6.5	395	86,121	79,505	1,091	5,525
    Maryland__________________________ 227.3	14,963	213.0	13,980	14.3	983	181,444	165,154	2,764	13,526
    Massachusetts___________________ 552.0	39,047	523.0	36,994	28.9	2,053	477,560	443,052	6,118	28,390
    Michigan__________________________ 727.3	52,434	681.9	49,171	45.4	3,264	634,561	582,777	7,558	44,226
    Minnesota_______________________ 336.2	21,751	323.3	20,886	13.0	865	263,415	248,697	2,840	11,878
    Mississippi_______________________ 201.5	9,416	183.1	8,482	18.5	934	112,714	99,092	1,443	12,179
    Missouri__________________________ 466.1	29,546	437.7	27,720	28.4	1,826	357,422	328,173	4,536	24,713
    Montana____________________________ 65.8	4,346	62.3	4,110	3.5	235	53,283	49,502	638	3,143
    Nebraska__________________________ 149.0	9,324	143.5	8,970	5.5	354	112,576	106,422	1,316	4,838
    Nevada__________________________ 19.6	1,348	18.5	1,261	1.1	87	16,180	14,710	279	1,191
    New Hampshire_____________________  69.8	4,689	66.7	4,473	3.1	216	56,894	53,093	755	3,046
    Social Security Administration
    127
    New Jersey	____________ 592.7	43,494	561.4	41,154	31.3	2,340	529,279	489,437	7,456	32,386
    New Mexico	______ 59.0	3,229	53.9	2,961	5.1	268	38,898	34,801	554	3,543
    New York ----------- -	1,709.8	122,974	1,613.8	115,942	96.0	7,032	1,493,763	1,378,302	20,081	95,380
    North Carolina	"	-______ 391.1	20,731	352.6	18,617	38.5	2,114	249,637	218,172	3,380	28,085
    North Dakota	.	_______________ 58.5	3,549	56.2	3,424	2.3	126	43,243	41,108	481	1,654
    Ohio	'	_____ 908.2	63,223	850.9	59,249	57.3	3,973	770,345	706,485	9,720	54,140
    Oklahoma	—-	222.6	13,215	206.2	12,195	16.4	1,020	158,247	143,055	1,951	13,241
    Oregon	_____ 195.6	13,322	184.9	12,560	10.8	761	161,920	149,740	1,954	10,226
    Pennsylvania'	1,171.9	82,022	1,094.8	76,506	77.0	5,517	1,004,132	914,699	13,254	76,179
    Puerto Rico	  149.8	5,025	140.4	4,739	9.4	287	57,225	53,391	551	3,283
    Rhode Island'	’ _______ 95.7	6,671	90.0	6,265	5.8	406	81,283	74,849	966	5,468
    Routh Carolina	  188.4	9,747	166.2	8,549	22.2	1,199	118,061	100,519	1,725	15,817
    South Dakota	  68.5	4,160	65.8	4,002	2.7	158	50,702	47,932	591	2,179
    Tennessee	  333.0	17,630	301.1	15,870	31.9	1,760	211,814	186,169	2,757	22,888
    Texas	- _____ 740.6	42,757	685.8	39,472	54.8	3,286	512,498	461,725	7,005	43,768
    Utah	________ 63- 6	4> 191	60.6	3,989	3.0	203	50,851	47,418	696	2,737
    Vermont.	  44.5	2,801	41.6	2,623	2.9	179	34,057	31,145	423	2,489
    Virgin Islands___________________ 1- 5	70	1.5	68	(3)	3	807	766	13	28
    Virginia	  323.8	18,437	291.5	16,584	32.3	1,854	223,682	196,083	2,996	24,603
    Washington'	'	'	  277.3	19,093	262.9	18,054	14.4	1,039	233,296	216,344	2,699	14,253
    West Virginia ____________________ 223.7	13,311	191.2	11,479	32.5	1,832	163,176	136,534	1,727	24,915
    Wisconsin	— ______________________ 419.5	28,326	399.3	26,947	20.2	1,379	343,150	320,569	3,891	18,690
    Wyoming ___________________________ 26.7	1,738	25.2	1,643	1.5	95	20,935	19,360	309	1,266
    Abroad______________________________ 118.5	7,676	115.5	7,454	2.9	222	90,694	86,893	784	3,017
    1 Benefits under the old-age and survivors insurance (OASI) parts of the old-age, survivors, and disability insurance program are'payable from the OASI trust fund to old-age'(retired-worker) beneficiaries and their dependents and to survivors of deceased workers. Benefits under the disability insurance.(DI) part of the program are payable from
    the)D I trust fund to disability (disabled-worker) beneficiaries and their dependents.
    3 Distribution by State estimated.
    3 Less than 50.
    * Less than $500.
    128
    Department of Health, Education, and Welfare, 1962
    Table 5.—Old-age, survivors, and disability insurance: Selected data on employers, workers, taxable earnings, and contributions, by State for specified periods
    [In thousands, except for average taxable earnings. Preliminary, corrected to October 26,1962]
    State	Employers reporting taxable wages July-September 1961 i	Calendar year 1959
    		Workers reported with taxable earnings i 2	Reported taxable earnings 3		Contributions 4
    			Amount	Average per worker
    Total		4,260	71, 500	$202,346,000	$2,830	$9,884,400
    Alabama-. 		64	1,090	2,419,000	2,220	118 300
    Alaska		 _			4	80	205,000	2, 560	10 000
    Arizona	_	28	490	1,220,000	2 490	59 700
    Arkansas			 _		40	580	1,114,000	1,920	53 400
    California		 			 __	383	6,270	18,256,000	2 910	891,500
    Colorado	 			42	680	1.665,000	2 450	80 300
    Connecticut	 __	66	1,150	3,406,000	2,960	167’ 300
    Delaware. 			13	'210	' 567,000	2, 700	27 900
    District of Columbia		30	480	1,141,000	2, 380	56 400
    Florida	 _		 _ _ __ _	133	1,940	4,268', 000	2,200	207 900
    Georgia	 		94	1,450	3, 098; 000	2,140	151, 500
    Hawaii		 _ .. 			13	230	600,000	2,610	29 400
    Idaho			15	280	634; 000	2,260	30.200
    Illinois		 ... 			227	4,500	13,332; 000	2,960	652,300
    Indiana		100	1,930	5, 585; 000	2; 890	273 100
    Iowa	 		 			66	1,090	2; 751,000	2,520	129,700
    Kansas.	 	 __	54	880	2,110,000	2; 400	100,600
    Kentucky	 	 .	61	980	2,183,000	2,230	105, 300
    Louisiana			 		_		67	1,050	2, 449,000	2; 330	119 700
    Maine				 _			25	'390	858; 000	2,200	41, 800
    Maryland		_.		77	1,190	2,931,000	2,460	143,400
    Massachusetts		 . 		122	2,240	6,234 000	2,780	306,600
    Michigan	 	.	. ..	159	3,150	9,941,000	3; 160	488; 200
    Minnesota. ... _ 		74	1,310	3, 453,000	2,640	166 400
    Mississippi		 __		 			38	640	1,228,000	1,920	59, 500
    Missouri.	 _		 ... _	108	1,840	4,753,000	2, 580	231,000
    Montana			 . _	16	280	706,000	2; 520	33,800
    Nebraska	 . 				39	600	1,392,000	2,320	65,400
    Nevada					8	150	356,000	2; 370	17,400
    New Hampshire.. __			 			17	280	740,000	2,640	36,300
    New Jersey...			 		158	2, 700	7, 885,000	2; 920	386 900
    New Mexico			20	340	' 723; 000	2,130	35,100
    New York	 __ 		481	8,100	24, 470,000	3; 020	1,202,200
    North Carolina			104	1,740	3; 809; 000	2; 190	185,700
    North Dakota 		 		_.	14	230	509,000	2,210	23; 300
    Ohio		 	 _ 		203	3, 850	11,550,000	3; 000	566,200
    Oklahoma			------ ..	49	900	2,071,000	2,300	100,000
    Oregon	 			43	790	2,033,000	2, 570	98,600
    Pennsylvania	 	 		257	4, 680	13, 662,000	2; 920	669,900
    Puerto Rico		 			19	470	543,000	1,160	26,500
    Rhode Island	 ... 	 _	21	360	944,000	2; 620	46,300
    South Carolina	 	 	.	51	830	1,769,000	2,130	86,600
    South Dakota.. _		 		18	250	547,000	2,190	25,300
    Tennessee. .. ... 	 ___ _ _ .	79	1,270	2,865; 000	2,260	139, 500
    Texas	 . .		 ...	236	3,740	8,614,000	2; 300	418; 200
    Utah		17	360	' 870; 000	2,420	42.400
    Vermont. .		 			11	150	331,000	2,210	16,000
    Virgin Islands		1	10	15,000	1,500	800
    Virginia	 		91	1,400	3,282,000	2,340	160,600
    Washington..		 	 _	65	1,150	3,230,000	2; 810	157; 400
    West Virginia		37	650	1, 660,000	2, 550	81,500
    Wisconsin.			 .	.. _	94	1,620	4, 546,000	2,810	220,700
    Wyoming			 ...	9	150	' 340; 000	2, 270	16,300
    Foreign 5						1	90	274,000	3,040	13, 500
    Oceanborne vessels. _ _		110	330,000	3; 000	16,500
    Uniformed services (on basic pay)		—	3,300	5,883,000	1,780	294,200
    i Data represent number of employers reporting taxable wages by the State of their reporting headquarters. An employer is a legal entity such as a corporation, partnership, or a single ownership for which a single tax return is filed. Excludes agricultural employers.
    2 Workers employed in more than one State are counted in each State. National and state totals represent unduplicated counts of workers.
    3 Annual taxable limit with respect to wages from a single employer, or on self-employment income was $4,800 in 1959. Averages rounded to nearest $10.
    < Contribution rate was 2J^ percent, each, for employees and employers; and 3% percent for self-employed persons in 1959.
    » Represents employment and earnings of U.S. citizens outside the listed States and groups by American employers.and their foreign subsidiaries.
    Social Security Administration
    129
    Table 6.—Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1960-62
    [In thousands, except for average monthly benefit and average taxable earnings; corrected to October 18,1962]
    Item	1962	1961	1960
    	Fiscal year
    Benefits in current-payment status (end of period):
    Number (OASI and DI)1 					17,280.4	15,624.2	14,261.8
    Number (OASI)	 	 		16i 128.5	14,726. 5	13, 740.3
    Number (DI). 					 _ 	 		1,151.8	897.7	521.6
    Old-age (retired-worker)				9,347.6	8,414.0	7,813.0
    Disability (disabled-worker)				679.3	558.1	370.8
    Wife’s or husband’s (OASI and DI). __ _	 		—	2,596.6	2,432. 5	2,279. 9
    Wife’s or husband’s (OASI)._ _ 	 _ 		2,463.9	2,329.9	2,223.5
    Wife’s or husband’s (DI) _ 			 			132.7	102.6	56.4
    Child’s (OASI and DI)i 2. '		2,407. 5	2,141.3	1,903.5
    Child’s (OASI)2		2,067.6	1,904.3	1,809.1
    Child’s (DI)2		339.9	237.0	94.4
    Widow’s or widower’s	 __	1,778.1	1,621.9	1,471.3
    Mother’s 	 _ _ 			434.6	419.9	387.9
    Parent’s	 __ __			 .. -		36.7	36.4	35.5
    Total monthly amount (OASI and DI)_ _	_				$1,128,166	$992,032	$889,863
    Total monthly amount (OASI) 		$1,053,102	$931,705	$851,791
    Total monthly amount (DI)	 __ __ __	$75,064	$60,327	$38,071
    Old-age (retired-worker) _-			 	 		$710,736	$627,400	$575,295
    Disability (disabled-worker)	 	_	_			$60,948	$49, 895	$33,123
    Wife’s or husband’s (OASI and DI) __ 	 _	$101,821	$94,195	$87,701
    Wife’s or husband’s (OASI)		 _ 		$97,489	$90,759	$85,676
    Wife’s or husband’s (DI)		$4,333	$3,437	$2,025
    Child’s (OASI and DI) 2_		$110,061	$99,233	$84,789
    Child’s (OASI)2. .J		$100,277	$92,238	$81, 865
    Child’s (DI)2.. 	 		$9,784	$6,995	$2,924
    Widow’s or widower’s		 -			$116,317	$94,270	$84, 229
    Mother’s 	 __ 		$25,797	$24,823	$22,609
    Parent’s _				 	 		$2,487	$2,215	$2,117
    Average monthly amount:
    Old-age (retired-worker)__			 _ 		__			$76.03	$74.57	$73. 63
    Disability (disabled-worker)			 - 		$89.73	$89.41	$89.33
    Wife’s or husband’s (OASI and DI)		 		$39.21	$38.72	$38.47
    Wife’s or husband’s (OASI)	 		$39.57	$38.95	$38. 53
    Wife’s or husband’s (DI) 	 			$32.65	$33. 50	$35. 92
    Child’s (OASI and DI)2		$45.71	$46.34	$44. 54
    Child’s (OASI)2		$48. 50	$48.44	$45.25
    Child’s (DI) 2__ 		$28.78	$29.51	$30.98
    Widow’s or widower’s. 			 		 			$65.42	$58.12	$57.25
    Mother’s	 _ 		 	 	 		$59.36	$59.11	$58.29
    Parent’s	 _ 		 .....			$67.68	$60.85	$59.67
    Benefit payments during period:
    Monthly benefits (OASI and DI). . .	.	. 		$13,495,123	$11,721,534	$10,632,223
    Monthly benefits (OASI)			.		 _	$12,483, 747	$11,017,539	$10,103,937
    Monthly benefits (DI)		 . ._ ..	. .	$1,011,376	$703,995	$528,304
    Old-age (retired-worker)	 .					$8,339,881	$7, 371,205	$6,803,478
    Disability (disabled-worker)	 	 _ 			$816,349	$589,497	$450,114
    Supplementary (OASI and DI)			 		$1,485,396	$1,300,137	$1,183,515
    Supplementary (OASI)	 ._	.. .	$1,290,369	$1,185,639	$1,105,327
    Supplementary (DI)			 			 		$195,027	$114,498	$78,190
    Survivor _.	_ __ 	 _ _ 			$2,853,497	$2,460,695	$2,195,132
    Lump-sum death payments ... _ _. 			$174, 089	$166, 993	$165,772
    Workers insured for OASI benefits (midpoint of period—
    Jan. I):3 4 _ 	 	 _ 		89,300	85, 300	79, 600
    Fully insured										88,700	84,400	76,600
    Currently but not fully insured		 		600	1,000	2,900
    Workers insured for disability (midpoint of period—Jan. I):3.	50,900	48,800	46,300
    Estimated number of employers reporting taxable wages, 1st
    quarter of fiscal yeari		4, 250	4,230 Calendar year	4,170
    Estimated number of workers with taxable earnings		75,000	74,000	73,000
    Estimated amount of taxable earnings	 	 		$220, 000,000	$210,000,000	$207,600,000
    Average taxable earnings 5		$2,930	$2,840	$2,840
    i Benefits under the old-age and survivors insurance (OASI) parts of the old-age, survivors, and disability insurance program are payable from the O ASI trust fund to old-age insurance (retired-worker) beneflcaries and their dependents and to survivors of deceased workers. Benefits under the disability insurance (DI) part of the program are payable from the DI trust fund to disability insurance (disabled-worker) beneficiaries and their dependents.
    2 Includes benefits payable to disabled persons aged 18 or over—dependent sons and daughters of disabled, deceased, or retired workers—whose disability began before age 18.
    3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from: (1) provisions that coordinate the old-age, survivors, and disability insurance and railroad retirement programs and (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported on more than 1 account number.
    4 Excludes agricultural employers.
    8 Rounded to nearest $10.
    130
    Department of Health, Education, and Welfare, 1962
    Table 7.—Special types of public assistance under plans approved by the June 1962, and total payments to recipients, [Including vendor payments for medical care and cases
    State	Old-age assistance			Medical assistance for the aged			Aid to dependent children
    	Number of recipients, June	Payments to recipients		Number of recipients, June	Payments to recipients		Number of recipients, June
    		Average payment, June	Total, fiscal year (in thousands)		Average payment, June	Total, fiscal year (in thousands)	Families	Total1	Children
    Fiscal year: 1960		2.358, 539 2,295,925 2,236,870	$68.01 67.90 72. 55	$1,894,639 1.914, 946 1,899,039				794,396 877,961 944,043	3,023,311 3,382,095 3,692,566	2,330,108 2,612,611 2,853,387
    1961					46,247 101,634	$201. 33 171.36	$42.899 196.127
    1962
    Alabama.
    	101,234 1,362 13,690 55,513 257,999 49, 518 9,851 1,129 2,911 70,422 93,156 131 1,193 5,742 66,285 24,967 3i; 568 25,880 54,757 126,995 11,111 9,435 59,410 53,100 44,241 78,949 109,252 6,183 13,534 2,483 4,628 18,527 10,843 58,039 45,908 6,181 87,828 85,399 15,815 48,191 36,255 6,233 28,932 8,145 50,479 221,039 6,733 5,483 532 14,084 44,153 17,114 31,578 2,750	62. 93 70.45 59.34 56.54 103.42 99.11 80. 77 49. 44 83.99 60.19 49.17 38.39 70.44 71.42 82.90 68.58 73.00 86. 51 53. 86 81.24 69. 85 69.48 81.72 80.30 101. 22 36.03 61.35 65.37 77.92 83.89 90.66 95.03 59.66 79.39 50.94 82.50 80. 93 84. 47 86.25 74. 55 9.05 82. 74 41. 53 77.16 45.60 64.84 73. 85 72.98 33.89 56.10 97.00 44.30 87.63 78.35	72,076 1,157 9,961 35,302 292, 760 58,317 18,945 692 2,937 50,376 53,325 37 998 5,259 66,115 20,439 32,904 26,894 35,190 114,355 9,181 7,531 62,175 51,398 51,780 33,674 81,287 4,937 12,794 2,394 5,067 18,567 8,913 57,932 27,402 6,651 83,677 86,478 16,064 41,074 3,911 6,266 14,999 7,510 27.993 155, 542 6,596 4,796 222 9,327 48,450 8.978 34,784 2,649	162	183. 90	121	21,794 1,252 9,214 6,396 90,461 8,761 11,146 2,023 4,976 26,321 16,758 185 3,018 2,476 61,492 12.381 10,052 6,662 22,155 22,327 6,028 11,957 19,041 33,342 11,371 20, 522 26,913 1,882 3,285 1,284 1,045 20,996 7.427 87,037 28,253 1,845 35,238 19,325 8,217 69,059 57,560 5,019 8,991 2,948 22,391 19,643 4,063 1,345 302 10, 704 13,424 31,804 11,168 764	88,320 4,301 38.003 24,662 337,022 33,886 42,043 8,486 22,724 97,956 62,818 1,003 12,351 9.337 264, 520 46,887 37,718 25,788 79,655 92,231 21,540 50,527 66,180 120,017 39,940 80,459 104,970 7,212 12,880 4,683 4,155 76,326 29,221 360, 547 111, 727 6.922 140,300 70,652 30,476 280.685 226,436 19,003 36,040 10,438 84,477 81, 530 15, 678 4,880 1,043 43,652 49,698 125,872 41,814 2,875	69,331 3,236 29,369 19,011 260,052 26,697 32,141 6,634 18,133 78,339 48.761 841 9,876 6,908 206.411 35,650 28,661 20, 462 59,871 71,973 16.001 39,893 49. 701 88,446 31,344 63,159 80,206 5,600 9,943 3,740 3,189 58,193 22,579 277,649 86, 545 5,416 107, 517 53,946 23,371 214,804 181. 595 14, 500 28,734 7,953 64,445 62,196 11,998 3,668 877 34,273 37,608 97,612 32,096 2,233
    Alaska.
    Arizona	...
    Arkansas					1,343 16,429	47.40 290. 45	355 18,002
    California
    Colorado.
    Connecticut—					3,961	192.42	1,152
    Delaware
    District of Columbia..	. ...
    Florida	 .
    Georgia
    Guam					17 412 1,168 392	(«) 260.06 143.72 246.76	(’) 811 1,804 634
    Hawaii
    Idaho
    Illinois.
    Indiana
    Iowa.
    Kansas
    Kentucky..				2,164 270 397 5,051 20,391 4,896	18. 40 394.15 265. 72 54. 79 179.03 318.81	311 359 402 1,832 41,673 17,149
    Louisiana	 Maine.
    Maryland
    Massachusetts	 Michigan
    Minnesota
    Mississippi
    Missouri.’. _
    Montana
    Nebraska
    Nevada
    New Hampshire	 New Jersey					33	(2)	13
    New Mexico
    New York						26,965	135.48	99,071
    North Carolina	 North Dakota	 Ohio
    				836	210.45	1,450
    Oklahoma					571 (<) 3,926 1,913	239.60 w 245. 80 26.14	886 231 2,883 331
    Oregon	 _
    Pennsylvania.. ...
    Puerto Rico
    Rhode Island.
    South Carolina	 South Dakota					494	156. 50	852
    Tennessee					678	57.21	182
    Texas
    Utah					612	148.08	508
    Vermont
    Virgin Islands	 Virginia					88	18.10	24
    Washington						948 7,517	217.18 36.97	1,409 3,683
    West Virginia..
    Wisconsin
    Wyoming

    i Includes as recipients the children and 1 parent or other adult relative In families in which the requirements of at least 1 such adult were considered in determining the amount of assistance.
    Social Security Administration
    131
    Social Security Administration: Number of recipients and average payment, by program and State, fiscal year 1962
    receiving only such payments; data corrected to October 15, 1962]
    Aid to dependent children—			Aid to the blind			Aid to the permanently and totally disabled
    	Continued
    Payments to recipients				Payments to			Payments to
    				recipients			recipients
    			Number			Number
    			of recip-			of recip-
    Average	Average	Total,	ients, June		Total,	ients,		Total,
    payment	payment	fiscal		Average	fiscal	June	Average	fiscal
    per	per	year (in		payment,	year (in		payment,	year (in
    family,	recipient,	thousands)		June	thousands)		June	thousands)
    June	June
    $110. 78	$29.11	$1,021,097	107,978	$72.85	$92,309	362,815	$65.96	$271,208
    116. 70	30.29	1,118,991	105,601	73.36	93,991	383,675	68.21	301,361
    123.14	31.48	1,338,603	100,398	77.47	92,819	417,042	72.00	334,528
    45.35	11.19	11,089	1,628	43. 93	842	12,753	40.85	5,998
    86.38 122.36 62.16	25.14	1,677 13,014 4.885	98	77.20	90
    	29.67		865	71.94	754
    	16.12		1,967	61.17	1,358	7,706	48.32	3,900
    168.61	45. 26	178,448	12,886	121. 72	17,909	21,978	100.79	21,258
    134.01	34. 65	13,054	248	86.83	250	5,647	71.85	4, 718
    159.40	42.26	21,397	301	99.34	385	2,349	123.41	3,614
    91.40	21. 79	2,482	265	76.51	221	450	64.50	342
    151.92	33.27	9,887	196	69.92	171	3,049	75.27	2,499
    62.04	16.67	18, 710	2,523	62.28	1,866	12,908	66.03	9,197
    86.84	23.17	17,237	3,217	52.20	2,179	24, 567	51.34	14,555
    67.36	12. 42	145	6	(2)	2	84	24.85	26
    148.46	36.28	4,894	83	99. 66	86	1,037	107. 83	1,165
    156.32	41.45	4,478 125, 553	130	73. 51	119	1,994	67. 74	1,348
    199. 86	46.46		2,883	91.39	3,115	27,167	98. 49	26,261
    108. 78 146. 45	28 72	15, 705 15,170	1,850 1,328	76.68	1,702
    	39.03			100.21	1,620	801	67.86	603
    143.16	36. 98	11, 359	566	87.08	592	4,175	90.10	4,418
    90. 69	25.22	23,529	2,418	60.07	1,738	8,670	62. 70	6,267
    100.57	24.35	26,361	2,754	81.21	2,666	17,649	57.71	11, 504
    100.40	28.10	7,150	411	71.40	340	2,247	71.23	1,887
    128.25	30.35	17,273	418	66.00	333	6,486	67.63	5,062
    158.49	45.60	34,824	2,228	121.18	3,251	10,436	131. 77	15,989
    143.92	39. 98	53.027	1,723	81. 55	1,660	5,981	102. 62	6,326
    165.06	46. 99	21,232 8.839	1,026	108. 96	1,354	2,843	60.58	1,956
    35.87	9.15		3,485	38.13	1,893	13,312	34.44	5,356
    95.15	24.40	30.235	4,833	65.00	3,820	15,032	63.41	11,584
    130.21	33.98	2,981	295	73. 54	273	1,260	73. 67	1,115
    118.13	30.13	4,534	701	94.15	822	2,196	78.87	2,008
    107.21 166.55	29.39 41.89	1,695 2,092	174	98. 94	209
    			246	95.72	263	488	106.13	564
    172. 75	47.52	39,340	930	88. 78	965	7,533	94. 65	7,512
    122.86	31.23	11,272	362	69. 57	283	2,898	72.80	2,390
    177.12	42.76	184,879	3,347	96. 61	3,963	35,383	110. 21	46, 990
    87.26	22.06	28,941	5,045	56. 59	3,400	21,275	61.72	14,465
    153. 64	40. 95	3,413	88	80. 40	81	1,247	103. 70	1,422
    116. 93	29.37	47,321	3,438	80.35	3,198	15,400	79.77	13,051 12,362
    124.32	34.01	28,222	1,746	104. 75	2,056	10, 855	98.81
    137.83	37.16	14,025	315	94. 37	298	4,886	92.65	5,345
    130. 73	32.17	107,256	17,857	74.68	16,079	18,476	64.13	13,327
    14.79	3.76	10,298	1,687	8.33	173	22,350	8.75	2,325
    51.16	39.92	9,265	114	84.42	115	2,740	86.24	2,964
    57.20	14.27	6,242	1,69S	48.85	993	8,144	45.32	4,443
    103. 71	29.29	3,652	149	63. 77	117	1,109	65.04	861
    69.88	18.52	19,043	2,504 5,345	46.28	1,443	11, 522	45.68	6,150
    78.87	19.00	18,115		61.86	4,310	7,741	54.00	4,926
    133.37	34. 56	6,913	173	78.10	175	3,676	77. 84	3,165
    110.10	30. 34	1,718	106	61.70	79	874	63.85	656
    56. 87	16. 47	205	16	(’)	6	96	34.08	41
    99.13	24.31	12,606	1,175	62.64	867	6,553	62.09	4,834
    148.63	40.15	24,759	675	108.86	814	8,419	94.70	7,971
    109.20	27. 59	37,307	935	47.32	522	7,327	45.62	3,834
    168.35	44. 96	19,539	880	94.26	946	4,700	104. 91	5,430
    140.86	37.43	1,314	60	80.78	55	573	78.90	541
    2 Average payment not computed on base of fewer than 50 recipients. ’ Less than $500.
    « No payments made in June 1962.
    132
    Department of Health, Education, and Welfare, 1962
    Table 8.—Special types of public assistance under plans approved by expenditures and percent from Federal funds, [Includes vendor payments for medical care; amounts
    State	Federal grants to States1						Expenditures for assistance and administration
    	Total	Old-age assistance	Medical assistance for the aged	Aid to dependent children	Aid to the blind	Aid to the permanently and totally disabled	Old-age assistance
    							Amoimt	Percent from Federal funds
    Fiscal year:
    1960		$2,033,761	$1,157,523		$660,232	$48,824	$167,182	$2,014,736	58.1
    1961		2,180,466	1,211,709	$33,507	704,108	48,517	182,625	2,035; 554	59.9
    1962		2,466,974	1,256,388	109,866	853,685	47; 483	199,552	2,020,168	62.8
    Alabama		69,592	54,403	200	9,569	653	4,767	75,231	72.9
    Alaska				1,865	748		1,062	56		1,257	59.8
    Arizona			17,749	7,254		9,968	527		10; 196	70.9
    Arkansas		36,586	27,584	438	4,373	1,020	3,171	36; 656	74.9
    California		288,115	161,555	16,268	92,247	7,558	10,487	314;459	49.6
    Colorado		41,749	29,280		9,190	143	3,136	60; 677	50.7
    Connecticut		19,857	8,070		10,281	152	1,355	20,074	42.0
    Delaware		2,960	514		2,031	149	265	764	66. 9
    Dist. of Col			10,271	1,957		6,716	102	1,495	3,250	59. 4
    Florida			62,485	38,035		16,365	1,319	6,766	52,918	71.7
    Georgia		68,951	41,740		14,204	1,725	11,282	56,537	73.7
    Guam			125	25		81	2	17	42	50.0
    Hawaii		4,749	732	354	3,086	51	525	1,096	65. 8
    Idaho				8,721	3,741	1,289	2,582	81	1,027	5,477	69.7
    Illinois		120,743	42,765	646	62,961	1,691	12,681	72; 739	59.3
    Indiana		27,090	14,149		11,837	1,104		22,525	65.2
    Iowa	 				33,140	21,588		10,277	' 801	474	35,296	61. 8
    Kansas			27,855	17,897		7j 205	336	2,416	28,852	61.8
    Kentucky	 .	52,722	27,141	253	19; 138	1,336	4,854	36,833	73.4
    Louisiana	 _	118,088	82,149	1,614	23,347	1,659	9,320	119; 034	70. 5
    Maine		14,146	6,675	360	5,549	230	1,333	9,590	71.1
    Maryland		22,402	4,998	842	13,035	216	3,312	7; 945	64. 3
    Massachusetts		84,227	37,105	22,319	17,864	1,205	5; 734	67; 902	57.3
    Michigan			75,147	32,375	9,031	29,721	' 895	3,126	55,323	60. 2
    Minnesota		42,295	29,267		10,961	612	1,455	54,553	55. 2
    Mississippi			41,769	27,601		8,101	1,516	4; 552	35,758	76. 9
    Missouri		90i403	57,240		22,920	2,195	8,048	85,186	67.1
    Montana			6^ 394	3,434		2,034	' 181	745	5,356	65. 9
    Nebraska. 			13,998	8,767		3,505	421	1,305	13,793	65.0
    Nevada		2,862	1,459		1,295	108		2,574	58. 7
    New Hampshire		4,927	3,158	111	1,226	143	288	5,439	59.3
    New Jersey		34,705	10,490		19,891	522	3,803	20,184	53. 7
    New Mexico		17,196	6,820		8,446	214	1,715	9,574	71.9
    New York		203.023	36,118	42,669	101648	2,054	20,534	67; 507	58. 4
    North Carolina		59,616	21,571		24,489	2,712	10,845	29,018	74.4
    North Dakota		8,627	4,706	1,047	2,087	59	728	7,220	66.1
    Ohio 		95,322	50j839		34;478	1,939	8,066	88; 906	59. 7
    Oklahoma				88,846	61,107	476	19,772	1,047	6,444	89,248	68. 4
    Oregon	...	22^ 034	10,038	1,187	7; 889	152	2,768	17,569	59.7
    Pennsylvania		119,569	26' 608	4,395	77^012	3,064	8,491	44,548	61. 9
    Puerto Rico		8,875	1,997		5,431	101	1,345	4,492	46. 2
    Rhode Island		11,414	4^061		5,634	66	1,653	6,855	60.3
    South Carolina		22,447	11,926	770	5; 509	760	3,482	15,884	75.7
    South Dakota		9,329	5,498		3,058	93	680	8,021	70.6
    Tennessee		44,852	22,108	244	16,473	1,121	4,906	29,798	75.1
    Texas		137,702	115’251		15; 371	3; 227	3,852	160,501	71.3
    Utah		11,670	4,493	396	4; 835	' 107	1,838	6,979	67.9
    Vermont 		5,458	3,511		1,372	63	512	5; 070	70. 4
    Virgin Islands		310	143	14	121	5	27	261	49.9
    Virginia		22,599	7,515		10,552	669	3,864	10,125	74.8
    Washington	50,140	28,738	565	16,432	386	4,018	51,173	55. 9
    West Virginia		44,954	7,304	4,377	29,615	407	3,251	9,465	76.9
    Wisconsin			33,360	20,398		10,001	498	2; 463	37,541	56.0
    Wyoming		2,947	L745	—	'839	31	332	2,895	61.4
    1 Based on cash advanced for the year; may differ slightly from flscal-year expenditures from Federal funds reported by States.
    ? Less than $500.
    Social Security Administration
    133
    the Social Security Administration: Federal grants to States and total by program and State, fiscal year 1962
    in thousands; data corrected to October 15,1962]
    Expenditures for assistance and administration—Continued
    Medical assistance for the aged		Aid to dependent children		Aid to the blind		Aid to the permanently and totally disabled
    Amount	Percent from Federal funds	Amount	Percent from Federal funds	Amount	Percent from Federal funds	Amount	Percent from Federal funds
    		$1,130, 515	58.9	$100,203	48.9	$302, 925	55.8
    $45,899	49.8	1,240,092	57.8	102,212	47.6	335,615	54.7
    208', 752	50.7	1,488,491	56.8	101,493	46.9	373,350	54.0
    145	74.2	12.162	79.4	888	74.2	6,494	74.3
    		1, 775 13,430 5,290	60.8	99	55.2
    			73.6	793	64.7
    436	74.4		79.8	1,411	72.1	4,324	72.9
    19,365	50.0	206, 966	44.7	19, 926	37.0	25,119	42.3
    		14, 973	60.6	274	53.3	5,303	59. 5
    1,283	34.4	23.623	43.9	410	39.2	3,945	34. 3
    		2,765	72.7	256	58.4	406	62.3
    		10,897	60.3	185	59.5	2, 710	55. 7
    		20, 593	79.4	1,974	68.0	10,132	66.7
    		18,655	75.6	2,323	72.4	15, 786	72.1
    (2)	50.0	155	50.0	2	49.9	31	50.0
    839	53.2	5. 547	57.6	114	48.6	1,283	42.1
    1,955	65. 0	4,800	54.3	127	64.0	1,481	70.2
    '675	50.0	137,943	45.3	3, 567	47.1	29,146	42.7
    		17, 545 16,749	67.9	2,010	55.0
    			60.8	1,763	45.6	717	64.3
    		12,419	57.1	643	52.1	4, 816	50.7
    453	67.6	25,065	75.3	1,864	71.5	6, 753	70. 9
    485	66.7	30,231	73.9	2,834	58.6	13,463	69.6
    408	66.4	7,720	73.5	355	68.2	2,057	65.1
    1,953	50.0	19,175	66.4	352	63.3	5,426	62.7
    43', 855	48.6	38, 755	44.2	3,457	35.1	17, 578	33.0
    17i 578	50.0	56, 530	52.4	1,737	51.9	6,757	45. 7
    		23,335	47.3	1,448	42.1	2,153	67.4
    		10, 240	77.9	2,020	75.3	6,119	74. 7
    		32, 798	71.8	4,171	53.5	12,372	65.1
    		3,320	61.2	323	57.8	1,305	58. 8
    		4,971	68.7	884	47.9	2,237	56. 8
    		1,940 2,323	65.8	244	44.0
    14	57.5		52.0	286	49.4	662	44.8
    		43,475	44.6	1,111	48.4	8,786	44.8
    		12,346	69.1	307	71.4	2,674	64. 5
    105,402	49.9	212,811	47.4	4,820	44.3	54,109	39. 7
    		31,359	76.5	3,863	70.3	15,608	71.2
    1,609	69.1	3,780	54.5	97	61.0	1, 593	47. 4
    		51, 510	66.3	3, 733	53.8	14, 567	55. 4
    918	65.9	29,636	66.7	2,136	49.2	13,158	49.1
    386	51.4	15, 819	50.4	324	46.7	5, 921	47.2
    2,935	50.0	118,664	63.2	17,030	18.6	15,122	59.8
    341	50.0	11,633	46.3	214	47.1	2,846	47.1
    		10,219	52.4	129	50. 9	3,299	49.3
    1,054	74.3	6, 843	79.5	1,068	72.6	4,827	72.9
    		4,095	72.5	130	70.1	959	69.9 72.9
    379	62.5	20, 763	78.2	1, 532	73.4	6, 716
    		19,688	77.8	4,493 182	69.7	5,513	69. 4
    534	62.8	7,686	61.6		58.1	3,361	56.2
    		1,910	71.3	87	70.6	727	70.0 49.5
    43	50.0	256	49.8	8	50.0	47
    		14,035	73.8	961	70.4	5,484	69.8
    1,467	49.8	27,383	56.5	872	43.4	8,636	47.1
    <239	67.7	38,893	74.8	550	73.7	4,225	73.0
    		21,482	47.4	1,046	48.5	6,002	41. 8 53.8
    		1,514	54.0	60	54.0	594

    134
    Department of Health, Education, and Welfare, 1962
    Table 9.—Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, child welfare services, and research or demonstration projects in child welfare under the Social Security Act, by program and State, fiscal year 1962 1
    [In thousands]
    State	Maternal and child health services	Crippled children’s services	Child welfare services
    United States	 Alabama			__			$23,851.7 684.4	$24, 093. 5 766. 4	$18,645.9 472.5
    Alaska.. 			173.9	148.8	69.7
    Arizona	 			 					232.5		184.8
    Arkansas 				386.9	403.6	283. 5
    California	 	 		1,338. 0	1, 080.9	1, 027. 6
    Colorado	 	 		' 423. 2	' 304. 6	' 208.2
    Connecticut		 	 -	396.2	286.2	182.9
    Delaware __ 	 			130.1	129.6	77.4
    District of Columbia	 		311.2	280. 2	89.2
    Florida 	 			 	 		774.1	584. 3	453.7
    Georgia					734.2	841.9	533. 9
    Guam		 				68.7	52. 0	7.8
    Hawaii 	 				 _	180.4	181.9	115.4
    Idaho-	 _ 		 ... -					190.6	162.9	95.3
    Illinois		 	 -		-	673.3	748.0	700.9
    Indiana 	 . 			 --		373. 6	572.2	444.5
    Iowa	 					 						307. 0	498.7	315.9
    Kansas 		 __ 		260. 5	287.3	251. 5
    Kentucky 					548. 7	526.7	430.5
    Louisiana			 — — -	480.5	569.7	446. 0
    Maine 		 			-			-	177.7	155.2	149.7
    M aryland 		451.3	465. 7	296.6
    Massachusetts				416.3	452.3	404.4
    Michigan	 _			 _ -		920.9	954.3	733.9
    Minnesota	 						509.4	693.7	380.9
    Mississippi			-	625.4	565.0	362.3
    Missouri	 __		523.3	442.1	411.4
    Montana			141.7	193.3	119. 6
    Nebraska		140.5	121.3	184.2
    Nevada 		 		123.2	82.3	71. 7
    New Hampshire						108.9	124.0	100.1
    New Jersey			354.7	276.6	418.1
    New Mexico 		 -			254.9	217. 7	160.5
    New York 	 		1,179.3	894.5	1, 010. 7
    North Carolina			' 889. 0	1,011.4	' 631. 6
    North Dakota 	 	 		140.2	' 145.1	130.1
    Ohio								1, 005. 0	910.5	818.8
    Oklahoma 	_ 	 _ 	 —	381.1	366.9	283.7
    Oregon	_ 		212.3	239.0	206.3
    Pennsylvania		...	1,091.1	1,130.8	939.5
    Puerto Rico - _ 	 	-			531.3	654.3	440.5
    Rhode Island 		220.1	178.0	120.9
    South Carolina 							527.0	583.1	400.4
    South Dakota 						63.4	140.5	130.5
    Tennessee 			666.8	727.0	471.7
    Texas		1, 036.0	1, 485. 0	1, 039. 6
    Utah 		138.8	' 164. 4	' 156.8
    Vermont 	 		125.7	126.0	91.9
    Virgin Islands 				108.7	108.6	56.3
    Virginia 			753.1	695.1	472.4
    Washington . 			389.4	320.3	284.9
    West Virginia		431.1	404.4	278.8
    Wisconsin 					417.5	513.4	413.2
    Wyoming		128.6	125.8	82.7
    1 Based on checks issued basis. Additional payments were made for special project grants to institutions of higher learning and to public or other non-profit agencies and organizations as follows: maternal and child health services, $986.0; services for crippled children, $544.1; research or demonstration projects in child welfare, $131.3.
    Social Security Administration
    135
    Table 10.—Federal credit unions: Assets, liabilities, and capital, Dec. 31, 1960, and Dec. 31, 1961
    Assets, liabilities, and capital	Amount			Percentage distribution
    	Dec. 31,1961	Dec. 31, 1960	Change during year	Dec. 31, 1961	Dec. 31, 1960
    Number of operating Federal credit unions		10,271	9.905	366
    Total assets		$3, 028,293,938	$2, 669, 734, 298	$358,559,640	100.0	~00.0
    Loans to members		2, 245,223, 299	2,021,463,195	223,760,104	74.2	75.7
    Cash				190,190, 576	157, 615,757	32,574,819	6.3	5.9
    U.S. Government obligations		94, 652, 577	93, 577, 264	1,075,313 106,178,953	3.1	3.5
    Savings and loan shares 		412, 428, 717	306,249, 764		13.6	11.5
    Loans to other credit unions		54, 943, 499	61, 701, 066	-6, 757,567	1.8	2.3
    Land and buildings		11.861,150	9,699,908	2,161,242	.4	.4
    Other assets		18,994,120	19,427,344	-433, 224	.6	.7
    		- ———	1 ■	■■	■	-	- —	■ ■ —	■■ -
    Total liabilities and capital		3,028.293,938	2,669, 734, 298	358,559, 640	100.0	100.0
    Notes payable	 Accounts payable and other liabil-	59, 698,027	71,275,679	-11,577,652	2.0	2.7
    bilities					16,151,362	12,372,686	3,778,676	. 5	.4
    Shares	 			 —	2,673,488, 298	2,344,337,197	329,151,101	88.3	87.8
    Regular reserve		133,939,870	111, 703,332	22,236,538	4.4	4.2
    Special reserve for delinquent loans..	4,604,374	4,456,218	148,156	.2	.2
    Other reserves 1	 		7,645, 471	5, 899, 292	1, 746,179	.2	.2
    Undivided earnings2		132, 766, 536	119,689,894	13, 076,642	4.4	4.5
    1 Reserve for contingencies and special reserve for losses.
    * Before payment of yearend dividends.
    Table 11.—Federal credit unions: Selected data on operations, as of Dec. 31, for each year 1934—61 1
    Year	Number of operating Federal credit unions	Number of members	Assets	Shares	Loans outstanding
    1934 2			39	3,240	$23,300	$23,100	$15,400
    1935			772	119, 420	2,372,100	2,228,400	1,834,200
    1936			1,751	309. 700	9,158.100	8, 510,900	7,343,800
    1937			2,313	483,920	19, 264, 700	17, 649, 700	15, 695,300
    1938			2,760	632,050	29,629, 000	26,876,100	23,830,100
    1939			3,182	850, 770	47,810,600	43,326,900	37,673, 000
    1940			3,756	1,127,940	72,530,200	65,805,800	55,818,300
    1941	4,228	1, 408, 880	106,052,400	97, 208,900	69,484, 700
    1942	_____________	4,145	1,356,940	119,591,400	109,822,200	43,052,500
    1943			3,938	1,311,620	127,329, 200	117,339,100	35,376, 200
    1944			3,815	1,306,000	144,365, 400	133,677, 400	34, 438, 400
    1945			3,757	1,216, 625	153,103,120	140, 613,962	35,155, 414
    1946			3,761	1,302,132	173,166, 459	159, 718,040	56,800,937
    1947			3,845	1, 445,915	210,375,571	192,410,043	91,372,197
    1948			4,058	1, 628,339	258,411, 736	235,008,368	137, 642,327
    1949			4,495	1, 819, 606	316,362, 504	285, 000,934	186,218, 022
    1950			4,984	2,126,823	405,834,976	361,924, 778	263, 735,838
    1951	_____________	5,398	2,463,898	504, 714, 580	457, 402,124	299,755, 775
    1952			5,925	2,853, 241	662,408,869	597,374,117	415,062,315
    1953			6, 578	3,255, 422	854,232, 007	767,571,092	573,973, 529
    1954			7,227	3,598, 790	1,033,179,042	931, 407, 456	681,970,336
    1955			7, 806	4, 032,220	1, 267, 427, 045	1,135,164.876	863,042, 049
    1956			8,350	4, 502,210	1,529, 201, 927	1,366,258,073	1,049,188,549
    1957			8,735	4,897,689	1, 788, 768,332	1,589,190, 585	1,257,319,328
    1958			9, 030	5,209,912	2, 034,865,575	1,812,017,273	1,379,723, 727
    1959			9, 447	5,643, 248	2,352,813,400	2, 075, 055, 019	1, 666,525,512
    I960			9,905	6, 087,378	2, 669, 734,298	2,344,337,197	2, 021,463,195
    1961		10, 271	6,542,603	3,028,293,938	2,673,488,298	2, 245,223,299
    i Data for 1934-44 on membership, assets, shares, and loans outstanding are partly estimated.
