    [Annual Report of the U.S. Department of Health, Education, and Welfare, 1954]
    [From the U.S. Government Publishing Office, www.gpo.gov]

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    HEALTH, EDUCATION, and WELFARE
    1954
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    HEALTH, EDUCATION, and WELFARE
    1954
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    U. S. DEPARTMENT OF
    HEALTH, EDUCATION, AND WELFARE
    As of March 1955
    Oveta Culp Hobby, Secretary
    Vacancy, Under Secretary
    OFFICE OF THE SECRETARY
    Roswell B. Perkins.................Assistant Secretary for Program Analysis.
    Bradshaw Mintener.................Assistant Secretary for Federal-State Relations.
    Chester S. Keefer...................... Special Assistant for Health and Medical
    Affairs.
    Donald M. Counihan.................Legislative Liaison Officer.
    Terence P. Soantlebury...........Executive Secretary.
    William C. McCamant..............Assistant to the Secretary.
    Parke M. Banta.........................General Counsel.
    Rufus E. Miles, Jr......................Comp tro Iler.
    Fordyce Luikart.........................Director of Administration.
    Robert J. deCamp...................... Director of Field Administration.
    J. Stewart Hunter................... Acting Director of Publications and Reports.
    Frederick H. Schmidt..............Director of Security.
    SOCIAL SECURITY ADMINISTRATION
    Charles I. Schottland..............Commissioner of Social Security.
    William L. Mitchell.................Deputy Commissioner of Social Security.
    Victor Christgau........... Director, Bureau of Old-Age and Survivors
    Insurance.
    Jay L. Roney................... Director, Bureau of Public Assistance.
    J. Deane Gannon........... Director, Bureau of Federal Credit Unions.
    Martha M. Eliot........... Chief, Children’s Bureau.
    PUBLIC HEALTH SERVICE
    Leonard A. Scheele................... Surgeon General.
    W. Palmer Dearing................... Deputy Surgeon General.
    Jack Masur................... Chief, Bureau of Medical Services.
    Charles E. Burbridge . . . Superintendent, Freedmen’s Hospital.
    Otis L. Anderson........... Chief, Bureau of State Services.
    William H. Sebrell, Jr. . , Director, National Institutes of Health.
    OFFICE OF EDUCATION
    Samuel M. Brownell................ Commissioner of Education.
    J. Kenneth Little................... Deputy Commissioner of Education.
    ii
    FOOD AND DRUG ADMINISTRATION
    George P. Larrick Commissioner of Food and Drugs.
    John L. Harvey...........................Deputy Commissioner of Food and Drugs.
    OFFICE OF VOCATIONAL REHABILITATION
    Mary E. Switzer Director of Vocational Rehabilitation.
    Emory E. Ferebee........................ Deputy Director of Vocational Rehabilitation.
    SAINT ELIZABETHS HOSPITAL
    Winfred Overholser................ Superintendent.
    Addison M. Duval......................Assistant Superintendent.
    FEDERALLY AIDED CORPORATIONS
    Finis Davis.................................. Superintendent, American Printing House for
    the Blind.
    Leonard M. Elstad................... President, Gallaudet College.
    Mordecai W. Johnson..............President, Howard University.
    REGIONAL DIRECTORS
    Lawrence J. Bresnahan...........
    Joseph B. O’Connor...................
    Michael J1. Shortley................
    Richard H. Lyle.........................
    Melville H. Hosch (Acting) . .
    James W. Doarn.........................
    James H. Bond...........................
    Albert H. Rosenthal................
    Fay W. Hunter.........................
    Region I, Boston, Mass.
    Region II, New York, N. Y.
    Region III, Washington, D. C.
    Region IV, Atlanta, Ga.
    Region V, Chicago, III.
    Region VI, Kansas City, Mo.
    Region VII, Dallas, Tex.
    Region VIII, Denver, Colo.
    Region IX, San Francisco, Calif.

    Letter of Transmittal
    Department of Health, Education, and Welfare,
    Washington, D. 0., December 1, 195^.
    Dear Mr. President: I have the honor to submit herewith the
    annual report of the Department of Health, Education, and Welfare
    for the fiscal year ending June 30, 1954.
    Respectfully,
    Secretary.
    The President,
    The White House,
    W ashington, D. C.
    285160
    V
    ALASKA HAWAII
    VI
    Contents
    The Secretary’s Report........................................
    Social Security Administration...........................
    Public Health Service...........................................
    Office of Education...............................................
    Food and Drug Administration...........................
    Office of Vocational Rehabilitation....................
    Saint Elizabeths Hospital.....................................
    American Printing House for the Blind . . . .
    Gallaudet College..................................................
    Howard University...............................................
    Page
    1
    17
    103
    171
    193
    221
    245
    259
    261
    263
    A detailed listing of the contents of this report, by
    topic headings, will be found on pages 271-278
    di

    The Secretary’s
    Report
    The Federal Government’s activities in health, education, and welfare
    are both a product and an instrument of modern American
    society.
    As a product, these activities have evolved from the development of
    a vast virgin land into a highly complex, industrial society. As an
    instrument, they are used as the modern means of furthering individual
    independence and dignity and of advancing national strength and
    vigor.
    The economic and social development of America is dated, of course,
    from the first settlements in the New World. As in other societies,
    America progressed through the social unit of the “community.” As
    a sparsely settled wilderness, the people’s strength and means of progress
    lay in the frontier stockades and settlements, which were forever
    pushed onward until the land was conquered.
    Political independence, growth, and change gave new dimensions
    to the community. States, as political entities, were formed as extensions
    of their communities’ interests. And the National Government,
    as a political entity of the whole, was created to represent the
    national interest of all the individual communities.
    Time has not diminished the contribution to life today of our
    earliest communities, nor has it erased the hard core meaning and
    strength today of the individual American community.
    In one form or another—sometimes in almost indiscernable shape,
    sometimes in clear outline and principle—today’s public activities
    in health, education, and welfare had their origins in the earliest
    settlements and colonial period of America.
    In some of the earliest settlements, where famine was a major
    hazard, a portion of the crops was set aside in a community storehouse
    for those in need during winter food shortages. Epidemics of
    2 Department of Health, Education, and Welfare, 1954
    communicable diseases were treated in many communities as a community
    responsibility, and “boards of quarantine” were established
    at ports to prevent the importation of disease from abroad. The
    earliest educational endeavors in America, from the “grammar”
    school in New England to the “old field” school in the South, contained
    the germ of the principle of “free” instruction for all children
    as a community responsibility.
    As the American economy developed, as our population grew, as
    the social aspects of life changed, so development, growth, and change
    have been necessary and desirable in our public activities in health,
    education, and welfare. In these activities, as in other fields, growth
    and change have been the orderly expectation of life in America.
    The America we know today, in all its aspects, has been most influenced
    by a historical fact marked by the year 1776. For our freedom
    as a people, as exercised through our democratic processes, has
    been the synthesizing and catalytic agent which has given our Nation
    its particular form, including our concepts and endeavors in public
    health, education, and welfare.
    Our independence as a people had hardly been won and the Federal
    Union formed before the national interest in education was demonstrated.
    In 1785 the first Federal grant of any nature was initiated
    by reserving land for establishing public schools in the Northwest
    Territory.
    A few years later, in 1798, the Federal Government established the
    Marine Hospital Service for the care of American seamen. This hospital
    service was the forerunner of the Public Health Service.
    A form of social security can be identified as far back as 1857, when
    the first municipal pension fund was established, providing disability
    and death benefits for New York City police.
    A few years later the first State gave formal recognition to the
    common nature of the problem of needy people and the common responsibility
    of all its communities in this problem. This was marked
    in 1863 by the founding in Massachusetts of the first State board of
    charities in America.
    These were a few of the early stirrings in health, education, and
    welfare, which were to grow and change to serve the needs of a people
    and nation as they grew and changed.
    A hundred years ago our population was about 23 million. At the
    end of calendar year 1954 it was nearly 164 million. A hundred years
    ago the value of all goods produced and services performed by the
    American people in one year was less than $10 billion. For 1954 it
    was about $357 billion. A hundred years ago the number of people
    employed in America was less than 8 million. At the end of 1954,
    the total was well over 60 million.
    The Secretary’s Report 3
    These few comparisons—of population, value of the national product,
    and employment—indicate growth in only its broadest and simplest
    form. But they imply a great deal more. Along with sheer
    growth has come social change—the way in which we live our daily
    lives.
    What are some of the implications, in today’s terms, of these social
    changes in relation to the Nation’s health, education, and welfare?
    And, more specifically, in the fact of today’s needs, what were some
    of the accomplishments in Federal activities in these fields during the
    brief span covered by this report, from July 1953 through June 1954?
    The Department and Its Work
    The Department of Health, Education, and Welfare is sometimes
    referred to as the “Department of Human Resources.”
    The activities of the Department touch the life of every man,
    woman, and child in America. It is true that all Federal activities
    have a direct or indirect bearing on the lives of all Americans. But
    health, education, and welfare are intimate elements of the daily lives
    of all people.
    The Department comprises five major units: The Public Health
    Service, Social Security Administration, Office of Education, Food
    and Drug Administration, and Office of Vocational Rehabilitation.
    It is through the activities of these units that the Department, in
    carrying out the laws of Congress, seeks to advance the health of the
    Nation, further the education of each succeeding generation, and
    strengthen the welfare, or security, of certain individuals and, hence,
    of all Americans.
    It is noteworthy that the great bulk of the Department’s work is
    carried on in partnership with the States and communities. Nearly
    all the programs for which the Department has Federal responsibility
    are actually operated by the States. One measure of the extent to
    which this is true is found in the amount of money spent by the Department
    in administering wholly Federal activities as against the
    amount allocated States for operating State programs to which the
    Federal Government makes financial contributions.
    For the fiscal year 1954, Congress appropriated $1.9 billion to the
    Department for all its activities, except for the self-supporting system
    of Federal old-age and survivors insurance. This amount was
    2.8 percent of the total funds spent by the National Government.
    About 93 cents of each dollar appropriated by Congress to the Department
    was passed on by the Department to the States, communities,
    and institutions, primarily for their use in providing the various
    cash benefits and services in which the Federal Government and the
    4 Department of Health, Education, and Welfare, 1954
    States jointly cooperate. The remaining 7 cents of each dollar was
    spent directly by the Department for all its other activities.
    In a broad sense, the term “health” covers the work of the Public
    Health Service, Food and Drug Administration, and Office of Vocational
    Rehabilitation. But activities in food and drugs and in
    vocational rehabilitation also involve direct economic factors for the
    public.
    Through the Public Health Service, the Department cooperates
    with the States in the control of epidemics, the sanitation of milk and
    water supplies, control of communicable diseases, and other health
    programs. The National Institutes of Health, a branch of the Public
    Health Service, conduct research programs in cancer, mental health,
    heart disease, dental health, arthritis and metabolic diseases, microbiology,
    and neurological diseases and blindness. The Public Health
    Service also facilitates research through grants of funds to universities,
    hospitals, and other research organizations. The Department,
    through the Public Health Service, also provides funds to assist the
    States and communities in the construction of hospitals.
    The health of the Nation is further protected and promoted by the
    Department’s Food and Drug Administration, which enforces Federal
    laws designed to insure the purity and truthful labeling of foods,
    drugs, and cosmetics. In addition, under these laws, the Food and
    Drug Administration formulates definitions and standards for foods
    to promote honesty and fair dealings in the economic interest of the
    consumer.
    Health and economic benefits are the twin elements of the program
    administered by the Department’s Office of Vocational Rehabilitation.
    The activities in this field, which are carried on in cooperation
    with the States, are designed to restore to useful employment disabled
    civilians who have job handicaps resulting from illness, accidents, or
    other causes. In addition to the advantages afforded disabled persons
    through this program, it works to the economic advantage of the country.
    A high percentage of the disabled persons rehabilitated are restored
    to self-supporting, tax-paying roles in the community, thus
    relieving both private and public funds of their support.
    Through the Social Security Administration, the Department operates
    its welfare programs. Only two are wholly Federal activities.
    One is the chartering and auditing of Federal credit unions. The
    other is the nationwide system of old-age and survivors insurance,
    commonly referred to as “social security.” All the others are State
    programs to which the Federal Government makes financial contributions.
    These programs are: Public assistance for the needy aged,
    blind, dependent children, and the permanently and totally disabled;
    maternal and child health services, services to crippled children,
    and child welfare services.
    The Secretary’s Report 5
    The national interest in, and services to, education is carried on by
    the Department’s Office of Education. The Office maintains advisory
    services to public and private school systems, colleges, and universities
    and conducts a research and statistical service. It also administers
    programs of financial aid for the nationwide activity of vocational
    education; for construction, maintenance, and operation of
    schools in areas where local facilities are overburdened by Federal
    activities; and to States for colleges of agriculture and the mechanical
    arts.
    A New Appraisal
    The Department of Health, Education, and Welfare was a little
    more than 2% months old when the fiscal year began on July 1, 1953.
    It was established by elevating its predecessor organization, the Federal
    Security Agency, to the rank of an executive department. And
    in taking this action, Congress marked the formal point in history
    when social and economic change had placed the health, education,
    and welfare of the American people as subjects for consideration at
    the highest council of government, the President’s Cabinet.
    In this context, and mindful that needs change with the times, the
    new administration of the Department, upon assuming office, had
    launched a thorough appraisal of the laws which were entrusted to
    the Department to administer. Task forces had been set up to study
    various areas of legislation and to recommend changes. Early in the
    fiscal year, proposed bills were prepared based on these studies and
    recommendations.
    The year’s major accomplishment was the enactment of legislation
    relating to the health, education, and welfare of the American people
    in which the President made specific and far-reaching proposals to
    Congress. By the end of the fiscal year, a substantial portion of the
    President’s proposals had been acted upon by committees of Congress
    and had either been passed by Congress by overwhelming majorities
    or were approaching final action in the legislative process.
    Developments in Health
    The first half of the 20th century has been marked by scientific
    achievements which at times have seemed to outstrip imagination.
    Notable among these accomplishments have been additions to medical
    knowledge and improved public health practices. Taken together,
    these advances have drastically reduced infant mortality, prolonged
    the life span, and, within their limitations, provided the means for
    healthier, more productive lives.
    6 Department of Health, Education, and Welfare, 1954
    But these results, in themselves, sometimes produce their own peculiar
    problems which, in turn, require change. Lengthening the life
    span, for instance, can necessitate change in the types and number of
    hospitals needed. Improved medical knowledge and related techniques
    can provide the means for rehabilitating more disabled people,
    and at the same time require special buildings and equipment and more
    of them. And scientific progress in one field, such as agriculture,
    can necessitate the imposition of controls to protect human life.
    Hospitals.—Our concept and the status of the hospital in the American
    community has changed completely over the years. The hospital
    originated as a charitable institution for the indigent. Patients of
    means could receive medical and nursing care at home. Today the
    hospital is considered essential for any serious illness, for diagnosis,
    for outpatient treatment, for medical research. It is, in reality, the
    hub of modern American medical care.
    In 1946 Congress enacted the Hospital Survey and Construction Act
    and placed administration of the law in the Public Health Service.
    The legislation provided Federal financial aid to the States and communities
    for building badly needed hospitals.
    For 8 years this hospital program had done a good job. It was
    widely accepted by the States and communities as one which produced
    real results with a minimum of friction. However, when a study of
    the hospital situation was made by one of the Department’s task forces
    it was evident that changing conditions required new remedies. The
    principal and guiding facts discovered in the study were the drop in
    the toll of infectious disease and the lengthening life span, which
    means that chronic illnesses were assuming greater importance. For
    instance, it was found that of the total current need for hospital beds,
    88 percent are needed for patients with chronic illnesses.
    While the original hospital construction program was meeting a
    real need in providing general hospitals, it was clearly indicated that
    particular emphasis must be given to special facilities for long-term
    patients, those with chronic illnesses. Moreover, on the purely economic
    basis, facilities for long-term patients are not as costly to construct
    or operate as general hospitals. In this way, also, the more expensive
    services of general hospitals could be freed for the acutely ill.
    The President in his health message recommended an adjustment in
    the hospital construction program to provide greater emphasis on
    facilities for long-term patients. By the end of the fiscal year Congress
    had enacted a bill which provided for funds, under a matching
    formula with States and local organizations, to build chronic disease
    hospitals, diagnostic and treatment centers, nursing homes, and rehabilitation
    facilities. The bill was signed into law by the President
    on July 12, 1954.
    The Secretary’s Report 7
    Vocational rehabilitation.—The United States has an estimated 2
    million men and women of working age who are so disabled that they
    cannot work in any employment without the benefit of vocational
    rehabilitation services.
    Each year about 250,000 people come to need vocational rehabilitation
    either because they suffer a disability or because they enter the
    working age bracket with a disability. This figure is not cumulative,
    however, on top of the fairly constant estimate of 2 million who at any
    given time need vocational rehabilitation. Erom 55,000 to 60,000 disabled
    people are rehabilitated annually through the Federal-State
    program. Others are rehabilitated through private and voluntary
    efforts. Still others die or leave the disabled group for other causes.
    The important fact, discovered in a thorough study of the vocational
    rehabilitation program, was that no inroad was being made on
    the backlog of disabled persons. These people, who could be useful
    workers, were entitled to a better hope than the limited program held
    out for them.
    Close examination of the problem disclosed that more could and
    should be done to give the Nation’s disabled people fair opportunities
    for productive employment and better lives. Changing circumstances,
    in this area as in others, offered the opportunity and, in fact, dictated
    its utilization. Indeed, the accomplishments of the Federal-State
    program itself pointed the way for providing better services for more
    disabled people. New knowledge and improved methods had been
    proved in actual practice and were awaiting wider use.
    This was the setting in which the President proposed a fourfold
    expansion within the next 5 years in the annual number of disabled
    people rehabilitated for self-support. The goal is an annual rate of
    200,000 persons rehabilitated by 1959. Legislation embodying the
    President’s proposals was adopted by Congress—by unanimous vote—
    shortly after the close of the fiscal year. The President signed the
    new law on August 3.
    The new legislation authorizes greater Federal financial support for
    the program—on a rising scale for the next 4 fiscal years from $30 million
    in 1955 to $65 million in 1958. It gives more latitude to the States
    in the operation of their programs. And it provides for Federal participation
    in the training of professional personnel to work with disabled
    persons.
    Equally important as an adjunct to the new vocational rehabilitation
    law was an adjustment made in the hospital construction program
    described above. Under the new hospital construction law, authorization
    was given to build urgently needed rehabilitation facilities.
    Along with its survey of the vocational rehabilitation program, the
    new administration of the Department had initiated a study which
    8 Department of Health, Education, and Welfare, 1954
    was to have a strong bearing on the recommendations for vocational
    rehabilitation. This was a study of all the Department’s legislation
    under which partnership activities were carried on by the Federal
    Government and the States—those activities of the States to which
    the Government gave financial support.
    This study clearly showed the desirability of adjusting all the Department’s
    Federal-State legislation so that Federal financial support
    would be based on three integrated objectives. One of these would
    be financial support of the current State activity. Another would be
    funds for extension and improvement of current programs' to help
    the States meet the costs of adding to and improving the particular
    services. And the third would be financial aid for special projects to
    help the States, localities, and nonprofit organizations and agencies
    meet special problems in connection with their programs or to carry
    out special projects' or research which held promise of providing new
    approaches in achieving the objectives of the programs. The new
    vocational rehabilitation law was the first measure which incorporated
    in legislative terms these three basic objectives of Federal
    financial participation in the Department’s joint activities with the
    States.
    To summarize, a combination of three actions now gives' new promise
    and hope to disabled persons themselves and to the Nation in fulfilling
    its obligation to them. One is the new vocational rehabilitation
    law. Another is the new hospital construction legislation, which
    authorizes the building of rehabilitation facilities. And the third
    is a new social security amendment, which preserves the benefit rights
    of disabled persons.
    Together, these measures constitute a long step forward, at long
    last, in coming to grips realistically with the hard core problem of
    vocational disability—the estimated 2 million backlog of disabled
    people.
    Food, drugs, and cosmetics.—The greatly expanded use of pesticide
    chemicals in recent years is helping to increase agricultural productivity
    and to protect agricultural commodities from contamination
    and spoilage. But residues from these chemicals can be harmful to
    consumers unless they are limited to safe amounts'.
    To insure the safety of foods and, hence, to protect the health of the
    consuming public, Congress enacted a law which provides a procedure
    for establishing safe tolerances for residues of pesticide chemicals on
    raw agricultural products. The new law, enforced by the Food and
    Drug Administration, has the effect of prohibiting the use of any
    pesticide for which a safe tolerance cannot be set. The President
    signed this legislation into law shortly after the close of the fiscal year.
    Action was also taken during the year to simplify the establishment
    The Secretary’s Report 9
    of standards which give economic protection to the consumer in the
    purchase of food. In setting standards to guarantee the composition
    and real value of food products, the law required the Food and Drug
    Administration to follow a procedure that was unnecessarily timeconsuming,
    burdensome, and expensive.
    An amendment to the law, signed by the President on April 15,
    1954, simplifies and reduces the cost of this procedure for both industry
    and the Government. The amendment permits the Department
    and industry to agree on the body of facts or noncontroversial points
    relevant to the food, prior to the formal public hearings which are
    conducted to establish standards for any food. Such facts, however,
    become a part of the official record and of the Department’s considerations
    in setting the standards.
    The spectacular increase in processed foods' and new drugs and cosmetics
    in recent years, along with scientific and technological changes
    in their processing, has made a profound impact on the enforcement
    responsibilities of the Food and Drug Administration. Recognizing
    the implications of these developments, the Department during the
    year requested Congress to authorize a thorough study of the current
    enforcement program and the amount and kind of enforcement needed
    to give up-to-date maximum consumer protection. It is expected that
    the study will be conducted by a citizens’ committee having broad
    expertness in the fields to be studied.
    Developments in Education
    America has more and better education than at any prior point in
    its history. In 1870, for instance, 57 percent of the children aged 5-17
    years were enrolled in the public schools with an average attendance
    of less than 80 days' during the year. Eighty-two years later, in 1952,
    85 percent were in school for an average yearly attendance of 178 days.
    Of our 161 million population at the beginning of 1954, 33y2 million
    were in elementary and secondary schools and 2% million in colleges,
    universities, and commercial and nurse-training schools. This was
    more than 22 in every 100 persons in attendance at full-time day
    school.
    It may be said that in no other major country in the world have the
    people achieved the near-universality of education as in America.
    But the adequacy of our educational system cannot be measured externally.
    It can be measured accurately only against our own
    concepts and needs.
    The American philosophy of education rests on two cardinal principles.
    One is the inalienable right of every person to have access' to
    knowledge in order to strive for his full potential as a person. The
    339010—55------ 2
    10 Department of Health, Education, and Welfare, 1954
    other is the function of education as the nervous system of our democratic
    form of society.
    Based on our own standards, it is a fact that adequate educational
    opportunities are being denied to many thousands of children today
    because of a shortage of teachers, classrooms, and related facilities.
    The Nation will enter the next school year, in September 1954, with
    a substantial classroom shortage, with new construction barely keeping
    pace with additional pupils, and obsolescence of existing classrooms.
    For the same school year there will be a shortage of nearly
    125,000 qualified elementary teachers. No general shortage of teachers
    in the secondary schools is anticipated for the same year.
    Every 10 minutes a new classroom of children reaches school age,
    and a new room and another teacher are needed. This goes on day
    and night, 7 days a week.
    There are a number of reasons for the deficits of classrooms and
    teachers. Events of history, internal and external, created some of
    the causes. The depression of the 1930’s denied the funds, and World
    War II denied the materials, to build classrooms. The tremendous
    birth rates since World War II created the mounting school enrollments
    and, hence, the need for the largest teaching staff in our school
    history. And to compound the problem, the teaching staff must be
    recruited from men and women born in the 1930’s, the depression
    years which were marked by the lowest birth rate in our modern
    history. Finally, active public concern over the problem and corrective
    measures by the political units involved have frequently lagged
    or been absent.
    In view of these facts and the essential function of education in the
    American way of life, the President in both his State of the Union
    and Budget Messages to Congress made specific proposals for legislation
    to further educational progress in the country. These proposals
    were based on the fundamental principle that the primary responsibility
    for providing public education and operating public schools is
    properly a State and local function. At the same time they recognized
    the national interest and responsibilities in education.
    By June 30, 1954, three bills incorporating all the President’s
    recommendations had been enacted by Congress. They were signed
    by the President on July 26.
    One of these laws is designed to help the States develop plans and
    action programs to remove the roadblocks that impeded educational
    progress. It provides funds for Statewide conferences on education
    to be held in every State. These conferences will bring together educators,
    parents, and representatives of school planning groups and
    other interested organizations to study the educational needs of their
    States and the resources and best methods for meeting them.
    The Secretary's Report___________________________________ _________________1 *
    The State conferences will deal with such problems as maintaining
    an adequate supply of well-prepared teachers; financing school buildings
    and equipment; financing education; improving local and State j| education organizations; and providing education to meet today’s
    I needs for the individual and for a democratic society.
    j Following the State conferences, the President will hold a White
    House Conference on Education in 1955, the first such conference ever
    to be held. The White House Conference will consider the findings
    and recommendations of the State conferences and seek to identify
    (anew the national interest and responsibility in education.
    Another of the new laws authorizes the Office of Education to conduct
    cooperative research programs with educational institutions and
    " agencies concerned with the problems of education. Such research
    is needed, and it will have the benefit which is inherent in educational
    institutions examining problems in their own field. This will be the
    first time an approach of such breadth and depth has been used by I government in the field of education. It will also have the advantage R of utilizing staff and facilities which are already available and thus
    hold to a minimum the addition of staff to the Office of Education.
    The third law enacted in the field of education authorizes the
    establishment of an advisory committee on education to the Secretary
    of Health, Education, and Welfare. The function of this committee
    will be to identify and study situations and trends in education and
    to make recommendations regarding them.
    j Developments in Welfare
    Social welfare attitudes and programs in the United States have
    had a long and varied development. Our earliest concepts stemmed
    from the Elizabethan “poor laws” which had been in effect in England
    only a few years before the first settlers from that country reached
    . our shores at Jamestown.
    From the very beginning of the colonization of America, towns
    accepted responsibility for aiding the needy. As the country developed
    politically and economically, the States began to share this
    responsibility with the communities. The depression of the 1930’s,
    with its devastation to jobs, savings, and the economy generally, made
    it clear that communities and States individually could not meet the
    need. The ultimate result was a sharing by the National Government
    of financial responsibility with the States for certain categories of
    needy people—the aged, blind, children, and the totally disabled. But
    the long established principle of State and community control and
    administration of welfare programs was maintained. The Federal
    Government helps financially, but the States operate the programs.
    12 Department of Health, Education, and Welfare, 1954
    But as America became highly industrialized and as more and more
    people became dependent upon money income for their livelihood,
    another concept in social welfare was taking hold. We began to see
    that the needs of some groups of people could best be met by using
    the principles of social insurance—the principles of sharing the risk
    and spreading the cost for protection against certain hazards in an
    industrial economy that few people can be sure of meeting solely
    through their own efforts.
    Social security.—Federal old-age and survivors insurance, or “social
    security,” is social insurance. Under this system, basic income protection
    is afforded retired workers, their families, and survivors.
    Employers, workers, and the self-employed contribute to the system
    during the working years to build up the funds from which payments
    are made.
    Among the first actions of the new administration of the Department
    was a sweeping examination of the adequacy of the old-age and
    survivors insurance system. The President had previously stated
    that the program should be extended wherever feasible to any groups
    excluded under the existing law.
    A study by a group of consultants showed that, among several
    deficiencies, millions of Americans who should have the protection
    of the system were not participating in it. When the program was
    started 17 years ago, it was not considered feasible to include farm
    and domestic workers or the self-employed. As social security gained
    recognition and understanding and as methods of recordkeeping were
    improved, means were developed to bring into the system practically
    all working people.
    The time had come to correct this deficiency and to adjust the program
    in other respects. On the basis of a report of findings and recommendations
    from the consultants, a bill relating to extension of the
    coverage of old-age and survivors insurance was submitted to Congress
    in August 1953. After study of the benefit structure, a more comprehensive
    bill was submitted in January 1954. Its enactment became
    effective with the President’s signature on September 1, 1954.
    This legislation was the most far-reaching adjustment in the social
    security law since amendments were made to it in 1939. In extending
    protection of the system to about 10 million additional persons, the
    new law made universal coverage of the program a virtual fact.
    Nine out of 10 of the Nation’s workers are now covered by this insurance
    system.
    In addition to giving protection to 10 million more people, the new
    law increases benefit payments to all present and future retired workers
    and most other beneficiaries. It also determines benefits on a more
    advantageous basis by permitting a worker to drop as many as 5 years
    The Secretary’s Report 13
    of low or no earnings and by increasing to $4,200 the amount of annual
    earnings that can be counted toward benefits.
    Disabled workers will no longer lose, through periods of unemployment
    resulting from disability, the protection they have earned under
    the system. The new law preserves their rights to any benefits they
    have earned up to the time of their disability.
    The retirement test—the amount of money a person may earn and
    still receive insurance benefits—has been liberalized under the new law.
    Workers under age 72 may now have earnings up to $1,200 in a year
    without loss of benefits. A beneficiary 72 or over can now receive
    insurance payments regardless of the amount he earns.
    The self-supporting social security system is coming of age. The
    fact of its extended protection to 9 out of 10 workers—that it more
    widely shares the risk and spreads the cost—is one evidence of its
    maturing.
    But the program’s coming of age has another important meaning.
    It is the changing relationship between old-age and survivors insurance
    and old-age assistance. Under the latter program, which is
    operated by the States with the aid of Federal funds, payments are
    made to the aged solely on the basis of need. In the early years of the
    two programs, it was natural that the number of old people receiving
    old-age assistance was greater than the number receiving old-age and
    survivors insurance.
    As the insurance program developed, the relationship changed. In
    every month since February 1951, the number of old people receiving
    old-age and survivors insurance has been greater than the number
    receiving old-age assistance. It is expected that this trend will continue.
    In a few years, when three-fourths of our aged population
    will be eligible for the insurance benefits, the role of old-age assistance
    will increasingly become one of supplementing the insurance benefits
    in cases of special need.
    Juvenile delinquency.—The Department is seeking to provide assistance
    to States and communities in meeting their problems of juvenile
    delinquency. During the coming fiscal year a special division will be
    established in the Department’s Children’s Bureau to provide technical
    assistance to the States and communities in their work in the area of
    juvenile delinquency.
    A national conference on juvenile delinquency, sponsored by the
    Department, was held June 28-30. Its 475 delegates included police
    officers, judges, teachers, probation officers, churchmen, welfare administrators,
    and representatives of a wide variety of civic, labor,
    fraternal, and religious organizations interested in action on behalf of
    youth.
    14 Department of Health, Education, and Welfare, 1954
    Working in small sections on particular aspects of the total problem
    of juvenile delinquency, the delegates reviewed certain resource documents
    which had been prepared for the conference. The delegates
    defined needs and goals and made recommendations for achieving the
    goals.
    Children of migrant workers.—The Department sponsored another
    conference which promises constructive steps in the interest of children
    of migratory agricultural workers.
    Meeting in Washington May 17-19, the conference was designed to
    assist the 10 States in the East Coast migratory stream in developing
    ways of increasing health, education, and welfare services to migrant
    families, especially their children.
    The conference developed a program which provided for certain
    activities within the States and for inter-State cooperation.
    Developments in Management
    Progress is not made alone by bringing laws abreast of the times.
    Equally important are the managerial factors in administering the
    laws. Efficiency and economy of operations can be achieved only by
    constant vigilance in this area.
    The Department’s new administration instituted a number of
    surveys designed to show how greater efficiency and economy could be
    accomplished. One of these studies was completed during the year;
    the others were planned and are in process.
    For the numerous State programs to which the Federal Government
    makes financial contributions through the Department, the Department
    has the responsibility for a continuing audit of the use of Federal
    funds. A survey of the Department’s audit practices, conducted by a
    team from the Department’s staff, resulted in 17 recommendations to
    promote greater efficiency, simplification, and economy.
    Plans were completed during the year for a survey of administrative
    management services throughout the Department. Specialists from
    outside the Government, working with the Department’s staff, will
    conduct a study of budget and fiscal management, personnel management,
    administrative planning, and general services.
    Plans were also initiated for administrative and operational studies
    of the Food and Drug Administration and of Freedmen’s Hospital in
    Washington, D. C., which operates under the Public Health Service.
    To eliminate duplication of functions, utilize to better advantage
    the skills of the staff, and assure uniform standards where applicable,
    two separate divisions of personnel in the Public Health Service were
    consolidated during the year. These divisions—one for civil personnel
    and the other for commissioned officers—had operated as separate
    units for many years.
    The Secretary’s Report 15
    At the end of the fiscal year, the Department had a total of 35,442
    full-time employees, only 34 more than at the end of the preceding
    year. The increase was held to this slight figure despite the employment
    of about 1,000 persons incident to the opening of the new Clinical
    Center of the National Institutes of Health, Public Health Service.
    The difference was offset by reductions in personnel elsewhere in the
    Department.
    Under the governmentwide program of incentive awards, employees
    in the Department made a substantial contribution during the year
    to economical and efficient operations. Through the study and recommendations
    by employees relating to a variety of operations, an estimated
    savings of about $100,000 was achieved for the first year alone.
    Cash awards to 436 employees for these suggestions totaled $8,559.
    Through the use of a new electronic machine in recording wages
    under the old.-age and survivors insurance system, a saving of about
    $60,000 was made during the year. This saving will be cumulative
    for future years as well.
    The Department freed 10,353 pieces of equipment, valued at $844,-
    095, for reuse and turned in an estimated $63,301 to the Treasury
    Department from the sale of useless records as waste paper.
    An estimated annual saving of $50,000 resulted during the year
    from reductions in the number of forms used in making payments to
    States in those programs to which the Federal Government gives
    financial aid.
    December 1, 1954.
    16 Department of Health, Education, and Welfare, 1954
    [On checks-issued basis]
    Table 1.—Grants to States: Total grants under all Department of Health,
    Education, and Welfare programs, fiscal year 1954
    States, Territories,
    and possessions Total
    Social
    Security
    Administration
    Public
    Health
    Service
    Office of
    Education
    Office of
    Vocational
    Rehabilitation
    American
    Printing
    House
    for the
    Blind
    Total________$_1_,810, 294, 426 $1,466,896,813 $117,043,924 $203,109, 612 $23, 059, 077 $185,000
    Alabama _____________ 37, 511,796 28, 007, 451 2, 562, 272 6,354, 596 582, 693 4, 784
    Arizona,..................... 15; 415; 022 9; 200; 043 i; 023; 197 5; 060; 963 129, 602 1,217
    Arkansas . ___________ 27,148,357 20, 715, 587 2; 550; 464 3; 514, 514 364; 338 3; 454
    California______________ 207, 286, 321 170,936, 798 4; 567; 371 30; 070; 303 1, 70L 318 10; 531
    Colorado. _ _ ____ ____ 32,171, 919 26, 680, 701 ' 643, 494 4, 672; 223 ' 173; 519 i;982
    Connecticut___________ 13; 144; 322 10; 188; 727 747; 794 i; 925; 482 279; 998 2,321
    Delaware _ _ _ .... 2, 063, 641 i; 587; 593 70; 601 '261; 724 143; 723
    District of Columbia___ 4, 707.227 3,966,219 392,816 96; 162 25L 634 396
    Florida________________ 46, 676, 098 39,193, 760 2,167, 894 4, 598, 548 712, 640 3, 256
    Georgia________________ 58,445,113 44, 270, 291 4, 070; 926 8; 515; 711 1, 583; 486 4, 699
    Idaho ________________ 7,859, 242 5,900, 579 188, 050 1, 711, 776 58,186 651
    Illinois_________________ 70,965, 704 60,450, 555 5, 020; 089 4,170, 345 1,314, 948 9,767
    Indiana________________ 26,854, 061 20, 643, 428 2, 865, 505 2, 998,934 342, 882 3,312
    Iowa..._______________ 26,183, 868 22, 265, 938 2, 007, 228 1, 607, 379 299, 416 3, 907
    Kansas________________ 28; 209; 230 20; 405; 242 2; 092; 420 5; 498; 760 210, 741 2, 067
    Kentucky___________ 39; 447; 727 3i; 942; 780 4; 197; 614 3; 173; 304 130; 660 3; 369
    Louisiana______________ 71, 677, 565 65, 728, 523 3, 485, 044 i; 997; 677 462; 669 3; 652
    Maine______ __________ 10, 223; 117 8; 939; 593 ' 142; 642 i; 056', 794 84; 088
    Maryland... __________ 20; 054; 236 10, 231, 245 786', 078 8; 590; 237 442; 968 3, 708
    Massachusetts__ ___ 53, 655, 496 49, 553, 638 2, 509; 660 i; 339; 549 245; 742 6, 907
    Michigan__ _________ . 58, 218, 341 47,882, 849 3,814, 649 5, 520, 069 991, 970 8,804
    Minnesota________ ____ 29, 507, 738 25; 775; 457 2; 197; 522 i; 224; 943 305; 456 4,360
    Mississippi.. .... . 29, 698, 256 23; 085, 206 3, 669, 969 2', 55L 600 388; 254 3; 227
    Missouri _____________ 85, 709,837 78; 617; 346 3, 288, 261 3; 360, 287 439; 725 4, 218
    Montana.. _______ ____ 8; 453; 772 6; 94L 898 ' 305; 245 1, 069, 841 130; 137 '651
    Nebraska_________ ____ 13,160, 500 10, 000,831 1, 096, 308 i; 867; 190 195; 124 1,047
    Nevada. . _ ________ 3; 27/ 705 i; 304; 587 ' 284; 705 i; 664; 385 24, 028
    New Hampshire______ 5, 040,316 4', 135; 421 287; 769 ' 568; 296 48; 860
    New Jersey____________ 18, 946, 668 13; 565,400 2,395, 798 2,495, 798 483', 274 6, 398
    New Mexico __________ 16; 28i; 323 10; 383; 070 ' 776; 325 5; 003; 917 116,171 i;840
    New York _ ________ 116,083, 574 103, 575, 702 4, 920,812 6, 094, 631 1,477,114 15,315
    North Carolina________ 41; 349; 101 32; 589; 852 < 486; 213 3; 457, 773 ' 805; 779 9; 484
    North Dakota_________ 5; 662; 189 A 67L 464 384,495 511, 483 93,869 ' 878
    Ohio ____________ _____ 73; 192; 733 58, 921, 274 6,458, 095 7, 298; 688 505; 023 9, 653
    Oklahoma____________ 58, 222, 344 50, 559,005 1, 900, 837 5, 290, 873 469,194 2; 435
    Oregon _______________ 15,176, 637 13; 127; 920 ' 842; 582 ' 882,414 32i; 598 2; 123
    Pennsylvania__________ 65; 853,161 53,908; 743 6, 856; 384 3,448; 997 1, 627; 713 Hi 324
    Rhode Island. . _____ 7,152, 215 5; 77i; 381 356, 220 918, 390 ' 106; 224
    South Carolina_______ 28,459, 419 19,16L 873 5, 547, 213 3, 242,853 504, 961 2, 519
    South Dakota. _______ 7, 669; 674 6,366,985 245, 091 ' 983; 059 73; 492 1,047
    Tennessee .... ___ 43, 664, 719 36,083, 911 4,123, 229 2,802, 786 650, 433 4, 360
    Texas____________ .. 106, 418,080 87, 960, 554 5,880,990 11, 572,124 997, 561 6,851
    Utah__________________ 10,328, 602 7; 050; 084 ' 416; 517 2; 753; 794 107; 301 '906
    Vermont. ____________ 4, 223, 856 3; 522; 147 273, 699 ' 33i; 685 96; 325
    Virginia_____ _ ... 3i; 405, 610 13, 284; 393 2, 678, 905 14, 950, 285 486; 762 5,265
    Washington ______ . _ 47; 780; 711 37,112, 218 1, 680,650 8; 522, 481 463,182 2,180
    West Virginia__________ 25; 864; 870 22,154,185 2; 653', 562 544, 963 509; 272 2,888
    Wisconsin ... _. _____ 29, 033, 571 25, 459,098 1, 868; 264 1,150, 359 550; 953 4,897
    Wyoming__ 3; 973; 461 2; 436,132 ' 203, 330 1, 257, 060 76; 939
    Alaska .. 3,818, 255 1, 608, 663 716,884 1,453, 362 39, 346
    Hawaii. _______ ___ 6; 622; 112 3; 694; 639 208; 966 2, 550, 991 167; 233 283
    Puerto Rico. _________ 10; 00i; 374 5, 098, 470 4,096,021 ' 514,263 290, 553 2,067
    Virgin Islands_________ ' 343; 610 ' 27i; 364 37,255 34, 991
    Social Security
    Administration
    Social Security in 1954
    Continuing its steady growth during the year, the social security program
    assured protection to ever larger numbers of people. As the
    fiscal year closed, legislation was in process to give new strength to the
    existing program and to make the scope of contributory old-age and
    survivors insurance nearly universal. The enactment of the Social
    Security Amendments of 1954, signed by President Eisenhower on
    September 1, placed the old-age and survivors insurance program
    within range of achieving its full potential effect as the basic incomemaintenance
    program for the country’s aged persons and for orphans
    and their widowed mothers.
    The amendments embody substantially all the improvements and
    expansions of old-age and survivors insurance which grew out of the
    Department’s intensive study of the program, initiated early in 1953.
    The President, in recommending the changes to Congress in a special
    message of January 14,1954, stated that the system “should remain, as
    it has been, the cornerstone of the Government’s programs to promote
    the economic security of the individual.” The changes recommended
    and adopted are designed to preserve and strengthen the program’s
    basic principles, of which the two most important are that the contributions
    of the workers themselves, and their employers, support the
    system, and that benefits have a relationship to the individual worker’s
    past earnings.
    Through the coverage of the expanded system, about 9 out of 10 of
    the Nation’s workers will have an opportunity to contribute toward
    their own retirement income and the support of their dependents.
    Most of those still remaining outside the system are Federal employees
    17
    18 Department of Health, Education, and Welfare, 1954
    covered by Federal staff retirement systems. Consideration of coverage
    for these employees was deferred to permit the development of
    a plan of coordination which would effect a national relationship
    between old-age and survivors insurance and the protection provided
    by the Federal staff systems.
    As a result of the steady growth of old-age and survivors insurance,
    benefits were paid to about 6.5 million people in June 1954, almost a
    million more than a year earlier. Of the beneficiaries at the end of the
    year, 5.1 million were aged 65 and over.' In the same month, public
    assistance payments were made to almost 2.6 million needy aged persons,
    slightly under the number receiving assistance in June 1953 and
    a smaller proportion of the aged population than at any other time
    since before World War II.
    Although the insurance system has progressed steadily toward its
    goal of providing income for all aged persons after retirement, it was
    not until February of 1951 that the number of aged drawing old-age
    and survivors insurance benefits exceeded the number on old-age assistance.
    When the insurance program began, many people—now living—
    had already retired or had depended on the earnings of persons
    already out of the labor force. The needy among them had no
    resource but the assistance program. Others were working outside the
    scope of the insurance system, limited as it was in its early years to
    employees in industry and commerce, or had insufficient coverage to
    meet the eligibility requirements for old-age benefits.
    The number of aged persons receiving old-age and survivors insurance
    benefits is now almost double the number of recipients of old-age
    assistance. The growth has been uneven throughout the country, however,
    reflecting the concentration of coverage in urban areas. Whereas
    counties in which the majority of people live on farms had more than
    two recipients of old-age assistance for every aged insurance beneficiary
    at the end of 1953, the ratio was reversed in predominantly
    urban counties.
    The newly enacted provisions of old-age and survivors insurance,
    extending coverage to farm operators and broadening the coverage
    of farm laborers, can be expected to iron out this unevenness in the
    course of time. An ever-increasing proportion of the Nation’s aged
    will look to the insurance program for their source of income during
    retirement, with the assistance program supplementing benefits when
    inadequate for maintenance or special needs, meeting needs of those
    not receiving benefits, and providing necessary services. Even within
    the next 5 or 6 years, as the expanded coverage of old-age and survivors
    insurance becomes effective, the proportion of the aged population
    who either are receiving insurance benefits or could receive benefits
    on retirement from gainful employment will increase from almost
    half to two-thirds.
    Social Security Administration
    Public assistance caseloads, other than the old-age assistance rolls,
    rose during the year. From 5.3 million in June 1953, the total number
    of needy persons receiving assistance, including general assistance, rose
    by about 6 percent to 5.6 million in June 1954.
    A total of 212,000 recipients of aid to the permanently and totally
    disabled in June 1954, an increase over the year of almost a fifth, reflected
    the establishment of Federal-State programs in 3 additional
    States as well as larger rolls in most of the 39 States having programs
    at the beginning of the year.
    Of the 2.1 million persons receiving assistance under the programs
    of aid to dependent children in June 1954, only 300,000 were paternal
    orphans and their mothers. The insurance program—under which
    survivor protection is gained in a relatively brief period of coverage—
    assumed the major share in the support of orphaned children soon
    after benefits were first payable; by June 1954, insurance benefits were
    being paid to 1.1 million children and some 300,000 young widows.