    2 First charter approved Oct. 1,1934.
    136
    Department of Health, Education, and Welfare, 1962
    Table 12.—Federal credit unions: Selected data on operations, by asset size and State, 1961
    Amount of members’ shares Amount of loans to members
    Number of
    Asset size and State	credit Number of Total assets	Made during 1961 Outstanding
    unions members (thousands) Total Average1 ___________________ as of
    (thousands) per member	Dec. 31, 1961
    Total Average1 (thousands) (thousands)
    All credit unions__________________ 10,271	6,542,603	$3,028,294	$2,673,488	$409	$3,134,278	$672	$2,245,223
    Credit unions with assets of:
    Less than $5,000________________________ 614	45,101	1,536	1,434	32	1,525	126	995
    $5,000-$9,999___________________________ 575	60.915	4,301	3,859	63	5,193	177	3,107
    $10,000-$24,999_______________________ 1,258	178,993	21,356	18,865	105	28,949	257	16,116
    $25,000-$49,000_______________________ 1,356	264,114	49,437	43,346	164	63,023	348	38,038
    $50,000-$99,999_______________________ 1,616	438,955	117,429	102,536	234	136,462	454	89,670
    $100,000-$249,999--------------------- 2,130	939,938	344,584	302,331	322	361,923	567	257,878
    $250,000-$499.999_____________________ 1,247	1,001,809	442,554	388,852	388	463,124	634	333,838
    $500,000-$999,999_______________________ 819	1,171,326	570,548	503,892	430	595,266	702	424,293
    $1,000,000-$1,999,999___________________ 421	1,063,938	581,590	511,999	481	599.839	766	438,589
    $2,000,000-$4,999,999___________________ 192	843,522	536,856	477,575	566	539,753	825	390,080
    $5,000,000 and over______________________ 43	533,992	358,103	318,799	597	339,221	907	252,619
    Credit unions located in:
    Alabama_________________________________ 172	88,119	36,761	32,358	367	41,215	532	27,767
    Alaska___________________________________ 30	25,148	9,107	8,319	331	11,453	564	7,440
    Arizona__________________________________ 77	73,263	36,315	32,168	439	44,293	768	31,849
    Arkansas_________________________________ 61	24,343	8,325	7,437	307	12,162	551	6,754
    California____________________________ 1,056	852,214	441,302	393,828	462	455,581	742	347,402
    Canal Zone________________________________ 7	11,938	3,188	2,865	240	3,946	210	1,759
    Colorado________________________________ 144	93,349	44,566	39,358	422	49,063	803	36,910
    Connecticut_____________________________ 302	218,255	124,109	110,920	508	107,394	650	74,245
    Delaware_________________________________ 40	21,946	7,697	6,716	306	8,003	642	6.403
    District of Columbia____________________ 141	233,352	105,997	92,795	398	114,562	755	86,190
    Florida_________________________________ 260	206,610	85,636	75,608	366	100,591	590	70,099
    Georgia_________________________________ 182	102,436	37,028	32,193	314	48,052	456	28,152
    Hawaii__________________________________ 164	116,199	82,331	73,420	632	80,493	965	57,844
    Idaho____________________________________ 57	29,013	13,767	12,084	417	13,665	746	11,610
    Illinois________________________________ 217	114,546	57,785	51,798	452	53,003	714	38,044
    Indiana_________________________________ 359	203,568	106,773	95,222	468	95,928	656	62,491
    Iowa______________________________________ 6	3,887	2,263	2,089	537	2,211	884	1,675
    Kansas___________________________________ 80	60,230	30,464	27,130	450	28,031	801	24,728
    Kentucky_________________________________ 74	28,725	10,374	9,390	327	11,313	548	7,202
    Louisiana_______________________________ 297	143,430	62,418	54,995	383	66,243	620	45,926
    Maine___________________________________ 107	61,806	27,113	23,240	376	29,763	668	20,121
    Maryland________________________________ 144	102,085	34,250	30,219	296	40,681	492	27,756
    Massachusetts___________________________ 287	145,442	55,095	49,411	340	53,383	539	37,512
    Social Security Administration
    137
    665171—63----10
    Michigan___________________________________ 411	442,519	244,173	213,131	482	225,598	880	187,347
    Minnesota___________________________________ 43	23,538	8,949	7,865	334	8,237	696	7,225
    Mississippi_________________________________ 87	47,254	17,952	15,609	330	22,421	480	15,021
    Missouri____________________________________ 44	28,093	12,981	11,689	416	11,754	612	8,215
    Montana____________________________________ 106	38,951	16,209	13,864	356	14,581	710	12,921
    Nebraska____________________________________ 86	51,814	24,084	21,385	413	24,765	797	18,139
    Nevada______________________________________ 58	30,134	14,259	12,471	414	17,504	739	11,932
    New Hampshire_______________________________ 25	18,448	6,830	6,145	333	7,419	552	5,169
    New Jersey_________________________________ 457	255,350	109,273	96,559	378	94,754	593	69,965
    New Mexico__________________________________ 48	46,517	23,263	20,393	438	30,208	764	18,824
    New York___________________________________ 912	521,765	225,674	200,124	384	218,362	671	159,720
    North Carolina______________________________ 47	37,217	9,671	8,442	227	12,651	417	8,031
    North Dakota________________________________ 32	11,185	4,489	3,947	353	3,948	655	3,649
    Ohio_______________________________________ 545	331,029	147,294	130,521	394	143,009	695	103,303
    Oklahoma___________________________________ 117	62,648	30,703	27,110	433	33,194	764	24,613
    Oregon_____________________________________ 179	78,988	35,297	30,865	391	40,227	778	29,689
    Pennsylvania_____________________________ 1,030	553,513	223,664	194,028	351	231,061	624	152,104
    Puerto Rico_________________________________ 35	16,583	5,126	4,369	263	6,332	373	4,417
    Rhode Island________________________________ 19	6,530	2,906	2,623	402	2,698	700	1,412
    South Carolina______________________________ 73	46,209	9,861	8,880	192	16,286	340	8,392
    South Dakota________________________________ 90	31,624	14,262	12,598	398	16,552	826	10,921
    Tennessee__________________________________ 184	105,584	53,998	47,858	453	65,361	627	38,973
    Texas______________________________________ 785	490,490	228,877	199,843	407	266,429	665	177,738
    Utah________________________________________ 84	35,979	18,264	16,180	450	21,135	835	15,449
    Vermont______________________________________ 3	1,351	537	457	338	462	269	276
    Virginia___________________________________ 158	94,263	30,707	26,616	282	36,218	513	24,267
    Virgin Islands_______________________________ 4	1,494	167	145	97	132	397	150
    Washington_________________________________ 173	112,898	59,898	53,177	471	61,792	775	47,131
    West Virginia______________________________ 113	40,259	16,715	14,535	361	20,340	571	12,531
    Wisconsin____________________________________ 4	995	403	355	357	255	527	332
    Wyoming_____________________________________ 55	19,477	9,144	8,141	418	9,564	884	7,488
    1 Based on unrounded data.
    Public Health Service
    Health of the Nation
    As the Federal Agency principally concerned with protecting and advancing the Nation’s health, the Public Health Service has a twofold obligation. It must concentrate on the urgent health needs of today, while looking to and preparing for emerging needs and long range goals.
    Both parts of this obligation are heavily affected by the change and growth which are such notable characteristics of our present society: growth of the population, and change in its composition; growth of industries and cities, of medical science and health knowledge, of techniques and resources; change in the way people live and work and use their leisure time.
    Responding to this changing scene and its implications for the future, the Public Health Service is placing major emphasis on several broad problem areas.
    They include environmental health and community health services. Last year’s annual report called special attention to these two topics, and the progress that has been made on them is discussed in detail in the appropriate sections of this report.
    Other broad areas which are receiving major attention include health manpower, where the need is great and will become more serious; research, which must be continued and accelerated; scientific communications, where the object is to speed the application of new knowledge in the health care of the people; the chronic conditions— heart disease, mental illness, cancer, and the others high on the list of causes of death or disability and of special import to the aged.
    The Service’s attacks on such problems are multifaceted. Typically they cut across more than one of the three major Bureaus and involve Divisions of the Office of the Surgeon General.
    Illustrative of both the need for this approach and the conduct of it is the realm of scientific communications. Here, the rapidly accelerating research effort—world wide in scope—is reporting results in
    139
    140
    Department of Health, Education, and Welfare, 1962
    such scope and volume that existing communication systems are not adequate to cope with the torrent of information.
    The Service’s response includes a vital action by the National Library of Medicine—the design, development, and installation of an electronic storage and retrieval system known as MEDLARS (Medical Literature Analysis and Retrieval System).
    The completion of this project will give the medical sciences in the United States access to a powerful tool unequaled elsewhere in the world. MEDLARS will provide a base for the centralized preliminary processing of information now conducted under circumstances of duplication and economic waste by multiple independent secondary publications. Further, it will constitute a new key to medical libraries generally, and, when coupled with photoduplication service, will enable libraries to meet modern research requirements for information with unprecedented effectiveness. The impact of the MEDLARS system on future developments in electronic storage and retrieval in particular, and on the structure of medical communication in general, is expected to be considerable.
    At the same time, the National Center for Health Statistics has completed installation of its computer facilities—modern data processing equipment which will result in more timely reporting of the health intelligence embodied in the national vital and health statistics produced by the Center.
    Also, during the year the National Institutes of Health published for the first time a Research Grants Index. This is a comprehensive listing of the scientists supported through PHS research grants programs, and it contains an index to the content of their work. It is unique in that it refers to work in progress rather than work that is described—months or even years after its completion—in published papers. Since the Service supports about half of all the medical research in the United States, plus some in other countries, the Index will help greatly to solve the mounting problem of keeping up with who is doing what and where it is being done.
    Other programs in all three Bureaus are aimed at the scientific communications problem. The importance of the subject has been recognized organizationally by the formalization in the Office of the Surgeon General of the Office of Information and Publications, and the Surgeon General has scheduled for the fall of 1962 a meeting at which representatives of the health professions can discuss PHS actions and proposals and relate them to the responsibilities of other organizations and groups.
    Another broad area which provides an example of action on several fronts is that of health manpower—which has been the subject of con-
    Public Health Service
    141
    CHART 1.—PUBLIC HEALTH SERVICE—1962
    Chief Professional Officers - ■ .....	Immediate Office of the	.--- External Advisory Groups
    Surgeon General--------------------------------------
    Internal Advisory Groups
    --------------------------Surgeon General	and Special Staff
    Office of	Deputy Surgeon General
    Surgeon General	Assistant Surgeons General	_____________________
    .----------------------------------- Executive Officer ------------------ National Library of Medicine
    Office of Information and Publications
    Divisions:
    Administrative Services
    Finance
    Health Mobilization
    International Health
    Public Health Methods
    Office of Personnel
    National Center for
    Health Statistics ]/
    National Vital Statistics Div.
    National Health Survey Div. ___________________r------------------------------------------i ------------------------- n_____________________ Bureau of--------------------------------------------------------------------------------National Institutes
    Bureau of State Services	Medical Services	Of Health
    Community Health	!	Environmental Health	Divisions:	National Institutes:
    Divisions 2/	:	Divisions 2/	Foreign Quarantine	Allergy & Infectious	Diseases
    ••••••••..........■£.............. Hospitals	Arthritis & Metabolic
    Accident Prevention	• Air Pollution	Indian Health	Diseases
    Chronic Diseases	• Environmental Engineering and	................ Cancer
    Communicable Disease	!	Food Protection	Chief Medical Officer,	Dental Research
    Center	: Occupational Health	Coast Guard	Heart
    Community Health Services	:	Radiological Health	Medical	Director,	Mental Health
    Dental Public Health and	:	Water Supply and	Bureau	of Prisons	Neurological Diseases
    Resources	:	Pollution Control	Medical Director,	and Blindness
    Hospital and Medical	:	Bureau	of Bnployees1
    Facilities	•	Compensation	Clinical Center
    Nursing	•	-------------------
    •	Divisions:
    Biologies Standards
    •	General	Medical Sciences
    1	I	Research Grants
    9 PHS Regional Offices	Research	Services
    .	------------------*	Research Facilities and Resources
    1/Separate organizational status similar to the National Library of Medicine is proposed	July 1, 1962
    ~ under the reorganization plan. 2/These groupings would become bureaus under the reorganization plan.
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    Department of Health, Education, and Welfare, 1962
    tinning and increasing Public Health Service attention. The Service recognizes that the need is both quantitative—in terms of the greater number of people that are required—and qualitative—in terms of the kinds and varieties of personnel needed—and is working on the problem accordingly.
    The PHS has worked to increase the supply of physicians and dentists. At the same time, the Division of Public Health Methods has completed two more of its series of health manpower studies—Section 12 on Medical and Psychiatric Social Workers and section 13 on Hospital House Staffs. It has also cooperated with the National League for Nursing in a study of practical nurse education published as “Education for Practical Nursing, 1960.” Many service programs support training of professional and technical personnel in a wide variety of disciplines.
    The institution of the NIH Research Career Award Program has given the Service a means of providing stable incomes for research careers in academic and research environments; and since the inauguration of the program in January 1962, awards have been made to 106 individuals in 61 institutions.
    A variety of Service programs are designed to promote more efficient use of existing manpower. For example, experimental projects demonstrated that dentists who work with a chairside assistant can treat substantially greater numbers of patients than can those who work alone; and the demonstrations have now been followed by a grants program to support the training of dental students in the use of chairside assistants.
    Toward a better utilization of its own manpower, the Surgeon General requested, and the Secretary of Health, Education, and Welfare appointed, an Advisory Committee on Public Health Service Personnel Systems. The Committee made its report in March 1962, and the Office of Personnel has begun the implementation of its recommendations.
    The Service is working in a comprehensive manner also on some of the more circumscribed but equally important topics, such as the problem of infant mortality. In this area, where there remains a great deal we do not know, the research programs of the National Institutes of Health and the Communicable Disease Center are continuously increasing medical knowledge of the factors contributing to infant mortality.
    The cooperative study now being sponsored by NIH, for example, is accumulating data related particularly to asphyxia in the newborn and congenital malformations. This study is certain to produce findings that will lead to the prevention of many infant deaths due to these causes. The Communicable Disease Center is conducting research
    Public Health Service
    143
    and developing control measures affecting the infectious diseases of infancy, particularly infant diarrhea and hospital-acquired infections. The accident prevention program also is cooperating in efforts to reduce the toll of accidental poisoning and home conflagrations which account for a large number of deaths among infants and young children. Other work is going forward in other parts of the PHS.
    The Service carries out its programs through the Divisions of the Office of the Surgeon General, such organizational units as the National Center for Health Statistics, the National Library of Medicine, and the three major Bureaus—Bureau of Medical Services, Bureau of State Services, and National Institutes of Health.
    While each of the organizational entities has its own particular program responsibilities, certain types of activities are common to many of the organizational units. Thus, research activities are associated with all areas of PEES responsibility. Cooperation with other agencies—State and local health departments, international organizations, public and private institutions, voluntary organizations—is a conspicuous aspect of many programs. Grants-in-aid for a wide variety of objectives are administered by many Divisions. Many different programs are sources of technical aid, consultation, and training assistance.
    Health Record
    Latest data from the continuing National Health Survey indicate that Americans, except those in resident institutions, experienced 359 million acute illnesses and injuries in a year. This equals about two conditions per person per year. These statistics refer largely to shortterm conditions involving either medical attention or at least a day of restricted activity.
    The 359 million acute conditions included 50 million accidental injury diagnoses among 45 million persons injured. Of the injured, 2.9 million were in accidents involving motor vehicles. The bulk of the remainder, 20.2 million, occurred in the home.
    In the same year, the average American’s activity was restricted some 16 days due to illness and injury. Six of the 16 days involved bed disability. Persons 17 years of age and older lost 5.4 days of work due to ill health, and children from 6 to 16 averaged 4.8 days lost from school.
    An estimated 74 million Americans—42 percent of the population— were reported to have 1 or more chronic conditions of varying severity. About 1 person in 12—14,217,000 in all, was limited in his major activity by chronic disease or impairment, and 1 in about 200—some 915,000 in all—was confined to the house continually by a chronic ailment.
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    Department of Health, Education, and Welfare, 1962
    After a long period of decline, the trend of the crude death rate appears to have leveled off. This phenomenon is not peculiar to this Nation: it seems to be occurring also in such countries as England and Wales, Finland, Norway, Sweden, Denmark, Japan, and Chile.
    The 1957 rate for the United States—9.6 per 100,000 population was
    CHART 2.—DEATH RATES BY AGE AND SEX, 1945-61 (Rates per 100,000 population)
    400.0	I	I	|	----------- 400.0
    Male	Female
    1	1	I
    ___	85 years ond over I	,	_ 85 years and over
    200.0 --------------------------------------------------------------------------------------------- 2000
    75-84 years 100.0 ---------------------------------------------------------------------------------------------|00.0
    75-84 years
    80.0-------------------------------------------------------------*V*"***»„«,	-------------- 800
    60.0 --------------------------------------------------------------------------------------------- 60.0
    65-74 years
    40.0---------------------------------------------------------------------------—— ---------------- 400
    65-74 years
    55-64 years 20.0 --------------------------------------------------------------------------------------------- 200
    55-64 years
    —	4 5-54 years	^*^******>»^
    100 ------------r—--------------------------------------------------------------------------------10.0
    8.0---------------------------------------------------------------------------------------------8.0
    45-54 years
    6.0---------------------------------------------------------------------------------------------go
    35-44 years
    40 -----------1---------------------------------------------------------------------------------4.0
    \	I	I	35-44 years
    V	.
    _____ 25-34 years	%-f,
    2.0	15-24 yeors^^^^J —|---------------------------------------------------------------------2.0
    *****J* "“**'**’’%	।	।	%^^^ 2 5-34 years
    i“Xj
    <	‘"7-4......"""	\ ,;-a4r, X----------------v
    1.0 -V------------------>•«'• --------------- ---------------------------"-J.......X------------1.0
    8	'	।	15-24 years	8
    5-14 years	"X	T""“X	|
    .6-----------------X.	---------- ----------X-^_------------------------------------ 6
    .2 Ll. L 1.1 I I I I I I I I 1 I I 1 I I 1 J L. 1 I I I I I I I I I I I .1 ±L..U jj .2 1945	1950	1955	I960	1965	1945	1950	1955	I960	1965
    Public Health Service
    145
    almost 5 percent larger than the 1954 rate of 9.2, which was an all-time low. In 1961, the crude rate stood at 9.3.1
    Crude rates are calculated on the total population of each period covered. This population almost invariably changes in composition over the years in ways that may affect crude rates. Thus, the greatest risk of dying occurs in infancy and in old age, and our present population is simultaneously growing both older and younger in composition. The proportion of the population over 65 probably has been increasing since the 18th century, while the proportion under 5 years of age has been increasing for more than 25 years.
    Since the leveling off of the crude death rate is also evident in the age-adjusted rate, the failure to decline cannot be ascribed to the changing age composition of the population. The 1961 age-adjusted death rate stands at 7.3 compared to the 1954 rate of 7.7. In recent years both the crude and the age-adjusted rates have varied only slightly from year to year, and almost entirely according to the presence or absence of respiratory disease outbreaks during the year.
    Obviously it is impossible for the death rate to decline indefinitely. But present levels of death rates in various countries do not seem to be at the irreducible minima, nor do they appear to be due to artifacts of registration or other technicalities; and an intensive study and evaluation of the situation is hi order.
    For the United States, a primary reason cannot be found in the fact that death rates already are extremely low, since a number of countries have still lower rates.
    A general resistance to decline in recent years is evident as far as age and sex are concerned. Since the curves of the chart are drawn on a uniform logarithmic (ratio) scale, direct comparison between curves or any of their parts can be made by comparing degrees of slope. In no age group is the rate of decline greater since 1954 than before. The chart also shows that male death rates by age in general have declined less rapidly since 1954 than the rates for females. Closer study of the data also shows that the divergence between the sexes by age and color groups is greater over the 7 years since 1954 than over the 7 preceding years, except for persons aged 15-34 (whites) and 15-24 (nonwhites). Males, then, not only have lagged behind females but at present they are falling even further behind. In what areas?
    The four leading causes of death are now diseases of the heart, malignant neoplasms (“cancer”), vascular lesions affecting the central nervous system (“strokes”), and accidents. In terms of age-adjusted rates, these four causes accounted for a little over 68 percent of all deaths about 10 years ago, compared to about 72 percent now, so
    1 All vital data are for calendar years.
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    Department of Health, Education, and Welfare, 1962
    that their importance is increasing. While sizeable declines were recorded for white and non white male groups when the four leading causes were excluded, these declines were nevertheless smaller than those scored by the female groups.
    For each of the four leading causes of death, males in each color group have fared less well in recent years than females. For diseases of the heart there was virtually no change in the male rates while each of the female rates was decreasing about 10 percent. For cancer, male rates increased while female rates were unchanged or decreased. For stroke, a decline for white males was surpassed by a greater decline for white femaler, while nonwhite males had an increase compared to a decrease for Ionwhite females. For accidents, the decline registered by each female group was greater than those scored by the comparable male group.
    About 1 infant in 40 died within a year of birth in 1961, compared to 1 in 10 during 1915. But while the infant death rate declined by 25 percent or more for every 10-year period until 1950, since then this rate of decline has been sharply reduced. Although the 1961 rate of 25.3 per 1,000 live births is the lowest yet recorded in the United States, the curve nevertheless is declining more slowly over recent years; nor is the rate as low as that in some other countries.
    The maternal death rate—31.7 per 10,000 live births in 1941— reached 7.5 in 1951 and 3.7 in 1961. This rate has declined so far that it may be pressing against a virtually irreducible lower limit.
    As a summary expression of all the forces working to extend or shorten life, in 1961 for the first time the life expectancy of the country’s total population at birth exceeded 70 years, reaching 70.2. This compares to 68.4 in 1951 and 64.8 in 1941, giving gains of 2.6 and 5.6 percent for the later and the earlier periods.
    In 1960, life expectancy by color and sex was as follows: white males, 67.4 years; white females, 74.1 years; non white males, 61.1 years; and non white females, 66.3 years. In recent years the average length of life has been increasing at a faster rate for women than for men, and at a faster rate for the nonwhite population than for the white population.
    Births, Marriages, and Divorces
    The total of 4,268,326 live births registered in 1961 were only slightly more than the 4,257,850 births of 1960. Since the number of births has not changed much during the past 5 years, and the population has continued to grow, the crude birth rate has declined somewhat each year since 1957. The rate was 25.0 per 1,000 live births in that year, 23.7 in 1960, and 23.3 in 1961.
    Public Health Service
    147
    The fertility rate, or number of live births per 1,000 women 15-44 years of age, also has declined somewhat annually since 1957. The 121.2 rate of that year was higher than any rate since World War I. The 1961 rate of 117.3 is slightly below the 1960 rate of 118.0. In recent years the fertility rate for nonwhites has been about 40 births per 1,000 above the rate for whites.
    In 1961, about 1,547,000 marriages were performed, an increase of 1.3 percent over the 1960 figure of 1,527,000. Because of concurrent changes in the country’s total population, however, the crude marriage rate remained constant for 1959, 1960, and 1961 at 8.5 marriages per 1,000 population.
    Divorces were estimated at 391,000 in 1960, compared to 395,000 in 1959. The crude divorce rate was 2.2 per 1,000 population in 1959, 1960 and 1961.
    Funds
    The total funds available to the Public Health Service in fiscal year 1962 amounted to $1,633.4 million (see table 1, p. 226). Appropriations and authorizations accounted for about $1,392.4 million of this amount. The balance was made up of repayments for services given to other agencies and of unobligated balances from previous years.
    About 72 percent of the total funds available was allocated to others, in the form of grants to State and local agencies, private institutions, universities, hospitals, and individuals outside the Federal Government. The remainder was used to support the direct responsibilities of the Public Health Service, such as hospital and medical care for legally designated beneficiaries, foreign and interstate quarantine, and Indian health services.
    Office of Personnel
    At the request of the Surgeon General, the Secretary of the Department of Health, Education, and Welfare appointed an Advisory Committee on Public Health Service Personnel Systems to study the recruitment and retention of personnel. The Committee, headed by former DHEW Secretary Marion B. Folsom, began its study in October 1961 and completed it in March 1962.
    In brief, the recommendations of the Committee were: (1) that the Surgeon General personally accept responsibility for the direction of personnel management in the Service; (2) that personnel staff services be reorganized and strengthened; (3) that personnel operations be substantially improved; and (4) that pay and rank be carefully examined and if inadequate, to explore the possibility of legislation that would make them more equitable.
    148
    Department of Health, Education, and Welfare, 1962
    A new Assistant to the Surgeon General for Personnel has been named, and under his direction, the Office of Personnel has begun the implementation of the recommendations of the Committee.
    PERSONNEL
    At the close of the fiscal year 1962, the Public Health Service had a total staff of 32,638. (See table 2, page 228.) This number includes 4,501 Commissioned Corps Officers, 26,808 full-time and 1,329 part-time Civil Service employees. (See table 3, page 230.) Commissioned Officers on duty included 1,909 members of the Regular Commissioned Corps, 2,366 members of the Reserve Corps on Active duty, and 226 Commissioned Reserve on temporary training duty.
    National Center for Health Statistics
    The National Center for Health Statistics, nearing the end of its second year in July 1962, has modernized its data processing by installing computer facilities. This has resulted in more timely reporting of Center activities. Another result is far better use of the Center’s professional manpower.
    When not being used for Center programs, the computer equipment is available to other elements of the Public Health Service, principally in the area of health statistics.
    As an experiment, the Center has undertaken negotiation of contracts with statisticians of foreign nations to provide analyses of mortality trends in those countries. This probably will be expanded to bring otherwise unavailable professional resources to bear on the Center’s statistical problems.
    NATIONAL HEALTH SURVEY
    During the year, the National Health Survey accelerated work on its newest data collection program—the Health Records Survey. With help from the Bureau of the Census, a master list of all types of resident institutions and hospitals in the Nation was constructed. This list will be used as a base for sampling studies. Next, pretesting began in the first of a series of surveys based on the master list. This is a survey of Resident Places Providing Nursing or Personal Care, designed to produce up-to-date knowledge of a population known to consist almost entirely of old people.
    The National Health Survey Division also operates a program of studies to improve health survey methods. Among these are projects to develop new methods of gathering information on personal health expenditures and to evaluate and refine the collection of data on health insurance coverage in the general population. A third continues the
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    149
    Health Survey’s series of studies to evaluate chronic disease information reported in the Health Interview Survey.
    By the end of the fiscal year, full-scale operation of the Health Examination Survey was beginning to be achieved. Data collection on the first cycle, primarily concerned with certain chronic diseases in the adult population, was more than three-fourths completed and work on the pattern of tabulation and analysis of these data was well under way. Meanwhile, plans were being completed for the second cycle, a nationwide probability sample of children from 6 through 11 years of age.
    The Health Interview Survey produced reports on several topics not previously reported on by the National Health Survey: (1) Persons receiving care in the home, (2) Proportion of hospital bill paid by insurance, (3) Duration of limitation of activity due to chronic conditions, and (4) Selected impairments by etiology and activity limitation. Estimates for topics discussed in earlier reports were updated with more recent data. Health interview data also served as the basis of a report on the health characteristics of currently employed persons.
    NATIONAL VITAL STATISTICS DIVISION
    During the year, the Division made substantial progress to reduce the lag between receipt and publication of data from the States. Considerable mortality and natality statistics for the 1961 data year were released well before the end of 1962.
    In fiscal year 1962 the Division published annual and provisional monthly data in vital statistics and six special studies: (1) Occupational mortality, (2) Number and type of medical care institutions, (3) Matching birth certificates and census information, (4) Characteristics of Georgia marriages, (5) Improving national divorce statistics, and (6) Standard error of age-adjusted death rates.
    The Division undertook its largest single reimbursable project to date, involving more than $300,000, to provide technical assistance for a series of monographs sponsored by the American Public Health Association to synthesize data of concern to public health and demography drawn from a wide array of sources.
    The Division’s computer programmer staff, built entirely during the year, is largely complete and trained. The Division and other Center components are developing ideas to use the computer facilities to strengthen vital statistics programs in the States.
    The ninth national meeting of the biennial Public Health Conference on Records and Statistics in June 1962 was singularly successful in improving vital and health statistics and makng them more useful and usable.
    150
    Department of Health, Education, and Welfare, 1962
    The Division is in the second year of the national mortality sample survey, based on a sample of deaths occurring throughout the country. Plans have been developed to begin a continuing national natality sample early in 1963. The third phase of a cystic fibrosis study is nearing completion.
    For the 1960 census year, marriage and divorce statistics were based on nationwide samples of marriage and divorce records collected from States and local areas. For 1961 and 1962, the samples are being collected only from the registration areas, which at the end of the fiscal year contained 35 States and 4 other areas for marriages and 21 States and 1 other area for divorces.
    The Division stimulated discussion and provided technical and consultative advice as required on the need for retaining the item on racecolor on vital records, beginning with a panel discussion at the annual meeting of the American Public Health Association.
    Efforts have been intensified, cooperating with State and Federal agencies, to develop minimum safeguards to reduce fraud associated with vital records and promote the integrity of vital records. A draft of measures to be applied was written.
    OFFICE OF ELECTRONIC SYSTEMS
    During the year, the Office of Electronic Systems completed installation of computer equipment—and IBM 1401 and the more powerful 1410 system. Conversion of data processing from mechanical equipment and from rented electronic equipment is proceeding on schedule.
    OFFICE OF HEALTH STATISTICS ANALYSIS
    This Office made some progress in staff recruiting and training. A start was made in the development of an index of health. The Office continued its study of changes in the general mortality trend as well as the infant mortality trend in the United States. Contracts have been negotiated in several countries for study to determine, if possible, the factor or factors responsible for the change in mortality trends in various parts of the world. This approach significantly increases the professional resources the Office can bring to bear on the problem.
    National Library of Medicine
    The new building in Bethesda, occupied April 16, 1962, affords the National Library of Medicine an excellent facility for the implementation of its computer-based bibliographic system termed MEDLARS. To become fully operational about September 1963, the new system will offer the capability of providing very detailed and specialized reference services, and enlarge, improve, and speed the preparation
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    of Index Medians. The preliminary design phase of the MEDEARS project was completed in December 1961. Work is progressing on the second phase covering detailed system design, equipment and facility specifications, site preparation, personnel training, and computer programs. Plans are to negotiate a contract for the final (implementation phase) in September 1962.
    BOARD OF REGENTS
    The Board of Regents held two meetings, on December 14,1961, and on April 13, 1962. Building problems, moving problems, budget problems, the progress of MEDLARS, and the progress of the Extramural Program occupied the major part of the Board’s attention. Drs. Norman Q. Brill, Harve J. Carlson, and Saul Jarcho joined the Board in the fall. Dr. Worth B. Daniels served as Chairman of the Board during the year, and was succeeded in April by Dr. Warner L. Wells.
    SCIENCE TRANSLATION PROGRAM
    On July 1, 1961, the Russian Scientific Translation Program was transferred from the National Institutes of Health to the National Library of Medicine. This change presented a new challenge to the Library and the opportunity to coordinate and improve international medical communication activities. The objective of the Science Translation Program is to communicate the results of high-quality medical research published in languages unfamiliar to American medical scientists. This program has supported the cover-to-cover translation of nine Soviet research journals, the comprehensive abstracting of Soviet research publications, and the preparation and publication of critical review papers. As a result of an extensive program evaluation begun early in 1962, the program has undergone some modification, stressing the coverage of such literature by abstracts and critical reviews. While full attention will be paid to Soviet contributions, the program will support translation and other communication activities from such languages as Japanese, where the quality of research is high. These activities will be closely coordinated with the Public Law 480 translation program conducted by the Library, and with similar programs conducted by the National Science Foundation.
    PROGRAM STATISTICS
    In fiscal year 1962 the Library acquired 11,338 books, 63,959 serial pieces, and added 739 new serial titles, increasing its collections to 1,084,256 items. The History of Medicine collection was increased by 147 old and rare items. The staff cataloged 17,257 titles, and 471 pictures were added to the art collection. There were 161,090 volumes circulated, and 10,242 reference questions answered. Main entries
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    published in the National Library of Medicine Catalog totaled 20,260. The Index Medicus published 141,911 items from 2,132 journal titles. Interlibrary loans increased to 113,485. Microfilm production amounted to 2,840,400 pages of which 570,662 pages were for preservation purposes and 2,243,862 pages for interlibrary loan.
    Division of Public Health Methods
    The Division of Public Health Methods conducts studies to identify emerging national health problems and to assess the significance of social, scientific, economic, and educational developments to health services and resources. In these areas, the Division provides advisory and consultative services within the Service, to other governmental agencies, and to national professional and voluntary agencies. Division responsibilities involve it also in planning, policy coordination, and program development and analysis within the Service. Finally, the Division provides technical assistance, clearance, and reference services on legislative matters other than appropriations; coordinates and analyzes plans of the several Service programs for substantive survey projects; and performs additional staff services in support of the Surgeon General and the Service as they are required.
    ORGANIZATIONAL CHANGES
    During the year, staff and resources engaged in studies and other activities in the general area of health economics were transferred to the Bureau of State Services to become part of the newly created Division of Community Health Services. The Division of Public Health Methods acquired from the Bureau of State Services the responsibility for providing staff services in support of the Surgeon General’s annual conferences with State and Territorial health authorities.
    Responsibility for editing and publishing Public Health Reports^ the Service’ official journal in public health practice and administration, was transferred to the Office of Information, Office of the Surgeon General. The Clearinghouse on Morbidity Projects, which puts out annual listings of current morbidity studies, was moved to the Division of Community Health Services, Bureau of State Services.
    PROFESSIONAL EDUCATION
    “Education for Practical Nursing, 1960,” published during the year, reports the findings of the first nationwide study of practical nurse training programs. The study was conducted in cooperation with the National League for Nursing.
    Data acquired from two questionnaires sent to all State-approved programs revealed great variation among them in number of students
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    admitted, size of affiliating hospital, curriculum length and content, types of nursing experience, faculty size and qualifications, and costs. Study findings for practical nurse training as a whole include the following: State-approved training programs increased from 150 in 1950 to 662 in 1960, a decade in which yearly graduates from practical nurse programs rose from 3,000 to more than 16,000. Of the 23,000 students admitted to training programs in the 1959-60 school year, more than two-thirds were high school graduates. One-third of these entering students w’ere less than 20 years old. Most training programs are a year in length, and all provide for clinical experience in hospitals.
    In response to a request from the Bureau of the Budget, the Division made a study of Federal support of schools of public health. Scheduled for publication in Public Health Reports, the report shows the amount and nature of Federal assistance in 1961 to the 11 schools of public health then in full operation and presents additional data concerning the schools’ enrollment, expenditures, and other sources of funds. Federal interest in higher education and the several methods currently used for providing Federal support are also discussed.
    HEALTH MANPOWER
    During the year, two publications were added to the Health Manpower Source Book series:
    Section 12, “Medical and Psychiatric Social Workers,” analyzes employment characteristics, levels of education, and annual salaries for the estimated 11,700 of these workers employed full-time in 1960. Findings with respect to professional training showed the proportion of workers with 2 or more years of graduate education in a school of social work to be generally higher for psychiatric than for medical social workers, for those in health programs rather than programs pointed at other objectives, for employees of National rather than State or local agencies, and for those in supervisory or consultative rather than direct-service positions.
    “Hospital House Staffs,” section 13 in the source book series, presents data for 1940-60 on internships and residencies in U.S. hospitals. The number of these positions offered, the number filled, and the number filled by graduates of foreign medical schools are related to the control, size, and geographic location of hospitals. The marked increase in house staff positions and the hospitals’ growing dependence on foreign medical graduates to fill them are indicated by the facts: throughout the ’fifties more than 10 percent of all positions offered went unfilled, while the proportion of filled positions accounted for by foreign house staff was rising from 10 percent in 1951 to 25 percent in 1960.
    665171—63---11
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    Department of Health, Education, and Welfare, 1962
    A summary of trends since 1900 and current statistics indicating the Nation’s total health manpower resources, the numbers of workers in the major health manpower categories, and the general health status of the population, was published under the title, “Chart Book on Health Status and Health Manpower.”
    Several shorter manpower studies were completed for publication. The latest report in a series on trends in medical practice appeared in the Journal of Medical Education, November 1961. It reports changes in the professional careers of physicians shown in a recent resurvey of 1935,1940, and 1945 medical graduates. A second study, on osteopathic college alumni, was published in the May 1962 issue of the Journal of the American Osteopathic Association. Another, presenting physician-population projections from 1961 through 1975 is scheduled for publication in the American Journal of Public Health.
    Other projects underway include a nationwide study of the number, distribution, and characteristics of pharmacists, and an extensive study of medical specialists which will show age, sex, race, State location, medical school attended, membership in specialty societies, and type of practice for some 26 specialties.
    Division of International Health
    During the year, the Division arranged for official United States representation and members served on delegations to the 15th World Health Assembly in Geneva, Switzerland, in May 1962, the 28th and 29th Sessions of the Executive Board of the World Health Organization also in Geneva, the 13th Meeting of the Directing Council of the Pan American Health Organization in Washington in October 1961, the 44th and 45th Meetings of the Pan American Health Organizations’ Executive Committee in Washington in October 1961 and April 1962, and the 12th Session of the Western Pacific Regional Committee of the World Health Organization which was held in Wellington, New Zealand in September 1961. In addition a member of the Division served as Alternate Commissioner to the Regular Annual Session of the South Pacific Commission in October 1961. This meeting was held in Noumea, New Caledonia.
    Official U.S. policies on topics discussed at these meetings were developed by the Division in consultation with the Department of State and the technical areas of the Public Health Service. The Division also participated in the development of policy on health related matters which came before meetings of the Food and Agricultural Organization, the United Nations Childrens Fund, the International Labor Organization, the Social Commission of the United Nations, and the South Pacific Commission.
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    The Division assisted in the appointment of more than 300 U.S. experts to serve as members of the WHO Expert Advisory Panels or as short-term consultants to the World Health Organization, or the Pan American Health Organization; and continued the assignment of 73 officers to the Headquarters’ Staff and overseas missions of the Agency of International Development.
    Twenty-seven Public Health Service officers were detailed to staff the medical organization of the Peace Corps. These officers are principally responsible for the health of Peace Corps volunteers. In addition they supply such local health service as time will permit on a volunteer basis.
    The International Education and Training Branch of the Bureau of State Services was transferred to the Division of International Health and provided program and guidance services to 623 new visitors and students from 92 countries.
    Arrangements were made under U.S.-U.S.S.R. agreements negotiated by the Division for the exchange of four scientific missions in FY 1962. These were in the fields of medical ecology, neurophysiology and pathology, virology and thoracic surgery. The latest agreement, concluded early in 1962, calls for the exchange of nine missions in calendar years 1962 and 1963. The agreement also calls for the exchange of up to 25 individual scientists from each country and the convening of joint meetings on specific subjects, including cancer, rheumatic diseases and virology.
    The Health Studies Program of the Division was combined with the International Survey activities of the Department, and the staff was transferred to the Office of the Secretary of FIEW. The Division continues to provide the reference and research facilities for the program.
    Division of Health Mobilization
    The authority and scope of the health mobilization program were considerably increased during the past year through the issuance of two Executive orders which assigned to the Department of Health, Education, and Welfare full responsibility for (a) the development of requirements, plans, and operating procedures regarding the Nation’s Emergency Medical Stockpile; (b) the preparation of national emergency plans and the development of preparedness programs covering health services, civilian health manpower, health resources, and educational programs.
    Prior to these orders, management of the emergency medical stockpile and coordination of the health mobilization activities had been carried on under the program direction and policy control of the Office of Civil and Defense Mobilization.
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    During the year, major program emphasis was concentrated in three areas:
    1.	Preparation of the civilan to meet his own health needs when deprived of the services of a physician.
    The medical self-help training course developed in cooperation with the American Medical Association and endorsed by all major governmental and private health organizations was introduced to the general population. Five thousand training kits containing film strips, projector, instructors’ lesson plans, student handbooks, and a resource manual, Family Guide—Emergency Health Care, were allocated to the respective States. All instruction is being conducted on a volunteer basis with training of one person in each family set as an ultimate goal.
    2.	Assistance to States and local communities to ensure an operational capability to care for civilian health needs in an emergency.
    Effective preparedness depends on having sufficient quantities of medical and surgical supplies and hospital facilities for use where they are needed; and on having predesignated personnel organized and trained to act in a disaster situation and utilize supplies and facilties in the most efficient, prudent manner possible.
    The contents and condition of the nearly $200 million civil defense medical stockpile were reviewed and plans coordinated for its incorporation into community survival efforts. Expansion was begun to increase the supplies of the 1,930 200-bed civil defense emergency hospitals (CDEH’s) stored throughout the United States to a 30-day capability from the former 3- to 4-day potential, and arrangements were made for the procurement, assembly, and distribution of an additional 750 hospitals.
    Physicians and members of the allied health professions were given training in the health aspects of civil defense, setup and utilization of CDEH’s, and in expanded functions whereby the allied health professions can relieve physicians by performing additional duties in an emergency.
    3.	Development of a coordinated emergency program for Federal agencies having health or health-related responsibilities.
    Basic policy on the objectives, organization, functions and administration of the headquarters and regional Emergency Health Service structure was developed and issued in coordination with other agencies, and policy formulation begun for each field facility.
    To answer a need of community civil defense health planners, a guide is being prepared to give detailed advice on developing a community emergency health service plan and organization and putting
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    them into operation. The guide will serve as a standard of comparison for evaluating and improving community emergency health service plans and organizations already in existence, and for creating new ones where there is a need.
    Bureau of Medical Services
    The Bureau of Medical Services operates hospitals, clinics, health centers, and other health services in 256 full-time and 429 part-time locations, in this country and abroad, on land and on the sea, at major ports and on remote inland reservations. Some 13,000 staff members are engaged in these activities of the Public Health Service that provide direct health care to many people and help to safeguard the Nation’s strength.
    Medical and hospital care is provided for American seamen. International travelers arriving from foreign points are checked against any possibility of contagious disease. American Indians and natives of Alaska are given comprehensive health care because they are not yet ready to provide it for themselves. Protection of the health of the men of the Coast Guard and the Coast and Geodetic Survey, and the cadets at the Coast Guard and Merchant Marine academies, is a responsibility of the Bureau.
    Members and retired members of the armed forces and their families receive care at hospitals and clinics of the Bureau where more convenient than military hospitals; in turn, Public Health Service commissioned officers may receive care in military facilities.
    A special hospital is devoted to treatment of leprosy. Treatment for narcotic addiction is given in two neuropsychiatric hospitals. The Bureau is responsible for medical and hospital care in all the Federal prisons and correctional institutions throughout the country.
    Medical and hospital care for civilian employees of the Government who are injured on duty or become ill from causes related to their work is administered by the personnel of the Bureau. In another program, health units are operated for a number of Federal departments and agencies that have asked for this help in protecting their employees’ health.
    The Bureau of Medical Services conducts clinical research and carries on training programs for medical and health personnel.
    The Bureau is guided by recommendations of the BMS Advisory Committee on Hospitals and Clinics, and the Indian Health Advisory Committee, made up of experts from hospitals and health programs all over the country.
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    Division of Hospitals
    The mission of the Division of Hospitals is primarily the operation of a medical care program for American seamen and other groups designated by Congress. In addition to seamen, patients include Coast Guardsmen and their dependents, uniformed service members of the Army, Navy, Air Force, Public Health Service, and Coast and Geodetic Survey and their dependents, civil service employees injured in line of duty, persons with leprosy, narcotic drug addicts, and several other groups.
    It maintains working relationships with other components of the Public Health Service, constituent agencies of the Department of Health, Education, and Welfare, other Government programs, and public and private organizations that relate to the work of the Division.
    The Division contributes to the fulfillment of the Nation’s needs for scientific and technical manpower and for improved health care by training physicians, dentists, and paramedical personnel in its hospitals, by conducting clinical research, and by providing medical care to a substantial segment of the population, including persons having leprosy and those addicted to narcotic drugs.
    A problem yet to be resolved which is felt nationwide but particularly in the larger cities is the need for post-hospital treatment and follow-up services at the local level for narcotic addicts.
    VOLUME OF PATIENT CARE
    Utilization of the 15 hospitals operated by the Division in fiscal 1962 exceeded that of the previous year. Admissions during 1962 totaled 51,251—-an increase of 3.4 percent over 1961. In addition, 948 babies were born. The average daily inpatient census rose 1.4 percent to 4,801. Total outpatient visits increased 6.9 percent, to reach 1,277,965.
    Department of Defense uniformed service personnel and their dependents accounted for 33 percent of all admissions, 14 percent of the total average daily patient load, and 39 percent of all outpatient visits to PHS hospitals and outpatient clinics.
    COOPERATION REGARDING NARCOTIC PROBLEMS
    Thirteen Federal officials, representing the Interdepartmental Committee on Narcotics, met at the Lexington PHS Hospital in June 1962 to become familiar with its operations and the program for the care of narcotic addicts. An Assistant Secretary of the Treasury headed the group. Members of the committee represented the White House, the Department of State, Justice, and Defense, the Public Health Service, the Bureau of Narcotics, and the Bureau of Customs.
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    Three narcotic control officers from Thailand spent 3 days at the Lexington PITS Hospital observing its program for treating narcotic addict patients. Members of the National Narcotic Enforcement Officers Association, Inc., visited Lexington for orientation to the hospital’s program for medical care and vocational rehabilitation of narcotic addicts. The association has a membership of 80 Federal, State, and municipal enforcement officers.
    RESEARCH
    In cooperation with the National Cancer Institute, NIH, a collaborative cancer research program is being developed in Public Health Service hospitals. Initial plans primarily concern cancer chemotherapy and involve the PHS hospitals at Baltimore and Boston.
    The San Francisco PHS Hospital and the Division of Chronic Diseases, BSS, are conducting joint research projects in heart disease control.
    A new program is underway for the early detection of oral cancer among patients in PHS hospitals and outpatient clinics. A pilot study is planned in the Staten Island, San Francisco, and Baltimore PHS hospitals and in the clinics in Washington, D.C., and Pittsburgh.
    A preventive medicine clinic was established in 1962 at the Boston PHS Hospital, in collaboration with the Division of Chronic Diseases, BSS. The new project aims to study and define the role of the hospital in the field of preventive medicine and public health. Intensive examination of outpatients from the hospital’s regular outpatient population is conducted. Patients with detected disease entities are referred to the appropriate inpatient or outpatient service for definitive therapy. The coordinator of preventive medicine activities also stimulates the interest of the hospital staff in public health practices and methods and coordinates existing practices from the standpoint of preventive medicine.
    Twenty-one research projects were completed in the Division’s research program in fiscal year 1962.
    PROFESSIONAL TRAINING
    Ninety medical interns completed formal training in the hospitals in 1962. Of these, 59 remained in the Public Health Service.
    Forty residents completed formal training in the following categories : anesthesiology, 2; dermatology, 1; general practice, 7; internal medicine, 9; obstetrics-gynecology, 1; ophthalmology, 3; pathology, 1; psychiatry, 3; radiology, 4; surgery, 8; urology, 1.
    Two medical officers completed 1-year residency training in otolaryngology. Two specialists completed 2 years of training in research methodology.
    - .. . .
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    Plans were completed for the addition of full pediatric services at the Baltimore and Seattle hospitals.
    GOALS FOR FUTURE
    Goals of the Division include: improved physical facilities and equipment to enable the hospitals and clinics to provide medical care of a quality equal to that available in non-Government facilities; improvement of medical care for an increasing number of patients; continuation of present research programs and expansion of research; continuation and increase of staff participation in teaching programs at medical and dental schools; expansion of approved residency training programs in the hospitals.
    FEDERAL EMPLOYEE HEALTH PROGRAM
    Health protection for Federal employees was recognized as a responsibility of management in 1914 when the Treasury Department established a “relief room” in its main building. Today there has evolved an employee health service, sanctioned by Congress, which authorizes preventive health programs, with professional responsibility for the programs vested in a physician in charge. On a reimbursable basis, the Federal Employee Health Program operates health units for Federal agencies requesting this service which serve as patterns of this type of health service.
    In 1962 two new health units were added, bringing the total to 39 serving more than 60,000 employees.
    Employee health maintenance examinations for personnel 40 years of age and older totaled 3,789. Immunizations were given as follows: influenza, 32,322; poliomyelitis, 12,017; smallpox, 2,129; tetanus, 32,147. Screening tests given were: diabetes, 9,342; glaucoma, 728; visual acuity, 2,553.
    More than a quarter of a million visits were made to the health units. About 1 of every 5 visits was for some service prescribed by a private physician or dentist; 1 of every 15 visits resulted in a referral to a private physician.
    FREEDMEN’S HOSPITAL
    Freedmen’s Hospital, Washington, D.C., provided care for 14,218 patients. The average daily census of 375 was the same as in 1961. The average length of stay for the 14,211 discharged patients was 9.8 days. There were 3,199 live births.
    Outpatient visits in 1962 totaled 96,267, a slight increase over 1961.
    Inadequacies of the hospital’s physical facilities caused numerous operating problems in caring for these patients. Excessive crowding frequently occurred in the medical, obstetrical, and newborn serv
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    ices. Renovations were undertaken on the third floor of the annex to allow the addition of 50 beds for medical and surgical patients.
    The attending and consulting staff of physicians and dentists totaled 217, an increase of 4; the courtesy staff consisted of 114.
    All training accreditations of the hospital were maintained. The hospital serves as the clinical teaching facility for junior and senior students of Howard University’s College of Medicine. The hospital also offers approved medical, dental, pharmaceutical, and dietetic internships and residency training in 14 medical specialties and in hospital administration. It has a school of nursing and a school of X-ray technology.
    The 50 available residency appointments at Freedmen’s Hospital were filled in 1962; among the residents were 20 graduates of foreign medical schools. There were also 22 medical interns, 2 dental interns, 2 pharmaceutical interns, 10 dietetic interns, 11 research fellows, and 1 administrative resident.
    The school of nursing graduated 35 student nurses, raising the total of the school’s graduates to 1,480.
    The school of X-ray technology continued efforts toward improving curriculum, clinical practice, and other activities. The six 1962 graduates of this 2-year course brought the total to 56.
    More than 32 clinical research projects were in progress during the year. Sixty or more scientific articles by staff members were published or were in press.
    Legislation authorizing the transfer of Freedmen’s Hospital to Howard University was approved by the 87th Congress on September 21, 1961. The actual transfer date had not been established as of the close of the 1962 fiscal year.
    Foreign Quarantine
    For the 15th successive year the Nation was free from quarantinable diseases known to have been introduced from abroad.
    Quarantinable diseases were introduced into some countries that had been free of such infection, and there was a resurgence of these diseases in some endemic areas of the world. The Division of Foreign Quarantine faces an increasingly significant challenge in preventing the importation of quarantinable diseases. In 10 years there has been an increase of nearly 300 percent in the annual number of quarantine inspections of persons arriving in this country by air.
    Special vigilance was maintained at U.S. quarantine stations during the year on the basis of outbreaks of quarantinable disease. By direct efforts and through cooperation of State and local health departments and other organizations, the Division took action to raise the immunity level of the traveling public, of persons employed in
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    port areas and adjacent communities, and of persons throughout the Nation who meet or treat the sick.
    QUARANTINABLE DISEASES
    There were five separate importations of smallpox into England and Wales, all from South Asia. These resulted in 69 additional cases with 24 deaths. One of the imported cases and one secondary case were not recognized as smallpox until resultant cases and deaths had been diagnosed.
    There were two smallpox importations into Germany, one from Africa, the other from South Asia.
    Several smallpox cases were detected on ships. The most significant instance occurred at Nowy Port, Poland, where one crew member of the S.S. Indian Resolve was found to have the disease. There were 70 secondary cases in crew members, and cases were confirmed in a quarantine officer and three Polish guards.
    There was a resurgence of smallpox in Ceylon. The disease is endemic in Brazil, Ecuador, and parts of Africa and Asia.
    The magnitude of the spread of cholera to areas of eastern Asia cannot be estimated. More than 7,000 cases were reported in the Philippines, where the presence of the disease posed a threat to other nations—especially danger of importation by small fishing craft into other Pacific islands.
    Sporadic cases of yellow fever continued to be reported from endemic areas of South America and Africa.
    Plague cases occurred sporadically in old endemic foci, with two major outbreaks—in Kolar District, India, and in Ecuador, including the port of Manta. Two cases of plague were reported in the United States in persons who had been in contact with wild rodents or their ectoparasites in areas of New Mexico of no importance to international traffic.
    Typhus (louse-borne) continued to be present at a low endemic level in some areas of Mexico, Ecuador, and Peru and in Yugoslavia and the United Arab Republic. Typhus and relapsing fever are a major problem in Ethiopia, where more than 2,000 cases of each disease were reported in calendar year 1961.
    INTERNATIONAL TRAFFIC
    In the United States, the number of inspections of aircraft for quarantine or immigration-medical purposes was about the same as in 1961—over 65,000. There was an increase of 12.9 percent in quarantine inspections of persons arriving by plane—from 2,417,238 to 2,728,253. Inspections of ships increased from 32,105 to 32,980 and inspections of persons arriving by ship increased from 1,966,580 to 1,985,318.
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    Persons subject to quarantine inspection arriving in the United States by all modes of travel, including land entry from the interior of Mexico, increased from 5,607,218 in 1961 to 6,112,332 in 1962. It was necessary to detain 65 persons in isolation, compared with 11 in 1961. The number of persons who were allowed to continue to their destinations in the United States, but placed under medical surveillance, was 328,928 compared with 91,985 in 1961.
    MEDICAL EXAMINATIONS
    Establishment of Fee
    A fee of $10 was established for visa medical examinations performed by the Division of Foreign Quarantine, effective December 1, 1961. Fee collections will repay the Government for cost of the visa examination activities of the Division of Foreign Quarantine.
    General Program
    The number of alien applicants for visas who were examined by medical officers abroad increased 2.2 percent, from 185,142 in 1961 to 189,192 in 1962. Of these, 97 percent were immigrants. There were 1,765 who were found to have diseases or conditions excludable under immigration law. Aliens examined on arrival at U.S. ports increased 5.2 percent, from 3,132,313 to 3,295,999. There were 3,049 found to have excludable diseases or defects; 18 percent of these had been so diagnosed abroad, but were admitted under special provisions of immigration law.
    Staff in Europe examined 6,552 refugee-escapees under Public Law 86-648, and 111 were found to have excludable conditions. Some with excludable conditions were admitted to the United States by the Immigration Service subject to necessary controls.
    Special arrangements were made for medical examination of Chinese refugees leaving Hong Kong for the United States.
    Immigration of Tuberculous Aliens
    The Division arranged for health controls for certain immigrants with tuberculosis whose entry is authorized by amendment to the Immigration and Nationality Act effective September 26, 1961. The immigrants must be members of the immediate family of a U.S. citizen, of a resident alien, or of an alien who has been issued an immigrant visa. Health control provisions contain improvements over those enforced under a similar, temporary law that applied to tuberculous aliens receiving visas before July 1,1961.
    The U.S. quarantine service placed 800 arriving aliens under health pontrols for tuberculosis in 1962, compared with 929 in 1961.
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    Additional Change in Immigration Law
    Amendment to the Immigration and Nationality Act also provided that “leprosy” and “tuberculosis in any form” are no longer specified within the act itself as conditions excluding aliens from admission to the United States. Leprosy and tuberculosis are now designated in Public Health Service regulations as “dangerous contagious diseases,” which are excludable under the act. Coverage of these two diseases by regulations allows more flexibility of terminology and procedures, in line with current medical concepts.
    Migratory Farm Labor
    In the program of recruiting farm workers from Mexico, 292,087 laborers were examined, with 4,533 rejections, at 3 centers in Mexico. At 5 border reception centers in the United States 310,247 examinations were made, with 5,519 rejections. At the reception centers 287,-672 serologic tests for syphilis were made, with 13,267 positive reactors. The rate of positive reactors decreased from 52 per 1,000 men tested in 1961 to 46 per 1,000 in 1962. Treatment is given to positive cases, and they are admitted to the country.
    ENTOMOLOGY AND SANITATION PROGRAMS
    The program for control of the yellow fever mosquito, Aedes aegypti, was carried on in more than 100 international traffic areas within the yellow fever receptive zone in southern United States and insular possessions. The infestation index was kept at zero in 88 of these areas and at a relatively low level in the rest.
    Inspections of aircraft arriving from foreign countries revealed the presence of more than 21,000 insects, including many of medical importance. There were 53 species of mosquitoes, 15 of which do not occur in this country.
    The Division’s entomologist in Honolulu discovered the presence of two species of mosquitoes new to Hawaii and Guam, respectively. Aedes vexans nocturnus, suspected in the transmission of Japanese-B encephalitis, was detected in Hawaii. Culex trltaeniorhynchus, the principal vector of Japanese-B encephalitis, was discovered in Guam.
    Only a small percentage of ships entering United States ports showed evidence of appreciable numbers of rats.
    The sanitation program has resulted in considerable improvements on many ships.
    OTHER QUARANTINE ACTIVITIES
    An improved surveillance method was adopted for use in placing arriving international travelers under control by local health officers.
    The U.S. Armed Services jointly issued revised quarantine regula
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    tions affording stronger defenses against disease importation, in accord with suggestions from the Division of Foreign Quarantine.
    At El Paso, Tex., procedure was initiated that permits certain private aircraft to enter from northern Mexico without inspection by a Public Health Service quarantine officer, provided the pilot completes a health certification form in the presence of a customs officer. A quarantine officer must be called in if any health problem arises. Extension of the procedure to private aircraft throughout the entire border area can help provide protection where coverage of all traffic by each Government inspection agency would present tremendous practical problems.
    The International Certificates of Vaccination against smallpox, cholera, and yellow fever were included in a booklet form published by the Division.
    Health Services for Indians and Alaska Natives
    More than 380,000 American Indians and Alaska Natives (Aleuts, Indians, and Eskimos) look to the Indian health program for preventive and curative medical service. The purpose of the Division of Indian Health is to provide this care to Indians and Alaska Natives where they are and when they need it, and to raise the level of health to that of the general population.
    MEDICAL FACILITIES
    In 1962, the Division operated 24 health centers, 17 school health centers, and several hundred field stations, 50 hospitals (seven in Alaska) with 3,280 beds, and had contract arrangements with 200 other hospitals with 1,000 beds. There were 18 contracts with State and local health departments for public health services. Physicians and dentists in private practice furnished medical and dental care on a contract basis. A new 34-bed hospital was opened at Kearns Canyon, Ariz. A new 50-bed hospital was opened at Kotzebue, Alaska—150 miles across the Bering Strait from the Soviet Union.
    The Kotzebue Hospital serves 7,500 natives, mostly Eskimos, from an area of 68,000 square miles and 28 scattered villages. There are no roads leading into Kotzebue. Transportation is by plane, dogsled, or boat.
    Additions to hospitals at Cass Lake, Minn., and Fort Defiance, Ariz., were completed. Health stations were constructed at Ponemah, Minn., Pryor, Mont., and La Plant, Wakpala, and Norris, S. Dak.
    HEALTH RESULTS
    Illustrative of the advances that have been made since the program was transferred to the Public Health Service in 1955 is the decline in
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    the numbers of new cases and of deaths due to tuberculosis, a continuous downward trend since a peak in 1956.
    The downward trend results partially from the new drugs and other measures being used successfully in controlling tuberculosis during the last few years. Of equal importance is the substantial improvement in the quality and scope of health services provided. For example, there has been an increase in outpatient treatment and in case finding.
    Even with the advances in the last 7 years, the average age at death is 41 for an Indian and 30 for an Alaska Native as compared to 62 for the general population. The tuberculosis rate is still 4% times greater among Indians and seven times greater among Alaska Natives than among the general population.
    The infant mortality rate has declined 40 percent since 1954 but is still three times greater than that of the total population.
    Despite the high prevalence of influenza, pneumonia, tuberculosis, and gastroenteritis, accidents are the leading cause of death. The rate of deaths due to accidents is three times higher among Indians and four times higher among Alaska Natives than in the total population. Accident prevention campaigns are under way.
    The second most common cause of death is heart disease. Degenerative diseases are less frequent than in the general population, because half of the Indians are under 20 years of age.
    PROFESSIONAL STAFF
    Improvements have been made in correcting critical staffing deficiencies. Additional health workers—including physicians, dentists, sanitary engineers, sanitarians and sanitarian aides, pharmacists, public health nurses, trained practical nurses, dental assistants, social workers, medical record librarians, nutritionists, dietitians, and health education workers—have been added to the field staff.
    The full-time staff now numbers about 5,000 with less than 150 in Washington. More than half of the staff is of Indian descent.
    HEALTH EDUCATION
    The goal of health education activities is to bring to the Indian people a better understanding of the fundamentals of good health, and to create within them a desire to assume responsibility for taking the necessary steps to improve their health.
    That a measurable degree of success is being achieved is indicated by the increasing cooperation of Indians in program activities—immunization, for example—and by the growing number of Indians who participate directly in program planning.
    Public Health Service
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    In 1962 the health education staff numbered 41, most of whom were Indians with college training in education, anthropology, or sociology.
    THERAPEUTIC SERVICES
    The more than 81,000 admissions to Indian hospitals in 1962 reflected a changing pattern in Indian health. There were fewer tuberculosis patients, and their hospitalization periods were shorter. This meant more facilities were available for the practice of preventive medicine.
    In 1962, the number of therapeutic services to outpatients and preventive health services continued to increase. At the hospitals, 674,000 outpatients visits were recorded in 1962—an increase of 7 percent over 1961. More than 400,000 visits for medical services were made to health centers, stations, and other clinic locations.
    There was a 6 percent increase in hospital nursing and a 5 percent increase in field nursing. The professional competence of nursing staff was upgraded through advanced training in nursing services administration and in maternal and child health. Additional training in pediatrics, obstetrics, medical surgical nursing, operating room nursing, and central supply techniques was provided for practical nurses.
    In Alaska, the number of clinics held in villages increased. Almost 100 villages were reached by doctor, nurse, or technician.
    Three additional hospitals were staffed with pharmacists in 1962, so that 89 percent of patients and 81 percent of those coming for outpatient care received medical care at hospitals with pharmacists. During the year 627,000 prescriptions were dispensed to 510,000 outpatients, an increase of 23 percent. The 175 health facilities which did not have pharmacists (schools, small hospitals, health centers, health stations and locations) received drugs and pharmacy services from hospitals with pharmacists.
    Many Indians living on reservations are almost untouched by present-day views of nutrition. Often their food customs have been handed down from generation to generation. In some instances their food resources are scarce. Thus education, in-service training, and cooperative research were important in the work of the nutrition and dietetics staff in 1962.
    Nutrition education and training materials were developed. Studies of nutritional status and dietary practice were conducted on two Montana reservations, in cooperation with the Interdepartmental Committee on Nutrition for National Defense. A 3-year nutritiondental study in Indian boarding schools in North Dakota and South
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    Dakota was completed. A diabetes study among Oklahoma Indians was begun, in cooperation with the Division of Chronic Diseases, Bureau of State Services.
    Medical record librarians w’ere added to the staffs of the hospitals in Gallup, N. Mex., Fort Defiance, Ariz., and Tuba City, Ariz. The goal is to provide a librarian for every hospital of 50 beds or more. For smaller hospitals, young Indians will be trained as medical record technicians.
    MATERNAL AND CHILD CARE
    An increasingly successful part of the Division’s work in maternal and child care has been in bringing to Indian mothers a perception of health practices that is in accordance with modern medicine. Eightyeight percent of Indian mothers now give birth to their babies in hospitals, and there is greater acceptance of prenatal care.
    Infant mortality has declined 30 percent in the past 7 years but the death rate between the ages of 28 days and 11 months remains high. Principal causes of these deaths are diarrhea and respiratory diseases. Therefore, efforts have been increased to educate mother and family in good health habits, and to inform them of the availability of health facilities and the importance of early care for sick children. Significant reduction in infant mortality will be realized only as economic status, housing, sanitation, and living conditions in general are improved.
    Consultants and physicians with special training in maternal and child health have been added to the staff. Specialized training in many phases of maternal and child care has been provided.
    Rehabilitation of handicapped children received increased attention.
    TUBERCULOSIS
    Tuberculosis, once the leading cause of death among Indians, has dropped to eighth place. The number of Indians entering hospitals with tuberculosis, the length of their stay, and the rate of new cases reported have declined, but in some areas tuberculosis is still several times more frequent than in the general population.
    In 1962 the daily tuberculosis census in the hospitals was approximately 24 percent of the total daily census—a reduction of approximately 58 percent in 7 years.
    The decline in the death rate in the last 7 years has been 48 percent among Indians and 83 percent among Alaska natives.
    DENTAL HEALTH
    Emphasis on preventive dental care was increased in 1962. Fluoridation equipment was provided at Mount Edgecumbe, Alaska, and
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    Metlakatla, Alaska, and on the Menominee Reservation in Wisconsin, and a program was begun for the use of dietary fluorides where water fluoridation is not feasible or adequate.
    There were 203,000 dental visits during the year; 95,500 patients were examined and 85,000 received dental services. This means that approximately 25 percent of the 380,000 Indians and Alaska natives were examined and they received about 54 percent of the care needed.
    A periodontal program was instituted by a trained periodontist. A total of 33 dental officers and 19 auxiliary dental workers received some type of training. Twenty-four women, Indians and Alaska natives, were trained as dental assistants.
    New mobile dental units were placed in service in the Aberdeen and Albuquerque areas.
    ENVIRONMENTAL SANITATION
    Environmental sanitation is a basic problem. Water supplies are often polluted and inadequate for domestic use, and frequently must be hauled for great distances. Waste disposal is often primitive.
    Under Public Law 86-121, enacted in 1959, the Public Health Service was given authority to work with the Indians and Alaska natives in construction of sanitation facilities for their homes and communities.
    The work is handled on an individual project basis. Participation of Indians and Alaska natives in the project construction and their assumption of responsibility for operation and maintenance of completed facilities are essential elements of the activity.
    In 1962, there were 57 projects authorized, on 30 Indian reservations and in 6 Alaska native villages and 6 Indian communities, to serve 4,800 homes and 24,000 persons. Funds appropriated aggregated $3 million.
    TRAINING FOR INDIANS AND ALASKA NATIVES
    More than half the employees of the Division are of Indian heritage. Formal courses and in-service training are provided for them and for Alaska natives in almost every phase of the Indian health program.
    Fifty-eight young women were trained as practical nurses in the Public Health Service school of practical nursing in Albuquerque. For the first time, practical nurses were given additional training to assist public health field nurses.
    Courses for sanitation aides, dental assistants, community health workers, and food service supervisors were given at many locations.
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    CONSTRUCTION ACTIVITIES
    A new 36-bed hospital at San Carlos, Ariz., was to be completed in the fall of 1962. Plans were developed for a new 12-bed hospital at Barrow, Alaska. Hospital additions at Red Lake, Minn., and Bethel, Alaska, were under construction. Alterations changing the former Fort Peck Hospital at Poplar, Mont, to an outpatient health clinic were underway. Contracts were being negotiated for plans and specifications for a new 27-bed hospital at Fort Yates, N. Dak., and for an additional wing and alterations at the Crow Agency Hospital, Crow, Mont. A study was underway of the feasibility of a 200-bed hospital in Phoenix, Ariz.
    Ninety-five new quarters for personnel at various locations were under construction, and 119 housing units were completed.
    PROSPECTS FOR THE FUTURE
    The success of the drive against tuberculosis and other critical health problems of the Indians has brought brighter prospects for the liberation of these Americans from the bondage of illness. Health education is contagious. More and more Indian people are learning and using improved health practices in their homes and communities. Tribes are creating new health programs of their own, and expanding existing activities. The low economic level of the Indians and Alaska natives, the barriers of language and culture, the hazards of travel over miles of desert or tundra are formidable obstacles. But a sound beginning has been made. The program is moving with faster pace toward the time when people now aided by the Federal Government may well assume the major responsibility for their own health services.
    Medical Services for Federal Agencies
    The medical services of the U.S. Coast Guard and the Federal Bureau of Prisons are legal responsibilities of the Public Health Service and are operated by Bureau of Medical Services personnel assigned to these agencies. The medical programs of the Bureau of Employees’ Compensation of the Department of Labor and the Maritime Administration of the Department of Commerce are conducted by personnel detailed to these agencies.
    UNITED STATES COAST GUARD, TREASURY DEPARTMENT
    A crew member aboard the U.S.C.G.C. Northwind while on the Bering Sea Patrol was struck by a large section of falling ice as it was being cleared from the vessel, and was knocked unconscious. Examination by the medical officer found the patient in shock, bleeding from the mouth, ears, and nose, and with serious head and back
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    injuries with suspected fractured skull and ribs. Treatment for shock was successful, and the patient soon became conscious and rational although in critical condition. He was evacuated by air to hospital facilities ashore. The physician, a Public Health Service officer, was credited with saving his life.
    In all, 103 PHS officers served the U.S. Coast Guard in 1962—33 physicians, 52 dentists, 12 nurses, a pharmacist, a dietitian, a scientist, and a sanitary engineer. Most were on full-time duty. Some were on temporary assignment aboard vessels in the Bering Sea Patrol or icebreakers in the Arctic and Antarctic, or on ocean weather duty in the Atlantic and Pacific.
    A training program to provide a small group of flight surgeons for the Coast Guard was begun. A training officer was added to headquarters staff to help develop training aids for nonmedical personnel, indoctrinate new professional personnel in military medicine, and review medical practices and standards. Improved utilization of mobile dental units was effected.
    BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR
    In July 1961 a student employed during the summer as a smoke jumper with the Aerial Fire Depot, Forest Service, Missoula, Mont., sustained serious back injuries when dashed against a rock by oscillations of his parachute. This resulted in loss of use of both legs and loss of major functions of both arms. Following approximately a year of rehabilitation services at the Institute of Physical Medicine and Rehabilitation, New York City, he was able to move about in a wheelchair and was ready to go on with his education—to prepare for a suitable vocation. He planned to enter the University of Florida in the fall of 1962.
    The case illustrates the continuing emphasis the Bureau of Employees’ Compensation gave in 1962 to the rehabilitation of Federal employees injured in the performance of duty. Rehabilitation facilities throughout the United States were used. Through cooperation with the Office of Vocational Rehabilitation, there was increased utilization of State vocational rehabilitation services.
    Medical officers of the U.S. Public Health Service are assigned to the Bureau and administer the complete medical program under the Federal Employees’ Compensation Act and related acts. During the year the Bureau was completely decentralized. Field offices were established in San Francisco, Seattle, Chicago, Cleveland, Boston, New York City, Washington, D.C., Jacksonville, and New Orleans. Medical services for injured employees are provided by hospitals and clinics of the Public Health Service and other Federal hospitals. Where no Federal medical facilities are available, medical treatment
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    in private hospitals is provided through the direction of private physicians designated by the Bureau.
    MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE
    The physician and two dental officers on duty at the U.S. Merchant Marine Academy, Kings Point, N.Y., cared for the health of 700 cadet midshipmen. The medical officer in charge of the Public Health Service Hospital on Staten Island acted as professional consultant for the academy’s health program.
    There were 692 admissions to the academy’s Patten Hospital. Outpatient medical services and treatments given by the physician numbered 4,066. There were 4,053 dental visits. The North Shore Hospital, a community hospital in Manhasset, N.Y., provided emergency medical care for cadets when necessary.
    BUREAU OF PRISONS, DEPARTMENT OF JUSTICE
    For the 32d year, the Public Health Service provided medical, psychiatric, psychological, dental, nursing, and related health services for Federal prisoners. The Bureau of Prisons operated 24 hospitals and 6 infirmaries in institutions over the country. Fifteen of the hospitals have been fully accredited by the Joint Commission on Accreditation of Hospitals.
    Full-time staff assigned to the program numbered 272. The staff was augmented by 275 consultants in the various medical specialties. Approximately 900 prisoners were assigned to the medical services where they receive training and assist with hospital care.
    There were more than 23,800 Federal prisoners at the end of the year. The hospitals provided 417,838 hospital relief days during the year, medical staffs performed 862 major operations and 6,649 minor operations, and the outpatient departments provided 1,054,502 treatments. A total of 36,634 physical examinations were performed. The two institutions for women reported 31 births. Deaths in all institutions totaled 45.
    There was a continued increase in the demand for psychiatric diagnostic and treatment services, which are required under the provisions of the Youth Corrections Act, the New Sentencing Act, and the act providing for the care and custody of insane persons charged with or convicted of offenses against the United States. Efforts to recruit additional trained personnel to provide these services were continued.
    Plans for New Psychiatric Hospital
    In May 1962 the Attorney General announced that a new 700-bed psychiatric hospital for Federal prisoners will be located at Butner, N.C., a site within easy commuting distance of the Duke University, University of North Carolina, and Bowman-Gray medical schools.
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    Planning of the facilities was completed with the assistance of consultants from the National Institute of Mental Health, Saint Elizabeths Hospital, and the Veterans Administration. An architectural competition for the hospital design was held, and a design prepared by A. L. Aydelott and Associates of Memphis, Tenn., was chosen by the judges. The new hospital will provide a full range of facilities and resources for diagnosis, treatment, training, and research.
    Recommendations of Advisory Committee
    The Surgeon General’s Advisory Committee on Hospitals and Clinics met at Atlanta in April 1962, following visits to prison hospitals, to consider the prison medical care program. The committee made a series of recommendations which included increases in staff and improvements in hospitals. These recommendations are receiving continued study.
    Hospital Improvements
    Modernization of the hospital at Chillicothe, Ohio, was completed; one wing was converted into office and conference rooms for the psychology training program. New offices were completed at the Atlanta penitentiary for the psychiatrist and psychologist. The hospital in Danbury, Conn., was renovated. Planning and construction of improved facilities for the care of disturbed psychiatric patients was underway in several locations. Some refurbishing of the hospital at Terre Haute, Ind., was completed. Construction of a new central dental laboratory was begun at Lewisburg, Pa.
    Clinical Services
    Cancer detection and the control of tuberculosis and other infectious diseases were stressed in preventive health programs at several institutions, including Alcatraz; Alderson, W. Va.; Atlanta; Leavenworth; El Reno, Okla.; and McNeil Island, Wash.
    Psychiatric services were extended in several institutions through use of consultants. For example, members of the psychiatric staff at the Public Health Service Hospital, Lexington, Ky., now visit the Federal Reformatory for Women at Alderson regularly to provide much needed psychiatric consultative services for women prisoners. This gives the Lexington staff access to certain unusual cases with important teaching value, which can be transferred to Lexington for continued study and treatment. The staff at Chillicothe obtains specialized eye, ear, nose, and throat treatments for young men through a similar cooperative arrangement with the Ohio State University Hospital.
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    Continued emphasis was given to high quality dental care, use of group treatment methods, and careful control of sedative-type drugs to prevent any abuses in their use. Improvements were made in training programs for medical technical assistants and in the programs for training prisoners in nursing techniques. The central dental laboratory at the Springfield Medical Center completed 2,505 dental prosthetic appliances.
    Demonstration Counseling
    A. demonstration project in group counseling was begun at the National Training School for Boys, Washington, D.C. Directed by a psychologist and a psychiatric social worker, the project is designed to establish a group counseling program using existing staff, and to measure the effect of the program on individual boys and on the school as a whole. Early reports indicated that the program was having a favorable effect in rehabilitation of youthful offenders.
    Research
    Recruitment of prisoner volunteers for cold virus studies conducted at the Clinical Center, National Institutes of Health, was continued. The staff at Leavenworth continued studies of prisoners with histories of drug addiction. At Lewisburg, a study to improve the standardization of the glucose tolerance test was begun. The psychiatrist and psychologist at Lewisburg are participating in this study with a pilot program designed to learn more about the motivation of prisoner volunteers. The staff at Atlanta worked with the Communicable Disease Center in a study of the transmission of gonorrhea, employing prisoner volunteers. Malaria studies at Atlanta were continued.
    Participation in Community Affairs
    Medical personnel shared professional experiences with colleagues in nearby communities. For example, the staff at Leavenworth attended medical grand rounds at the Wadsworth Veterans Administra-tion Hospital and clinical pathological conferences at the Kansas City Medical Center. The staff at Ashland, Ky., exchanged visits with the Department of Psychiatry at the University of Cincinnati. The staff of the Medical Center for Federal Prisoners in Springfield, Mo., is active in the Greene County Medical Society, and psychiatric personnel from the Medical Center assist in the staffing of the Greene County Guidance Clinic. Prisoners’ blood donations to the American Red Cross and local blood banks in 1962 totaled 12,531 pints.
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    Bureau of State Services
    Programs of the Bureau of State Services are primarily responsible for the application of health knowledge in two broad areas of need— to encourage the development of comprehensive health services in the Nations’ communities, and to safeguard human health against hazards of the natural and man-made environment. The solution to both these problems depends in large measure upon the actions of State and local health agencies. Therefore the Bureau concentrates a major share of its attention upon strengthening these activities— through grants in aid, through training and demonstration projects, and in many other ways.
    The programs of the Bureau have been grouped into two operating units, concerned respectively with community and environmental health, to make possible a more efficient and effective attack on these problems.
    Among the year’s highlights was the passage of the Community Health Services and Facilities Act of 1961, designed to stimulate improved community programs, particularly for the chronically ill and aged. In the first 6 months of operation, 44 grants were awarded under this act, totaling $2.3 million in Federal funds, to help support a wide range of special projects in this field.
    The Robert A. Taft Sanitary Engineering Center, now directly under the administration of the Bureau, conducts an extensive program of research training and consultation in problems of air and water pollution, radiological health, and food sanitation. Many of its projects are reported by the divisions in these program areas. The Arctic Health Research Center at Anchorage, Alaska, conducts studies of special health problems related to life in cold climates.
    Division of Accident Prevention
    Support of research into accident causes and preventive measures increased about 50 percent, both in funds and in projects, in fiscal year 1962 over fiscal year 1961—38 grants and $1,917,419 as against 25 grants and $1,254,666. This graphically illustrates the increasing interest and ability of the scientific community to devote its capabilities toward providing needed basic knowledge of both the human and the environmental factors involved in accidents—still the fourth leading cause of death in the United States, the leading cause in the age groups from 1 to 35 years old, and the leading destroyer of the Nation’s military and productive strength.
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    Similar progress accompanied the Division’s efforts in areas of immediate, practical interest. A dramatic increase in the installation and use of automobile seat belts resulted largely from the Division’s national campaign in cooperation with the American Medical Association and the National Safety Council. Results of the study on community organization and publicity to reduce accident rates in the Shenandoah Valley of Virginia were distributed to all public-health agencies. The Arkansas fire-prevention project continued to draw wide interest and praise from health and fire authorities. The “Blueprint for Life” program in Cleveland, Ohio, is providing valuable experience in the integration of all official civic and voluntary agencies on a concentrated effort to reduce accidents in a metropolitan area; the seven films produced in connection with it are now in nationwide use, and two were awarded Certificates of Merit by the National Committee on Films for Safety.
    Among many major new projects begun in fiscal year 1962 are:
    1.	Establishment of a center for the study of accidents to the aged, in cooperation with the Florida State and Pinellas County Health Departments.
    2.	A study of emergency medical services, in cooperation with the California State and San Francisco City-County Health Departments.
    3.	A study of methods to prevent injuries to the head (especially dental, visual and hearing impairments) in contact sports and outdoor recreation.
    4.	A study of accidental poisonings among children, with emphasis on preventive measures, in Charleston, S.C. (The Division is a cooperative member of the Steering Committee for National Poison Prevention Week, which was proclaimed for the first time in March 1962 by the President. Over 470 poison-control centers are now affiliated with the National Clearinghouse in this Division.)
    5.	A study of prevalence and prevention of accidents involving glass doors and glass areas adjacent to glass doors.
    6.	A study in Philadelphia, Pa., into the effectiveness of the group-discussion technique in reducing accidents.
    Many other projects are in various stages of planning, operation, and reporting, including such diverse subjects as mouth-to-mouth resuscitation; incorporation of accident prevention into the daily routine of local public-health nurses and sanitarians; accidents involving the use of power lawn mowers, flotation devices, guns, and coinoperated dry cleaners; and the comparative value of various media of communication in indoctrinating specific audiences.
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    Division of Chronic Diseases
    In fiscal 1962 the program activities of the Division of Chronic Diseases focused largely on the expansion and improvement of community-based, out-of-hospital services for the chronically ill and the aged.
    These activities were carried out in two principal stages:
    1. The utilization of a 1.7 million dollar appropriation to stimulate and support a series of pilot projects in selected States and communities, and;
    2. The rapid extension of such pilot projects to additional States and communities following passage in mid-year of the Community Health Services and Facilities Act of 1961.
    The Division carried the major burden of administering the expanded program of formula grants in the Act as well as a new program of special project grants. Under the former responsibility $4,858,872 (81 percent) of the total $6 million appropriation was utilized by the States.
    Of the 44 special project grants in the community health area which were approved and funded, 26 are being administered by the Division. These 26 projects account for nearly $1 million of the total $2.3 million first-year appropriation.
    CANCER CONTROL
    The Cancer Control Program is concerned with communication of “practice-ready” research information to medical and health workers in a form which will enable them to use it in their own communities.
    Demonstration Projects
    Grant projects offer (1) a means of testing and evaluating pilot programs under field conditions, and (2) an instrument utilized to demonstrate to local communities techniques and procedures of proven and established value. Since the inception of the project grant program in 1959, there have been 255 grants approved, in 34 States, the District of Columbia, Puerto Rico, and in cooperation with 4 national medical organizations. The amount of money involved totals $6,564,219.
    More than 250 conferences were held with staffs of health agencies in all of the States and Puerto Rico, largely to bring results of the experiences of demonstrations and pilot projects to other groups encountering similar problems.
    It is generally accepted that the best opportunity for cancer control lies in cancer of the cervix, since the Papanicolaou smear offers the possibility of early detection. However, this program is an extremely
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    complex one which has in it many chances for error. Based upon 3 years of intensive work with cervical cancer detection programs, the Cancer Control Program stated the 14 elements which are essential to the successful detection project. Utilizing resources available in the demonstration grant system, 18 communities throughout the country, which have technical resources available for good control programs, were selected for “model” programs. These showcase communities are to be used to communicate the procedures of good cervical cancer control to other areas.
    Clinical Traineeships, State Grants
    During the year, a program of senior clinical traineeships was initiated. Support in the form of stipends is made available to fully-trained physicians who have completed resident training in a medical specialty and who desire additional training in the specialty as it deals with the management of patients with neoplastic diseases.
    A system of grants to States for development of cancer control programs is being administered by the Cancer Control Program. In the fiscal year 1962, the amount granted to States was $3,500,000.
    DIABETES AND ARTHRITIS PROGRAM
    Activities of the Diabetes and Arthritis Program continue to be directed toward the goal of minimizing the severity and complications of diseases in its area of interest by early detection and prevention.
    Program Application
    Consultative services to States and regions were continued along with provisions for supplying screening materials and temporary loan of personnel. Continued evaluation of diabetes reporting by States was executed. A system designed to facilitate statistical reporting was developed and initiated on a pilot basis.
    Field trials of a teaching machine began. Adapted with a film sequence on diabetes, the machine was placed in various clinic settings for evaluation as a teaching method. Preliminary data suggest that it will be a valuable tool for education of both newly diagnosed patients and those with disease of long standing. Plans for a similar application of the teaching machine method to professional education resulted in extensive work on the filmstrip portion. Toward the end of the fiscal year, a physician director and a public health advisor were assigned to the Branch full-time for arthritis activities programing.
    Applied Research
    Plans took shape for studies in arthritis by the Boston Laboratory. Preparations were made for investigating methods of screening for gout and estimating its prevalence.
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    A study was initiated in a Federal prison to determine the reproducibility of the Glucose Tolerance Test and its proper place in the diagnosis of diabetes. Preliminary evaluation of data on the Federal Employee’s Health Study was begun. Factors relative to the prediction of diabetes and its long and short-term effects on new found cases are being considered.
    HEART DISEASE CONTROL PROGRAM
    The Heart Disease Control Program provides professional, technical, and financial assistance to health departments in all States and Territories to help them apply heart disease research findings in as many communities as possible.
    A major method is assignment of field officers to stimulate or conduct heart disease control programs. This year, 131 officers—medical, nursing, nutrition, social service, physical therapy, or public health advisors—have been assigned to States that requested them. Eleven career medical officers are training in public health.
    Heart Disease in Children
    Sixty-six laboratory technicians from all 50 States, 4 Territories, and 5 cities have now been trained in cooperation with the Communicable Disease Center in the fluorescent antibody technique for the rapid identification of the organism associated with the onset of rheumatic fever and rheumatic heart disease. In-State training courses have been conducted in 17 States for 320 technicians, and full use of training equipment and personnel is scheduled into late 1963. The aim is to make the technique widely available so that physicians will have a rapid means of diagnosing “strep throats” in order to prescribe antibiotic prophylaxis. Inexpensive portable equipment to taperecord heart sounds was developed for use in screening school children for heart disease, and preliminary field testing of the equipment was conducted in Dickinson, N. Dak., and Michigan City, Ind.
    Heart Disease in Adults
    Various projects have demonstrated effective methods of rehabilitating stroke patients, and services are being expanded. Prevention of strokes, though difficult, may be practical as a community service. A Portland, Oreg., study is investigating methods of preventing major strokes by early diagnosis and medical and surgical treatment of patients with signs and symptoms of cerebrovascular insufficiency.
    Childhood obesity in relation to adult morbidity and premature mortality from cardiovascular and other diseases is being evaluated in a Hagerstown, Md., study.
    An electronic system, including a digital computer, for analyzing electrocardiograms was developed and installed in Washington, D.C.
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    Tests relaying electrocardiographic signals by telephone from San Francisco and other locations to Washington will be conducted to demonstrate the use of the computer system as an aid to physicians in the diagnosis of heart disease.
    The program is conducting four field stations. The Heart Disease Control Laboratory at the Communicable Disease Center serves as a “bureau of standards” for many State and epidemiologic laboratories for the development and standardization of cholesterol determinations. A field and training station was established in San Francisco to provide professional consultative and laboratory services to health agencies and medical groups in the West. The reasons for the large geographic differences in the occurence of heart disease will be studied at the new Ecology Field Station in Columbia, Mo. The present study of the family aggregation of hypertension will be continued and new hypertension programs will be developed at the Memphis, Tenn., field station.
    NEUROLOGICAL AND SENSORY DISEASE SERVICE PROGRAM
    The Neurological and Sensory Disease Service Program, established in January 1962, launched a major national program to hasten community application of research knowledge in the care of persons with epilepsy, cerebral palsy, multiple sclerosis, Parkinson’s disease, mental retardation, vision, speech, and hearing defects, and other disorders of the nervous system.
    Project Grants
    The first project grants made by the new program gave impetus to the development and support of State and local efforts to improve and expand community services. Twenty-three grants were awarded to official, voluntary, and private nonprofit agencies, medical schools, and medical centers in 13 States and the Virgin Islands to support projects encompassing a broad spectrum of activities.
    Vision Conservation
    The Glaucoma Collaborative Study, involving validation of various screening tests to identify glaucoma in the earliest stage, continued in its third year at five university clinics in California, Iowa, Maryland, Missouri, and New York.
    At the University of Tennessee School of Medicine 300 of 4,500 persons screened for glaucoma have been selected for continuing study to confirm the efficiency of the Schiotz-type tonometer as a screening instrument. Evaluation of the effectiveness of followup procedures as a means of increasing the rate of successful referrals from glaucoma detection programs was inaugurated at the University of North Carolina School of Public Health.
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    Glaucoma test demonstration manikins were developed to provide physician orientation in testing for glaucoma. The plastic life-like models of the human head have movable eyelids and eyes that provide tension readings in the normal and glaucomatous range in alternate eyes when tested with the Schiotz tonometer.
    Hearing Conservation
    A regional audiometric calibration center is being established at the North Carolina School of Medicine. The purpose is to determine the feasibility of such regional facilities for use by local programs, and their relationship to promotion of community speech and hearing conservation programs.
    HEALTH SERVICES FOR LONG-TERM ILLNESS PROGRAM
    The program is concerned with the development of programs and projects for preventing the onset or progression of chronic disease and disability as well as care services both in nursing homes and in non-institutional settings.
    Support of Projects
    An increase in direct operationg funds during the fiscal year enabled the program to award $1.2 million to 47 nonprofit organizations and official health agencies in the form of contracts and cooperative agreements.