    Hence, the program of aid to dependent children has been devoted
    more largely to providing assistance for children who are in need
    because a parent is disabled or the father is absent from the home.
    To families in need of basic subsistence or an income to replace
    lost earnings, income-maintenance measures are of prime importance.
    But for many families, and in the event of circumstances not necessarily
    related to financial need, social welfare services are an essential
    part of a well-rounded social security program. Because economic
    need frequently results from the lack of timely help in keeping the
    family together and self-supporting, the program’s interest in the
    development of effective community welfare services promotes financial
    as well as humanitarian ends. Through the Bureau of Public
    Assistance and the Children’s Bureau, the Social Security Administration
    has continued to work with the State agencies in developing
    services for families who turn to the public welfare agency for help
    and in providing health and welfare services essential to the well-being
    of children.
    Again this year, the Children’s Bureau gave special attention to
    the problems of delinquent children. In the face of a continued
    upward trend in juvenile delinquency, the Bureau worked with the
    many voluntary and public agencies and civic groups directly concerned,
    in stimulating action for the improvement of services for
    delinquents. As the fiscal year closed, a National Conference on
    Juvenile Delinquency met in Washington at the invitation of the
    Secretary of the Department to review accomplishments, define the
    most urgent needs and formulate action for meeting these needs.
    Other areas to which the Children’s Bureau gave particular attention
    during the year, including the problems of children of migratory
    20 Department of Health, Education, and Welfare, 1954
    agricultural workers, are described in the section on Children with
    Special Needs.
    Federal credit unions continued to grow during 1954 in number,
    membership, and total assets. By the end of June, 3.4 million persons
    were members of credit unions, chartered under Federal act,
    which promote systematic savings and use funds thus accumulated
    for consumer loans at reasonable rates of interest.
    Program Administration in 1954
    The Social Security Administration has continued to review and
    appraise the operations of the existing social security programs.
    During the year, all bureaus and offices carried forward their efforts
    to improve procedures and organizational structure in order to maintain
    a high level of efficiency in carrying increasing work loads.
    Through advance planning, in anticipation of especially heavy and
    peak work loads following the 1954 amendments, it was possible
    speedily and smoothly to initiate the changes and meet the public’s
    need for information about the amendments.
    On January 25,1954, the Senate confirmed the Presidential appointment
    of Mr. John W. Tramburg as Commissioner of Social Security.
    In a year marked by legislative activity, special emphasis was placed
    on the Commissioner’s function of studying and making recommendations
    concerning the improvement of all phases of social security.
    Mr. Tramburg served also as a member of the Study Group on Federal
    Aid to Welfare established by the Commission on Intergovernmental
    Relations. Following Mr. Tramburg’s resignation on July 31, Mr.
    Charles I. Schottland was appointed Commissioner of Social Security.
    Other major appointments during the year included that of Mr.
    Victor Christgau as Director of the Bureau of Old-Age and Survivors
    Insurance and Mr. Jay L. Roney as Director of the Bureau of Public
    Assistance.
    To carry out the operation of the growing program, the Social Security
    Administration had 14,634 employees at the end of June, practically
    the same number as a year earlier. Of the total staff, about
    5,586 were departmental and 9,048 were in field, area, and regional
    offices.
    The 1954 amendments provide further opportunity to extend the
    “team” approach which has been used with great success by the Bureau
    of Public Assistance and the Office of Vocational Rehabilitation in
    the program of aid to the totally and permanently disabled. The
    new provision for protecting the benefit rights under old-age and survivors
    insurance during periods when the worker is under a longSocial
    Security Administration 21
    term total disability will result in increased prompt referrals to State
    vocational rehabilitation agencies. The referrals serve not only
    the purpose of determining the degree of disability but should, insofar
    as they are made at an early stage of the disability, greatly enhance
    the prospect of successful rehabilitation. To carry out the responsibilities
    of the Bureau of Old-Age and Survivors Insurance in administering
    this new program area, a Division of Disability Operations
    was established.
    The year was marked by considerable international activity in the
    field of social security. Through participation in these activities, the
    Social Security Administration gains valuable knowledge and insight
    from other countries at the same time that it contributes its own experience
    and knowledge. The Seventh Session of the International Conference
    of Social Work, held at Toronto, Canada, in June, brought together
    over 1,600 delegates from 48 countries to discuss and evaluate
    social welfare programs and training. Social Security Administration
    staff took an active part through the preparation of technical materials
    and participation in the meetings.
    During the year, the Social Security Administration cooperated
    in a number of United Nations studies and developed materials requested
    for various meetings of the International Labor Organization.
    The Foreign Operations Administration looks to the Social Security
    Administration for technical advice and assistance in the field of social
    welfare and for the mobilization of national social welfare resources in
    support of the overseas program. During the year, 23 specialists
    were on duty in 10 countries: Bolivia, Brazil, Chile, El Salvador,
    Mexico, Panama, Peru, Egypt, India, and Iraq. These specialists
    included consultants in the field of community organization, social
    work education, welfare administration, medical social work, and maternal
    and child health.
    The Social Security Administration provided guidance in planning
    and carrying out technical training to experts and visitors drawn
    from over 50 countries in all parts of the world. The total volume
    of visitors coming to the United States under arrangements with the
    United Nations or FOA increased during the year. There were 137
    long-term trainees, here for periods ranging from 6 months to 2 years,
    including 62 sent by the United Nations and World Health Organization
    and 55 under auspices of FOA. Over 600 other participants,
    here for shorter periods, received guidance in community organization,
    staff development, medical social work, child welfare, industrial welfare,
    credit cooperatives, migration and resettlement, rural community
    development, and welfare administration.
    22 Department of Health, Education, and Welfare, 1954
    Old-Age and Survivors Insurance
    The most significant event for old-age and survivors insurance during
    1954 was the enactment of the Social Security Amendments. These
    amendments build on and carry forward the basic principles of the
    contributory system, with benefits varying according to an individual’s
    past earnings and paid without a test of need. At the same time they
    give new scope to the system by making it practically universal and
    thus more effective in assuring continuing income in old age or to
    dependents in the event of the death of an earner.
    Under the new amendments, nearly 9 out of 10 workers in the
    United States will be under the system or eligible for coverage. Most
    of those remaining outside the old-age and survivors insurance system
    are Federal employees under separate retirement systems, for whom
    the problem of retirement protection is mainly that of coordinating
    the Federal retirement systems with old-age and survivors insurance.
    Retirement protection in one form or another for practically all of our
    people is an accomplished fact.
    Included in the law for the first time are provisions recognizing
    the special problem of maintaining benefit protection for workers who
    cannot continue their coverage under the system because they are
    totally disabled. Major improvements have been made in the benefit
    provisions of the law and the maximum amount of earnings creditable
    toward benefits has been increased, assuring more adequate protection
    for a large proportion of workers both now and in the future. The
    retirement test of the program has been made more equitable and more
    flexible, so that beneficiaries will feel freer to take part-time or shortterm
    work.
    The Significance of the Program - »
    The extension of coverage and other improvements brought about
    by the 1954 amendments will considerably increase the effectiveness
    of the program in the years ahead. Even before the adoption of the
    1954 amendments, though, the program was making a very substantial
    contribution to the economic security of the American people. The
    significance of that contribution is indicated by the data that follow.
    BENEFICIARIES AND BENEFIT AMOUNTS
    In June 1954 about 6.5 million people were receiving monthly benefits
    under the program. Some 5.1 million of these beneficiaries were
    aged 65 and over—3.5 million of them retired workers and 1.6 million
    the wives and dependent husbands of retired workers and the widows,
    Social Security Administration 23
    dependent widowers, and dependent parents of workers who had died.
    Of the remaining 1.4 million, some 300,000 were mothers and 1.1 million
    were children.
    In June 1954, the average insurance benefit paid to a retired worker
    who had no dependents also receiving benefits was $49.40 a month.
    When the worker and his wife both received benefits, the average for
    the family was $86.30. Families consisting of a widowed mother and
    two children averaged $112.70.
    These figures do not, of course, reflect the benefit increases provided
    in the 1954 amendments for persons now on the benefit rolls, which
    went into effect with benefits for the month of September; nor do they
    reflect the generally higher amounts that will be paid in cases figured
    on the basis of the 1954 benefit formula. It is expected that benefits
    awarded under the 1954 benefit formula to a retired worker and wife
    who come on the rolls in the fiscal year 1955, for example, will average
    $120 a month.
    THE PROTECTION PROVIDED
    Of the 13.7 million people aged 65 or over in the United States in
    December 1953, 48 percent either were eligible for benefits under oldage
    and survivors insurance or would be eligible when their income
    from work stopped. This percentage is expected to rise to 65 percent
    by 1960.
    Of the population under 65 years of age, 65 million were insured
    under the program at the beginning of the calendar year 1954. Some
    23 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 at 65 and their families are assured of protection in the event
    of their death. An additional 42 million were insured but would have
    to continue in covered work for an additional period to make their
    insured status permanent. Four out of 5 of the mothers and young
    children in the Nation were assured that they would receive monthly
    benefits if the father or working mother of the family died. Within
    1 or 2 years this ratio is expected to reach 9 out of 10.
    COVERAGE OF THE PROGRAM
    During the calendar year 1954 an estimated 62 million persons will
    have worked in employment or self-employment covered by old-age
    and survivors insurance. At the end of the 1954 fiscal year about 79
    percent of the Nation’s paid civilian jobs were covered by the program.
    An additional 8 percent of the jobs were covered by retirement systems
    of Federal, State, and local governments. About 13 percent of the
    Nation’s paid civilian jobs were not covered under any public program.
    This group consisted principally of farmers, self-employed profes24
    Department of Health, Education, and Welfare, 1954
    Chart 1.—COVERAGE HAS BEEN EXTENDED TO 10 MILLION MORE PERSONS
    OASI COVERAGE AFTER 1954 AMENDMENTS
    TOTAL PAID JOBS
    63 Million
    (June 1954)
    NEWLY COVERED
    10 Million People
    (During a year)
    New Coverage Effective Jan. 1, 1955
    *Approximately 40 percent are members of the Armed Forces (wage credits under old-age and survivors
    insurance are provided for military service from September 1940 to June 1955).
    **During a year about 300,000 farmers are also employed as hired farm workers.
    sional people, and farm or domestic workers who were not regularly
    employed by a single employer. While service in the Armed Forces
    is not covered by old-age and survivors insurance on a permanent
    contributory basis, wage credits of $160 are granted for each month
    of active military or naval service after September 15,1940, and before
    July 1, 1955.
    CONTRIBUTIONS AND DISBURSEMENTS
    Program expenditures during the fiscal year totaled $3,364 million,
    of which $3,276 million was for benefit payments and $89 million for
    administrative expenses. Total receipts were $5,040 million, including
    $4,589 million in contributions, $439 million in interest on investments,
    and $12 million in transfers from the railroad retirement
    account. Receipts exceeded disbursements by $1,675 million, the
    amount of the increase in the trust fund during the year. At the end
    of June 1954, the fund totaled $20.0 billion.
    All assets of the fund, except $703 million held in cash, were invested
    in United States Government securities as required by law.
    Approximately 85 percent of the total fund, or $17.1 billion, was invested
    in special certificates of indebtedness bearing interest at 2*4
    percent, the average rate paid on the total interest-bearing Federal
    debt at the time they were issued. The remainder of the fund, $2.3
    billion, was invested in public issues, identical with similar bonds
    owned by private investors and bearing interest at rates varying from
    Social Security Administration 25
    2% percent. The average interest rate on all investments of
    the trust fund at the end of the year was about 2.3 percent.
    ADMINISTERING THE PROGRAM
    Average staff of the Bureau of Old-Age and Survivors Insurance
    during the fiscal year approximated 14,000 employees. Located in
    Baltimore, Md., were about 4,600 employees responsible for establishing
    and maintaining the earnings records of persons covered by the
    program, plus the headquarters staff of some 700 people. Decentralized
    operations through 512 district offices and 6 area offices were staffed
    by approximately 8,700 employees. Claims services were brought to
    the people, also, through more than 3,000 itinerant service points
    fanning out from the parent district offices.
    The magnitude and quality of Bureau operations are indicated by a
    few key facts and figures. About 221 million earnings items were
    received, processed, and posted to individual accounts during the year.
    Approximately 1,888,000 claims were received during the year, and
    1,373,000 monthly benefit and 540,000 lump-sum awards were made.
    As of June 30, 1954, 6.5 million persons were being issued monthly
    benefit checks, requiring a series of highly mechanized and systematic
    actions to keep accurate records of a benefit roll of this dimension. In
    fiscal year 1954, administrative costs, including those incurred by the
    Treasury Department for collecting taxes and making disbursements
    to old-age and survivors insurance beneficiaries, were 1.9 cents out of
    each tax dollar collected and appropriated to the trust fund under the
    Federal Insurance Contributions Act.
    Substantial progress was made by the Bureau of Old-Age and Survivors
    Insurance and the Internal Revenue Service in their study of the
    plan to integrate old-age and survivors insurance wage reporting with
    annual reporting of withholding taxes and to eliminate the quarterly
    detailed listing of employee earnings items now required for the insurance
    program. Under the direction of an interagency steering
    committee, several work groups are developing and testing procedures
    which might be used if the plan is adopted. It is expected that adoption
    of the plan will result in savings to employers in reporting costs
    and will improve the Government’s administration of these benefitpayment
    and tax-collection programs.
    An undertaking of comparable scope and importance is the study
    of electronic developments and their possible application to the Bureau’s
    record-keeping operation. This study has as its objective keeping
    the costs of maintaining the records of earnings of individuals
    covered under the program to an absolute minimum. Broad plans
    have been developed for the use of an electronic data-processing
    machine in the earnings record and statistical operations.
    339010—55------3
    26 Department of Health, Education, and Welfare, 1954
    The policies and practices used to insure that beneficiaries correctly
    report events affecting their continued eligibility to receive benefits are
    being studied. A nationwide survey of a sample of approximately
    8,000 beneficiary families was carried out through interviews by district
    office personnel with the beneficiaries. Information thus obtained
    was checked against data contained in the claims folders and in the
    earnings records. Upon completion of the study, action will be taken
    to tighten up any policies and procedures where corrective action
    appears to be necessary.
    In September 1952, the House Appropriations Committee established
    a survey group to study the possibility of check writing by
    benefit payment agencies to replace the process of certification by the
    agency and disbursement by the Treasury Department. A successful
    trial installation has been made at the Railroad Retirement Board.
    The Bureau of Old-Age and Survivors Insurance has followed these
    studies closely and expects in the coming year to make an experimental
    application in one of its six benefit-payment centers with the
    assistance of General Accounting Office and Treasury Department
    representatives.
    The Bureau’s planning to achieve economies from housing all its
    records operations in one building progressed substantially in fiscal
    year 1954 with congressional action making $1,500,000 available for
    the acquisition of land and the preparation of plans and specifications
    for a building. Proposals for the sale or donation of a site
    were solicited, architects were appointed, and a site in the Woodlawn
    area of Baltimore County was selected. Congress appropriated
    $20,000,000 in August 1954 for use in construction of the building.
    Tentative plans call for construction to begin in late 1955 and to be
    completed in the latter part of 1958.
    The most immediate administrative concern of the Bureau is action
    to effectuate the amendments to the Social Security Act. Advance
    planning was directed toward enabling the Bureau to meet the schedules
    of action imposed by the various provisions of the amendments.
    Schedules for staffing and for training personnel were designed to
    accomplish the most economical processing of peak loads; and timely
    revisions of policies, instructions, and procedures provided basic operating
    tools. Plans were made in advance for special public information
    materials to coincide with the dates on which particular provisions
    of the legislation would become effective so that the public
    would be informed of its rights and responsibilities.
    The most immediate and urgent action was the conversion of the
    benefit amounts of approximately 6.6 million beneficiaries so that
    checks for the month of September 1954 could be released on time and
    in the increased amounts. To meet the schedule, conversion proSocial
    Security Administration 27
    cedures were developed and tested in advance and the great bulk of
    the work was performed mechanically.
    After careful study of administrative alternatives, a new operating
    division was established in the Bureau to administer the provisions
    of the amendments which provide protection for the benefit rights
    of the disabled. This division will be charged with the responsibility
    for administering a new program area for the Bureau. The new
    Division of Disability Operations will formulate methods, criteria,
    and standards for obtaining evidence and making disability determinations,
    coordinate with State agencies making these determinations,
    perform the administrative review of these determinations, and
    make Federal determinations in cases not covered by State agreements.
    Improving the Program—The 1954 Amendments
    The fiscal year 1954 was one of intensive legislative activity, culminating
    in the Social Security Amendments of 1954, signed by the
    President on September 1, 1954.
    Legislative activity began early in the fiscal year, with Chairman
    Reed of the House Committee on Ways and Means introducing the
    Administration’s first social security bill, incorporating the recommendations
    on extension of coverage set forth in the President’s message
    of August 1, 1953. The proposals had been developed by the
    Department with the assistance of a group of consultants from the
    fields of banking, insurance, education, social work, farm and labor
    organizations, and industry.
    Shortly before the opening of the second session of the 83d Congress,
    hearings on the social security system were held by a special
    subcommittee of the House Committee on Ways and Means, headed
    by Representative Carl T. Curtis. Testimony at these hearings, presented
    largely by the Department and by other Government agencies,
    was devoted to presentation of factual data on the law and the manner
    in which it operates. These data were thus available to the full
    Committee on Ways and Means for its subsequent consideration of
    the Department’s legislative proposals.
    The full-scale legislative proposals of the President and the Department
    were set forth in the President’s message of January 14,
    1954. Two weeks of open hearings before the House Committee on
    Ways and Means were conducted beginning April 1. These hearings
    drew testimony from groups interested in old-age and survivors insurance,
    including representatives from the field of business, labor,
    public employment, the professions, civic groups, agriculture, and
    public welfare. House passage of the bill was followed by hearings
    in the Senate from June 24 to July 29. Final passage came on
    August 20.
    28 Department of Health, Education, and Welfare, 1954
    COVERAGE
    The amendments afford old-age and survivors insurance coverage
    to about ten million people who during the course of a year work in
    employment that was formerly excluded. More than half of these
    people are in agriculture, either as farm operators or as farm workers.
    Since only a relatively small group of regular farm workers were
    previously covered by the program, the 1954 amendments provide retirement
    and survivors protection for most rural people for the first
    time.
    From the viewpoint of the effectiveness of the program in serving
    the purpose for which it was designed, the coverage of rural people
    has great significance. Farm people, like people in urban employment,
    can now look to the insurance program to maintain family income
    when earnings are cut off by the death of the family bread-winner or
    his retirement. The number of aged persons and orphans receiving
    public assistance in rural areas, which has been disproportionately
    high, can be expected to decline as farm people become insured under
    the program.
    About 3.6 million farm operators will now be covered by old-age
    and survivors insurance in the course of a year. Farmers, like persons
    in other types of self-employment, are covered only if their net earnings
    from self-employment equal $400 or more a year. A special
    provision in the law makes coverage possible for low-income farmers
    without requiring them to keep books and records that they ordinarily
    do not maintain. Under this provision a farmer who reports his
    income on a cash receipts and disbursements basis and whose gross
    income is $1,800 or less may report for credit under old-age and survivors
    insurance 50 percent of his gross income in lieu of his actual
    net; if the gross income of the farmer is more than $1,800 but his net
    income is less than $900, he may report $900 as his net income. Since
    low-income farm operators, who may not keep detailed records, nevertheless
    do know their gross income, they will be able to report their
    earnings and compute their social security taxes without difficulty.
    The amendments extend coverage to approximately 2.1 million
    additional farm workers during the course of a year. Previously a
    complicated coverage test had limited coverage to about 700,000 farm
    workers. Effective January 1, 1955, any agricultural worker is covered
    by old-age and survivors insurance if he is paid $100 or more in
    cash wages by one employer in a calendar year. It is estimated that
    under this test from 90 to 95 percent of the persons whose major
    employment is hired farm work will be covered. While the provision
    will exclude some migratory workers who spend their full time in
    farm work, most of those who will continue to be excluded from
    coverage by the provision are students and semiretired persons who
    Social Security Administration 29
    do farm work for a few weeks during the peak harvest period but
    otherwise are not gainfully employed. The amendments thus extend
    social security to most of the people who earn their living through
    hired farm work and at the same time continue to exclude most people
    whose farm work is temporary or incidental.
    Since farm workers’ earnings are covered on an annual basis, the
    law also provides for converting their annual earnings into quarters
    of coverage. One quarter of coverage will be credited for wages from
    farm work amounting to $100 or more but less than $200, two quarters
    for wages of $200 or more but less than $300, three quarters for wages
    of $300 or more but less than $400, and four quarters for wages of
    $400 or more. The law also specifies the manner of assigning these
    quarters of coverage to the calendar quarters of the year.
    Prior to the 1954 amendments, persons employed by State and local
    governments could not be brought into old-age and survivors insurance
    if they were in positions covered by a State or local retirement system.
    The amendments make coverage possible for most of these workers
    provided that a majority of the members of the system eligible to vote
    actually vote in favor of coverage in a written referendum. During
    the course of a year, about 3.5 million additional State and local
    government employees may now be covered by old-age and survivors
    insurance. (Policemen and firemen who are covered by a State or
    local retirement system will continue to be excluded from old-age and
    survivors insurance.) This extension of the basic old-age and survivors
    insurance coverage to employees under State and local government
    retirement systems will greatly improve their survivor protection
    and provide continuity of protection for those who move in and
    out of government service.
    The new law extends coverage to 100,000 self-employed accountants,
    architects, engineers and funeral directors. The self-employed groups
    that remain excluded are physicians, lawyers, dentists, osteopaths,
    veterinarians, chiropractors, naturopaths, and optometrists.
    The division of opinion regarding coverage among members of some
    of the professional groups led the Committee on Finance of the Senate
    to comment as follows:
    In the interest of securing as broad coverage as possible under the program,
    your committee carefully considered the possibility of allowing individuals
    working in such occupations to elect coverage on a voluntary basis. In this
    way the problem of diverse opinion on entrance into the program could have
    been resolved. Your committee concluded, however, that extension of coverage
    on an individual voluntary basis involved grave dangers with respect to the
    financing of the system, as well as discrimination against the great majority
    of workers covered under the program on a compulsory basis. Therefore, where
    the committee found that substantial agreement did not exist among a group
    as to whether it desired to be covered, the committee concluded that it would
    be wiser to continue the exclusion of that group rather than allow its members
    to elect coverage as individuals.
    30 Department of Health, Education, and Welfare, 1954
    Ministers, members of religious orders, and Christian Science practitioners,
    however, are being given the opportunity to secure coverage
    on an individual voluntary basis by indicating their desire to be
    covered as self-employed persons (whether or not they are actually
    self-employed). The Committee on Finance explained its decision
    to permit individual voluntary coverage for this group in the following
    words:
    A provision for coverage on an individual election basis, while not generally
    desirable, is considered by your committee to be justified in this area because
    of the special circumstances. Many churches have expressed the fear that their
    participation in the old-age and survivors insurance program as employers of
    ministers might interfere with the well-established principle of separation of
    church and state. Many church representatives also believe that individual
    ministers who do not wish to be covered on grounds of conscience should not
    be required to participate in the program.
    The amendments extend coverage to additional civilian employees
    of the Federal Government; old-age and survivors insurance protection
    is now available to practically all Federal civilian employees who
    are not under a Federal staff retirement system. In its report on the
    amendments the Committee on Ways and Means of the House of
    Representatives took the position that any Federal employee who
    lacked retirement protection “should be covered by old-age and survivors
    insurance if the services he performs for the government are of
    a type that would be covered if performed for a private employer.”
    To insure that the Federal service to which the amendments extend
    old-age and survivors insurance coverage will be counted toward
    benefits under only one retirement system, the amendments prohibit
    the crediting of this newly covered employment under any other
    Federal retirement system.
    The amendments extend and simplify the coverage of persons performing
    domestic service in private homes. Household workers will
    be covered in any calendar quarter in which they are paid $50 in cash
    wages by an employer. All household workers previously covered
    continue to be covered by the simplified test and, in addition, about
    200,000 more household workers will come under the program during
    1955. Probably 9 of every 10 persons whose domestic work is their
    major activity are now covered. Most of the household employees
    who continue to be excluded from coverage are students, housewives,
    and others who spend comparatively little time working for pay.
    Additional smaller groups, representing a combined total of about
    250,000 employees, were also brought into coverage, including employees
    in the fishing industry, American citizens employed by
    American employers on vessels and aircraft of foreign registry, and
    American citizens who work for foreign subsidiaries of American
    companies. Coverage of citizens working abroad for a foreign subsidiary
    of an American employer is dependent upon an agreement
    Social Security Administration 31
    Chart 2.—THE 1951 RELATIONSHIP BETWEEN EARNINGS LEVEL AND THE EARNINGS BASE
    HAS BEEN RESTORED
    EARNINGS BASE RAISED TO $4,200
    PERCENT OF MALE 4-QUARTER WAGE WORKERS
    EARNING OVER WAGE BASE
    between the American employer and the Secretary of the Treasury
    to pay social security taxes with respect to the United States citizens
    employed abroad by the foreign subsidiary.
    BENEFITS
    Following are the major benefit provisions of the new amendments:
    1. Increased payments for 6.6 million current beneficiaries.—For
    those beneficiaries already on the rolls when the new legislation was
    enacted, increased payments were provided ranging from $5 to $13.50
    a month for retired workers, with proportionate increases for dependents
    and survivors. The average benefit being received by retired
    workers with no dependents receiving benefits went from $50
    to $56; the average for retired couples both of whom were receiving
    benefits rose from $86 to $98; and the average payment to families
    consisting of a widow and two children rose from $113 to $126.
    2. A higher earnings base.—Beginning with the calendar year 1955,
    the maximum amount of annual earnings subject to social security
    taxes and counted in the computation of benefit amounts is raised
    from $3,600 to $4,200. This change was recommended by the Department
    as an essential provision in maintaining the wage-related character
    of the old-age and survivors insurance system. With rising
    wage levels, more and more workers have had only part of their
    annual earnings credited toward their social security benefits. A
    substantial proportion of beneficiaries were receiving about the same
    32 Department of Health, Education, and Welfare, 1954
    Chart 3.—BENEFIT LEVELS HAVE BEEN INCREASED
    BENEFIT INCREASES
    FOR 6,600,000 BENEFICIARIES
    ON THE ROLLS IN SEPTEMBER 1954
    AVERAGE MONTHLY BENEFITS
    benefit—at or near the maximum—not because their earnings were
    the same, but because their earnings exceeded the maximum that could
    be counted under the system. In 1938 only 6 percent of the men
    working regularly in covered employment had earnings in excess of
    the amount that could be credited for Social Security. By 1953 this
    proportion had risen to over 60 percent, even though the earnings
    base had been increased in 1950 from $3,000 to $3,600 a year. With
    the earnings base raised to $4,200, the proportion of regularly employed
    men with earnings in excess of the creditable maximum will
    drop to 43 percent, roughly restoring the relationship established at
    the time of the 1950 amendments. The increased earnings base will
    allowT for more significant variation of benefit amounts with earnings.
    3. Dropout of low earnings years from the computation of average
    earnings.—The new legislation provides for omitting up to 5 years of
    low earnings from the computation of the average monthly wage, on
    which benefits are based. This amendment will protect newly covered
    workers from having their benefits reduced on account of their prior
    Social Security Administration 33
    years of noncoverage. Equally important, it will give those previously
    covered the advantage of some future protection against lowering
    the average monthly wage because of periods of unemployment,
    short-term illness, or low earnings. With extension of coverage, most
    workers will have all their earnings (up to the maximum) counted
    for benefit purposes. When, in addition, low earnings are dropped
    out, there will be relatively few instances in which regularly employed
    workers will be having their benefits based on average earnings of
    less than $100 a month.
    4. A new benefit formula.—The newly enacted benefit formula,
    applicable to the average of a worker’s monthly earnings after low
    earnings years have been excluded, is 55 percent of the first $110 of
    average earnings plus 20 percent of the next $240. This replaces the
    old formula of 55 percent of the first $100 plus 15 percent of the next
    $200. Monthly retirement benefits under the revised formula will
    range from $30 to $108.50.
    Both lower paid and average income workers today are earning
    much higher money wages than in the past. With the benefit formula
    adjusted to yield a higher percentage replacement on higher money
    earnings, the relative degree of protection such workers can expect in
    the form of benefits from the old-age and survivors insurance system
    will be maintained.
    5. Amended family benefit and lump-sum provisions.—Maximum
    monthly family benefits are raised from $168.75 to $200. Where family
    benefits must be reduced to bring them within the limitation of
    80 percent of the worker’s average monthly earnings, provision is
    made that total benefits shall not be reduced below $50 or iy2 times
    the worker’s benefit amount whichever is larger. The lump-sum death
    payment will continue to be computed at 3 times the worker’s benefit,
    except that it may not exceed $255.
    THE RETIREMENT TEST
    The 1954 amendments significantly change the form of the retirement
    test under the old-age and survivors insurance program. The
    new test is put on an annual basis for wage earners as well as for selfemployed.
    Beginning with 1955, the monthly test for wage earners
    is abolished and beneficiaries who work may earn up to $1,200 in a
    year without having their benefits suspended. For each $80, or part
    of $80, earned in excess of $1,200, one month’s benefit will be suspended.
    Benefits will not be suspended, though, for any month in which the
    beneficiary neither earned wages of more than $80 nor rendered substantial
    services as a self-employed person. In applying the test,
    wage and self-employment earnings are combined, and for the first
    time earnings from noncovered work as well as covered work are
    taken into account. A special test is applicable for beneficiaries en34
    Department of Health, Education, and IE el fare, 1954
    gaged in noncovered work outside the United States. The age at
    which benefits are paid irrespective of earnings from work is reduced
    from 75 to 72.
    With the test on an annual basis retired beneficiaries will feel freer
    to take employment on a part-time or short-term basis, since the
    relatively small amount of earnings they gain from such work will
    not result in a complete loss of social security benefits. Under the
    former monthly test, where benefits were withheld for any month in
    which covered wages exceeded $75, beneficiaries were often restricted
    in the work they could take and still receive benefits.
    The amendments also correct certain other anomalies in the operation
    of the test. Thus, by combining wage and self-employment earnings
    in applying the test, the dual exemption formerly possible for
    persons with both types of income is eliminated. Extension of the
    test to earnings in noncovered work, and application of a test to noncovered
    work outside the United States, puts all beneficiaries on a
    substantially equal basis with respect to the conditions under which
    they may draw their benefits.
    DISABILITY “FREEZE”
    The 1954 amendments include a provision that will protect the
    benefit rights of workers and their families during periods when the
    worker is under a long-term total disability. A serious deficiency in
    the old law was its failure to protect the old-age and survivors insurance
    benefit rights of workers and their families during periods of
    the worker’s total disability. Under the old law the average monthly
    wage (on which benefits are based) had to be figured over the full
    time from a specified starting date until the worker became 65 years
    of age or died, so that periods during which a worker was out of
    employment by reason of disability caused his average earnings, and
    therefore his potential benefit, to be reduced. It was even possible,
    under the old law, for the worker and his family to lose the right to
    any benefits at all because of a long-continued disability which occurred
    before his retirement age.
    Under the amendments if a worker becomes totally disabled and
    the disability is expected to be of long-continued and indefinite duration
    he will be able to apply, after January 1,1955, to have his earnings
    record “frozen” while he is unable to work. This provision is analogous
    to the “waiver of premium” commonly used in life insurance
    and endowment annuity policies to maintain the protection of these
    policies for the duration of the policyholder’s disability. It has been
    estimated that about half of the standard ordinary life insurance
    issued currently is protected through “waiver of premium” in the
    event of disability of the insured.
    Social Security Administration 35
    The advantages of the disability freeze provision are available not
    only to persons becoming disabled in the future, but also to old-age
    insurance beneficiaries who were totally disabled for an extended
    period before they retired and who are still disabled. Such persons
    will be able to apply for a determination of disability and will be able
    to have their benefit amounts recalculated, excluding the entire period
    of their total disability occurring before they reached retirement age.
    For beneficiaries who qualify, this recalculation of their benefits will
    result in appreciable increases in monthly benefit payments. Benefit
    increases resulting from the freeze will be payable beginning with
    benefits for the month of July 1955.
    If application is filed before July 1, 1957, a disability freeze application
    can establish a period of disability beginning on the earliest
    date the individual was disabled and met the earnings requirements
    provided in the law. This means that an individual who was totally
    disabled as early as October 1941 can establish a period of disability
    provided he had acquired sufficient covered earnings credits, was continuously
    disabled until he filed his application for a disability freeze,
    and filed such application before July 1,1957. After the grace period
    provided in the law has expired (that is, beginning July 1, 1957) a
    period of disability can be established no more than one year retroactively
    from the time application is filed.
    Only persons who have been working regularly in jobs covered by
    the social security law are eligible for the protection of this provision.
    Not only must the worker be under a total disability, as that term is
    defined in the law, but he must have had substantial and recent earnings
    under the program before becoming disabled—to be specific, he
    must have acquired covered earnings credits for 5 years out of the 10
    years before becoming disabled, and one and one-half years of these
    5 years must have occurred during the 3 years before he became disabled.
    Only those individuals who have been totally disabled for at least 6
    months by illness, injury, or other physical or mental impairment
    which can be expected to be of long-continued and indefinite duration
    may qualify for the freeze. The impairment must be medically determinable
    and must prevent the individual from performing any
    substantial gainful work. An individual will also be considered to
    meet the definition of disability if he is totally blind within the meaning
    of that term as defined in the law.
    Determinations of disability will, for the most part, be made by
    State agencies administering vocational rehabilitation programs
    or other appropriate State agencies with which the Secretary of
    Health, Education, and Welfare may make agreements. The Department
    of Health, Education, and Welfare will develop and promulgate
    36 Department of Health, Education, and Welfare, 1954
    standards to be used in determining disability for the purposes of the
    freeze. The use of such standards will promote equal treatment of all
    disabled persons under the freeze provision regardless of State of
    residence. The cost of making disability determinations will be met
    out of the Federal old-age and survivors insurance trust fund. In
    cases where the individual is not covered by an agreement between
    the Department and a State, disability determinations will be made by
    the Department. Department determinations will be necessary for
    individuals residing outside the United States, or residing in States in
    which no agreement has been made, and individuals in certain types
    or classes of cases which have been excluded from the agreement at
    the State’s request, such as the large number of backlog cases.
    The Congress, on the recommendation of the President, placed
    great emphasis upon the importance of greater effort in the rehabilitation
    field, enacting a law which lays the foundation for a tremendously
    expanded rehabilitation program. A byproduct of the old-age
    and survivors insurance disability freeze provision will be an increase
    in the number of referrals to State vocational rehabilitation agencies,
    not only for the purpose of determining the degree of disability, but
    also for the vital human purpose of combating disability and thus returning
    disabled people to a productive status in our economy. The
    prompt referral of disabled persons for necessary rehabilitation services
    is expected to increase the effectiveness of these services, and
    greatly enhance the prospect of successful rehabilitation.
    FINANCING THE PROGRAM
    In considering the financing arrangements for old-age and survivors
    insurance, Congress has recognized that the assets of the trust fund
    need not be and should not be maintained at a level required of private
    insurance. Congress has, however, made clear its intent that the oldage
    and survivors insurance program be self-supporting from contributions
    of covered workers and employers. Since under the 1954 amendments
    future benefit outlays, expressed as a percent of payroll, will be
    higher than formerly, the long range schedule of contribution rates set
    in 1950 was adjusted to meet the additional costs. The former rate of
    314 percent each on employer and employee for years beginning with
    1970 was increased to 314 percent each for the years 1970-74 and to
    4 percent each in 1975 and thereafter with corresponding increases
    for the self-employed. The adjusted contribution schedule was
    arrived at after review of long-range actuarial cost estimates of the
    new program by the Committee on Ways and Means of the House
    of Representatives and the Committee on Finance of the United
    States Senate.
    Social Security Administration 37
    Congressional committees are fully aware of the difficulties involved
    in making exact predictions of the actuarial status and financial operations
    of a program that reaches into the distant future. As economic
    and other conditions change it is essential that new cost estimates for
    the old-age and survivors insurance program be prepared from time to
    time in order to take into account the latest operating experience and
    other newly available information.
    Normally, several different estimates are prepared, combining different
    assumptions as to employment and earnings, mortality and other
    demographic factors, and interest rates. No one of the estimates is
    considered to be the most probable for the long run. Each represents
    a reasonable set of assumptions tending in the direction of either high
    costs or low costs. The assumptions used are reviewed by an Actuarial
    Advisory Committee from outside of the Government. At present the
    members of the Committee are Reinhard A. Hohaus, Vice President
    and Chief Actuary, Metropolitan Life Insurance Company; Clarence
    A. Kulp, Professor of Insurance, University of Pennsylvania; Kermit
    Lang, Assistant Actuary, Equitable Life Insurance Company of Iowa;
    and W. R. Williamson, Consulting Actuary.
    The result of preparing such a series of estimates is a range of possible
    costs rather than a single figure. It is clearly impossible, however,
    to base a schedule of contribution rates on a range of possible
    costs. In determining the contribution schedules, congressional committees
    have adopted the practice of relating the contribution rates to
    the “intermediate” cost estimate based on high employment assumptions.
    This “intermediate” estimate is merely the midpoint between
    the high and low cost estimates; it is not an attempt to predict the
    precise cost of the program and should not be regarded as such.
    The level-premium cost of the benefit payments and administrative
    expenses of the program, after making allowance for the existing trust
    fund and the lower contribution rate for the self-employed as compared
    with the combined employer-employee rate, is estimated at 7.50 percent
    of payroll (on the “intermediate” basis using an interest rate of 2.4
    percent), or about 0.9 percent of payroll higher than the corresponding
    cost of the old program. As a result of the upward revision in the
    contribution schedule, revenues were increased nearly 1.1 percent on a
    level premium basis. Thus the deficiency of 0.6 percent of payroll
    indicated by the latest estimates for the old law was reduced by onethird
    to 0.4 percent. It should be pointed out that changes in a number
    of factors—for example, interest rates, mortality rates, or wage
    levels—-could modify these results. No one set of long-range estimates
    should be looked upon as “final.”
    38 Department of Health, Education, and Welfare, 1954
    Public Assistance
    Amendments to the public assistance titles of the Social Security
    Act* passed by the 83d Congress in 19541 extend two amendments
    which would otherwise have expired during the coming fiscal year.
    A 1952 amendment raised the maximums on the amounts of individual
    payments in which the Federal Government can participate
    and increased the Federal share within these maximums.1 2 Primarily
    as a result of this amendment, average monthly payments from June
    1952 to June 1954 have been increased by $4.54 for the blind; $4.34
    for the aged; $3.17 for the disabled; and $1.45 for mothers and children.
    In most States these increased payments were financed entirely
    from the additional Federal funds. This amendment which would
    have expired on September 30, 1954, was extended until September
    30, 1956. If this more generous matching provision had not been
    extended, States would have received about $150 million less in Federal
    aid during the remainder of the 1955 fiscal year. As a result,
    States would either have had to reduce payments to the needy or raise
    more State and local funds to maintain present payments.
    Similarly, an amendment passed in 1950 permitted Federal approval
    of certain State plans for aid to the blind even though they did not
    require consideration of the blind individual’s income and resources
    in determining his need, if they met all other requirements for approval.
    3 However, Federal funds still are available only for cases in
    which income and other resources have been considered. This amendment
    which would have expired on June 30, 1955, was extended for 2
    additional years. Approval of the Pennsylvania and Missouri aid
    to the blind laws granted under this temporary provision was thereby
    extended until June 30,1957.
    Other actions taken by the 83d Congress directly affect the public
    assistance program. The 1954 amendments to the Social Security Act
    expanding and liberalizing the old-age and survivors insurance program
    will have both long-time and immediate effects on public assistance.
    The expansion of the old-age and survivors insurance program to
    almost universal coverage is expected to reduce gradually the number
    of needy aged who are dependent on old-age assistance. With extension
    of coverage to many self-employed farmers, additional farm
    workers, and other groups not formerly included, it is estimated that
    by about 1980, a very high proportion of the retired aged will receive
    old-age and survivors insurance benefits and will need old-age assist-
    1 Public Law 761, 83d Congress, approved Sept. 1, 1954.
    2 Public Law 590, 82d Congress, approved July 18, 1952.
    3 Public Law 734, 81st Congress, approved Aug. 28, 1950.
    Social Security Administration 39
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    40 Department of Health, Education, and Welfare, 1954
    ance only to supplement low benefit payments or to pay for medical
    or nursing care or other special needs.
    More immediate effects are anticipated from the liberalization of
    the old-age and survivors insurance system. Some 463,000 aged persons
    now receiving old-age assistance to supplement their insurance
    benefits will get increases of about $5 per month. About 32,000 families
    who are now receiving aid to dependent children payments to
    supplement their insurance benefits will also get benefit increases.
    Some additional widows and children receiving public assistance will
    now receive benefits because of the extension of protection to the
    survivors of wage earners who died after 1939 and before September
    1950 and who, although they had at least 6 quarters of coverage, were
    not insured under the provisions of the 1939 act.
    In addition, amendments to the Vocational Rehabilitation Act
    which extend and improve vocational rehabilitation services will increase
    the services available to the disabled, some of whom receive
    public assistance.4 Better care for needy persons who are ill or disabled
    should also result from the new amendments to the hospital
    survey and construction provisions of the Public Health Service Act,5
    which make funds available to States for diagnostic or treatment
    centers, chronic disease hospitals, rehabilitation facilities, and nursing
    homes.
    Another action taken by the 83d Congress will enable the Bureau
    to begin work on certain responsibilities delegated to the Department
    by the Federal Civil Defense Administration. An appropriation of
    funds will enable the Bureau to plan a program for cash assistance
    to civilians injured or in need because of enemy attack and for clothing
    to civilians in need because of attack.6 7
    Caseload and Expenditures1
    About 6 percent more needy persons received assistance in June
    1954 than a year earlier. From 5.3 million in June 1953 the total
    number, including those receiving general assistance, increased to 5.6
    million in June 1954. The old-age assistance program was the only
    one which showed a decline. All the other four programs showed
    an increase in the number of persons receiving aid. Factors contributing
    to this increase included the normal growth of the relatively
    new program of aid to the permanently and totally disabled; the discontinuance,
    early in 1954, of benefits paid by the United Mine
    Workers to disabled miners and families of deceased miners, many of
    4 Public Law 565, 83d Congress, approved Aug. 3, 1954.
    5 Public Law 482, 83d Congress, approved July 12, 1954.
    8 Public Law 663, 83d Congress, approved Aug. 26, 1954.
    7 Averages and totals include money payments to recipients and vendor payments for
    medical care and cases receiving only such payments.
    Social Security Administration 41
    whom became eligible for public assistance; and an increase in the
    number of persons receiving general assistance, probably reflecting
    somewhat lower levels of employment in some areas of the country.
    The 1.6 percent increase in expenditures for assistance in 1954 over
    the preceding 12 months, an increase of $40 million, brought total
    Federal, State, and local expenditures for public assistance for the
    fiscal year to $2,563 million. Monthly average payments for families
    receiving aid to dependent children rose $1.10 and the average per
    general assistance case was up $4.46. There was little change from
    last year in the average payments for recipients of other types of
    assistance for the Nation as a whole. Average payments by State
    and by category are given in chart 4.
    Although a few States had to reduce payments because of limited
    funds, several others raised payments to meet a higher proportion of
    need or to reflect price changes that occurred in the preceding year
    or earlier. Vendor payments for medical care accounted for a sizable
    portion of the increase in a few States with greater than average
    change in payments.
    At the end of the year fewer than 1 in every 30 in the population
    was receiving public assistance. The proportion of the population
    receiving assistance, by States, is given in chart 5. The total expenditures
    of $2,563 million represented 0.9 percent of personal income
    payments in the Nation in the calendar year 1953. The Federal share
    of this expenditure was $1,321 million.
    Old-age assistance.—About 26,500 fewer persons received old-age
    assistance in June 1954 than in June 1953. The 2,582,000 persons
    receiving assistance represented a decrease of 1 percent from the
    number in June a year earlier and 227,000 fewer than the number
    aided in the peak month of September 1950. In June 1954, for the
    Nation as a whole, 184 out of every 1,000 persons aged 65 and over
    received old-age assistance, the lowest proportion since before World
    War II.
    The national trend downward, starting in October 1950, continued
    • for most States during the year. More than half the States had fewer
    aged recipients in every month of the year. In some of the States
    with larger-than-average decreases in caseloads, stricter policies regarding
    relatives’ responsibility were the primary factor in the declines.
    The largest percentage decrease for any State, however, occurred
    in Montana where a new lien law gave the State a claim against
    the estates of recipients of old-age assistance. The national average
    monthly old-age assistance payment in June 1954 was $51.45 as compared
    with $51.08 in June 1953.