    The projects varied in complexity and scope from the creation of a homemaker program by a hospital in a rural community in Nebraska to a nationwide program by the National Sociey of Crippled Children and Adults to eliminate those architectural barriers in public buildings which prevent disabled persons from participating in normal activities.
    The program supported a 2-week national conference at Michigan State University attended by nutritionists and dietary consultants from 28 States to demonstrate new techniques for improving food service standards in nursing homes.
    An experimental and intensive 6-week summer school course in nursing home administration carrying degree credit, the first of its kind in the Nation, was conducted by the University of Oklahoma; 33 students from 16 States attended.
    Development of Materials, Data Collection
    The Kenny Rehabilitation Institute in Minneapolis received financial support from the program to develop resource material for the training of personnel who will provide rehabilitation nursing.
    A project intended to stimulate medical schools and schools of public health to incorporate into their curricula the concepts and methodology for the prevention of disability is in progress.
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    Four workshops based on a simplified method of teaching nursing skills were conducted by the program. An Instructor’s Guide for Teacher Training Courses is being prepared.
    Program staff worked on the compilation of data received from the first national inventory of coordinated home-care programs. Two regional workshops on home care were held during the year and a second National Workshop for Home Care is scheduled for December 1962.
    Communicable Disease Center
    The Communicable Disease Center, Atlanta, Ga., carries out Public Health Service programs in the control of infectious diseases. It conducts epidemiological, field, and laboratory studies and provides various types of technical assistance to State health departments. Because of the global nature of infectious diseases, CDC also participates in health efforts around the world. It provides technical support and personnel for the health programs spearheaded by the International Cooperation Administration. It also cooperates with the World Health Organization through representation on expert advisory panels and committees and as a laboratory diagnostic and study center.
    Plans were completed for the physical transfer of the Tuberculosis Branch from Washington to the Atlanta headquarters, although the move did not take place until the beginning of the 1963 fiscal year. This transfer brings to the Atlanta headquarters all of the CDC Branches: Epidemiology, Laboratory, Technology, Tuberculosis, Venereal Disease, Training, and Audiovisual, which was given branch status this year.
    Of special note was a series of 13 3-day seminars on hepatitis beginning early in 1962 and continuing throughout the spring, summer, and fall. Sponsored in cooperation with State public health associations, the seminars were designed to communicate existing knowledge of hepatitis and its control to State and local practitioners of public health. The seminars followed in the wake of an unusually high number of cases of hepatitis in 1961. Additional seminar series are planned in other important diseases.
    Also of special interest was a program of communicable disease control demonstrations sponsored by CDC in cooperation with State and local health departments and DHEW Regional Offices. The demonstrations are designed to measure selected communities for their health status, including immunization levels and conditions favorable to transmission of communicable diseases. Effective prevention and control measures will later be demonstrated. Demonstrations have
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    been initiated in Huntsville, Ala.; Fredericksburg, Va.; and Lebanon, Pa.
    EPIDEMIC AND DISASTER AID
    Epidemic aid included calls in 27 States, four Indian reservations, an interstate steamboat, a U.S. Navy base, Chile, the Philippines, Honduras, and American Samoa. Also investigated was a Salmonella hartford epidemic involving 19 States.
    Hepatitis led with eight epidemic aid calls. There were five influenza calls and four poliomyelitis calls. Other calls were for enteric diseases, Coxsackie infections, diphtheria, encephalitis, staphylococcal infections, plague, tularemia, histoplasmosis, erythema infec-tiosum, rabies, measles, and typhoid. CDC assisted the Texas State Department of Health with vector control during hurricane Carla in 1961.
    REPRESENTATIVE DISEASE STUDIES
    Quota Sample Surveys
    The quota sample survey, a useful tool developed at CDC in 1959 to assess polio immunization levels of different population groups within a community, was adapted to include diphtheria, whooping cough, and tetanus. CDC has contracted with the Bureau of the Census to include questions on immunization against these four diseases in its Current Population Survey. Methods are being developed to improve the immunization level of infants in the lower socioeconomic groups shown by quota sampling surveys to be the hardest to reach.
    Venereal Diseases
    The threefold increase in reported cases of infectious syphilis since 1957 underscores the urgency of the National Venereal Disease Program’s syphilis eradication campaign. All available resources of the National Program are directed toward implementing the recommendations of the Task Force on Syphilis Control in the United States.
    This five-member Task Force, in its report to the Surgeon General, pressed for increased effort in epidemiology, development of a comprehensive educational program, continued research in immunology, therapy, and laboratory procedure, and expansion of research in the sex behavior of adolescents and young adults.
    Epidemiologic activities were strengthened along lines recommended by the Task Force. Shortage of venereal disease control personnel has always hampered operations in the field. On July 1, 1962, the National Program assigned 461 persons to State and local health departments to assist them in eradication activities.
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    Another high-priority item was the development of a comprehensive educational program to reach the general public and also professional personnel, including physicians, nurses, teachers, social workers, ministers, and youth and family-serving agency personnel.
    Laboratory research was continued to develop new diagnostic tests and to refine widely-used older ones for syphilis and gonorrhea. Of particular interest in syphilis serology was the development of the Rapid Plasma Reagin (RPR) card test. Featuring the use of a plastic-coated card, this test can be completed quickly outside the laboratory. It is intended primarily for screening purposes. Additional progress was made in the effort to develop an effective fluorescent antibody procedure for detecting Neisseria gonorrhoeae. Such a procedure would have particular value in diagnosing gonorrhea in the asymptomatic female.
    T uberculosis
    Continued gains in the control of tuberculosis are contingent on bringing all known patients under treatment. In 1962 Congress for the first time authorized special project grants for tuberculosis. Twenty-six areas with unusually severe tuberculosis problems received grants to improve their services to these patients and their contacts, and, in some instances, to increase diagnostic services for persons with X-rays suggesting tuberculosis.
    Funds were used also to provide three 3-day regional symposia on “Rational Therapy and Control of Tuberculosis” for physicians. Some 350 physicians in public health and clinical practice attended the symposia.
    Large-scale prophylactic trials of isoniazid, a drug widely used in the treatment of tuberculosis, showed it to be effective in preventing disease among household contacts of patients during the year the drug was taken. Further observations are being made to determine the duration of protection after the drug is stopped and to see whether there are any unsuspected beneficial or detrimental long-term effects of the drug.
    Influenza
    Warning of expected widespread outbreaks of influenza in the United States in the winter of 1962-63 was made public in April. The warning was based on findings of the Surgeon General’s Advisory Committee on Influenza, which met in Washington, D.C. The public was informed that population groups at highest risk should begin immunization by September.
    In their capacity as International Influenza Center for the Americas (WHO), CDC’s respirovirus laboratories were instrumental in identifying strains of virus active within the Western Hemisphere.
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    Isolation of influenza A from other countries led to the prediction that Asian influenza would recur during the winter of 1962-63.
    Poliomyelitis
    Pending the licensing of all three types of Sabin oral polio vaccine, CDC urged mass use of Salk vaccine during the fall and winter to protect infants, pre-school children, and other susceptible groups in advance of the polio season. The CDC epidemic reserve of oral polio vaccine has been used to stop epidemics in Syracuse, Atlanta, Laredo, San Antonio, and Newberry County, S.C. These areas received over 3 million doses. Also, in a gesture of international good will, CDC rushed 354,000 doses to Chile to stop a severe epidemic.
    Measles Vaccine Trials
    Trials were conducted cooperatively with health departments in Seattle, Cincinnati, Rochester, Buffalo, and in DeKalb County, Ga. A series of three injections was given to 4,860 children: 50 percent received placebos, 25 percent received 2 injections of killed vaccine and 1 of live vaccine, and 25 percent received 3 injections of killed vaccine.
    Leprosy, Other Diseases
    For the first time in medical history, a technique of growing leprosy bacilli (Mycobacterium leprae} has been developed. It is being grown in the footpads of mice at CDC, and will provide an effective means for testing different drugs. Preliminary results of experimental work at CDC also indicate that a vaccine against leprosy is likely. Research shows that BCG vaccine imparts significant levels of immunity against M. leprae.
    The CDC also made important progress with regard to salmonellosis, rabies, mosquito-borne viral encephalitis, and vector control.
    LABORATORY
    A major step benefiting diagnostic laboratories in the world is the development of model specifications for production of bacterial and viral reagents. Diagnostic reagents standardization is being devel-oped in close cooperation with the NIH program for developing specifications for respiratory virus reagents. An ad hoc committee of experts drew up model specifications for the Laboratory Branch. Production specifications for most commonly used reagents should be available to commercial companies within 3 years.
    Three years of effort in developing a single standard complement fixation test applicable for use as a diagnostic procedure for identifica« tion of fungal, viral, parasitic, and bacterial infections met with success during fiscal year 1962. A standard test, the “Laboratory Branch Complement Fixation Test” (LBCF), has been evaluated, its
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    sensitivity and specificity found acceptable, and the protocol distributed to State laboratories.
    AUDIOVISUAL
    On January 1, 1962, the National Archives of Medical Motion Pictures were transferred from the National Library of Medicine to the Public Health Service Audiovisual Facility at CDC. The Facility is developing as a national information center on medical films and where they can be obtained.
    During the year, the Facility completed 28 motion pictures, 26 filmstrips, and 26 exhibits. More than 50,000 showings of CDC films throughout the country reached an estimated audience of more than 2 million people.
    TRAINING
    More than 9,000 persons from State and local health departments, Federal agencies, academic institutions, industry, and other organizations attended 379 CDC courses in communicable disease control presented throughout the country and at CDC headquarters. Of these, more than 2,000 persons participated in short seminars—developed to present current data on single subjects of immediate, widespread interest—at 13 State public health association meetings, and 148 attended the MEND symposium on Control of Infectious Diseases in Emergencies.
    CDC’s training personnel also developed courses and training material for other Divisions of the Public Health Service and for the Peace Corps. Under contract with the Department of Defense, they reviewed now rare communicable diseases that might become important in a major disaster.
    Division of Community Health Services
    In the area of community health services, an important forward step was the establishment in November 1961 of the Division of Community Health Services.
    The Division’s responsibilities are to coordinate the Service’s activities in the fields of medical care administration, health economics, and public health administration. It administers public health training grants and awards programs, and coordinates the administration of special project grants affecting community health services. Health education, migrant health, and school health are also Division responsibilities.
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    GRANTS FOR IMPROVING COMMUNITY HEALTH SERVICES
    Special Project Grants
    One hundred and ninety-four applications were received and 44 projects approved and funded this year under provisions of the Community Health Services and Facilities Act. The applicants represent a wide variety of public and other nonprofit national, State, and local groups.
    Many of the projects now in progress are concerned with some particular aspect of out-of-hospital care for the chronically ill and aged. Others are aimed at basic problems of comprehensive care and community coordination involving all pertinent public and private organizations in their areas.
    One community project would provide a full range of medical and other out-of-hospital services to medically indigent individuals on an outpatient basis. The center represents the combined resources of five of the community’s hospitals. It will also coordinate home nursing, physical therapy, homemaker, psychiatric, and screening services through inter-agency cooperation.
    Another is working toward the establishment of a regional health information center. It will utilize electronic equipment to store patient data and will make this information rapidly available in order to improve patient care. The center will also serve teaching and research purposes.
    No organized community efforts have responded effectively to health problems identified by Selective Service rejections. Now two large cities are operating pilot projects to pave the way for a nationwide program for helping these young men.
    Formula Grants
    The strongest direct impact of Federal aid on community health probably is to be found in the response of State health departments to the new chronic illness formula grants. With a few exceptions, State health departments are using the bulk of these funds to strengthen central staff concerned with the chronically ill and aged. As a result, for example, additional numbers of these people will receive some measure of community health service in their own homes; more nursing homes will offer a better than minimum standard of care to their patients; more people will be screened for certain chronic conditions.
    TRAINING
    Larger appropriations to the Public Health Service have enabled schools of public health, nursing, and engineering to increase enrollment and strengthen their educational programs. An encouraging
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    amount is going into programs in the newer aspects of public health— such as medical care administration, air and water pollution, control of chronic diseases, radiological health, accident prevention, and metropolitan planning.
    MIGRATORY AGRICULTURAL WORKERS
    The Division has developed plans for implementing the President’s recommendations on migrant health in his Flealth Message of 1962. Under these plans, special project grants to public and private organizations will be made for establishment and operation of family health service clinics and other projects to improve migrants’ health services and conditions.
    OTHER DIVISION ACTIVITIES
    A source book on medical care financing and utilization was completed.
    The Division assisted in planning and carrying out the International Conference on Health and Health Education, held in the United States for the first time.
    Studies conducted or under way include one to correlate chronic illness morbidity with expenditures for medical care; an analysis of X-ray and laboratory costs for a defined population; two studies on prepayment for drugs; and several projects in the area of the behavioral sciences.
    In cooperation with the Children’s Bureau and the Social Security Administration, the Division published a Directory of Homemakers Services—1961.
    Division of Dental Public Health and Resources
    The Division seeks to promote an adequate supply of dental manpower and to assure that professional skills are used most efficiently and effectively; to assist State and local health agencies in expanding dental health programs and to experiment with methods for their improvement; to influence more people to seek dental care and to find ways of making care available to those whose needs cannot be met under current patterns of dental practice. It is concerned as well with both research into the prevalence of dental diseases and a wider application of known measures of prevention.
    STRENGTHENING MANPOWER AND EDUCATIONAL RESOURCES
    A better trained and more productive dental force is essential to adequate dental care for all our people; and the Division emphasizes programs which will stretch the available manpower supply by teaching dentists more efficient methods of practice. In 1962,
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    undergraduate students in 42 dental schools were learning to work effectively with chairside assistants under a grants program administered by the Division. Proper use of a chairside assistant enables the dentist to provide improved services for more people.
    In cooperation with the Division, six universities, junior colleges, and vocational schools were engaged in experimental programs testing how much and what kind of training a qualified dental assistant should have. The Division continued its effort to stimulate interest in dental assisting as a career by preparing brochures and a recruitment film and by developing a program to aid vocational educators in inaugurating and expanding dental assistant training courses.
    Continuing activities in dental education included preparation for a comprehensive survey of the costs of dental education, to be conducted in cooperation with the American Association of Dental Schools, and consultative services to domestic and foreign dental schools on facilities planning. Research in programmed instruction in selected aspects of dental education initiated this year will seek ways of improving the dental curriculum.
    SPECIAL PATIENT CARE
    The dental health of millions of aged, handicapped, and chronically ill persons poses a particular challenge to dentistry and public health agencies. The institutionalized and homebound cannot go to the dentist ; the dentist traditionally is neither prepared to go to the patient nor schooled in the techniques of care for patients with handicaps. Programs initiated this year in 10 dental schools are giving students necessary technical training and practical experience in treating institutionalized and homebound persons. Extension of the programs to other schools will assure that future dentists are prepared to treat special patients. Publication of Dental Care for the Chronically III and Aged: A Community Experiment, a report on the Division’s 4-year study of the dental treatment needed by the chronically ill and aged of Kansas City and a service program conducted to meet that need, provides guidance and stimulus for community action. A hospitalcentered program established this year in Missouri will obtain additional information on the problems of service for special patients and provide a second prototype for community programs.
    DENTAL CARE FINANCING PLANS
    Dental prepayment plans have proved to be a potent weapon not only in reducing the cost barrier to the receipt of dental care but in increasing utilization of services. The Division encourages the development of dental care financing plans by assisting professional and
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    consumer groups in their organization and operation and by operating a national clearing house for information on prepayment.
    ATTITUDE STUDIES
    Studies conducted by the Division attempt to reveal why people seek, or fail to seek, dental care, why they support, or oppose, such measures as the fluoridation of water supplies, and why they choose to enroll in dental prepayment plans.
    COMBATING DENTAL DISEASES
    To strengthen its efforts to promote the use of fluoridation, the one best means of preventing dental caries, the Division established a special fluoridation unit staffed by specialists in engineering, social science, information, and statistics to provide assistance to States and communities seeking to adopt water fluoridation. As of June 30,1962, over 42,350,000 people in 2,245 communities were enjoying the protection derived from drinking artificially fluoridated water.
    Testing of home fluoridators, intended for areas where central water supplies are not used, devices for defluoridation of water with excessive fluorides, and the effects of fluoridating school water systems continued. First-year examinations were conducted in a study of the effectiveness of a stannous fluoride dentifrice on 2,200 children in Seattle, Wash. Continuing also was a study of cytological testing of oral smears as a screening method in the early detection of oral cancer.
    IMPROVING DENTAL PUBLIC HEALTH PRACTICE
    Completion of a comprehensive survey of State dental programs, which includes details of activities, staffing, and financial support, provided information necessary to efforts to improve the practice of dental public health. A similar survey of community dental health programs was initiated in 1962.
    A NATIONAL DENTAL CENTER FOR RESEARCH AND TRAINING
    Formally opened on November 6,1961, the Dental Health Center in San Francisco is a new facility for applied research into the epidemiology of dental diseases and methods for their prevention and for the training of dental public health workers. Already underway is the first comprehensive birth-record study ever undertaken of cleft lip and palate, malformations which afflict 250,000 people.
    Training programs at the Center, now just beginning, ultimately will teach dental public health personnel from State and community agencies and foreign countries better methods of conducting public programs.
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    Division of Hospital and Medical Facilities
    In. steadily increasing numbers, communities around the Nation are finding that their growing health facility problems can best be resolved through coordinated commmunitywide planning. Thus, the Division of Hospital and Medical Facilities, during the past year, has directed much of its efforts to providing guidance along with the necessary incentive for communities to carry out such planning. In addition to providing leadership to State and local planning agencies in the planning process, grants were awarded to a dozen communities where planning activities are being accelerated. The experience gained will have widespread application for other communities with similar problems. These grants are the first to be made for this purpose under the newly expanded Hill-Burton hospital research and demonstration program made possible by the 1961 Community Health Services and Facilities Act.
    There are many other continuing activities in the planning area in which the Division staff is engaged.
    PROGRAM HIGHLIGHTS
    For the public at large, the Hill-Burton program is thought of chiefly in terms of its tremendous impact on hospital and medical facility construction in every section of the United States. While in itself an outstanding achievement, of equal—if not greater— importance are the qualitative contributions of the program enumerated below:
    Continuous statewide planning for additional hospitals and health facilities was initiated, bringing a sense of orderliness to the improvement and distribution of facilities within each State.
    Standards of bed and facility needs were introduced.
    A better distribution of facilities has been achieved, vitally needed physicians and board qualified specialists have been attracted to many rural areas, and, in general, the quality of medical care in rural areas has been upgraded.
    Health facility operations have been improved through the requirement of the Hill-Burton program that States adopt standards of maintenance and operation for health facilities constructed under the program. Most States have gone much farther than is required by this legislative provision by making such standards applicable to all health facilities and establishing such standards in the form of a licensure program.
    THE CONSTRUCTION PROGRAM
    Although a large portion of the Hill-Burton funds goes into the construction of general hospitals, other types of facilities are also
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    provided grants. These grants average approximately one-third of the total cost of the projects. Other facilities aided include nursing homes, diagnostic and treatment centers, chronic disease hospitals, mental hospitals, public health centers, rehabilitation facilities, tuberculosis hospitals, and State health laboratories. Federal funds in the amount of $1.8 billion have been channeled into the construction and remodeling of these facilities as of June 30, 1962. Since the first Hill-Burton grant was awarded in 1947, a total of 6,236 projects have been approved. Of this total, 4,728 were completed and in operation as of June 30, 1962. The remaining 1,508 are under construction or in the planning stage. These projects will provide 274,208 inpatient beds and 1,644 other health facilities.
    RESEARCH ACTIVITIES
    A growing activity in the Hill-Burton program is hospital research which operated on a budget of $8.1 million last year as compared with $1.2 million which was authorized during previous years. Some of the areas of investigation include the development of more effective organizational patterns for providing services; better community planning and coordination of hospital facilities and operations; improvements in architectural and equipment design; noise control; fire and explosion hazards; bacterial contamination in hospitals and other health facilities; and the various aspects of progressive patient care.
    UNMET NEEDS
    A constant effort is being made to adjust the program to resolve the wide array of health facility problems which still confront the Nation. Chief among these are: obsolescence of many facilities— mainly in metropolitan areas; an ever-increasing critical shortage of long-term care beds; the need for better planning and coordination of health facilities; and the acute shortage of community-based facilities and services for the mentally ill and mentally retarded.
    Division of Nursing
    The Division of Nursing, with its responsibility for a diversified program of consultation to health agencies and institutions, training for nurses, and research, is constantly seeking new and improved ways to meet the increasing and pressing nursing needs.
    TRAINING IN RESTORATIVE NURSING
    Funds were made available by the Congress this year for demonstration training for public health nurses in new methods of restorative nursing services for the chronically ill at home; and the Division
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    negotiated special contracts with two universities and one hospital to sponsor intensive courses. As a result, about 100 nurses will have the opportunity to learn the newest restorative measures which can be applied for patients in their own homes or in nursing homes.
    OUT-OF-HOSPITAL NURSING CARE
    Still the greatest single nursing need is for more care available to patients outside hospitals, and especially to the chronically ill at home. The Division made a significant contribution in this area through provision of consultation, methods and materials to help States and agencies developing programs of nursing care in the home.
    Two projects were completed and publications issued to promote extrahospital nursing services. “How to Determine Nursing Expenditures in Small Health Agencies” (PHS Pub. No. 902) outlines a simple time study method which agencies with limited accounting resources can use for establishing appropriate fees for various nursing services. Conferences to teach its application have been held on request in 10 States to date. “Nursing Care of the Sick at Home in Selected U.S. Cities” (PHS Pub. No. 901) updates the information first collected and analyzed by the Division in 1959 on the extent and distribution of agencies in the Nation which regularly provide home nursing care for the sick.
    A survey planned last year is underway to determine the proportion of patients receiving care at home who are over 65, the services they require, and source of payment.
    Extensive consultation was given to State health departments on the use of formula grants for extension of nursing services and on applications for nursing project grants. Five nursing projects were approved this year.
    HOSPITAL NURSING
    Studies of outpatient nursing activities to improve services were completed this year cooperatively with three university hospitals. Findings show that administration could be improved so that patients could receive more skilled care if professional personnel were relieved of messenger, clerical, and other miscellaneous duties. Consultation was given to 18 hospitals in two States on studies of nurse utilization in inpatient units, and to another State which is conducting a statewide study of nurse utilization in 25 hospitals.
    FIELD CENTER FOR NURSING STUDIES
    Initiating a response to a long-recognized need, the Division was able to establish, equip, and staff in San Francisco, a small nursing research field center for nursing studies and demonstrations. Studies have already been undertaken, cooperatively with the Public Health
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    Service Hospital there, to determine optimum staffing patterns and standards for quality of care.
    MANPOWER AND RELATED STUDIES
    The most comprehensive inventory of the Nation’s nurse supply ever conducted will be carried out by the American Nurses’ Association under contract agreements arranged by the Division. To be completed by October 1963, the inventory will provide an enumeration of nurses by city and State, as well as other data including areas of specialization. The Office of Civil Defense, Department of Defense, contributed funds to help finance this project.
    The Division’s biennial census of public health nurses has been expanded this year to include data on the work of nurse consultants in State and local health agencies and boards of education.
    For several years communities have been offering refresher courses to reorient inactive nurses to current practice and encourage their return to nursing, but the effect of such courses had not been evaluated. This year, in cooperation with the Chicago Council on Community Nursing, a follow-up study was completed of 453 refresher “graduates,” most of whom had been professionally inactive for 10 to 24 years. The study revealed that three-fourths of their number are now at work and making a significant contribution to nursing.
    Inactive nurses in 12 States are being asked if they plan to return to work and under what conditions they would do so. Some 9,000 nurses in 6 States have already responded to their questionnaires.
    Data from 6,000 questionnaires are being analyzed to determine what proportion of needed nursing service the 66,000 “part-time” nurses in hospitals actually supply. A tentative finding is that a part-time nurse works about 20 hours a week.
    All 1,800 nurses in Wyoming are being asked by questionnaire about their employment history for a 2-year period to find out more about the factors contributing to mobility.
    For the 1964 conference required by law to evaluate the professional nurse traineeship program, work is progressing on the study of educational needs of nurses.
    PROFESSIONAL NURSE TRAINEESHIP PROGRAM
    A total of $6,604,000 was appropriated this year to help prepare professional nurses as teachers, supervisors, and administrators.
    Ninety-three schools of nursing and of public health received grants to support full-time long-term study for 2,000 nurses. The program also enabled 6,000 nurses to participate in 125 short-term intensive courses, including 10 home health institutes for 200 students.
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    SUPPORT OF EXTRAMURAL RESEARCH AND RESEARCH TRAINING
    Awards under the Research Grants and Fellowships Program reached almost $1,900,000. Of this total $1,500,000 was for research projects and the remainder for fellowships and a new program of research training. The first grants for research training for nurses were awarded to the University of California at San Francisco, which will offer nurses preparing for research a doctoral program in sociology and to Boston University for similar programs for nurses in psychology, biology, anthropology, or sociology. Full-time predoc-toral fellowships were awarded to 62 Fellows, including 26 new appointees, for study at 27 universities. Fellows are enrolled for research training in graduate departments of education, social and biologic science (including human growth and development), and biostatistics.
    Funds for research supported continuation grants for earlier studies and 15 new projects—more than half of which are in clinical areas.
    INTRA-AGENCY COOPERATION
    To assist the Surgeon General’s Consultant Group on Nursing in arriving at recommendations for the Federal role in improving nursing service, the Division supplied staff and services. Statistical and research personnel made projections of future nurse supply and demand, interpreted study data on costs of nursing education and professional school capacity, and developed an analysis of needs in research and graduate education.
    Division of Air Pollution
    With the swift advances of our scientific-technologic age, the protection of the air around us as a vital environmental resource has surged into a national problem of critical importance. The problem is compounded by the concentration of population in metropolitan areas.
    To help combat this growing problem, the Division of Air Pollution is authorized (by Public Law 84-159) to conduct a national program with three principal features: research, personnel training, and technical assistance to States and communities.
    RESEARCH
    In response to the directive contained in Public Law 86-493, the Division made a thorough study of the health effects of motor vehicle emissions. The final report, entitled “Motor Vehicles, Air Pollution, and Health,” incorporated the findings of many intramural research
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    projects and extramural research grants, and was presented to Congress in June 1962.
    Continuing field studies sought to determine the relationship of air pollution to asthma, industrial absenteeism, respiratory infections, respiratory symptoms, pulmonary function, and infant mortality. Laboratory studies on health effects were expanded. Many of these explored the biological and physiological effects of air pollutants on animals. Lung cancer of a type found in humans was produced in mice exposed to ozonized gasoline following recovery from an influenza virus infection. Animals were also rendered more susceptible to respiratory infections from a bacterium causing pneumonia following exposure to ozone or nitrogen dioxide.
    INSTRUMENTATION, SAMPLING, AND ANALYSIS
    Further advances were made in designing instruments for sampling pollutants or assessing their effects. Improved filter devices were developed for industrial-type installations.
    The National Air Sampling Network continued sampling particulates and certain gaseous pollutants. A Continuous Air Monitoring Program was established in seven cities to record continuously the concentration of seven different gases.
    TECHNICAL ASSISTANCE AND TRAINING
    Statewide air pollution surveys were completed, in cooperation with each State’s health agency, in Colorado, South Dakota, and Kansas; and substantial assistance was given in surveys conducted by State or local health departments in eight other States.
    Intensive technical courses in air pollution were given at the Sanitary Engineering Center to 193 trainees. Two field courses were presented 8 times, to 801 trainees.
    GOALS
    To explore ways of utilizing more widely and more rapidly technological control measures which are already available is one of the major objectives of a forthcoming National Conference on Air Pollution, called by the Surgeon General, to be held in Washington December 10-12,1962.
    The Division continues to be guided by the basic recommendations for air pollution research and time phasing which were presented in the 1960 report (by the Surgeon General’s Task Group) entitled “National Goals in Air Pollution Research.” The 1962 report of the Surgeon General’s Committee on Environmental Health Problems (the Gross Committee) endorsed these goals but found the recommended level of support to be “minimal.” The report identified the following areas as currently in need of particular emphasis: studies
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    of urban pollution levels; interrelationships of air pollution and the social and economic development of communities; development of automatic instrumentation for identification and measurement of air pollutants; interactions of pollutants in the atmosphere; and synergistic effects of pollutants on physical and biological systems. The Division will undertake to provide that emphasis.
    For the long run, the Division’s primary goals will be to learn more about the health effects of air pollution and—above all—to expedite the translation of what is now known and what is learned hereafter about air pollution into actual control measures.
    Division of Environmental Engineering and Food Protection
    Programs carried out in this division are directed to safeguarding drinking water, milk, and other food supply; controlling environmental dangers which arise because of urbanization; and protection against environmental risks encountered in the home, at work, while aboard common carriers in interstate travel, and in outdoor recreational areas.
    MILK AND FOOD BRANCH
    Technical assistance was given to all States and to industry. More than 120 seminars and training courses on milk and food sanitation attended by over 7,000 individuals were sponsored or participated in by PHS milk and food personnel.
    Participation by States in the Cooperative State-PHS Program for the Certification of Interstate Milk Shippers increased for the tenth consecutive year. The 1962 Food Service Sanitation Manual was published as a guide for both public health agencies and the food service industry in the conduct of effective food protection programs. A method has been devised for removing strontium-90 from milk by ion-exchange resins. A pilot project, cosponsored by the Public Health Service, the Department of Agriculture and the Atomic Energy Commission has been established at Beltsville, Md. Studies have been initiated on iodine-131 countermeasure proposals in cooperation with State and local health agencies and national dairy industry organizations.
    SHELLFISH SANITATION BRANCH
    During the year a new Shellfish Sanitation Branch within the Division was created to strengthen and emphasize this activity. Two Shellfish sanitation research centers, one at Kingston, R.I., and the other at Dauphin Island, Ala., were authorized.
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    During 1962, 22 shellfish producing States participated in the Cooperative Program for the Certification of Interstate Shellfish Shippers. The Fourth National Shellfish Sanitation Workshop was held in Washington, D.C., with an attendance of 148 persons including industry, State agencies, the Federal Government, and the Government of Canada.
    A survey party from the Division visited the Hiroshima area of Japan at the request of the Japanese Government to review the sanitary aspects of shellfish production prior to the completion of an agreement between the U.S. and the Japanese Government covering importation of fresh or frozen shellfish between the two countries.
    SPECIAL ENGINEERING SERVICES BRANCH
    Two publications dealing with recreational sanitation were issued, and special efforts were devoted to solid waste engineering activities. In cooperation with the Office of Education a manual on environmental engineering for the schools was produced and distributed. A major aspect of the Branch’s activities continues to be the handling of requests from individuals, organizations, and governmental agencies on problems of general sanitation.
    INTERSTATE CARRIER BRANCH
    In carrying out PHS regulatory functions under the Interstate Quarantine Regulations, special citations and letters of commendation for excellence in sanitation were awarded to 20 railroad and 41 vessel operating companies during the year.
    The Advisory Committee on Revision of the Public Health Service Drinking Water Standards completed its work and the 1962 standards became effective April 6, 1962. Drinking water supply quality was determined nationally by analyses of 194 public water supplies in 134 cities. Studies were continued on possible relationships between drinking water quality and cancer, heart disease, and infectious hepatitis. The Division assisted Alabama University research scientists in their study of water quality and possible relationship to the incidence of arthritis; the State of Maine in a study of agricultural insecticides and water supplies; and the Department of Defense in a study of drinking water stored in public fallout shelters.
    Division of Occupational Health
    As American technology develops, occupational health must not only continue the application of conventional methods for the detection of old and new toxic agents, but must also extend its traditional concept in new dimensions. The combined effects of physical and
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    chemical agents, for example, require deeper study. The psychological component of occupational health problems must also be persistently considered. The role of the occupational environment in the cause and progression of chronic diseases, too, must be studied more thoroughly.
    The establishment last year of a section of physiology and the addition of a staff psychologist will permit a new depth and direction in studies by the Division of Occupational Health. This new direction is reflected in a changing emphasis in the noise studies being conducted by the Division. Long interested in the effects of industrial noise on hearing, the Division is now probing psychologic and neurophysiologic effects.
    In toxicology, a new area of exploration is opening up with recent work on a predictive test of hypersusceptibility to hemolytic chemicals and drugs. This test is based on the detection of inherited deficiencies of specific enzymes. Predictive tests may have great significance for industry, where approximately one million workers are involved in the manufacture of industrial chemicals and several times that number are exposed to chemicals through handling and use.
    Field studies during the year ranged from health hazards in uranium mining to health and medical problems at airports. Field work in the revaluation of the silicosis problem in the metal mining industry was completed, and the extensive data are now being analyzed.
    The strengthening of the Division’s statistical competence has permitted expanded studies of occupational morbidity and mortality. Currently, mortality records of workers in the asbestos products industry throughout the country are being examined, with a detailed and searching analysis of the mortality experience of asbestos products workers in a selected State. This epidemiologic technique, using records of the Federal Bureau of Old-Age and Survivors Insurance, will be extended to other industries.
    At the request of the governor, the Division undertook a study of occupational health problems and needs in the State of Washington.
    As part of its program to offer short-term training courses not given elsewhere, the Division presented 16 separate courses. In addition to basic courses on industrial hygiene engineering and chemistry, four special technical courses were given on ion exchange techniques for fluoride and mercury, heat stress and its control, solvent analysis techniques, and air sampling and evaluation. Special workshops and courses were also held for local health officers, occupational health nurses, and sanitarians.
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    Division of Radiological Health
    The Division of Radiological Health is responsible for the development of a public health program to prevent undue radiation exposure of the population. The principal components of this program are environmental surveillance and special radiation safety activities, technical assistance to the States, basic and applied research, and training of radiological health personnel.
    ENVIRONMENTAL SURVEILLANCE
    With the resumption of Soviet nuclear testing in September 1961 and U.S. testing in April 1962, the Division’s radiation surveillance activities were accelerated and expanded. A Radiation Surveillance Center was established in the Division to provide comprehensive and continuing evaluation of environmental radioactivity data collected by the Federal-State monitoring networks.
    More than 20 air sampling stations were added to the existing 45-station Radiation Surveillance Network; operation of this Federal-State activity was placed on a round-the-clock schedule. Sampling of milk, water, and food was increased to determine more specifically the amounts of radioactive materials likely to be ingested. The analytical laboratories went on double-shift operations when required in order to handle the increased work-load. Early in 1962, a third regional laboratory was opened at Winchester, Mass., to conduct radiochemical support activities for 15 northeastern States.
    The Institutional Diet Sampling Program, initiated in 1960, was expanded. The purpose of this program is to secure an estimate of the total dietary intake of radionuclides by children and teenagers aged 5 to 18 years. In conjunction with this program, the Division contracted with Consumers Union of U.S.A., Inc. to sample teenage and infant diets in 30 cities for the presence of strontium 90 and other radionuclides.
    In connection with the development of a Radiation Intelligence System, a pilot project was conducted during the summer of 1961 in Montgomery County, Md., to evaluate the effectiveness of household interviewing techniques in assessing radiation exposure to the population. The findings were sufficiently encouraging to warrant extension of the methodology on a national scale, utilizing the interview system of the Bureau of the Census.
    The Division participated in a number of special long-term radiation safety projects during the year, including surveillance activities with Joint Task Force-8 in Hawaii and the Pacific testing area; medical and health physics support for the nuclear ship Savannah during its sea trial period; and off-site and on-site surveillance at Savannah ports-of-call.
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    STATE ASSISTANCE
    A major step was taken to strengthen State radiological health programs with the approval by Congress of a system of matching grants to the States—$1,500,000 for the first year.
    Fifty professional staff members of the Division have been assigned to State health departments; some 25 more are being trained for early State assignments.
    Through the Division’s diagnostic X-ray inspection and correction program, more than 50,000 dental X-ray machines in some 45 States have been inspected, either by physical survey or the Surpak (mail survey) method. Work is in progress to adapt the Surpak technique for use in the inspection of medical X-ray machines.
    RESEARCH
    A number of long-term research projects were initiated to determine more accurately the genetic and somatic effects of low-level radiation.
    A Radiological Health Animal Research Laboratory was established at Colorado State University, Fort Collins, Colo. At this facility, a large colony (2,000) dogs will be studied for their response to low-level radiation.
    The development of a Registry of Radiation Pathology will further the knowledge of radiation effects through the study of morbid anatomy. The Registry has been established under the auspices of the Research Council of the National Academy of Sciences and is located in the Armed Forces Institute of Pathology.
    Other projects of long-term significance include a tri-State study of congenital malformations, a joint study of radiation effects on primates, a nationwide bone sampling program for radio-strontium analysis, and a midwest environmental health study.
    In addition to intramural and contract research, the Division completed its first full year of managing a system of extramural grants formerly funded by the National Institutes of Health. There are now 66 active grants funded by DRH in the amount of $1,196,000.
    TRAINING
    For the second year, the Division provided grants to universities for the training of radiation health specialists. Congressional support of the program was increased to $1 million in fiscal year 1962, enabling assistance to 20 schools.
    The Division also stepped up its own training programs: shortcourse training was provided for more than 1,100 public health personnel in government and industry.
    665171—63---14
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    Division of Water Supply and Pollution Control
    Since the turn of the century, while the national population has a little more than doubled, there has been an eightfold increase in water use. Present use of 325 billion gallons a day is expected to double by 1980 and triple by the year 2000. Wise management of the water resource has therefore assumed a position of number one social-economic importance. Prominently involved is the abatement, control, and prevention of pollution, for there is now nearly six times as much pollution in the Nation’s surface waters as 60 years ago.
    Since its beginning in 1948, this program has emphasized Federal-State-local cooperation under a declared policy to “recognize, preserve, and protect the primary responsibilities and rights of the States.” The Water Pollution Control Act goes beyond the usual public health legislation, directing the conservation of “waters for public water supplies, propagation of fish and aquatic life and wildlife, recreational purposes, and agricultural, industrial, and other legitimate uses.” Thus it assigns to the Department of Health, Education, and Welfare a major role in conservation and water resource development. During the first year under major amendments (July 1961) to the Federal Water Pollution Control Act the Division’s program has nearly doubled in size and scope.
    CONSTRUCTION GRANTS, PROGRAM GRANTS
    As a result of increased funds for construction grants, fiscal 1962 set an all-time record with a 22 percent increase over the preceding year in municipal sewage treatment construction. Approved were 754 projects to which the Federal grants contributed $65 million, and local governments $332 million, a ratio of about 1-5. In the 6-year history of this grant program 3,500 awards totaling $290 million have been made to support municipal funding of $1.4 billion. All this will provide sewage treatment for 35 million people and improve water quality in over 38,000 miles of streams.
    Despite this massive effort, there are still 5,290 U.S. communities of 43 million total population needing new, enlarged, or improved sewage treatment facilities.
    Grant funds to State and interstate agencies, increased from $3 million to $5 million per year under the 1961 legislation, have enabled most of the States to expand their water pollution control programs. Stimulated by the grants, State funding has risen from $4.2 million in 1956 (before grants) to $7.6 million in 1961 (under the $3 million authorization) to $9 million in 1962 (under the $5 million authorization). Water pollution control budgets of 33 States showed substantial increases in 1962 over 1961.
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    BASIC DATA
    To maintain continuous intelligence on the nature and extent of pollution, the National Water Quality Network of major watercourse sampling stations was enlarged from 91 to 121, with 300 as the ultimate goal. Thus are regular checks made on more than 15 physical and chemical parameters in water, including radioactivity, organic chemicals, coliform organisms, temperature, alkalinity, plankton, dissolved oxygen, and others. Experiments in electronic measuring and recording promise completely automatic network monitoring of waterways in the early future.
    Continuing data are also collected, analyzed and published on water and waste treatment facilities and needs, on bond issues to finance these public works, on contracts awarded for the construction of such facilities, and on pollution-caused fish kills. Completed during the year was the first nationwide inventory of Federal establishments to determine the extent of pollution coming from them.
    ENFORCEMENT
    Five enforcement actions (two at request of the Governors of Washington and Michigan under the new intrastate provision of the Water Pollution Control Act) were initiated as follows: (1) Puget Sound, Wash.; (2) Detroit River, Mich.; (3) Raritan Bay, N.Y.-N.J.; (4) Mississippi River, Clinton Area, Iowa-Ill.; and (5) North Platte River, Nebr.-Wyo.
    Additional conference sessions were held in pending cases: (1) the North Fork of Holston River, Va.-Tenn.; and (2) the Colorado River Basin, Ariz.-Calif.-Colo.-N. Mex.-Nev.-Utah-Wyo.
    The three-step Federal enforcement procedure—conference, public hearing, and court action—has been initiated in 18 situations in the history of the program. In only one case has the third (court action) step of the enforcement procedure been necessary.
    RESEARCH AND TRAINING
    Research activities include both intramural projects at the Robert A. Taft Sanitary Engineering Center, Cincinnati, and extramural research projects supported by grants in some 80 universities and other institutions in about 40 States. Together they seek answers to problems in wastes origin; more efficient and economical characterization, treatment and disposal of wastes; improved methods in water quality measurement; and the supplementation and conservation of w’ater supplies. A major project in advanced waste treatment to approach 100 percent purification of wastes, is continuing.
    Research grants awarded during the year supported 159 projects totaling $2.67 million, including 1 in support of the first international
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    conference on water pollution research scheduled for September 1962.
    Newly implemented in fiscal 1962 were fellowships totaling $98,000 to scientists and engineers at academic institutions in 16 States and 1 foreign country; 11 demonstration (applied research) grants totaling $300,000 in 10 States; and 23 grants totaling $693,000 to institutions in 13 States to establish or expand training programs in the field of water supply and pollution control.
    Sites were selected for four of seven regional laboratory and research facilities authorized in 1961.
    COMPREHENSIVE PROGRAMS, INTERAGENCY COORDINATION
    Comprehensive water pollution control programs to protect and conserve water quality for all uses for a projected period of 50 years have been initiated or expanded in basins of the Columbia River, Great Lakes and Illinois Waterway, Susquehanna River and Chesapeake Bay, Delaware River, Ohio River, and Colorado River. In addition, field study projects on problems of national significance have been established with respect to the effects of pesticides on water quality and of recreational uses on water supply reservoirs.
    Coordination of programs with other Federal water resource development agencies continued. Technical services under such interagency agreements represent a major and expanding activity. Of particular significance in Federal reservoir construction are requirements of the Water Supply Act of 1958 and of the 1961 amendments to the Water Pollution Control Act requiring, respectively, a determination of municipal and industrial water supply needs and stream flow regulation for quality control. Serving much the same as a consulting engineer, the Division has prepared reports for the Federal construction agencies on 97 projects, and has 209 others in progress or scheduled.
    ADVISORY BOARD
    The nine-member Presidentially appointed Water Pollution Control Advisory Board continued its policy of holding certain of its meetings outside of Washington to provide public forums to assess regional problems and progress in water pollution control.
    The National Institutes of Health
    National Institutes of Health continued to grow and reorganize as necessary to meet its expanding role in support of biomedical research. At the period’s end, plans were completed for establishing the new Division of Research Facilities and Resources. Designed to centralize administration of some of NIH’s major research support activities, the new Division will oversee programs for: health research facilities con
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    struction, support for primate centers, general clinical research centers, special resources centers, and general research support grants.
    In this period a new branch was set up in the Viruses and Cancer Program to help fulfill the broadened program for study of viruscancer relationship, and the Cancer Chemotherapy National Service Center was reorganized to quicken the search for drugs useful in cancer treatment.
    At the request of the President, legislation to convert the Division of General Medical Sciences to Institute status and to establish a new National Institute of Child Health and Human Development was introduced early in this period.
    The new Institute—-which would incorporate both the Center for Anins; Research and the Center for Research in Child Health—would conduct and support research and training relating to child health and human development, particularly the special health problems of children and aged persons. Its research would cover the gamut of development and adaptation beginning with reproduction and terminating; in old age.
    Increased costs of large-scale clinical research facilities and enlarged manpower needs have caused a sharp upswing in expenditure per professional worker. Anticipated Large-scale population studies; use of more complex, automated instrumentation; and expanding U.S. involvement in international medical research are expected to swell the requirements for highly skilled technicians and professionals. In the decade, 1960-70, it is expected that the existing pool of trained biomedical investigators will increase each year by 4,500, in contrast to the 3,500 annual increment in the 1954-60 interval.
    To help achieve this goal, plans were made for a steady growth of training facilities, so that, by 1970, the medical research manpower pool would be doubled. Steps taken include:
    (1)	Expansion of the pre-doctoral fellowship program to attract research students in the medical sciences.
    (2)	Expansion of the medical student research program, which exposes selected undergraduate students to research.
    (3)	Extension of the post-doctoral fellowship and graduate training programs to provide advanced training for research.
    (4)	Provision of support to graduate schools.
    (5)	Increase in training of foreign nationals in the United States and of U.S. citizens for research overseas.
    Growth has now brought the training program to a point where a simpler mechanism is needed within NIH to help training institutions plan, finance, and conduct a more orderly program of science education. Such education must look to the long-range needs in medical research manpower: a large, strong group of medical and biologi
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    cal scientists not limited in training to a specialized aspect of a disease problem, but so schooled as to be able to meet unpredictable problems.
    Communicating results of research is, ultimately, a function of education and training. The continued growth of knowledge and technology requires incorporation of new findings into the educative scheme of the health sciences. NILE programs continue to have profound influence upon education and training in these sciences. More than half of the $400 million in research grants made available during this period through NIH has gone to medical, dental, and other health professional schools of the country. In addition, NIH devoted over $135 million to direct support of fellowships, training grants, and other training activities, many of which seek improvement in content of the undergraduate and graduate curricula and effective communication of current research information to health practitioners.
    NIH maintained close liaison with the State Department in carrying out its research obligations under the International Health Research Act of 1960 (which for the first time explicitly established the authority of the Public Health Service to support research and related activities in foreign countries) and under Public Law 480 (which authorizes use of excess U.S.-owned foreign currencies for the mutual benefit of those countries and the United States).
    Public Law 480 funds have thus far been made available in nine countries: Brazil, Burma, Egypt, India, Indonesia, Israel, Pakistan, Poland, and Yugoslavia. In these countries, NIH has developed a total of 58 proposals for collaborative research projects, covering an extensive range of pertinent subjects.
    Since NIH’s foreign program is primarily designed to improve health in the United States, any grant under this program must necessarily be of benefit to the United States as well as to the host country. The obligation to the latter, however, is a continuing one and NIH has been giving increasing attention to the effects of a grant on the medical research of a recipient country.
    To facilitate more effective administration of foreign grants through increased mutual knowledge and understanding of the problems, NIH’s Office of International Research established a small unit in Paris during this period, as an extension of the office of the Science Attache housed within the American Embassy, and plans were being made for setting up two or three similar units in other countries.
    Steady annual increases in support since 1946 have produced, as of the end of this reporting period, a research grants program of $400 million, supporting more than 15,000 research projects conducted in almost 1,500 institutions throughout this country and abroad, and covering the full gamut of biomedical research. While the major portion of the program continues to aid investigations originating in
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    grantee institutions, a significant number of grants sustain programs (cancer chemotherapy, psychopharmacology, and other collaborative projects) which reflect initiative of NIH staff.
    Careful review and reassessment have been undertaken of policy and operational procedures of the NIH extramural programs, which, for the past 5 years, have experienced unprecedented growth. The mutual dependence of Federal Government and Institutions of higher learning resulting from this growth necessitates examining the instruments—the grant and the contract—which have been the basis of their relationship.
    The programs of the National Institutes of Health have utilized almost exclusively the grant as the basic means of providing support for research and research training activities carried out in universities and institutions of higher learning. Although it has been acknowledged that there are circumstances where a contract is preferable to a grant—as in sponsoring research by a profit-making organization— the grant will continue as the basic instrument for sponsoring research. A contract—in essence a procurement instrument—is a promise to deliver a specified product for a predetermined price. It makes a recipient of funds an agency of government, and thus subject to the full extent of restrictions that bear upon use of Federal funds by a Federal department and its agents.
    A grant, on the other hand, is a conditional gift, a bestowal in response to a request, representing a mutual pursuit by grantor and grantee of a common objective. The grant establishes a relationship of trust; it imposes on grantor and grantee the obligation to act in the public interest. In accepting the grant, the grantee assumes the obligation to use the funds for their designated purpose and with the same probity and prudence with which that institution uses its own funds. It is under conditions of mutual trust and restraint made possible by a grant that scientific freedom can best be guaranteed.
    Improved administration of grants and tighter control over monies granted (more detailed accounting and more precise audits) have been introduced with the purpose of furthering the quality and productivity of medical research, while maintaining freedom and flexibility for investigator and institution.
    In this period, the Research Career Award Program was put into effect. Consisting of two groups—Research Career and Research Career Development Awards—the program is designed to assure younger as well as more mature investigators some measure of support early in their careers, thus permitting individuals of superior potential to reach their maximum productivity.
    At the end of the period, there were a total of 50 General Clinical Research Centers. Authorized by Congress in 1960, the Centers pro
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    vide a special setting for unrestricted but significant clinical investigation in medical schools and other medical research institutions, permitting precise controls and observations of the patient, his diet, therapy, and necessary tests and procedures.
    Institute of Allergy and Infectious Diseases
    This Institute is concerned with a formidable array of diseases, such as measles, asthma and hay fever, hepatitis, viral encephalitis, smallpox, streptococcal and staphylococcal infections, tuberculosis, poliomyelitis, rabies and others. Steady progress is being reported in every area, particularly in the field of upper respiratory infections, our most prevalent illnesses.
    Due to accomplishments in clarifying the causes of respiratory diseases, the opportunity is now present to design protective vaccines. During the past year, the Vaccine Development Program was initiated. A number of contracts have now been awarded to non-Federal research groups experienced in developing and testing vaccines. This major collaborative effort to design vaccines against the widespread respiratory infections often grouped under the term “common cold” is also aimed at serious complications of colds, such as viral pneumonias.
    One of the infectious organisms being employed in the experimental vaccines is the “Eaton agent,” an important cause of pneumonias in children and adults. As a step toward culturing this formerly little-understood microbe for vaccines and for diagnosis of illness, Institute investigators collaborated with specialists at the Wistar Institute in Philadelphia and succeeded for the first time in growing it in cell-free media. They also resolved the question of the precise nature of this agent, previously thought to be a virus, by identifying it as a member of the obscure pleuropneumonia-like organisms group. This is the first “PPLO” linked with any human disease. The new finding provides the rationale for tetracycline therapy of the infection.
    The Institute also has established a Viral Reference Reagents Program of wide import. It will provide standardized reagent materials which eventually will permit virus researchers throughout the world to recognize the viruses they isolate and compare their results.
    The Institute continued its assessment of resistance of malaria strains to widely used drugs and participated in development of new antimalarials. Its scientists developed a sensitive and reliable blood test for observing antibody production in response to malaria infection. This may help identify previously undetected human reservoirs of the disease which afflicts hundreds of millions of people, imposing a heavy tribute on world health and economy.
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    Institute of Arthritis and Metabolic Diseases
    One of the most significant and dramatic scientific accomplishments of the year—representing a major breakthrough in the chemistry of heredity—was the partial “cracking” of the so-called genetic code by Institute biochemists. This code involves the two hereditary chemicals, DNA and RNA, and provides the means by which living cells store and transmit genetic information. In collaboration with researchers from the University of California, these scientists have demonstrated that a universal genetic code may control the development of a variety of organisms. These findings, illuminating certain aspects of the systematic reproduction of all living matter, have attracted world-wide attention.
    From continuing studies of rheumatoid arthritis it has become apparent that both immunologic and genetic aspects are involved in this crippling disease. During the past year, major emphasis has been given to the immunological mechanisms, particularly those relating to the so-called rheumatoid factors.
    The rheumatoid factors are found in the blood of most rheumatoid arthritics, and recent studies of their source as well as their physical, chemical, and biological characteristics suggest they are large antibodies produced as a body defense against an altered type of gamma globulin in the blood.
    Under continuing investigation are such aspects of the rheumatic diseases as genetic and environmental factors. Institute scientists making a family study of patients with Sjogren’s syndrome, a disorder often accompanied by rheumatoid arthritis, have found that normal blood relatives of patients often have a variety of hidden or ignored signs of the disease, thus indicating a genetic predisposition.
    Advances have also been made in management of the various forms of arthritis. Institute scientists have found, for example, that a high calcium diet may offset further “bone-thinning” that often occurs in patients treated with the corticosteroid hormones.
    Striking progress was made in studies of gout, another of the rheumatic disorders. Scientists at the Institute were able to demonstrate that deposits of sodium urate crystals are the cause of the acute inflammation and painful and disabling attacks of gout. They have shown also that the painful symptoms of gout probably result from the metabolic activity of white blood cells in the inflamed joint, and that the familiar drug colchicine decreases the activity of these cells, and thus interrupts the gouty attack.
    In diabetes research, one of the most promising advances of the year has been the development by grantees at the Joslin Clinic in Boston of special tests which can reveal the “pre-diabetic” patient
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    before he develops frank diabetes and is discovered through current tests.
    Encouraging results have come from studies of several other serious but less known diseases including Wilson’s disease, marked by accumulation of excess copper in the body; a newly-discovered metabolic disease, histidinemia, which may cause speech and hearing defects in some children; and an uncommon but serious form of blood disease occurring in newborn infants, which has been found to result from blood-platelet differences in mother and offspring.
    The Institute has continued to extend its extramural research program in gastroenterology. Grantees at the University of Minnesota Medical School have been able to produce rapid healing of duodenal ulcers in a substantial number of patients by freezing stomach mucosa for short periods of time. Freezing is done by a subzero cooling liquid circulated through a balloon placed in the stomach. Further studies are needed, but the new technique may avoid the need for surgery in many duodenal ulcer cases. Another advance in the field of gastroenterology has been the development of a unique, flexible endoscope by a grantee at the University of Alabama Medical School. The device has a revolutionary optic system, employing fiber optics, which permits examination of gastrointestinal areas not previously accessible with conventional instruments.
    Cancer Institute
    There are, according to a new estimate, approximately 105 basic kinds of cancer, and each presents a somewhat different set of problems in research on causes, detection and diagnosis, and treatment. Accordingly, an increasing share of the research conducted and supported by the National Cancer Institute is focused on specific kinds of cancer and on the individual who has cancer.
    During the year, the 25th since the establishment of the National Cancer Institute, its programs were strengthened to take maximum advantage of the resources provided by the Congress and to capitalize on the latest experimental and clinical findings. An effort was begun to coordinate and accelerate research on treatment of acute leukemia patients and on the relationship of viruses to leukemia. A contract-supported program set up to provide essential supplies and services for virus-cancer investigators moved rapidly toward full-scale operation. A series of steps was taken to increase the effectiveness of the nationwide cancer chemotherapy research program, which the National Cancer Institute administers. Experimental and epidemiological studies of potential cancer hazards in the environment were expanded. And finally, the investment in efforts to develop improved methods of diagnosing cancer was increased.
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    INSTITUTE RESEARCH
    The advantages of orienting research toward specific kinds of cancer were exemplified by advances made in caring for patients with acute leukemia. Thanks to the work of scientists in many places, gradual progress has been made in drug treatment and supportive therapy, with the result that 50 percent of acute leukemia patients now live a year or more from diagnosis. The results of clinical research during the year raised the prospect of an additional increase.
    The leading achievement was a reduction in the risks of fatal hemorrhage and infection, complications that often take the lives of acute leukemia patients before drug treatment has had time to take effect. Transfusions of pooled platelets from numerous donors proved highly effective in preventing and controlling hemorrhage.
    Tests of two new drugs rang another hopeful note. One of them, vincristine, a periwinkle plant extract, showed promise in acute lymphocytic leukemia, the type that children usually have, and in lymphomas, such as Hodgkin’s disease and lymphosarcoma.
    The other new drug, a synthetic compound known as methyl-GAG (for methylglyoxal-bis-guenylhydrazone), though its side effects required careful attention, induced remissions of acute granulocytic leukemia more often than any drug previously available.
    A promising approach to direct studies of the role of viruses in human leukemia materialized early in the year as a result of work with a virus-induced leukemia of mice and rats. An electron-microscope study provided the key by revealing virus particles in the blood of animals bearing the experimental leukemia. The same technique is now in use for studies of blood samples from acute leukemia patients.
    Also in virus research, a new experimental leukemia virus was isolated that causes recognizable effects in mice in 7 days, thus making available a system potentially useful for rapid testing of new drugs.
    There were also a number of noteworthy accomplishments in research on other aspects of cancer. The effects of a gene on normal growth and on the occurrence of liver tumors in mice of an inbred strain were eliminated by removing the pituitary gland from animals l-to-2 months old. Thus, the mice were prevented from growing normally, and when they were 16 months old none had liver tumors, though 60 percent or more would ordinarily have had them at that age. Several other genes are also known to influence the occurrence of certain tumors in inbred mice in addition to governing the inheritance of normal characteristics. A broader understanding of these effects and of the role of normal growth processes in the genesis of cancer is being sought.
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    GRANT-SUPPORTED RESEARCH
    A long-term investigation of the transmission of a virus that causes leukemia in chickens turned up evidence that chickens born with the virus, unlike those infected later in life, became tolerant of it; that is, they did not form antibodies to it. The virus survived and was reproduced in their bodies as long as they lived. The virus passed from hens to their offspring during pregnancy; roosters played no role. Chickens that were not born with the virus picked it up from those who were. Thus, the virus spread through an entire laboratory flock. Though few chickens developed leukemia, the incidence was six times as high in those born with the virus as in those infected by contact.
    Evidence was obtained that virus-caused tumors can be reproduced with nucleic acid isolated from them even when they appear to contain little or no whole virus. This was one achievement in experiments with virus-induced tumors in rabbits. A similar approach is being used for human cancer studies at the National Cancer Institute and elsewhere. Also, an experimental vaccine was developed that increased the frequency with which virus-induced benign tumors in rabbits regressed instead of becoming malignant.
    A monkey virus that contaminated some lots of polio vaccine and caused cancers when tested in newborn hamsters was found to cause abnormalities in adult human cells in tissue culture.
    An abnormal chromosome, called the Philadelphia chromosome, previously seen in white cells from a few patients with chronic myelocytic leukemia, has been found in a high percentage of untreated patients. It disappears from the blood after treatment. That it is related to the genesis of leukemia has yet to be determined; no flow like it has been seen regularly in other types of leukemia, nor has the Philadelphia chromosome appeared in all cases of the chronic myelocytic type.
    Encouraging preliminary results were achieved with two investigative methods of therapy for lung cancer, in which the prognosis has long been poor. Published reports on work with small numbers of patients indicated that high-voltage cobalt-60 radiation prior to surgery made operations possible in some cases originally deemed inoperable, and that combined radiation and treatment with a drug, AB-132, brought about marked regression of inoperable cancer. Both approaches are being studied in larger groups of patients.
    New evidence that exposure of pregnant women to X-rays in diagnostic doses makes their children’s risk of dying from cancer abnormally high came from a survey of births in 37 large hospitals from 1947 to 1954.
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    One of the year’s outstanding accomplishments by a grantee won recognition from scientists everywhere for its significance in the understanding of one of the basic phenomena of life—the immune response, which helps protect man against disease and causes him to reject transplants of tissue from any donor except an identical twin.
    Institute of Dental Research
    Laboratory research reaffirmed previous findings that, as an infectious and transmissible disease, experimental dental decay is far more specific than has been realized, and is highly dependent on the critical interaction between host, diet, and microflora. Knowledge that dental decay could be induced in a strain of caries-inactive hamsters by oral inoculation of a specific strain of streptococcus opened the way for studies to determine the feasibility of vaccines for immunizing test animals against tooth decay. Although it would be premature at this time to apply any of these findings to humans, the Dental Institute plans to direct a major emphasis to clinical studies.
    Studies of nutrition and dental caries emphasized changing concepts of the dietary etiology of dental caries. Focus on the necessity for calcium and the avoidance of sugar was widened to include such diet factors as the quantity and quality of protein, the role of lysine, and the cariogenicity of certain heat-processed food.
    Gains were made in new knowledge of the submicroscopic structure, and physical and chemical properties of teeth. In research on periodontal disease, a better understanding of calculus formation was achieved through use of new techniques of germfree study, electron diffraction, and X-ray and electron microscopy.
    Significant results of studies of hereditary conditions with oral manifestations included: description of a heretofore unrecognized hereditary disease (benign intra-epithelial dyskeratosis) affecting the conjunctiva and the soft tissues of the mouth; description of a new neurological condition inherited as a recessive trait which, in addition to causing spasticity and certain skin changes, also causes defects of speech and chewing; and clarification of mechanisms of abnormal oral development based on longitudinal twin studies and analysis of family data.
    A new clinical program was launched in a multidisciplinary approach to physiological studies of laryngeal and pharyngeal anatomy and function in children, and cleft-palate patients with speech and feeding disorders.
    GRANTS AND AWARDS
    Basic studies bearing on periodontal disease with special emphasis on the physiology of occlusion and the responses of tooth-supporting
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    tissues to traumatic or other injurious influences are being pursued by grantees at Eastman Dental Dispensary, Rochester, N.Y. Grantees at the University of Kentucky Medical Center are studying chromosomal abnormalities as possible causes of a cleft palate in association with one or more unrelated physical defects, and the distribution of such genetic defects in families of children with cleft palate.
    Increased grants were made to non-Federal institutions to train clinical and basic science personnel for research, and support was continued to dental schools for training undergraduate dental students to work with chairside assistants.
    Heart Institute
    In 1962, the attack on the complex of disorders of the heart and blood vessels was accelerated by strengthened programs of the National Heart Institute in support of research and training, and the aid provided, through its appropriation, for community programs.
    In atherosclerosis, the complicated processes of fat metabolism were the focus of productive investigations, and cholesterol continued to receive much attention. Heart Institute studies have defined the probable sequence of steps involved in cholesterol synthesis and identified the intermediate products evolved; this basic knowledge has been of notable importance and current pertinence with relation to cholesterol-lowering drugs.
    Recent findings in other basic studies suggest that the body may regulate its serum lipid levels through nerve, hormonal, or other mechanisms that affect triglyceride synthesis or breakdown, and that one of the most important regulatory factors may be glucose. Glucose appears to be essential to the synthesis of triglycerides, the form to which fatty acids absorbed from the circulation or synthesized from other substances are converted for storage in adipose tissue. Without glucose, triglycerides broken down to release their fatty acids to supply metabolic fuels could not be replaced.
    In hypertension research, the study of amines received much attention since a number of these substances are powerful stimulants and blood-vessel constrictors, and several are thought to be involved in the mechanisms by which the body regulates blood pressure. One of these, norepinephrine, is of particular interest because it seems to be the key to the action of many drugs now used to treat hypertension.
    Alpha methyl dopa is a new drug, still in the experimental stages, that appears to act by blocking the storage sites of norepinephrine at nerve terminals. Findings reported during the year suggest that the drug may have advantages over other blood-pressure-reducing agents.
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    Questions of toxicity and tolerance have not yet been completely answered, however.
    Another experimental blood-pressure-lowering drug undergoing clinical tests is MO-911.
    Among advances in diagnosis of heart attacks was the modification and improvement of precordial scanning as a simple and sensitive technique for detecting left-to-right shunts, one of the most frequently occurring signs of congenital heart disease. The technique has also been adapted to detect acquired valvular defects and for measuring heart output, although catheterization is required for these.
    Findings from epidemiology studies further defined factors associated with an increased risk of developing coronary heart disease. Among these factors are an elevated serum-cholesterol level, elevated blood pressure, enlarged left ventricle, cigarette smoking, and low vita] capacity. Accumulated data indicate that combinations of factors increase susceptibility, so that those at high risk can now be determined to some degree.
    GRANT-SUPPORTED RESEARCH
    Successful long-term use of implantable artificial cardiac pacemakers in patients with Stokes-Adams syndrome was reported by scientists at Harvard University and at the University of Minnesota. In this syndrome, the heart’s conduction system—which originates and transmits the electrical impulses causing the heart to beat—is damaged by disease and partial or complete heart block may result. Regular heart rhythm can be restored with use of an artificial pacemaker, set at a pace suitable for normal activity, and then implanted under the skin to remain until its batteries require replacement in about five years.
    A significant achievement was the development by investigators at Marquette University of instrumentation and techniques for accurately locating the heart’s specialized conduction system during open heart operations.
    Investigators at Jefferson Medical College reported that blood stored in acid-citrate-dextrose solution, the most widely used anticoagulant and preservative for banked blood, can be restored to a nearly normal biochemical state by a combination of anion and cation exchange resins.
    Serum cholesterol levels can be reduced by thyroid hormones, but the doses needed to maintain low serum cholesterol also increase basal metabolic rate and may cause angina pain in heart patients. In doing studies at the University of Louisville it was found that several synthetic analogs, near relatives of thyroxine, appear able to hold serum cholesterol down without elevating basal metabolism in patients with normal thyroid function.
    216
    Department of Health, Education, and Welfare, 1962
    Angiotensin II, a blood-vessel constrictor that results from the action of a kidney enzyme called renin, has been suspected of playing an important role in essential hypertension, since blood angiotensin levels have been reported higher in patients with high blood pressure than in others. Findings from recent radioactive tracer studies by scientists at Mount Sinai Hospital, New York City, indicate that the metabolic inactivation of angiotensin proceeds more slowly in hypertensives than in normotensives, and may account for the higher concentrations found in hypertension.
    Improved techniques for accurately locating clots and lesions obstructing coronary arteries and for preventing constriction of small blood vessels at the site of surgical incision have increased the safety and effectiveness of surgery to remove such atherosclerotic obstructions.
    Impressive results continued to be reported by investigators at Baylor University and other institutions in surgical treatment of certain clots and atherosclerotic deposits that prevent an adequate supply of blood from reaching the brain.
    Institute of Mental Health
    Progress in the field of mental health has proceeded at an accelerated pace during recent years and important advances were made during the past year in the various Institute programs. The Institute’s activities have included both those designed to develop more effective methods of treating mental and emotional disorders, and those which attempt to find ways of preventing such disorders.
    The Institute’s program was given impetus this year through the wide public interest aroused by Action for Mental Health, the Report of the Joint Commission on Mental Illness and Health. The Report, sharply focusing attention on needs in mental health and the promise for control of the mental disorders that lies in knowledge now at hand, has stimulated the initiation of new programs for action at community, State, and Federal levels. Its impact will increasingly be felt on mental health programs in the years ahead.
    GRANT-SUPPORTED ACTIVITIES
    The Institute’s grant program is designed to support a complex variety of research programs, mental health projects and training activities—all ultimately aimed at the solutions of mental illness in its many forms.
    More than a third of the grant program was concerned with the major psychosis, schizophrenia, which accounts for more than half of all patients hospitalized for mental disorders in the United States. Research covered a wide range of studies, including testing of prom
    Public Health Service
    217
    ising therapeutic measures; the collection and analysis of trends in hospital populations, as well as programs for advanced training of personnel; and the development of hospital, clinic, and community services for diagnosis, treatment, and rehabilitation.
    Over 18 percent of grant funds were directed to the important problems of mental retardation, juvenile delinquency, and other abnormal and behavioral problems.
    Grant support in the area of alcoholism and drug addiction has made possible the relocation at Rutgers of the Center of Alcohol Studies, and such investigations as thyroid therapy for acute alcoholic stupor, studies on detection of problem drinkers among industrial employees, and programs for the rehabilitation of drug addicts.
    The past year was a period of major development in the Institute’s international research grant program, and a continuing expansion of this program is seen for the next several years.
    I he Psychopharmacology Service Center was engaged in stimulating and facilitating grant support of research in studies of drugs used in mental illness.
    To facilitate dissemination of information on developments in psychopharmacology, an abstracting service was initiated. The publication, which provides coverage of world-wide current literature in this field, fills an important need in bringing together relevant information on drugs for the benefit of clinicians and scientists approaching the subject of psychopharmacology through many disciplines.
    BASIC AND CLINICAL INTRAMURAL RESEARCH
    Extensive research continued in the synthesis, degradation and distribution of the biogenic amines in the body and brain, in an effort to determine whether abnormalities in the metabolic processes may play some role in the etiology of mental illness, particularly schizophrenia.
    The studies begun last year of factors affecting mobilization of free fatty acids (FEA) in schizophrenic and normal patients were extended. The results indicate that some schizophrenics do not exhibit a normal fall in FFA in response to insulin.
    A major continuing project in the area of schizophrenia research is the study of families. NIMH investigators, for example, have found that the presence and variety of schizophrenic illness can be predicted from the form of thinking in the rest of the family in which the patient has developed. The findings suggest an environmentally determined rather than a gene-determined interpretation of schizophrenic thought disorder.
    Testing the addiction liabilities of new narcotic drugs remains an important part of the Institute’s research program at the Addiction
    665171—63---15
    218
    Department of Health, Education, and Welfare, 1962
    Research Center, Lexington, Ky. A search for analgesic compounds with effects differing from morphine has been the subject of intensive research at the Center in the past years. A new series of compounds, the indanes, has now become available. These indanes differ from agents previously studied in that they are analgesic in animals and in man.
    The intermediate metabolism of psychoactive drugs, and the individual differences in their handling in the body, represents a principal research interest of the Institute’s Clinical Neuropharmacology Research Center at St. Elizabeths Hospital, Washington, D.C.
    COMMUNITY SERVICES AND PROGRAM DEVELOPMENT
    The development of comprehensive community mental health programs was encouraged through grants-in-aid to the States, professional and technical assistance to States through consultation, surveys of special mental health problems, conferences, demonstration projects, and support of research projects designed to develop improved methods of diagnosis, care, treatment and rehabilitation of the mentally ill.
    The Institute also extended its program development activities in special problem areas of significance for mental health—rehabilitation, aging, juvenile delinquency, mental retardation, suicide prevention, alcoholism, drug addiction, among others.
    The Institute played a major role in activating a large demonstration project, Mobilization for Youth, designed to attack the problem of juvenile delinquency on the lower east side of Manhattan.
    TRAINING
    The Institute’s training programs were widened this past year through increased support for psychiatric training of general practitioners, including both specialized residency training, and postgraduate education in psychiatry to enhance general practice skills.
    Institute of Neurological Diseases and Blindness
    To a decade of progress, observed by the Institute this year, may be added important gains in the Institute’s programs toward increased prevention, control, and cure of disabling neurological and sensory disorders.
    COLLABORATIVE PERINATAL RESEARCH
    Useful and encouraging clues have begun to emerge from the Institute-supported mother-child study aimed at shedding light on the relationship between events of pregnancy, birth, and the first month of life, and the occurrence of brain-damaging disorders of infancy and childhood.
    Public Health Service
    219
    Analysis of information collected on 7,500 of the more than 25,000 pregnancy studies to date at the 15 collaborating medical centers has confirmed that expectant mothers who smoke are more likely to give birth to a premature infant than the nonsmoker. This finding is significant because prematurity is an important factor in brain damage and infant deaths.
    Prematurity has also been linked to some symptomless infections in the expectant mother. This finding underscores the need for improved diagnosis and early treatment of maternal infections during pregnancy.
    Special related studies conducted at some of the collaborating hospitals have also proved fruitful. For example, an Institute grantee developed a simple, inexpensive screening test which permits early detection of the brain-damaging but treatable disorder known as phenylketonuria, or PKU.
    PRIMATE RESEARCH IN PUERTO RICO
    The broad study of perinatal problems in humans is paralleled by studies of monkeys at Institute laboratories in Puerto Rico. Now in its sixth year of operation, the project has established conclusively that birth asphyxia causes brain damage resulting in syndromes resembling cerebral palsy and mental retardation in humans. Current research is aimed at developing means of prolonging survival of asphyxiated monkeys and preventing brain damage.
    MULTIPLE SCLEROSIS, MUSCULAR AND NEUROMUSCULAR DISEASES, EPILEPSY
    Further strides were made toward understanding the biochemical process by which myelin, the protective sheath around nerve fibers, is formed and is also caused to disintegrate. Observations of diseases in animals which have strikingly similar resemblances to multiple sclerosis support the theory that this and other disorders which rob nerve fibers of this protective sheath may be due to a latent viral agent. Also highly suspect as a possible cause is auto-immunization or sensitivity to certain substances normally occurring in brain tissue.
    This year scientists identified a substance which induces an experimental disease in animals (allergic encephalomyelitis) as a small basic protein found in the nerve sheaths in the brain. Moreover, this same substance not only induced the disease but was utilized to suppress it as well. In similar studies of allergic encephalomyelitis in tissue culture, grantees helped demonstrate that an antibody-like factor in the blood of multiple sclerosis patients destroys myelin.
    Developments in the intriguing field of immunology, especially in regard to auto-immune diseases, have also had an impact on neuromuscular research. Preliminary results reenforce earlier predictions
    220
    Department of Health, Education, and Welfare, 1962
    that myasthenia gravis might be an auto-immune disease. Grantees have determined that a constituent of serum, called serum complement, from myasthenic patients varies in concentration in relation to the severity of the symptoms. The constituent is involved in immune reactions of the blood.
    Encouraging preliminary reports were made on the use of a new anticonvulsant drug, R594, in children with certain types of epilepsy previously resistant to drug therapy. In other studies of the clinical course and therapeutic evaluations, grantees have found brain-wave recordings to correspond to the type, degree and localization of seizure.
    VISION, HEARING, HEADACHE
    Research progress in the Institute’s laboratories and at other research centers promises to aid in controlling and treating eye disorders which affect millions, especially older persons. In glaucoma, the second leading cause of blindness in the United States, Institute scientists identified an important enzyme in the fluid formation within the eye which causes increased pressure. This basic discovery is expected to pave the way to the clinical use of a new type of drug to inhibit formation of the excess fluid and prevent damage to eye tissue.
    Last year an Institute trainee discovered a cure for herpes keratitis, or “winter pink eye,” by applying an antiviral drug to the treatment of this common inflammatory eye disorder. The treatment rapidly cleared the acute inflammation without scarring the cornea. When the treatment is perfected, many people may be saved from blindness.
    Outstanding basic research by an Institute grantee has established the mechanisms by which sounds received in the inner ear are conveyed to the brain. These findings make it possible to determine whether deafness is caused by damage to the ear or to the portion of the brain concerned with hearing.
    To the countless sufferers from migraine headache, the release in 1962 of a research drug to physicians generally for prescription use brought hope that effective prevention was at hand. This drug was carefully checked by a “double-blind” technique by an Institute grantee and other specialists, and its minor side effects cautiously evaluated. Called methysergide maleate, the compound may not be used for all patients, but under medical guidance is proving helpful for many patients as a preventive.
    Grantee findings that persons subject to migraine headaches had about twice the incidence of abnormal brain-wave patterns as other persons encouraged treatment with anticonvulsants. The reported results have been favorable in 80 percent of a highly selected group of cases.
    Public Health Service
    221
    Division of Biologies Standards
    This Division is responsible for the administration of control measures for all biological products used for the prevention and cure of disease in man. These products—the vaccines, antitoxins, therapeutic serums, and human blood and its derivatives—are developed for the most part from potentially pathogenic microorganisms. Rigorous control procedures are essential in their preparation to reduce to a minimum the hazards which might occur in processing, and to ensure final products of satisfactory potency.
    Effective administration of these responsibilities requires the design and development within a research context of adequate and practical standards for the production and testing of biologies, careful surveillance of production methods, and the continuous improvement of testing procedures. Thus, the varied research activities of the Division’s six laboratories—Bacterial Products, Biophysics and Biochemistry, Blood and Blood Products, Control Activities, Viral Immunology, Virology and Rickettsiology—are essentially product-oriented. Their scope, direction, and intensity are dictated by the need to provide essential information for the formulation of requirements and regulations governing the licensing and release of biological products.
    An appreciable part of the Division’s research this year has been devoted to work on the adventitious simian virus, SV-40, found in some kidney-tissue cultures from which live and killed polio vaccines and adenovirus vaccine are prepared. Since, with few exceptions, the role of animal viruses in the production of human disease is unknown, their exclusion from all commercial vaccines is required by the Public Health Service. In addition to devising elaborate test systems for the detection of SV-40 during the processing of the vaccines, the Division is continuing to study the pathogenesis of the virus for man, monkeys, and other laboratory animals; the development of simpler tools for working with it; and the exploration of its ecology in monkeys in their native habitat as well as in the laboratory.
    During the year, the solution of problems relating to the licensing of live poliovirus vaccine was of pressing urgency. This involved working out delicate testing methods to assure the genetic stability of the three virus strains, as well as developing techniques for detecting the presence of SV-40. These problems were satisfactorily resolved, and in March, Type 3 was licensed, thereby making available the complete series of oral vaccines for protection against all three types of polio.
    The development this year of regulations for measles vaccines necessitated the formulation of an extensive array of controls covering three products—inactivated measles vaccine, live measles vaccine, and
    222
    Department of Health, Education, and Welfare, 1962
    standardized gammaglobulin. Concurrently, the Division is developing standard reference materials which will serve to correlate laboratory results so that the potency of the vaccines produced by individual manufacturers can be evaluated on a sound common basis.
    Throughout the year, the Division’s Laboratory of Blood and Blood Products carried on an extensive investigation of alleged violations of the Biologies Law in the sale of plasma and whole blood. The evidence, involving the updating of whole blood and the processing of plasma for sale without license, was turned over to the U.S. Department of Justice.
    At the close of the fiscal year, 288 biological products were licensed under the provisions of the Public Health Service Act for commercial use in this country and abroad.
    Division of General Medical Sciences
    The primary responsibility of this Division is the administration of NIH grant and fellowship programs for research and training in the sciences basic to medicine and biology and in certain clinical areas which encompass or cut across categorical Institute programs. It administers certain other grant programs also, and the NIH centers for Aging Research and for Research in Child Health.
    RESEARCH GRANTS
    Grant-supported research has indicated that the genes of all living vertebrates may have a common evolutionary origin, so that deviation in the molecular structure of a gene actually constitutes a kind of “molecular disease.” This approach to genetics may lead to practical methods of fighting diseases which originate in the germ plasm.
    The hitherto mysterious role of the thymus gland is being analyzed. This has bearing on such varied things as skin grafts and growth. Here is a new approach to transplantation of organs as well as to stimulating healthful growth and inhibiting harmful growth.
    Four different patterns of defective bilirubin metabolism have been described in jaundiced premature infants, and these have been tied to the patterns for recovery.
    RESEARCH TRAINING GRANTS
    Grant funds have been made available to research institutions to extend and improve graduate research training. Fellowships at various levels have been awarded to promising scientists and teachers. The Division is providing training aid in 20 different basic fields and for 596 separate programs.
    THE GENERAL CLINICAL RESEARCH CENTERS
    This period has seen the emergence of the General Clinical Research Center as a genuine research tool. By the end of the 1962 fiscal year,
    Public Health Service
    223
    56 awards had been made and 25 centers were open for patients. In addition to general centers for study of metabolic diseases, nutritional ailments, surgical conditions and other problems in adults, centers have been established for study of children’s diseases and even for the special study of prematurity.
    Reports from the basic scientists and physicians associated in the Centers indicate new leads in muscular dystrophy; knowledge of a new inborn error of metabolism; a new method for the use of a transistorized pacemaker for cardiac stimulation, a technique for utilizing the artificial kidney on a regular basis over a period of years, and a method for the determination of the life span of human blood platelets.
    CENTER FOR RESEARCH IN CHILD HEALTH
    In 1961, a Center for Research in Child Health—designed to achieve greater understanding of the pattern of human life and development— was established in the Division. The Center will be a focal point for research in health problems of childhood and adolescence, infant mortality, mental retardation, congenital abnormalities, and other conditions which primarily afflict children.
    CENTER FOR AGING RESEARCH
    The Center for Aging Research has encouraged research programs in the field of aging through the Division of General Medical Sciences and the Institutes, and has also provided a central clearing house for research information in the entire field of aging.
    Grants for research in aging continue to increase, now constituting some 300 projects.
    GENERAL RESEARCH SUPPORT GRANTS
    General research support grants provided stable allotments to a substantial number of medical research institutions for developing and maintaining well-balanced programs of general research and research training. These broad institutional grants can be used with great flexibility within the research framework and within prescribed objectives to provide resources and personnel for new projects.
    SPECIAL RESOURCE CENTERS
    Research facilities of a highly complex type which can be used for several colleges or several departments within a parent institution constitute Special Resource Centers. If, for example, a university has dozens of projects which would benefit from the presence of a computer center, a special research resource facility for this can be established with grant funds. Such centers are designed to facilitate the many varying aspects of research, in broad scope or fine detail.
    224	Department of Health, Education, and Welfare, 1962
    Division of Research Grants
    The Division of Research Grants continued to administer and coordinate the grant and award program of the National Institutes of Health, and to provide both technical assistance and review and appraisal services for the other grant awarding units of the Public Health Service. Functions included processing and scientific or technical review of grant applications, and the providing of fiscal, statistical, and information services.
    In response to the mounting volume of applications for grants, the number of study sections—whose primary function is technical review of applications—was increased from 40 to 45.
    During the year the Division undertook to improve financial management of grants through the strengthening of its policies and the coordination and streamlining of accounting procedures to be followed by investigators and budget officers in grantee institutions.
    A major contribution to medical and scientific communication was the Division’s first issue of an annual subject-matter index of active PHS research grants.
    A new “Grants Associate” program, designed to recruit and train professional staff for Institute and Division grants branches and for DRG, was established.
    The Division published a survey of the current professional status and geographic distribution of 2,917 former PHS fellows. The survey showed that approximately 87 percent of former fellows remain engaged in some research activity, and that approximately 67 percent spend some time in teaching.
    Division of Research Services
    The NIH research investigator looks to the Division of Research Services as a central source for biomedical computing and data-proc-essing services; for studies of environmental conditions having a bearing on his work; for planning and consultation on laboratory and structural design; for noncommercial scientific instruments, fabrication of necessary equipment, and plans for laboratory automation; for supplies of laboratory animals, glassware, and media; for visual documentation of research findings by means of exhibits, motion pictures, and other aids; and for central and satellite library services.
    Pioneering work in germfree technology begun by the Division in 1954 led to the establishment of germfree laboratories in three of the Institutes. Most recently, in anticipation of the time when scientists will demand genetically defined animals, the Division has established foundation breeding colonies leading to the routine issuance of germfree and specific pathogen-free animals.
    Public Health Service
    225
    The NIH Animal Center at Poolesville, Md., is slated to become a model installation. The present schedule calls for completion of a farm animal building, kennel building, power plant, roadways, fencing, and utilities in 1964.
    Far-ranging improvements leading to increasingly useful library and bibliographic services are under way. Satellite libraries have been inaugurated to serve the specialized information needs of geographically distant groups.
    An ad hoc steering committee is studying the long-term needs of the Institutes for computer systems and data processing. The high-speed digital computer acquired in 1961 was operating near the two-shift level at the end of the fiscal year, with an almost equal balance between research, extramural, administrative, and epidemiological program applications.
    Clinical Center
    To meet the demand on all central services stimulated by an increase of 1,500-bed days over its predicted 75 percent utilization of available bed days, the Clinical Center, in this period, introduced automation and expanded services wherever feasible.
    Clinical Center staff, collaborating with NHI and NINDB staff, expended much effort on preparations for the opening of the new surgical wing, scheduled for late fiscal year 1963. This unique facility will offer opportunities to observe parameters of surgery to a degree never before possible.
    The Clinical Pathology Department, by adapting advanced research laboratory techniques and developing standards of precision, not only provided services crucial to the research patient’s welfare, but also aided the entire field of medical diagnosis. The use and further development of automatic data computers illustrate the Pathology Department’s techniques for solving the problems stemming from the large number of laboratory tests now available to the clinical investigator.
    226
    Department of Health, Education, and Welfare, 1962
    Table 1.—Statement of appropriations, authorizations, and obligations, Public Health Service, fiscal year 1962
    [In thousands]
    Appropriations	Funds available for obligation				Total funds available	Amounts obligated
    	Appropriations and authorizations	Net transfers between appropriations	Repayments for services	Prior year unobligated balances
    Total		$1,392,485	0	$71, 985	$159,478	$1,633,437	$1,323,267
    	1	■	■■	■	—
    Appropriations, PHS		1,391,977	0	71,985	159,197	1,623,159	1,314,311
    Buildings and facilities		18,230			5,027	23,257	2,171
    Accident prevention	 Chronic diseases and health of the	3,616	—	31	—	3,647	3,574
    aged	 Communicable disease activities	10,955	$2,000	74	—	13,029	10,585
    (1962)	 Communicable disease activities	9,988	—	1,030	—	11,018	10,956
    (1961 and 1962)	 Community health practice and re-	—			892	892	747
    search		24,331	-2,000	16		22,347	21,958
    Control of tuberculosis		6,493		9		6,502	6,463
    Control of venereal diseases		6,000				6,000	5,985
    Dental services and resources		2,500	-100			2,400	2,293
    Nursing services and resources		7,673	-32	4		7,645	7,553
    Hospital construction activities
    (1962)	 Hospital construction activities	1,772						1,772	1,766
    (1962-63)	 Hospital construction activities	209,728				209, 728	62,849
    (1961-62)		8,590			124,515	124,515	124,423
    Air pollution	 Milk, food, interstate, and com-		—	7	—	8,597	8,283
    munity sanitation..			7,422		235		7,657	7,595
    Occupational health		3,970		16		3,986	3,930
    Radiological health		 Water supply and water pollution	10,502	-20	829	—	11,311	11,230
    control			 Grants for waste treatment works	20,304	-34	505		20,775	19,383
    construction	 Grants for waste treatment works	80,645		—		80,645	57,996
    construction (1960-62)	 Grants for waste treatment works				1,101	1,101	1,098
    construction (1961-62)....			1 50,009		6, 574	6,507	6,507	6,507
    Hospitals and medical care						56,583	56,875
    Foreign quarantine activities (1962).	6,082	-734	376		5,724	5,641
    Foreign quarantine activities (1962-
    63)	 Construction of Indian health facili-		734	—		734	563
    ties.			8,285			4,498	12,783	7,018
    General research and services, NIH. National Cancer Institute (1962)		127,589 142,738		—	26	127,589 142,764	118,157 117,660
    National Cancer Institute (1961-63).	108,838			692	692	385
    Mental health activities				72		108, 910	108,084
    National Heart Institute (1962)		131,862		18		131,880	110,867
    National Heart Institute (1962-63) .. National Institute of Dental Re-	1,000		—		1,000
    search		 Arthritis and metabolic diseases ac-	17,335		—		17,335	15,103
    tivities	 Allergy and infectious diseases activi-	81,802	—	391	—	82,193	79,318
    ties (1962)	 Allergy and infectious diseases activ-	56,074	-750	12	—	55,336	54,013
    ities (1962-63)	 Neurology and blindness activities..	70, 762	750	1		750 70,763	658 62,987
    Grants for cancer research facilities.. Gra nts for construction of health re-	5,000				5,000	5,000
    s earch facilities.		 Sc ientific activities overseas (special	30,000	-	—-		16	30,016	30,011
    foreign currency program)		9,000			3,679	12,679	3, 915
    National health statistics	 Operations, National Library of	4,642	—	171	—	4,813	4,658
    Medicine...		 Retired pay of commissioned offi-	2,066	-	—-	14	—	2,080	1,870
    cers			 Salaries and expenses, Office of the	32,360		—		2,360	2,360
    Surgeon General	 Construction of mental health, neu-	5,374	186	323	-	-	5,883	5,789
    rology research facility						12,128	12,128	406
    1 Supplemental appropriation bill pending.
    3 Does not include $17,000 to be deappropriated.
    Public Health Service
    227
    Table 1.—Statement of appropriations, authorizations, and obligations, Public Health Service, fiscal year 1962—Continued
    [In thousands]
    	Funds available for obligation
    Appropriations	Appropriations and authorizations	Net transfers between appropriations	Repayments for services	Prior year unobligated balances	Total funds available	Amounts obligated
    Indian health activities. _			3 $53,007		$901		$53,908	$53,596 8,104
    Hospital and medical facility re-	10,000				10,000
    Bureau of State Services manage-			5,026		5,026	5,005
    National Institutes of Health management fund				34,613		34,613	33,734
    General research support grants, NIH					20,000		20,000	20,000
    Civil defense medical stockpile ac-	35,433				35,433	24, 507
    Consolidated working fund, HEW,			199	$116	315	165
    Consolidated working fund, HEW, PHS		—			538		538	517
    Appropriations, special project funds made available by other agencies						9,489	8,489

    Salaries and expenses, Bureau of Prisons (transfer to HEW, PHS). American Sections, International Commissions, State (transfer to HEW PHS) 		-					2,457 93	2,455
    						90
    Salaries ’ and 'expenses, Office of Emergency Planning (transfer to HEW PHS) 						115	114
    Research and development, Office of Emergency Planning (transfer tn HEW PHS)							3
    Civil Defense, Department of Defense (transfer to HEW, PHS)						1
    Farm labor supply revolving fund, Bureau of Employment Security					430	410
    Inter American social economic program (transfer to HEW)							588	487
    Civil defense and defense mobilization, functions of federal agencies, Office of Emergency Planning (transfer to HEW, Office of Secre-					502	501
    Administrative expenses, economic assistance, Executive (transfer to HEW)								39	38
    Development grants, economic assistance, Executive (transfer to HEW)								3,709	3,003
    Supporting assistance, economic assistance, Executive (transfer to HEW")	...	---					580	432
    Contingency fund, economic assistance, Executive (transfer to HEW)								405	400
    Military assistance, Executive					51	51
    Consolidated working fund, DHEW Office of the Secretary .					516	508

    Gift funds donated for general and specific purposes		508.2			281.5	789.7	467.0

    Contributions, Indian health facili-	288.9			178.5	467.4	283.2
    Public Health service unconditional (rift fund			35.3			30.8	66.1	25.9
    Public Health service conditional (Tift fund			10.9			10.9	21.8	12.1
    Patients’ benefit fund, Public	40.0			19.1	59.1	43.3
    Special statistical work, vital sta- fifties		 -	133.1			42.2	175.3	102.5

    3 Includes $432,000 contract authorization, and excludes $435,000 liquidation of prior contract authorization.
    228
    Department of Health, Education, and Welfare, 1962
    Table 2.—PHS total paid employment by Bureau and Division, as of June 30, 1962
    Full-time	Part-time and intermittent
    Grand	United States
    total	.________________ Territories	Advisers
    Total	and	Foreign	Total and
    Washing-	possessions countries	consultants Other
    Total ton metro- Outside
    politan area
    Public Health Service—All Bureaus---- 32,638	31,309	30,968	13,522	17,446	149	192	1,329	280	1,049
    Office of the Surgeon General-------- 1,286	1,269	1,185	1,053	132	1	83	17	10	7
    Immediate Office of the Surgeon General___ 58	58	58	58
    Division of Finance_.________________________ 148	148	148	147	1 __ZZZZZZZ
    Division of Administrative Services_._________ 136	136	136	89	47	.