    Aid to dependent children.—About 17,600, or 3 percent, more families
    were receiving aid to dependent children in June 1954 than in
    339010—55------ 4
    42 Department of Health, Education, and Welfare, 1954
    Chart 5.— PROPORTION OF POPULATION RECEIVING ASSISTANCE (RECIPIENT RATES) IN THE UNITED STATES, JUNE 1955
    llllllllllllllllllllllllllllllllll.
    r- O a» boislsLis
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    a95o25So»±i£o35»iz
    BASED ON POPULATION ESTIMATED BY Bl»EAU OF PUBLIC ASSISTANCE AS OF JULY 1954. BASED ON POPULATION ESTIMATED BY THE BUREAU OF PUBLIC ASSISTANCE AS OF JUNE 1954. 1/ BASED ON CENSUS DATA,
    LY 1952 EXCEPT FOR TERRITORES WHICH ARE PARTLY ESTIMATED BY THE BUREAU OF PUBLIC ASSISTANCE. S AVERAGE FOR 42 STATES; NO PROGRAM IN ALASKA, ARIZ, CALIF, FLA, INO, IOWA, KY, MAINE, NEBR, NEV, ANO TEX.
    *ERAGE FOR 45 STATES; NUMBER AIDED NOT AVALABLE FOR ARIZ, CONN, DEL, FLA, OKLA, TEX, VT, ANO VA. Si NO FEDERAL PARTICIPATION.
    Social Security Administration 43
    the preceding June. Nearly three-fourths of the States were aiding
    more families in June 1954 than a year earlier, including 12 States in
    which the number of families represented an increase of more than
    10 percent, with one State showing nearly 30-percent increase. On
    the other hand, 13 States were aiding fewer families than in the previous
    year; relatively large decreases occurred in 5 jurisdictions. The
    average monthly payment per family in June 1954 was $85.08 (or
    $23.81 per person) as compared with $83.98 per family (or $23.89
    per person) in June 1953.
    Aid to the permanently and totally disabled.—Forty-two States, as
    compared with 39 a year earlier, are now administering programs
    with Federal financial participation provided under a 1950 amendment
    to the Social Security Act. Connecticut, Minnesota, and Tennessee,
    which established programs during the year, contributed to
    the 18-percent increase in the number of recipients. The total number
    of recipients in the 42 States was 211,700 in June 1954, as compared
    with 179,400 in 39 States in 1953. The average monthly payment was
    $53.51 as against $53.72 in June 1953.
    Aid to the blind.—About 2,000 recipients were added during the
    year to the aid to the blind program, bringing the total to about 101,000
    in June 1954. All jurisdictions are administering aid to the blind
    with Federal financial participation. The average monthly payment
    in June 1954 was $55.80 as compared with $55.53 in June 1953.
    General assistance.—The 299,000 cases on the rolls in June 1954
    represented an increase of 16.5 percent from the preceding June.
    Caseloads increased in two-thirds of the 48 jurisdictions for which
    data are available; in about half the States they rose by 10 percent or
    more, including 11 States where the increases exceeded 30 percent.
    Fewer cases were reported in 16 States with the largest decrease due
    to continued transfer of cases to the program of aid to the permanently
    and totally disabled. General assistance, financed entirely from State
    and/or local funds, is affected by lower employment levels to a greater
    extent than the federally aided assistance programs, since it includes
    a larger proportion of persons who are actually or potentially employable.
    The national monthly average per case was $51.62 in June
    1954 as compared with $47.16 a year earlier.
    Effect of Old-Age and Survivors
    Insurance on Public Assistance
    As indicated in chart 6, the increase in the number of aged persons
    receiving old-age and survivors insurance benefits during the past few
    years has been accompanied by a decline in the number of aged persons
    dependent on public assistance. In 1954 almost twice as many aged
    44 Department of Health, Education, and Welfare, 1954
    persons received insurance benefits as received public assistance, whereas,
    as recently as 1950 more aged received assistance than benefits.
    Between 1950 and 1954 there was also a 50-percent increase in the
    number of paternal orphans receiving benefits, and a decline in the
    number of such children receiving assistance.
    Aged persons receiving tooth insurance and assistance.—In February
    1954 about 460,000 or 10 percent of the aged insurance beneficiaries
    received old-age assistance to supplement their insurance benefits.
    They represented 18 percent of the old-age assistance caseload for that
    month.
    Insurance beneficiaries who receive minimum or near minimum
    benefits and who have few other resources, and those with special
    needs, often require additional financial help. Before September
    1954, the minimum insurance benefit paid to a retired worker was
    $25 per month, and minimums for aged wives and widows of insured
    workers were $12.50 and $18.80, respectively. Early in 1953 about
    40 percent of those receiving both insurance and assistance received
    benefits of $25 a month or less; half received less than $30. The 14
    percent who received old-age assistance to supplement benefits which
    exceeded $50 per month undoubtedly included many persons who
    needed assistance to help meet costs of medical care or other unusual
    expenses.
    The number of aged persons getting both assistance payments and
    insurance benefits increased sharply immediately after amendments to
    the Social Security Act in 1950. Because benefits paid to newly eligible
    persons were generally low, many old-age assistance recipients
    receiving benefits for the first time continued to need assistance.
    Since then, the number of persons getting both types of payment has
    continued to rise but at a more gradual rate. The net increase in the
    number of aged persons receiving both types of payment from September
    1950 to August 1951 was 100,000, and only 187,000 from September
    1950 to February 1954.
    The proportion of assistance recipients with benefits has risen from
    nearly 10 percent in September 1950 to 18 percent in February 1954.
    As the older old-age assistance recipients come off the rolls, usually
    because of death, and as the new old-age assistance cases are more likely
    to be eligible for insurance, the proportion of assistance cases receiving
    both types of payments is expected to increase further. On the other
    hand, with increasing numbers of persons becoming eligible for insurance
    benefits, the proportion of insurance beneficiaries receiving assistance
    has decreased from 13 percent in 1950 to 10 percent in 1954.
    The broader coverage of the old-age and survivors insurance program
    will have little effect on the present caseload in old-age assistance
    which consists mostly of individuals who never had an opportunity to
    Social Security Administration 45
    Chart 6.—GROWTH IN SOCIAL INSURANCE PROTECTION FOR THE AGED1
    1 Average monthly number of beneficiaries and recipients, by years, per 1,000 persons aged 65 and
    over in the population.
    obtain coverage under the insurance program. Half the recipients are
    aged 75 or over, and some were already out of the labor market before
    the Social Security Act was passed. There are also the needy aged who
    worked in employments not covered, or only recently covered, by the
    insurance program, and wives and widows of uninsured workers.
    About three-fifths of the recipients of old-age assistance are women,
    most of whom have had no recent employment, if any at all.
    Average assistance payments to individuals receiving both insurance
    and assistance are lower than assistance payments to recipients who do
    not receive benefits. The average monthly old-age assistance payment
    for recipients not getting insurance benefits was $53.94 in February
    1954; the average monthly amount of assistance for recipients getting
    both insurance benefits and assistance payments was $43. The average
    insurance benefit received by aged persons getting both assistance and
    benefits was $33.91 in February 1954.
    46 Department of Health, Education, and Welfare, 1954
    Families with children receiving both insurance and assistance.—
    Since the insurance program provides benefits primarily to those
    children whose insured parent has died, its effect on the size of the
    aid to dependent children program is limited. Death of the father
    was the cause of dependency for only one-sixth of the families receiving
    aid to dependent children in November 1953, but incapacity of
    the father accounted for more than one-fifth, and absence of the
    father for more than one-half.
    About 32,000 families received payments under both programs in
    November 1953. In 23,000 of these families the father was dead.
    In the other 9,000 families an aged, retired parent was the insurance
    beneficiary, or the children’s benefits were based on the wage record
    of a natural father who died, and their eligibility for assistance on
    the more recent absence or incapacity of a stepparent.
    The proportion of assistance families also receiving survivors’
    benefits has risen only slightly from less than 5 percent in September
    1950 to about 6 percent in November 1953. On the other hand, as
    the number of families with benefits has increased, the proportion
    receiving both insurance benefits and assistance payments has declined
    from 8 percent in September 1950 to 5 percent in November 1953.
    Savings in the program for aid to dependent children have also
    resulted, since relatively less assistance goes to families receiving
    insurance benefits than to other families. In November 1953 the
    average assistance payment to families not receiving insurance benefits
    was $90.07; for families receiving insurance benefits and assistance
    payments the average assistance payment was $71.35. The
    average insurance benefit received in November 1953 by families
    getting both aid to dependent children and a benefit under the insurance
    program was $59.02.
    Program Developments
    Increasing attention is being focused by the Bureau, the States,
    and other interested groups on the coordination of welfare, medical,
    vocational, and other services with financial assistance to help needy
    persons become self-sufficient to the fullest extent of their capacities.8
    Since characteristics of persons receiving public assistance show a
    close correlation between financial need and neglected health and
    personal problems, questions are being raised about the extent of
    individual and family breakdown which might have been prevented
    if necessary and appropriate help had been available to them at
    8 The appropriateness of welfare services in the administration of public assistance was
    indicated in a report of the House Ways and Means Committee (Report on H. R. 6000,
    p. 55, 1949) which stated, “there is ample authorization for Federal sharing in the costs
    of welfare services to applicants for and recipients of State-Federal assistance.”
    Social Security Administration 47
    the time of crisis. Interest and attention is being directed to learning
    how needy persons can be helped to achieve a greater degree of selfsufficiency,
    and to determine the nature of services needed to achieve
    this goal.
    The Bureau has also been working with other bureaus in the Department
    and national private agencies in planning for the development
    and utilization of other needed resources in an effort to bring
    to public assistance recipients the services now available through
    other programs.
    SERVICES TO AID TO DEPENDENT CHILDREN FAMILIES
    The aid to dependent children program was established to provide
    aid to needy children who live with a relative and who are deprived of
    parental support or care because of the death, incapacity, or absence
    of a parent. For 16 States studied in 1942, death of the father was the
    most frequent cause of dependency, accounting for 37 percent of the
    aid to dependent children caseload, and absence of a father from the
    home accounted for 36 percent.
    By 1948, death as a cause of dependency had declined in relative importance.
    Absence of a father accounted for need in 46 percent of the
    Chart 7.—NUMBER OF CHILDREN RECEIVING AID TO DEPENDENT CHILDREN WITH FATHER
    DEAD,1 AND NUMBER OF SURVIVOR CHILDREN RECEIVING OLD-AGE AND SURVIVORS
    INSURANCE, 1950-1954
    1 Data available only for October 1942, June 1948, and November 1953.
    48 Department of Health, Education, and Welfare, 1954
    families receiving aid to dependent children in the United States, and
    rose to 54 percent in November 1953. This shift was due partly to the
    expansion of the old-age and survivors insurance program in providing
    income to children of insured workers who die. With the availability
    of insurance benefits to surviving children, the proportion of
    families receiving aid to dependent children where need was due to the
    death of the father declined from 37 percent for 16 States in 1942 to
    17 percent in the country as a whole in 1953. Chart 7 shows the decline
    in the actual number of paternal orphans receiving assistance
    from 1940 to 1954 in contrast with the rise in the number of survivor
    children receiving insurance benefits.
    The increasing size of the group of children needy because of the
    absence of the father has focused public attention on the problems of
    broken families, especially those involving desertion and abandonment.
    The size and complexity of the problem of deserting parents
    is also of major concern to Federal and State public assistance agencies.
    Various proposals have been made for coping with these problems.
    For example, recognizing that the legal responsibility of a
    parent for the support of his minor children is clearly established in
    the laws of every State, Congress amended the Social Security Act in
    1950 to require that, effective July 1, 1952, State public assistance
    agencies give prompt notice to appropriate law-enforcement officials
    when assistance is furnished to children who have been deserted or
    abandoned by a parent.
    Notification was given in about one-fourth of the cases receiving
    aid to dependent children in June 1952. Law-enforcement officials
    were notified of the desertion or abandonment of about 368,000 children
    in 155,000 families. In about 5,100 cases involving approximately
    9,000 children (fewer than 1 percent of the caseload in June
    1952), the relative caring for the children preferred to have assistance
    discontinued or reduced to having enforcement officials notified.
    The whereabouts of about half of the absent parents brought to the
    attention of law-enforcement officials was unknown. The whereabouts
    of an additional 18 percent of the absent parents, though
    known, was outside the State. About 40 percent of the absent parents
    had been away for 5 or more years, 45 percent had been gone from 1 to
    5 years, and 12 percent less than a year.
    The increasing interest and concern about the social problems of
    aid to dependent children families has also sharply pointed up the
    need for planning additional ways of helping families to deal with
    their problems in a constructive way. Social agencies have long
    been working with individuals who have problems resulting from desertion
    and illegitimacy. Never before, however, have these problems
    been as concentrated in one program as now in the aid to deSocial
    Security Administration 49
    pendent children program. This concentration has led to concerted
    effort by Federal, State, and local public welfare agencies in planning
    to meet other needs of aid to dependent children families in addition to
    financial assistance.
    Public Assistance-Children's Bureau working group on services.—
    A working group composed of staff from both the Children’s Bureau
    and the Bureau of Public Assistance has developed a draft statement
    concerning the cooperative activities that could be utilized in the
    development of services for aid to dependent children families. During
    the year, this committee has been considering basic concepts of
    service in the aid to dependent children program, the potentialities
    of the child welfare and aid to dependent children programs in providing
    needed services, goals toward which work could be directed, and
    the nature of program and administrative planning required to achieve
    these goals.
    The committee recognized that, while many families receiving aid
    to dependent children are able to handle their own problems, many
    other families have problems which require more specialized types of
    service than are now available to them. It was recognized that States
    need staff equipped to offer such services. Therefore, the social service
    needs of aid to dependent children families were identified to
    provide perspective to States in determining how much they are able
    to do, and to plan their direction in relation to staffing, training, program
    planning, and policy formulation. The committee’s draft statement
    is being used for discussion and evaluation of the subject by both
    child welfare and public assistance agencies throughout the country.
    State developments in services.—Other activities of both State
    agencies and Bureau staff have also been related to services. A conference
    on services in the aid to dependent children program was
    held in Shreveport, La., in March 1954. Public assistance and child
    welfare staff from Arkansas, Louisiana, New Mexico, Oklahoma, and
    Texas participated in the discussions. Services needed and those
    provided in a group of aid to dependent children cases were analyzed.
    Out of the discussion, minimum services needed in all aid to dependent
    children cases and in special problem cases were identified. Some of
    the principles developed by the working group of the Children’s
    Bureau and Public Assistance on services needed in aid to dependent
    children families were tested out in this conference. Recommendations
    made dealt with ways of achieving increased social benefits
    through the aid to dependent children program.
    One State conducted a workshop for its field staff on methods of
    helping parents and children use their own resources to achieve maximum
    independence. A report on this workshop was issued by the
    State agency. Another State made an intensive study of its caseload
    50 Department of Health, Education, and Welfare, 1954
    to determine the extent, sources, and nature of criticisms and complaints
    made about its aid to dependent children program in recent
    years.
    A project on services has been conducted by one State with special
    funds appropriated by the State legislature in an effort to further
    protect children from the effects of family breakdown. Help has been
    given in many types of family difficulties through use of available
    community resources and by providing counseling in a variety of
    areas including education, housing, nutrition, home management, consumer
    education, social adjustment, and parent and child adjustment.
    Effort was made to identify special services which might prevent
    further deterioration in family relationships and to bring appropriate
    community resources into play at an early stage. Other work done
    included planning with adolescents for vocational training and employment
    and helping parents and children with health problems.
    Problems remaining when assistance was terminated were also identified,
    and in some instances work with the family was continued for a
    period of time. While increasing use was made of existing facilities,
    the dearth of community resources for diagnosis and treatment of
    various kinds of health and emotional problems and for vocational
    rehabilitation was markedly evident. It was found that the needs
    of many aid to dependent children families cannot be met without
    the development of additional community resources.
    EMPHASIS ON REHABILITATION AND SELF-CARE
    During the last few years there has been a marked increase in both
    Federal and State interest in the provision of services aimed at
    rehabilitation and self-care. Examples include study of the kinds
    of services needed, organizational changes and caseload adjustments
    to emphasize services, demonstration projects, and re-focus in staff
    development and policy development to clarify the services to be given.
    Experiments conducted by several States in selected localities have
    shown the social benefits and the potentials for savings in public
    assistance expenditures when services are provided. States are increasingly
    requesting help and looking to the Bureau for leadership
    in developing these services, in determining the qualifications of
    workers needed to provide them, and in the training of staff.
    It is believed that some recipients of public assistance who, because
    of age or disability require considerable care from others, could be
    helped to learn how to care for themselves and thus release the time
    of others in the family for more productive pursuits. Some of the
    120,000 who live in institutions might also be helped to live in a setting
    outside an institution. Institutional care as well as the cost of care
    of aged persons in their own homes is costly. Any improvement in
    Social Security Administration 5 1
    a person’s ability to care for himself would be beneficial not only
    in terms of cost, but to the individual himself.
    Others receiving public assistance, with the help of vocational rehabilitation
    and other services, might be helped to return to employment.
    For example, 20 percent of the recipients of old-age assistance
    are under 70 years of age, and 82 percent of all aged recipients are
    physically able to care for themselves. In fiscal year 1953, 15,000
    recipients of old-age assistance returned to employment and had
    public assistance discontinued. Employment or increased earnings
    of a member in the family also accounted for 35 percent of the aid
    to dependent children cases closed during the past year. Nearly
    6 percent of blind recipients earn some income. Even among recipients
    of aid to the permanently and totally disabled, rehabilitation
    has enabled some to return to employment. The aged, the blind, and
    those receiving aid to the permanently and totally disabled constituted
    21 percent of the more than 11,300 assistance recipients rehabilitated
    in fiscal year 1953 by State vocational rehabilitation agencies.
    C o ordination of public assistance and vocational rehabilitation
    programs.—Nearly 20 percent of new referrals to State vocational
    rehabilitation agencies came from State public assistance agencies,
    and slightly less than 20 percent of the persons rehabilitated by vocational
    rehabilitation agencies in fiscal year 1953 received some public
    assistance before or during their rehabilitation. Amendments to the
    Vocational Rehabilitation Act passed in 1954 make possible even
    closer coordination of the services available under both public assistance
    and vocational rehabilitation programs.
    In the enactment of the amendment to the Social Security Act in
    1950 introducing the aid to the permanently and totally -disabled
    program, the intent of Congress was made clear that State public
    assistance agencies should work closely with vocational rehabilitation
    agencies in making the opportunity available to those for whom vocational
    rehabilitation appeared possible. Since then, the Bureau of
    Public Assistance and the Office of Vocational Rehabilitation have
    been reviewing their policies and practices in order to increase the
    effectiveness of their cooperative efforts. State agencies administering
    aid to the permanently and totally disabled have been required
    in their State plan to include a description of their working agreements
    with vocational rehabilitation agencies. The 1954 amendments
    to the Vocational Rehabilitation Act now also require a State
    vocational rehabilitation plan to provide for cooperation with, and
    the utilization of, the services of the State agency administering
    public assistance.9
    » Public Law 565, sec. 5 (a), (9), 83d Congress, approved Aug. 3, 1954.
    52 Department of Health, Education, and Welfare, 1954
    During the past year, representatives of both the Office of Vocational
    Rehabilitation and the Bureau of Public Assistance have been
    considering ways in which they can help State and local agencies to
    provide better rehabilitation services to public assistance recipients.
    The importance of early identification and referral of public assistance
    recipients who could probably benefit from rehabilitation services
    is being stressed.
    Increasing use of State review team.—In States presently administering
    the aid to the permanently and totally disabled program,
    determinations of the eligibility factor of permanent and total disability
    are in most cases made by a State review team. In addition
    to the physician and social work members of the team representing
    the State public assistance agency, a representative of the State vocational
    rehabilitation agency is often a regular team member. States
    have found this joint activity has many values. The opportunity
    afforded the applicant of having his total situation studied and understood,
    and appropriate suggestions made for helping him, is also
    enhanced.
    Within the past few years, new ways have been tried to serve disabled
    people in all the assistance programs. In some States, a State
    review team has been used in an appraisal of the incapacity of parents
    in the aid to dependent children program. In other States, teams,
    similar to the State review team, have been set up in some local communities.
    They are usually called “evaluation teams” or “clinic teams”
    and are made up of medical representatives, vocational rehabilitation
    and employment counselors, and social workers. The individual being
    evaluated is interviewed by each team member. A number of seriously
    disabled people after a thorough current appraisal have been
    found to be far from hopeless as far as rehabilitation is concerned.
    Other activities relating to services.—Staff of the Children’s Bureau
    and the Bureaus of Public Assistance and Old-Age and Survivors
    Insurance are jointly considering the need for services of both children
    and retired workers receiving insurance benefits, and evaluating the
    resources available to them. A Bureau of Public Assistance staff
    member also serves on an American Public Welfare Association committee
    on the aging. This committee is studying services needed by
    all old-age and survivors insurance beneficiaries and the role of public
    welfare in providing them. Bureau staff likewise worked with the
    National Social Welfare Assembly’s Conference on Individualized
    Services, encouraging the development of individualized services in
    small communities and rural areas, and strengthening the working
    relationships between public and private social welfare agencies. Representation
    has also continued on the national Committee on Homemaker
    Services which is studying and evaluating the effectiveness of
    homemaker services. The value of homemaker service where needed
    Social Security Administration 53
    for families receiving public assistance is also being studied by the
    Bureau.
    Exploratory work also has been done toward strengthening services
    through greater use of citizen participation. Volunteers can serve a
    real purpose in the field of public assistance through rendering services
    that would include personal interest in public assistance recipients;
    interpretation of the purpose and function of public assistance
    to lay groups; and promotion of a closer understanding between voluntary
    and public welfare agencies and other organizations concerned
    with services to people. An experienced volunteer has been working
    on this aspect of the program.
    STANDARDS OF INSTITUTIONAL CARE FOR THE AGED, BLIND, AND
    DISABLED
    The nationwide movement to raise standards of institutional care,
    considerably advanced by a Social Security Act amendment passed
    in 1950 and effective July 1, 1953, continued with increasing vigor
    during the past year.
    The standard-setting amendment, intended to assure adequate standards
    of care and protection against hazards threatening the health
    and safety of residents of institutions, requires a State to designate
    an authority to establish and maintain standards for institutions in
    ■which individuals may live and be eligible for federally aided assistance.
    Under this amendment, each State is responsible for adopting
    safety and sanitation regulations and for setting standards of care
    at levels that seem practical and realistic in that State. Most States
    already had authorities that set standards for hospitals and institutions
    caring for children, but comparable protection had not been
    given generally to adults. Substandard institutions for aged and
    infirm adults still exist in many parts of the country and many public
    assistance recipients, because of their limited economic circumstances,
    are living in these institutions.
    The amendment has already achieved in large measure the congressional
    intent of State assumption of responsibility for standards in
    institutions in which persons eligible to receive public assistance payments
    may live. All hospitals are now covered under a standard-setting
    authority in almost all the States and Territories, and there is
    marked increase in coverage in domiciliary care and commercial homes.
    However, in some States there are still certain types of institutions
    not yet covered by the State’s standard-setting authority. Federal
    financial participation is not available for assistance payments to
    needy persons in these institutions. In general, however, States are
    assuming increasing responsibility for a more adequate quality of institutional
    care. With most legislative activity required under the
    54 Department of Health, Education, and Welfare, 1954
    standard-setting amendment completed, States are now moving on to
    the consideration of other areas of standard setting.
    There has been continuing cooperative activity with national organizations,
    both public and private, concerned with institutional care.
    The many voluntary and public welfare agencies which worked cooperatively
    in developing plans for carrying out this amendment have
    continued to lend their aid and support in its implementation. Representatives
    of some, of the organizations included on the National
    Advisory Committee which initially helped the Bureau define and
    interpret its responsibilities under this amendment have continued
    to serve on similar advisory committees of State and local agencies
    administering the program and on national committees concerned
    with this area. The Public Health Service has also continued its cooperation
    in coordinating the activities of public health and public
    assistance agencies in relation to standard setting for institutions.
    Bureau representation has continued on the National Social Welfare
    Assembly’s committee on standards of care for older people in institutions,
    and in the planning and sponsoring of three regional conferences
    on this subject during the year. These conferences, held in
    Washington, D. C., New Orleans, and St. Louis, brought together
    representatives of standard-setting authorities and health and welfare
    agencies active in this field; and administrators of nursing homes,
    homes for the aged, and other institutions. The purpose of these conferences
    was to advance the quality of institutional care by bringing
    together people with major responsibility and interest in this area
    under circumstances which would permit interchange of experience
    and viewpoints and consideration of common problems. Discussion
    brought out the need for further consideration by public assistance
    agencies of the adequacy of the rates being paid for care of public
    assistance recipients in institutions, and the availability of public
    medical services for this group. It also pointed to the need for further
    participation of public assistance agencies in community planning
    for institutional care, since public assistance recipients constitute
    a high proportion of those receiving institutional care in many communities.
    Although there was evidence of considerable variation in
    the quality of care given, the intensity of interest and ingenuity of
    effort being expended in many parts of the country in an attempt to
    improve standards of institutional care is heartening.
    The National Social Welfare Assembly published a comprehensive
    report of these conferences. Since considerable content of the discussions
    was related to the role of public assistance agencies, a summary
    of the report was prepared by the Bureau for State agency use.
    The viewpoints expressed at these conferences concerning public
    assistance programs and practices warrant consideration and further
    evaluation by public welfare agencies.
    Social Security Administration 55
    PUBLIC INSPECTION OF PUBLIC ASSISTANCE ROLLS
    There are now 29 States with legislation permitting public inspection
    of disbursement records of persons receiving federally aided public
    assistance. A provision of the Revenue Act of 1951 made it possible
    for States to enact legislation to make available to the public the
    names, addresses, and amounts of assistance received by individuals,
    without loss of Federal funds.
    Two States, Ohio and Pennsylvania, passed legislation in fiscal
    year 1954 providing for public access to public assistance disbursement
    information; 20 States had passed such legislation in the previous
    year.
    States that have studied the effect of such legislation found that
    only a very limited number of requests were made to inspect the
    assistance rolls. Also, after the first few months following passage
    of their legislation, public interest appreciably lessened. In general,
    the provision making it possible for the public to inspect the lists of
    those receiving assistance appears to have had little effect on either
    caseloads or expenditures under the public assistance programs.
    Most of the studies made by interested individuals and groups on the
    effect of this legislation have reached similar conclusions.
    Administrative Operations
    Mr. Jay L. Roney assumed the responsibilities of the Bureau Director
    on March 29, 1954, replacing Miss Jane M. Hoey. Mr. Roney
    was formerly Director of Public Welfare in South Dakota, and more
    recently was a member of the field staff of the Children’s Bureau.
    The closing of the Department’s Cleveland regional office resulted
    in replanning of the Bureau’s regional staff and workload in the three
    realined regions. Budget limitations for the ensuing year also resulted
    in additional replanning at the end of fiscal year 1954 of staff
    and workload both in the regional and central office of the Bureau.
    Mr. Roney, Bureau Director, was appointed new Chairman of the
    Interdepartmental Committee on International Social Welfare Policy.
    The committee met several times during the year to consider social
    welfare items on the agenda of the United Nations Economic and
    Social Council, and to prepare for the inter-American conferences.
    The Bureau continued to provide technical services to trainees and
    visitors from other countries, arranging study and observation programs
    for trainees and briefer consultations for short-term visitors.
    The Bureau also recommended experts for overseas missions and
    provided technical information to social welfare consultants serving
    as United States consultants in other countries. In addition, the
    Bureau cooperated in providing data for several international studies
    in social welfare conducted by the United Nations.
    56 Department of Health, Education, and Welfare, 1954
    During the year the Bureau continued its review, analysis, and
    evaluation of many aspects of the State and local public assistance
    programs, as well as its study of characteristics of certain groups of
    recipients. Technical help was also provided to States upon, request
    in many areas of public assistance administration.
    REVIEW OF STATE AND LOCAL OPERATIONS
    During fiscal year 1954, administrative reviews of State and local
    administration of public assistance were conducted in 25 States.
    A total of 10,536 case records was analyzed and administrative processes
    were studied in 29 local agencies in 9 States.
    The nature of the review varied both in scope and method. In 11
    States statistically selected Statewide samples of case records were
    reviewed to determine the eligibility of persons receiving assistance
    and the accuracy of payments made to them. In six jurisdictions the
    case review was supplemented by administrative analyses in selected
    local agencies. Subject areas examined were eligibility and payment,
    application process, various aspects of the aid to the permanently and
    totally disabled program, appeal hearings, State supervision, and local
    administration. To a more limited extent, the operations of special
    investigating units were studied in six States. In addition, test checks
    were made in three States to determine the validity of data procured
    by the States in their own review process.
    STUDIES AND PUBLICATIONS
    Financial support of parents toy' adult children.—In cooperation
    with the States a study was made of the general support laws and
    State old-age assistance plan provisions on responsibility of adult
    children for support of their aged parents. A report summarizing
    the findings of the study was published in two articles in the Social
    Security Bulletin for April and May 1954. These are entitled “Old-
    Age Assistance: Plan Provisions on Children’s Responsibility for
    Parents,” and “Old-Age Assistance: Determining Extent of Children’s
    Ability to Support.” A summary tabulation of pertinent plan provisions
    in each State was also prepared.
    Characteristics of recipients of aid to the permanently and totally
    disabled.—Two articles analyzing selected characteristics of recipients
    of aid to the permanently and totally disabled revealed through the
    nationwide study conducted in 1951, were published in the October and
    November 1953 issues of the Social Security Bulletin. These were
    entitled “Aid to the Permanently and Totally Disabled: The Young
    Recipients” and “Aid to the Permanently and Totally Disabled:
    Characteristics of Men and Women Recipients.”
    Some of the significant findings of this study follow:
    Social Security Administration 57
    Diseases of the heart were found more frequently than any other group of
    diseases or impairments. One-fourth of the recipients of aid to the permanently
    and totally disabled had a disease of the heart as the sole or major impairment
    resulting in permanent and total disability.
    The young disabled persons, those under age 35, were the most seriously handicapped
    of all recipients of aid to the permanently and totally disabled. Many
    suffered from mental deficiency and other disabilities of congenital or birth
    origin. Relatively more of them than of the older recipients were confined to
    their homes and required services from other persons in daily activities, and their
    disabilities were also of longer duration.
    The numbers of men and women receiving aid to the permanently and totally
    disabled were about equal, although the men appear to have been more severely
    disabled than the women.
    Characteristics of recipients of old-age assistance.—Work is nearing
    completion on the study of the requirements, income, resources,
    and social characteristics of recipients of old-age assistance initiated
    in 1953. Preliminary information obtained from this study has already
    been made available for specific uses by public and private
    groups. Release of tabular data and highlights of the findings is
    planned for early 1955.
    Preliminary data include the following findings of interest:
    Four-fifths of all needy aged receiving public assistance are 70 years of age
    or older, a fourth are 80 or older, and more than a thousand are over 100 years
    old. In spite of the extreme age of many of these needy persons, 82 percent are
    physically able to care for themselves and less than 4 percent are bedridden.
    The remainder require considerable care from others. Most (69 percent) are
    widows, widowers, or single persons, and 60 percent are women. Although the
    majority of all aged persons live in large cities, more of the old-age assistance
    recipients live in small communities. Almost 60 percent live away from metropolitan
    centers, chiefly in towns of 2,500 or less, on farms, or other rural places.
    Most of the needy aged men and women live with some relative (59 percent) ;
    over a fourth live alone; and less than 5 percent live in any type of institution
    or nursing home. Others live with friends, or in hotels or boarding homes.
    More than half (54 percent) have been dependent on public assistance for less
    than 5 years, and only 5 percent have received it for 15 or more years.
    Social information for determining permanent and total disability.—
    In October 1953, Social Information Report was issued as Public
    Assistance Report No. 24, for use by State and local agencies in determining
    eligibility with respect to permanent and total disability.
    This report gives a detailed description of the material local workers
    can report that will help the State agency decide whether a person is
    eligible for aid to the disabled and to recommend appropriate services
    to help the person become more self-sufficient and, if possible, selfsupporting.
    A similar guide on what information is needed from
    local doctors was issued about a year ago. States have also found this
    publication useful to local staff in understanding and working with
    incapacitated parents in the aid to dependent children program and
    in other cases where illness is a factor in dependency.
    339010—55------ 5
    58 Department of Health, Education, and Welfare, 1954
    Public assistance charts.—In collaboration with, staff of the Departmental
    Council, work was also done in planning and providing basic
    data for a series of wall charts on public assistance, prepared as part
    of a Department-wide chart project for presenting information on
    the programs. The charts with accompanying text were reproduced
    in a booklet, Public Assistance, Graphic Presentation of Selected Data,
    for administrative use and distribution to State public assistance
    agencies.
    TECHNICAL ASSISTANCE TO STATES
    State agencies have been generally interested in improving their
    administration to operate at a maximum of efficiency, and in providing
    services that will help dependent persons achieve self-maintenance
    wherever possible as well as strengthen family relationships. To this
    end, technical assistance has been provided by the Bureau to State
    agencies upon request in the development of specific program areas,
    in management improvement, and in staff development.
    Development of specific program areas.—Consultation services have
    been made available on various aspects of program development.
    State agencies have requested technical assistance especially in the
    development of welfare services, and in the improvement of the medical
    aspects of their programs, including the determination of permanent
    and total disability in the aid to the permanently and totally
    disabled program, and the incapacity factor in the aid to dependent
    children program. States have also requested consultation on other
    aspects of the eligibility process, including clarification and improvement
    in their standards and policies governing the determination of
    need and the determination of blindness and in development of appropriate
    services in the aid to the blind program.
    Management improvement.—Technical assistance and consultation
    have also been provided in many areas to insure proper and efficient
    administration of public assistance programs. Several States have
    been helped in the review of their administrative and fiscal procedures
    and controls. Technical assistance on State and local organization has
    been given States resulting in a realinement of functions in many
    instances. Consultation was given on workload management; size of
    visitor caseload; program financing and administrative budgeting;
    use of machine equipment; and requisitioning, payment, inventory,
    and accounting procedures. Administrative and fiscal principles and
    techniques also have been developed for the use of State agencies.
    These have included principles governing Federal financial participation
    in costs of assistance and administration; and recommended
    standards on the simplification of agency manuals of instructions,
    development of State policies and procedures relating to improper
    payments, and local agency management.
    Social Security Administration 59
    As part of tlieir management improvement efforts, States are increasingly
    interested in using various devices for measuring and
    evaluating the job they are now doing. As a basis for advising State
    agencies with respect to a systematic approach to this problem, the
    Bureau is working on a methodology for testing and controlling the
    quantity and quality of that part of public assistance administration
    included in the visitor’s job. One State is now testing this overall
    methodology and is working specifically on defining the duties and
    scope of work of the public assistance visitor, the quality of performance
    expected, and tests that can be used in evaluating performance
    relating to determination of initial eligibility.
    RECRUITMENT, SELECTION, AND TRAINING OF PUBLIC ASSISTANCE
    PERSONNEL
    Since the maintenance of efficient administration and a high quality
    of welfare services is dependent largely upon the skill of agency staff,
    Federal and State agency efforts have been directed increasingly toward
    meeting the problems facing State agencies in adequately staffing
    their programs. Emphasis has been placed on improvement of the
    recruitment process, selection methods, and staff training programs.
    The shortage of professionally qualified staff continues to be a problem
    for all public assistance agencies. Less than 5 percent of the
    public assistance workers have professional social work training,
    although about 20 percent have had some work in a graduate school
    of social work. Although 75 percent of the workers have not had
    any professional social work training, two-thirds of them are college
    graduates and thus potentially eligible for professional training. In
    an effort to improve the qualifications of public assistance workers,
    52 State public assistance agencies have established plans for educational
    leave within present provisions for Federal matching of State
    administrative costs. However, because of limitations on amount
    and/or use of funds in some States, more than half the State agencies
    with educational leave plans provide no financial help to workers in
    obtaining graduate education. The advisory committee to the Children’s
    Bureau and the Bureau of Public Assistance, meeting in its
    19th year, recommended that the Bureau give further attention to
    financing professional educational programs and seek legislative authority
    to provide Federal grants for graduate social work training.
    The high rate of staff turnover continues to be of concern to many
    State agencies. Although in the Nation as a whole the turnover rate
    has lessened, about one-fifth of the public assistance executive and
    social work staff left public assistance agencies during this year.
    A slightly higher proportion was hired during the year. Staff turnover
    was more concentrated in some areas; for instance in two large
    60 Department of Health, Education, and Welfare, 1954
    States the number of personnel leaving the agency was as high as a
    fourth of the total positions.
    In attempting to meet the problems of shortage of qualified staff
    and the high rate of staff turnover in the State public assistance programs,
    State agencies have directed their attention to improvement
    of recruitment programs. The Bureau has also cooperated with the
    Council on Social Work Education which has given nationwide leadership
    to the development of an intensive recruitment campaign to
    attract young men and women to social work as a career. In addition,
    the Council on Social Work Education, with a grant from the
    Field Foundation, collaborated with the Children’s Bureau and the
    Bureau of Public Assistance in sponsoring a workshop for Federal
    and State public welfare staff members who carry some responsibility
    for selection of staff for social work positions and for educational
    leave. The facilities of the New York School of Social Work were
    used in the workshop held in August 1954.
    The need for orientation and continued training for staff who are
    coming into the agencies or changing positions in the agencies is highlighted
    by the fact that more than 8,000 persons (23 percent of the
    total social work staff) were new to their agencies within the year.
    In addition, an undetermined number were new to their jobs because
    of transfers or promotions.
    The Bureau has continued work in the development of appropriate
    content, methods, and techniques as a means of being of assistance to
    State agencies in the improvement of their staff training programs.
    Help has been given to State agencies through consultative services on
    the development of comprehensive staff development programs, improvement
    of orientation programs, including the establishment of
    training centers for beginning workers; improvement of supervisortrainee
    programs; and the development of handbooks or manuals
    for supervision and other aspects of staff development.
    The large number of new staff coming into the agencies places
    heavy responsibility on supervisory positions for helping this staff
    learn their jobs and develop skills in carrying out the agency program.
    Several State agencies are doing special work in strengthening supervision.
    One agency has, over a period of several years, worked intensively
    on the improvement of the supervisee-trainee programs.
    Plans are underway for cooperative work with this State agency in
    the development of a training document to be issued by the Bureau
    for the use of all State agencies in strengthening the supervisory aspect
    of their training programs. Several States have held a series of
    special institutes on improving methods and skills of the supervisory
    group. Others have placed special emphasis on strengthening the
    teaching skills of the State agencies’ field representatives.
    Social Security Administration 61
    In order to coordinate the efforts of the Bureau with that of other
    national agencies and organizations in this area, there has been active
    participation with committees of the American Public Welfare Association
    concerned with personnel and training, and with the national
    committee of the Council on Social Work Education on the development
    of teaching materials for schools of social work and for welfare
    agencies.
    Children’s Bureau
    During the year 1954 many individuals and State and local agencies
    have focused attention on the need to take stock and evaluate their
    health and welfare programs for children—what others know, how
    far knowledge is being applied—what are the next steps. Such stocktaking
    becomes imperative because of the overwhelming increase in
    the number of children and the predictions about future increases.
    The new knowledge of child development which was crystallized
    in the Midcentury White House Conference on Children and Youth
    is being put to work in an increasing number of towns and cities.
    This knowledge is being tested in the laboratory of the community.
    1940 1950 1954 1960 1965
    62 Department of Health, Education, and Welfare, 1954
    The desire to apply new knowledge and skills still far exceeds the
    actual application. Present programs are being critically examined
    for their adequacy and in some places plans are being made to expand
    existing services to make a start toward absorbing the several million
    additional children who represent the increasing wealth of our human
    resources.
    The costs and methods of providing services are being reviewed to
    see if there are ways of providing higher quality with greater efficiency.
    The Children’s Bureau is participating actively in these program
    reviews. The interdependence of the child health and child
    welfare programs becomes increasingly more evident in the light of
    these evaluations.
    Programs of the Bureau
    The Children’s Bureau was created in 1912 by an Act of Congress
    to investigate and report upon all matters pertaining to the welfare of
    children and child life among all classes of our people. In 1935, the
    Bureau was given the additional responsibility of administering the
    grants to the States provided under the Social Security Act, Title V,
    to enable them to extend and improve the services for promoting the
    health and welfare of children, especially in rural areas and in areas
    of special need.
    THE RESEARCH PROGRAM
    The legislative charge on the Children’s Bureau, “to investigate and
    report upon all matters pertaining to the welfare of children” is
    almost as broad as the complex of factors which shape our society.
    A carefully developed research plan has guided the Bureau’s small
    research staff in helping to carry out this legislative mandate. The
    Bureau’s research activities include (1) technical studies on problems
    affecting child health and welfare, conducted by the Bureau directly
    or jointly with other agencies, or by other agencies with the Bureau
    providing technical assistance and consultation; (2) statistical reporting
    in the fields of child health and welfare, with particular
    attention to the State grant-in-aid programs administered by the
    Bureau; and (3) research interpretation to provide public information
    on the findings and conclusions of studies and investigations of
    child life and development.
    In its technical research, questions as to the effectiveness of various
    specific programs and practices in child health and welfare have
    received major emphasis. The following are some examples briefly
    described. A pilot study to develop methodology for determining
    whether there is a most favorable age for placing children for adoption
    was completed during the fiscal year. The Bureau is assisting
    Social Security Administration 63
    the social agencies which participated in this study to continue the
    project with private foundation support. The ineffectiveness and
    limited effectiveness of some delinquency-prevention programs, the
    lack of any panacea for preventing or reducing juvenile delinquency,
    the need to experiment with different methods of mobilizing parents’
    interests in preventing and reducing delinquency—these were among
    the conclusions of technical research explorations by the Bureau’s
    staff. The values and limitations of several survey methods of ascertaining
    a community’s need for day care were determined in a pilot
    study conducted by the Planning Council of a midwestern city with
    Bureau co-sponsorship. A joint study by the Children’s Bureau and
    the Child Welfare League of America, initiated in 1954 and financed
    by private foundation funds with technical direction provided by the
    Bureau, is designed to develop a method for determining unit costs
    of institutional care of children.
    Research consultation by the Bureau included the following: with
    the Governor Bacon Health Center, Delaware, on a followup study
    of children discharged from this residential treatment institution;
    with the Department of Health, District of Columbia, on a study of
    births, infant deaths, and fetal deaths, which demonstrated that the
    incidence of prematurity is considerably lower where there is early
    prenatal care than where prenatal care is received late in pregnancy
    or is not received at all, and which revealed a close association between
    (a) pregnancies terminating in unfavorable outcomes and (b) low
    birth weight or complications of parturition; with the Department of
    Public Welfare, Florida, on planning and securing private foundation
    support for a followup study of independent adoptions, which
    would throw new light on the success or failure of independent adoptions
    and the relative validity of criteria ordinarily used in judging
    adoptive homes; and with an official of the Hospital and Convalescent
    Home for Crippled Children, Tokyo, Japan, on establishment of a
    statistical reporting system for crippled children.
    Among other Children’s Bureau activities during the fiscal year in
    cooperating with public and private agencies on studies directly involving
    child health and welfare were the following: assisting the
    Office of Education in planning a followup study to determine whether
    children who live for several months in “home-management houses”
    maintained by some university home economics departments are adversely
    affected by this experience; advising the Public Health Service
    on evaluation of live-born infants in a study to determine the effects
    of insulin treatment during pregnancy on women with abnormal
    glucose tolerance; and consulting with a joint committee of the Community
    Chests and Councils of America and the National League for
    Nursing on evaluation and revision of their social statistics reporting
    system on health services.
    64 Department of Health, Education, and Welfare, 1954
    In statistical reporting and analysis, a major development during
    the year was the revision of the annual report of State maternal and
    child health services, first adopted in 1936. The new report, providing
    a better and more current picture of significant State developments
    and activities in these areas, will become effective with reporting for
    1955. A juvenile court reporting system, based on scientific sampling
    procedures, was developed for the purpose of securing more representative
    data on the number of juvenile delinquency court cases
    throughout the Nation. Among the program analyses completed
    during the fiscal year were statistical studies of adoptions of children
    reported by State agencies, expenditures by States for child welfare
    services, and of the nature and extent of educational leave in public
    child welfare programs.
    Research interpretation activities assist the Bureau in carrying
    out the legislative mandate to “report upon all matters pertaining
    to the welfare of children.” During this fiscal year, the Bureau
    prepared for publication a pamphlet entitled The Adolescent in
    Your Family, and continued revision of Your Child From One to Six,
    to present for general public information the most current and expert
    thought and findings on these two vital periods of child care. Bureau
    staff completed studies on estimated prevalence of handicapping conditions
    in childhood and on eruption and attack patterns of children’s
    teeth, both of which were published in professional journals. The
    Bureau’s Clearinghouse published bulletins on current research to
    enable investigators in the field of child life to keep in touch with
    studies being conducted in their areas of special interest.
    Of more than 100,000 letters received in the Children’s Bureau
    during the fiscal year, over 1,200 required individual replies by research
    staff personnel—to parents, members of citizen groups, students,
    professional persons, commercial organizations, and others
    concerned with specific problems about children and child life. These
    individual letters interpreting research findings of the Children’s
    Bureau provided information and advice for anxious parents, helped
    them to understand unfamiliar medical diagnoses and treatment plans
    for children with specific handicaps and problems, and explained
    statistical data on child health and welfare to professional workers
    and citizen groups. The individual letters of advice, information,
    and guidance on child life and development represent the most direct
    contact between the Children’s Bureau and the public it serves.
    GRANTS TO THE STATES
    Federal funds through the Children’s Bureau continue to provide
    supplementation to State and local resources for child health and
    welfare programs.
    Social Security Administration. 65
    During the fiscal year 1954, the appropriation for grants to the
    States totalled $30,000,000. This was divided as follows: $11,927,700
    for maternal and child health services; $10,843,400 for crippled children’s
    services, and $7,228,900 for child welfare services.
    The contribution of Federal funds to States has brought not only
    additional services to the children of each State, but a stronger program
    than would have been possible without them. In the words of
    one State agency, they have furnished the “lifeblood of progress” in
    the programs.
    Maternal and Child Health Services
    The program of maternal and child health services, for which
    Federal funds are available, is in operation in all the States, the
    District of Columbia, Alaska, Hawaii, Puerto Rico, and the Virgin
    Islands.
    For the 1953 calendar year, 178,000 expectant mothers were admitted
    to prenatal medical clinics under the maternal and child health
    program and 49,000 mothers received medical care after delivery.
    Well-child clinic service was provided for 412,000 infants and for
    592,000 preschool children.
    While the maternal and child health program is primarily one of
    preventive health services, medical care is also a feature of the program
    in some of the States. Thus, 16 States are purchasing medical
    and hospital care for premature infants, usually on a demonstration
    basis; some of the States provide medical and hospital care for mothers
    with complications of pregnancy; others provide dental treatment
    in addition to prophylaxis.
    The principal developments have been in the increase in demonstration
    programs and other activities in behalf of prematurely born
    infants, the increase in programs for the postgraduate training of
    personnel, and much emphasis on the emotional growth of infants
    and children and the parent-child relationship.
    The value that State health agencies put on their nutrition services
    has been put to the test as it has been necessary to reduce expenditures.
    In only one State has there been a reduction in staff through
    an administrative decision of the health agency. In another State
    in which the legislature eliminated the nutrition position from a lineitem
    appropriation budget so many protests have been received from
    professional and citizens’ organizations and from local units that were
    the recipients of consultation that vigorous efforts are being made to
    find funds to carry on the work.
    Maternal mortality studies are continuing to pay dividends in the
    States where they have been sponsored jointly by the Divisions of
    Maternal and Child Hygiene and the Maternal and Child Welfare
    66 Department of Health, Education, and Welfare, 1954
    Committees of the State Medical Association. Request for earlier
    consultation by physicians and improved hospital reports have been
    noted. The most encouraging trend is a sustained interest physicians
    are taking in their responsibilities to improve some of the conditions
    brought to light by the studies. Evidence of this was shown in the
    publication of reports on maternal mortality by Minnesota and Iowa
    this year and in the search for the establishment of some acceptable
    standards of obstetrical care for practitioners and hospitals. Missouri,
    Kansas, and Nebraska showed renewed and active interest in
    maternal mortality studies during the year.
    Iowa has published reports on maternal mortality studies and
    neonatal studies which represent the work of the maternal and child
    health division of the State Health Department and the Iowa State
    Medical Association. It was a joint project in which obstetricians,
    recommended by the Maternal and Child Welfare Committee and
    paid for by the maternal and child health division, have investigated
    the maternal deaths and have discussed the management of the case
    with the physicians involved. Having found that hemorrhage was
    the major problem in Iowa, they presented their findings and suggestions
    at the annual meeting of the State Medical Association. The
    neonatal mortality studies were used in interesting hospitals and physicians
    in improved care for infants. Numerous institutes on care of
    the newborn were held in centers throughout the State with increased
    attendance and demand for more such help as the services became
    known.
    Major attention has been paid also to developing standards for
    hospitals. State legislation which has recently been passed, relative
    to standards established under the Hospital Survey and Construction
    Act, will prove of benefit to women and children receiving care
    in either hospitals or convalescent homes. The States are in the
    process of amending or developing new standards and regulations
    for hospitals, and the State maternal and child health and crippled
    children’s directors are trying to see that standards for newborn
    infants recommended by the American Academy of Pediatrics and
    modern and adequate standards for maternity care are incorporated
    in the hospital standards.
    Crippled Children’s Services
    The crippled children’s program is administered by the State health
    department in 32 States and Territories, by the State welfare department
    in 8 States, by a combined State health and welfare department
    in 1 State, by a crippled children’s commission in 4 States, by the
    State department of education in 3 States, and by the State medical
    school in 4 States.
    Social Security Administration 67
    Implicit in the Federal legislation for crippled children’s services
    is a broad concept of medical care which starts with locating children
    in need of care and then through diagnostic and medical care provides
    all possible physical restoration. It does not stop, however, with
    medical or surgical treatment, but combines treatment of both the
    physical handicap and unfavorable social and psychological influences
    which together determine the degree and duration of disability. It
    utilizes services provided through the companion programs of maternal
    and child health and child welfare services.
    All of the 53 States and Territories, with the exception of Arizona,
    are participating in this program of crippled children’s services. In
    providing these services the State agencies hold crippled children’s
    clinics at varying intervals in different parts of the State. The
    physicians are specialists, usually in private practice, who give clinical
    care in these clinics, in hospitals, and convalescent homes and are paid
    by the State agency on a part-time salary or fee basis. Hospital care
    is purchased on the basis of average daily cost per patient. In many
    programs a pediatrician participates with the orthopedist or other
    specialist conducting the clinic. Other personnel include the public
    health nurse, the medical social worker, physical therapist, nutritionist
    and speech therapist as needed, and various consultants.
    A record total of 251,000 children received physicians’ services during
    1953 under the crippled children’s program. About 100,000 of
    these children had not previously been served under the program.
    The conditions for which these children receive service or care are
    grouped diagnostically as follows: congenital malformations, conditions
    of bones and organs of movement, poliomyelitis, cerebral palsy,
    ear conditions, burns and accidents, rheumatic fever, eye conditions,
    and epilepsy and other diseases of the nervous system. The remainder
    include tuberculosis of bones and joints, birth injuries, and miscellaneous
    conditions.
    The great research findings of recent years are beginning to be
    applied in the crippled children’s programs and made available to
    children in rural areas through the development of preventive and
    treatment services for children with hearing impairment including
    the fitting of hearing aids, special programs for children with epilepsy,
    and regional centers for the surgical treatment of children with congenital
    heart disease and for postgraduate training in these specialties.
    The research developments in audiology during and after the war
    have been brought to children in rural areas in seven States through
    special projects for children with hearing impairment. Medical and
    surgical diagnostic and treatment services, audiometer testing, fitting
    of hearing aids, speech training, and auditory training are beginning
    to make it possible for some school-age children and some preschool
    68 Department of Health, Education, and Welfare, 1954
    children to have effective speech and hearing. With such help they
    are going to regular schools and living at home, rather than in segregated
    residential schools.
    Other special projects are demonstrating how community programs
    can be developed for children with epilepsy and children who have
    cerebral palsy. Training programs in these specialized fields are
    making it possible for the several types of personnel of State crippled
    children’s agencies to improve their contributions to the health
    and welfare of crippled children. Project grants are under consideration
    to make it possible for children to have artificial hands similar
    to those available to veterans which are as yet not available to children.
    Much progress has been made by surgeons, pediatricians, psychiatrists,
    social workers, and nurses in helping children and their families
    adjust to long-term illness and permanent handicaps. The adequacy
    of parents as individuals, the parent-child relationships and the insight
    of the program personnel in the emotional problems of crippling
    have direct bearing on how the child will react to his handicap and
    grow up with it. It is through the extension and continued improvement
    of the maternal and child health, the crippled children’s, and
    the child welfare programs that the objective of a healthy personality
    for the crippled child can be achieved. Each of these programs when
    active in a locality contributes to the effectiveness of the others.
    Child Welfare Services
    The grant-in-aid programs for child welfare services help the
    States carry out their objectives for children and the day-to-day programs
    for their care. They provide States with an opportunity to
    extend and strengthen their child welfare services. The $8,783,900
    which was available through grants for child welfare services during
    1954 was used by the States primarily for placing child welfare workers
    in rural counties where these services had not been previously
    available.
    The services which such child welfare workers offer include helping
    parents and children to live happily and responsibly together and with
    other people in the community, protecting children who are neglected
    or abused, assisting in constructive planning for the potential delinquent,
    and providing information and consultation to parents of
    emotionally disturbed and mentally or physically handicapped children.
    Day-care facilities for children of employed mothers, foster
    homes for children who must be away from their own family, homemaker
    service to care for the children when the mother cannot carry
    her usual role, social casework help for unmarried mothers, and the
    careful placement of children in adoptive homes are but a few of the
    important functions through which the local child welfare worker
    helps the community provide for its children.
    Social Security Administration 69
    Chart 9.—CHILDREN IN FOSTER FAMILY HOMES INCREASE AS CHILDREN IN INSTITUTIONS
    DECREASE
    At the present time 74 percent of the Nation’s children, 43 million,
    live in counties which have the services of full-time child welfare
    workers paid from public funds. Federal child welfare funds for
    workers’ salaries have made such services possible in some of these
    counties.
    On December 31, 1953, nearly 266,000 children were reported as
    receiving child welfare services from State and local public welfare
    agencies. In the 50 States and Territories from which the Children’s
    Bureau got complete reports, 42 percent of the children receiving services
    were in foster family homes, 41 percent were living with parents
    or relatives, and 17 percent were living in children’s institutions or
    elsewhere out of a family home.
    Improving conditions in the family so that a child can remain there
    rather than be removed and placed in foster care is being strongly
    recommended by psychiatrists and other social scientists because of the
    social values for the child. Several States, especially in the South, are
    stressing services for children in their own homes instead of removal
    to foster care.
    An interesting and important demonstration project is being carried
    out in New York City where a special program has been established
    to offer social case work directly to children and families in their
    own homes to prevent family breakdown.
    Family breakdown and other causes not entirely identified are contributing
    to the increase in juvenile delinquency. According to
    estimates based on data received from juvenile courts which report to
    70 Department of Health, Education, and Welfare, 1954
    the Bureau, there were 13 percent more juvenile delinquency court
    cases in 1953 than in 1952. This means an increase for the fifth consecutive
    year, or 45 percent in the period 1948-53. Many groups are
    at work to provide services which can help stem this rising tide of
    delinquency.
    THE PROGRAM OF INTERNATIONAL COOPERATION
    This year saw a major change, in the administration of the international
    program. In the past, the Children’s Bureau has recruited and
    sent professional personnel abroad as its employees, receiving funds
    for this program from the Foreign Operations Administration and its
    predecessor agencies. As of April 26, 1954, all members of the staff
    of the Children’s Bureau who were working abroad were transferred
    to the staff of the Foreign Operations Administration in accordance
    with a new policy of the latter agency.
    The Children’s Bureau, in cooperation with other units of the Social
    Security Administration and with the Public Health Service, has
    responsibility for recruiting personnel and providing program consultation
    for child welfare, maternal and child health, and crippled
    children’s programs abroad under FOA auspices. Such programs
    are being carried on in Iraq, India, Mexico, El Salvador, Panama,
    Egypt, Brazil, and Bolivia.
    Sixty-six long-term trainees and observers from 35 countries who
    came to this country with interests in child health and welfare were
    assigned to the Training Branch of the Bureau for program planning
    and consultation. The majority were on fellowships or scholarships
    of the United Nations, the World Health Organization, and FOA.
    Their time here ranged from a few months to 2 years.
    During the past year, there has been an increase in the number
    of foreign visitors attending schools of public health and schools
    of social work on a full-time basis for an academic year. Also,
    there has been more and more direct relation of the training to the
    work to be done in the home country.
    Correspondence with other countries continues to flourish. A source
    file by country is being built up of correspondence and printed and
    mimeographed materials. This file has already been useful in providing
    background material when new information or requests come in.
    Because of the reduction in the amount of free Children’s Bureau
    publications available, the amount of material sent in reply to foreign
    requests must be limited.
    For the first time, the Children’s Bureau was asked to contribute to
    the report of public health conditions and progress that is requested
    every 4 years by the Pan American Sanitary Bureau from each of
    its member countries. Material was prepared on four items in the
    Social Security Administration 71
    report outline: Maternal and Child Hygiene, School Health, Nutrition,
    and Medical Care (Crippled Children’s Program). These reports
    from the various countries were to serve as a basis for the
    technical discussions that were scheduled to take place during the XIV
    Pan American Conference at Santiago, Chile, in the autumn of 1954.
    The Chief of the Bureau serves under a Presidential appointment as
    Representative of the United States on the Executive Board of the
    United Nations Children’s Fund (UNICEF).
    PUBLICATIONS
    Children.—With its December 1953 issue, The Child yielded
    to its successor, Children, which is now the official periodical of the
    Children’s Bureau.
    Children is designed to be “a professional journal on services for
    children and on child life.” It includes data, discussion, and debate
    on the physical, social, emotional, and cultural aspects of child growth
    and development; on standards of child care and professional training
    ; and on developments in professional techniques, personnel, and in
    programs serving children and their parents. It is written by and for
    doctors, nurses, nutritionists, social workers, occupational and physical
    therapists, juvenile court judges, researchers, teachers, health educators,
    and others working with children, most of whom are from outside
    the Bureau. In addition to publishing substantial articles of professional
    significance, Children includes items of news, and notices of
    books, pamphlets, films, and other materials useful to professional
    workers.
    Three issues of Children appeared in the last half of the fiscal year
    1954. From January to July, paid subscriptions increased from 2,947
    to 5,526.
    Bulletins for parents.—Since its earliest days, the Bureau has been
    attempting to help parents by means of a series of bulletins based on
    sound research in child development. This series currently includes:
    Prenatal Care, Infant Care, Your Child From One to Six, Your Child
    From Six to Twelve, and The Adolescent in Your Family (released
    October 1954). Infant Care continues to be the Government’s longtime
    best seller. The Superintendent of Documents sold 588,704
    copies of Infant Care during 1954.
    Other publication activities.—During the year 18 publications were
    issued; 10 others were in press or ready to go to press on June 30,1954.
    Eight more were in some phase of preparation at the close of the fiscal
    year.
    Major attention was given to publications in the field of juvenile
    delinquency. This resulted in the release of Some Facts About Juvenile
    Delinquency; Police Services for Juveniles; Standards for Spe72
    Department of Health, Education, and Welfare, 1954
    cialized Courts Dealing With Children; and Juvenile Court Statistics
    (Statistical Series No. 18). At the close of the year, work was
    well underway on Training Personnel for Work With Juvenile Delinquents;
    Tentative Standards for State Institutions Serving Delinquent
    Children; and Parents and Delinquency.
    Other publications issued during the year included Medical Social
    Services for Children; Your Child's Feet and Footwear; Allies for
    Children (Child Welfare Report No. 5) ; Selected References on Adoption;
    Selected References on Day Care; Main Causes of Infant, Childhood,
    and Maternal Mortality 1939-191$ (Statistical Series No. 15) ;
    Personnel in Public Child Welfare Programs, 1952 (Statistical Series
    No. 16) ; Research Relating to Children (Bulletin No. 2), and Medical
    Social Services for Hospitalized Children.
    Trends Affecting Child Life
    Parents’ Groups
    Parents of children with special problems are organizing into groups
    for study, mutual help, and social action toward improved specialized
    services in many parts of the country. Often these groups of parents
    are forming associations and in a growing number of cases national
    organizations are being formed. Such groups are being formed by
    parents of children who have such conditions as epilepsy, blindness,
    mental retardation, cerebral palsy, deafness, or multiple sclerosis.
    Many of them as groups are carrying out fund-raising drives and are
    seeking legislative action and financial appropriations. The Bureau
    has many contacts with these groups and gives such help as is possible.
    The Child Study Association of America in cooperation with the
    New York State Department of Health and the Children’s Bureau
    began an experimental program for the training of public health
    nurses as group leaders in March 1954. The project was initiated
    because nurses are being called upon more and more to conduct parent
    discussion groups and their original training has not equipped them
    with the specific skills required for this type of leadership. As a result
    many nurses are using traditional concepts of the teaching role which
    offers very little opportunity for discussion of problems by group
    members. Fifteen nurses were recruited for the experimental program
    who are currently employed in Westchester, Nassau, and Suffolk
    Counties, with two participants from the New York City Health
    Department.
    The Whole Child
    There has been a growing and insistent demand to bring into focus
    one of the primary objectives of medical education, a consideration
    Social Security Administration 73
    of the whole patient, his environment, and his reaction to it. Public
    health education has also stressed the social and emotional aspects of
    child growth and development. At the same time social work education
    has recognized the importance of incorporating the newer knowledge
    concerning growth and development of children into the curriculum,
    and of exploring the role of the medical social worker in
    preventive services. These trends in education have led to an awareness
    that the maternity clinic and the child health conference afford
    an invaluable opportunity for students to participate with the health
    team in the promotion and maintenance of positive health and the
    prevention of disease. This increased use of maternal and child health
    services for teaching purposes for a variety of professional disciplines
    places added responsibility on State and local health agencies to see
    that these programs are adequately staffed with qualified personnel.
    Only then can the student appreciate the roles medicine, nursing, nutrition,
    medical social work, and related fields can play in achieving
    good health.
    Social Services to Children in Their Own Homes
    Social services that help parents and children improve their relationships
    to each other, and that help parents in understanding and
    providing the care and protection their children need contribute to
    the preservation of home life for children. There is growing recognition
    that such services can be a strong preventive measure in relation
    to delinquency. Coupled with this is an increased awareness of the
    community’s responsibility through its social agencies to strengthen
    and maintain family life for the children. The possibilities of such
    social services for children living in their own homes have caught the
    imagination of child welfare workers during the past year.
    Instead of waiting for a juvenile court referral or for a family to
    come to the agency asking for help with their child, social workers in
    some communities are taking the initiative by offering their services
    where there are evidences that a child may be in some kind of trouble.
    Obviously, finding children when early signs of difficulty appear prevents
    more serious problems from developing. By reaching out to
    such children and their families with the offer of practical help
    through existing community services, time, effort, money, and, most
    important, human resources are being saved.
    Homemaker service is one specific means of service to children when
    a crisis arises in a family because of the illness, hospitalization, or
    death of the mother. A woman chosen and trained by the social agency
    is placed in the home to help keep the family together until the emergency
    is past. Many requests for consultation on homemaker service
    are being received by the Children’s Bureau which indicate widespread
    339010—55------ 6
    74 Department of Health, Education, and Welfare, 1954
    interest. Actually, some communities which are just beginning this
    service are hesitant about publicizing it for fear the demand will be
    too great.
    Adoption
    Adoption is recognized as the most desirable substitute for a child’s
    own home when permanent placement is necessary. Estimates based
    on reports from 37 States indicate that there were approximately
    90,000 adoption petitions filed in the country in 1953. There continues
    to be evidence that many of these children are being placed without
    the benefit of a social agency’s services. It would seem that many
    adoptive applicants who are unable to secure children from social
    agencies do secure them through the so-called “black market.” Since
    social agencies believe the help they give insures greater protection
    for the baby, the adoptive parents, and the natural parents, they are
    attempting to increase their efforts and stretch their imagination so
    that more adoptions will have this protection and the waiting time
    can be shortened for the prospective adoptive parents.
    Group Care for Children
    The number of children in institutions because of economic dependency
    is decreasing. This reflects the effectiveness of programs
    such as old-age and survivors insurance and aid to dependent children
    which provide the financial means to meet need resulting from the
    absence, incapacity, or death of the breadwinner. In contrast, the
    number of children needing group care because of other causes is
    increasing. At least a dozen metropolitan and county areas report a
    vexing anomaly between unused institutional beds for dependent
    children and unavailable beds for physically, mentally, emotionally
    handicapped children, delinquents, dependent adolescents, children
    needing short-term care, and some children in minority groups. This
    discrepancy between the types of need for institutional care and
    resources available is of grave concern to planning bodies and to
    groups of parents who are seeking care for their children. It is part
    of the reason why the Children’s Bureau is receiving an increased
    number of inquiries regarding residential treatment centers for emotionally
    disturbed children, resources for mentally retarded children,
    resident facilities and programs for adolescents, and group shelter
    care of a more temporary nature.
    Interest in group care for the emotionally disturbed and the mentally
    retarded child continues to be expressed in various ways. Three
    State legislatures have passed bills for establishment of State treatment
    centers for disturbed children. At least a dozen metropolitan
    communities are studying the need for such centers. There is conSocial
    Security Administration 75
    siderable demand for guidance in planning and organizing such facilities.
    Community planning groups need much help in recognizing
    the limited role that residential treatment plays in a total community
    program, and in identifying more specifically the different kinds of
    emotionally disturbed children who will need different kinds of
    resources.
    Children With Special Needs
    The Bureau is placing emphasis at the present time on the problems
    of five groups of children. The following brief information concerning
    these groups of children and the Bureau’s activities are given to
    illustrate how the purposes, philosophy, and multiprofessional staff
    of the different organizational units within the Bureau are interrelated
    and intermeshed with a view to stimulating and creating the
    most effective service to children.
    JUVENILE DELINQUENCY
    The upward trend in juvenile delinquency continues. For more
    than two and a half years the Children’s Bureau has been giving
    increased attention to the problems of delinquent children. Several
    voluntary organizations and foundations have cooperated in supporting
    an independent, privately financed, special juvenile delinquency
    project. Cooperatively with this project, the Bureau has been conducting
    a program aimed at the stimulation of State and local action
    Chart 10.—JUVENILE COURT DELINQUENCY CASES ARE RISING
    1940 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
    76 Department of Health, Education, and Welfare, 1954
    for the improvement of services for the juvenile delinquent. This
    program has involved work with about 100 national voluntary organizations,
    and with citizen groups in many communities.
    The Bureau has continued its work with State and local public
    agencies and planning groups by providing consultation on programs
    of the courts, training schools, police, probation, and other services
    for the treatment and prevention of delinquency. One outstanding
    accomplishment during the year was the publication of the booklet,
    Standards for Specialized Courts Dealing kVith Children. This was
    prepared by the Children’s Bureau in cooperation with the National
    Probation and Parole Association and the National Council of Juvenile
    Court Judges. Judges, probation officers, child welfare officials
    and others representing the fields of law and social work reviewed the
    principles in this publication for the adaptation of current knowledge
    to the day-by-day practices in the care of children coming before
    the courts.
    A number of other publications have been issued relating to juvenile
    delinquency. Some have been technical publications for people who
    are providing services for delinquent youth. Others have been designed
    to tell citizens at large about the nature of the problems of
    juvenile delinquency and to aid them in their civic action programs.
    Statistical and research studies have also been made to provide some
    of the information needed as a basis for improving services for delinquent
    youth.
    All this activity on the part of the Children’s Bureau and the Special
    Project culminated in the National Conference on Juvenile Delinquency,
    which met in Washington, D. C., on June 28-30, 1954, at
    the invitation of Oveta Culp Hobby, Secretary of Health, Education,
    and Welfare.
    Approximately 475 persons, from 43 States, the District of Columbia,
    Hawaii, the Virgin Islands, Puerto Rico, and Guam, attended the
    meeting. They included police officers, judges, probation officers,
    welfare and health workers, educators, churchmen, and others who
    are professionally engaged in programs having to do with youth, as
    well as representatives of a wide variety of civic, labor, fraternal, and
    religious organizations interested in citizen action in behalf of youth.
    The invitation to the conference listed three principal purposes:
    (1) to review accomplishments to date; (2) to discuss and define the
    most urgent needs at the present time; and (3) to formulate the next
    steps to be taken to meet these needs.
    MENTALLY RETARDED CHILDREN
    The Children’s Bureau has long been concerned about children who
    are seriously handicapped in mental capacity. There are many such
    children in our country. The exact number is not known but it is
    Social Security Administration 77
    estimated that about 1 person per 100 is mentally defective and that
    about 750,000 children of school age are of low intelligence. As the
    number of children increases, so does the number of such children.
    At the same time, the growing complexity of our society makes their
    social and vocational adjustment ever more difficult.
    In view of this situation, the Children’s Bureau is hearing more and
    more about the problems that these children present—to parents,
    doctors, nurses, teachers, and social workers—to all who are concerned
    about their health, education, and welfare. The number of parent
    groups at the grass roots level concerned about this special group of
    children is growing rapidly. Educators have given much attention
    to these children’s needs, but the problem is not only one of schooling.
    The extension and improvement of services is needed to provide more
    effectively for these children, starting when they are very young, even
    in infancy in many cases, through community planning and the development
    of health and welfare activities that will help parents to
    understand these children and care for them at home whenever this
    is desirable and possible. Research and reporting upon the nature
    of the problems and the methods which parents and others have successfully
    used in helping these children to be as self-sufficient and
    happy as possible are urgent needs. Equally urgent is putting into
    wider action the knowledge and experience we now have.
    CHILDREN OF MIGRATORY AGRICULTURAL WORKERS
    There are in this country hundreds of thousands of children of
    migrant agricultural workers. These workers follow the crops and
    pass into and through one State after another. No one State feels
    that it can take responsibility for the health, welfare, and education
    of the children of these families. Because these children are not
    residents of any State, they do not receive the services that are available
    to other children in the communities through which they travel.
    The Children’s Bureau, working with the Office of Education, the
    Public Health Service, and the Bureau of Public Assistance, is undertaking
    a special project along the East Coast. The East Coast migratory
    stream involves about 35,000 fruit and vegetable harvesters.
    The project’s purpose is to help the 10 States in the East Coast migratory
    stream get together on ways to increase health, education,
    and welfare services to migrant families, especially their children.
    A joint committee within the Department laid the groundwork for
    the plans, working with central and regional staff.
    As a point of departure for the project, a conference was held in
    Washington, D. C., on May 17, 18, and 19, with representatives of
    the 10 States. Invitations to the conference were issued jointly by
    the Surgeon General of the Public Health Service, the Commissioner
    of Education, and the Chief of the Children’s Bureau. One hundred
    78 Department of Health, Education, and Welfare, 1954
    and seventy-five delegates took part in the meetings. Delegates were
    members of State departments of health, education, and welfare, and
    other persons, selected by the States, from public and private groups
    working directly with migrant families. Other delegates represented
    national organizations with active programs for migrant families,
    the Departments of Labor and Agriculture, and the Housing and
    Home Finance Agency.
    A committee formed of State delegates and the Joint Committee
    within the Department planned the 3-day conference. Following
    an opening general session, small work groups brought out State and
    interstate problems, specific questions for which the delegates wanted
    answers and proposals for action.
    Out of the conference came a definite program of action. State
    groups went home with a plan for State activity and for their part in
    interstate cooperation. Within the Children’s Bureau, and in the
    Department, plans are being developed for picking up the recommendations
    of the conference, defining responsibility for working on them,
    and moving ahead with work with the States and in the Federal
    Government.
    In nearly every region of the country services for migrant children
    are receiving increased consideration. Although many of the States
    have offered some services to this group, the development of interstate
    cooperation in an attempt to provide some continuity of service is in its
    infancy.
    BLACK MARKET IN BABIES
    The black market in babies is that vicious practice of selling a baby
    to a couple who are impatient and are willing to pay a high price to a
    middleman for a baby for them to adopt.
    That a black market in babies exists in this country is becoming
    increasingly known as publicity is given to action by law enforcement
    authorities to specific cases that are brought to light. The full extent
    and seriousness of the practice is not known. That it exists in many
    more places than has been apparent is undoubtedly true. The diversity
    of factors contributing to its existence and the resources that communities,
    States, and nations need to combat it have never been fully
    explored. Basically, the problem centers in the vulnerability of the
    unmarried mother to exploitation. It is a problem that involves
    health, medical and hospital, welfare, and law enforcement agencies.
    For many years the Children’s Bureau has worked with the States in
    improving health and welfare services to unmarried mothers and
    services for the placement of children, including adoptive placement.
    About 32,400 of the 146,500 children born out of wedlock in 1951 were
    born to mothers 17 years of age or younger. Such young mothers are
    often entirely dependent on the community for help in planning for
    Social Security Administration 79
    themselves and their babies, in obtaining adequate maternity care in a
    hospital, and in finding their places in the community after the baby is
    born. Too many of the babies of such young mothers get into the black
    market.
    Because of the seriousness of the situation, the Bureau plans to devote
    time and effort to investigate this problem and determine steps
    that can be taken to eliminate it. Advice will be sought from legal,
    medical, social work, and other professional groups, from adoptive
    parents and law enforcement agencies, and legislative problems will
    be explored. Facts will be brought together, drawing on the experience
    of all groups concerned with the practice, especially those in local
    communities. Consultations with the professional groups were begun
    this year, and the work will be more fully developed in 1955.
    FETAL AND NEONATAL MORTALITY
    An increasing number of public health officials, pediatricians, and
    obstetricians see the need for a concerted attack on fetal and neonatal
    mortality in the United States. The need is documented by a report
    now in preparation by the Bureau dealing with the size and locations of
    fetal and neonatal losses as indicated in official statistics for the several
    States.
    About 143,000 infants annually lose their lives in the mid or late fetal
    and neonatal periods. These losses suggest that about 1 in 25 pregnancies
    which reach 20 weeks or more of gestation results in death of
    the infant before, during, and just after birth. These deaths comprise
    nearly 10 percent of the total mortality in the United States, from all
    causes and at all ages.
    An estimated 35,000 fetal and neonatal deaths, or about 25 percent of
    the annual national loss, could probably now be prevented if it were
    possible to reduce excessive risks in some areas of the country to match
    the best experience in other parts of the United States. Beyond this,
    wider gains can also be expected, as ways are found to improve further
    what seems today to be the best experience. The program must be
    essentially a preventive one if the number of fetal deaths is to be
    reduced. More knowledge as to causes of fetal deaths is needed, but
    there is great need to make more effective in action the knowledge we
    already have.
    Training Personnel for Programs With Children
    If services for children are to be of value, they must be manned
    by competent workers. The recognition of the need for services has
    advanced much more rapidly than the production of an adequate
    number of competent workers to fill the increasing demand. To overcome
    this strategic gap States are investing a substantial part of
    80 Department of Health, Education, and Welfare, 1954
    their funds to increase the number of skilled workers through specialized
    courses in training centers, in-service training programs, and
    fellowships for advanced training of staff members.
    CHILD HEALTH
    In an attempt to improve service both in the hospitals and in public
    health departments, the State health departments have developed
    extensive and well-planned institutes and workshops and other methods
    of in-service training for their personnel. However, due to the
    fact that there has been a reduction in funds for the programs of
    many State health departments, such training programs have had
    to be severely curtailed in some of the States this year.
    The Massachusetts Department of Public Health and the Harvard
    School of Public Health presented a 2 weeks’ institute on Child
    Growth and Development for medical social work faculties from many
    parts of the country. The purpose of the institute was to present new
    knowledge of a multidisciplined approach to child growth and development
    which those attending could incorporate in their teaching
    programs.
    A 2 weeks’ institute for nurses was conducted by the Harvard
    School of Public Health. The focus of the institute was to help
    nursing leaders interested in parent education enrich their understanding
    of child growth and development and explore methods for
    utilization of this knowledge. This institute was sponsored jointly
    by the American Red Cross and the Children’s Bureau. The Child
    Study Association of America participated in the latter phase of the
    program. Registration included nurses from 23 States and Puerto
    Rico.
    As a result of the Institute on Care of Premature Infants for physicians
    and nurses conducted at the New York Hospital-Cornell Medical
    Center, similar programs for physicians and nurses have been
    established in other States. In the Mountain States of the West where
    programs for care of premature infants have not progressed as rapidly
    as in other areas, there has been increased interest in the preparation
    of personnel to initiate programs on a local or State level.
    Fifteen States conducted institutes, conferences, or workshops in
    maternity or pediatric nursing. All of these report enthusiastic attendance
    and several of them have reported improvements in hospital
    care or public health nursing service following these opportunities for
    learning.
    Postgraduate training programs for physicians in the field of maternal
    and child health are under way at a number of places. The Conference
    on Public Health Aspects of Rheumatic Fever and Pediatric
    Cardiology at New Haven and the Conference on Premature Care
    at the New York Hospital are among the best known. Others are the
    Social Security Administration 81
    Chari 11.—PREVENTION OF PREMATURITY AND BETTER CARE OF PREMATURE BABIES
    WOULD GREATLY REDUCE MORTALITY IN THE FIRST MONTH OF LIFE
    Death rate for premature babies is over 20 times
    that for full term babies
    Deaths under 28 days per 1,000 live births
    Tristate Obstetric Seminar at Daytona Beach, Florida, the pediatric
    and obstetric conferences in Texas, the postgraduate training program
    at Bowman Gray University. Colorado, as a new development, held
    a 2^-day institute on the care of newborn and premature infants for
    physicians and hospital administrators. This is the first year the
    administrators were included, but the response was so good and the
    effects so valuable that the inclusion of administrators may be an
    annual affair. Six States, in addition to Colorado, were represented
    at the institute.
    The Medical School of the University of Puerto Rico graduated
    its first class in medicine this June. Forty-five students received an
    M. D. degree. Emphasis in Puerto Rico is on training personnel. This
    is being done largely by training Puerto Rican residents as specialized
    personnel. The crippled children’s program developed a working
    agreement with the School of Physical Therapy and Occupational
    Therapy in Puerto Rico whereby the students will receive field practice
    in clinics and treatment centers of the crippled children’s program.
    The newly organized Association of State and Territorial Directors
    of Public Health Nutrition has formed a committee to explore possible
    sources of financial assistance to students of public health nutrition
    as the first step in a recruiting campaign. The Nutrition Section of
    82 Department of Health, Education, and Welfare, 1954
    the Bureau has been asked to work with the Association of State
    Directors in this and other concrete activities.
    The number of local health departments employing full-time nutritionists
    has increased by about 15 percent during the year. The
    major handicap to the development of programs has been the dearth
    of qualified candidates to fill vacancies and newly created positions.
    Enrollment in graduate programs in public health nutrition has
    dropped off as few nutritionists are eligible for GI educational benefits
    and as some State health agencies have curtailed training programs.
    With the addition of the University of California School of
    Public Health to the facilities for graduate training in public health
    nutrition, there is for the first time a course on the West Coast.
    CHILD WELFARE
    The extent of professional training in social work that has been
    obtained by child welfare workers throughout the country remains
    uneven. It is, of course, directly related to availability of funds as
    well as to conviction within the State as to the value of professional
    competence and the State’s responsibility to contribute to this. In
    some States such professional training is considered the very heart
    of the child welfare program and is carefully protected when funds
    diminish. In others, it is the first area to be affected by fluctuation
    of funds. Some States are spending less for this as they use more
    funds for salaries of workers returning from educational leave.
    Various other methods of in-service training are in use. Institutes
    and workshops continue to be widely used. Some States have full-time
    consultants on training and others are trying to get such consultants.
    Most States are focusing on the quality and quantity of supervisory
    staff, giving all possible help to such staff, helping them to define
    function and perfect methods. In some States supervisory caseloads
    are too high and geographic areas too great for even qualified supervisory
    staff to give effective supervision. The number of requests
    for consultation by the State agencies for assistance in reorganizing
    their training programs in order to make them more effective indicates
    a more dynamic approach to training on the job. Consultation has
    been given by Children’s Bureau staff to a number of States in their
    efforts to bring about continuity in their training and to devise
    methods by which all forms of training will be more closely tied
    in with day-to-day practice.
    Community efforts to make service available to children wherever
    they may live, coupled with the continued difficulty of securing personnel
    with professional training, has led to an increased use of untrained
    staff for beginning social work positions in a number of
    States. To overcome this, some States are setting up training units
    for the preliminary training of workers who have not attended schools
    Social Security Administration S3
    of social work, before they are given regular work assignments. In
    other instances, States may place workers in counties, but only under
    a well-formulated plan of training that includes joint planning with
    State and local administrative staff in regard to what will be expected
    from these workers and in regard to orientation programs and plans
    for continued on-the-job training. The Children’s Bureau consultant
    on training has participated in such planning in several of the States.
    During the 12 months ended August 31, 1952, 500 persons concluded
    the educational leave they had been granted by State and local
    public child welfare agencies. These individuals are equal in number
    to about 10 percent of the persons employed full-time in the child
    welfare services programs of State and local public welfare agencies.
    The Children’s Bureau contributes to in-service training programs
    for child welfare staffs through such activities as: (a) consultation
    to State and local agencies by regional child welfare representatives
    and by special consultants, individually or in joint meetings, at the
    request of the agencies; (b) consultation in the planning of institutes
    and workshops; (c) provision, through child welfare funds, for the
    costs of such institutes and for the cost of attendance by staffs of public
    agencies; and (d) actual leadership of such institutes and workshops.
    In Texas, a series of three workshops planned jointly by the Regional
    Child Welfare Representative and the Consultant on Group
    Care, led by the latter in Dallas, El Paso, and Corpus Christi, included
    broad representation from public and voluntary agencies, institution
    staff members, and planning groups. The focus was around the constructive
    use of institutions in treatment of children and resulted in
    effective community planning in that area.
    In West Virginia, at the May 1954 State conference, the Regional
    Child Welfare Representative of the Bureau presided and acted as
    discussant at a 1-day institute led by a member of the faculty of the
    School of Social Work at the University on services to children in their
    own homes when the request for help comes from the family itself.
    Persons participating were from public and voluntary agencies having
    responsibility for this type of service. In addition, during the
    week of June 7, 1954, two consecutive 2-day institutes were held to
    cover the total public child welfare supervisors and workers of the
    State on services to children in their own homes when a complaint has
    been made by someone outside of the family. These were led by a
    member of the faculty of the Western Reserve School of Social Work.
    Original planning was by the staff of the West Virginia Division of
    Child Welfare and the Regional Child Welfare Representative of the
    Bureau. Child welfare services funds were used for the expenses and
    honorarium to provide the leader and the travel costs of the child welfare
    staff who participated. Both of these institutes were focused on
    developing the skills of the workers attending.
    84 Department of Health, Education, and W elf are, 1954
    A workshop on adoption and foster home care was held for 41/2 days
    in Helena, Montana, at the request of the Director of Child Welfare
    Services, for the child welfare staff of the State Department of Public
    Welfare and representatives of voluntary agencies and of institutions.
    This was led by the Children’s Bureau Consultant on Foster Home
    Care, and the regional Child Welfare Representative participated
    both in planning and in the institute itself.
    Relationships With Other Agencies and Organizations
    It is the philosophy of the Children’s Bureau to work on a continuing
    and sustaining basis with other national organizations, public and
    private, concerned with child health and welfare. A staff committee
    on working relationships is formulating a statement of principles in
    relation to such groups and developing recommendations for a process
    within the Bureau work planning to bring the relationships with these
    organizations into the proper focus of serving children together.
    The development of a pattern for relationships with national organizations
    has been stimulated by the request of the Child Welfare
    League of America for a joint study of interagency relationships.
    The League is making a self-study of its function and program in
    relation to that of other agencies. Bureau staff members have also
    conferred with the League on studies of adoption practice and day care
    programs. Relationships continue active with the American Academy
    of Pediatrics and the American Public Health Association. The
    Children’s Bureau is an advisory member of the National Health
    Council.
    There are several outstanding examples of teamwork with other
    Bureaus within the Department. One is the Children’s Bureau-
    Bureau of Public Assistance Committee which is working on services
    to children in aid to dependent children families. The frequency
    with which Bureau of Public Assistance and Children’s Bureau staff
    at the regional level are jointly giving help to State staffs is increasing
    all the time. The consultants on staff development and training of the
    two Bureaus are working very closely together. Another area of cooperation
    is with the Bureau of Old Age and Survivors Insurance.
    The Inter-Bureau Committee on Common Social Welfare Matters,
    composed of representatives from the Children’s Bureau, the Bureau
    of Public Assistance, and the Bureau of Old-Age and Survivors Insurance,
    gives joint consideration to problems related to all three
    Bureaus.
    A working committee of the Division of Social Services of the Children’s
    Bureau and the District of Columbia Board of Public Welfare
    has met monthly to consider the problems involved in the institutional
    program and the relationship between the institutional program and
    Social Security Administration 85
    the Child Welfare Division of the District. A subcommittee has
    given considerable time to training programs for institutional staff.
    In connection with the United Nations Survey of Programs of
    Social Development, the nutrition staff of the Bureau developed the
    Department’s statement on nutrition in the United States in cooperation
    with the Office of Education and the Public Health Service and
    represented the Department in preparing the composite report with
    the Department of Agriculture for the Department of State.
    Members of the Bureau staff have worked very closely with the Department
    of State relative to cross-border placements from Canada
    and the Refugee Relief Act. In both instances staff has actively participated
    in the establishment of procedures for the protection of
    children coming into the United States and the Bureau has channeled
    such procedures to the States.
    Interdepartmental Committee on Children and Youth
    The Interdepartmental Committee on Children and Youth, for
    which the Children’s Bureau provides secretarial service and on which
    the Chief serves as acting chairman, forms a natural center for exchange
    of information and for the development of working relationships
    between Federal agencies in areas of interest and action in
    behalf of children and youth.
    The Interdepartmental Committee on Children and Youth has active
    subcommittees on employment certification, American-related
    children outside the United States, services to children in Territories
    and Islands, and on migrants and their families. The last-named
    committee has prepared a pamphlet to be issued by the Interdepartmental
    Committee on Children and Youth entitled When the Migrant
    Families Come Again, a Guide to Community Services.
    The major new activity during the past year has been the development
    of a working relationship between the Interdepartmental Committee
    and the National Council of State committees on children and
    youth. With the dissolution of the National Midcentury Committee
    for Children and Youth, the National Advisory Council for State
    and Local Action for Children and Youth was left without a central
    informational exchange. The Federal agencies also lost contact with
    the State committees on children and youth which were implementing
    many of the Midcentury White House Conference recommendations.
    To overcome this gap, and in keeping with the Presidential
    charge at the time of its formation for responsibility of assisting in
    the development of appropriate working relationships between the
    Federal Government and the State and Territorial committees for
    children and youth, the Interdepartmental Committee signed a statement
    of understanding in October 1953 with the National Council.
    86 Department of Health, Education, and Welfare, 1954
    This provides that the member State and Territorial committees of the
    Council will provide information on a continuing basis of their activities
    to the Interdepartmental Committee. In return the Interdepartmental
    Committee will maintain a file of such information and
    disseminate it to members of the Council and the Interdepartmental
    Committee, either in the form of summaries or in answer to specific
    inquiries.
    The Interdepartmental Committee, at its meeting on October 13,
    1953, established a secretariat to carry out the information service
    for the State committees. As of June 1954, current files have been
    established for 46 State and Territorial committees based on material
    they have provided. Seven informational mailings have been sent
    to all State committees, and individual answers prepared for the
    limited number of information requests received.
    The highlight of this activity was a joint conference held in Washington,
    D. C., on May 5 and 6,1954. Forty-four persons representing
    25 State and Territorial committees and 43 representatives of member
    agencies of the Interdepartmental Committee on Children and Youth
    participated in a 2-day discussion of program needs based on the
    emerging problems for children and youth.
    Federal Credit Unions
    Federal credit unions made good progress during the year ended
    June 30, 1954. On that date there -were 6,990 in operation, membership
    totaled 3.4 million, and total assets amounted to $920.4 million,
    of which $623.5 million was outstanding in loans to 1.5 million members.
    As compared with June 30, 1953, these totals indicate an increase
    of 674, or 10.6 percent, in the number of these organizations;
    an increase of 361,000, or 11.7 percent, in the number of members;
    an increase of $166.3 million, or 22.2 percent, in assets; and an increase
    of $120.6 million, or 23.9 percent, in the amount of loans outstanding.
    They were operating in every State and in the District of Columbia,
    Alaska, Hawaii, Puerto Rico, Virgin Islands, and the Panama Canal
    Zone. Of the total, 5,793, or 82.9 percent, were serving groups of
    employees; 1,042, or 14.9 percent, were serving members of cooperatives,
    churches, labor unions, or other types of associational groups;
    and 155, or 2.2 percent, were serving residents of small rural communities
    or well-defined urban neighborhood groups.
    Federal credit unions are cooperative thrift and credit associations
    that actively promote systematic savings and use the funds thus accumulated
    to make consumer loans at reasonable rates of interest.
    They provide these services only for members who are drawn from
    the groups specifically identified in their charters. Each Federal
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    credit union is a separate corporation; each is managed and operated
    by officials elected by and from its members. The officials learn to
    work together under democratically imposed disciplines, and by actual
    experience acquire skills in the management of a financial institution
    dedicated to helping members help themselves. The Federal Credit
    Union Act is the basis for a practical adult education effort of growing
    significance to working people and their families.
    Thrift is encouraged through the establishment of convenient
    facilities, the policy of accepting savings in very small amounts, and
    through a variety of educational efforts among members and potential
    members. Most Federal credit unions urge borrowing members
    to add to their share accounts (savings) as they repay their loans.
    In this way persons who join the credit union in order to obtain loans
    are encouraged to build up a cushion of savings, and not infrequently
    such savings represent the members’ first successful attempts to set
    aside a part of their current earnings.