    Division of Public Health Methods____________ 56	55	54	54 ______. _ .	i	1	1
    Division of International Health__________ 64	63	63	63	1	i
    Division of Health Mobilization___________ 142	136	136	96	40	6	3	*3
    Office of Personnel-------..........................	172	169	169	169	_	3	_	3
    Office of Information____________________ 35	33	33	33 ______________ 2	2
    National Center for Health Statistics_____ 326	322	322	321	i	4	4
    Regional offices-------------------------- 38	38	38 ... .	38	.	~	'
    Details to AID------------------------------- 79	79	11	6	5	68’
    Details to Peace Corps________________________ 22	22	7	7	1	14
    Other details_________________________________ 10	10	10	10 ZZZZZZZZZZ___________ZZZZZZZZZZ ZZZZZZ.ZZZZZ ZZZZZZZZZZ
    Bureau of Medical Services----------- 14,368	13,723	13,623	1,390	12,233	ST 66	645	1	644
    Office of the Chief___________________________ 31	31	31	30	1
    Division of Foreign Quarantine--------------- 709	662	581	41	540	16	65	47	47
    Division of Hospitals------------------------ 6,954	6,577	6,559	299	6,260	18 . .	377	'	377
    Freedmen’s Hospital-------------------- 892	869	869	869	_	__ 23	23
    Division of Indian Health-------------------- 5,387	5,193	5,193	123	5,070 ______ 194 "T 193
    Details to Bureau of Prisons ..._A___________ 283	283	283	18	265 __________
    Details to Bureau of Employees Compensation___ 11	8	8	4	4 _ZZZ_ZZZZZZZ ZZZZZZ~ZZ 3	3
    Details to U.S. Coast Guard.. ..............  91	90	90	5	85 ZZ ZZZZ -~ZZ	1	1
    Details to other agencies_L______.............	10	10	9	18 ZZZZZZZZZZZZ i"________________
    Bureau of State Services------------- 6,715	6,440	6,415	1,913	4,502	17	8	275	130	145
    Office of the Chief--------------------- 528	516	516	200	316 ______________ 12	2	10
    Public Health Service
    229
    Community Health
    Division of Accident Prevention___________________________ 167	166	166	93	73 ______________ 1 _____________ 1
    Division of Chronic Diseases___________________ 631	601	599	327	272	2 _______ 30	24	6
    Communicable Disease Center____________________ 2,058	1,997	1,983	97	1,886	14 ______ 61	11	50
    Division of Community Health Services_____________________ 204	203	203	137	66 ______________ 1 _____________ 1
    Division of Dental Public Health and Resources____________ 276	188	188	115	73 ______________ 88	51	37
    Division of Hospital and Medical Facilities____ 186	185	185	118	67 ______________ 1 _____________ 1
    Division of Nursing____________________________ 87	87	87	63	24 _____________________________________
    Details to other agencies---------------------- 5	5	5	2	3 _____________________________________
    Environmental Health
    Division of Air Pollution______________________ 360	352	352	83	269 ______________ 8	17
    Division of Environmental Engineering and Food	Protection-. 271	266	266	88	178 ______________ 5	2	3
    Division of Occupational Health___________ 176	176	176	45	131 _____________________________________
    Division of Radiological Health________________ 796	774	765	353	412	1	8	22	2	20
    Division of Water Supply and Pollution Control_ 965	919	919	189	730 ______________ 46	37	9
    Details to other agencies_________________ 5	5	5	3	2 _____________________________________
    National Institutes of Health_________ 10,053	9,664	9,532	8,954	578	97	35	389	138	251
    Office of the Director____________________ 1,213	1,194	1,187	1,186	1 _______ 7	19	2	17
    National Cancer Institute__________________ 1,266	1,220	1,217	1,091	126	  3	46	23	23
    National Heart Institute__________________________________ 624	597	592	471	121	  5	27	11	16
    National Institute of Allergy and Infectious Diseases_____ 657	651	608	427	181	36	7	6	2	4
    National Institute of Arthritis and Metabolic Diseases____	599	550	543	541	2	  7	49	38	11
    National Institute of Dental Research________ 241	234	233	230	3	  1	7	6	1
    National Institute of Mental Health________ 1,035	942	939	802	137	  3	93	31	62
    National Institute of Neurological Diseases and Blindness_	612	580	518	513	5	61	11	32	20	12
    Clinical Center___________________________ 1,658	1,606	1,606	1,606 ____________________ 52 ____________ 52
    Division of Biologies Standards___________ 209	209	209	209 ____________________________________________
    Division of Research Grants_______________ 562	536	536	536 _____________________ 26	1	25
    Division of Research Services_____________ 1,229	1,205	1,205	1,203	2 ______________ 24 ____________ 24
    Division of General Medical Sciences______ 143	135	135	135 _____________________ 8	4	4
    Details to other agencies_________________ 5	5	4	4 _______________ 1 ___________________________
    National Library of Medicine__________ 216	213	213	212	1 _______________ 3	1	2
    230
    Department of Health, Education, and Welfare, 1962
    Table 3.—PHS total paid employment by Bureau, commissioned officers, and civil service, as of June 30, 1962
    Commissioned officers	Civil service
    Grand	United States	United States
    total	_______________________ Territories,	______________________ Territories,
    Total	possessions, Total	possessions,
    Washing-	and foreign	Washing-	and foreign
    Total ton metro- Outside countries	Total ton metro- Outside countries
    politan	politan
    area	area
    Public Health Service—Total--- 32,638	4,501	4,363	1,407	2,956	138	28,137	27,904	12,450	15,454	233
    Office of the Surgeon General----- 1,286	190	106	85	21	84	1 096	1 096	977	119
    Bureau of Medical Services-------- 14,368	1,862	1,845	92	1,753	17	12,506	12,402	1,330	11,072	104
    Bureau of State Services---------- 6,715	1,416	1,402	349	1,053	14	5,299	5,281	1,588	3 693	18
    National Institutes of Health----- 10,053	1,031	1,008	880	128	23	9,022	8,911	8 341	570	111
    National Library of Medicine______ 216	2	2	1	1 _______ 214	214	214
    Public Health Service
    231
    Table 4.—Research grants and awards, fiscal year 1962
    Fellowships
    Research projects Research facilities_____________ Training projects Traineeships	Total
    Program	Full-time	Part-time
    Num- Amount Num- Amount Num- Amount Num- Amount Num- Amount Num- Amount Num- Amount her	her	her	her	her	her	her
    Total____________ 15,088 $373,175,879	112 $36,759,841	3,736 $26,780,145	20	$12,960	3,348 $115,245,835	323 $2,825,839 22,627 $554,800,499
    Allergy and infectious diseases. 1,804	33,965,083 _ 193	1,805,908 ______ 170	5,633,481 ________ 2,167	41,404,472
    Arthritis and metabolic diseases____________ 2,756	53,103,397 ________ 142	1,747,729 _______ 332	9,556,342	54	371,694	3,284	64,779,162
    Cancer______________ 1,923	47,646,982	13	4,887,081	243	2,138,793 ______ 220	6,932,165 ________ 2,399	61,605,021
    Dental research______ 412	6,591,614	  101	810,075	  158	4,039,818	  671	11,441,507
    General medical sciences_ 2,366	85,617,614 ____ 1,724 10,866,193	20	12,960	686	30,251,002 ________ 4,796 126.747,769
    Heart______________ 2,604	69,406,141	  490	4,399,490	  377	11,493,113	  3,471	85,298,744
    Mental health...___ 1,724	40,481,055	  718	3,785,940	  1,145	39,374,975	  3,587	83,641,970
    blindness_________ 1,499	36,363,993	    125	1,226,017	  260	7,964,939	269	2,454,145	2,153	48,009,094
    Health research facilities, Division of Research Grants____________ 99 31,872,760 _________________________________________________ 99	31,872,760
    232
    Department of Health, Education, and Welfare, 1962
    Table 5.—Payments to States or localities within States for public health services, fiscal year 1962 1
    [In thousands of dollars]
    Venereal	Chronic Hospital Waste
    disease Tubercu- General Mental Cancer Heart Water diseases and treatment State	special losis health health control disease pollution and health medical works
    projects control	control control of the aged facilities construction
    construction
    Totals__7.__________________	2 $2,569	$3,499	’$14,920	$6,622	$3,389	$4,598	<$4,340	’$4,859	$164,384	$42,103
    Alabama__________________________ 40	80	398	125	77	117	97	115	3,265	1,220
    Alaska___________________________ 1	17	41	52 _______ 4	16 _______ 636	74
    Arizona______________________________ 17	45	132	50	25	1	36	17	1,540	427
    Arkansas_____________________________ 75	53	256	58	44	78	63	62	4,031	870
    California__________________________ 107	252	989	465	240	275	268	356	7,004	1,736
    Colorado______________________________ 3	29	163	66	34	69	44	52	1,750	762
    Connecticut__________________________ 11	34	134	73	36	61	76	38	664	656
    Delaware_____________________________ 11	15	27	66	26	28	48	40	639	379
    District of Columbia_________________ 71	33	42	67	26	47	38	40	605	117
    Florida_____________________________ 106	83	417	164	84	125	107	169	5,458	1,022
    Georgia_____________________________ 234	76	433	145	84	126	109	47	5,800	1,264
    Hawaii________________________________ 1	19	56	67	26	44	36	40	695	331
    Idaho_________________________________ 6	14	91	67	26	51	26	40	998	616
    Illinois____________________________ 218	197	611	298	155	169	149	254	4,895	1,624
    Indiana_______________________________________ 65	349	144	77	113	112	53	3,160	1,101
    Iowa_________________________________  8	32	251	80	29	47	63	45	3,466	572
    Kansas_______________________________ 15	28	196	73	44	59	55	81	2,574	795
    Kentucky_____________________________ 40	87	302	112	61	99	88	89	4,117	1,091
    Louisiana____________________________ 67	71	337	118	67	111	89	43	2,271	1,315
    Maine_________________________________________ 20	100	66	9	16	37	23	1,103	167
    Maryland_____________________________ 35	74	222	98	52	89	89	73	2,999	611
    Massachusetts_________________________________ 86	349	149	95	120	135	135	3,180	1,004
    Michigan_____________________________ 59	131	518	246	127	162	171	198	4,966	1,408
    Minnesota_____________________________ 1	40	298	104	65	78	82	121	3,329	976
    Mississippi__________________________ 31	53	340	93	63	113	81	122	4,695	865
    Missouri_____________________________ 43	82	351	141	85	118	52	153	4,315	633
    Montana_______________________________ 7	18	82	67	21	30	24	23	801	434
    Nebraska_____________________________ 13	20	148	66	31	13	28	20	1,277	341
    Nevada________________________________ 8	12	40	47	5	11	11	25	681	484
    New Hampshire____________________________ 13	57	65	25	19	33 _______ 1,254	175
    Public Health Service
    233
    New Jersey___________________________ 67	96	370	184	100	122	145	144	2,834	1,008
    New Mexico___________________________ 35	30	117	67	26	57	30	40	1,514	805
    New York __________________________  532	330	945	504	273	283	306	418	9,353	1,587
    North Carolina______________________ 114	75	520	171	97	124	133	168	5,946	1,170
    North Dakota_________________________ 11	15	94	67	26	51	26	40	1,473	846
    Ohio _ _____________________________   9	153	661	304	161	197	208	262	5,745	1,287
    Oklahoma_____________________________ 19	45	238	79	51	86	59	93	2,458	1,109
    Oregon _______________________________ 6	30	148	66	25	35	46	22	1,685	773
    Pennsylvania________________________ 117	214	823	362	206	226	240	340	8,484	2,503
    Rhode Island__________________________ 2	19	64	65	26	49	61	40	948	142
    South Carolina_______________________ 83	51	303	94	57	108	82	73	4,783	415
    South Dakota__________________________ 9	13	100	65	9	12	27	15	1,499	180
    Tennessee ___________________________ 87	91	391	133	74	127	103	58	4,882	1,134
    Texas	  142	154	816	323	175	235	192	209	10,646	1,264
    Utah_____________________________________ 13	106	39	6	9	18 -........  312	882
    Vermont _____________________________________ 14	54	67	26	14	26	33	417	403
    Virginia ____________________________ 46	80	330	136	72	76	98	100	6,737	643
    Washington .	  4	45	202	91	47	79	64	62	1,751	792
    West Virginia _______________________ 19	46	190	67	41	65	59	68	1,711	481
    Wisconsin	.	  49	310	128	74	103	97	105	3,992	824
    Wyoming______________________________________ 10	54	24	7	14	18	33	274	289
    Guam____________________________________ 9	11	29	6	6	6 ........  4,727	-------
    Puerto Rico______________________ 33	130	335	96	60	117	28	50	45	496
    Virgin Islands___________________ 6	8	8	29	5	10	5	12 ---------------
    1 Additional amounts as follows were paid during fiscal year 1962: $1,943,000 for the	2	Includes	$974,000 in services and supplies furnished in lieu of cash.
    Public Health Service traineeship program, $6,466,000 for the professional nurse	8	Includes	$6,000 withheld to cover assignment of commissioned officers in	lieu	of
    traineeship program, $1,089,000 to schools of public health for the provision of pub-	cash,
    lie health training, $1,097,000 for project grants for graduate training in public health,	4	Excludes	$252,000 paid to water pollution interstate agencies as follows:	$12,000
    $360,000 for the Public Health Service air pollution training and demonstration pro- to New England Interstate Water Pollution Control Commission, $112,000 to Ohio gram, $502,000 for project grants for training in radiological health, $386,000 for the	River Valley Water Sanitation Commission, $42,000 to Interstate Commission on the
    Cuban refugee health program, $1,486,000 for community cancer demonstration	Delaware River Basin, $59,000 to Interstate Sanitation Commission, $27,000 to Inter-
    and training projects, including $56,000 for personal services in lieu of cash; $491,000 state Commission on the Potomac River Basin, for tuberculosis control projects and $5,000 furnished in lieu of cash, $116,000 for	»Includes $4,000 withheld to cover assignment of commissioned officer in lieu of
    Water Pollution Demonstration Projects, $310,000 for community health demonstra- cash.
    tion projects, $3,192,000 for Alaska psychiatric hospital.
    665171—63----16
    Office of Education
    Highlights of the Year’s Activities
    In 1962 the Office of Education recast its program and structure to increase its effectiveness for helping achieve excellence in education. The redirection has been focused on these principal concerns—that the highest quality educational program of which our Nation is capable be assured through all possible avenues, and that opportunities for desired education be extended to all the people.
    Recognizing the need for trained technical manpower, the high level of unemployment among youth who leave school early, and the nationally pressing need for expanding and improving training opportunities for youth and adults, the Office of Education initiated a reassessment of existing vocational education programs with a view to their adaptation to the needs of the coming decade.
    Following the pattern of successful programs in science and foreign languages, the Office of Education embarked on a project for the improvement of quality in the teaching of English. The combination of curriculum development and improved instructional practice is the objective of the project. The Office also planned a similar program in the social studies and surveyed means by which it might strengthen education in the arts.
    Project English provides an illustration of the more effective coordination of Office and extramural resources. A broad approach to the problem of teaching English has been initiated with specialists of the Office in English, research, and administration working closely together. In this project, instruction at all levels is being considered through study, research, and demonstration in curriculum development and instructional technique. Research contracts in colleges and universities are coordinated with the Office staff work. The multilat
    235
    236
    Department of Health, Education, and Welfare, 1962
    eral approach in the Office has accelerated similar types of cooperation among professors of English, education, and other disciplines within the participating institutions.
    The Office turned its attention also to the relationship of educational and social problems, such as those of education for expanding urban areas and adult literacy. It conducted a comprehensive review of current grant and contract programs in order to assure that they are supporting equal educational opportunity for all, and began to stimulate research and studies related to problems of desegregation, education of migrant children, the disadvantaged, and culturally different youth. It brought together responsible leaders to consider the need for educating the American people more effectively for the attainment of the goals of a free society, and the ways in which American ideals might be given better expression in education.
    As the Federal interest in education has grown, so has the variety of programs and the number of departments and agencies responsible for their operation. Because of its concern that educational institutions be continually strengthened as they participate in Federal programs, the Office of Education laid the foundation for a pattern of relationships with Federal agencies for the purpose of promoting a more coherent Federal educational policy and better coordination of the educational activities of these agencies. This concern with the effects of Federal programs was included in a special study of the Federal Government and higher education, two parts of which were completed during the year.
    These new directions have been accompanied by a change in the Office structure. The organization of the Office, which had largely reflected the levels of education or major grant-in-aid legislation, was revised with the formation of three bureaus concerned with: (a) educational research and development encompassing all levels of education; (&) financial assistance program administration; and (c) international education program administration. This bureau structure will enhance the ability of the Office to concentrate its resources more effectively for the solution of major problems that cut across educational levels. It will promote more uniform administration of financial assistance programs and thereby ease the administrative tasks of the State and local education agencies. It will assure more effective coordination of Office activities in the support of the overseas programs of the Federal Government.
    The reshaping of Office activities has sharpened the accomplishments of the programs with which the Office has been entrusted over the years. Among the latter are financial assistance to improve the quality of education in specialized fields, as in vocational education, mathematics, science and foreign languages; administration of
    Office of Education
    237
    financial aid to students in institutions of higher education; consultative service on a wide range of educational matters; the collection and dissemination of statistics describing the condition of American education, its needs and accomplishments; the advancement of fundamental research for the progress of education; the administration of the large and intricate program of assistance to the Nation’s schools in federally impacted areas. These programs constitute the most substantial portion of the responsibilities placed upon the Office of Education. They are avenues through which the Federal Government contributes to a strengthening of the leadership as well as of the educational programs of the State and local education agencies and institutions of higher education.
    The Office of Education has a responsibility to view from a national perspective the large educational needs that affect the Nation as a whole—the regions, the States, and the communities. It has a responsibility to report such needs and recast its efforts to assist in fulfilling these needs. In 1962, the Office initiated new programs that focused, as its continuing activities focus, on support and supplementation of State, local, and institutional efforts. It has done so with the constant concern that the pluralistic structure of American education be judiciously preserved and strengthened.
    Social Problems and Education
    PROBLEMS OF URBAN AREAS
    As the result of a social and economic revolution leading to urbanization, almost two-thirds of the people of the United States are concentrated in 212 metropolitan areas. This upheaval of home and family and social organization has, of course, brought great problems to the cities. They are problems of education, health, and housing; of sanitation and transportation; of social adjustment and employment; of delinquency and crime. To an extent greater than in the past, the Office of Education is widening its field of vision to recognize more clearly the effects of social-demographic problems on education.
    The changing nature of urban centers is a source of many problems in education. One of the problems has been that of coping with the educational needs and opportunities created by Federal action in such areas as public welfare, public housing, urban renewal, and freeway construction. In December 1961 a group of educators met with the Commissioner of Education to discuss the impact of Federal programs on education, and their meeting led to the May 1962 Conference on the Impact of Urbanization on Education, at which representatives of Federal agencies concerned with public housing, urban renewal, city freeways, child welfare, education and labor, and
    238
    Department of Health, Education, and Welfare, 1962
    youth employment and delinquency met with school board members and superintendents from the 15 large cities that form the Research Council of the Great Cities Program for School Improvement. A valuable opportunity was thus provided for Federal and local officials to discuss and better understand their mutual problems and responsibilities.
    A series of intensive case studies will be undertaken in a limited number of large cities where effective work has been done in coordinating school system planning with the planning and programs of urban renewal and other related urban development projects.
    School facilities planning problems, which exist in every metropolitan area, were the subject of a conference held in the spring of 1962. As a result of this conference, an effort is underway to identify and to analyze the characteristic problems of planning school facilities in metropolitan centers.
    In addition, the financing of urban schools was the subject of a conference called in May which resulted in a study concerned with the improvement of State school fund distribution formulas.
    Two other conferences held in May directly attacked the problem of teaching hard-to-reach youngsters: “Teaching Children and Youth Who are Educationally Disadvantaged,” and “Improving English Skills of Culturally-Different Youth in Large Cities.” At these meetings there was a review of promising efforts in the field, identification of significant problems hindering progress, and projection of new approaches to the problems.
    The high rate of mobility of families has often contributed to a breakdown in the school-community rapport so necessary to the success of the school program. The need to identify, attract, and develop sources of support and leadership among new residents is recognized by a current project on the improvement of school-home programs in disadvantaged neighborhoods in selected large city school systems. Still another study, a cooperative research project, is designed to evaluate the effectiveness of all-day neighborhood schools in New York City. When completed, these studies may provide information concerning a more effective educational approach to culturally deprived children.
    The Office of Education has also participated in the joint task force established by the Department of EEealth, Education, and Welfare and the Housing and Home Finance Agency to promote concerted and improved health, education, and welfare services in public housing projects and urban development areas. This joint task force is designed to help public housing families on relief rolls work their way out of dependency.
    Office of Education
    239
    FREEDOM AND WORLD UNDERSTANDING
    In March 1962 approximately 140 leaders in American education met at the Office of Education to consider the state of American education in the light of the traditional ideals of freedom and the present need for achieving a greater understanding of other cultures, and to discuss methods of educating more effectively for the attainment of the goals of a free society. This conference on “The Ideals of American Freedom and the International Dimensions of Education,” was addressed by the Secretary of Health, Education, and Welfare, the Assistant Secretary of State, and the Commissioner of Education. Their addresses and a summary of the salient ideas evolved from the deliberations of several committee sections have been published under the title, Education for Freedom and World Understanding. Discussion at the conference was characterized by the acknowledgment of shortcomings and an eagerness to strengthen and improve the educational resources of the United States. The conferees sought to define that common core of ideals which should command the allegiance of all Americans, and to discover ways and means to give those ideals more effective expression in education.
    EQUAL OPPORTUNITY FOR EDUCATION
    On March 30, 1962, the Commissioner of Education announced before a subcommittee of Congress plans for a clearinghouse on the educational problems of school desegregation. The establishment of this clearinghouse in the Office of Education provides a means for disseminating to interested citizens reliable information on educational practices used successfully by various school systems. Professional advice of the highest quality can thus be made available to the community, and significant research on the educational implications of desegregation can be stimulated. The clearinghouse will become active in fiscal year 1963.
    Further, the Office of Education has concerned itself with the matter of civil rights and education. All colleges and universities conducting institutes for high school language teachers and guidance counselors under titles V and VI of the NDEA starting in 1962-63 have agreed that in selecting individuals for attendance at the institute and in otherwise conducting the institute, no discrimination will be made on account of sex, race, creed, color, or national origin of an applicant or enrollee.
    Advances toward the goal of equal education have been made through the administration of the programs of school assistance in federally affected areas. A policy has been adopted under which segregated schools will, in the fall of 1963, be deemed unsuitable for the dependents of military or civilian personnel living on a military
    240
    Department of Health, Education, and Welfare, 1962
    installation and attending off-base schools; appropriate steps will be taken, where necessary and feasible, to provide suitable education for these children on the installation.
    As a part of its annual review of State vocational education programs supported with Federal funds, the Office this year is inquiring for the first time into the availability of courses of training in predominantly Negro and predominantly white schools. A directive will be sent to all States advising that any program for training in a vocation offered with the assistance of Federal funds must be equally available to all children of the school system in which it is offered.
    Special Programs
    EXCEPTIONAL CHILDREN
    Of the approximately 6 million school-age “exceptional” children in the United States in need of special education, it is estimated that not over one-fourth have access to it. Exceptional children are usually defined as those who are blind, partially seeing, deaf, or hard of hearing ; those with impaired speech; those who are crippled or who have special health problems; those who are socially maladjusted or emotionally disturbed, mentally retarded, or highly gifted. Statistical surveys made by the Office of Education in 1948 and 1958 show that progress is being made, for during that decade the estimated percentage of those receiving specialized help rose from about 10 percent to about 25 percent, although the progress was rather uneven from one area of exceptionality to another.
    All States now have made some provision for meeting the needs of at least some types of exceptional children. Developments in State legislation and programs for children suggest that in the relatively near future a large number of States will offer special education opportunities to all types of exceptional children. The extension of programs into some of the more sparsely populated areas is also encouraging. Of significance too is the increase of special education staffs in the various State departments of education. Special Education Personnel in State Education Departments, a directory issued by the Office of Education in September 1961, listed about 270 such positions, or an average of over 5 persons per State.
    Special programs are developing in new or neglected areas of education, especially for emotionally disturbed or multihandicapped children. Some of these programs are on an experimental basis. Attention is also being given to children of a wider age range, including those in nursery and kindergarten or those in the older age bracket for whom school-work programs are being developed increasingly.
    Office of Education
    241
    A diversity of organizational patterns was also noted in the most recent studies: full-time attendance in special classes, part-time attendance in special education combined with part-time attendance in regular grades, instruction in home and hospital, or in residential schools. The net result of these developments will be provisions for meeting more precisely the educational needs of the individual child.
    Special education has been expanding at such a rate that an adequate supply of qualified teachers, as well as personnel for professional preparation and supervisory positions, continues to be a difficult problem. This has appeared to be of sufficient nationwide importance to bring about congressional approval of two laws providing for the training of such personnel. Under the provisions of Public Law 85-926, approximately 500 fellowships have been made available for advanced study in the education of the retarded. Beginning in September 1962 under the provisions of Public Law 85-276, over 400 persons will receive scholarships to prepare to become teachers of the deaf. Thus, Federal funds are being used in two important areas of exceptionality to make an attack on the problem of shortage of professional personnel.
    There is continued need for further research and fact-finding on the education of exceptional children. Through the authorization given the Office of Education under Public Law 531 (Cooperative Research Program) and Public Law 85-864 (National Defense Education Act) a substantial number of research studies in this field have been completed. The Office of Education is currently conducting its sixth study of the opportunities for professional preparation of teachers of exceptional children. It will include information on colleges and universities offering sequences of preparation in the various areas of exceptionality and other status information. In addition, the Office has underway studies on State financial aid to public school systems and studies in the special areas of the visually handicapped, those who have speech impairments, and the mentally retarded. These are all steps toward the ultimate goal of providing adequate educational opportunity for all children who need it.
    CAPTIONED FILMS FOR THE DEAF
    The Captioned Films for the Deaf program, for the first time since it was enacted in 1958 (Public Law 85-905) operated under the maximum authorized appropriation of $250,000. The program now serves 682 groups of deaf people in 48 of the 50 States.
    A library of mostly full-length feature pictures, some of them educational or documentary films, tripled in size, reaching a total of 402 prints of some 113 titles. The demand continued to mount faster than supply, and the booking office located at the Indiana School
    242
    Department of Health, Education, and Welfare, 1962
    for the Deaf in Indianapolis was obliged to turn down many requests.
    In addition to captioned educational films for classroom use, the Office has begun to provide educational and training films for the adult deaf. Due to the nature of their handicap, deaf adults benefit little from the many audiovisual training films available to the general public. However, these films can be acquired from commercial sources and captioned at a reasonable cost to make them highly serviceable to deaf people.
    The films can be borrowed by groups of eight or more. The total audience for the year numbered 165,925 deaf persons, and participation continued to double in each 6-month period. Analysis of attendance records submitted to the Office of Education revealed that despite this growth, captioned films are still reaching only 10 percent of the total deaf population.
    EARLY SCHOOL LEAVERS
    In many American communities graduation from high school is considered the minimum education necessary for a boy or girl who wishes to obtain employment. This idea has grown steadily as unskilled labor has been replaced by machines. The manpower requirements for the future are expanding the aspiration for at least a high school education into a national goal.
    In 1962 the percentage of young people of graduation age who completed high school was 64 percent. This national average varies by State from one which estimates that 80 percent of its young people graduate from high school to another which places its estimate at 40 percent.
    Early school leaving occurs frequently in rural districts characterized by a low level of income. Although compulsory school attendance is generally not required beyond age 16, 2 years short of the age at which pupils normally graduate, there is little demand for raising the age to 18. More reliance is therefore placed on counseling pupils to remain in school, on the force of public opinion, and on the growing requirement that young men and women must have high school diplomas to qualify for the more desirable job openings. These measures in the past have brought a steady increase in high school completion; however, there is general agreement that the Nation’s needs require a greatly accelerated increase in high school completion rates.
    The national concern for finding means and methods of reducing the number of high school dropouts has produced a vast number of inquiries, in response to which the Office of Education supplies information and assistance through its several programs of review, research, and grants. Guidance specialists are on constant alert for
    Office of Education
    243
    significant local guidance programs which have promise for holding potential dropouts in schools. The Office administers two grant programs which are contributing to the ultimate solution of this critical problem: under provisions of title V of the National Defense Education Act, grants for State and local guidance services, and for institutes for counselor training; and under title II of the act, loans to enable qualified college students to continue their education. During fiscal year 1962 plans were developed to undertake special guidance and counseling institutes for schools located in culturally deprived areas of large urban centers where the dropout problem is acute. In studying the dropout problem the Office cooperates with the President’s Committee on Youth Employment and also with the President’s Committee on Juvenile Delinquency.
    PHYSICAL FITNESS SURVEY
    At the request of President Kennedy’s Council on Physical Fitness, the Office conducted a special study on physical fitness based on a scientific sample of the Nation’s public schools. This study determined the extent to which schools were conducting physical fitness testing programs and the degree to which a bulletin published by the President’s Council influenced the adoption of such a program. Results of this study as applied to the entire school-age population indicated that 15 million or approximately 40 percent of the Nation’s young people failed to meet satisfactory physical standards. The Council has requested that this study be repeated during 1963 in order to provide a means of measuring the expansion and effectiveness of health and physical education programs in American schools.
    PROGRAMS AND SERVICE FOR ADULTS
    In the field of adult education, the Office of Education provides leadership and attempts to bring about a broad, unified, and coordinated approach. A major effort is the promotion of the concept of lifelong learning. The program includes general adult education, education for the aging, fundamental and literacy education, citizenship education, statistics on adult education, and professionalization of personnel in this field. The Office also provides consultative services to a substantial number of public and private agencies.
    The following research reports have been completed and distributed : Adventures in Learning; Frontiers Past Sixty in Hamilton, Ohio; Literacy and Basic Elementary Education for Adults: A Selected Annotated Bibliography ; and Statistics of Public School Adult Education (1958-59).
    Three major research studies on aging have been approved under the Cooperative Research Program and are currently underway. They are: “Specialization of Attitudes Toward Adult Education by
    244
    Department of Health, Education, and Welfare, 1962
    Social Class,” “A Study of the Role of Colleges and Universities in the Education of the Aged,” and “An Evaluation of Communication Media Used in the Adult Liberal Studies Program.”
    Consultative services were provided to assist in the planning and development of curriculums for the aging in North Dakota, Iowa, and Minnesota. Assistance was also furnished the planning board of the Midwest Program on Airborne Television Instruction begun in June 1962 at Purdue University.
    The Office provided advisory service to the Department of State for a mission to the Dominican Republic under the Agency for International Development, to the UNESCO World Committee of Literacy Experts, and to an African educational materials seminar.
    Current statistics indicate that adult enrollments are increasing in all sections of the United States and State departments of public instruction are giving more attention to public school adult education. Eight States and Territories now have more than 1 staff specialist in this field at the State level; 12 others provide 1 staff person; 10 have one part-time person; 24 have no designated personnel for this purpose. In more than one-third of the cities, where the need for adult education programs is acute, there are no public school adult education programs.
    TRAINING THE UNEMPLOYED
    With the passage of the Manpower Development and Training Act of 1962 (Public Law 87-415), a program has been launched jointly by the Office of Education and the Department of Labor to meet the needs of unemployed and underemployed persons. Training projects usually originate at the local level, where training activities are conducted. Although no funds were made available until August 1962, it is anticipated that 45,000 people will be trained in fiscal year 1963.
    The Office of Education also approves vocational retraining programs for unemployed and underemployed persons under the Area Redevelopment Act (Public Law 87-27), helps States and localities develop training program proposals, and provides sample syllabuses for the various programs. In fiscal year 1962, over 9,000 people in distressed areas in 34 States and in American Samoa were trained in 147 projects.
    CIVIL DEFENSE EDUCATION
    An understanding of the role of the individual, the family, and the community in State and national plans for protection against disasters which threaten the Nation and its people is an elemental need in the total civil defense effort. To contribute to fulfillment of this need, the Civil Defense Adult Education program was initiated by the Office of Education in cooperation with the Office of Civil and Defense
    Office of Education
    245
    Mobilization in 1959. The success of pilot programs in Florida, Kentucky, Minnesota, and Texas, in 1959-60 led to extension to three other States in 1960-61 and eight more at the beginning of the 1962 fiscal year. Following the President’s delegation of responsibility for the civil defense program to the Department of Defense in 1961, provisions were made for offering the Civil Defense Adult Education program to all States. By June 1962, 35 States, the District of Columbia, and Puerto Rico had contracted with the Office of Education to conduct the program in their States. Extension of the program to all States at an early date is an immediate goal.
    This program is offered, without charge, through the adult education facilities in the various States. Twelve hours of instruction in the understanding of and protective measures against nuclear, chemical, and biological dangers, as well as natural disasters, is provided at the local level by selected teachers who receive special training in courses conducted by State staff members. Attendance of not less than 15 hours is required for teacher certification. The total cost of the program, $1,655,000 in 1962, including payment to teachers in the local areas, is paid through the Department of Defense from Federal funds provided to the States under contractual agreement with the Office of Education.
    Interagency Cooperation
    As the Office has recently concerned itself with areas previously neglected in large part, it has turned also to the relationship of the various Federal agencies whose activities involve or affect education, and to the effect of their programs on the educational resources of the Nation. The Office, in its function as the primary Federal agency concerned solely with education, during the year laid the foundation for a pattern of relationships with other Federal agencies to promote a more coherent Federal policy and better coordination of activities.
    The need for the coordination of Federal programs, especially in institutions of higher education, has been documented in several major studies. To examine whether educational programs are distorted by the impact of a variety of Federal programs ranging from the purchase of specific research services to the support of students pursuing specific courses of study, the Office of Education completed certain phases of a survey which may serve as a benchmark for the development of policies and procedures to strengthen the educational programs and objectives of institutions of higher education in the national interest.
    The Commissioner of Education sought both formally and informally to extend and increase the exchange of views and cooperation between the Office and other Government agencies. These efforts
    246
    Department of Health, Education, and Welfare, 1962
    led to joint projects and to the planning of future programs that involve the responsibilities of more than one agency. For example, close liaison was established with the directors of the Office of Science and Technology, the National Science Foundation, the Atomic Energy Commission, and the National Aeronautics and Space Administration for the purpose of coordinating information and policy regarding Federal programs in education and the impact of such programs. The above listed endorsed the establishment of a task force and a consultative policy group, each consisting of representatives of the departments and agencies operating programs in education, that will assist the Office in its responsibility to report on Federal programs in education and to assess the impact of such programs. The task force and the consultative group are now being formed.
    The Office of Education is assisting the chairman of the Civil Service Commission in developing and undertaking a program to promote education for the public service. A committee within the Office of Education is considering ways to develop a better understanding of education for public service among the schools, including improved guidance services; steps necessary for the strengthening of inservice educational and training programs, both within the Office of Education and governmentwide; means of attracting more and better college students and graduates to educational preparation for public service positions; and ways of engaging colleges and universities more specifically and more vigorously in educational preparation for public service.
    The Office of Education also assists in the administration of the Juvenile Delinquency and Youth Offenses Control Act of 1961. During fiscal year 1962 the staff of the Office assisted in the evaluation of applications to the President’s Commission on Juvenile Delinquency and Youth Crime for training grants, planning grants, and grants for demonstration projects. Office personnel also provided technical counsel to citizens about to draw up requests for grants and prepared to provide field service to the committee on approved projects.
    Under an agreement with the Department of Defense, the Office began a national inventory of school facilities and personnel for resource evaluation and damage assessment. Through the combined efforts of the Office, Bureau of the Census, and the State education agencies, more than 106,000 public and nonpublic school plants which can be made available to the Office in the event of an emergency disaster were added to the National Resource Evaluation Library. During 1963, inventory forms from each school will be processed. Additional funds from the Department of Defense will enable the Office to identify and inventory an estimated 10,000 additional schools, and add newly constructed school plants to keep the inventory data
    Office of Education
    247
    current. A conversion deck of data cards with Census, Office of Education, and National Resource Evaluation Center codes will also be developed to establish a data flow system among the respective agencies.
    International Organizations and Programs
    Cooperation with other Federal agencies has extended to international activities. In the past year, coordination and cooperation in international programs have been greatly increased through closer contact with the Department of State, the U.S. Information Agency, and the Peace Corps. For example, an education liaison officer has been designated to work with the Agency for International Development of the State Department, and that Agency in turn is assigning one of its senior officers to a position in the Bureau of International Education of the Office.
    The Office cooperated with the U.S. National Commission for UNESCO in the formulation, review, and revision of projects for the proposed UNESCO program and budget and in the dissemination of information on UNESCO’s program to the U.S. educational community. The Office also participated in the planning of the Commission’s biennial conference, and an Office specialist prepared background papers on African education for consideration at the conference.
    The Office participated in a variety of international seminars, workshops, and meetings held under the auspices of intergovernmental organizations; prepared reports and annotated bibliographies; and supplied publications on U.S. educational practices in response to requests from various bodies of the United Nations, such as UNESCO and UNICEF, the International Labour Organization, the International Bureau of Education, the Organization of American States, and other international agencies.
    A number of major studies on education in the United States were developed for international use, on subjects which included higher education, the access of women and girls to education in rural areas, vocational and technical education, educational planning, the education and training of professional engineers, and the inservice education of primary school teachers. The Office, which acts as secretariat for the United States membership in the International Bureau of Education, prepared the 1962 publication, Progress of Public Education in the United States of America in English, French, Russian, and Spanish for presentation to the IBE’s International Conference on Public Education at Geneva in July. The Office also published in both French and English its replies to the questionnaires which
    248
    Department of Health, Education, and Welfare, 1962
    formed the basis of discussion of the two technical committees of the Conference.
    Office specialists served as experts or delegates at some 20 international seminars, workshops, or conferences held in Europe, Asia, Africa, and Latin America under the sponsorship of the United Nations, UNESCO, International Bureau of Education, International Labour Office, and World Health Organization. The Office also was represented in Santiago, Chile, at the Conference on Education and Economic and Social Development in Latin America, and at a meeting of Asian ministers of education in Tokyo, Japan.
    Educational Research and Development
    Elementary and Secondary Education
    STRENGTHENING STATE DEPARTMENTS OF EDUCATION
    The Office of Education provides informational, consultative, and research services and administers several Federal assistance programs to enable State agencies to increase their effectiveness in dealing with the schools.
    Improving Statistical Services.—One of the programs of the Office of Education is concerned with the improvement and expansion of the statistical services of State education agencies. Under this program, administered under the provisions of section 1009 of title X of the National Defense Education Act, the States may obtain grants of up to $50,000 annually on the basis of approved State plans, the Federal funds to be matched equally with State funds. As a result of this program the statistical services staff of the State education agencies has more than doubled, and the number of States and Territories using data processing equipment has almost quadrupled since 1958. In fiscal year 1962 there were 53 plans approved for a total of approximately $1.5 million. Several States requested the full $50,000 available to them, and some overmatched the Federal funds.
    These Federal and State monies, with professional assistance of the Office of Education staff, have provided during this fiscal year continued improvement in the standardization of educational terminology and in the development of a total systems approach in the collection, processing, interpretation, and dissemination of educational information.
    Improving Supervisory Services.—In addition, the National Defense Education Act provides Federal grants to expand and improve the consultant services of State supervisory staffs. Up to $5 million annually is authorized on a matching basis for State supervisory programs in science, mathematics, and modern foreign languages. Funds
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    249
    are also authorized for State guidance supervisors. The number of State supervisors in the areas of science, mathematics, and modern foreign languages has increased from 33 to more than 200, and the number of guidance supervisors from 99 to approximately 250. State consultant services to local school districts have greatly improved. States are providing more inservice education programs for teachers and administrators, and curriculum guides and other professional publications have increased in number and improved in quality. There has also been a growth of local guidance programs in the secondary schools. The effectiveness of these programs has led educational administrators to explore ways of providing comparable leadership services in other areas and fields.
    STAFF IN PUBLIC SCHOOLS
    The seriousness of the problems of salary, of recruitment, and of teacher preparation must be alleviated if the schools of the Nation are to meet the responsibilities ahead of them, for the schools will be able to compete for personnel only when teaching offers a high level of personal and professional satisfaction. A system of free public education is accepted by society as vital to the growth of the Nation; but the schools will grow in strength only as the teaching staff grows, and if society demands the best education for its youth, it must also be willing to support the cost of the best possible education program.
    Shortage of Teachers.—The continuously increasing public school population represents a critical factor in the Nation’s ability to staff its schools with an adequate number of qualified teachers. In the fall of 1961 the number of classroom teachers in the public schools was 1,461,000, an increase of 53,000 over the previous year. However, it is estimated that more than 100,000 teachers leave the classroom annually and must be replaced. Tens of thousands are still needed to eliminate double sessions and overcrowding, to replace teachers who are inadequately prepared, and to provide certain vital educational services now omitted because of lack of staff.
    Within the nationwide shortage of teachers, three types of imbalance are particularly noticeable. First, the extent of the shortage varies within and between different geographical regions. Second, the shortage of teachers in elementary schools is more critical than that in secondary schools, even though the latter currently have a higher enrollment growth rate. Third, the supply of teachers in certain fields is seriously inadequate. Comprehensive counseling programs at the college level are needed to help prospective teachers develop their career plans.
    Need for Improved Selection and Training Procedures.—It is not enough merely to staff each classroom with a teacher—it is vital that
    665171—63---17
    250
    Department of Health, Education, and Welfare, 1962
    the teacher be professionally qualified and competent. In the report, “Ten-Year Aims in Education, Staffing, and Constructing Public Elementary and Secondary Schools, 1959-1969,” a dual program recommended for achieving this goal is to elevate the salary level and improve the procedures for the selection of teachers. The selection process includes first the recruitment of students into the teacher preparation program, followed by the preparation program itself, and then the attempt on the part of each local school district to select the most competent candidates possible.
    It is essential to foster cooperative efforts among the agencies and groups responsible for training, selecting, and assisting in the upgrading of teaching personnel. The existence of cooperative professional relationships among the State departments of education, the local
    CHART 1.—CHANGES WITHIN THE PUBLIC ELEMENTARY AND SECONDARY SCHOOL SYSTEM, UNITED STATES, 1957-58 TO 1959-60
    Percent decrease	Percent increase
    -20	-10	0	+10	+20	+30
    -30
    +40
    +50
    0
    i r~ । i । i i mQm No. of local school districts
    ' . A " A.-;’ I No. of 1 teacher schools
    Total instructional staff £ sf9.8> :J
    Enrollment:
    Grades K-8
    Grades 9-12 and
    postgraduate I
    High school graduates -	'
    Current expenditures	'
    A '	Capital outlay
    I nterest
    Average annual salary 1ft_
    of instructional staff -
    Current expenditures per pupil Al/ ;
    in average daily attendance + ’
    ._________I_________I______________________I_________I_________I_________I__________
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Statistics of Slate School Systems, 1959-60.