    With very few exceptions loans granted by Federal credit unions
    are repayable in installments determined by the credit committee
    and the member to be within the member’s ability to pay and large
    enough to pay off the loan within the maximum period of 3 years permitted
    by the Federal Credit Union Act. The maximum loan without
    security is $400, and the maximum loan with security is 10 percent
    of the credit union’s assets. The board of directors of each unit may
    adopt lower limitations on loans than those permitted by law. The
    maximum interest rate that any Federal credit union may charge
    is 1 percent per month on unpaid balances, inclusive of all charges
    incidental to making the loans. During calendar year 1953, the latest
    date for which such information is available, the average size of
    loans granted by Federal credit unions was $388.
    The Bureau of Federal Credit Unions grants charters to groups
    determined to be eligible and qualified as defined in the Federal Credit
    Union Act. Since 1948 a minimum of 100 potential members has
    been required by Bureau policy for each applying group that was
    otherwise eligible and qualified. Manuals and instructional materials
    are furnished to each newly chartered Federal credit union.
    Field personnel of the Bureau supervise and examine the units after
    they are organized. The purpose of this supervision and the examinations
    is to determine that each Federal credit union is being
    operated in accordance with the law, its charter, and sound financial
    practices.
    Program Operations
    At the end of fiscal year 1954 the Bureau had a budgeted staff of
    208—23 departmental and 185.field. At the end of the previous year
    88 Department of Health, Education, and Welfare, 1954
    there were 23 departmental positions and 188 field positions provided
    in the budget. The reduction of three in the number of field positions,
    notwithstanding the growth in the number and size of Federal
    credit unions, was made possible by the adoption of streamlined procedures
    for processing examination reports. Although efforts to
    simplify procedures without impairing the quality of service to Federal
    credit unions will be continued, it is expected that the growth
    in the workload during the next 2 years will necessitate expansion in
    the examiner staff. The results of improving procedures in the future
    will be reflected in terms of fewer additions of personnel than would
    otherwise be indicated by the actual and projected growth of Federal
    credit unions.
    During the year the Bureau staff made 6,291 examinations of Federal
    credit unions, 765 more than during fiscal year 1953. This
    represented completion of 86 percent of the examination program
    during 1954 as compared with 84 percent during 1953. Of the total
    examinations made in 1954, 73 or 1.2 percent were in cases of actual
    or suspected defalcations. These 73 examinations accounted for 4.6
    percent of the total field examiners’ time devoted to examinations.
    In fiscal year 1953 these examinations accounted for 1.2 percent of
    the total number and 8.2 percent of total time devoted to the
    examination program by the field examiners.
    During fiscal year 1954, 854 charters were granted by the Bureau
    to groups that had made application and had been determined to be
    eligible. This exceeded the number of charters granted in fiscal year
    1953 by 40. In a number of cases, where the applying group was
    clearly ineligible under the law or the Bureau’s policy as to minimum
    number of potential members, the group was advised to withdraw the
    application. In a number of other cases the determination of ineligibility
    was made in the Washington office of the Bureau and the
    application was denied. The Bureau continued its policy of encouraging
    and training volunteers to assist with this organization work.
    As a result, slightly less than 1 percent of field examiners’ official time
    was devoted to chartering and organization work during the year.
    The Federal Credit Union Act specifies three kinds of fees and provides
    that the revenue from these fees shall be used to defray the
    costs of administering the law. The charter and investigation fee is
    $25. For each calendar year after the year in which its charter is
    granted each Federal credit union pays a supervision fee the amount
    of which is determined by the amount of its assets as of December 31 in
    accordance with section 5 of the act. The third fee is paid to the
    examiner at the conclusion of the examination. It is computed in
    accordance with a schedule fixed by the Director in accordance with
    the act and regulations published in the Federal Register. The
    schedule in effect at the end of fiscal year 1954 was $56 per examiner
    Social Security Administration 89
    day or 50 cents per hundred dollars of the Federal credit union’s assets
    as of the effective date of the examination, whichever was lower, with
    a minimum fee of $25 per examination, except that no fee was assessed
    for the first examination made within 1 year after the charter was
    issued. Effective March 15, 1954, the minimum fee was increased
    from $5 to $25 and the fee for all initial examinations of new Federal
    credit unions was waived. Revenue from these fees totalled $21,575
    for chartering, $277,619 for supervision, and $993,596 for examinations
    during fiscal year 1954, as compared with $20,775, $221,169, and
    $878,078, respectively, during fiscal year 1953.
    Prior to fiscal year 1954, revenue from fees was insufficient to cover
    the costs of administering the Federal Credit Union Act. The difference
    was made up by appropriations of Treasury funds authorized by
    Congress. No such appropriation was available to the Bureau in
    fiscal year 1954, but the Bureau had the use of a $250,000 workingcapital
    fund which is to be repaid with interest over a 10-year period
    beginning not later than July 1,1955, as provided by the 82d Congress.
    Beginning in fiscal year 1956 the revenue of the Bureau from fees collected
    from Federal credit unions must be sufficient to pay the annual
    installments on the working-capital loan and the interest and, at the
    same time, to set aside a working-capital fund to replace the borrowed
    capital. A working-capital fund is essential in financing the operation
    of the Bureau because the revenue from supervision fees is
    seasonal. Although it may be truly said that the Bureau became selfsupporting
    beginning with fiscal year 1954, it will be necessary to
    practice extraordinary economies and to pay special attention to
    financing the program in order to balance income and costs. The
    fees charged at present are such that increasing them at this time
    will not be a desirable means of defraying the increasing costs of
    administration.
    During the year the Bureau of the Budget transferred responsibility
    for accumulating and publishing annual statistics on State-chartered
    credit unions from the Bureau of Labor Statistics to the Bureau of
    Federal Credit Unions. No appropriation of Treasury funds was
    provided for this operation. Since the workload has been absorbed
    without adding staff the only additional expense is for postage used
    in obtaining the data from State credit union supervisors and the
    cost of reprinting the report, which is published in the Social Security
    Bulletin. As of December 31, 1953, there were credit union laws in
    all States except Delaware, Nevada, South Dakota, and Wyoming.
    In addition, there were local credit union laws in the District of
    Columbia and in Puerto Rico. Operating under these laws were
    7,096 State-chartered credit unions with 3.4 million members and
    $1.04 billion in assets of which $733.5 million was outstanding in loans
    to members.
    339010—55------ 7
    90 Department of Health, Education, and Welfare, 1954
    In cooperation with the Foreign Operations Administration, the
    Bureau planned and guided the training for a 6-month period of
    Mr. Cecilio Montemayor and Mrs. Rosario Pulido in the organization,
    supervision, and examination of Federal credit unions. Mr. Montemayor
    is in charge of the organization and supervision of cooperatives
    and credit unions, and Mrs. Pulido is in charge of the examination of
    cooperatives and credit unions in the Republic of the Philippines.
    Their program of study included instructions in the Washington
    office, in several regional offices, and by several examiners of the
    Bureau in actual contacts with Federal credit unions.
    The second session of the 83d Congress passed three laws that pertain
    to the operation of the Bureau of Federal Credit Unions. One
    law provides for refunds of interest to borrowers when authorized
    by the board of directors of a Federal credit union subject to the
    reserve requirements of the Act and any regulations issued by the
    Director. This law also authorizes the Director to designate and
    empower examiners to take oaths and affirmations on all matters pertaining
    to the organization and supervision of Federal credit unions.
    The second clarifies the authority of the Director of the Bureau to
    prescribe minimum surety bond coverage for officials and employees
    of Federal credit unions. The third transferred to the Bureau responsibility
    for examining and supervising credit unions chartered
    by the District of Columbia. District-chartered credit unions will
    pay examination and supervision fees computed on the same basis as
    for Federal credit unions.
    Strengthening the Program
    The growth in numbers and size of Federal credit unions is an
    important factor in the administration of the Bureau’s program
    responsibilities. Solutions to new problems must be developed, and
    trends must be studied in order that the probable impact of indicated
    developments can be anticipated and the necessary changes
    in procedures be readied for installation at the appropriate time.
    Manuals and instructional materials furnished to the officials of
    Federal credit unions are revised from time to time to keep them up
    to date and pertinent. Advice and suggestions of the operating officials,
    of the field examiners and of the leaders of the organized credit
    union movement are solicited. This procedure has fostered good
    cooperation with the Bureau and has been of material assistance in
    the development of practical aids to credit union operations. This
    procedure of proven value is being continued.
    An integral part of each examination is the instruction of the
    Federal credit union officials. Since these instructions can be and
    Social Security Administration 91
    are geared to prevailing or anticipated conditions in the credit union
    concerned, the examination program is a progressive rather than a
    static influence on the development of sound credit union service in
    the Nation. The knowledge this experience gives the field examiners is
    a valuable resource in keeping the Bureau’s policies and regulations
    in tune with the times.
    During the past 3 years an effective orientation and basic training
    course has been evolved for new examiners. Attention is now being
    given to the development of a more formal training plan for senior
    examiners. Various proposals are being considered and evaluated,
    with special reference to the cost of such programs and their potential
    value in the building of a staff of career employees that will be even
    more competent to cope with new conditions in the credit union field
    of endeavor.
    The Bureau is continuing efforts to collect and maintain basic statistical
    data on Federal credit unions and to encourage research in
    this field by graduate students and faculty members of colleges and
    universities. The results of these efforts will provide the means for
    detecting need for change and for evaluating proposed legislation,
    proposed amendments to published regulations, and proposed revisions
    of manuals for Federal credit union officials.
    Table 1.—Social Security Administration: Funds available and obligations
    incurred, fiscal years 1954 and 1953 1
    [In thousands; data as of June 30,1954]
    Item
    Funds available 1 2 Obligations incurred
    1954 1953 1954 1953
    Total___________________________________________ . $1,496,414 $1, 435,928 $1,483,202 $1,434,457
    Grants to States___________________________ ... ... . 1,428,000
    1,398,000
    | 1, 398,000
    30,000
    11,928
    10,843
    7, 229
    68,414
    298
    63, 746
    1,551
    1,525
    1,294
    1,368,600
    1,340,000
    1,340,000
    28,600
    12,747
    11,482
    4,371
    67,328
    294
    62, 500
    1,600
    1, 550
    1,384
    1,415,420
    1,386,931
    f 931,711
    J 35,561
    ] 347,236
    [ 72,423
    28,489
    11,787
    10,601
    6,101
    67,782
    286
    63,188
    1,535
    1,521
    1,252
    1,367,571
    1, 338,989
    903, 241
    33,017
    343, 321
    59,410
    28, 582
    12,729
    11,482
    4,371
    66,886
    291
    62,332
    1,576
    1,532
    1,155
    Public assistance___________________________________
    Old-age assistance______________________________
    Aid to the blind________________________________
    Aid to dependent children______________________
    Aid to the permanently and totally disabled....
    Maternal and child health and welfare services_____
    Maternal and child health services______________
    Services for crippled children___________________
    Child welfare services_____ _____________________
    Administrative expenses 3_____________________ ________
    Office of the Commissioner 4________________________
    Bureau of Old-Age and Survivors Insurance 5______
    Bureau of Public Assistance________________________
    Children’s Bureau 6________________________________
    Bureau of Federal Credit Unions___________________
    1 Funds available and obligations as reported by administrative agencies.
    2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments,
    recoveries, and fee collections for services rendered.
    3 Funds made available and obligations incurred for salaries, printing and binding, communications,
    traveling expenses, and reimbursement items for services rendered to other Government agencies.
    4 Appropriations by Congress from general revenues accounted for approximately 63 percent of the administrative
    expenses of the Office of the Commissioner in 1953, and approximately 57 percent of such expenses in
    1954; balance from old-age and survivors insurance trust fund.
    5 For administration of the old-age and survivors insurance program, which involved benefit payments of
    $2,627,000,000 in 1953 and $3,275,000,000 in 1954.
    6 Includes expenses ,for investigating and reporting on matters pertaining to the welfare of children
    authorized by the act of 1912, as well as expenses for administration of grants to States
    92 Department of Health, Education, and Welfare, 1954
    Table 2.—Financing social insurance under the Social Security Act: Contributions
    collected and trust fund operations, fiscal years 1952—1954
    [In millions]
    Item 1954 1953 1952
    Contributions collected under—
    Federal Insurance Contributions Act1______________ $4, 590 $4, 097 $3, 594
    Federal Unemployment Tax Act2___ 275 276 '259
    State unemployment insurance laws 34____ 1,246 1,368 1,432
    Old-age and survivors insurance trust fund:
    Receipts, total__________________________ 5,029 4,483 3,932
    Transfers and appropriations 15_______________________ 4, 590 4,097 3,598
    Interest and profits on investments____________ « 439 387 334
    Expenditures, total_____________ . .. . ... 3,364 2,717 2,067
    Monthly benefits and lump-sum payments 7_____ 3, 275 2,627 1,982
    Administration__________________________ . 89 89 85
    Assets, end of year________________________________ . 20,043 18,366 16,600
    State accounts in the unemployment trust fund:
    Receipts, total_________________________ „. 1,450 1,555 1,606
    Deposits 4___________________ 1,246 1,371 1,439
    Interest____________________ 204 184 167
    Withdrawal for benefit payments______________________________ 1,617 913 1,000
    Assets, end of year_____________________________________________ 8,396 8,563 7,920
    1 Contribution paid by employers and employees on wages up to and including $3,600 a year: 1*4 percent
    each. Contributions paid by the self-employed on income up to and including $3,600 a year: 2J4 percent.
    Includes deposits by States under voluntary agreements for coverage of State and local employees. Includes
    deductions in fiscal years 1953 and 1954 to adjust for reimbursement to the general Treasury of the
    estimated amount of taxes subject to refund on wages in excess of $3,600.
    2 Tax paid only by employers of 8 or more. Employers offset against this tax—up to 90 percent of the
    amount assessed—contributions which they have paid under State unemployment insurance laws or full
    amount they would have paid if they had not been allowed reduced contribution rates under Stateexperience-
    rating provisions. Rate is 3 percent of first $3,000 a year of wages paid to each employee by subject
    employer; because of credit offset, effective rate is 0.3 percent of such wages.
    3 Contributions plus penalties and interest collected from employers and contributions from employees,
    reported by State agencies.
    4 Contributions and deposits by States usually differ slightly, primarily because of time lag in making
    deposits.
    6 Includes transfers from the general fund of $3,734,000 for fiscal year 1952, to meet administrative and other
    cost of benefits payable to survivors of certain World War II veterans as defined in title II of the Social Security
    Act Amendments of 1946.
    6 Includes interest transferred from the railroad retirement account under the financial interchange provision
    of the Railroad Retirement Act, as amended in 1951.
    7 Represents checks issued.
    Source: Compiled from Daily Statement of the U. S. Treasury and State agency reports.
    Social Security Administration 93
    Table 3.—Old-age and survivors insurance: Estimated number of families and
    beneficiaries in receipt of benefits and average monthly benefit in currentpayment
    status, by family group, end of June 1954 and 1953
    [In thousands, except for average benefit; data corrected to Nov. 5,1954]
    June 30, 1954 June 30, 1953
    Family classification of beneficiaries Number
    of
    families
    Number
    of beneficiaries
    Average
    monthly
    amount
    per
    family
    Number
    of
    families
    Number
    of beneficiaries
    Average
    monthly
    amount
    per
    family
    Total____________ _____ . _ _____ - 4, 689.4 6,468.8 4,009.8 5, 573.6
    Retired worker families_________________ 3, 519. 4 4, 577.6 2, 977. 5 3,887. 6
    Worker only__ ____________ __ ___ 2, 545.4 2, 545.4 $49. 40 2,137.7 2,137.7 $48.20
    Male. ______________ .. ___________ li 669.9 L 669.9 53.80 li 443.1 1J 443.1 52.10
    Female. - _______________ _____________ 875.5 875.5 41.10 694.6 694.6 40.10
    Worker and wife aged 65 or over _________ 904.9 1,809.8 86.30 781.8 1, 563.6 83.70
    Worker and wife under age 65 L___________ .6 1.2 95. 60 .6 1.2 95. 20
    Worker and aged dependent husband______ 7.3 14.6 75.20 5.5 11.0 74. 20
    Worker and 1 child —___________ ________ 9.2 18.4 76.00 7.9 15.8 75. 40
    Worker and 2 or more children. ___________ 5.8 20.4 79.40 5.3 18.5 81.20
    Worker, wife aged 65 or over, and 1 or more
    children_______ ______ _____ .8 2.6 98.90 .9 2.9 97. 70
    Worker, wife under age 65, and 1 child____ 28.5 85.5 100. 70 24.1 72.3 94.00
    Worker, wife under age 65, and 2 or more
    children. . ___ ______________________ 16.9 79.7 93.40 13.7 64.6 88.10
    Survivor families___ ______________ _____ ____ 1,170.0 1, 891.2 1,032.3 1, 686.0
    Aged widow. .. ___________________ ____ 585.2 585.2 41.00 498.1 498.1 40. 80
    Aged dependent widower________________ . .9 .9 34.40 .6 .6 33. 90
    Widowed mother only 1____________ ____ __ 2.1 2.1 45.20 2.4 2.4 43.30
    Widowed mother and 1 child.___________ . 118.2 236.4 91.00 109.4 218.8 88. 50
    Widowed mother and 2 children _______ 78.6 235.8 112.70 72.0 216.0 107.90
    Widowed mother and 3 or more children___ 68.8 323.4 112. 20 61.1 283.3 105. 50
    Divorced wife and 1 or more children._____ .2 .6 111. 50 .2 . 5 95.00
    1 child only_________________ . __________ 174.8 174.8 42.20 159.3 159.3 41.40
    2 children...____ ___________________ ______ 73.3 146.6 72.20 65.5 131.0 70. 70
    3 children _____________________ ______ _ 26.0 78.0 88.30 23.4 70.2 86.20
    4 or more children____ ___________________ . 19.1 83.0 92. 60 19.4 83.3 90.10
    1 aged dependent parent___________________ 21.2 21.2 42. 60 19.3 19.3 41.90
    2 aged dependent parents__________________ 1.6 3.2 81.40 1.6 3.2 80.70
    i Benefits of children were being withheld.
    94 Department of Health, Education, and Welfare, 1954
    [In thousands, except for average taxable earnings, data corrected to Nov. 10, 1954]
    Table 4.—Old-age and survivors insurance: Selected data on benefits, employers,
    workers, and taxable earnings, by State, for specified periods,
    1952—1954
    State
    Monthly benefits
    in currentpayment
    status, end of
    fiscal year
    1954 1
    Benefit payments, fiscal
    year 1954 1
    Employers
    reporting
    taxable
    wages,
    July-
    September
    1953 2
    Calendar year 1952
    Workers
    with
    taxable
    earnings
    3
    Amount of taxable
    earnings 4
    Number
    Amount Total Monthly
    benefits
    Lumpsum
    payments
    Total
    Average
    per
    worker
    Total............6.., 468.8 $278, 702 $3, 275, 457 $3,185, 282 $90,175 3, 650 60,000 $128,800,000 $2,147
    Alabama ______ 94.3 3, 251 38, 518 37 393 1 125 50 901 1 443 OOO 1 602
    Alaska.._________ 3.5 136 1, 572 1 501 71 3 73 138 OOO 1 8Q0
    Arizona___________ 28.4 1,152 13, 644 13, 230 414 18 304 533 OOO 1 753
    Arkansas_________ 55.6 1' 906 22, 389 21, 845 544 31 474 655 OOO 1 389
    California_________ 525.1 23,351 273,376 266, 702 6 674 291 4 995 10 760 000 2 154
    Colorado__________ 53.2 2,196 25, 741 25 120 621 37 ’ 584 1 020 OOO 1 747
    Connecticut______ 109.9 5,340 62, 635 60 914 1 721 56 1 063 2 441 OQ0 2 296
    Delaware. ________ 14. 8 660 7, 772 7 537 ’ 235 10 I97 387 OOO 1 964
    Dist. of Col_______ 24.3 1, 042 12 323 11, 908 415 27 541 973 OOO 1 709
    Florida___________ 160.3 6, 876 80,178 78 537 1 641 86 1 221 1 800 000 1 474
    Georgia__________ 96.3 3, 283 39 067 37 768 1’ 299 71 l’ 210 1 859 OOO 1 5^6
    Hawaii____________ 14.8 576 6, 740 6’ 604 ’ 136 10 178 358 OOO 2 011
    Idaho_____________ 21. 2 825 9, 751 9’ 447 304 14 217 358 OOO 1 6^0
    Illinois___________ 390.6 17, 874 211,157 204,172 6, 985 220 4 265 9 341 000 2 190
    Indiana___________ 186.1 7,952 93, 389 90, 896 2, 493 84 1 ’ 775 3 699 000 2 084
    Iowa_____________ 95.5 3' 852 45,009 43, 987 1 022 70 ’ 825 1 502 000 1 £21
    Kansas___________ 70.3 2, 795 32, 777 31,945 832 47 759 1 350 000 1 779
    Kentucky_________ 102.7 3’792 44' 688 43, 522 1,166 49 841 1 434 000 1 705
    Louisiana_________ 75.1 2, 713 32,198 31,163 1 035 52 896 1 475 OOO 1 646
    Maine_____________ 55.9 2, 296 26, 743 26 213 530 25 370 610 000 1 649
    Maryland_________ 89. 6 3, 847 45 519 44 023 1 496 58 1 040 1 956 000 1 881
    Massachusetts____ 282.4 13, 230 154, 582 150,923 3, 659 117 2469 4,481,’ 000 2,066
    Michigan__________ 280.6 13,039 153,446 149,118 4,328 136 2 935 6 919 000 9 357
    Minnesota________ 113.9 4,851 56, 881 55, 420 1 461 71 1’ 082 2 068 000 1 911
    Mississippi________ 45.8 1,459 17,369 16, 774 ’595 33 ’497 664, 000 1,336
    Missouri__________ 164.2 6, 875 80 872 78 517 2 355 94 1 709 3 2.47 OOO 1 900
    Montana__________ 22.5 929 10, 900 10, 633 ’ 267 17 221 388 000 1 756
    Nebraska_________ 43.3 1, 720 20, 255 19, 647 608 34 459 791 000 1 723
    Nevada___________ 6.4 ' 274 3, 238 3,136 102 6 108 179’ 000 1 ’ 657
    New Hampshire... 34.2 1,480 17, 290 16, 884 406 16 245 436^ 000 1,780
    New Jersey_______ 250.0 11,895 140,139 135, 787 4 352 129 2 349 5 140 000 2 188
    New Mexico______ 16.5 '563 6,668 6, 486 182 16 7 234 ’ 353’ 000 1 509
    New York________ 732.0 33, 785 396^ 992 385, 560 11,432 466 7 979 17 391* 000 2 180
    North Carolina___ 107.6 3, 718 44,196 42,773 1, 423 71 b 331 2,107^ 000 1, 583
    North Dakota____ 12.1 443 5,231 5,075 156 13 134 209,000 1, 560
    Ohio ____________ 387.8 17, 595 206, 830 201 040 5,790 176 3 742 8 393 000 2 243
    Oklahoma. _ _____ 70.0 2,645 31,138 30, 322 816 45 ’ 776 1 ’ 339’ 000 1 726
    Oregon____________ 82.8 Z, 621 42, 284 41, 338 946 43 653 1 ’ 271 ’ 000 1’ 946
    Pennsylvania_____ 535.6 24, 548 288, 640 280, 508 8,132 230 4 672 10 221 ’ 000 2 188
    Puerto Rico______ 16.2 420 4,703 4, 595 108 17 ’ 324 ’ 225* 000 ’ 694
    Rhode Island____ 47.6 2,205 25, 790 25,146 644 19 392 785’ 000 2 003
    South Carolina___ 56.1 1,857 22, 076 21,401 675 39 698 1,125^ 000 L 612
    South Dakota_____ 16.5 630 7,433 7, 210 223 16 181 301,000 L663
    Tennessee_________ 95.8 3,374 39, 896 38,747 1,149 63 1 076 1 720 000 1 599
    Texas_____________ 212.7 7,932 94^ 000 91, 098 2 902 193 3 030 5? 316’ 000 1 ’ 754
    Utah.. _____ 24.0 ' 978 11, 536 11, 220 316 14 ’ 280 ’ 507’ 000 J* 811
    Vermont__________ 19.0 783 9,132 8, 938 194 11 131 220’ 000 l’ 679
    Virginia__________ 106.5 4,026 47^ 572 46, 209 1,363 73 1 249 2 088’ 000 l’ 672
    Virgin Islands____ .2 5 60 58 2 («) 5 3^ 000 ’600
    Washington______ 124.3 5, 559 64, 943 63,456 1,487 56 980 2 011 000 2 052
    West Virginia_____ 92.1 3, 694 43,300 42’ 419 '881 32 646 1’, 264’ 000 1’ 957
    Wisconsin_________ 154.3 6,774 79; 488 77', 367 2,121 87 1 390 2 983* 000 2’ 146
    Wyoming.............. 8.7 ' 358 4, 258 4,102 156 8 121 ’ 197’ 000 l’ 628
    Foreign«._________ 39.8 1,724 19,133 18,948 185 60 159’ 000 2’ 650
    Maritime7________ 110I 207’, 000 L 882
    1 State of residence estimated.
    2 State 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 single ownership, for which
    a single tax return is filed.
    3 Preliminary estimate. State data represent workers employed in the State at some time during the
    year. Workers employed in more than 1 State counted once in each of the States in which employed.
    4 Preliminary estimate. State data represent taxable earnings distributed according to the State in
    which earned.
    5 Fewer than 500 employers.
    8Benefit data relate to persons in foreign countries receiving old-age and survivors insurance benefits.
    Employment and earnings data relate to citizens of the United States employed by American employers.
    7 Relates to employment of ofiicers and crews of American vessels.
    Social Security Administration 95
    Table 5.—Old-age and survivors insurance: Selected data on benefits, employers,
    workers, and taxable earnings for specified periods, 1952—1954
    [In thousands except for average monthly benefit and average taxable earnings; corrected to Nov. 10, 1954]
    Item 1954 1953 1952
    Fiscal year
    Benefits in current-payments status (end of period):
    Number___________________________ ______ ______________ 6,468.8
    3,519.4
    959.1
    5,573.6 4,593.8
    Old-age________ _______________________________________ 2,977. 5 2,372.3
    Wife’s or husband’s______________________________________ ' 826. 6 668.3
    Child’s___________________________________________________ 1,111.9 1,003.3
    499.0
    896.8
    Widow’s or widower’s____________________________________ 586.3 421.7
    Mother’s_________________________________________________ 267.7 244.8 214.0
    Parent’s.. ______________________________________________ 24.4 22.5 20.6
    Total monthly amount____ _______________________________ $278,702
    $182,334
    $26,302
    $34, 770
    $24,016
    $10, 249
    $1,030
    $232,999
    $150,124
    $22,050
    $30,541
    $20,332
    $9,015
    $936
    $161,739
    Old-age__________________________________ ______________ $99,592
    Wife’s or husband’s______________________________________ $15,170
    $24,009
    $15,162
    $7,053
    $754
    Child’s______________________________ ____ _______________
    Widow’s or widower’s _________________________________
    Mother’s________________________________________________
    Parent’s___________ ____________________________________
    Average monthly amount:
    Old-age_______ ______ ______________________________ $51.81 $50.42 $41.98
    Wife’s or husband’s______________________________________ $27.42 $26.68 $22. 70
    Child’s___________________________________________________ $31.27 $30.44 $26.77
    Widow’s or widower’s ____________ _______ ___________ $40.96 $40. 75 $35.95
    Mother’s________________________________________________ $38. 28 $36.82 $32.95
    Parent’s_________________ __ ___________________________ $42.26 $41.68 $36.60
    Benefit payments during period:
    Monthly benefits_________________________________________ $3,185,282
    $2,068,404
    $318, 614
    $798,264
    $90,175
    $2,551, 224
    $1,624,605
    $252,994
    $673, 625
    $76,268
    $1,924,107
    $1,191,351
    $193, 525
    $539, 231
    $58, 270
    Old-age________________________________ ______ _______
    Supplementary________________________________________
    Survivor _______________________________________________
    Lump-sum payments______________ __________________ -
    Estimated number of living workers with wage credits (midpoint
    of period—Jan. 1:1
    Total_________________________________________________ _____ 93,600
    69,200
    90,900
    66,600
    (1 2)
    87,800
    62,600
    (2)
    Fully Insured_____________ - _________________________
    Currently but not fully Insured_________________________ (2)
    Uninsured______________________ _______ _________ 24,400 24,300 25,200
    Estimated number of employers reporting taxable wages, 1st
    quarter fiscal year _______ _____________________________ 3,620 3,645 3,635
    Calendar year
    Estimated number of workers with taxable earnings_________ (3) 61, 000
    $137,000,000
    $2,246
    60,000
    Estimated amount of taxable earnings________________________ (3) $128,800,000
    Average taxable earnings _________________________________ (3) $2,147
    1 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from:
    (1) provisions that coordinate the old-age and survivors insurance and railroad retirement programs, and
    (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count
    of persons with taxable earnings reported on more than 1 account number. The effect of such duplication
    is substantially less significant for insured workers than for uninsured workers.
    2 Not possible under the 1950 amendments until July 1, 1954.
    Not available.
    96 Department of Health, Education, and Welfare, 1954
    Table 6.—Special types of public assistance under plans approved by the Social Security Administration: Number of
    average payment, June 1954, and total payments to recipients, by program and State, fiscal year 1954
    [Includes vendor payments for medical care and cases receiving only such payments]
    [Corrected to Oct. 16, 1954]
    I
    11 Iifil §8§ $ i is i<§®§ i
    " i i* ~ i
    i ■le3s IS :i
    i i i
    11
    6f
    Average
    ment
    June
    SSSS
    24.94
    ” ” 30?77‘
    13S28 !
    i1 s5r-t 33 1i
    3253 i
    5382
    is is i
    is is i
    Aid to
    •
    Number
    of
    recipients,
    June
    ssg s i ;8 :
    00 : Iro Bw ,-T :
    : : : :
    888J feiBi i" i2 i
    1 i|
    Total,
    fiscal
    year (in
    thousands)
    sss*
    3-s§8§822£
    2
    8-28828™
    w- -tw
    Aid to the b
    Average
    payment,
    June
    838
    588
    SSSoMNOOoS
    83S3S8S8S3
    8328823883
    3383382838
    litil &*s*§*
    5-25888585
    -* ~*2*
    |22823§gg3
    S&
    Total,
    fiscal
    year (in
    thousands)
    Sa§ §§53323285
    00- MwTeococo ores' a«-s^“-22-
    88s
    888
    333S38SSSS
    2852583882
    8882888885
    8388888228
    £
    Average
    payment
    per
    family,
    June
    883
    sss
    8858858283
    SS8S8S58S3
    2888328888
    3S88SS8d8S
    Aid to depei
    Ia
    Children
    Iff
    i§§§S§358§
    S*«‘2*8¥£S*N*-*5
    §S§8§8§^3
    8^382*2382
    11
    i
    1 838 5333825883
    S-*2*8*8r—*i5*3*"*-*3*
    8§3§SS2^2
    32-85825*83
    § 11 585 SssfiSBai
    o-J-sFoo'w'io-^r cfg'
    82^§^§l88
    s-M-^oW^-oo^-
    Total,
    fiscal
    year (in
    thousands)
    §85
    3§§
    *-<
    £888°83£8§
    5*-*“*8*^*s*2* ~*8*
    3SS85SS838
    3* -2*58888*-*
    ! fall 283
    32 S
    8328838338
    8888825833
    82588
    53883
    28888
    53853
    o Number
    of recipients,
    June
    oToTcf
    35§5§35§5S §SS8388g§8
    S*-*2S*2*S2*^*3* S*^*5*3*3*S*3*22*
    i
    Fiscal year:
    1952_____________
    1953_____________
    1954_____________
    Alask“ !ZZZZZZ"ZZZZZIZZZ
    Arizona_________________
    California_______________
    Colorado_______ ____ ____
    Connecticut __ _____
    Delaware________________
    District of Columbia____
    Georgia_________________
    Idaho. JZZZZZZZZZZZZZZZZZ
    Illinois__________________
    iiiii : : : : ; iiiii
    ilj i
    Social Security Administration 97
    SBFSsS ■ 2 2“2§§52°8§ 5§88 i^S§§ §88
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    Is§sgggl3s §§89SS§§li gssgi=£ss§gs §si
    g'SR'SSg"^'”'”' 8=8‘s“3'SS8S “SRS'S”'”' »‘S SfS’
    Maryland___ ____________
    Massachusetts___________
    Michigan_________ ______
    Minnesota_______ ________
    Mississippi______________
    JTU\ U1OnOnnU,U ,-14 1----______________
    Montana........................ ..
    Nebraska_______________
    Nevada__________ _______
    New Hampshire......... ........
    New Jersey______ _______
    New Mexico_____________
    New Y o rk______________
    North C a ro lin a ........... ..
    North Dakota _______
    O h io ............................... -|
    Oklahoma________ _______
    Oregon.......... .........................
    Pennsylvania____ ______
    Puerto R ico .........................
    Rhode Island___________
    South Carolina----------------
    South Dakota...... ................
    1 1
    1 1
    hi ii
    >>
    : !:
    ip
    II
    West Virginia____________
    Wyoming________________
    98 Department of Health, Education, and Welfare, 1954
    Table 7.—Special types o f 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 1954
    [Includes vendor payments for medical care; amounts in thousands; data corrected to October 25,1954]
    Expenditures for assistance and administration
    Aid to the permanently
    and totally
    disabled
    Percent
    from
    Federal
    funds
    49.2
    51.0
    51.2
    75.7
    71.0
    54.9
    17.7
    54.7
    55.4
    (3)
    66.4
    51.9
    53.7
    44.3
    47.7
    63.1
    57.5
    38.0
    47.7
    57.7
    § os
    $85,922
    116,971
    141,284
    2,964
    952
    3,284
    » 768
    71
    1,2’59 8
    3,476
    859
    649
    5,304
    2,601
    7,173
    2,719
    11,307
    1,561
    2 81
    Aid to the blind
    ________________
    Percent
    from
    Federal
    funds
    47.0
    48.8
    49.6
    76.0
    53.5
    54.9
    68.7
    39.1
    48.6
    37.5
    55.8
    57.5
    64.8
    66.8
    58.6
    53.2
    51.4
    54.4
    46.0
    47.5
    69.6
    58.8
    64.2
    59.4
    38.5
    53.4
    43.8
    Amount
    $62,942
    69,498
    72,102
    509
    45
    549
    904
    13,140
    297
    352
    187
    176
    1,825
    1,684
    71
    149
    3,119
    1,211
    1,262
    537
    1,195
    1,257
    345
    301
    1,897
    1,342
    1,170
    Aid to dependent
    children
    Percent
    from
    Federal
    funds
    52.0
    55.8
    57.2
    77.2
    65.9
    68.1
    78.2
    45.7
    56.3
    43.1
    66.5
    60.3
    76.7
    70.4
    59.7
    48.2
    50.0
    63.4
    48.5
    51.9
    74.0
    73.5
    67.8
    62.8
    45.4
    53.0
    49.2
    Amount
    $598,629
    618, 294
    619,064
    8,871
    973
    4,545
    4,919
    83, 561
    7,398
    7,007
    857
    2,966
    13,227
    12,051
    3,579
    2,845
    32,545
    8,515
    8,974
    5,576
    14,592
    15,666
    4,327
    6,586
    19, 522
    24,204
    10,487
    Old-age assistance
    Percent
    from
    Federal
    funds
    52.5
    55.0
    56.0
    75.0
    52.8
    58.2
    72.4
    47.9
    39.6
    41.4
    67.2
    57.9
    64.6
    69.2
    64.0
    56.5
    53.8
    58.2
    55.3
    50.7
    70.6
    63.2
    65.2
    62.2
    44.2
    56.7
    48.8
    Amount
    $1, 572, 790
    1,671,805
    1,684,075
    23,161
    1,277
    9,598
    21,100
    237,873
    51,385
    16,741
    862
    1,938
    37,990
    44,911
    1,020
    6,132
    76,274
    23,270
    31,818
    28,185
    24,201
    77,412
    7,647
    6,104
    88,873
    53,926
    41,470
    Federal grants to States 1
    Aid to
    the permanently
    and
    totally
    disabled
    $45,165
    59,410
    72,423
    2,291
    656
    1,848
    223
    34
    680
    2,394
    463
    354
    2,359
    1,251
    4,459
    1,565
    4,483
    741
    103
    Aid to
    the blind
    $29,397
    33,017
    35,561
    383
    25
    307
    629
    5,064
    147
    124
    105
    101
    1,195
    1,121
    40
    82
    1, 574
    665
    573
    243
    824
    741
    220
    175
    717
    717
    528
    Aid to dependent
    children
    $303,280
    343,321
    347,236
    6,831
    620
    3,116
    3,916
    37,636
    4,092
    3,021
    569
    1,774
    10,121
    8,248
    2,125
    1,392
    15,777
    5,317
    4,288
    2,771
    11,009
    11,372
    2,883
    3,962
    9,196
    12, 222
    5,018
    Old-age
    assistance
    $799,845
    903, 241
    931,711
    17, 803
    667
    5,563
    15, 507
    113,426
    20,502
    6,497
    575
    1,095
    24,392
    31,004
    656
    3,446
    40,011
    12,774
    16,947
    14,257
    17,021
    48, 742
    4,928
    3,744
    39,931
    29,719
    19,461
    Total
    $1,177,688
    1,338,989
    1,386,931
    27,308
    1,311
    8,985
    20,707
    156,126
    26,590
    9,866
    1,284
    3,651
    35,709
    42,767
    3,282
    5,275
    59,720
    18,755
    21,807
    18, 522
    28,854
    65,314
    8,031
    9,446
    54,328
    43,399
    25,110
    State
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    **ii« i ■ i i i i i i £4 i i i i i i i i i i i iiii Siii i i i i i i i i i i i i i i i i i i i iiii W||| i i i i i i i irs i i i i i i i i i i i i co i i
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    Social Security Administration 99
    SsS i i3 33335S33SS t*£«
    ij§ i i- §8K§§”§§2§
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    $IS3 !§§*§!
    :
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    ^3§SSg|g|
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    dscal-
    year expenditure
    inning Jan. 1,1954.
    §88§S§
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    838^3§B§
    ^ggfeocs
    §§
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    jbtly from fi
    icipation beg
    Missouri..................................................... ..
    Montana..........................................................
    Nebraska____________________________
    Nevada............................................................
    New Hampshire............ ..............................
    :
    &
    2N
    ew Mexico— ......... ........ ............... ............
    New Y ork— ................. ..............................
    North Carolina........... . . .
    North Dakota_______________________
    Ohio.............................................................. ..
    Oregon.......... ..................................................
    1
    kc
    S
    &
    Rhode Island________________________
    South C a ro lin a ........................ ... S m ith ‘D n .lrn ta
    •1
    :
    :
    :
    1’
    oQ cX
    >HEh
    Vermont_____________________________
    Virgin Isla n d s........................ .................... V irg in ia ............... ..................... ..................
    Washington ._ _____________________
    West Virginia............ ....................................
    Wisconsin.............................................. ..........
    Wyoming............ .................................... ..
    1 Based on checks issued; differ slig
    funds reported by States.
    2 Program approved for Federal part
    100 Department of Health, Education, and Welfare, 1954
    Table 8.—Maternal and child health and welfare services: Grants to States for
    maternal and child health services, services for crippled children, and child
    welfare services under the Social Security Act, by program and State, fiscal
    year 1954 1
    [In thousands]
    State
    Maternal and child health
    services Services for crippled children Child
    welfare
    services
    Total Fund A Fund B Total Fund A Fund B
    United States_______$11, 898.1 $5, 936. 3 $5, 961. 8 $10, 727.1 $5, 305.4 $5, 421. 7 $6, 755. 2
    Alabama__________________ 447.7 126.1 321.6 362.1 118. 6 243 5 229 0
    Alaska_________________ .. 80.0 47.1 32.9 142.1 45.9 96.2 36 4
    Arizona___________________ 110.8 64.2 46.6 64 0
    Arkansas__________________ 241.0 89.0 152.0 292. 5 89.0 203 5 172 3
    California_____ ___________ 484.1 288.7 195.4 318.1 233 9 84 2 214
    Colorado___________ .. 194.0 77.3 116.7 90 6 70 6 20 0 •7% 7
    Connecticut_______________ 124.3 84.1 40. 2 182. 9 79 1 103 8 65 9
    Delaware _ ___ __ 84. 5 50. 6 33. 9 69.1 49.3 19 8 39 7
    District of Columbia ____ 154.3 63.2 91.1 132. 2 55.4 76 8 28 9
    Florida____________________ 247.7 108.1 139.6 180.8 97.0 83 8 124 8
    Georgia_______ ____________ 431.0 134.9 296.1 360.2 125.0 235 2 294 9
    Hawaii___________________ 136.2 57.5 78.7 138.5 55.1 83. 4 42 0
    Idaho ___________________ 85.8 59.4 26.4 78. 5 57. 2 21.3 40 0
    Illinois____ _______________ 314.7 233.6 81.1 353.6 200 6 153. 0 163 1
    Indiana. _________________ 193.3 137.0 56.3 155.0 103.0 52 0 61 6
    Iowa_____________________ 153.2 108.0 45.2 211. 5 96. 5 115 0 157 4
    Kansas . ________ ________ 127.2 87.4 39.8 120.9 81 1 39 8 109 4
    Kentucky _________ ______ 334.8 118.6 216. 2 355.0 111. 7 243.3 232 1
    Louisiana. _______________ 311.5 119.9 191.6 238.2 106.0 132.2 168 9
    Maine______ ________ _____ 92.2 64.5 27.7 87.1 62.7 24.4 71 6
    Maryland__ ___________ 322.7 97.7 225.0 260.7 89.6 171.1 97.0
    Massachusetts.___________ 322.6 139 8 182.8 192.6 128.1 64 5 76 6
    Michigan .. _____ ____ 340.8 204.6 136.2 315.3 173.1 142.2 210 7
    Minnesota .. _____________ 224.4 118.8 105.6 216.3 104.8 111. 5 164 3
    Mississippi________________ 338.4 108. 4 230. 0 292. 8 98. 8 194.0 213 3
    Missouri___________________ 250.2 129.4 120.8 250.8 118.6 132.2 169 7
    Montana. ________________ 85.1 59.0 26.1 89.7 55.9 33.8 61. 7
    Nebraska.__ _____________ 91.3 72. 6 18.7 103.9 70.0 33.9 40.3
    Nevada___________________ 65.1 42.5 22.6 52.4 32.0 20.4 33.9
    New Hampshire. ______ 71.3 54. 9 16. 4 84.0 53.7 30.3 48.8
    New Jersey______ _________ 145.9 141.3 4.6 173.5 127.8 45.7 78.3
    New Mexico...___________ 108.7 65.5 43.2 76.0 60.7 15.3 69.4
    New York.. _____________ 436.0 344.9 91.1 337.5 298.4 39.1 183.1
    North Carolina__________ 523. 6 150.0 373.6 425.3 142.9 282.4 333.0
    North Dakota.__________ 86.8 60.4 26.4 85.2 57.9 27.3 44.8
    Ohio ____________________ 383.2 229.5 153.7 328.6 196.2 132.4 162.7
    Oklahoma_________________ 160.4 93.6 66.8 236.2 91.9 144.3 142.2
    Oregon ______________ 110.4 79.5 30.9 99.4 73.1 26.3 57. 5
    Pennsylvania_________ ____ 467. 5 265.4 202.1 446.2 243.9 202.3 298.3
    Puerto Rico____ _________ 370.2 129.6 240.6 315.7 113.0 202.7 162.6
    Rhode Island ___________ 83.4 59.6 23.8 101.1 57.6 43.5 39.1
    South Carolina___ _________ 262.1 100.9 161.2 284.4 98.4 186.0 207.7
    South Dakota____________ 63.9 41.0 22.9 79.1 57.8 21.3 71.9
    Tennessee_________________ 424.6 124.9 299.7 351.2 118.4 232.8 227.1
    Texas. ________ _________ 519. 5 247.6 271.9 507.7 211.7 296.0 321.1
    Utah______________________ 125.4 64.6 60.8 114.7 60.5 54.2 57.6
    Vermont _______ ________ 78.8 52.4 26.4 72.7 51.4 21.3 52..1
    Virgin Islands __________ 80.4 44.3 36.1 64.0 44.2 19.8 30.2
    Virginia___________________ 344.2 125.5 218.7 310.1 115.8 194.3 213.3
    Washington . ___________ 169.9 99.3 70.6 146.4 89.3 57.1 109.7
    West Virginia___ _______ 219.7 94.0 125.7 144.7 86.9 57.8 177.8
    Wisconsin_________________ 197.1 126.2 70.9 246.6 112.9 133.7 169.8
    Wyoming______________.... 76.2 49.4 26.8 53.4 32.4 21.0 40.4
    1 Based on checks issued less refunds.
    Social Security Administration 101
    Table 9.—Federal credit unions: Number of members, amount of assets,
    amount of shares, and amount of loans outstanding Dec. 31, 1935—1953
    Year
    Number of
    reporting
    credit
    unions1
    Number of
    members
    Amount of
    assets
    Amount of
    shares
    Amount of
    loans
    1935_____________________________ 762 118,665 $2,368, 521 $2, 224, 608 $1, 830,489
    1936____________________________ 1,725 307,651 9,142,943 8, 496, 526 7, 330, 248
    1937_____________________________ 2,296 482,441 19, 249,738 17,636, 414 15, 683, 676
    1938_____________________________ 2,753 631, 436 29,621, 501 26,869,367 23,824, 703
    1939______ ___________________ 3,172 849, 806 47, 796, 278 43,314, 433 37,663, 782
    1940_________ ___________________ 3,739 1,126, 222 72, 500, 539 65, 780,063 55, 801,026
    1941_____________________________ 4,144 1,396,696 105, 656,839 96,816,948 69, 249, 487
    1942____________________________ 4,070 1, 347, 519 119, 232,893 109,498, 801 42, 886, 750
    1943_____________________________ 3,859 1,302,363 126,948,085 116,988, 974 35,228,153
    1944____________________________ 3, 795 1,303,801 144,266,156 133, 586,147 34,403,467
    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
    1 In the period 1945 through 1953, the number of operating and reporting credit unions was the same.
    In other years, the number of credit unions which reported was less than the number in operation.
    Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1953, and
    Dec. 31, 1952
    Assets and liabilities
    Amount Percentage distribution
    Dec. 31,1953 Dec. 31, 1952 Change during
    year
    Dec. 31,
    1953
    Dec. 31,
    1952
    Number of operating Federal credit
    unions________________________________ 6, 578 5,925 653
    Total assets_______________________ $854, 232, 007 $662, 408, 869 $191, 823,138 100.0 100.0
    Loans to members__________ _________ 573, 973, 529 415,062, 315 158, 911, 214 67.2 62.6
    Cash. ______ __________________________ 76, 710; 132 66, 033', 714 10, 676, 418 9.0 10.0
    United States bonds_________________ _ 86, 646,022 85,859.900 786,122 10.1 12.9
    Savings and loan shares___ _____________ 95, 728,053 80,155, 252 15, 572, 801 11.2 12.1
    Loans to other credit unions____________ 15, 571i 638 10; 297i 188 5' 27L 450 1.8 1.6
    Other assets____________________________ 5i 602, 633 5; 000; 500 ' 602,133 .7 .8
    Total liabilities___________________ 854, 232,007 662, 408, 869 191, 823,138 100.0 100.0
    Notes payable_____ _____ ... _______ 21, 481, 388 16,091, 405 5, 389, 983 2.5 2.4
    Accounts’ payable and other liabilities.. _ 2, 273,236 i; 715; 599 '55L 637 .3 .3
    Shares__________________________________ 767, 571, 092 597,374,117 170,196. 975 89.8 90.2
    Reserve for bad loans________ ________ 24i 811', 688 19i 571i 805 5^ 239,883 2.9 3.0
    Special reserve for delinquent loans ___ 1, 367, 212 ' 988,926 ' 378, 286 . 2 . 1
    Undivided profits_____ 2________________ 36^ 727, 391 26, 667; 017 10,060,374 4.3 4.0

    Public Health Service
    Health of the Nation
    The improved health of the American people is one of the great
    achievements of the twentieth century. The average life-expectancy
    is longer and the chances of preventing or curing disease are greater
    than at any prior time in our history. This achievement has been
    made possible by the advance of science in many fields and by the
    application of medical and public health knowledge.
    Today, medical science is making rapid progress against diseases
    which once appeared to be insoluble mysteries. Among these, the
    major killers and crippiers are heart and circulatory ailments, cancer,
    arthritis and rheumatism, disorders of the nervous system, and mental
    disease. Infectious diseases caused by viruses still present many unsolved
    problems.
    These challenges require teamwork by health agencies at all levels
    of government with the many professional and voluntary groups
    working in the health fields. As a member of the Nation’s health
    team, the Public Health Service continued throughout the past year
    to strengthen its working relationships with other organizations dedicated
    to the improvement of human health.
    HEALTH RECORD
    The estimated general death rate for 1953 1 was 9.6 per 1,000 population,
    approximately the same as in the past 5 years. There has been
    little change in the difference between the male death rate and the
    female death rate, the former being about 11 per 1,000 and the latter
    about 8 per 1,000.
    Infant mortality continued to decline, with a death rate of 27.9 per
    1,000 live births in 1953. The maternal death rate was 5.6 per 10,000
    1 All vital statistics are given for the calendar year.
    103
    104 Department of Health, Education, and Welfare, 1954
    live births. These may be contrasted with rates of about 40 infant
    deaths per 1,000 live births and, 23 maternal deaths per 10,000 live
    births in 1943.
    Among the leading causes of death, the only disease to show a substantial
    decline in recent years has been tuberculosis. A decrease of
    about 20 percent, from 16.3 per 100,000 population in 1952 to 12.5
    per 100,000 was reported in 1953. The use of new drugs has been
    chiefly responsible for the reduction in deaths. In contrast, the number
    of tuberculosis cases reported to the Public Health Service has
    been decreasing by only 3 percent.
    Death rates from diseases of the cardiovascular-renal systems and
    cancer increased slightly. The death rate due to heart diseases and
    other circulatory disorders was 501.4 per 100,000 population in 1953,
    as compared with 498.3 per 100,000 in 1952, while the corresponding
    cancer death rates were 144.7 and 143.4 per 100,000. These causes accounted
    for two-thirds of all deaths in 1953.
    There were no significant changes in the death rates due to motorvehicle
    accidents and other accidents. An outbreak of influenza early
    in 1953 contributed to an increase in the death rate due to influenza
    and pneumonia from 30 per 100,000 in 1952 to 33 per 100,000 in 1953.
    Among the communicable diseases, the most notable increase occurred
    in the number of reported cases of infectious hepatitis, from
    17,482 in 1952 to 33,700 in 1953. The most striking increases were in
    the West South Central States. Poliomyelitis incidence in 1953 was
    below the nationwide epidemic incidence of 1952. A total of 35,592
    cases, both paralytic and non-paralytic, was reported in 1953, as contrasted
    with the corresponding figure of 57,879 in 1952.
    BIRTHS, MARRIAGES, AND DIVORCES
    The estimated birth rate in 1953 was 25.1 per 1,000 population.
    About 4,000,000 live births occurred in 1953, although the number of
    registered births was slightly under that figure (3,909,000). About
    92 percent of all registered births occurred in hospitals and 96 percent
    were attended by physicians, in contrast with corresponding
    ratios of 37 percent and 87 percent in 1935.
    There was no significant change in the numbers of marriages and
    divorces in 1953, and the corresponding rates were also substantially
    the same. The marriage rate was 9.7 per 1,000 population and the
    divorce rate, 2.5 per 1,000.
    Funds and Personnel
    Total funds available to the Public Health Service in 1954 were
    $266 million (see Table 1, page 164). About $210 million of this
    Public Health Service 105
    amount was in appropriations and authorizations; reimbursements
    for services to other agencies and unobligated balances from prior
    years for hospital construction grants and for construction of other
    facilities constituted the balance.
    The number of full-time employees in the Public Health Service
    at the close of fiscal year 1954 was 15,315 (see Table 2, page 165). This
    number included 1,211 members of the regular commissioned corps
    of the Public Health Service, 1,253 members of the reserve corps on
    active duty, and 12,851 full-time Civil Service employees.
    Health Emergency Planning
    An important task of the Office of Health Emergency Planning
    is to coordinate emergency activities of the Public Health Service
    and to integrate these with activities of other Federal and national
    agencies, such as the Office of Defense Mobilization, the Federal Civil
    Defense Administration, the Atomic Energy Commission, the
    American National Red Cross, and with other executive departments.
    Regional representatives of the Public Health Service, the American
    National Red Cross, and the Federal Civil Defense Administration
    held a series of meetings to discuss collaboration during natural disasters.
    Results of these meetings were presented to the State and
    Territorial Health Officers Association, which recommended similar
    cooperation between the Red Cross and State health personnel. Such
    agreements have been reached in 6 States and are being negotiated in
    7 other States and Puerto Rico.
    In addition to supplies and equipment, the Public Health Service
    was called upon to furnish technical and epidemiological aid during
    the Hidalgo County (Texas) flood in April 1954. During the Iowa-
    Kansas flood in June, water purification units and assistance in training
    local operators were furnished to the Iowa State Department of
    Health. Mobile water treatment units and consultation were furnished
    to the Kansas State Board of Health during the water shortage
    in Kansas and Missouri in March.
    Public Health Service officers were provided for assignment to
    critical positions in the Health Office of the Federal Defense Administration,
    including regional medical consultants, directors of casualty
    and blood services, and radiological health consultants. Within the
    Service, an Advisory Committee to the Surgeon General on Health
    Emergency Planning was established to assist in developing policies
    and plans on emergency activities and to facilitate interchange of
    information among the various programs of the Service.
    339010—55------ 8
    106 Department of Health, Education, and Welfare, 1954
    Public Health Methods
    The Division of Public Health Methods provides staff assistance to
    the Surgeon General in the fields of public health administration,
    research, practice, needs, and resources. It gives consultation in these
    fields to governmental, voluntary, and professional organizations,
    advising on methods of evaluation and formulation of programs. It
    participates in surveys, studies, and conferences and collects, analyzes,
    and publishes data for use by the Service and other health organizations.
    The Division also publishes the official technical journal of
    the Service, the monthly Public Health Reports.
    HEALTH MANPOWER SOURCE BOOKS
    Present plans call for the compilation of at least eight sections of
    a series of Health Manpower Source Books. Sections on physicians
    and nursing personnel were completed in fiscal year 1953 and Sections
    3, 4, and 5 in 1954. Work on sections 6, 7, and 8 was in progress
    during 1954.
    Medical Social Workers (Sec. 3) brings together data on the number,
    distribution, employment, and personal characteristics of medical
    social workers, plus information on education and training facilities,
    their utilization, and needs.
    County data on health personnel and facilities in 1950 (Sec. 4)
    presents data from the 1950 Census for 16 health occupations and for
    facilities in such geographic units as trading areas, standard metropolitan
    areas, county groups, health service areas, and State hospital
    regions. The numbers of health personnel are related to population,
    land area, purchasing power, and other health resource and general
    economics data.
    State data on health occupations and health industries, 1950 (Sec. 5)
    presents data on the occupational and industrial distribution of personnel
    in 16 health occupations for each geographic region and State,
    and according to age, sex, and conditions of employment.
    HEALTH SERVICES AND FACILITIES
    To bring together relevant facts on the problem of care in prolonged
    illness, the Division prepared a comprehensive Source Book on Care
    of the Long-Term Patient. The 69 tables of this publication are
    grouped under four major headings: (1) persons with long-term diaabling
    illness; (2) the patient at home; (3) the patient in an institution
    ; and (4) integration of facilities and services. Three appendices
    list data on the location of rehabilitation centers, chronic disease hospitals,
    and chronic disease units in general hospitals.
    Public Health Service 107
    A 1950-52 Supplement to the Digests of Selected References on
    Chronic Illness was issued during the year. Together, the two volumes
    contain some 1,150 digests classified under the general headings
    of dimensions of the problem, contributory factors, prevention and
    control, rehabilitation, noninstitutional services, institutional services,
    design and construction of institutions.
    An analysis of variations in income and expense ratios in nonprofit,
    short-term general hospitals in 1951 was completed. A study of 11
    home care programs was undertaken as a joint project of the Public
    Health Service and the Commission on Chronic Illness. The Division,
    aided by the American Public Health Association, has completed
    a study of 12 selected regional plans of hospitals, medical
    schools, and health departments for coordinating medical activities
    in urban and rural areas.
    A study of the costs of medical education in Emory University
    has been started to assist the university in analyzing some of the administrative
    problems of financing its medical school. It is hoped
    that the study will develop procedures that will prove helpful to
    other institutions.
    STATISTICAL STUDIES OF ILLNESS
    A clearinghouse on sources of morbidity data serves as a means
    of interchange of advice and experience in planning and conducting
    statistical studies of illness. The first listing of clearinghouse
    projects (Sources of Morbidity Data, Listing No. 1, 1953) was issued
    in September 1953. It is a classified list of studies, citing the types,
    purposes, and methods of data collection; the organization conducting
    the study; the names of principal investigators; plans for publication
    and references to reports published; and the name and address of the
    person prepared to give additional information.
    An analysis of consolidated data from six surveys of illness in
    selected areas of the United States shows case rates, by age, for about
    100 disease categories. Data on hospitalized cases, by age and sex,
    are included for 35 diagnostic groups. Consolidation of findings
    permits study of the duration and severity of illness in terms of days
    of disability, days in bed, and days of hospital care.
    An article published in Public Health Reports summarizes the
    results of a study of trends in two 6-year periods in age-specific death
    rates for cardiovascular-renal diseases, ulcers of the stomach and
    duodenum, hernia and intestinal obstruction, and diabetes mellitus
    among white men and white women.
    Long-term records of surveyed families in Hagerstown, Md., facilitate
    investigations of the subsequent history and illness experience
    in families that have been included in earlier surveys. Special studies
    108 Department of Health, Education, and Welfare, 1954
    completed or in progress in Hagerstown during the year include an
    analysis of the effects of radiation on the offspring of radiologists;
    preparations for a proposed followup study of persons found in earlier
    studies to have evidence of pulmonary or cardiac disorders; and an
    investigation of the health of older persons and their availability
    for work.
    National Institutes of Health
    The conduct and support of medical research is the major responsibility
    of the National Institutes of Health. In its own facilities
    and through its program of grants and fellowships, the NIH works
    with medical schools, universities, private foundations, voluntary
    health agencies, and pharmaceutical laboratories, in advancing
    medical science.
    With the Clinical Center added to its basic science laboratories,
    the National Institutes of Health now combines research in the
    processes of disease with study of the patient and application of
    research findings. By July 1954, the values of integrated basic and
    clinical research were becoming evident in important findings reported
    by the several Institutes. A full year of operation of the Center had
    shown that the plan is workable and holds great promise for the
    future.
    The Clinical Center
    Beginning with a single nursing unit of 25 beds, which received
    its first patients on July 6, 1953, the Clinical Center grew according
    to a planned schedule. By the year’s end, 250 beds in 10 units and
    approximately 65 percent of the total basic and clinical research area
    were available for use. It is not expected that full capacity will be
    reached until 1956.
    During the year, 865 in-patients from all parts of the country were
    admitted. They were distributed among the Institutes as follows:
    Cancer, 202; Heart, 189; Arthritis, 82; Neurology and Blindness, 172;
    Microbiology, 176; and Mental Health, 44. The average length of
    stay was 30 days. A total of 322 ambulatory patients was seen by
    clinicians of the Center in out-patient facilities and follow-up studies.
    The Institute of Dental Research conducted several clinical studies
    utilizing selected patients from the ambulatory group. It is expected
    that out-patient and follow-up studies will increase in scope
    and volume in the future.
    Public Health Service 109
    CLINIC AND LABORATORY
    Many research projects require observation of patients for longer
    periods of time and the use of a greater variety of techniques than
    are possible in most hospital environments. The Clinical Center’s
    facilities and its operational scheme meet these needs to an unusual
    degree. Patients are admitted on referral by their physicians when
    they have a condition required for a specific research project.
    Patients are expected to remain in the Center as long as they are
    needed for study purposes and to cooperate in prolonged follow-up
    observations after their discharge. General medical, nursing, and
    related services in the Center are of the high quality provided in good
    hospitals everywhere. Occupational and physical therapy services,
    religious ministry, and recreation programs are available. These
    services, provided by the staff of the Center and volunteer workers,
    help to maintain the patients’ morale. During the year, the total
    staff and the patients participated in a wide range of studies which
    ultimately will produce important findings related to the diagnosis
    and treatment of serious diseases and to the improvement of individual
    health.
    The study of healthy individuals helps scientists to understand the
    meaning and underlying causes of phenomena observed in ill patients.
    Arrangements have been made with certain religious groups and the
    National Selective Service Board whereby the Clinical Center may
    recruit and accept healthy volunteers as study patients. The procedures
    employed are carefully designed to prevent the exposure of
    these volunteers to undue hazards.
    Research Grant and Fellowship Programs
    The Public Health Service encourages independent research in the
    medical and allied fields by scientists throughout the country, and
    supports locally conducted field investigations and demonstrations.
    In fiscal year 1954, an increased proportion (68 percent) of the funds
    appropriated by Congress to the National Institutes of Health went
    to non-Federal agencies in the form of research grants, fellowships,
    traineeships, training grants, teaching grants, and field investigation
    and demonstration programs.
    The National Institutes of Health, through its Division of Research
    Grants, administers research grants and fellowships within the programs
    of its seven Institutes, plus a general grants program. National
    Advisory Councils, made up of national leaders in medicine, research,
    education, and public affairs have been established by law to select
    research projects for approval by the Surgeon General, and to advise
    the Public Health Service on broad research problems. To assist the
    110 Department of Health, Education, and Welfare, 1954
    councils, study sections composed largely of nongovernmental
    specialists in medical and allied research areas undertake technical
    review and evaluation of the grant applications.
    During fiscal year 1954, 3,596 applications for research grants were
    considered; 2,855 recommended awards, totaling $29,951,150, were approved
    for payment. The Public Health Service also awarded fellowships
    totaling $2,132,004 to 490 successful candidates in 130 research
    institutions. In addition, 323 teaching grants amounting to $5,894,-
    184; 251 training grants totaling $4,222,806; and 488 traineeships totaling
    $7,444,832 were made to physicians and other graduate students
    for advanced clinical study. Eighty-five grants, totaling
    $1,091,344, were awarded for the conduct of field investigations and
    demonstrations.
    Table 3, page 167, presents the numbers and amounts of research
    grants, fellowships, and field investigations and demonstrations
    awarded in 1954, by State and county. Table 4, page 168, shows
    similar data for the teaching grants, traineeships, and training grants.
    Some of the significant findings in studies supported by the Public
    Health Service are described in the reports of the various institutes.
    GENERAL GRANTS PROGRAM
    Many of the most important problems confronting medical research
    do not fall within the specific interest of any particular institute.
    The general grants program supports research in various biological,
    clinical, and public health areas. Because such research requires longterm
    support, 69 percent of the grants during fiscal year 1954 went
    to continuing studies.
    A considerable part of the general grants was awarded for research
    on the living cell. During the year, one group of grantees made
    significant progress toward the yet-unsolved problem of duplicating
    cell protein manufacture by synthesizing oxytocin, a substance secreted
    by the posterior pituitary gland. Another group has succeeded in
    building an amino acid, arginine, into proteinlike materials, removing
    one of the obstacles to the synthesis of such complex compounds as
    ACTH and vasopressin.
    Clinical studies have invalidated the commonly held theory that
    hyperacidity is necessary to produce peptic ulcer. Other grantees
    report definite progress toward an understanding of how hydrochloric
    acid is produced in the stomach.
    Radioactive isotope tracers are being employed in research on hay
    fever, contact dermatitis, and other allergic conditions. Another
    group of investigators has constructed an artificial smog generator
    which will permit study of the injurious effects of various chemical
    components of atmospheric pollution.
    Public Health Service 111
    Arthritis and Metabolic Diseases
    An operating program of clinical investigation, set up by the National
    Institute of Arthritis and Metabolic Diseases at the Clinical
    Center, has contributed significantly to medical knowledge. Meanwhile,
    continued basic research has thrown new light on such metabolic
    disorders as arthritis, diabetes, obesity, and diseases of the liver and
    endocrine glands.
    With the American Rheumatism Association and the Arthritis and
    Rheumatism Foundation, the Institute sponsored the first National
    Conference on Research and Education in the Rheumatic Diseases,
    held at the Clinical Center on November 19.
    RESEARCH PROGRESS
    A new and simple procedure has been devised to separate and purify
    the anti-hemophilia factor from blood, in quantity and purity previously
    unobtainable. The absence of this factor in the blood of
    persons with hemophilia is apparently responsible for their tendency
    to bleed excessively. Work is proceeding toward further purification
    and identification of the factor.
    Rheumatoid arthritis is often accompanied by an associated anemia,
    which decreases the patient’s resistance and complicates successful
    treatment. The nature of this anemia has now been determined. In
    such patients, red blood cells are destroyed at an increased rate and
    red-cell-producing tissues fail to compensate in a normal fashion.
    These findings should lead to more successful treatment, increasing
    the resistance and stamina of the arthritic patient.
    Work is continuing on the development of a new diagnostic test for
    rheumatoid arthritis, first reported last year. Now about 90-percent
    accurate, the test is based upon an agglutination reaction that occurs
    when a patient’s blood is mixed with sensitized red blood cells
    of sheep. The reaction is caused by a factor found to be in the plasma
    protein fraction of the patient’s blood plasma. Although the protein
    has been concentrated 300 times, the active factor has yet to be
    completely purified.
    A study recently completed by NIAMD scientists reveals that
    Philadelphia school children at 6 to 9 years of age averaged 2 inches
    taller and 2 to 4 pounds heavier in 1949 than children of the same
    age in the late 1920’s.
    In collaboration with the United Nations, the Institute is conducting
    extensive research to identify the geographic sources of opium, thereby
    assisting the U. N. in controlling illicit drug traffic. Methods being
    investigated include infrared analysis, ash analysis, chromatography,
    X-ray diffraction, and studies of methoxyl and organic nitrogen
    content.
    112 Department of Health, Education, and Welfare, 1954
    New and ingenious tools have been devised to measure cortical hormones
    and their metabolites in body fluids, as an aid to determining
    exactly what happens to these hormones in the body.
    Growth hormone has been shown to affect profoundly the production
    of collagen, an important constituent of connective tissue. In
    certain endocrine imbalances, such as thyroid insufficiency, collagen is
    produced faster than all other proteins. This discovery is of additional
    importance because abnormalities of connective tissue are known
    to be present in rheumatic diseases. The availability of growth
    hormone in pure form now permits a definitive study of its relation
    to arthritis.
    Rice, which is quite deficient in protein content, is a major item in
    the diet of millions of people. It is also a major constituent of a diet
    used in the treatment of high blood pressure. Institute scientists have
    found that its value in laboratory animals can be increased threefold
    by the addition of two essential amino acids, lysine and threonine.
    Clinical investigations are now underway to determine the effect of
    enriched rice diets on human nutritional status.
    Employing a specially constructed “respiratory chamber,” Institute
    clinicians are undertaking a new series of energy and mineral metabolism
    studies. The chamber is a specially equipped room designed
    to measure continuously the total energy expenditure of human subjects
    at various time intervals. Such studies are particularly important
    with relation to obesity and its influence in predisposing its
    victims to early development of high blood pressure and diabetes.
    RESEARCH GRANTS AND SOME RESULTS
    Research grants totaling $3,272,307 were approved for payment to
    359 projects by the National Advisory Arthritis and Metabolic Diseases
    Council from 1954 appropriations. These projects were conducted
    in 38 States, the District of Columbia, and one foreign country.
    Research fellowships totaling $174,834 were awarded to 41 applicants,
    and training stipends totaling $238,836 to 69 trainee physicians.
    Results include the determination of a quantitative relation between
    a hormone and its metabolic effect on a specific process. Methods for
    the preparation of radioactively labeled insulin have been developed
    and described, permitting the study of insulin action in the body.
    The long-term effects of treated diabetes in humans are under close
    study. Approximately 200 diabetic children, under observation since
    the onset of the disease, have been given exhaustive chemical and
    clinical examinations at 6-month intervals. It is hoped that most of
    these patients can be studied for at least 30 years.
    Public Health Service 113
    Cancer Research and Control
    An expanded search for new knowledge on the causes, prevention,
    and cure of malignant diseases continued under the National Cancer
    Institute’s program. The Nation’s investment in cancer research and
    control during the past 17 years has yielded important results. New
    methods are available which give greater hope for the control of
    these diseases than could be entertained in the past. However, data
    on cancer incidence indicate that, even if the risks of cancer remain
    constant, the number of people affected by the disease can be expected
    to increase by 50 percent in the next 25 years. This is because the
    total population has increased and a higher proportion are reaching
    the ages where the cancer risk is greater.
    LABORATORY AND CLINICAL STUDIES
    The study of proteins has been hampered by their resistance to separation
    and isolation. Institute biochemists have devised a new chromatographic
    method for separation of soluble proteins in their natural
    state. Human serum can apparently be fractionated into at least
    14 different components, and enzymatically active proteins may be
    separated from one another.
    Drugs used in the treatment of clinical cancer sometimes have undesirable
    effects. In a project designed to develop more effective and less
    toxic drugs, the Institute is studying the pharmacological properties
    of drugs that have potency in affecting established tumors in
    laboratory animals.
    Institute scientists and members of several non-Federal institutions
    collaborated in studies of the tendency of leukemic cells to become
    resistant to, or dependent on certain drugs. It has been found that
    resistance or dependence induced by antipurine drugs renders cells
    of some experimental leukemias unusually sensitive to drugs with
    antifolic action. Combined therapy, with each drug exerting its
    activity independently, has strikingly increased the survival time of
    leukemic mice and has even resulted in cures.
    Studies in endocrinology have shown that massive parenteral estrogen
    therapy of mammary cancer with water-soluble estrogens is
    clinically feasible. Results indicate that more profound and more
    rapid regressions of breast cancer can be obtained by massive doses
    than by conventional oral administration of estrogenic substances.
    The search continues for effective means of protection against large
    doses of irradiation. One experiment showed that lyophilized cortical
    bone from rats will protect mice against lethal doses of X-rays in much
    the same manner as bone marrow. This makes it more probable that
    a humoral factor is responsible for this phenomenon.
    114 Department of Health, Education, and Welfare, 1954
    A. 3-million electron volt generator is being installed in the radiation
    wing of the Clinical Center, to be used for experimental research on the
    radiochemical and biological effects of X-rays and electron energy.
    BIOSTATISTICAL STUDIES
    A report on “Geographic Distribution of Mortality from Cancer of
    the Lung in the United States, 1948-49” was completed. Similar
    data for cities of 100,000 and over are complete and under analysis.
    A report presenting an analysis of the 10-city cancer morbidity survey
    was completed and prepared for printing as a Public Health Monograph.
    Several new epidemiological and statistical studies were undertaken
    to obtain additional data on the possible relationship between
    cigarette smoking and lung cancer.
    SUPPORT OF RESEARCH AND CONTROL
    Research grants totaling $7,552,188 were recommended for 669 projects
    by the National Advisory Cancer Council and approved by the
    Surgeon General for payment during 1954. Of these, 135 grants in the
    amount of $2,632,687 were made for work related to the chemotherapy
    of cancer. The council also recommended 85 field investigation grants
    totaling $1,228,356. Research fellowships were awarded to 177 applicants.
    The construction program was terminated with payment of
    the last active cancer research construction grant in June. Fifty of the
    fifty-five construction projects for which funds were made available
    in former years were completed by the end of the year.
    In addition, grants totaling more than $2,273,000 were made to 82
    medical schools, 42 dental schools, and 6 schools of osteopathy for
    undergraduate teaching. During the year, 154 physicians received
    training stipends for advanced clinical study in 71 schools. Cancer
    control programs in the States received financial assistance in the
    amount of $2,250,000.
    STUDIES SUPPORTED BY GRANTS
    A Subcommittee on Chemotherapy of the National Advisory Cancer
    Council was established to spearhead a national program designed to
    bring about earlier solutions to problems that seriously limit the chemotherapeutic
    attack on cancer, including leukemia. Mechanisms for
    closer cooperation, including the rapid exchange of information,
    has expedited progress in this promising field.
    Grant-supported scientists found that cortisone therapy in large
    doses by mouth produced significant, though brief remissions of
    metastatic breast cancer. The measurement of calcium excretion
    proved to be a better index than histological appearance or clinical
    behavior in differentiating skeletal metastatic breast cancer which
    Public Health Service 115
    reacts to or is unaffected by estrogen therapy. This permits an early
    decision as to whether estrogen therapy should be continued or not.
    Progress was made in the evaluation of cancer therapy by supervoltage
    radiation (in excess of 1 million electron volts) to learn whether it
    will offer more effective therapy for cancer than the more conventional
    (250,000 electron volts) levels generally in use. One grantee has
    developed a new technique utilizing supervoltage radiation for the
    diagnosis of lung cancer. Clinical evaluation of this technique may
    demonstrate its possible use as an X-ray lung cancer screening device
    for large segments of the population.
    The cytology test continued to prove its effectiveness as a diagnostic
    aid in the detection of uterine cancer at an early stage when chances for
    cure are greatest. At the end of the year, screening of 63,661 women
    was completed, with discovery of 475 cancers, 60 percent of which were
    unsuspected prior to examination.
    A film produced jointly by the institute and the American Cancer
    Society, “Oral Cancer—The Problem of Early Diagnosis,” was completed
    and made available for professional use.
    Dental Research
    The National Institute of Dental Research conducts and sponsors
    research in the most prevalent dental and oral diseases. These include
    dental caries, periodontal disease, malocclusion, cleft palate, harelip,
    and oral cancer. For the past 5 years, annual appropriations of
    $221,000 have been used to help support about 24 research projects
    each year in dental schools and other institutions. Additional studies
    are conducted in the Institute’s facilities and the Clinical Center.
    A research grant project at the University of Illinois has shown
    that the general health of individuals is reflected in the tissues of the
    mouth. The results so far suggest that certain changes in the oral
    tissues may serve as a guide to early recognition and diagnosis of systemic
    disease.
    At Yale University, a research grant is supporting studies on
    the transplantation of embryonic “tooth germs” into the eyes of
    experimental animals, where their further development can be directly
    observed. It has been found that a cancer-inducing agent, known as
    methylcholanthrene, had changed the microscopic appearance of the
    “tooth germ” transplants to resemble that of malignant tumors.
    During the year, a special technique was developed in the Institute’s
    laboratories for isolating and cultivating a group of bacteria
    associated with dental caries and periodontal disease. Experimental
    animals are being studied to evaluate the use of antibiotics and other
    therapeutic agents. Certain of the new antibotics, such as bacitracin,
    show some promise.
    116 Department of Health, Education, and Welfare, 1954
    Studies on the metabolism of ingested fluorides received increased
    attention during the year. Epidemiologic studies on fluoridation of
    public water supplies in Michigan, Maryland, and Illinois continue
    to demonstrate striking reduction in the incidence of dental caries.
    The Institute recently completed a 10-year field study in two Texas
    towns, where medical and dental examinations of over 200 residents
    showed that no physiological changes attributable to fluoride could
    be detected in persons who had long used water supplies naturally
    containing eight times the amount of fluoride recommended for caries
    control.
    Other projects included electron-microscope studies of dental and
    related tissues, and nutrition research into the incidence of caries in
    animals receiving processed or natural foodstuffs. The latter studies
    indicate that overprocessed foods lead to increased tooth decay in rats.
    Research projects now under way at the Clinical Center include: a
    study on developmental abnormalities of the face and jaws, including
    harelip and cleft palate; evaluation of methods for the treatment of
    malocclusion; evaluation of various clinical procedures in the treatment
    of periodontal disease; and a study of vitamin therapy in wound
    healing following surgery in the oral cavity.
    Heart and Circulatory Research
    Research conducted by the National Heart Institute expanded
    during the year. The opening of the Clinical Center permitted a
    balanced and integrated program of laboratory and clinical investigation
    of the Nation’s leading causes of death.
    Heart research in universities and hospitals throughout the country,
    supported by the Institute through grants, also made important contributions
    to knowledge of heart and blood vessel diseases. More than
    600 research grants amounting to $7,120,146 were made to 140 institutions
    in 41 States, the District of Columbia, and Hawaii.
    Increased emphasis was given in 1954 to Institute programs designed
    to help relieve scarcities of medical, scientific, and other personnel
    especially qualified in the cardiovascular diseases. Research
    fellowships totaling $597,972 were awarded to 127 individuals, and
    clinical traineeships amounting to $396,900 were awarded to 116 physicians.
    One hundred and eighteen grants, amounting to $2,692,708,
    were made to medical schools and other institutions for undergraduate
    and graduate training in cardiovascular medicine and public health.
    Resources of the Institute also assisted the progress made in 1954
    in development of community programs for controlling heart disease.
    This aid, provided in conjunction with the Bureau of State Services,
    included technical assistance and grants to the States and Territories.
    Public Health Service 117
    RESEARCH ADVANCES AT NHI
    Atherosclerosis underlies coronary heart disease, as well as the many
    other manifestations of hardening of the arteries. Studies aimed at
    understanding its development constitute a major area of Institute research.
    Because atherosclerosis is related to the abnormalities of fat
    content of the blood, the mechanisms by which fat is handled by the
    body are now under study. Studies of the heparin-containing “clearing”
    system, which breaks down the large fat-laden molecules to
    smaller entities, have been extended and its role in the body evaluated.
    The concentration of fatty substances in the blood is increased when
    substances which tie up the heparin in the body are administered.
    This indicates that the clearing system, heretofore studied in the test
    tube, affects the normal regulation of blood fat in the human body.
    Studies of the formation and release of heparin and the distribution of
    “clearing” activity in body tissues are in progress. The abnormalities
    which may be present in relatively young individuals who have suffered
    attacks of coronary thrombosis are under study. The effect on
    blood fats of administering certain hormones is being evaluated.
    The series of events leading to congestive heart failure—the abnormal
    retention of salt and fluid—has received further study by a
    number of approaches. Development of a technique for inducing
    heart failure in dogs provides a tool for the study of the mechanism of
    heart failure itself, as well as for the study and evaluation of the effect
    of drugs on the failing heart. It has been shown that the adrenal
    glands play an important role both in experimental heart failure and
    in human heart disease. A promising lead currently being exploited
    is an indication that there may be, in the circulating blood, a hormone
    necessary for the normal contraction of the heart muscle. Using the
    beat of the heart muscle itself as a method of measuring this substance,
    studies intended to isolate and identify it are under way. Their ultimate
    purpose is to determine the source of this substance and its role
    in the maintenance of normal heart function.
    Investigations aimed at improving the treatment of heart disease
    through the development of new drugs have been prosecuted vigorously.
    Studies of the way in which drugs are broken down in the
    body have led to the isolation of an enzyme system which apparently
    converts most of the drugs in general use to inactive compounds.
    Using this system, it may be possible to determine whether drugs may
    be rendered inactive too rapidly to be useful or so slowly as to be
    undesirable. Also, using information on the way drugs are broken
    down, it may be possible to improve them. A search for new drugs
    to control irregularities of the heart beat has produced several encouraging
    leads. Such disturbances of the heart rhythm are an old
    and persistent problem in many forms of heart disease, but the need
    118 Department of Health, Education, and Welfare, 1954
    for a solution has been greatly accentuated by the frequency of serious
    irregularities in patients whose body temperature must be reduced
    for the performance of certain surgical operations on the heart and
    blood vessels.
    Drugs are being sought to reduce the blood pressure in hypertensive
    patients. The first compound isolated and identified in the Institute’s
    laboratories has now been given preliminary trial in patients. This
    particular substance, andromedotoxin, derived from Rhododendron,
    will probably not become an important agent for the treatment of
    hypertension; however, it may provide a starting point for the development
    of drugs with more desirable characteristics.
    New techniques and scientific instruments often lead to major advances
    in research. An instrument recently perfected in the Institute’s
    laboratories makes possible the chemical analysis of minute
    amounts of a number of compounds by the fluorescence which they
    emit when excited by light of the proper wave length. Currently
    under development is an instrument which it is hoped will permit
    the accurate analysis of salts (sodium and potassium) in volumes as
    small as one one-millionth of a cubic centimeter of body fluids. This
    might make it possible to analyze the content of single body cells.
    RESEARCH GRANTS ACCOMPLISHMENTS
    Notable advances were made by scientists whose research was supported
    by grants from the National Heart Institute. The following
    illustrations represent only a small fraction of the important contributions
    of grantees during the past year.
    Clinical studies in rheumatic fever showed that a new antiserum
    test is a sensitive and reliable indicator of rheumatic activity if other
    unrelated pathologic processes are excluded. The substance used,
    known as C-reactive protein (CRP) antiserum, indicates the presence
    of an underlying inflammatory condition in the body. CRP is a
    specific protein, not present in normal blood serum, which appears in
    response to a number of inflammatory conditions. Since rheumatic
    fever often exists without definite outward manifestations, the antiserum
    test promises to be a valuable aid in diagnosing the condition.
    Important progress was made in the use of drugs for treatment of
    high blood pressure. One drug, obtained from the root of the Indian
    Snakewood plant (Rauwolfia serpentina), has been found effective
    in reducing blood pressure in mildly hypertensive patients. Headache,
    fatigue, and shortness of breath are relieved, and patients frequently
    express a sense of relaxed well-being. Studies have shown
    also that patients with more severe forms of hypertension may benefit
    from Rauwolfia used in combination with other more powerful drugs.
    In combined therapy, beneficial effects of the other drugs may be
    Public Health Service 119
    heightened and their harmful reactions sometimes suppressed or
    moderated.
    A dramatic advance in heart surgery made by a grantee was a new
    two-person “cross-circulation” technique for maintaining blood circulation
    in a patient’s body while the flow through the heart itself is
    cut off so that the operation can be performed. The blood systems of
    the patient and another person are joined by thin plastic tubes and a
    simple mechanical pump, so that the patient’s blood passes through
    the other person’s body to be purified and replenished with oxygen.
    The method has been successfully used in operations for congenital
    heart defects.
    Mental Health
    In its cooperative programs of research, training, and community
    mental health services, the National Institute of Mental Health observed
    during the past year significant trends toward a coordinated
    approach to the prevention, treatment, and control of mental illness.
    The first National Conference of Governors on Mental Health, held
    in February 1954, and the Conference of Governors of Southern
    States, held later in the year, recognized that research and the training
    of personnel are the basic tools of progress against these disorders.
    They adopted the concept that preventive, therapeutic, and institutional
    services cannot operate effectively in isolation from one another,
    nor from the communities they are created to serve. A ten-point
    program was adopted by the national conference, and a similar plan,
    including regional cooperation in the training of personnel, was
    adopted by the Southern conference.
    To accelerate research in important psychiatric fields, the Institute
    inaugurated a special research grants program designed to support
    the work of outstanding young psychiatrists desiring to engage in
    research as their permanent career.
    RESEARCH PROGRAMS OF THE INSTITUTE
    Important progress was made in methodology and knowledge of the
    nervous system. A new tool, developed for studying the subarachnoid
    function, has revealed unexpected differences in the barrier between
    cerebrospinal fluid and the brain. Other studies include methods
    of recording spatial patterns of electrical activity of the cerebral
    cortex and of measuring local circulation in the brain.
    At the Drug Addiction Center of the Public Health Service Hospital
    in Lexington, Ky., a team of scientists continued to study factors
    which lead to and maintain addiction. Studies on pain-relieving
    drugs, including synthetic substitutes for codeine, were also continued.
    120 Department of Health, Education, and Welfare, 1954
    It was formerly believed that lysergic acid diethylamide (LSD-
    25) produced no change in the condition of schizophrenic patients.
    Studies at the Clinical Center demonstrated that characteristic
    changes do occur, even in acutely ill patients. The nature of these
    changes and the mode of action of the drug are now under study.
    Simultaneous psychotherapy of mother-daughter pairs, one or both
    of whom show symptoms of schizophrenia, is under study as a means
    of determining the psychological interactions between family members
    which may affect occurrence of the disease. Both parents of
    adult schizophrenic patients also are being interviewed by Institute
    staff members for the same purpose.
    Efforts are being made to identify factors which determine whether
    a disturbed child will express rage by destructive actions or will
    repress his feelings.
    INSTITUTE-SUPPORTED RESEARCH
    During fiscal 1954, 180 research grants totalling $2,611,768 were
    awarded in 30 States, the District of Columbia, and Puerto Rico.
    Projects supported by these grants covered a wide range of problems
    in mental disease and deficiency.
    Studies on schizophrenia were conducted in the following areas:
    basic physiology and metabolism; activity of the adrenal cortex
    under mental and emotional stress and after electroshock therapy;
    metabolism of steroids in normal and schizophrenic subjects; physiological
    effects of inhalation of carbon dioxide; social and familial
    backgrounds as causative factors in schizophrenia.
    Research projects in the field of mental deficiency included: study
    of a specialized preschool program to accelerate the development of
    mentally handicapped children; effect of specialized therapy and
    instruction on the intelligence quotient; the selection of psychologically
    qualified technicians, aides, and other institutional personnel;
    nutritional requirements and metabolic patterns of mongolian idiots;
    intellectual functioning in mentally defective as compared with normal
    children; growth patterns in various types of mental deficiency.
    MENTAL HEALTH STATISTICS
    A cooperative study with the Warren State Hospital of Pennsylvania
    has yielded important data upon which to base predictions of
    length of stay in mental hospitals, according to the age, sex, and
    diagnoses of the patients. The records of the Warren State Hospital
    cover a continuous period of 40 years, and the analysis of these data
    has provided mental hospital administrators with a statistical method
    for describing accurately the movement of the patient population.
    Public Health Service 121
    COMMUNITY SERVICES
    The Institute aided in the development of community services in
    the States through financial grants, consultation, demonstrations, and
    cooperative activities with other State and Federal agencies and
    voluntary organizations.
    Rehabilitation of the mentally ill received increased attention in
    the States. Some of the measures adopted were foster-home care,
    vocational rehabilitation, supervision of patients in their own homes,
    and expanded out-patient services for patients discharged from mental
    hospitals. Useful information on rehabilitation of mental patients
    was obtained in two studies, one at the Boston State Hospital and the
    other at the Harvard School of Public Health.
    PROFESSIONAL ORIENTATION
    During the year, the training program continued to augment manpower
    resources in the mental health professions. Two hundred and
    sixty-six grants to 149 medical schools, graduate training centers,
    and other institutions, totaling $4,346,117, included funds for 747
    traineeships for advanced work in many professional fields.
    Microbiological Research
    Many chronic diseases are of infectious origin or have an important
    infectious component. The National Microbiological Institute has
    placed increased emphasis on the relationship of infections and such
    chronic disorders as heart disease, cancer, and neurological diseases.
    One of the major findings of the Institute in the past year concerns
    the chronic disorder known as chorioretinitis, an eye disease which
    produces a devastating inflammation of the retina and its supporting
    structures. In recent years, ophthalmologists have suspected that this
    disease might be caused by microscopic parasites known as Toxoplasma.
    A scientist of this Institute proved this hypothesis by isolating
    the Toxoplasma organism from an eye removed from a patient
    suffering from chorioretinitis.
    Studies aimed at better treatment methods for such eye diseases were
    begun immediately in the Clinical Center, in cooperation with the
    Institute of Neurological Diseases and Blindness. The drug investigated
    was an antimalarial drug, Daraprim, which earlier had been
    found active against toxoplasmic infection in mice when administered
    in conjunction with sulfadiazine. Preliminary results in patients
    proved encouraging.
    A new group of respiratory viruses has been uncovered by means of
    prolonged growth of adenoid cells in tissue culture. These have been
    classified into 6 types, 2 of which have already been shown to produce
    339010—55------ 9
    122 Department of Health, Education, and Welfare, 1954
    clinical illness. Epidemiologic studies by Institute scientists indicate
    that these agents cause widespread infection, particularly in
    childhood and early adulthood.
    Some vaccines used in immunization are known to fail on occasion.
    During the past year, a Microbiological Institute scientist has developed
    a standard potency test for the whooping cough vaccine.
    This test, adopted by manufacturers, marks the first time any nation
    has succeeded in developing a standard requirement for this vaccine.
    There is reason to believe that the test will reduce the number of
    vaccine failures in whooping cough.
    Outstanding progress against amebic infections, which afflict an
    estimated 7 percent of the Nation’s population, has been reported in
    two areas. Basic studies with germ-free and conventional guinea pigs
    yielded concrete evidence that common intestinal bacteria have a role
    in the experimental production of disease by the ameba. In another
    study, a new antibiotic, Puromycin, proved highly effective against
    induced amebic infections in the guinea pig.
    Many of the clinical studies initiated during the year were closely
    integrated with fundamental laboratory and epidemiologic research,
    some of which was already in progress. A good example was an outbreak
    of a disease resembling poliomyelitis among nurses at a nearby
    private institution. Within a few hours after the first cases had been
    reported by private physicians, the patients had been referred to the
    Clinical Center and concurrent clinical, laboratory, and epidemiologic
    studies were begun.
    Among the many clinical projects inaugurated in the Center were
    investigations of rheumatic fever, histoplasmosis, infectious hepatitis,
    brucellosis, and amebiasis.
    The Institute’s laboratory at Hamilton, Mont., continued its extensive
    inquiry into endemic diseases of the western areas of the United
    States, with special emphasis on the diseases of animals transmissible
    to man.
    RESEARCH GRANTS
    Microbiological research grants to the Nation’s universities and
    research laboratories totaled 217 and amounted to $2,062,000 in the
    past fiscal year. These grants supported studies in 97 institutions
    located in 35 States and the District of Columbia, Hawaii, and 3
    foreign countries. Thirty-two fellowships totaling $116,948 were
    also awarded.