    Office of Education
    251
    districts, the professional associations, and the teacher education institutions is, the report notes, prerequisite to improvement in the quality of teacher education. There is evidence that, through the efforts of these several groups, a positive change is occurring in the teacher education program of the Nation.
    The professional growth of the teacher in service is a matter of great concern to the Office. Recent developments in instructional techniques, organization, and materials have made the need for strong inservice development programs even more important than in the past.
    Need for Salaries Competitive With Those in Other Occupations.— The second major staffing aim is to provide for adequate salaries. An important criterion of adequacy of salary is the degree to which the salary is competitive with that in other occupations. Not long ago the Office of Education recommended a salary level increasing annually to about $7,200 by 1963-64, a figure which will not be met at the present rate of increase. This level, a 50-percent increase over the salary level 5 years earlier, would undoubtedly help the schools compete with other employers for college graduates. However, there are other salary features which must be considered in addition to the national average. The beginning salary, the potential maximum, and the anticipated timespan between the two are taken into account in estimating a career-earning potential. This is an index which is receiving increasing attention by salary analysts as well as by college students considering career choices.
    Most teacher organizations strive for a salary schedule which has a minimum salary adequate to compete for staff and a maximum salary which doubles the minimum in approximately 10 years. This goal is met in few communities today. This relatively unfavorable competitive status applies not only to the recruitment of new staff, but also to the retention of existing staff. Beginning salaries for teachers are from $500 to $1,500 below the averages reported in major business and industrial positions requiring preparation comparable to that of the teacher, and salaries after 5 or 10 years show even larger differentials. The 30- or 40-year earning potential for classroom teachers is significantly below that which individuals in other occupations requiring similar experience and education can anticipate.
    FACILITIES NEEDED
    The public elementary and secondary schools in the 50 States and the District of Columbia enrolled 37.5 million pupils in the fall of 1961—an increase of 1.2 million, or 3.4 percent, over comparable enrollment 1 year earlier. Of the 1961 total, an estimated, 1,693,000 pupils, or 4.3 percent, were enrolled in excess of the normal capacity of accessible, publicly owned school facilities then in use.
    252
    Department of Health, Education, and Welfare, 1962
    CHART 2.—SUMMARY OF EXPENDITURES FOR PUBLIC ELEMENTARY AND SECONDARY SCHOOLS: UNITED STATES, 1959-60
    Total Expenditures: $15,613,255,000 Interest: $489,514,000 - 3.1%^
    . z. Capital outlay	\\
    $2,661,786,000 L :	\\
    I?• o% ((MBS	\ \
    ~ ~ ’***' 1	'■ ■ ■	7-I nstruction
    1	$8,350,738,000
    other s^00' 5et','CW	53'5%
    //
    \ \	/ /	I
    \ \	s /	/ /
    k	//
    \/ §	//
    W^z 3S	/J
    \\u/ *> ,&'/	/ 90
    '	Cx? / £	S‘X^*
    ________ ’
    nt Exv ----------To
    ^enditures:
    ♦Other current expenditures: $132,567,000 - 0.8%
    Note: Data are for 50 States and the District of Columbia. Because of rounding, detail may not add to totals.
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Statistics of State School Systems, J959-60.
    Local school officials, confronted by more pupils than their facilities were designed to handle, followed one or more of several alternatives to accommodate them: using rented or donated quarters such as churches, lodge halls, and other buildings; converting to instructional use spaces in school buildings designed for other purposes; utilizing substandard and/or makeshift facilities; and dividing the school day into two or more sessions so that two or more groups could use the same facilities each day.
    Office of Education
    253
    More than 571,000 pupils were affected by the shortened school day in 1961, an improvement over the previous year when 657,000 were affected by curtailed sessions. Notwithstanding this improvement, the country’s need for additional classrooms is pressing; and in localities where population growth has been rapid, the need is acute.
    In the fall of 1961, State education agencies reported the need of 127,300 additional instruction rooms—60,300 to accommodate pupils in excess of the normal capacity of accessible, publicly owned facilities and 67,000 to replace unsatisfactory rooms then in use. The percentage distribution for these two categories of need was 47.4 and 52.6, respectively, but this distribution was heavily weighted by the high concentration of unsatisfactory rooms in several States.
    The present backlog results from the fact that construction of new facilities has not kept pace with needs. Of the 72,000 instruction rooms to be completed during 1961-62, only a small proportion could be applied against the reduction of the reported backlog of 127,300 rooms, because thousands of rooms are required to accommodate population shifts, to replace rooms abandoned for one reason or another during the year, and to house the enrollment increase of 1.4 million pupils from 1961-62 to 1962-63.
    Moreover, under present and probable future conditions, classroom needs will continue during the remaining years of this decade. The average annual rate of classroom construction for the past 6 years (1955-56 through 1960-61) was 69,200 instruction rooms, a number only slightly in excess of requirements for increased enrollments.
    Since an increasing number of school districts reached statutory debt limitations through long-term financing of school facilities, and a significant number of communities voted against school bond issues during the past year, the trend toward less school construction may continue. Meanwhile, classroom needs will continue to mount, for enrollment will increase by almost 1 million pupils in each of the remaining years of this decade; loss of school facilities by fire and other causes wfill continue; population shifts will cause abandonment of satisfactory facilities in some communities and create the need for new ones in others; current emphasis on urban renewal will have implications for school construction; limited-access highways are creating problems with respect to the location and size of present and future school centers; public acceptance of, and sometimes insistence upon, extending the school program downward to include kindergarten and nursery and upward to include junior college and perhaps programs for adult education (including retraining for new jobs) will create a need for thousands of additional classrooms; and finally, new concepts of teaching, of the learning process, and of goals to be accomplished
    254
    Department of Health, Education, and Welfare, 1962
    Table 1.—Enrollment in grades 9—12 in public and nonpublic schools, and population 14—17 years of age: United States, 1889—90 to 1961—62
    School year	Enrollment, grades 9-12 and postgraduate 1			Population 14-17 years of age2	Total number enrolled per 100 persons 14-17 years of age
    	All schools	Public schools	Nonpublic schools
    1889-90			359, 949	3 202, 963	3 94,931	5,354. 653	6.7
    1899-1900			699, 403	3 519' 251	3 110' 797	6,152,231	11.4
    1909-10 . 		1,115,398	3 915', 061	3 117, 400	7, 220, 298	15.4
    1919-20		2,500,176	3 2,200', 389	3 213', 920	7, 735,841	32.3
    1929-30 		4,804, 255	3 4,399,422	3 4 34L 158	9,341, 221	51. 4
    1939-40			7,123, 009	6, 635,337	487, 672	9, 720, 419	73.3
    1941-42 		6' 933’ 265	6, 420,544	512, 721	3 9', 749' 000	71.1
    1943-44		Q, 030, 617	5, 584, 656	445,961	3 9, 449, 000	63.8
    1945-46 		6,237' 133	5, 664,528	572' 605	3 9' 056, 000	68. 9
    1947-48		6, 305,168	5, 675,937	629,231	3 8,841,000	71. 3
    1949-50		6,453, 009	5, 757, 810	695,199	8, 404, 768	76. 8
    1951-52		6^ 596' 351	5' 917' 384	678j 967	3 8, 525, 000	77.4
    1953-54		7,108' 973	6,330,565	778' 408	3 8,878, 000	80.1
    1955-56		7, 774, 975	6,91L 790	857,185	3 9, 229, 000	84.2
    1957-58		8' 868,586	7,905' 569	963,017	3 10,164, 000	87.3
    1959-60 «		9, 700,000	8, 600, 000	1,100, 000	11,154,879	87.0
    1961-62 3		10,800i 000	9i 600' 000	1,200; 000	312; 027; 000	89.8
    1	Unless otherwise indicated, includes enrollment in subcollegiate departments of institutions of higher education and in residential schools for exceptional children. Beginning in 1949-50, also includes Federal schools.
    2	Includes all persons residing in continental United States, but excludes Armed Forces overseas. Data shown are actual figures from the decennial censuses of population unless otherwise indicated.
    3	Excludes enrollment in subcollegiate departments of institutions of higher education and in residential schools for exceptional children.
    < Data for 1927-28.
    6 Estimated by the Bureau of the Census as of July 1 preceding the opening of the school year.
    6 Estimated data for 50 States and the District of Columbia.
    Note: Unless otherwise indicated, data are for 48 States and the District of Columbia.
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Biennial Survey of Education in the United States.
    will tend to make obsolete many buildings that might otherwise remain useful.
    The Office of Education offers assistance to State departments of education, and through them to local school systems, by providing technical information and consultative services on numerous problems associated with schoolhousing needs, such as long-range planning; construction and technological advances; functional planning; the development of educational specifications; and the selection, purchase, and utilization of supplies, furniture, and equipment.
    FINANCING PUBLIC EDUCATION
    For the 1961-62 school year, the total amount of revenue provided from all sources for the support of public elementary and secondary schools was estimated to be approximately $16.6 billion. This represented an increase of more than $1.3 billion, or 8.7 percent over the estimated $15.3 billion provided during the previous year.
    Office of Education
    255
    Local School Revenue
    Taxes raised at the local level still provide over half the funds available to the local boards of education (see chart I). The system of local taxation is, therefore, of considerable significance as a source of funds for educational purposes.
    Property Taxes.—-In the typical school district, the local board of education levies taxes on the property located in the district. The property tax is the basic source of revenue for the county or other intermediate unit. While the property tax continues to provide the bulk of money for education, it shows the least responsiveness to the growth of the economy. There is frequently a time lag between an increase in the value of property and the inclusion of the increase in the tax base.
    While property tax levies and bases have increased greatly in the recent past, there is little assurance that this performance can be repeated in the future. Statutory and constitutional limitations as well as psychological factors have made it extremely difficult for many local units to obtain the levies needed to raise adequate funds. As a consequence there has been considerable interest expressed for greater State support and to a much lesser extent for relief of the property tax through local nonproperty taxes.
    N onproperty Taxes.—Taxes on such items as wages, motor vehicles, deed transfers, hotel occupancy, amusements, general sales, and other business transactions are among those levied on nonproperty sources for schools. Taxes of this type are not in general use, but they do produce about one-fifth of the local school revenue in Pennsylvania and considerably smaller amounts in other States. The town, city, or county which provides money for dependent schools tends to use nonproperty taxes to a greater extent than do independent school districts, but even here a major portion of the property tax rate is frequently designated for schools. This has the effect of shifting the nonproperty tax sources to nonschool functions, thereby causing the schools to rely heavily on the property tax.
    Bonded Indebtness.—Since most school construction in the United States is based on bond financing, information on debt cost is important to school boards and officials. The Office of Education reports monthly in School Life the average net interest costs on Moody-rated school bonds. An annual publication, Bond Sales for Public School Purposes, gives State by State the number and amount of bond sales, as well as the net interest costs by issuing agencies and by Moody ratings. These reports supply boards of education with information which will help them make judgments on the acceptance or rejection of bids for the sale of bonds. According to the Moody ratings, the average net interest cost declined from 3.41 percent in July 1961 to 3.21 percent in June 1962.
    256
    Department of Health, Education, and Welfare, 1962
    TOTAL REVENUE RECEIPTS: $14,747,000,000
    Note: Data are for 50 States and the District of Columbia.
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Statistics of State School Systems, 1959-60.
    The annual sale of school bonds has increased from $1.87 billion to $2.56 billion over the 6-year period ending in 1961-62. In 1961-62 school bond sales rose to a high of $2.56 billion, 5.8 percent above the previous peak of $2.42 billion reached in 1957-58. This is 8.5 percent above the 1960-61 sales, which totaled $2.36 billion. The total amount of school bond sales for the 6-year period was $13.4 billion.
    The average net interest rate on all school bonds, rated and nonrated, declined from 3.91 percent in 1959-60 to 3.52 percent in 1960-61 and continued downward to 3.33 percent in 1961-62. The total expenditure for debt service, amount required for repayment of principal and interest, is a rapidly expanding item in school budgets.
    State Funds for Schools
    In spite of the considerable pressure for increased funds, the States continued to provide an average of about 40 percent of the total public school revenue for grades K-12, a pattern which has prevailed since 1948. Although there is a slight tendency for this percentage to rise, the amount of rise is so slight that the plateau of State support
    LOCAL $7,874,000,000 53.4%
    CHART 3.—REVENUE RECEIPTS FOR PUBLIC ELEMENTARY AND SECONDARY SCHOOLS, BY SOURCE: UNITED STATES, 1959-60
    INTERMEDIATE $383,000,000 OTHER 2.6% \	$70,000,000
    FEDERAL	\ / o 5%
    $652,000,000----SjSJL
    4.4%
    STATE j $5,768,000,000 39.1%	'
    Office of Education
    257
    Table 2.—Office of Education enrollment estimates: United States, 1960—61 and 1961—62
    [Estimates are for total enrollment during the school year. These figures are larger than the figures for fall enrollment]
    Type of school, by grade level	School year 1960-61	School year 1961-62
    Total elementary secondary and higher education 	 		47,900,000	49,300,000
    Kindergarten through grades		 - 			 - ■ -
    	33,800,000	34,200, 000
    Public school system (regular full-time)	_ _
    	28, 400, 000 5, 200,000 200,000	28, 700, 000 5,300, 000 200,000
    Nonpublic schools (regular full-time)	_
    Other schools 1
    	10,100, 000	10,800, 000
    "PnUlin enhnnl QvQtem tre.mil ar full-time)		 			8,900, 000 1,100, 000 100,000	9,500,000 1, 200, 000 100, 000
    1 UU11L otllUUl oyovuiLl	iuji uiixivy-—		 Nonpublic schools (regular full-time)		 --		—

    ICi nd er or Art am through IXrade 12				 -- 	 		43,900,000	45,000,000
    Public school system (regular full-time)	_ _ - 	 -
    	37,300,000 6,300, 000 300, 000	38,200. 000 6,500,000 300,000
    ~N~ on pi i bl ic schools (regular full-time) _ _			-----------	- - -—

    Higher education: Universities, colleges, professional schools, junior colleges,	4, 000,000	4,300,000
    normal dCIIOOIo, 	described has lead to a critical shortage of qualified teaching person-
    nel in several important instructional areas. To assist in the solution of this critical problem, this office has undertaken a study to provide for institutions of higher education reliable estimates, by major field, of the demand for instructional staff during the next decade. Recurring studies provide data on faculty salaries, fringe benefits, and working conditions. It is expected that the Office of Education status and projections reports on faculty personnel will be useful to graduate schools in developing programs for preparing college teachers, as well as to the college and university officials who select and appoint college teachers.
    STUDENTS AND CURRICULUM
    Student Services.—In the fall of 1961 there were 3,891,000 students enrolled in American institutions of higher education, 1,026,000 of them (26.4 percent) enrolled for the first time. It is well known that even more students will be enrolled in the next 5-year period. As
    Office of Education
    271
    CHART 6.—PERCENTAGES OF DEGREE-CREDIT STUDENTS ENROLLED IN VARIOUS TYPES OF INSTITUTIONS OF HIGHER EDUCATION: UNITED STATES AND OUTLYING PARTS, FALL 1961
    Other professional, 1.5%
    Schools of art, 0.5% Theological, religious, 1.1% Technological schools, 2.9% "
    Teachers
    10.3%
    Libera ar s
    colleges
    28.5%
    Junior
    13.4%
    Universities
    41.9%
    colleges
    colleges
    Source: U. S. Department of Health, Education, and Welfare, Office of Education, Survey of Opening (Fall) Enrollment in Higher Education, 196J.
    enrollments increase, the problems related to meeting the diversified needs of a larger and more heterogeneous student population will multiply at an accelerating pace.
    Several activities of the Office of Education have been devoted to the study and solution of these problems. Staff members at the request of institutions have consulted with them on problems relating to student financial assistance and the management of their student service programs; two studies were undertaken: one analyzing institutional expenditures for student services and the other devoted to the staffing and administration of student services. Preliminary findings from the first of these studies indicate that exclusive of housing and other auxiliary enterprises, publicly controlled institutions of higher education annually spend for student services an average of $38 per student. The comparable figure for privately controlled institutions is $46 per student.
    Information Services.—The rapidly increasing number and quality of high school students planning to enter college has added to the
    272
    Department of Health, Education, and Welfare, 1962
    complex problems related to college admission and financial assistance and has demonstrated the need for improved and expanded information about post high school opportunities. Traditional patterns of selecting a college are no longer adequate for today’s high school graduate facing the increasingly selective admissions competition. Rising college costs make the financing of higher education difficult for many students and their parents; for some, impossible.
    Financial Assistance.—During the year the Division of Higher Education completed a national survey of institutional student financial assistance—scholarships, loans, and student employment financed by funds controlled by the colleges and universities. Based upon returns submitted by 1,677 institutions, the total volume of such assistance for the academic year 1959-60 was $211,011,345. Of this total, approximately $98.5 million was disbursed as compensation to students, $98.2 million in the form of scholarship grants, and $14.4 million as institutional student loans (not including loans under the National Defense Student Loan Program). As a byproduct of this study, the Office completed and published another directory of undergraduate student aid resources, Financial Assistance for College Students: Undergraduate.
    On the invitation of the Rhode Island State Board of Education, the Office of Education completed an evaluation of the several State scholarship programs. The principal problems studied involved the rapid increase in scholarship costs, the need for and effectiveness of certain categorical scholarships, the administrative problems of multiple scholarship awards, standards for renewals, institutional transfer of scholarship students, and the administration of the financial needs test in setting stipends. Following the preparation of extensive statistical and documentary materials, consultation, and conferences with educational leaders and groups, a report of the findings and recommendations for the improvement of the scholarship programs was presented to the board and the administrative staff of the State department of education in January 1962. The board accepted the principal recommendations of the report and proceeded with their implementation.
    Graduate Study.—A report, Doctoral Study: Fellowships and Capacity of Graduate Schools, documents the number, value, type, and major source of graduate fellowships recently awarded by major universities in all principal academic fields. The report also concerns the capacity of graduate schools for further expansion and the principal barriers to such expansion.
    Two statistical reports have been prepared showing the number of students obtaining advanced graduate degrees from two major groups of institutions. The institutions are the 39 United States members
    Office of Education
    273
    of the Association of Graduate Schools in the Association of American Universities and the 68 land-grant colleges and universities.
    Summer Sessions.—A preliminary report of summer session programs in colleges and universities was prepared and distributed in April, in reply to numerous requests for summer-session data. Two publications, Regular-Y ear Scholarship Programs of Institutions of Higher Education Applicable for Summer Session Study, 1960, and Travel Programs Sponsored by Institutions of Higher Education in Summer Sessions, 1960, have been issued; three additional publications are in the final stages of preparation.
    Teacher Education.—A major contribution has been made in the area of fifth-year programs of classroom teacher education: Fifth-Y ear Programs of Classroom Teacher Education: A Survey Report, will soon be off the press; meanwhile, three prepublication issues have been issued on the Teacher Education Series, “The Teaching Internship Program,” “Fifth-Year Preservice Programs for Graduates of
    CHART 7.—TOTAL DEGREE-CREDIT ENROLLMENT IN RELATION TO POPULATION AGED 18-21: UNITED STATES, FALL 1939 AND FALL 1946 THROUGH FALL 1961
    Millions (ratio scale)
    20 ।----------------------------------------------------------------------
    18 -	“
    16------------------------------------------------------------------------
    14 -	~
    12 —	-
    10—*_____ _____ __ ^^^^^^^^^^opulatior^ageH^^^^^ —
    8------------------------------------------------------------------------
    7 —	-
    6 —	“
    5 -	-
    4--------------------------------------------------------------------———
    Degree-credit students^_
    2------------------------------------------------------------------------
    J I I I I I I I I I I I I	I	I	I	I	I	I I I IJ_l_
    1939	1945	1950	1955	1960 1961
    Fall of year for enrollment - July 1 for population
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Surveys of Opening (Fall) Enrollment in Higher Education.
    274
    Department of Health, Education, and Welfare, 1962
    Liberal Arts Colleges,” and “Fifth-Year Programs of Classroom Teacher Education.”
    Toward the solution of problems in staffing higher education, the Office published a survey of placement services as a 2-part directory entitled Placement Services for Personnel in Higher Education. In addition to the directory it includes an analysis of the problems involved. It was used along with a parallel Office-developed working paper as basic material for a cooperatively sponsored professional conference.
    Education for Public Service.—Following a series of meetings between the Commissioner of Education and the Chairman of the Civil Service Commission and their respective Washington and field staffs, a Committee on Education for Public Service was established within the Office of Education. This Commitee will collaborate with representatives of the Civil Service Commission on educational programs designed to strengthen and improve Government service through the Government Employees Training Act.
    Public Administration.—A 1961 publication, Graduate Study in Public Administration, became during 1962 a standard reference source concerning all graduate programs in the field of public administration offered in the colleges and universities of the United States. Providing information never before available in a single volume, this new publication has been circulated widely throughout the United States and the countries of the free world. Upon special invitation, a related paper was presented by the author at the Xllth International Congress of the Administrative Sciences in Vienna in July 1962.
    Degree Requirements in Mathematics.—The Office has undertaken a nationwide survey of mathematics requirements and programs for both baccalaureate and advanced degrees. Several articles have been published dealing with earned-degree trends in mathematics and the physical and biological sciences.
    Organized Occupational Curriculums.—The Office completed during fiscal 1962 its fifth annual survey of Organized Occupational Curriculums in Higher Education. Such curriculums, primarily for the education of technician and semiprofessional workers, are becoming more and more a function of 2-year colleges. Whereas in 1955-56 2-year institutions provided only slightly more than half of the graduates and enrolled a somewhat larger portion of the students than did 4-year institutions, in 1959-60 organized occupational curriculum graduates from 2-year institutions outnumbered those from 4-year institutions by almost 2 to 1 (33,148 to 18,217) and the 2-year colleges enrolled close to 70 percent of the students (170,831 of 246,496) in these curriculums of at least one but less than 4 years in length.
    Office of Education
    275
    Engineering Education.—The Office continued its annual study of engineering enrollments and degrees, leading to the publication Engineering Enrollments and Degrees, 1961. A report on transfers to schools or colleges of engineering was also published.
    The Office also contributed to the preparation of a 3-volume publication, Report on Education and Training of Professional Engineers, prepared under the auspices of the Conference of Engineering Societies of Western Europe and the United States of America. It deals with systems of engineering education in the participating countries.
    CHART 8.—TRENDS IN DEGREE-CREDIT ENROLLMENT FOR 4-YEAR INSTITUTIONS AND JUNIOR COLLEGES, BY TYPES OF INSTITUTIONAL CONTROL: UNITED STATES AND OUTLYING PARTS, FALL 1939 AND FALL 1947 THROUGH FALL 1961
    2,000,000 r——i	।	।	।	।	।	।	।	|	|	|	|	|	|	|	~1
    1,800,000 -	•«••*** ~
    1,600,000 -------- -----------------------------------------------------------------——------------------------------------------------------
    1,400,000 -	z**’**	**'
    4-year PRIVATELY controlled institutions	—.•»
    1,0)0, Uuu —	11
    1,000,000 -	|,t*»**‘‘>‘**“>*>>*«>>*
    4-year PUBLICLY controlled institutions
    800,000 ------- ---------------------------------------------------------------------------------------------------------------------------
    700,000 -
    600,000 ***
    500,000 -	“
    s 400,000 --------1 --------------------------------------------------------—-----------------------------------------------------------------
    ~ 300,000 -	^•*"**’*	~
    §	PUBLICLY controlled junior colleges
    = <-•***
    f
    §200,000---------- ---------------------------------------------------------------------------------------------------------------------------
    & '
    5
    100,000 -----------------------------------------------------------------------------------------------------------------------------------
    ■J	'^^PRIVATELY controlled junior colleges
    50,000 ------ -------------------------------' ------------------------------------------------------------------------------------------
    25,000 I_____ I I_____________________I______I________I________I_______I_______I__________i____I________I . —J___________I______I________
    1939	1947	1948	1949	1950	1951	1952	1953	1954	1955	1956	1957	1958	1959	1960	1961
    Fall of Year
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Surveys of Opening (Fall) Enrollment in Higher Education.
    276
    Department of Health, Education, and Welfare, 1962
    Table 4.—Earned degrees conferred by institutions of higher education: United States, 1869—70 to 1961-62
    Earned degrees conferred
    Academic year	All degrees	Bachelor’s and first professional	Master’s except first professional	Doctor’s
    1869-70		9,372 13,829 16,703 29,375 39, 755 53,516 139,752 216, 521 496,874 401,203 356,608 376,973 436,979 476,704 515,200	9,371 12,896 15, 539 27,410 37,199 48, 622 122,484 186,500 432,058 329,986 290.825 308,812 362, 554 392.440 425,000	0 879 1,015 1,583 2,113 4,279 14,969 26,731 58,183 63, 534 56,788 59,258 65,487 74,435 78,800	1 54 149 382 443 615 2,299 3,290 6,633 7,683 8,995 8,903 8,938 9,829 11,400
    1879-80
    1889-90
    1899-1900
    1909-10
    1919-20
    1929-30
    1939-40
    1949-50
    1951-52
    1953-54
    1955-56
    1957-58
    1959-601
    1961-62 3

    1 Data for 50 States and the District of Columbia.
    3 Estimated.
    Note: Unless otherwise indicated, data are for 48 States and the District of Columbia. More bachelor’s degrees were conferred in 1949-50 than in any other year, since many veterans of World War II completed their education that year.
    Source: U.S. Department of Health, Education, and Welfare, Office of Education, Biennial Survey of Education in the United States, and Circulars on Earned Degrees Conferred by Higher Educational Institutions.
    LAND-GRANT INSTITUTIONS
    The specific contribution of the Office to the Centennial Celebration of the establishment of the Land-Grant Colleges was a publication entitled, Land-Grant Colleges and Universities 1862—1962. Along with a reprinting of the first Morrill Act of 1862, and all subsequent legislation and amendments, as well as administrative rulings pertaining thereto, the bulletin presents a brief chronology of the development of each of the 68 institutions of higher education now constituting the “land-grant” system.
    A survey of enrollment in agricultural curriculums in the landgrant colleges and universities for the 1961—62 academic year showed an increase of 3 percent in undergraduate enrollment and an increase of 2.5 percent in graduate enrollment over the previous year. For the first time in recent years the proportion of agricultural enrollment to total enrollment in these institutions did not decrease.
    The Office has provided United States representation in the meetings of the Organization for Economic Cooperation and Development, including a study and discussion of the Structure and Orientation of Intellectual Investments in Agriculture in Relation to Economic and Social Developments in the 14 member countries.
    FEDERAL PROGRAMS
    In view of the Federal Government’s extensive support of programs in higher education, it is important that the impact of its activities
    Office of Education
    277
    in universities and colleges be clearly understood. Accordingly, the Commissioner of Education in February 1960 instituted a survey of Federal programs in higher education to consist of the following three parts: (a) A report on Federal programs in higher education and participating institutions, to be compiled on the basis of data from Federal agencies. (b) A study of the effects of Federal programs in 36 institutions of higher education. (Later contracted by the Office of Education to the Brookings Institution.) (c) Observations and recommendations on the Federal role in higher education based on the evidence of parts a and b as well as opinions of administrators of the programs.
    A few of the preliminary findings of the director’s report, which is nearing completion:
    Federally sponsored programs in higher education are designed generally to increase the Nation’s productivity and potential in special fields such as agriculture, health, national security, science, engineering, and world affairs.
    Federal programs emphasize research and graduate education. Between 1955 and 1960 about 75 percent of all Federal income reported by colleges and universities was for research and development.
    Funds for Federal activities in higher education are largely concentrated within 100 institutions. In 1959, 100 institutions received more than 93 percent of all the funds for programs of research, graduate fellowships, and grants for facilities and equipment; 100 institutions received 88 percent of the funds for “education and training” programs. The 100 major participants, as measured by total Federal income in 1960, included 54 public and 46 private institutions.
    In general, faculty members and administrators participating in federally sponsored programs reported that in their opinion the Federal activity was appropriate, beneficial, and constructive; that its deficiencies arose primarily from its piecemeal nature; that most of the difficulties were being eliminated with experience; that its dangers lay more in the policies and standards of participating institutions than in any dictatorial tendencies on the part of Federal agencies and departments.
    Educational Statistics
    During fiscal year 1962 the Office of Education conducted two basic recurring surveys of State school systems: One, conducted biennially for those school years ending in an even number, reported detailed data on the organization, staffing, enrollment, and financing of public schools and basic information on the status of nonpublic schools; the other reported findings on the fall enrollment, teachers, and schoolhousing in the public schools.
    Studies of local school systems provided data for reports on current expenditures per pupil, elementary and secondary school programs, teacher turnover, and the beginning public classroom teacher. The Office also developed projections of public and nonpublic ele
    278
    Department of Health, Education, and Welfare, 1962
    mentary and secondary school enrollment, investigated the best possible methods for gathering meaningful statistics on school facilities, and provided advance estimates for college enrollments and resulting professional staff needs.
    The Office continued its survey of nonpublic elementary and secondary schools resulting in a classified universe of the 4,000 secondary schools and a tentative group of some 13,000 elementary schools. From findings of these surveys, work was begun on a directory listing accredited and nonaccredited high schools.
    A study of subject offerings and enrollments in private and parochial high schools was also launched. The data collected were largely comparable with similar information collected the previous year from a substantial sample of public secondary schools. In 1963 separate statistical reports will be prepared on the two levels of nonpublic schooling below college. At the same time, nationwide information on courses offered and the extent to which they are being utilized in both public and private schools will be available for the first time in 30 years.
    The Office of Education conducts a broad and comprehensive program of statistical surveys in higher education. Needs are recognized both for prompt publication of data for immediate use and for analyses which require more preparation time. An example of a fastmoving survey, confined to only a few basic data items, is the annual survey of early fall enrollment. Data are collected as of late September and October, are reviewed and processed as received, and are published in early December. The publication gives for each of approximately 2,000 institutions the total enrollment of men and women students in work creditable toward bachelor’s degrees and also the number of such students who are entering college for the first time. Both sets of figures are needed for establishing trends and projecting future changes.
    Another effort to provide current data in higher education is the annual reporting of higher education data needed for institutional planning and management. Questionnaires were mailed to colleges and universities in July 1961 asking for information on student charges and staff and faculty salaries for the coming school year (1961-62). Institutional listings and summaries of the data were provided by type of institution, control, and region. This published report was supplied to administrative personnel in institutions of higher learning in September 1962.
    New statistics prepared during the year included a projection of college enrollment which distinguished full-time enrollment for the first time and which analyzed the effect of increasing levels of education among parents on the college attendance rates of their children. Pro-
    Office of Education
    279
    j ections of earned degrees by major field of study were prepared for use in manpower studies stimulated by the Manpower Development and Training Act.
    Other surveys included studies of engineering enrollments and degrees by field of concentration; graduate students enrolled for advanced degrees by field of study, years of study completed, and whether enrolled on a full-time or part-time basis; faculty and other professional staff by type of position; detailed financial statistics on receipts, expenditures, and property; junior-year enrollments in selected fields within the sciences, mathematics, and foreign languages; opening fall enrollment in degree-credit courses; data on organized occupational curriculums; and a detailed analysis of landgrant institutions, showing enrollment, degrees conferred, faculty, current-fund income and expenditures, and plant assets and obligations.
    Sponsored Research
    COOPERATIVE RESEARCH PROGRAM
    During fiscal year 1962 the Cooperative Research Program assumed an expanded national role in pursuance of its charge to stimulate and support the study of problems facing American education. The Program’s support for basic and applied research continues to provide a source of new knowledge and new applications of existing knowledge on an ever-increasing variety of topics at all levels. A study completed during this fiscal year, for example, revealed that up to 44 percent of some teachers’ verbal behavior in the classroom was devoted to the control of pupils. Such behavior is believed to impede rather than facilitate learning. Although the researcher who conducted this study believes that little can be done to change the behavior of teachers who emphasize control, instruments now available could be used to screen out teacher training candidates who are likely to exhibit such behavior.
    Research proposals in all areas continued to be received in increasing quantity and improved quality. Projects approved covered a wide range of topics and problems of import for education, as indicated by the following examples: Academic achievement of adult students; the technology of programed instruction; comprehension of rapid speech by the blind; dynamics of personality development during the college years; relationship of group counseling to academic performance; development of sensitivity to esthetic values; community attitudes toward educational change; financial analysis of college operations; cross-national study of educational attainment; retraining of unemployed workers.
    280
    Department of Health, Education, and Welfare, 1962
    During fiscal year 1962 the Cooperative Research Program paid increasing attention to the problem of reducing the tremendous time lag that occurs between the results of research and their application in the classroom. In addition to continuing to distribute brief descriptions, summaries, and monographs, the Program made arrangements with the Library of Congress to have final reports of projects microfilmed. Microfilmed copies of many reports are now available through the Library of Congress to interested individuals at a modest fee.
    Two crucial areas requiring a concentration of research and development efforts were identified in this fiscal year: the teaching of English and the utilization of talent.
    Project Talent
    The purpose of this program of research and demonstration is to attack the deplorable condition which allows 70 percent of the talented young people in the United States to remain unidentified and dormant. Following research conferences, seminars, and research development contracts, basic and applied research and demonstration studies in this area are now underway with support from the Cooperative Research Program.
    As a major effort in Project Talent 440,000 secondary school children throughout the country are being tested, studied, and followed through their school experiences. Some of the results now available indicate, for example, that when the same achievement tests are given to children in the ninth grade and twelfth grade, the upper 25 percent of the ninth-grade students score higher than the average twelfth graders. This of course has important implications for curriculum planning.
    Illustrative of other studies in the utilization of talent are projects to determine the value of various problem-solving strategies and to follow up on the career patterns of college graduates. As a part of the latter program a research development conference was held to review and reassess research aimed at devising better tests to measure creativity, problem-solving ability, and underachievement.
    Project English
    English is basic to all other fields of study and important as well in the adult lives of all American citizens. Through research, improvement of teacher preparation, and dissemination of what is already known about effective teaching materials and practices, “Project English” is intended to support and extend the work already being done on the local and State levels by various professional organizations. It is not in any way an attempt by the Federal Government to control the content of the curriculum.
    Office of Education
    281
    An increasingly important feature is the collaboration between staff members of departments of English in colleges and universities and their counterparts in colleges of education, State education departments, and elementary and secondary schools.
    Curriculum Study Centers.—The purposes of these centers are (i 965	1, 605	1 076	67	532
    1959		7,512	6, 900	1, 607	1,034	64	479
    1960		7,691	6,983	1, 894	1,101	58	504
    1961		L 933	6' 976	1,981	1,395	70	440
    1962		7i 940	6,838	1 2,024	1 1,649	81	484
    i Differs slightly from comparable numbers for earlier years in that the earlier figures include “paper” discharges and readmissions made in order to change legal categories.
    Table 2.—Patients on the rolls, by status and by sex, time since admission, ethnic group, and age, June 30, 1962
    Sex, time since admission, ethnic group, and age	Patients on rolls, total	Resident patients 1			On vacation	On convalescent leave	On unauthorized leave
    		Total	In hospital	On temporary visit
    Total		7,883	6,894	6,617	277	83	837	69
    Males	 _	 			3,987	3, 587	3,446	141	34	314	52
    Females		3; 896	3,307	3,171	136	49	523	17
    Time since admissions
    Less than 6 months		773	686	625	61	5	74	8
    6-11 months	 . .		474	326	311	15	6	133	9
    1 year		 ...	780	562	529	33	18	187	13
    2 years. 					587	439	406	33	13	120	15
    3-4 years	 			719	576	539	37	19	111	13
    5-9 years		 _	980	866	824	42	9	100	5
    10-19 years	 ..	1,574	1,483	1,439	44	10	76	5
    20 years and over	 		L996	1,956	L944	12	3	36	1
    Median time since admission
    (years)		8	10	11	3	3	2	2
    Ethnic group
    White		4,160	3,765	3,618	147	43	322	30
    Non white		3,723	3; 129	2,999	130	40	515	39
    Age (years)
    Less than 15	 __	15	11	10	1	0	4	0
    15-17		36	24	22	2	0	11	1
    18-24		267	219	194	25	3	42	3
    25-34		854	650	587	63	16	160	28
    35-44		1,304	1,039	958	81	21	227	17
    45-54		L 508	1,284	1,223	61	20	193	11
    55-64		ij 623	1,470	L445	25	12	136	5
    65-74				1,172	1,119	1’106	13	7	42	4
    75-84		831	807	'801	6	4	20	0
    85 and over		273	271	271	0	0	2	0
    Median age		55	56	57	41	46	44	36
    i Resident patient status should not be confused with the D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit.
    406
    Department of Health, Education, and Welfare, 1962
    Table 3.—Movement of patients on the rolls, by sex, time since admission, ethnic group, and age, fiscal year 1962
    Sex, time since admission, ethnic group, and age	Patients on rolls June 30, 1961	Admissions	Discharges	Deaths	Patients on rolls June 30, 1962
    Total		7,992	2,024	1,649	484	7,883
    Males		 		4,047	1,129	962	233	3 981
    Females	.		3; 945	'895	687	251	3/J02
    Time from admission to June 80,1962
    Less than 6 months			1,080	290	19	773
    6-11 months	 			944	402	65	474
    1 year				472	77	780
    2 years	 				165	50	587
    3-4 years				117	52	719
    5-9 years 		 				86	71	980
    10-19 years			_ _ _			72	64	1 574
    20 years and over	 				45	86	1’ 996
    Ethnic group
    White		4,244	1, 036	836	284	4 160
    Nonwhite			3,748	988	813	200	3^ 723
    Age (years')1
    Less than 15		16	12	20	0	15
    15-24		280	235	150	3	303
    25-34	 		873	446	393	5	854
    35-44		1,345	434	447	19	1 304
    45-54		1,610	303	323	29	1 508
    55-64		1, 608	192	171	69	1 623
    65-74		1,197	175	104	109	1 172
    75-84		' 799	158	35	155	831
    85 and over		 _ 		264	69	6	95	273
    Median age		54	42	41	75	55
    'For individual age groups, the number of patients at the beginning of the year plus admissions minus discharges and deaths do not equal the number of patients at the end of the year. This is because some patients age from one group into the next during the year. For example, 7 patients who were less than 15 years of age on June 30, 1961, became 15 years old by June 30, 1962.
    Saint Elizabeths Hospital
    407
    Table 4.—Patients on the rolls by status and legal category, June 30, 1962
    Legal category	Patients on rolls, total	Resident patients 1			On vacation	On convalescent leave	On unauthorized leave
    		Total	In hospital	On temporary vist
    Total				7,883	6.894	6,617	277	83	837	69
    Reimbursable		6.228	5,378	5,144	234	77	741	32
    D.C. resident			5,382	4,714	4,534	180	58	587	23
    DC, voluntary		310	' 187	158	29	11	106	6
    Veterans’ Administration..	411	364	341	23	5	39	3
    U.S. Nationals from aboard.	59	55	54	1	1	3	0
    U S. Soldiers Home		41	35	34	1	0	6	0
    Indians (PUS)		21	21	21	0	0	0	0
    Other reimbursable		4	2	2	0	2	0	0
    Nonreimbursable		1,655	1, 516	1,473	43	6	96	37
    Total, excluding pris-
    oners		803	757	731	26	4	42	0
    D.C nonresident		313	275	261	14	2	36	0
    Military		252	250	248	2	0	2	0
    Virgin Islands. 			134	132	132	0	1	1	0
    Federal reservation		36	33	26	7	1	2	0
    Public Health Service	-	17	17	16	1	0	0	0
    Coast Guard..		14	14	14	0	0	0	0
    Canal zone			15	15	15	0	0	0	0
    Other, excluding prisoners.	22	21	19	2	0	1	0
    Prisoners			852	759	742	17	2	54	37
    D.C. total		782	689	672	17	2	54	37
    For examination		87	81	81	0	0	2	4
    Mentally incompetent-	248	238	235	3	0	6	4
    Not guilty by reason of
    insanity		296	240	233	7	2	32	22
    Under sentence			90	89	89	0	0	0	1
    Sex psychopath		61	41	34	7	0	14	6
    U.S. prisoners		49	49	49	0	0	0	0
    Military prisoners		21	21	21	0	0	0	0
    1 Resident patient status should not be confused with D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit.
    408
    Department of Health, Education, and Welfare, 1962
    Table 5.—Movement of patients on the rolls by legal category, fiscal year 1962
    Legal category	Patients on rolls, June 30, 1961	Admissions	Discharges	Deaths	Net changes in legal category	Patients on rolls, June 30, 1962
    Total		7,992	2,024	1,649	484		7,883

    Reimbursable		6, 265	1,432	948	432	-89	6,228
    D.C. Resident		5, 464	1,213	618	401	-276	5 382
    D.C. voluntary		292	192	227	10	+63	310
    Veterans’ Administration		406	12	58	16	+67	411
    U.S. Nationals from abroad		(>)	3	1	1	+58	59
    U.S. Soldiers Home		51	7	15	3	+1	41
    Indians (PHS)		45	0	23	1	0	21
    Other reimbursable		7	5	6	0	—2	4
    	■ 	 ———			 ■	-	—
    N onreimbursable		1, 727	592	701	52	+89	1,655
    Total, excluding prisoners..			889	186	385	38	+151	803
    D.C. nonresident		313	0	248	14	+262	313
    Military..		272	0	7	12	-1	252
    Virgin islands		138	4	3	5	0	134
    Canadian insane		51	0	0	0	-51	(1)
    Federal reservations		37	83	75	3	-6	36
    Public Health Service		28	2	12	2	+ 1	17
    Coast Guard		14	0	0	0	0	14
    Canal Zone		16	0	0	1	0	15
    Foreign Service (Employees)		10	0	4	0	-6	(!)
    Other, excluding prisoners		10	97	36	1	-48	22
    Prisoners		838	406	316	14	-62	852
    D.C. total		786	364		1		—					 ■
    			295	13	-60	782
    For examination	 Mentally incompetent		342	J	188 I	53	146 91	2 9	} 0	f	87 I	248
    Not guilty by reason of insanity..	229	79	23	1	+12	296
    Under sentence		151	39	27	1	-72	90
    Sex psychopath		64	5	8	0	0	61

    U.S. prisoners		30	42	21	0	-2	49
    Military prisoners		22	0	0	1	0	21
    1 Two categories, Canadian Insane and Foreign Service (Employees), were discontinued effective Novem-,^nd January 1962 respectively. Patients in these categories were transferred to the new Category U.S. Nationals from Abroad.	J
    Saint Elizabeths Hospital
    409
    Table 6.—Discharges by status from which discharged and by condition, environment, and employment, fiscal year 1962
    Legal category	Total	From resident patient status 1			From vacation	From convalescent leave	From unauthorized leave
    		Total	Direct from hospital	From temporary visit
    Total .		 		1,649	954	926	28	35	572	88

    Condition or type
    Medical discharges		973	361	342	19	31	533	48
    Condition on discharge:
    Recovered 	 .	60	19	17	2	1	40	o
    Socially recovered	604	143	131	12	24	413	24
    Improved .			233	138	133	5	5	77	13
    Unimproved		68	53	53	0	1	3	11
    No mental disorder		8	8	8	0	0	0	0
    Administrative discharges		676	593	584	9	4	39	40
    Type of discharge:
    Against medical advice. To legal or police au-	72	57	56	1	0	1	14
    thorities... ..		224	224	224	0	0	0	()
    To home State or conn-
    try _	_ ... 	 _	80	77	77	0	0	2	1
    To VA hospital	 Expiration of limited	37	36	36	0	0	1	0
    stay, court order, for admission to private hospital, etc		263	199	191	8	4	35	25
    Environment
    Lives alone			194	78	74	4	4	95	17
    With spouse 		 		265	109	103	6	6	144	6
    With relatives (not spouse)		426	217	202	15	13	184	12
    With others. _	.	_	63	32	31	1	0	31	0
    In foster-care home.. . 		10	0	0	0	0	10	0
    In D.C. Village	 In other home for aged, nurs-	34	3	3	0	0	31	0
    ing, or convalescent home	 In inpatient psychiatric insti-	19	14	14	0	0	4	1
    tution... .	.. 	 __	184	167	167	0	2	10	5
    In penal institution	..	235	234	234	0	0	1	0
    In other institution _	54	38	38	0	1	14	1
    Unknown environment. ._ _	165	62	60	2	9	48	46
    Employment
    Full time		244	67	62	5	7	167	3
    Part time or intermittent 		40	14	14	0	0	25	1
    Not employed		 .	1,079 286	757	738	19	13	277	32
    Unknown employment. 			116	112	4	15	103	52

    1 Resident patient status should not be confused with D.C. resident legal category. The former is defined as patients in the hospital plus those on temporary visit.
    665171—63---27
    American Printing
    House for the Blind
    As the Official schoolbook printery for the blind in the United States, one of the principal functions of the American Printing House for the Blind, in Louisville, Ky., is the provision of special educational books and supplies for the blind school children throughout the country through the Federal act “To Promote the Education of the Blind.” This act, originally passed in 1879, authorizes an annual appropriation to the Printing House for this purpose. Allocations of books and materials are made on a per capita basis. Only those pupils may be registered whose vision comes within the accepted definition of blindness as follows: “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20 degrees.”
    The Printing House maintains large catalogs of Braille books, Talking Books, recorded tapes, Braille music publications, large-type texts, and tangible apparatus. A rich collection of educational material is thereby provided for the kindergarten through the high school grades. A total of 7,706 blind pupils was enrolled through public educational institutions for the blind and 8,267 through State departments of education—a total of 15,973 blind pupils being served by the Printing House—for the fiscal year ending June 30, 1962.
    During the 1962 fiscal year, Braille books, educational periodicals, and music made up approximately 49.8 percent of the materials required by the schools; Braille slates, Braillewriters, maps, and other mechanical devices about 15.7 percent; Talking Books about 2.5 percent; recorded educational tapes about 0.5 percent; and large-type books about 29 percent. Approximately 2.5 percent was used for miscellaneous items.
    411
    Gallaudet College
    Gallaudet College, established in 1857, is the only institution of higher learning in the world devoted exclusively to the education of the deaf. It is accredited by the Middle States Association of Colleges and Secondary Schools. Public Law 420,83d Congress, approved June 18, 1954, clearly defines its status as a college, its relationship with the Federal Government and its responsibility to provide education and training to deaf persons and otherwise to further the education of the deaf.
    The college’s principal activity is a 4-year undergraduate course of studies leading to the B.A. and B.S. degrees. In addition, Gallaudet offers a 1-year college preparatory course. Deaf children of nursery age are taught in the Hearing and Speech Center. Elementary and secondary education for deaf children of the District of Columbia and adjacent States is provided by the Kendall School, a laboratory school serving the college’s Department of Education. This department, established in 1891, trains graduate students, both deaf and hearing, for positions as teachers and administrators in schools from 48 States, the District of Columbia, and 9 foreign countries. Enrollment in the Kendall School was 92, of which 80 came from the District of Columbia.
    The editorial offices of “dsh Abstracts” and of the “American Annals of the Deaf” are on the Gallaudet campus.
    413
    —I
    Howard University
    Howard University, located in the District of Columbia, was chartered by an act of Congress, dated March 2, 1867. The university consists of 10 schools and colleges, offering programs of higher education on the undergraduate, graduate and professional levels. Undergraduate students are registered in the college of liberal arts; graduate students seeking the master’s and doctor of philosophy degrees are registered in the graduate school; professional students are registered in the colleges of medicine, dentistry, pharmacy, fine arts (including the school of music and the departments of art and drama) and the schools of engineering and architecture, social work, law, and religion. (The school of religion receives no support from Federal funds.)
    The educational program of the university is conducted in keeping with the democratic purposes of land-grant colleges and State universities, with the low tuition fees and living costs which characterize these institutions, and with an educational program resting upon and permeated by the content and spirit of a general or liberal education. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and undertakes to discharge a special responsibility for the admission and training of Negro students.
    ENROLLMENT OF STUDENTS
    During the school year 1961-62, the university served a total of 8,704 students as follows: 6,338 during the regular academic year and 2,366 in the summer session of 1961. The total net enrollment, excluding all duplicates, was 7,118 distributed in the 10 schools and colleges as follows: liberal arts, 3,552; graduate school, 805; engineering and architecture, 778; fine arts, 375; social work, 126; medicine, 377; dentistry, 726; pharmacy, 177; law, 128; and religion, 74. The enroll
    415
    416
    Department of Health, Education, and Welfare, 1962
    ment of Negro professional students at Howard continues to be greater than in all the public-supported universities in all the Southern States.
    GEOGRAPHICAL DISTRIBUTION OF STUDENTS
    Of the total of 6,699 students seeking degrees, 5,762 or 86 percent came from the States and the District of Columbia, while 937 students or 14 percent came from outside the continental United States including 2 possessions of the United States, 58 foreign countries, and 13 island possessions of the British, French, and Dutch West Indies. The percentage of foreign student enrollment to the total student enrollment at the university continues to be the highest in any American university.
    The students from the United States were distributed as follows: New England States, 2 percent; Middle Atlantic States, 17 percent; East North Central States, 6 percent; West North Central States, 2 percent; Mountain States, 0.5 percent; South Atlantic States, 58 percent; East South Central States, 7.5 percent; West South Central States, 6 percent; and Pacific States, 1 percent.
    The 937 students from outside the continental United States came from 58 foreign countries including Greenland, Canada, and Mexico, 5 countries in the Caribbean area, 3 countries in South America, 9 countries in Europe, 17 countries in Africa, 12 countries in the Near and Middle East, and 9 countries in the Far East. In addition, there were students from Puerto Rico, the Virgin Islands, .and 13 of the British, French, and Dutch possessions in the West Indies.
    VETERANS
    During the 1961-62 school year, the student enrollment included 291 veterans and dependents of deceased veterans receiving allowances from the Veterans’ Administration. One hundred eighty-nine of them were enrolled in the four undergraduate divisions of the university, and 102 were enrolled in the graduate and advanced professional schools. The number of enrolled veterans is steadily decreasing, and unless there is new legislation providing benefits for “peacetime veterans,” there will be few veterans who have educational benefits still available to them after the 1962-63 school year.
    ARMY AND AIR FORCE ROTC
    Army ROTC.—There were 610 students enrolled in Army ROTC during the 1961-62 school year. Of this number, 284 were in the first-year course, 245 were in the second year, 44 were in the third year, and 37 were in the fourth year. There were 33 students commissioned as reserve officers in the Army during the year.
    Air Force ROTC.—A total of 537 students was enrolled in Air Force ROTC. Of this number, 303 were in the first-year course, 201 were in the second year, 19 were in the third year, and 14 were in the
    Howard University
    417
    fourth year. During the year, 8 students were commissioned as reserve officers in the Air Force.
    THE FACULTY
    There were 801 teachers serving the university during the school year. Of this number, there were 431 full-time teachers, while 370 were part-time. The full-time equivalent of the teaching staff was 533.6. Of this full-time equivalent, 472.7 were teaching in the rank of instructor and above.
    The university continues, as always, to seek for its faculty the most able persons who are selected on the basis of their competence and character, without regard to sex, race, color, creed, or national origin. It is to be noted, however, that the Howard University faculty has always included the largest group of Negro teachers and scholars at the university level found anywhere in the United States. Indeed, many of the most outstanding Negroes in public life have served at Howard University at some time during the course of their careers. Among such persons were the founder and operator of the first blood plasma bank, a governor of an American possession, an under secretary of the United Nations, and a member of the United States Court of Appeals.
    The faculty continues to remain active in making a valuable contribution to education and the advancement of knowledge through significant research and scholarly publications.
    GRADUATES
    During the 1961-62 school year, there were 731 graduates from the 10 schools and colleges. These graduates came from 36 States, the District of Columbia, Puerto Rico, the Virgin Islands, 22 foreign countries, and 7 island possessions of the British, French, and Dutch West Indies. The 22 foreign countries included Greenland, Haiti, Cuba, British Guiana, Panama, 4 countries in Europe, 4 countries in Africa, 3 countries in the Middle East, and 6 countries in the Far East.
    The 731 graduates were distributed among the 10 schools and colleges as follows: liberal arts, 311; engineering and architecture, 93; fine arts, 19; the graduate school, 68; social work, 43; medicine, 72; dentistry, 57; dental hygiene, 11; pharmacy, 28; law, 19; and religion, 10. In addition, honorary degrees were conferred upon three persons.
    From the date of its establishment in 1867, Howard has graduated 23,174 persons. The great majority of these graduates have been Negroes. Throughout its 95-year history, Howard has been a pioneer in providing Negroes with educational opportunities which were either not available or offered in only a limited amount elsewhere. Among institutions in which Negro students are in a majority, the university
    418
    Department of Health, Education, and Welfare, 1962
    still stands as the only one affording a complex system of undergraduate, graduate, and professional training.
    The largest number of graduates has entered the field of teaching, especially in the Southern States. In the field of medicine, there have been 3,239 graduates; 2,547 graduates have gone into dentistry and dental hygiene; 2,452 have entered the field of law; 822 have entered the ministry; 954 have gone into the fields of engineering and architecture; and 571 graduates have gone into social work. Numerous graduates of the university have been engaged in government activities, not only in the United States but also in many countries abroad.
    PUBLIC SERVICE AT HOME AND OVERSEAS
    Throughout the history of Howard, teachers and students have rendered valuable and distinguished service to government in the United States and overseas. This we view as being intimately related to the functions of a university—teaching, research, and public service.
    During the 1961-62 school year, the university systematically undertook programs to aid in the improvement and development of the local community. As an illustration of this, the Vice-President for Special Projects provided leadership in the establishment of an interdisciplinary program involving social work, sociology, religion, psychology, medicine, government, law, and other departments, which, together with the churches in the 49th census tract in Washington, are giving guidance and assistance to the people in that area in solving their most pressing social, economic, and cultural problems. A more limited program has also been initiated along similar lines in a second neighborhood area in the community.
    Early in the summer of 1962, Howard undertook an extensive Peace Corps training project which involved the training of volunteers going to Niger, Senegal, Togo, Sierra Leone, and Cyprus. In providing training for programs in five countries simultaneously, Howard had a greater number and variety of Peace Corps training programs at one time than any other institution in the country.
    Many members of the faculties gave significant public service as individuals. A professor of law was on leave of absence to serve as chairman of the Public Utilities Commission of the District of Columbia, a professor of sociology was appointed to the Advisory Board of the National Capital Transportation Agency, an associate professor of government was appointed to the District of Columbia Board of Elections, and a professor of preventive medicine and public health was presented a “community service award” by the Health and Welfare Council of the National Capital Area. These examples are illustrative of the service being given by many other members of the staff.
    Howard University
    419
    In 1961-62 as in the past, there were teachers from Howard working and studying abroad. An associate professor of government, with the aid of a Rockefeller grant, was engaged in studying guerilla warfare in Laos and Viet Nam; a professor of English was working for the United States Information Agency in West Germany; the librarian of the university served as an adviser at the library of the University of Rangoon in Burma; the director of recording was on leave to serve as registrar in the establishment of a new educational institution in Sukka, Nigeria; and a professor of anatomy was working in India on the staff of the Agency for International Development.
    Members of the staff were studying and teaching abroad, including one in Japan and another in Italy. There were many students traveling and studying in other countries, including 18 members of the university choir who participated in a choral workshop in Puerto Rico.
    It is readily recognizable, therefore, that students and members of the staff are continuing the Howard tradition of significant service to people both at home and elsewhere.
    THE BUILDING PROGRAM
    During the school year 1961-62, construction proceeded on the new home economics building, which was expected to be ready for use in the fall of 1962. Work was begun on the construction of a new building providing for the physical education programs for men. The new physical education building will contain about 113,000 square feet and will include the following general categories of space: a gymnasium area for 2,500 spectators; a gymnasium for regular program work; two special exercise rooms; a standard intercollegiate-size swimming pool with seating for approximately 400 spectators; classrooms and offices; locker space and shower rooms; and equipment storage and other related spaces.
    Plans and specifications were in preparation for the construction of a proposed new classroom building for the college of liberal arts and a new women’s residence hall. Construction is expected to begin near the end of this school year. In addition, the university leased a facility to serve as a warehouse service building.
    The university began a program of intensive study of its educational and physical plant needs for a number of decades in the future. The present master development program was completed in 1951. Its basis, however, rests essentially on a program which was designed in 1931. In view of the severe limitations placed upon its growth by the present limited campus, the university is endeavoring to make an even more intensive use of its present land resources, as well as exploring ways of expanding its campus area.
    Detailed Contents
    THE SECRETARY’S REPORT
    Page
    To Promote the General Welfare________________________________ 1
    Organization for Action_______________________________________ 2
    Past as Prologue______________________________________________ 3
    Progress—1962_________________________________________________ 4
    Tasks for Tomorrow____________________________________________ 9
    Table 1.—Grants to States: Total grants under all Department of
    Health, Education, and Welfare	programs, fiscal year 1962__ 12
    SOCIAL SECURITY ADMINISTRATION
    SOCIAL SECURITY IN 1962______________________________________ 13
    International Activities_____________________________________ 17
    Cuban Refugee Program________________________________________ 19
    Assistance Provided to Cuban Refugees______________________   22
    Unaccompanied Cuban Refugee Children’s Program_ _____________ 22
    OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE________________	23
    Unmet Needs______ ___________________________________________ 26
    Health Insurance for the Elderly_____________________________ 26
    Keeping Benefits Up To Date__________________________________ 29
    Extension of Program Coverage________________________________ 31
    Disability Insurance_________________________________________ 34
    The Retirement Test__________________________________________ 35
    Other Objectives_____ ______________ _ _____________________ 36
    What the Program Is Doing_____ __________________________     36
    Beneficiaries and Benefit Amounts____________________________ 36
    Disability Provisions______________________________________   38
    The Protection Provided______________________________________ 39
    Income and Disbursements_____________________________________ 40
    Administering the Program____________________________________ 41
    Research Activities______________________________________ -	47
    Financing the Program________________________________________ 48
    Old-Age and Survivors Insurance Benefits_____________________ 49
    Disability Insurance Benefits________________________________ 49
    Summary and Conclusions______________________________________ 49
    BUREAU OF HEARINGS AND APPEALS_______________________________ 50
    PUBLIC ASSISTANCE____________________________________________ 55
    Administrative Actions in Fiscal 1962____________________—	57
    State Agency Reaction to Administrative Changes_____________  58
    421
    422
    Department of Health, Education, and Welfare, 1962
    Page
    Public Welfare Amendments of 1962______	_ ______ _______________ 59
    To Promote Self-Reliance____________________________________ 60
    To Upgrade Staff Skill in Providing Services________________ 61
    To Provide Work Incentives and Encourage Efforts To Achieve
    Self-Support______________________________________________ 61
    To Extend the Adequacy and Scope of Public Assistance_ _	62
    To Assure More Effective Administration____ ____ . ________ 63
    Trends in Caseloads and Expenditures_______	____________________ 64
    Caseloads___________________________________________________________ 64
    Expenditures________________________________________________________ 66
    Source of Funds for Public Assistance Payments________________ _	68
    Program Developments_____________________________________________    68
    Developments in Medical	Care__ ________________________________     68
    Medical Assistance for the Aged (MAA)_______________________ 69
    Increased Medical Care Provisions Under Old-Age Assistance (OAA)------------------------------------------------- _	72
    Efforts To Improve Medical Care Programs___	____ 75
    From Work Relief to Work and Training.. _ .	_	_________ 77
    Effect of Federal Aid to the Unemployed___________________________ _ _	79
    Assistance to U.S. Citizens Returned From Foreign Countries_	80
    Civil Defense Emergency Welfare Services. .  .. ________ __________ 82
    Administrative Developments_________________________________________ 82
    Welfare Services____________________________________________________ 83
    Administrative and Fiscal Standards. _. _ _ ______________________   84
    Staff Development___________________________________________________ 85
    Program Interpretation______________________________________________ 8“
    International Activities___	____ ____ _ . __________________ _	87
    CHILDREN’S BUREAU_______________________________________III11III 88
    Legislative Developments____________________________________________ 92
    Public Welfare Amendments of 1962___________________________________ 93
    Intercountry Adoptions______________________________________________ 95
    Juvenile Delinquency________________________________________________ 95
    1962 Appropriations for the Children’s Bureau_______________________ 95
    Youth Development Unit______________________________________________ 96
    The Interdepartmental Committee on Children and Youth. ___________	96
    The National Committee for	Children	and	Youth_________________ 97
    Services to State Committees for Children and Youth________________ 97
    United Nations International	Children’s	Fund	(UNICEF)___________	98
    Civil Defense_______________________________________________________ 98
    Programs of the Bureau______________________________________________ 99
    Research in Child Life______________________________________________ 99
    Technical Research__________________________________________ 99
    Statistical Reports________________________________________ 101
    Research Interpretation____________________________________ 101
    Health Services for Mothers and Children___________________________ 102
    Maternal and Child Health Programs_________________________ 102
    Crippled Children’s Services_______________________________ 106
    Child Welfare Services_______________________________________________ 107
    Research and Demonstration Projects in Child Welfare_______ 107
    Teamwork To Improve Child Welfare and Family Services______	108
    Financing the Ongoing Child Welfare Program________________ 108
    Improvement in Child Welfare Services______________________ 109
    Steps To Meet Continuing Staff Shortages___________________ 109
    Changes in State Structure for Services____________________ 109
    Development of Child Welfare Services in Specialized Areas_	110
    Detailed Contents	423
    Page
    Juvenile Delinquency Service_____ ___________________________ _______ 113
    International Activities_____________________________________________ 115
    International Research (Foreign Currency Program)___ . _____ 115
    International Training____________________________________    116
    Assistance to Other Training Agencies______ ________ ___ ___ 118
    Summary_______________________________________________________________ 118
    BUREAU OF FEDERAL CREDIT	UNIONS____________________________ 118
    Consumer Protection_________________________________________________   120
    Student Loans for Higher Education_________ _________________________  120
    Manpower Utilization_______________________ — --------— _	_ __	120
    Strengthening Research and Statistics. _ -------------------- ------- 121
    International Activities____________________________— — ------------- 121
    Extending Coverage to Low-Income Groups__________________ . .	.	122
    Table 1.	-—Social Security Administration: Funds available and obligations incurred, fiscal years 1962 and 1961--------------------------- 123
    Table 2.	—Financing social insurance under the Social Security Act:
    Contributions collected and trust fund operations, fiscal years 1960-62 __	124
    Table 3.	—Old-age, survivors, and disability insurance: Number of families and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of December 1961 and
    December 1960______________________________________________________ 125
    Table 4.	—Old-age, survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June
    1962 and amount of benefit payments in fiscal year 1962, by State--	126
    Table 5.	—Old-age, survivors, and disability insurance: Selected data on employers, workers, taxable earnings, and contributions, by State for specified periods___,________________________________________________	128
    Table 6.	—Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1960-62______________________________________________________________ 129
    Table 7.	—Special types of public assistance under plans approved bj the
    Social Security Administration: Number of recipients and average payment, June 1962, and total payments to recipients, by program and
    State, fiscal year 1962..------------------------------------------ 130
    Table 8.	—Special types of public assistance under plans approved by the
    Social Security Administration: Federal grants to States and total expenditures and percent from Federal funds, by program and State, fiscal year 1962__________________________________________________________ 132
    Table 9.	—Maternal and child health and welfare services: Grants for maternal and child health services, services for crippled children, child welfare services, and research or demonstration projects in child welfare under the Social Security Act, by program and State, fiscal year 1962. _	134
    Table 10.	—Federal credit unions: Assets, liabilities, and capital, Dec. 31,
    1960, and Dec. 31, 1961____________________________________________ 135
    Table 11.	—Federal credit unions: Selected data on operations, as of
    Dec. 31, for each year 1934-61_____________________________________ 135
    Table 12—Federal credit unions: Selected data on operations, by asset size and State, 1961... ______________________________________________ 136
    Chart 1.—82 percent of aged beneficiaries had half or more of their retirement income from benefits______________________________________________ 24
    Chart 2.—When hospitalization becomes necessary, medical costs for the aged run high__________________________________________________________ 27
    424
    Department of Health, Education, and Welfare, 1962
    Page
    Chart 3.—Old people go to the hospital more often and stay longer than younger persons________________________________________________________ 28
    Chart 4.—Between 1940 and 1961 the percentage increase in average earnings exceeded the percentage increase in average benefits______________ 30
    Chart 5.—The earnings base covers the total annual earnings of a smaller percentage of regularly employed men than in the past__________________ 32
    Chart 6.—9 out of 10 workers are covered under the OASDI program__	33
    Chart 7.—Both benefit payments and number of beneficiaries have increased rapidly since 1950_____________________________________________ 38
    Chart 8.—The number and percentage of population aged 65 and over eligible for OASDI benefits are increasing_____________________________ 40
    Chart 9.—Hearing requests: total received, cleared, and pending___	51
    Chart 10.—Reviews before Appeals Council: receipts, disposals, and pending.--------------------------------------------------------------- 53
    Chart 11.—Cumulative civil actions filed, decided, and pending, December 1957 through June 1962________ __________________________'____	54
    Chart 12.—Why increased public assistance expenditures?___________ 56
    Chart 13.—Medical assistance for the aged: average payment per recipient for vendor payments for medical care, June 1962________________________ 74
    Chart 14.-—Vendor payments for medical care_______________________ 75
    Chart 15.—Salary, public assistance caseworker and other selected positions, July 1962_______________________________________________________ 85
    Chart 16.—Increasing child population_____________________________ 90
    Chart 17.—Births out of wedlock are increasing____________________ 91
    Chart 18.—Trends in juvenile court delinquency cases and child population 10 to 17 years of age, 1940-60____________________________________ 92
    Chart 19.—Maternal and child health services are reaching more people_ _	103
    Chart 20.—Trend in the number of children served in the crippled children’s program and in the number per 1,000 children under 21, 1937-60-	106
    Chart 21.—Child welfare agencies provide social services for children-- 111
    PUBLIC HEALTH SERVICE
    HEALTH OF THE NATION_______________________________________________ 139
    Health Record______________________________________________________ 143
    Births, Marriages, and Divorces____________________________________ 146
    Funds_____________________________________________________________ .	147
    Office of Personnel________________________________________________ 147
    Personnel__________________________________________________________ 148
    National Center for Health	Statistics______________________________ 148
    National Health Survey_____________________________________________ 148
    National Vital Statistics Division_________________________________ 149
    Office of Electronic Systems_______________________________________ 150
    Office of Health Statistics Analysis_______________________________ 150
    National Library of Medicine_______________________________________ 150
    Board of Regents___________________________________________________ 151
    Science Translation Program________________________________________ 151
    Program Statistics_________________________________________________ 151
    Division of Public Health Methods_________________________________ _	152
    Organizational Changes_____________________________________________ 152
    Professional Education___________________________________________   152
    Health Manpower____________________________________________________ 153
    Detailed Contents	425
    Page
    Division of International Health_____________________________________ 154
    Division of Health Mobilization______________________________________ 155
    BUREAU OF MEDICAL SERVICES___________________________________________ 157
    Division of Hospitals________________________________________________ 158
    Volume of Patient Care______________________________________________  158
    Cooperation Regarding Narcotic Problems______________________________ 158
    Research____________________________________________________________  159
    Professional Training________________________________________________ 159
    Goals for Future_____________________________________________________ 160
    Federal Employee Health Program______________________________________ 160
    Freedmen’s Hospital__________________________________________________ 160
    Foreign Quarantine___________________________________________________ 161
    Quarantinable Diseases_______________________________________________ 162
    International Traffic________________________________________________ 162
    Medical Examinations___________________;___________________________ 163
    Establishment of Fee_________________________________________ 163
    General Program_______________________________________________ 163
    Immigration of Tuberculous Aliens_____________________________ 163
    Additional Change in Immigration Law__________________________ 164
    Migratory Farm Labor__________________________________________ 164
    Entomology and Sanitation Programs____________________________________ 164
    Other Quarantine Activities___________________________________________ 164
    Health Services for Indians and Alaska Natives________________________ 165
    Medical Facilities____________________________________________________ 165
    Health Results________________________________________________________ 165
    Professional Staff____________________________________________________ 166
    Health Education_____________________________________________________  166
    Therapeutic Services__________________________________________________ 167
    Maternal and Child Care_______________________________________________ 168
    Tuberculosis__________________________________________________________ 168
    Dental Health_________________________________________________________ 168
    Environmental Sanitation______________________________________________ 169
    Training for Indians and Alaska Natives_______________________________ 169
    Construction Activities_______________________________________________ 170
    Prospects for the Future______________________________________________ 170
    Medical Services for Federal Agencies_________________________________ 170
    United States Coast Guard, Treasury Department________________________ 170
    Bureau of Employees’ Compensation, Department of Labor_______________ 171
    Maritime Administration, Department of Commerce_______________________ 172
    Bureau of Prisons, Department of Justice______________________________ 172
    Plans for New Psychiatric Hospital____________________________ 172
    Recommendations of Advisory Committee_________________________ 173
    Hospital Improvements_________________________________________ 173
    Clinical Services_____________________________________________ 173
    Demonstration Counseling______________________________________ 174
    Research______________________________________________________ 174
    Participation in Community Affairs___________________________  174
    BUREAU OF STATE SERVICES______________________________________________ 175
    Division of Accident Prevention_______________________________________ 175
    Division of Chronic Diseases__________________________________________ 177
    Cancer Control________________________________________________________ 177
    Demonstration Projects________________________________________ 177
    Clinical Traineeships, State Grants___________________________ 178
    665171—63----28
    426
    Department of Health, Education, and Welfare, 1962
    Page
    Diabetes and Arthritis Program---------------------------------------- 178
    Program Application------------------------------------------- 178
    Applied Research______________________________________________ 178
    Heart Disease Control Program----------------------------------------- 179
    Heart Disease in Children------------------------------------- 179
    Heart Disease in Adults--------------------------------------- 179
    Neurological and Sensory Disease Service Program---------------------- 180
    Project Grants________________________________________________ ISO
    Vision Conservation___________________________________________ ISO
    Hearing Conservation------------------------------------------ 181
    Health Services for Long-Term Illness Program------------------------- 181
    Support of Projects__________________________________________  181
    Development of Materials, Data Collection--------------------- 181
    Communicable Disease Center------------------------------------------- 182
    Epidemic and Disaster Aid____________________________________________ 183
    Representative Disease Studies---------------------------------------- 183
    Quota Sample Surveys----------------------------------------- 183
    Venereal Diseases_____________________________________________ 183
    Tuberculosis_________________________________________________ 184
    Influenza___________________________________________________   184
    Poliomyelitis________________________________________________ 185
    Measles Vaccine Trials________________________________________ 185
    Leprosy, Other Diseases_______________________________________ 185
    Laboratory___________________________________________________________ 185
    Audiovisual__________________________________________________________ 185
    Training______________________________________________________________ 185
    Division of Community Health Services-------------------------------- 185
    Grants for Improving Community Health	Services----------------------- 187
    Special Project Grants_______________________________________ 187
    Formula Grants_______________________________________________ 18'
    Training_____________________________________________________________ 18z
    Migratory Agricultural Workers--------------------------------------- 188
    Other Division Activities-------------------------------------------- 188
    Division of Dental Public FIealth and	Resources----------------------  188
    Strengthening Manpower and Educational	Resources--------------------- 188
    Special Patient Care_________________________________________________ 189
    Dental Care Financing Plans------------------------------------------ 189
    Attitude Studies______________________________________________________ 150
    Combating Dental Diseases____________________________________________ 190
    Improving Dental Public Health Practice------------------------------- 190
    A National Dental Center for Research and Training------------------- 190
    Division of Hospital and Medical Facilities-------------------------- 191
    Program Highlights___________________________________________________ 101
    The Construction Program--------------------------------------------- 191
    Research Activities___________________________________________________ 102
    Unmet Needs__________________________________________________________ 102
    Division of Nursing__________________________________________________ 102
    Training in Restorative Nursing-------------------------------------- 102
    Out-of-Hospital Nursing Care_________________________________________ 103
    Hospital Nursing_____________________________________________________ 193
    Field Center for Nursing Studies------------------------------------- 193
    Manpower and Related Studies------------------------------------------ 194
    Professional Nurse Traineeship Program------------------------------- 194
    Support of Extramural Research and Research Training----------------- 195
    Detailed Contents	427
    Page
    Intra-Agency Cooperation_____________________________________________ 195
    Division of Air Pollution____________________________________________ 195
    Research_____________________________________________________________ 195
    Instrumentation, Sampling, and Analysis______________________________ 196
    Technical Assistance and Training____________________________________ 196
    Goals________________________________________________________________ 196
    Division of Environmental Engineering and Food Protection_________	197
    Milk and Food Branch_________________________________________________ 197
    Shellfish Sanitation Branch__________________________________________ 197
    Special Engineering Services Branch__________________________________ 198
    Interstate Carrier Branch___________________________________________  198
    Division of Occupational Health___________________________________ 198
    Division of Radiological Health___________________________________ 200
    Environmental Surveillance________________________________________ 200
    State Assistance_____________________________________________________ 201
    Research_____________________________________________________________ 201
    Training_____________________________________________________________ 201
    Division of Water Supply and Pollution	Control_____________________ 202
    Construction Grants, Program Grants__________________________________ 202
    Basic Data___________________________________________________________ 203
    Enforcement__________________________________________________________ 203
    Research and Training________________________________________________ 203
    Comprehensive Programs, Interagency Coordination_____________________ 204
    Advisory Board_______________________________________________________ 204
    THE NATIONAL INSTITUTES OF HEALTH____________________________________ 204
    Institute of Allergy and Infectious Diseases_________________________ 208
    Institute of Arthritis and Metabolic Diseases________________________ 209
    Cancer Institute_____________________________________________________ 210
    Institute Research___________________________________________________ 211
    Grant-Supported Research_____________________________________________ 212
    Institute of Dental Research_________________________________________ 213
    Grants and Awards____________________________________________________ 213
    Heart Institute______________________________________________________ 214
    Grant-Supported Research_____________________________________________ 215
    Institute of Mental Health___________________________________________ 216
    Grant-Supported Activities___________________________________________ 216
    Basic and Clinical Intramural Research_______________________________ 217
    Community Services and Program Development___________________________ 218
    Training_____________________________________________________________ 218
    Institute of Neurological Diseases and Blindness_____________________ 218
    Collaborative Perinatal Research_____________________________________ 218
    Primate Research in Puerto Rico______________________________________ 219
    Multiple Sclerosis, Muscular and Neuromuscular Diseases, Epilepsy_	219
    Vision, Hearing, Headache____________________________________________ 220
    Division of Bi ologics Standards_____________________________________ 221
    Division of General Medical Sciences_________________________________ 222
    Research Grants____________________________________________________    222
    Research Training Grants_____________________________________________ 222
    The General Clinical Research Centers________________________________ 222
    Center for Research in Child Health__________________________________ 223
    Center for Aging Research____________________________________________ 223
    General Research Support Grants______________________________________ 223
    Special Resource Centers_____________________________________________ 223
    Division of Research Grants__________________________________________ 224
    428
    Department of Health, Education, and Welfare, 1962
    Page
    Division of Research Services____________________________________ 224
    Clinical Center__________________________________________________ 225
    Table 1.	—Statement of appropriations, authorizations, and obligations, Public Health Service, fiscal	year 1962__________________________ 226
    Table 2.	—PHS total paid employment by Bureau and Division, as of
    June 30, 1962__________________________________________________ 228
    Table 3.	—PHS total paid employment by Bureau, commissioned officers, and civil service, as of June 30, 1962__________________________ 230
    Table 4.	—Research grants and awards, fiscal year 1962_________ 231
    Table 5.	—-Payments to States or localities within States for public health services, fiscal year 1962______________________________________ 232
    Chart 1.—Public Health Service—1962_____________________________ 141
    Chart 2.—Death rates by age and sex, 1945-61____________________ 144
    OFFICE OF EDUCATION
    HIGHLIGHTS OF THE YEAR’S ACTIVITIES______________________________ 235
    Social Problems and Education____________________________________ 237
    Problems of Urban Areas__________________________________________ 237
    Freedom and World Understanding__________________________________ 239
    Equal Opportunity for Education__________________________________ 239
    Special Programs_________________________________________________ 240
    Exceptional Children_____________________________________________ 240
    Captioned Films for the Deaf_____________________________________ 241
    Early School Leavers_____________________________________________ 242
    Physical Fitness Survey__________________________________________ 243
    Programs and Service for Adults__________________________________ 243
    Training the Unemployed_________________________________________  244
    Civil Defense Education__________________________________________ 244
    Interagency Cooperation__________________________________________ 245
    International Organizations and Programs_________________________ 247
    EDUCATIONAL RESEARCH AND DEVELOPMENT_____________________________ 248
    Elementary and Secondary Education_______________________________ 248
    Strengthening State Departments of Education_____________________ 248
    Staff in Public Schools__________________________________________ 249
    Facilities Needed________________________________________________ 251
    Financing Public Education_____________________________________   254
    Local School Revenue_____________________________________ 255
    State Funds for Schools__________________________________ 256
    Federal Support__________________________________________ 258
    Offerings and Enrollments________________________________________ 259
    English__________________________________________________ 259
    The Arts_________________________________________________ 259
    Foreign Languages________________________________________ 259
    Science__________________________________________________ 261
    Mathematics______________________________________________ 263
    Guidance and Testing Services____________________________________ 264
    Identifying Talent_______________________________________ 264
    Testing Programs_________________________________________ 265
    Professional Personnel___________________________________ 265
    Higher Education_________________________________________________ 267
    Administrative Problems and Services_____________________________ 267
    Students and Curriculum__________________________________________ 270
    Detailed Contents	429
    Page
    Land-Grant Institutions___________________________________________ 276
    Federal Programs-------------------------------------------------  276
    Educational Statistics__________________________________________   277
    Sponsored Research______________________________________________   279
    Cooperative Research Program---- --------------------------------- 279
    Project Talent____________________________________________ 280
    Project English___________________________________________ 280
    Project Social Studies_________________________________    282
    New Educational Media_____________________________________________ 282
    Research__________________________________________________ 282
    Dissemination of Information______________________________ 283
    EDUCATIONAL ASSISTANCE PROGRAMS___________________________________ 286
    New Federal Legislation. _________________________________________ 286
    Federally Impacted Areas__________________________________________ 287
    Vocational and Technical Education________________________________ 290
    Area Vocational Education_________________________________________ 291
    Trade and Industrial Education____________________________________ 292
    Distributive Education____________________________________________ 293
    Agricultural Education____________________________________________ 293
    Office Education__________________________________________________ 294
    Home Economics Education__________________________________________ 295
    Training and Retraining___________________________________________ 295
    Area Redevelopment Act____________________________________ 295
    Manpower Development and Training Act_____________________ 296
    Programs in Higher Education______________________________________ 296
    Land-Grant Colleges_______________________________________________ 296
    Teachers of the Deaf______________________________________________ 296
    National Defense Education Act____________________________________ 297
    LIBRARY SERVICES__________________________________________________ 299
    INTERNATIONAL EDUCATION___________________________________________ 302
    Educational Exchange and Technical Services_______________________ 304
    Teacher Exchange Program__________________________________________ 304
    Teacher Development Program_______________________________________ 305
    Technical Assistance Training Program----------------------------- 305
    Nongrant Visitor Programs_________________________________________ 306
    International Assignments for Specialists_________________________ 306
    Clearinghouse on Educational Exchange______________________ - -	306
    Credential Evaluation_____________________________________________ 307
    International Studies____________________________________________  307
    Educational Materials Laboratory__________________________________ 308
    Table 1.	—Enrollment in grades 9-12 in public and nonpublic schools, and population 14-17 years of age: United States, 1889-90 to 1961-62._	254
    Table 2.	—Office of Education enrollment estimates: United States, 1960-61 and 1961-62________________________________________________________ 257
    Table 3.	—Gross national product related to total expenditures for education: United States, 1929-30 to 1961-62------------------------------- 258
    Table 4.	—-Earned degrees conferred by institutions of higher education:
    United States, 1869-70 to 1961-62_______________________________ 276
    Table 5.	—Grants and other financial assistance to States, administered by the U.S. Office of Education, fiscal year 1962--------------------- 288
    Chart 1.—Changes within the public elementary and secondary school system, United States 1957-58 to 1959-60------------------------------ 250
    430
    Department of Health, Education, and Welfare, 1962
    Page
    Chart 2.—Summary of expenditures for public elementary and secondary schools: United States, 1959-60___________________________________ 252
    Chart 3.—Revenue receipts for public elementary and secondary schools, by source: United States, 1959-60_________________________________ 256
    Chart 4.—Trends in enrollment in full-time elementary and secondary day
    schools: United States, fall 1954 to fall 1961__________________ 260
    Chart 5.—Approximate retention, fifth grade through college entrance:
    United States, 1924-32 and 1954-62______________________________ 266
    Chart 6.—Percentages of degree-credit students enrolled in various types of institutions of higher education: United States and outlying parts, fall 1961_________________________________________________________ 271
    Chart 7.—Total degree-credit enrollment in relation to population aged
    18-21: United States, fall 1939 and fall 1946 through fall 1961- 273
    Chart 8.—Trends in degree-credit enrollment for 4-year institutions and junior colleges, by types of institutional control: United States and outlying parts, fall 1939 and fall 1947 through fall 1961--------- 275
    Chart 9.—Vocational education enrollments and expenditures: United States, 1935-65___________________________________________________ 290
    FOOD AND DRUG ADMINISTRATION
    Introduction______________________________________________________ 311
    Administrative Progress___________________________________________ 318
    Food, Drug, and Cosmetic Act______________________________________ 321
    On the Food Front_________________________________________________ 321
    Radioactivity in Foods____________________________________ 321
    Chemicals in Foods________________________________________ 321
    Other Harmful Contaminants________________________________ 324
    To Keep Food Clean_______________________________________  326
    Pocketbook Protection_____________________________________ 329
    Foods for Special Dietary Purposes________________________________ 330
    Nutritional Quackery______________________________________ 331
    Drugs and Devices_________________________________________________ 334
    Illegal Sales of Prescription	Drugs_______________________ 335
    Safety Controls_________________________________________   337
    Counterfeit Drugs_________________________________________ 338
    Repacked Physicians’ Samples______________________________ 338
    Medical Quackery__________________._______________________ 339
    Medicated Feeds___________________________________________ 340
    New Drugs_________________________________________________ 341
    Devices___________________________________________________ 343
    Cosmetics and Colors______________________________________________ 345
    Certification Services____________________________________________ 346
    Federal Hazardous Substances Labeling Act_________________________ 347
    Enforcement of Other Acts_________________________________________ 348
    Civil Defense_____________________________________________________ 348
    New Court Interpretations_________________________________________ 348
    Changes in the Law and Regulations________________________________ 350
    Regulations_______________________________________________________ 351
    Scientific Investigations_________________________________________ 355
    Enforcement Statistics____________________________________________ 360
    Conclusion____________________________■___________________________ 361
    Detailed Contents
    431
    Page
    Table 1.—Actions on foods during the fiscal year 1962_______________ 327
    Table 2.—Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1962_____________________________________________________ 361
    Table 3.—Import samples collected, examinations made, and lots detained during the fiscal year 1962____________________________ 361
    Chart 1.—Retail sales of food in the United States, calendar years 1952-61_______________________________________________________ 314
    Chart 2.—Retail sales of drugs in the United States, calendar years 1952-61_______________________________________________________ 314
    Chart 3.—Retail sales of cosmetics in the United States, calendar years 1952-61_______________________________________________________ 315
    Chart 4.—Budgeted positions for Food and Drug Administration enforcement operations (excluding fee-supported certification services), fiscal years 1953-63_________________________________________________ 319
    Chart 5.—Time (in man-years) spent on FDA research for enforcement and certification, fiscal years 1957-63_______________________ 356
    OFFICE OF VOCATIONAL REHABILITATION
    Halfway to a Long-Time Goal___________________________________ 363
    The Steady Climb Since 1954_________________________________________ 364
    Seeking Out the Disabled______________________________________ 367
    The Growing Funds for State Programs________________________________ 368
    A New Look at Rehabilitation________________________________________ 370
    Research—Window on Progress_________________________________________ 370
    The Mechanics of Research___________________________________________ 370
    The Program Begins To Move__________________________________________ 371
    Help for the Mentally Retarded______________________________________ 371
    More Aid for the Mentally III_______________________________________ 374
    Better Sight for Better Jobs________________________________________ 374
    The Rehabilitation Complexities of Older Persons____________________ 375
    The Disabled Worker_________________________________________   376
    The Severely Disabled	Worker_______________________________ 377
    Living Without Sight__________ _____________________________________ 378
    The Tragedy of the Deaf-Blind_________________________________ 379
    The World Without Sound_______________________________________ 380
    Training for a Complex Program______________________________________ 381
    Rehabilitation Medicine—A New Speciality______________________ 382
    The Rehabilitation Counselor__________________________________ 383
    Meeting Other Shortages_______________________________________ 384
    The Rehabilitation Team_______________________________________ 384
    The Social Worker in Rehabilitation___________________________ 385
    The Rehabilitation Facility___________________________________ 386
    Rehabilitation Around the World_______________________________ 388
    The Hard Fight Against Dependency_____________________________ 389
    Table 1.—Number of referrals and cases, by agency, fiscal year 1962_ 391
    Table 2.—-Vocational rehabilitation grants, 1962, State divisions of vocational rehabilitation_____________________________________ 393
    Table 3.—Vocational rehabilitation grants, 1962, State commissions or agencies for the blind________________________________________ 394
    432
    Department of Health, Education, and Welfare, 1962
    Page
    Chart 1.—Rehabilitations by years--------------------------------- 364
    Chart 2.—Principal causes of disability among 1962 rehabilitants--	366
    Chart 3.—Major occupations of rehabilitated persons in 1962------- 367
    Chart 4.—Sources of referrals of 1962 rehabilitants--------------- 368
    Chart 5.—Funds for State vocational rehabilitation programs------- 369
    Chart 6.—Federal funds expended for research and training in vocational rehabilitation----------------------------------------------------- 372
    Chart 7.—Persons of 45 years or more rehabilitated, 1945-62------- 375
    Chart 8.—1962 training grants in areas of shortages of personnel in vocational rehabilitation______________________________________________ 382
    SAINT ELIZABETHS HOSPITAL
    Psychiatric Services________________________________________________ 399
    Medical and Surgical Branch----------------------------------------- 399
    Nursing Branch______________________________________________________ 400
    Clinical Training Branch____________________________________________ 400
    Psychology Branch___________________________________________________ 400
    Recreational Therapy Branch_________________________________________ 400
    Occupational Therapy Branch_______________________________________ 401
    Volunteer Branch____________________________________________________ 401
    Social Service Branch_______________________________________________ 401
    Biometrics Branch___________________________________________________ 401
    Medical Records Branch______________________________________________ 402
    Laboratory Branch___________________________________________________ 402
    Sanitary Engineering Branch_________________________________________ 402
    Chaplains Branch____________________________________________________ 402
    Library Services____________________________________________________ 403
    Office of Personnel_________________________________________________ 403
    Division of Administration------------------------------------------ 404
    Needs of the Hospital_______________________________________________ 404
    Table 1.—Patients, admissions,	and	discharges, fiscal years 1935-62- 405
    Table 2.	-—Patients on the rolls, by status and by sex, time since admission, ethnic group, and age, June	30,	1962------------------------- 405
    Table 3.	—Movement of patients on the rolls, by sex, time since admission, ethnic group, and age, fiscal year	1962---------------------------- 406
    Table 4.	—Patients on the rolls by status and legal category, June 30, 1962	 407
    Table 5.	—Movement of patients on the rolls by legal category, fiscal year 1962__________________________________________________________ 408
    Table 6.	—Discharges by status from which discharged and by condition, environment, and employment,	fiscal year 1962---------------------- 409
    AMERICAN PRINTING HOUSE FOR THE BLIND
    Services of Schools and Classes for the Blind--------------------- 411
    GALLAUDET COLLEGE
    The College’s Activities------------------------------------------ 413
    Detailed Contents
    433
    HOWARD UNIVERSITY
    Page
    Enrollment of Students_________________________________________ 415
    Geographical Distribution of Students__________________________ 416
    Veterans_______________________________________________________ 416
    Army and Air Force ROTO________________________________________ 416
    The Faculty____________________________________________________ 417
    Graduates______________________________________________________ 417
    ’	Public Service at Home and Overseas___________________________ 418
    The Building Program___________________________________________ 419
    U.S. GOVERNMENT PRINTING OFFICE:1963
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