    A number of significant findings were reported by grantees during
    the past year. Cortisone and certain related compounds were found
    to diminish resistance to pneumococcal and influenza-virus infections
    in a study of hormones in relation to infections. Another grantPublic
    Health Service 123
    supported project, concerning treatment of tuberculosis in children,
    showed that isoniazid, PAS, and Promizole produced no significant
    toxic effects in the doses used.
    Neurological Diseases and Blindness
    The national research attack on the neurological and sensory disorders
    has almost doubled in strength during the past 3 years. The
    past years saw that work begin to bear results; it was a year of major,
    practical achievement.
    Scientists have long sought the cause of epilepsy. During the past
    year, as a result of work by scientists of the National Institute of
    Neurological Diseases and Blindness, the cause was clarified and the
    means given, thereby, of establishing a rational, therapeutic treatment.
    Three metabolic defects were found to occur in epileptic brain
    tissue—in acetylcholine and potassium metabolism, and most important,
    it is believed, in glutamic acid metabolism. The Institute has
    begun the administration of glutamine and a related substance, asparagin,
    to a few patients. Results have been encouraging: frequent,
    intractable seizures, unresponsive to other forms of therapy, have
    been partially or wholly controlled. Whether a new, more effective
    treatment for epilepsy has in fact been established remains to be seen.
    At present the blood-brain barrier, through which the drugs must
    pass, offers the principal difficulty.
    Muscular dystrophy patients at the Clinical Center have been found
    to excrete an unknown sugar. This is the first metabolic defect found
    which does not seem to occur in other neurological or neuromuscular
    diseases and may, therefore, provide a clue to the cause of the disorder.
    RESEARCH GRANTS ACCOMPLISHMENTS
    Prevention of one major cause of blindness—retrolental fibroplasia—
    can now be achieved. Animal studies, which had indicated
    that oxygen was closely related to the occurrence of the disorder, were
    confirmed this year through a broad clinical investigation conducted
    at 18 hospitals by more than 75 ophthalmologists and pediatricians
    working under grants from the Public Health Service, the National
    Foundation for Eye Research, and the National Society for the Prevention
    of Blindness. As a result of this study, physicians and hospitals
    were advised that except in clinical emergencies, administration
    of oxygen to premature infants should be approached with
    extreme caution. The study revealed that most of the risk of contracting
    retrolental fibroplasia occurred from oxygen given during the
    first week of life.
    124 Department of Health, Education, and Welfare, 1954
    New methods for the management of infants with kernicterus or
    erythroblastosis fetalis were proposed as a result of findings in another
    grant-supported project. Kernicterus occurs in newborn children as
    a result of Rh incompatibility. Of the estimated 2,000 patients
    yearly, approximately half die and half live with severe neurological
    disorders or mental deficiency. Previous treatment of kernicterus
    through blood transfusion rendered the disease latent, for either death
    or brain damage with the resulting cerebral palsy eventually ensued.
    A sensitive blood test was needed to determine the amount of bilirubin
    remaining in the blood after transfusion (thereby indicating the subclinical
    presence of the disease) and the level at which it constituted
    a danger. This means of measuring the amounts of bilirubin has now
    been obtained. With it has emerged the new practice of multiple
    exchange transfusions (recirculating the babies’ blood several times)
    for all Rh incompatible infants within 48 hours after birth.
    A grant recipient has elaborated a method which facilitates the
    difficult procedure of analyzing protein in spinal fluid analysis. Since
    the protein, gamma globulin, is elevated in patients with multiple
    sclerosis, this new methodology may provide a rapid, objective diagnostic
    procedure. Methods presently in use permit diagnosis only
    after the disease has run its course for an average of 6 years.
    Bureau of Medical Services
    The Bureau of Medical Services administers the programs of the
    Public Health Service which relate to care of the individual; the
    development of hospital, nursing, and dental resources ; the construction
    of hospitals and medical facilities; and foreign quarantine. The
    Bureau operates the hospital and out-patient facilities of the Service
    and exercises professional supervision over personnel assigned to
    other Federal agencies for the administration of medical and hospital
    programs. Other functions include the development of data and the
    conduct of studies on nursing, dental, and hospital resources in the
    United States.
    Hospitals and Medical Care
    The Division of Hospitals conducts the medical care program for
    merchant seamen and other legal beneficiaries of the Public Health
    Service. Other beneficiary groups include the officers and enlisted
    men of the U. S. Coast Guard, officers and crew members of the Coast
    and Geodetic Survey, commissioned officers of the Public Health
    Service, Civil Service employees of the Federal Government injured
    Public Health Service 125
    or taken ill as a result of their employment, and several smaller groups
    with specialized illnesses.
    The Division also administers a service to Federal departments
    requesting consultation on establishing or improving health activities
    for their personnel. As one phase of this program, the Public Health
    Service operates 14 separate health units, most of them for agencies
    in the national capital area.
    In 1954 the Public Health Service maintained 16 hospitals, 25 outpatient
    clinics, and 96 outpatient offices. Twelve hospitals provide
    general medical and surgical services; 1 is exclusively for patients with
    tuberculosis; 2 treat narcotic addiction and neuropsychiatric disorders
    ; and 1 cares for persons with leprosy. Most of the hospitals
    are located at major ports. Outpatient clinics and offices are located
    in other areas where Service beneficiaries are concentrated. Staffed
    by full-time personnel, the clinics provide a range of medical, dental,
    and allied health services.
    VOLUME OF SERVICES
    Admissions to hospitals and clinics in 1954 reflected the curtailment
    begun in 1953 when one hospital was closed and five others were converted
    to outpatient clinics. The volume of services provided was
    also influenced by numerical reductions in some of the beneficiary
    groups—American seamen and Federal employees, for example—and
    by decreases in the numbers of patients referred by other agencies,
    especially the Veterans Administration.
    Total inpatient admissions declined 16 percent—from 57,387 in
    1953 to 48,282 in 1954; the average daily patient census dropped 11
    percent from 6,335 to 5,640. However, outpatient visits fell only 6
    percent, and remained over the 1,000,000 mark. The general hospitals
    admitted 43,329 patients in 1954 as compared with 51,545 in
    1953. The daily number of patients at these stations averaged 2,947
    or 12 percent fewer than the average for 1953.
    SPECIAL HOSPITALS
    The tuberculosis hospital at Manhattan Beach, Brooklyn, N. Y.,
    maintained an average daily patient census of 343 throughout the
    year, a rate higher than its 325-bed capacity. The outpatient department
    registered 4,227 visits, a 12-percent increase, showing augmented
    interest of discharged patients in returning for checkups.
    During the year, a laboratory to determine pulmonary function
    studies was established, and an outstanding chest surgeon served as
    consultant. These developments greatly increased the amount of
    successful chest surgery performed. An orientation program was
    126 Department of Health, Education, and Welfare, 1954
    launched for patients and their visitors. Steps were taken to give
    hospital personnel a higher degree of protection against the disease.
    The Public Health Service operates at Carville, La., the only hospital
    in the continental United States devoted entirely to the treatment
    of leprosy. Any patient with leprosy (Hansen’s disease) in the
    United States may be admitted and will receive complete medical care
    and maintenance. The hospital also conducts diversified social service
    and community activities programs.
    During 1954, the sulfone drugs still constituted the “treatment of
    choice” at Carville. Most sulf one-treated patients enjoy greatly improved
    general health, and if treatment is begun in the early stages,
    the ravages of leprosy can be avoided. Because the effect of these
    drugs is slow, clinical investigators at Carville are continuing the
    search for more efficient and quicker-acting agents.
    Admissions to the Public Health Service Hospital at Carville
    totaled 60 in 1954, as compared with 90 the year before. The average
    daily census declined from 385 to 360, as patients with “closed” cases
    were discharged. As in many other chronic diseases, the patient with
    leprosy may enjoy long periods relatively free from disease activity.
    The Public Health Service hospitals at Lexington, Ky., and Fort
    Worth, Tex., admitted 4,536 patients during the year, 13 percent
    fewer than in 1953. Treatment for narcotic drug addiction generally
    consists of withdrawal of drugs under close observation and treatment,
    followed by thorough medical, psychiatric, and social study. Through
    work therapy combined with psychotherapy, an effort is made to
    rehabilitate the patient so that he can meet the ordinary problems of
    living without recourse to narcotics. The medical staff advises a
    minimum of 135 days of treatment for voluntary patients. Those
    sentenced by Federal courts usually remain a year or more.
    CLINICAL RESEARCH
    Approximately 100 clinical studies were underway at Public Health
    Service hospitals during the year. Many of these were conducted as
    cooperative studies with other Public Health Service programs or as
    part of the individual hospitals program; others were initiated independently
    by staff physicians interested in a particular problem.
    The Manhattan Beach hospital cooperated with the Division of
    Special Health Services, Bureau of State Services, in its chronic disease
    and tuberculosis program and tested the use of isoniazid in the
    treatment of tuberculosis. The Lexington hospital participated
    in cooperative research with the National Institute of Mental Health
    in a continuing effort to find nonaddicting, pain-relieving drugs as
    effective as those in the opium series.
    Public Health Service 127
    PROFESSIONAL EDUCATION
    In 1954, seven Service hospitals were approved for postgraduate
    preparation of physicians by the American Medical Association. The
    American Dental Association approved eight Service hospitals for
    dental internships. On July 1, 1954, 72 medical interns, 30 dental
    interns, and 111 residents were on duty. At several of the hospitals,
    qualified trainees participated in approved professional education
    programs in dietetics, pharmacy, physical therapy, occupational
    therapy, social service, medical record library science, anesthesiology,
    medical technology, X-ray technology, and hospital administration.
    The 1954 spring semester began an affiliation between the Public
    Health Service Hospital, Fort Worth, Tex., and Texas Christian
    University. Students received general orientation in modern hospital
    treatment of mental diseases. They then were given individual
    practice assignments, working with patients under staff instruction
    and supervision in such specialty areas as vocational guidance, recreation,
    occupational therapy, and educational therapy (which includes
    pastoral counseling by graduate students of the School of Religion).
    Official university credit is granted for work satisfactorily completed
    at the hospital.
    FREEDMEN’S HOSPITAL
    Freedmen’s Hospital is the teaching hospital of the Howard University
    School of Medicine. It also operates a School of Nursing.
    The hospital has 329 general beds, 51 bassinets, and a 150-bed
    tuberculosis annex.
    In 1954, Freedmen’s Hospital admitted 11,746 inpatients, a slight
    increase over the previous year. The daily inpatient census in 1954,
    however, averaged 440 as compared with a 1953 figure of 457.
    The outpatient department reported 56,061 visits to its 33 organized
    clinics. Registrations of new patients totaled 6,487. Each of
    these figures represents a slight increase over 1953.
    Forty residents, 10 interns, 8 externs, and 4 fellows received advanced
    medical training. There were also 145 undergraduate medical
    trainees and 2 dental interns at the hospital. The School of Nursing
    enrolled 101 student nurses, 31 of whom completed the requirements
    for graduation. Other approved hospital training programs conducted
    at Freedmen’s during the year included 2 pharmaceutical internships,
    10 diabetic internships, and 1 administrative residency.
    Four social service students, one clinical psychology student, and 55
    practical nursing affiliates also received experience and instruction in
    their fields.
    During the year, approximately 70 clinical research projects were
    in progress, half of which reached completion.
    128 Department of Health, Education, and Welfare, 1954
    The Women’s Auxiliary of Freedmen’s Hospital increased its membership
    by 35 percent—now numbering over 700—and organized a
    Junior Auxiliary of high-school students. The growth of this volunteer
    program offers continuing evidence of the cordial relationship
    between Freedmen’s Hospital and the Washington community.
    Many local organizations contribute to the welfare, comfort, and entertainment
    of its patients.
    Health Protection at Ports and Borders
    To protect the Nation from epidemic disease imported from abroad,
    the Division of Foreign Quarantine enforces national and international
    quarantine regulations at all points of entry to the United States
    and performs the required medical examination of foreign citizens
    entering this country under the immigration laws and regulations.
    During 1954, not one case of plague, cholera, yellow fever, smallpox,
    louse-borne typhus, or relapsing fever was reported in the United
    States. Total arrivals from foreign countries numbered 47,307 aircraft,
    27,171 ships, and over 39 million persons.
    Yellow fever was reported as far north as Honduras, Trinidad, and
    parts of Colombia and Venezuela. The vector of urban yellow fever,
    the Aedes aegypti mosquito, still exists in the South Atlantic and
    Gulf States in sufficient quantity to render many localities receptive
    should the infection ever be reintroduced.
    Severe smallpox epidemics broke out in several parts of Asia during
    the year, notably in India and Indochina, and the disease remained
    widespread in Africa and parts of South America. Europe was comparatively
    free of smallpox, despite a mild outbreak in The Hague,
    Netherlands.
    India had an unusually bad cholera year, but the infection did not
    spread beyond that general area. Less than a thousand cases of plague
    were reported in India—a mere 1 percent of the incidence 30 years ago.
    MEDICAL EXAMINATIONS
    Under the Refugee Relief Act of 1953, medical examination services
    were provided in Austria, Germany, Greece, Hong Kong, Italy, Japan,
    and the Netherlands. Of 8,000 refugees examined abroad, 165 were
    found to be excludable under immigration law, and 980 had other
    physical diseases or defects that may cause exclusion or require posting
    of bond. At United States ports, 127 refugees were examined;
    1 was certified for excludable disease (tuberculosis) and 28 for diseases
    or defects that may cause exclusion.
    Of aliens other than refugees, the number examined abroad by Public
    Health Service officers increased from 121,075 in 1953 to 147,539
    Public Health Service 129
    this year. The number examined at ports of arrival increased from
    1,609,655 to 1,671,885. Aliens certified for excludable diseases numbered
    3,037, about twice the figure for 1953.
    In the farm placement program, 180,871 labor recruits were examined
    in Mexico under supervision of Public Health Service officers;
    5,854 were rejected for physical or mental conditions. At border
    stations 231,904 examinations were made, with 3,593 rejections. A
    new Mexican-United States agreement, signed March 10, 1954, permits
    recruitment of some laborers at the border; they are given
    complete examination at border stations.
    SPECIAL PROBLEMS
    More than 36,000 aircraft arriving in our country were treated for
    control of mosquitoes and other insects capable of transmitting disease.
    Entomological surveys were conducted in airport areas, and control
    measures were applied or recommended when necessary. Many ships
    arriving at United States ports were also inspected for the presence
    of mosquitoes.
    Psittacosis (parrot fever) was contracted by a quarantine inspector
    and an airline employee, apparently transmitted by three birds imported
    from Mexico. Diagnosis was made from blood cultures, and
    both persons responded well to antibiotic treatment.
    Two more ports adopted radio pratique (quarantine clearance by
    radio), thus simplifying operations for the ships concerned.
    SERVICES FOR TRAVELERS
    The international vaccination certificate form is now issued with
    the passport application, rather than with the passport itself. This
    will encourage travelers to be vaccinated early enough to have maximum
    immunity during their journey. A new edition of the booklet,
    “Immunization Information for International Travel,” brought up
    to date the statement of vaccination requirements for entry to various
    countries.
    Thirteen additional yellow fever vaccinating centers were designated
    by the Service in conformance with World Health Organization
    requirements. There are now 49 of these centers in medical facilities
    of private industry and 31 within the Service.
    Hospital Survey and Construction
    The Division of Hospital Facilities administers the hospital survey
    and construction program established by Congress in 1946. The
    objective of the program is to assist States, local communities, and
    nonprofit organizations in the construction of hospital facilities and
    130 Department of Health, Education, and Welfare, 1954
    public health centers. Under the law, construction grants are made
    by the Public Health Service on the basis of plans submitted by
    official State hospital agencies. The appropriation for construction
    grants in 1954 was $65 million.
    In its 7 years of operation, the program has helped expand the
    Nation’s health plant. On June 30, 1954, 2,283 projects had been
    approved, providing 109,200 hospital beds and 483 health centers.
    About two-thirds of the projects were in operation. The total cost
    of construction was estimated at $1,849,000,000 toward which the Federal
    Government contributed one-third ($618 million) and State and
    local sources, two-thirds.
    When all projects thus far approved have been completed, 82,974
    beds will have been added to general hospitals; 12,193 beds for mental
    patients; 7,889 for tuberculosis patients; and 6,151 for chronic disease
    patients. It is estimated that the 59,200 general beds already in operation
    would provide for 10 percent of the total patients admitted to
    general hospitals in the course of a year.
    A large portion of the grant program is directed toward areas with
    few previous hospital facilities or none at all. Over three-fourths of
    the 891 hospitals which are entirely new are located in areas which
    previously had no acceptable facilities. Of the new facilities approved,
    56 percent are located in communities of less than 5,000 population
    and only 10 percent in cities which exceed 50,000 population.
    Of the new hospitals, 57 percent have fewer than 50 beds and only 21
    percent have 100 beds or more.
    MEETING PRESENT AND FUTURE NEEDS
    The bed deficit of the Nation is still large. Current State hospital
    plans indicate that 812,000 additional beds are required. The greatest
    remaining need is for beds in mental and chronic disease hospitals,
    which require 337,000 and 266,000 beds, respectively.
    The aging of the population has intensified the need for more beds
    for chronic illness. The average number of days of hospital care re-r
    quired by persons over 65 is twice that of persons under 65. Many
    older people who now occupy beds in general hospitals could be cared
    for in nursing homes and chronic disease hospitals at one-third the
    cost.
    Facilities for early diagnosis and treatment of ambulatory patients
    would also reduce the demand for general hospital beds. In urban
    areas, this need could be met by expanded outpatient departments in
    hospitals or by new diagnostic and treatment centers.
    To meet these needs, the Congress passed the Medical Facilities Act
    of 1954 (Public Law 482), which was approved by the President on
    July 12,1954. The broadened program authorized annual allotments
    Public Health Service 131
    for the construction of chronic disease hospitals, diagnostic and treatment
    centers, rehabilitation facilities, and nursing homes. Funds
    amounting to $2 million were also authorized to assist the States in
    surveying their needs for these additional medical facilities, as a
    prelude to statewide plans for a construction program.
    Nursing Resources
    The Division of Nursing Resources continued to develop new
    methods and materials to aid hospitals and nurses in making better
    use of nursing time and skills, and to study basic questions affecting
    the supply of nurses.
    TRAINING OF NURSING AIDES
    The Division carried forward a program, begun in 1952, to improve
    the training of nursing aides in hospitals. The program has been
    developed in cooperation with hospital and nursing organizations
    throughout the country.
    During the year, the first illustrated handbook, with instructor’s
    guide, for the training of nursing aides was completed by the Division,
    and published by the American Hospital Association. National and
    State Leagues for Nursing sponsored regional institutes to train
    instructors, in cooperation with hospitals, State health departments,
    vocational education departments, and other organizations. By the
    end of June, 10 States had held teacher-training institutes and about
    250 hospitals and nursing homes, employing 12,000 aides, had used
    the handbook in their training programs.
    STUDIES OF NURSING ACTIVITIES
    A manual was developed to help hospitals determine whether nursing
    time is diverted from actual care of patients to duties that other
    employees can perform. The method, which adapts industrial worksampling
    techniques to the problems of utilization of hospital personnel,
    has been tested in three hospitals. Results showed that staff
    nurses were actually spending only about half of their time in caring
    for patients, the remaining time being spent on tasks that could be
    assigned to clerks, maids, and messengers.
    A study of sources of recruitment for new hospitals was undertaken
    in collaboration with the Division of Hospital Facilities and the
    administrators of 500 small general hospitals and the 3,000 nurses on
    their staffs. The study showed the extent to which inactive nurses are
    a potential source of personnel for a new local hospital and suggested
    ways of attracting inactive nurses info active practice.
    132 Department of Health, Education, and Welfare, 1954
    The Medical College of Virginia and the Virginia State Hospital
    Association assisted in a study of clinical experience for student nurses.
    The evidence indicated that small hospitals can furnish students a
    broad variety of clinical experience, a fact of special importance to
    nursing educators.
    Substantial progress was made on a study of costs of nursing education,
    conducted by the Divisions of Nursing Resources and Public
    Health Methods in cooperation with the National League for Nursing.
    Six colleges and universities have participated. The project is designed
    to provide a method by which educators, schools of nursing,
    and their associated hospitals and agencies may develop long-needed
    base figures and cost-finding techniques.
    Rapid progress was made on a study of patients’ opinions of the
    nursing care they receive in hospitals, requested by the Commission
    on Nursing of Cleveland, Ohio. Preliminary work was completed on
    a job satisfaction study undertaken jointly with the Division of
    General Health Services. The purpose of both projects is to develop
    methods any hospital can adapt to make its own study.
    Dental Resources
    The Division of Dental Resources studies the utilization of dental
    services and the availability of dental manpower. It gives technical
    assistance to other parts of the Public Health Service, and serves as
    a center for information on dental health needs and resources.
    UTILIZATION AND SUPPLY OF DENTAL SERVICES
    An analysis of nearly a quarter of a million dental examinations of
    Public Health Service beneficiaries revealed the cumulative effect of
    dental disease in adults. In a study of dental care received by patients
    who were members of a prepaid medical care plan, it was found that
    the time required for initial dental care was from 2 to 3 times that
    required each subsequent year.
    The Division compiled a directory of dental clinics in the United
    States during 1954, and continued a study, in cooperation with the
    Division of Public Health Methods, of dental health manpower distribution
    in the United States. Two additional studies were initiated
    during the year, one in collaboration with the American Dental
    Hygienists’ Association and the other in collaboration with the
    Council on Dental Education of the American Dental Association,
    relating to problems of distribution of dental hygienists and the ability
    of students in dental and dental hygiene schools to meets the costs of
    their education.
    Public Health Service 133
    SPECIAL DENTAL STUDIES
    During the year an investigation was carried out to determine
    whether customary radiographic methods used in examination of
    patients could be simplified and adopted for wider use in apparently
    healthy population groups. In addition, studies on dentofacial morphology
    were continued and an analysis of data from approximately
    8,000 human profiles, ages 6 through 24, was undertaken. The Division
    participated in several conferences dealing with cleft palate
    rehabilitation and field training for public health dentists.
    Medical Services for Federal Agencies
    The Public Health Service has the legal responsibility for providing
    medical services to certain other Federal agencies. Through the
    Bureau of Medical Services, medical, dental, psychiatric, and nursing
    personnel are assigned on a reimbursable basis to those agencies requesting
    assistance in the operation of medical programs.
    OFFICE OF VOCATIONAL REHABILITATION
    Since 1943, when medical services were incorporated by Federal
    law as services provided to disabled persons through the public vocational
    rehabilitation program, the Public Health Service has detailed
    medical officers to assist in the administration of the program’s medical
    aspects. During the year, both the chief medical officer and the consultant
    on rehabilitation centers for the Office of Vocational Rehabilitation
    were on detail from the Public Health Service. A description
    of the vocational rehabilitation program is contained in the section of
    the Department’s Annual Report devoted to the Office of Vocational
    Rehabilitation.
    BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR
    The medical care program of the Bureau of Employees’ Compensation
    is staffed by medical officers of the Public Health Service.
    Approximately 90,000 cases reported to the Bureau during the year,
    of which 30,000 required medical or dental care, hospital services,
    prosthetic and orthopedic appliances, or transportation.
    Public Health Service hospitals were utilized in about 50 percent of
    the 4,200 cases requiring hospitalization. When Public Health
    Service hospitals and clinics are not available, designated private
    physicians provide the necessary medical services. Special examinations
    and review of case records by qualified specialists are also
    provided for in the medical care program.
    During 1954, a special study of hearing loss cases was initiated
    at one of the large military proving grounds. Periodic medical
    134 Department of Health, Education, and Welfare, 1954
    examinations have disclosed progressive hearing loss occurring among
    gunners and others exposed to the noise created by detonation.
    Quantitative sound data indicated that existing noise levels are capable
    of producing nerve deafness. Steps were taken to have the injured
    personnel evaluated by specialists in order that proper and adequate
    rating of the hearing loss may be made.
    Cases involving death or loss of earning capacity from infectious
    hepatitis have increased in frequency. There has also been an
    apparent increase in the number of poliomyelitis cases which have been
    reported to the Bureau of Employees’ Compensation.
    A pilot study on physical rehabilitation of injured employees has
    been established through the Public Health Service Outpatient Clinic
    in Washington. The number of cases is still too small to warrant any
    definite conclusions. However, certain areas for improvement have
    become apparent and corrective measures are being instituted. Cooperation
    has continued with the Kessler Institute for Rehabilitation at
    West Orange, N. J., and with the Institute of Physical Medicine and
    Rehabilitation, New York City.
    BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR
    The Public Health Service and the Bureau of Indian Affairs have
    been cooperating for a number of years in an effort to improve the
    health and medical services for some 350,000 Indians in continental
    United States and Alaska. On July 1,1955, the Public Health Service
    will assume full responsibility for the Indian health program.
    Despite some reduction in deaths and disease, the health of the
    Indian people was still below that of the general population. Proportionately,
    the Indian population during 1953 had 20 times as
    many deaths from measles, 9 times as many deaths from tuberculosis,
    4 times as many deaths from pneumonia and influenza, 3 times as
    many infant deaths, and 2 times as many accidental deaths, as did the
    general population.
    At the end of fiscal year 1954,58 hospitals were being operated by the
    Bureau with a total authorized bed capacity of 2,840 divided as follows:
    1,473 general, 1,292 tuberculosis, and 75 orthopedic. Additional
    patients were cared for through contracts with other hospitals.
    Three institutes in rehabilitation techniques were held for Bureau
    medical and nursing personnel. In addition, medical social worker
    positions were established in the sanatoriums, medical centers, and
    area offices to assist tuberculosis patients and their families. Qualified
    pharmacists were employed in the Anchorage Hospital, Phoenix
    Medical Center, Talihina Medical Center, and the Washington Office,
    to improve the use of drugs and assure control of narcotics.
    The problem of obtaining sufficient staff continued unsolved in 1954.
    The possibility of assistance from medical colleges was explored as a
    Public Health Service 135
    means to provide additional staff and also improve the quality of
    service. As a result, the Cornell Medical Center of New York supplies
    the Navajo Medical Center with a tuberculosis clinician. Energetic
    recruitment and improved living conditions and job incentive
    opportunities reduced the high turnover rate of nursing personnel.
    Increasing emphasis has been placed on the participation of Indian
    personnel in the Bureau’s health programs. A special training program
    for dental assistants and dental laboratory technicians at the
    Mt. Edgecumbe Vocational School in Alaska has been supported and
    two practical nursing schools enlarged. Indian girls have been encouraged
    to enter professional nursing schools, and Indian graduate
    nurses were informed about opportunities for public health nursing
    preparation. Plans were also made for Indian practical nurses to
    assist public health nurses in clinics and in the field.
    The tuberculosis control program continued to stress the finding of
    new cases. Voluntary BCG vaccination of the newborn was continued.
    Tuberculin testing has revealed that the infection rate
    among Indian children has been substantially lowered since 1936.
    The use of isoniazid in the treatment of tuberculosis patients continued
    at the Navajo Medical Center. As a result of a survey of
    Alaskan health problems, a program of chemotherapy is being initiated
    for tuberculosis cases awaiting hospital admission.
    As part of the program to improve sanitation of Indian homes
    and communities, 18 additional Indian sanitarian aides were recruited
    and trained. The field staff of professional or technical personnel
    was increased to provide a total of 10 sanitary engineers, 3 sanitarians,
    and 33 sanitarian aides. Special emphasis was given to the development
    and protection of family and community water supplies, construction
    and maintenance of facilities for the disposal of excreta,
    refuse, and garbage, and the control of flies and other insects. The
    work was carried out in cooperation with Indian tribal councils and
    State and local health agencies.
    Dental services were concentrated in the areas of severest need.
    Community dental programs have been established in areas where
    contractual agreements can be set up. These result in improved preventive
    control, protective services, and conservation of teeth.
    Health education activities increased during the year, in cooperation
    with State health departments, private organizations, and universities.
    The Bureau collaborated with private and university radio stations in
    presenting broadcasts on Indian health problems. An intensive educational
    campaign was initiated for Indian seasonal agricultural
    workers. Educational projects were also carried on in selected areas
    to reduce infant deaths, and to inform Indian leaders about tuberculosis
    control, basic sanitation, and healthful living conditions. Reservation
    health personnel initiated and assisted in producing a teach136
    Department of Health, Education, and Welfare, 1954
    ing film in the Navajo language on the control of diarrhea and enteritis
    in young children. A training program was inaugurated to prepare
    Indian aides for work in community health education activities.
    MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE
    The medical program for 1954 consisted of medical and dental outpatient
    and inpatient care at training facilities; professional guidance
    and supervision of the emergency rooms at the Maritime Administration
    Reserve Fleet; and release of clinical information from all
    medical records in the custody of the Maritime Administration. Professional
    services were furnished by medical and dental officers of the
    Public Health Service. A part-time medical officer was employed
    at one unit and a consultant opthalmologist at another.
    The closing of two Maritime Service Training Stations and the
    Headquarters medical office necessitated many changes. An autonomous
    medical program is now in operation at the U. S. Merchant
    Marine Academy, Kings Point, N. Y., the only training facility remaining
    in operation; the office of the Public Health Service Regional
    Medical Director in New York City is used for liaison purposes. Centralized
    procurement of medical materiel was necessarily discontinued.
    UNITED STATES COAST GUARD, TREASURY DEPARTMENT
    At the close of 1954, 86 Public Health Service officers were on
    duty with the Coast Guard. There were 40 dental officers, 35 medical
    officers, 9 nurses, 1 scientist officer, and 1 sanitary engineer officer.
    Full-time medical service was maintained during the year for ocean
    weather station vessels.
    A new uniform health record was instituted during the fiscal year
    and is now in use generally throughout the Coast Guard. A new
    medical allowance list was issued for all Coast Guard units, and health
    records were consolidated into all personnel jackets.
    A sanitary engineering officer was assigned to Coast Guard Headquarters
    on September 1, 1953. Sanitary surveys of all types of
    Coast Guard units were made to determine problems and needs, and
    standards in several areas of sanitation were adopted. The correction
    of reported deficiencies in sanitary facilities and operational
    techniques was initiated.
    FOREIGN SERVICE, DEPARTMENT OF STATE
    The Medical Service was given the responsibility for distributing
    gamma globulin for use by Americans overseas outside of military
    installations for the prevention of poliomyelitis. Regulations were
    issued and regional stockpiles established. Approximately 4,500 cc.
    were distributed during the year.
    Public Health Service 137
    The Medical Director inspected posts in northern and eastern
    Europe and Near and Far East during the year. It was found that
    the health conditions and facilities available to United States Government
    personnel at posts in the Near and Far East have greatly improved
    since 1951 because of the establishment of health units, the
    designation of a medical adviser for each post, and the implementation
    of previous recommendations. In 1954, a new health unit was established
    at Monrovia, Liberia.
    BUREAU OF PRISONS, DEPARTMENT OF JUSTICE
    The Public Health Service continued to provide medical and psychiatric
    care for Federal prisoners in 26 institutions throughout the
    country. With a prison population of over 20,000, there were 12,800
    admissions to the hospitals for a total of 423,047 hospital relief days.
    Over 800 major and 5,187 minor operations were performed; 29,000
    routine physical and neuropsychiatric examinations and 750,000 treatments
    were provided by outpatient departments. In addition,
    physical examinations and other health services were provided for
    guards and other prison employees. Only 49 deaths were recorded.
    The commonest cause was some form of cardiovascular disease.
    The use of inmate hospital aides has been continued; currently, 96
    medical technical assistants provide subprofessional assistance
    throughout the prison hospital system. The practical nurse training
    program at the Federal Reformatory for Women, Alderson, W. Va.,
    was so successful that similar projects were launched in Terre Haute
    and McNeil Island. After successful completion of the course, each
    practical-nurse student is eligible for the State board examination.
    Trained inmate dental aides assist the professional staff.
    To implement the Youth Corrections Act, the Federal Correctional
    Institution at Ashland, Ky., was designated as the first diagnostic
    and treatment unit to receive young offenders. An effective diagnostic
    team, consisting of a psychiatrist, clinical psychologist, and paroleofficer
    social workers, has been developed there during the year.
    Psychiatric services elsewhere have been expanded to include additional
    group therapy programs at Atlanta and at the National Training
    School, Washington, D. C. A group of prisoner drug addicts is
    receiving psychiatric treatment at Milan, Mich.
    Large numbers of prisoner volunteers continued to participate
    in medical research on the common cold, malaria, hepatitis, topical
    fluoride treatment of dental decay, and the effects of industrial noises
    on hearing. These projects were conducted cooperatively with the
    National Institutes of Health and the Bureau of State Services.
    339010—55------ io
    138 Department of Health, Education, and Welfare, 1954
    Bureau of State Services
    The Bureau of State Services administers the Federal programs
    of assistance to the States for the improvement of public health
    services throughout the country and in the Nation’s international
    activities. It also conducts specialized research in fields closely
    related to the development of public health services.
    In 1954 the Bureau was reorganized to create a more flexible operating
    organization and to promote greater efficiency and economy in
    meeting its responsibilities. The reorganization followed a year-long
    study of the Bureau’s structure. Since its establishment in 1943,
    the number of separate operating divisions in the Bureau increased
    from 3 to 16. The reorganization consolidated the Bureau’s activities
    under six divisions: General Health Services, Special Health Services,
    Sanitary Engineering Services, International Health, Dental Public
    Health, and the Communicable Disease Center, located in Atlanta, Ga.
    Three of the divisions are new. The Division of General Health
    Services includes the activities of the former Divisions of State
    Grants, Public Health Nursing, Public Health Education, the National
    Office of Vital Statistics, and the Arctic Health Research Center
    in Anchorage, Alaska. The Division of Special Health Services
    includes the activities of the former Divisions of Chronic Disease and
    Tuberculosis, Venereal Disease, and Occupational Health. The
    Division of Sanitary Engineering Services encompasses the former
    Divisions of Sanitation, Water Pollution Control, Engineering Resources,
    and the Robert A. Taft Sanitary Engineering Center, in
    Cincinnati, Ohio. The other three divisions—International Health,
    Dental Public Health, and the Communicable Disease Center—continue
    with their former titles and functions.
    General Health Services
    Administration of grants-in-aid to the States, services in public
    health education and public health nursing, conduct of the Nation’s
    program of vital statistics, and a research program in Arctic health
    problems comprise the responsibility of the Division of General
    Health Services. Significant achievements and promising plans for
    future projects were reported in each program area.
    STATE GRANTS SERVICES
    Federal appropriations for grants-in-aid to the States for public
    health services, exclusive of hospital construction and construction
    of community facilities, totaled $24,174,000 for the fiscal year 1954.
    This represents a decrease of 30 percent as compared to the 1953 total.
    Public Health Service 139
    The following breakdown shows amounts and purposes for which
    payments were made:
    General health services___________________________________ $10, 693, 000
    Venereal disease special projects____________________________ 3,105, 000
    Tuberculosis control----------------------------------------------------------- 4, 274, 000
    Mental health activities___________________________________ 2, 308, 000
    Heart disease control_____________________________________ 1, 054, 000
    Cancer control___________________________________________ 2, 213, 000
    Construction of community facilities------------------------------------- 4,125, 000
    Hospital construction_______________________________________ 88, 219, 000’
    Table 5, page 169 shows the distribution of these sums by State.
    State appropriations available to State health departments, exclusive
    of State funds for hospital and sanatorium care, increased by 10.6
    percent over the preceding fiscal year, reaching a total of $116,227,000.
    This increase compensated in some measure for the reduction in Federal
    funds. However, 7 States accounted for two-thirds of the total
    increase, while 14 States reported decreases. The average per capita
    appropriation for all States was 66.5 cents, as compared to 60.8 cents
    in 1953. Nine States appropriated more than $1 per capita. Local
    funds for comparable health service totaled $120,887,000.
    The seventh annual study of salary scales for State health department
    personnel shows a continued rise in median salary levels in all
    classifications of personnel analyzed. Comparisons with a study
    made in 1940 showed increases over the 13-year period ranging from
    71.4 percent for directors of vital statistics to 135.8 percent for medical
    personnel other than State health officers. When adjustments
    were made for the increased cost of living, these percentage differences
    are reduced to —10.7 percent and —22.9 percent respectively.
    There has been little change in the past few years in total coverage
    of the population by local health units. At the end of the fiscal year
    1954, 2,218 counties had full-time local health services, as compared
    with 2,197 at the end of the previous fiscal year. About 88 percent
    of the total population was covered by local health services. The situation
    with regard to personnel also remains essentially unchanged
    with many of the organizations able to provide only limited services
    because of the personnel shortage.
    Assistance was provided to the Office of the Secretary in developing
    the Department’s legislative proposal for a unified grant-in-aid system.
    The legislation as drafted in the Department proposed a single
    grant for public health purposes instead of the several categorical
    grants made at present. Under the proposed system grants would be
    made for three purposes: (1) to assist the States in support of their
    basic services to the people; (2) to help the States in extending and
    improving their services; and (3) to encourage research and development
    of new techniques through special project grants.
    140 Department of Health, Education, and Welfare, 1954
    The staff worked with the National Institute of Mental Health on
    the development and issuance of the Mental Health Program Guide.
    This Guide, the first in a series, is designed to aid regional office consultants
    and State program directors in planning and operating effective
    mental health programs. Similar guides are planned for heart
    disease and diabetes control programs.
    PUBLIC HEALTH EDUCATION SERVICES
    The aim of this program is to assist public health personnel in
    developing sound health education for the public and special groups,
    through technical assistance and studies in educational and social
    psychology.
    Consultation services were made available in six regional offices.
    In addition, health educators were assigned to several operating programs
    in the Service, and consultation was provided to others. F if teen
    health educators served in overseas assignments.
    The staff assisted in developing a course in preventive medicine and
    public health for medical students at Georgetown University. Assistance
    was given to all graduate schools of public health offering
    courses in public health education, by interpreting the needs of the
    field, participating in course content, and arranging field experience
    for the students.
    In cooperation with the Division of Sanitary Engineering Services
    a study was completed on “Why Sanitary Engineers Leave the Field
    of Public Health.” The report of the findings discussed possible
    courses of action to reduce the rate of loss.
    During the past 2 years, the public health education staff has
    cooperated with the National Tuberculosis Association and the chronic
    disease and tuberculosis programs of the Service in a study to identify
    factors which influence public participation in tuberculosis control
    programs. Thus far,. 1,200 interviews have been coded and tabulated.
    The findings will be useful in planning future tuberculosis control
    programs, especially in reaching those segments of the population with
    the highest tuberculosis prevalence rates.
    An evaluative study of the reactions of 73 Fellows from foreign
    countries to their public health training in the United States and a
    study of orientation problems of clerical and secretarial employees
    in the Service both yielded information useful in improving future
    programs.
    In cooperation with the Heart Disease Control Program, Division
    of Special Health Services, two booklets on sodium-restricted diets
    were evaluated. The study was designed to uncover barriers to the
    understanding and use of these booklets by patients and to identify
    means of improving the material.
    Public Health Service 141
    Continuing efforts are being made to foster closer working relationships
    between schools of public health, social science departments in
    universities, and State and local health departments in the conduct
    of joint studies of public health problems and practices.
    PUBLIC HEALTH NURSING SERVICES
    The public health nursing staff continued to supply qualified nurses
    for operating programs throughout the Service. Regional and headquarters
    public health nursing consultants also worked closely with
    State and local programs and conducted several studies in public
    health nursing problems.
    Special efforts were made, in cooperation with State and local
    public health nurses, to meet the needs of schools of nursing which
    have introduced the teaching of public health practice into their
    basic curricula. The number of such schools has increased, thus
    increasing the demand for consultation with qualified public health
    nurses, as well as for opportunities for the student nurses to obtain
    field practice in local health programs.
    The Council of State Public Health Nursing Directors has undertaken
    a survey of its members to determine the amounts and types
    of consultation the States require of the Public Health Service in
    this field. The data from the survey will be used by Public Health
    Service staff in planning future procedures for providing public
    health nursing consultation.
    A broad functional study of public health nursing was undertaken
    during the year. An overall list of public health nursing responsibilities,
    prepared by the study staff, was reviewed by a committee of
    the American Nurses’ Association.
    The value of sound recording devices as a supervisory tool in public
    health nursing was an unexpected byproduct from a tryout of such
    equipment as a means of data collection in the field. Preliminary
    reports of the use of group interviews to obtain consumer opinion
    were reviewed by special consultants. The research design for the
    field portion of the study was completed and approved. After a
    careful screening, 16 nurses in 8 “good” local health departments in
    5 States were selected to keep detailed records of nursing service to
    patients in about 1,300 households. These records will be coded and
    analyzed.
    NATIONAL OFFICE OF VITAL STATISTICS
    The National Office of Vital Statistics conducts a program of national
    vital and health statistics for the broad purposes of demography,
    as well as for the purposes of planning and appraising specific
    activities in such fields as health,, social welfare, education, defense,
    and business enterprise. Between the 10-year censuses, vital statistics
    142 Department of Health, Education, and Welfare, 1954
    give a running account of population changes due to births and
    deaths.
    The mortality statistics program provides an index of public health
    and medical problems, as well as a means of evaluating progress in
    these fields and in the study of population changes. Preparatory
    work for the Seventh Revision of the International Lists of Diseases
    and Causes of Death was completed during the year. The seventh
    revision is scheduled to take place in 1955 and future revisions will
    take place every 10 years thereafter.
    A special study of industrial and occupational mortality in 1950
    proceeded during the year. A supplementary question was added
    to the Current Population Survey of February 1954 in order to determine
    the usual occupations and the ages of persons not in the labor
    force. Unpublished data for 1950 on nonwhite and unemployed
    groups also were made available by the U. S. Census Bureau.
    The natality statistics program prepares annual and special statistics
    from the birth and fetal death records. The first in a series
    of reports on the relationship of birth weight to the death of infants
    shortly after birth has been completed and released for publication.
    Other factors related to neonatal mortality, such as gestation age at
    birth, place of birth, type of attendant, age at death and cause of
    death, also were under study.
    During the year several steps were taken which will improve the
    registration of marriages and divorces and increase the comparability
    of statistics prepared by the States and the NOVS. Among these
    were the development of standard record forms and the completion
    of model law sections on the registration of marriages, divorces, and
    annulments.
    Work continued during the year on the preparation of the official
    life tables of the United States, based on population enumerated in
    the 1950 Census and mortality data for the 3-year period 1949-51.
    The life table is a simple mathematical form for expressing the probability
    of death and the expectation of life at stated ages. Among
    the most important users of life tables are life insurance companies,
    planning agencies, demographers, vital statisticians, and governmental
    agencies.
    The statistical reporting of communicable disease morbidity consists
    of collecting and consolidating summary data furnished by the
    States. Wide variations in State and local reporting practices produce
    defects in national statistics. As an aid to uniformity, a revised
    edition of the “Manual of Procedures for National Morbidity Reporting”
    was distributed to the States for their guidance. Procedures
    were developed to insure more prompt reporting of unusual outbreaks
    of disease, as a means of implementing an agreement between the DePublic
    Health Service 143
    partment of Health, Education, and Welfare, the Department of
    Agriculture, and the Federal Civil Defense Administration.
    Detailed data were collected on poliomyelitis cases from a number of
    individual counties where gamma globulin had been administered on
    a mass scale. This was done to make possible more equitable distribution
    of this product.
    The NO VS, in collaboration with State registration executives, is
    drafting proposed revised sections of a model vital statistics act which
    can be used as a pattern by the States. Five sections of the model
    act were completed and approved by the Public Health Conference
    on Records and Statistics.
    The provision of technical assistance to other countries was continued
    under the program of the Foreign Operations Administration.
    Short-term services were provided to Brazil and Paraguay, and 11
    full-time technicians served the following countries: Brazil, Chile,
    Egypt, El Salvador, Haiti, Iran, Lebanon, Peru, and Venezuela.
    ARCTIC HEALTH RESEARCH CENTER
    Two cooperative studies with the Alaska Health Department and
    the Alaska Native Service were initiated, thus bringing the Center’s
    research program into closer relation with direct services to the people.
    The studies were concerned with chemotherapy of tuberculosis in a
    home care program under conditions perculiar to Alaska and with
    sanitation in native villages. The Center also joined with the Epidemiological
    Board of the Armed Forces and the Harvard University
    School of Public Health in a study of enteric diseases.
    Studies of the effect of larvicides on fish and fishfood organisms in
    Alaskan streams were completed during the year. Dosage levels of
    DDT have been established which kill black fly larvae and can still be
    safely and effectively used on Alaska’s salmon streams without endangering
    the fish.
    Current studies have produced evidence showing that the enzymatic
    systems of cells are irreversibly damaged by freezing, thus destroying
    normal metabolic activity. This is contrary to a previously held belief
    that the only damaging effect of freezing was physical destruction
    of the cell wall.
    Through the use of a water-soluble, acidic dye (uranin) and a strain
    of enterococci {Streptococcus zymogenes), a hardy organism, readily
    detectable and highly resistant to extreme change in temperature, it
    has been possible to trace the flow of simulated pollutants in ground
    water thus facilitating the following steps: («) Formulation of safe
    standards for water supplies in Alaska with respect to location from
    points of possible pollution; (&) establishing a reliable means of
    determining actual pollution in Alaskan water supplies; (c) provision
    144 Department of Health, Education, and Welfare, 1954
    of highly specific simulants for detection of other forms of contamination.
    Investigation was begun of the clam and mussel beds of the Cook
    Inlet region. Findings to date have showed no evidence of the musselpoisoning
    organism, Gonyaulaoc catenella^ in the Cook Inlet clam beds.
    Investigation of clam beds along the Aleutian chain have, however,
    indicated a significant degree of contamination at False Pass, Dutch
    Harbor, and Kodiak Island. The first human fatality due to shellfish
    poisoning reported outside southeastern Alaska occurred in June
    of this year at False Pass. Careful investigation of this incident
    revealed that mussels taken from beds in that area were extremely
    toxic. Four ounces of the material contained sufficient toxin to kill a
    man in less than 3 hours.
    Continuing studies included: hematological investigations of the
    moderate anemia found to be widespread among Alaskan Eskimos;
    the public health significance of hydatid disease; operation of community
    water supply and sewage disposal systems; and evaluation
    of insect control methods applicable in Alaska.
    Division of Special Health Services
    The new Division of Special Health Services combines five major
    programs: Chronic Disease,, Heart Disease, Occupational Health,
    Venereal Disease, and Tuberculosis. The job of this Division is to
    assist States in putting to work the results of research in disease
    control and health conservation.
    CHRONIC DISEASE PROGRAM
    The Chronic Disease Program continued to provide technical
    assistance in the development of State and local diabetes control
    programs, to conduct studies to determine prevalence and incidence,
    and to develop improved methods of detection, treatment, and
    management of diabetic cases.
    A long-range study was launched to determine the effect of insulin
    treatment on selected pregnant women. The study is designed to
    determine: (1) if women with abnormal carbohydrate tolerance have
    a higher rate of fetal wastage (stillbirths, miscarriages, abortions)
    than women who do not, and (2) if treatment of such women with
    insulin during pregnancy will reduce fetal wastage and prevent or
    delay the occurrence of diabetes in the mother and offspring.
    Tentative criteria for diagnosis have been established in the Diabetes
    Screening and Diagnostic Test Validation Study at Boston City
    Hospital. It appears that blood tests are more efficient than urine
    tests. The evaluation of sodium fluoride as a preservative in stored
    and shipped blood continued during the year. Comparisons were
    Public Health Service 145
    being made of the preservative action of sodium fluoride alone, sodium
    fluoride with mercuric chloride, and potassium oxalate with mercuric
    chloride.
    Eighteen State and local health agencies received consultation during
    the fiscal year. Technical consultation was provided for five
    short-term screening programs. Four short-term detection programs
    which used the Clinitron were completed, with 5,400 persons screened.
    Courses on various aspects of a diabetes program were held in the
    Boston Diabetes Office.
    Home care programs can help to alleviate the shortage of hospital
    beds for the chronically ill. In cooperation with the Division of
    Public Health Methods and the Commission on Chronic Illness, a
    study of 11 representative home-care programs in the United States
    was launched.
    Consultation was given to the Upholsterers International Union regarding
    health services for older people in a retirement village the
    Union is planning to establish in Florida. A panel presentation was
    made to the National Social Welfare Assembly Conference on Individualized
    Services on unmet health needs for the aging.
    VENEREAL DISEASE PROGRAM
    During fiscal 1954, State and Territorial health departments reported
    approximately 142,000 cases of syphilis, 245,000 cases of
    gonorrhea, and 5,000 cases of other venereal diseases. These figures
    represent a decline from 1953 of about 13 percent in syphilis, 2 percent
    in gonorrhea, and 11 percent in other infections. Early syphilis
    (primary, secondary, and early latent) accounted for 33,700 cases as
    compared with 43,600 in 1953.
    There were an estimated 5,300 deaths from syphilis in calendar year
    1953. There were no significant changes in syphilis death rates or
    in the rate of first admissions to mental institutions due to syphilitic
    psychoses. The general death rate due to syphilis in 1953 was 3.4
    per 100,000 population, as compared with 3.7 in 1952. The infant
    mortality rate due to syphilis was about 2 per 100,000 live births,
    as it has been for the past 5 years. The rate of first admissions to
    mental institutions was 1.8 per 100,000 in 1953 as compared with 6.1
    in 1943.
    More than 2 million diagnostic examinations made in local clinics
    yielded about 304,000 positive diagnoses, although many of these
    patients were already known to the examiners. Clinic personnel
    interviewed about 183,000 patients and completed 400,000 investigations
    of persons exposed to venereal infection, 70 percent of whom
    were brought to examination. Health department laboratories reported
    an estimated 12,418,000 serologic tests, compared with 13,778,-
    000 in 1953.
    146 Department of Health, Education, and Welfare, 1954
    Federal project funds helped to support 42 prevention and control
    centers, blood testing campaigns in areas of high syphilis prevalence,
    the services of interviewers and investigators, and field studies of
    penicillin therapy and Treponema pallidum, immobilization (TPI)
    testing. The Venereal Disease Research Laboratory continued to
    provide public health laboratories with reagents and control serums
    to aid in the diagnosis of syphilis.
    A study of syphilis immunology continued, with the participation
    of volunteers from the inmate population of Sing Sing Prison and
    in cooperation with the prison medical staff and the New
    York State Department of Health. It has been shown that acquired
    immunity does develop in man, that it evolves rather slowly, and that
    it reaches a significantly high degree. Evidence suggests that the
    administration of killed Treponema pallidum may produce a booster
    effect on this immunity.
    Other cooperative studies showed that adequate therapy in
    latent syphilis prevents progression to the late manifest stages of
    the disease; that syphilis lowers, by about 17 percent, the. life expectancy
    of persons 25 to 50 years of age who have received no appreciable
    amount of therapy; and that penicillin successfully arrests
    the process of asymptomatic neurosyphilis.
    A survey of the residences of contacts showed that an average of
    8.8 percent of contacts of civilian patients resided outside the reporting
    State, as contrasted with 36.3 percent of contacts of military patients.
    Data from 47 States showed that 22 percent of all patients with
    primary and secondary syphilis were under 20 years of age at diagnosis,
    and 80 percent were under 35 years. Data on gonorrhea followed
    substantially the same age patterns. In both diseases, the rate increased
    rapidly after 14 years of age. The study also demonstrated
    that females acquire syphilis earlier in life than males.
    Problems of laboratory testing for syphilis were further investigated
    in 1954. Work on the agglutination test, using killed T. palliduan,
    has led to several significant findings even though the test is
    not ready for clinical application. T. pallidum, the organism of
    syphilis, induces formation of a variety of substances in the blood,
    only one of which can be measured by the TPI test and another by
    serologic tests, while many such substances may enter into agglutination
    of the syphilitic organism.
    Twenty-four Prevention and Control Centers participated in a
    study of penicillin reactions covering 16,000 patients, most of whom
    were treated with a one-injection schedule but some of whom were
    treated on schedules of more than 3 weeks’ duration. No deaths
    occurred among these 16,000 patients because of penicillin reactions.
    Less than 1 percent had reactions sufficiently severe to bring them
    back to the clinic. A 2-year study of the effectiveness of benzathine
    Public Health Service 147
    penicillin G yielded success rates of 96 to 100 percent in the primary
    and secondary stages of syphilis.
    Two postgraduate courses on venereal disease were held in 1954 for
    physicians in private practice, the armed services, and health departments.
    The Venereal Disease Research Laboratory conducted 14
    refresher classes on serologic techniques and other phases of laboratory
    diagnosis. A manual was prepared which sets forth diagnosis and
    treatment procedures for all five of the venereal diseases.
    OCCUPATIONAL HEALTH PROGRAM
    A study of the effect of noise on hearing, designed to develop a basis
    for noise control in industry, was undertaken. Serial audiograms
    were obtained from a group of workers employed in the industries at
    four Federal penitentiaries, together with measurements and analyses
    of the noise conditions.
    In the study of uranium mining and milling in the Colorado Plateau,
    the year’s major accomplishment was the development of adequate
    methods to control exposures to radioactive materials in mines by
    proper ventilation.
    Environmental and dermatologic studies were made to determine
    whether or not exposures during the processing of shale oil will
    produce cancerous or precancerous skin changes. The information
    will aid in the establishment of practicable control measures.
    Largely as a result of study of ozone toxicity, the threshold limit
    value for ozone has been lowered. Ozone itself was found to be
    a highly toxic gas, and no evidence was found that nitrogen oxides
    account for ozone toxicity.
    Possible hazards arising from the use of substances which selectively
    bind or remove certain metals from the circulation were studied.
    These agents were found useful in treating lead and other metal intoxications
    but may cause problems due to binding of essential metals.
    In the field of dermatology, work has continued on the development
    of chemically pure nickel and cobalt salts to permit controlled
    cross-sensitivity studies. Under a contract with the U. S. Air Force,
    the skin sensitization properties of 13 mildew-proofing agents
    were evaluated. Waterless hand cleansers and silicone protective
    creams were evaluated.
    Industrial hygiene engineering research in the past year has contributed
    to the development or modification of various instruments,
    methods, and techniques for the appraisal and control of potentially
    hazardous factors in the working environment.
    TUBERCULOSIS CONTROL PROGRAM
    Twenty-six hospitals cooperated with the Public Health Service
    in evaluating the treatment of tuberculosis with isoniazid, alone or
    148 Department of Health, Education, and Welfare, 1954
    in combination with other drugs. Results with 1,600 patients showed
    that isoniazid alone is as effective as any combination of drugs in
    treatment of the disease when lung cavities are not present. Good
    results also were obtained with combinations of any two of the three
    drugs—streptomycin, PAS, and isoniazid. The selection of drugs
    for use alone or in any combination depends upon the specific circumstances
    in the individual case.
    Animal studies conducted during the year included the basic relation
    between immunity and tuberculin allergy induced by BCG,
    small-scale trials on the effect of isoniazid in combating experimental
    tubercular infection, and techniques for administering isoniazid.
    These will provide the basis for large-scale studies of effectiveness
    of isoniazid in preventing the development of tuberculosis after an
    experimental infection.
    Further progress was made in a study of tuberculosis among former
    student nurses who were skin-tested and X-rayed at 6-month intervals
    during their course of training. Questionnaires on personal health
    after training have been secured for nearly all of the 26,000 participants,
    and about 3,000 have been screened to select a group which
    has experienced tuberculosis episodes. Causes of death among the
    entire group have been analyzed.
    A study was begun of the health needs and home treatment of
    nonhospitalized tuberculosis patients with active disease. By the
    end of the fiscal year, complete data had been assembled for 6 of the
    37 geographic areas selected for the study.
    Since the interstate movement of tuberculous individuals represents
    a serious control problem, the disease is being studied among migratory
    agricultural workers and other nonresident populations. Arrangements
    were made with the Colorado State Department of Public
    Health to survey a group of migratory agricultural workers and their
    families, totaling about 12,000 persons. Two studies of tuberculosis
    among nonresident populations were completed and three similar
    studies were planned.
    Studies were initiated in Ohio and Michigan on the hospitalization
    experience of a selected sample of minimal, moderately advanced, and
    far-advanced cases of tuberculosis reported each year since 1946.
    Arrangements were completed for the development in Hawaii of a
    continuous record system showing prehospital history, status on first
    admission, a summary of subsequent hospitalization, and experience
    since last discharge.
    Completion of the Pittsburgh survey terminated direct efforts to
    assist large metropolitan areas in mass case-finding programs. Over
    the past 6 years, the Public Health Service has assisted health authorities
    of 25 metropolitan centers in the X-raying of nearly 8 million
    people and in the discovery of about 50,000 persons with tuberculosis,
    Public Health Service 149
    6,500 of whom had active disease. In addition, 65,000 other chest
    abnormalities were discovered and referred for further study.
    HEART DISEASE CONTROL PROGRAM
    State heart control programs progressed with grant assistance
    under seven general activity heads: prevention, case-finding, diagnosis
    and management, services to cardiacs, rehabilitation services, training
    and education, and operational studies. During the year, Heart
    Disease Control Program consultants assisted 38 States and Territories
    in technical details of programs.
    In Los Angeles, the Public Health Service, in cooperation with the
    State, county, and city health departments, began a study of the usefulness
    of chest X-ray in screening for cardiovascular diseases.
    At Herrick Memorial Hospital in Berkeley, Calif., a group of about
    150 persons was observed to determine the relative value of group
    psychotherapy as compared with standard nutritional instruction in
    bringing about weight loss.
    A rehabilitation study at Cedars of Lebanon Institute for Medical
    Research, Los Angeles, will attempt to determine: (1) whether measures
    of oxygen consumption of workers can be used to establish energy
    requirements for the job; (2) whether there are significant differences
    in energy output between cardiacs and noncardiacs doing the same
    job; and (3) whether physiological tests can be used to predict the
    amount of energy which a cardiac can safely expend on job activities.
    This study is being carried out in cooperation with the Lockheed Aircraft
    Corp. The aim of the study is to establish job placement criteria
    for cardiacs, and to develop a procedure for establishing energy
    requirements of jobs. Another study dealt with the relationship between
    the food habits of older people and the development of cardiovascular
    and other chronic diseases.
    The Joint Committee on Anti-Coagulant Therapy continued its
    work on revision of a prothrombin manual for medical laboratory
    technicians. The Committee also cooperated with the Heart Disease
    Control Program in the development of a program for demonstrating
    prothrombin techniques at medical group meetings.
    Sanitary Engineering Services
    Creation of the Division of Sanitary Engineering Services brought
    under unified direction the Public Health Service programs dealing
    with the environment—water, air, food, and shelter.
    SANITARY ENGINEERING CENTER
    The Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio,
    formerly the Environmental Health Center, was dedicated on April 8,
    150 Department of Health, Education, and Welfare, 1954
    1954. The Center is the research arm of the Division, seeking and
    applying new knowledge and techniques in problems of air pollution,
    water pollution, food sanitation, and radiological health. It also
    conducts advanced training for scientists and health personnel.
    Responsibility for air pollution research was assigned to the Center
    on July 1,1954. Among the subjects to be studied are: the particulate
    content of the air in 30 to 40 American cities; techniques for determining
    volatile and gaseous contaminants; mortality statistics as related
    to meteorological conditions; survey methods for regional air
    pollution studies; the nature and amount of air pollutants caused by
    specific sources; and the physiological effects of air pollutants.
    Radioactivity in air, though not now a health hazard, constitutes a
    new characteristic of our environment. Allergenic material is showing
    new patterns, with city air frequently containing more potential
    allergens than that of the surrounding countryside.
    In a field survey, the Center identified a material which formed a
    heavy foam on the Ohio River at Wheeling, W. Va., as a synthetic
    detergent identical in properties with certain commercial formulations.
    Other field studies were conducted in connection with water
    supply and pollution problems including guides to industrial wastes
    in the steel, pulp, and paper industries.
    New data confirm the discovery that the coxsackie virus is inactivated
    at a rapid rate in Ohio River water. Further work is in
    progress to discover how and why.
    Eighty algicides were given laboratory screening and field tests.
    It has been found that treatment of impounded water before the appearance
    of algae is frequently more satisfactory than efforts to cope
    with algae blooms as they occur. Runoff from land treated with the
    insecticide Dieldrin was observed to be toxic to fishes in l-to-3 dilution.
    Techniques for isolating and measuring the few parts per billion of
    the chemical present were developed.
    Shellfish studies have further confirmed the role of the coliform
    organism as a suitable indication of pollution. Examination of shellfish
    during harvesting and marketing has demonstrated increased
    bacterial contamination during these operations.
    The observed variation of efficiency of quaternary amines as sanitizing
    agents has been found to relate directly to the hardness of the
    water. The use of quaternary amines in sanitizing milk and food
    equipment appears to offer distinct advantages. These findings point
    out measures required to make the quaternaries suitable in waters
    not initially compatible with their use.
    Procedures have been devised for making effective use of standardized
    infrared spectra as a tool in identification of bacteria. To
    date, 468 spectra have been obtained on identified bacteria. A coding
    Public Health Service 151
    system has been developed for rapid mechanical sorting and comparison.
    Measurable amounts of radioactivity have been found in rain subject
    to contamination by bomb testing. It is estimated that, in a 3-month
    period in 1953, 13.5 curies of activity were deposited by rainfall on
    each square mile in the Cincinnati area. In the Columbia River, the
    aquatic fauna and flora have shown a capacity for a high degree of
    concentration of radioactive materials.
    It is estimated that the 195 trainees who attended the courses in
    advanced sanitation training at Cincinnati will disseminate this technical
    information to more than 7,000 people. Special attention has
    been given during the year to developing a comprehensive training
    program dealing with the biological aspects of water pollution control.
    A service has been inaugurated which permits a State laboratory to
    evaluate its efficiency in water analysis. In an evaluation, several
    laboratories cooperate in examinations of portions of a single sample.
    RADIOLOGICAL HEALTH
    The disposal of the very large quantities of radioactive wastes
    produced by power reactors is a major factor in the economic development
    of the atomic power industry. The Public Health Service is
    cooperating with the Atomic Energy Commission to solve these waste
    disposal problems.
    State and local health departments requested aid in radiological
    health and safety problems. A joint State-Public Health Service
    pilot program has been completed in New Jersey which will serve both
    as a guide for future Public Health Service programs of this nature
    and as a means for the New Jersey State health personnel to form a
    functional radiological health program of their own. The Division
    has also conducted training programs in Arkansas, California,
    Florida, Michigan, Oregon, Texas, Washington, and Hawaii.
    Conventional water treatment methods cannot be depended on to
    remove all radioactive contamination in water supplies. Flocculation
    removes suspended and colloidal contamination but dissolved constituents
    are usually not adequately eliminated. A method has been
    devised for the accurate determination of very low levels of radioactive
    contamination in waters. Standard techniques for the quantitative
    determination of radioactive components in low-level mixtures
    of radioisotopes in water are now being sought.
    Courses in radiological health have been adapted primarily to meet
    the needs of State and local health department personnel. Considerable
    interest in radiation hygiene, however, is being manifested also
    by industry, universities, the Armed Forces, and various Government
    agencies. In addition to actual training activities, staff members
    152 Department of Health, Education, and Welfare, 1954
    provided technical assistance to various groups concerned with specific
    radiological health problems.
    WATER SUPPLY AND WATER POLLUTION CONTROL
    The Comprehensive Program for Water Pollution Control for the
    Missouri Drainage Basin, completed this year, provided an overall
    action program for one-sixth of the land area of the United States.
    Its development involved agreement by 10 States on water quality objectives
    and treatment requirements. It has been approved by the
    Surgeon General and adopted by the Missouri River Interagency
    Committee as an essential part of the overall water resource development
    program for that basin. The pollution abatement activities of
    the individual States are geared to this comprehensive plan. During
    the year, 13 similar programs were developed for smaller drainage
    basin areas and adopted by the Surgeon General.
    Municipalities spent about $162 million (1950 dollar value) in 1953
    to provide 329 new sewage treatment plants and 286 additions or improvements
    to existing plants. This represents a 32-percent increase
    over 1952 expenditures, but is still far short of the amount needed to
    overcome the backlog of construction needs.
    More than 100 areas of potential interstate pollution have been
    identified. The States concerned have been asked to report on corrective
    action taken or planned.
    The Surgeon General issued formal findings and notifications to
    oilfield operators in Arkansas whose operations are having a detrimental
    effect on the waters of the Cornie Creek Drainage Basin in
    Louisiana. This is the first formal enforcement action taken by the
    Service under the Water Pollution Control Act. Pollution control
    agencies of Arkansas and Louisiana have cooperated fully. Corrective
    action has been taken by many of the operators and effective
    action by the others is anticipated.
    Industrial waste guides for the milk processing and meatpacking
    industries, designed to aid plant management in waste control, were
    developed by the National Technical Task Committee on Industrial
    Wastes as part of the joint Government-industry attack on pollution.
    The scope of industry’s efforts is indicated by 405 research projects
    currently underway.
    Current estimates of the dollar volume of planned public works
    projects in the fields of water supply and sewerage were developed
    for the Council of Economic Advisers. Also, mobilization readiness
    planning data on public water supplies were collected through field
    surveys for all municipalities over 10,000 population and for many
    between 5,000 and 10,000 population.
    The water supply and pollution control field studies for the
    Arkansas-White-Red and New England-New York water and land
    Public Health Service 153
    resource development programs were completed. Results of the Division’s
    Fort Randall Reservoir studies on the effects of impoundment
    on water quality will be used in planning large scale impoundment
    projects in the Missouri River development program.
    INTERSTATE CARRIER SANITATION
    A seminar on interstate carrier sanitation resulted in several important
    policy changes to improve operations and develop more uniform
    procedures for dealing with carriers. A better procedure for
    administering the Interstate Quarantine Regulations relating to interstate
    carrier equipment will result from the establishment this year
    of a formalized equipment review program.
    During the year, routine inspections were made of 1,477 railroad
    dining cars and 1,493 vessels in operation. Supervision was maintained
    over the sanitary construction of railway passenger cars,
    vessels, and aircraft. Also, 483 milk sources, 304 frozen dessert
    sources, 186 commissaries, 340 airline catering points, and 10 other
    food sources were inspected and certified for use by interstate carriers.
    Surveys were made of 905 water supplies, 1,088 railroad watering
    points, 739 vessel watering points, 182 airline watering points, and
    7 sources of bottled water.
    The sanitation of trains moving to and from the Third National
    Boy Scout Jamboree held in California in July 1953 required considerable
    additional work. Six outbreaks of food poisoning aboard
    interstate carriers were reported during the year, two on special trains
    en route to the Jamboree.
    Training courses in food sanitation were conducted for dining car
    employees by three regional offices. Region V worked with officials of
    a major airline to prepare a sanitation course which will be followed
    by that airline in training of its employees.
    GENERAL ENGINEERING ACTIVITIES
    Consulting services were provided to the National Park Service and
    other Federal agencies. Environmental health surveys were carried
    on at six Public Health Service hospitals.
    Sanitary collection and disposal of refuse were aided by publication
    of the manual “Refuse Collection and Disposal for the Small
    Community,” and through seminars, training programs, and
    demonstrations.
    Construction work on 21 of the 33 sanitary engineering projects in
    the community facilities program was substantially completed by the
    end of the year at a total cost in excess of $5 million. The 12 remaining
    construction contracts involve about 65 percent of the total
    estimated construction cost for the sanitary engineering portion of the
    339010—55------ 11
    154 Department of Health, Education, and Welfare, 1954
    program. A number of these will be completed in calendar year 1954;
    several will continue into 1955.
    MILK AND FOOD SANITATION
    The Cooperative State-Public Health Service interstate milk shipper
    certification program was converted from a demonstration project
    to a permanent activity. The list of “Sanitation Compliance Ratings
    of Interstate Milk Shippers” was issued on a quarterly basis. Standardization
    and certification of State rating personnel and the spot
    checking of the State rating surveys were done by the regional milk
    and food consultants.
    Sanitary standards for grade A milk and dry milk products were
    developed in draft form for submission to the National Conference on
    Interstate Milk Shipments, State health and agriculture departments,
    industry, and interested Federal agencies.
    The Industry-Health National Council on Food Protection, cosponsored
    by the National Restaurant Association, the National Sanitation
    Foundation, and the Public Health Service, was organized for
    the purpose of developing comprehensive plans for a nationwide program
    of food protection.
    Studies of the effects of pasteurization on Q-fever organisms in milk
    demonstrated a marked difference between the heat resistance of the
    Henzerling and S. H. strains. The significance of heat resistance of
    the various strains of this organism may require further laboratory
    study.
    HOME ACCIDENT PREVENTION
    The W. K. Kellogg Foundation supported statewide home accident
    prevention demonstrations in eight States. Representatives of the
    Foundation, the National Safety Council, and the Public Health
    Service developed the agenda and served as consultants, for a 3-day
    conference of professional personnel from these States.
    The three local health department demonstration programs have
    reached the point where Kellogg Foundation support can be replaced
    gradually by local appropriations. In 2 communities, home accident
    prevention activities have become well integrated with the health
    department program.
    The Division’s home accident prevention staff met with representatives
    of the oil industry and State and local fire officials in Kentucky
    to study the explosion hazards resulting from intermixture of class
    I and II petroleum products. State legislation designed to eliminate
    these hazards has been adopted. The information gained in this
    conference was applied in Arkansas in connection with the high
    rate of deaths due to kerosene and other explosives.
    Public Health Service 155
    Poison information centers have been established in a number of
    cities based on the success of the Chicago center which began operation
    during the year. The Public Health Service and the Food and Drug
    Administration assisted in the development of these activities.
    The American Standards Association has recommended supplementary
    design criteria for dress guards on gas heaters, as a result of
    Public Health Service reports of injury and death among children
    from this fire hazard.
    HYGIENE OF HOUSING
    Many communities are attempting to accelerate housing rehabilitation
    through enforcement of minimum health and safety standards.
    The Division of Sanitary Engineering Services furnishes assistance
    through seminars, publications, and consultation. During the year,
    training was provided in housing appraisal techniques, and assistance
    was given in preparing housing ordinances.
    Communicable Disease Center
    The Communicable Disease Center has as its goal the eradication of
    communicable diseases in the United States or their suppression to the
    point where they no longer are significant public health problems.
    This goal can be reached only by the combined efforts of Federal,
    State, and local agencies. To this common cause the Center contributes
    epidemic aid, laboratory assistance, and a variety of technical
    services in consultation and training.
    EPIDEMIOLOGIC SERVICES
    The National Center for the Evaluation of Gamma Globulin in
    the prophylaxis of poliomyelitis was established at CDC in collaboration
    with the Association of State and Territorial Health Officers,
    the American Physical Therapy Association, and the University of
    Pittsburgh. A group of 20 medical officers, 8 nurse epidemiologists,
    and 6 statisticians made field studies in this program.
    Analysis of extensive data on the use of gamma globulin did not
    yield statistically measurable results. Therefore, its value in community
    prophylaxis as practiced during 1953 has not been adequately
    demonstrated. However, data on the effectiveness of gamma globulin
    in use for contact cases indicated that with the preparations involved
    and in the dosages used the administration of gamma globulin to
    familial associates of patients with poliomyelitis has had no significant
    influence on: (1) the severity of paralysis developing in subsequent
    cases; (2) the proportion of nonparalytic poliomyelitis
    156 Department of Health, Education, and Welfare, 1954
    occurring in subsequent cases; and (3) the pattern of familial
    aggregation of cases in the country at large.
    At the request of States, CDC personnel investigated 23 epidemics.
    Officers assigned to the Epidemic Intelligence Service investigated
    189 outbreaks of disease, in addition to their poliomyelitis activities.
    A nationwide surveillance program has been set up to detect possible
    reintroduction of infectious diseases into areas now free of them, and
    to prevent their reestablishment and spread as endemic diseases. Only
    29 indigenous cases of malaria were reported in 1953, and 25 of these
    were known to have been infected during the previous season of high
    national incidence. None of the 21 suspected smallpox cases reported
    was confirmed. Diphtheria, leprosy, psittacosis, murine typhus, and
    sylvatic plague are also being observed.
    LABORATORY SERVICES
    A total of 229 physicians, scientists, laboratory administrators and
    technicians attended refresher courses, and 500 others attended field
    workshops. An extension service in parasitology was established for
    State laboratories. Through this service and the existing student
    extension services in parasitology, general medical mycology and the
    pulmonary mycoses, a total of 3,030 specimens were distributed to
    laboratory personnel throughout the country to further training in
    this field.
    Ten States requested epidemic aid requiring laboratory assistance.
    In addition, special laboratory services were provided to 20 other
    States. Diagnostic services were provided to State and local health
    departments, Federal agencies, foreign countries, and miscellaneous
    organizations. A total of 36,702 specimens were received from ^8
    States, 3 Territories, and 33 foreign countries.
    Major research activities included:
    Bacteriology: Studies on enteric organisms; development of improved
    methods for identifying airborne pathogens; and continued
    diphtheria studies directed toward improving the in vitro virulence
    tests.
    Hematology and Biochemistry: The development of a relatively
    simple technique for determining serum components by paper electrophoresis
    used to plot normal and abnormal protein patterns for various
    diseases.
    Mycology: Studies of pathogenic fungi; studies on soil as a source
    of human and animal infections; and ringworm studies to determine
    the source of infection, possible animal reservoirs, and the mode of
    transmission from animals to man.
    Parasitology: Studies to improve sensitivity and specificity of laboratory
    diagnostic procedures; trichinosis studies with emphasis on
    Public Health Service 157
    earlier identification; investigation of methods and media for more
    rapid identification of intestinal protozoa in culture and evaluation of
    drugs used in treatment of amebiasis and pinworm.
    Virus and Rickettsia Studies: Completion of rabies vaccine evaluation
    studies; evaluation of tissue culture studies and increased use of
    tissue cultures in the isolation of poliomyelitis and other viruses; hostvirus
    studies on both western and eastern equine encephalomyelitis;
    and development of improved diagnostic methods for detecting psittacosis
    infection in birds.
    DISEASE CONTROL ACTIVITIES
    The Center answered about 4,200 requests for consultation and assistance
    in communicable disease control. Cooperative community
    demonstration projects were conducted in 9 States.
    Sixty-seven requests for technical assistance on vector control and
    allied problems in connection with water resource development were
    acted upon for Federal agencies in 35 States. Two field investigations
    of irrigated areas showed that more than three-fourths of all
    mosquito production was directly related to poor irrigation practices.
    DEVELOPMENT OF EQUIPMENT AND CONTROL METHODS
    Studies with DDT-resistant houseflies have shown that resistance
    may be due to several factors, including detoxification of the chemical
    by the insect and the amount of chemical it absorbs during the period
    of treatment. The major progress in the chemical control of resistant
    houseflies has been in the commercial development of organic phosphorus
    compounds, such as malathion, which are highly effective
    against resistant strains but which exhibit relatively low toxicity to
    mammals.
    As a sanitary method of treating garbage and other organic wastes
    to prevent arthropod and rodent breeding, and at the same time produce
    a valuable humus, high-rate composting in mechanical units offered
    encouraging results. In preliminary runs, a stable product which did
    not attract flies and which showed good humus content was obtained in
    5 to 10 days.
    A survey gave no indication of illness resulting from exposure to
    parathion or tetraethyl pyrophosphate (TEPP) among 169 workers in
    an urban area surrounded by orchards where large quantities of these
    compounds were applied as sprays and dusts.
    TRAINING ACTIVITIES
    Assisting the States in training programs in public health practice
    and the control of communicable and preventable diseases is one of the
    activities of the Center. A total of 3,595 trainees attended 163 courses
    158 Department of Health, Education, and Welfare, 1954
    conducted by the Center, most of them presented in the States. Five
    regional field training stations were operated all or part of the year.
    During the year, 13 training films were produced and 9 were revised.
    Subjects included bacteriology, food sanitation, parasitic infections,
    insect and rodent control, and training methods.
    DISEASES UNDER STUDY
    Encephalitis: Investigations were conducted on the biology of three
    recognized vectors of eastern equine encephalitis. In a study among
    New Jersey pheasant flocks, EEE virus was isolated from (J view mosquitoes
    and from Culiseta melanura. This latter species is probably
    not involved in the transmission of the disease to man.
    Western equine encephalitis virus was isolated from mosquitoes collected
    in October, March, and April. To date, mosquitoes have been
    found with WEE virus in every month of the year except November,
    December, and February. A new technique of refrigerating the containers
    rather than freezing the mosquitoes before shipment has resulted
    in more pools of virus-positive mosquitoes than heretofore.
    Diarrheal Diseases: With the completion of fly control studies, investigations
    are being extended to include housing and basic sanitation
    factors which have been found to contribute to the spread of diarrheal
    diseases.
    In investigations of the prevalence of Salmonella organisms in processed
    foods and in poultry processing plants, 23 percent of the samples
    of fresh pork sausage were found to be contaminated. A lower percentage
    of smoked pork sausage and dry dog meal containing meat was
    found to harbor similar bacteria. In some CDC investigations of
    processing plants, both facilities and equipment were found to be
    extensively contaminated with Salmonella.
    Leptospirosis: CDC assisted the State of Washington in establishing
    a statewide leptospirosis control program. In studies of
    leptospiral infection in endemic areas, 1,232 rodents collected in
    southwestern Georgia were examined in the laboratory. Thirty were
    positive for Leptospira organisms.
    Malaria: Observations of factors related to malaria transmission
    were continued in an area of former endemicity in southwestern
    Georgia. No cases of malaria were detected in the population, and
    it is apparent that conditions favorable to the transmission of this
    disease did not exist.
    Murine Typhus: A study was made to determine the feasibility of
    eradicating murine typhus fever from farms and isolated rural premises
    in a county of southwest Georgia where previous studies had shown
    that over 30 percent of the commensal rats harbored murine typhus
    fever antibodies and were infested by the vector flea. Of the 650
    Public Health Service 159
    premises under study, 288 were cleared of rats, and presumably of
    typhus, and 34 remained infested. The largest area freed of rats was
    25 square miles.
    Plague: Surveillance was continued in port cities of the western
    United States where plague has occurred. Studies in the San Francisco
    Bay area indicated an intermingling of wild and domestic rodents
    that permitted an interchange of their common fleas. Other findings
    suggest that “permanent” reservoirs of enzootic plague exist in the
    continental United States and in Hawaii.
    Q-Fever: Studies revealed that the greatest amount of infectious
    material in sheep was discharged during the lambing period. It was
    found that these materials, even though dried, remained infectious for
    many weeks. At present, the infection is presumed to be airborne.
    Studies have shown that the usual commercial pasteurization temperatures
    do not destroy all Q-fever organisms which may be found in milk
    from infected cows. Temperatures of 145° F. for 30 minutes were
    needed to kill all rickettsiae in experimentally contaminated milk.
    Rabies: Rabies infection has been found in three genera of insectivorous
    bats in Florida. Studies to determine the significance
    of findings related to bat rabies in the United States are being conducted.
    A joint program of surveillance and control of rabies in wildlife
    was initiated in New Mexico to include a search for rabies infection
    in bats in the southwestern part of the United States.
    Ringworm: In a study of the spread of ringworm infections between
    animals and humans, lesions were reported in 10 human contacts
    of 31 dogs and cats infected with Microsporum canis. Four
    species of dermatophytes were isolated from 47 percent of samples of
    animal hair received from 13 States and from Canada.
    Schistosomiasis: Cooperative surveys with the Commonwealth of
    Puerto Rico Department of Health to measure the rates of schistosomiasis
    among school children show that the incidence of the disease
    in different geographic areas varies from 0 to 27 percent. In some
    schools, rates up to 53 percent were encountered.
    Division of Dental Public Health
    The Division of Dental Public Health provides technical assistance
    to State and local health departments and conducts studies designed
    to develop, test, or improve dental public health practices.
    In working toward a solution of dental health problems, the Division
    utilizes knowledge gained from its own studies and develops competence
    in the use of procedures advanced by others. Dental programs
    are conducted in 46 States, but many of these are of a minimum nature;
    hence, there is continuing request for professional and technical as160
    Department of Health, Education, and Welfare, 1954
    sistance. Through consultation and field activities, the Division
    meets these requests on a limited basis.
    CONSULTATIVE ACTIVITIES
    A working document was developed which provides a practical
    method for States to use in developing dental health programs. The
    document, which culminates several years of effort, outlines the elements
    which must be considered in planning and carrying out successful
    State dental health programs.
    Pilot studies in specialized fields are being conducted in 20 States.
    These serve as a stimulus to State and local health departments in
    improvement of dental health programs.
    Assistance was given to the Commission on Chronic Illness in
    developing the dental parts of the Baltimore Health Survey, including
    the preparation of a set of dental questions for the household interview
    survey and physical examination card. The Division will also
    participate in the physical examination of persons interviewed as a
    part of the multiple screening procedure.
    FIELD PROJECT ACTIVITIES
    The Grand Rapids water fluoridation project continued into its
    10th year, in cooperation with the National Institute of Dental Research.
    Beneficial effects were exemplified by the 62-percent reduction
    in dental caries in 7-y ear-old children, and a 45 percent reduction
    in tooth decay in 14-year-olds who have been drinking fluoridated
    water part of their lives. Intervening age groups showed corresponding
    reductions.
    Two studies have been initiated to determine the dental service
    requirements of children receiving the full benefit of naturally
    fluoridated water in Cambridge, Md., and the changing dental needs
    of children living in Gainesville, Fla., whose supply has been fluoridated
    since 1949. Other studies dealt with the effectiveness of
    topically applied caries preventives, the development of more precise
    measures for determining the prevalence of periodontal disease in
    child populations, and the fluid intake of infants and youth.
    The problem of a variable fluoride intake related to differences in
    temperature and other climatic factors is being studied in several of
    the Western States. Current investigations are aimed at determining
    the optimum concentration in lower temperature areas.
    The pilot defluoridation studies in Bartlett, Tex., and Britton,
    S. Dak., are continuing. During the year improved regeneration
    procedures have reduced the fluoride concentration of finished water
    to a desirable level. The procedures employed are now believed to be
    economical and practical enough for general adoption.
    Public Health Service 161
    Division of International Health
    The Public Health Service continued its participation in international
    public health work during 1954 through both the international
    health agencies and agencies of the United States Government
    operating abroad, such as the Foreign Operations Administration.
    Through the Division of International Health, the Public Health
    Service maintains active relationships with the World Health Organization
    and the Pan American Sanitary Organization. Matters of
    policy are conducted through the Department of State, and technical
    matters directly with the two organizations.
    During the year the Service furnished members of official delegations
    and participated in the formulation of policy and preparation
    of instructions to the delegations to the following meetings: Seventh
    World Health Assembly; sessions of the Directing Council of the Pan
    American Sanitary Organization; meetings of the Executive Committee
    of the Pan American Sanitary Organization; WHO Regional
    Committee for the Western Pacific; and WHO Regional Committee
    for the Americas.
    The Chief of the Division and the International Health Representative,
    hold Presidential appointments as United States Representative
    and Alternate, respectively, on the Executive Board of the World
    Health Organization. Under these appointments they serve in their
    personal capacities and not as representatives of the Government.
    During the year the Division worked out arrangements in this
    country in connection with the WHO program to establish internationally
    recognized nonproprietary names for drugs moving in
    international commerce. Arrangements were completed to provide
    for review of proposed nonproprietary names by interested groups
    in this country.
    In addition, procedures were worked out to provide for adequate
    review of monographs proposed for inclusion in the International
    Pharmacopoeia. Volume I of this publication was issued in October
    1951 by the World Health Organization, and volume II was under
    preparation. At a series of meetings attended by representatives of
    the American Pharmaceutical Association, the U. S. Pharmacopoeia,
    the National Formulary, and the American Homeopathic Pharmacopoeia,
    industry, and government, it was agreed that a United States
    Committee on International Standards for Drugs be established to
    provide competent and representative previewing of monographs
    proposed for inclusion in the International Pharmacopoeia.
    Initially the membership of the Committee includes representatives
    of the IT. S. Pharmacopoeia and National Formulary Revision Committees,
    the American Homeopathic Pharmacopoeia Committee on
    162 Department of Health, Education, and Welfare, 1954
    Manufacture, the Combined Contact Committee of the American Drug
    Manufacturers Association and American Pharmaceutical Manufacturers
    Association. The American Pharmaceutical Association provides
    administrative support for the Committee. WHO now sends
    each monograph to the American Pharmaceutical Association in its
    capacity as administrative staff for the Committee. The Committee
    decides on proper distribution for review and forwards comments to
    WHO for consideration.
    VOLTA RIVER BASIN DEVELOPMENT
    In April the Special Commissioner of the Preparatory Commission
    for the Development of the Volta River Basin in Gold Coast,
    Africa, and his special consultant were in Washington to discuss
    problems in medical entomology, preventive medicine, occupational
    health and housing in connection with public health, medical care,
    and housing problems of the Volta River Development Authority.
    These conference were arranged by the Division of International
    Health.
    COOPERATION WITH FOA
    Early in the year the Director of the Foreign Operations Administration
    and the Secretary of Health, Education, and Welfare set forth
    the principles governing relationships between FOA and constituents
    of the Department. Following this, detailed operational guides and
    operating agreements, covering the nature and extent of Public Health
    Service and Children’s Bureau participation in FOA programs, were
    developed.
    Public Health Service responsibility in FOA programs was considerably
    increased when the Service was asked to accept staffing and
    programming responsibility in Latin American countries on the same
    basis as for other countries throughout the world. In previous years,
    these functions had been handled directly by the Institute of InterAmerican
    Affairs.
    Representatives of the Division of International Health, the Children’s
    Bureau, and the Public Health Division of FOA prepared a
    statement of health program priorities for international technical
    assistance programs. This statement was transmitted to all FOA
    field missions as a basic guide for fiscal year 1954 programs and for
    development of the budget for fiscal year 1955. It was later adopted
    as a basic guide for continuing use in planning and developing technical
    assistance programs in health.
    A significant project was the work done on specifications and
    standards for insecticides and spraying equipment. A number of
    problems had developed in connection with DDT, which is used in
    substantial quantities in malaria control programs, and which in some
    instances had been received overseas in unusable condition. The
    Public Health. Service 163
    Division arranged discussions of these problems with major DDT
    manufacturers, the National Agricultural Chemical Association, the
    Department of Agriculture, and the Communicable Disease Center.
    The Center agreed to develop specification for DDT to be used in the
    technical assistance programs, and a continuing review is under way.
    Malaria control operations are being carried on in 17 countries
    with the assistance of FOA and PUS staffs. Approximately 100
    million people were protected against malaria by these programs
    during the fiscal year. Surveys have shown that industrial production
    increases when workers and their families are free from attacks
    of malaria. Tremendous savings are effected through increases in
    earning power and in land value and through decreases in medical
    expenses and individual indebtedness. In Mysore, India, for example,
    it was found that such savings in the course of a year amounted to 93
    times the amount of money spent to protect the community. During
    the year approximately 11,000 tons of DDT, and some small amounts
    of dieldrin were purchased for use in FOA malaria programs, and
    further increases in malaria control programs are anticipated.
    Although designed primarily for the control of malaria, these programs
    also have other beneficial effects. For example, in Pakistan,
    kala-azar has also been effectively controlled through the DDT spraying
    program, and in Thailand, where dieldrin has been used, there has
    been a remarkable reduction in the transmission of filariasis.
    Technical assistance programs in health were continued in 38 countries
    during the year. Toward the end of the year Saudi Arabia requested
    that such assistance in that country be discontinued, and
    arrangements were undertaken to withdraw the health personnel assigned
    to that mission. A new program was inaugurated in Surinam.
    During the year 100 professional health workers were recruited for
    assignment to overseas missions. Of this number, 23 are medical
    officers, 36 are sanitary engineers or sanitarians, 25 are nurses, and 16
    are in other professional categories.
    TRAINING OF FOREIGN NATIONALS
    The Division prepared or assisted in the programs arranged for
    792 foreign health workers from 66 countries who were in this country
    for study or observation. This number is 42 fewer than those who
    were trained in fiscal year 1953, but 168 more than in 1952.
    During the year, 48 schools, 29 clinical centers, and 10 inservice
    training organizations were utilized in the placement of participants
    for training and observation. Many Federal, State, and local agencies,
    as well as private and voluntary organizations, cooperated in the
    training of foreign students and visitors. Of the 792 health workers,
    352 came from the Far East, 261 from the Western Hemisphere, and
    the remainder from Europe, Africa, and the Middle East.
    164 Department of Health, Education, and Welfare, 1954
    Table 1.—Statement of appropriations, authorizations, obligations, and
    balances for the fiscal year 1954
    [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
    Balances
    Retired pay of commissioned officers.._
    Foreign Quarantine Service ._ ___
    $1,197
    2,900
    6, 000
    5,000
    13, 250
    5,000
    33,100
    4,675
    20, 237
    12, 095
    2,900
    1,082
    15,168
    1,740
    3,162
    875
    $94 $1, 291
    2,908
    6, 000
    5,000
    13, 877
    5,190
    36, 576
    11,973
    20, 089
    12, 056
    3, 005
    1,082
    15,168
    1,740
    3,263
    877
    $1,110
    2, 892
    5,991
    4,987
    13,846
    5,185
    36, 559
    11, 906
    $181
    $8 16
    Control of tuberculosis___________ ... 9
    Control of venereal diseases ... 13
    Assistance to States, general_________ 275 $352 31
    Control of communicable diseases__ _ 6 184 5
    Hospitals and medical care____________
    Operating expenses, National Institutes
    of Health______ _ _____
    14 3, 462
    7, 298
    17
    67
    Salaries, expenses, and grants, National
    Cancer Institute. _________________ -148 19, 538
    11, 768
    2,982
    1,080
    14, 952
    1,632
    3, 252
    875
    551
    Mental health activities____ . ________ -57 18 288
    Salaries and expenses _____ __ -96 201 23
    Disease and sanitation investigations
    and control, Alaska_ .. ___ __ 2
    Salaries, expenses, and grants, National
    Heart Institute__ _______________ 216
    Dental health activities . ______ 108
    Engineering, sanitation, and industrial
    hygiene___ _ .... 1 100 11
    Salaries and expenses, hospital construction
    services _ ... 2 2
    Arthritis and metabolic disease activities__
    __ _ _ __ __ _____ 7,000
    5,738
    4,500
    -16 6,984
    5, 726
    4,500
    447
    6,895
    5, 685
    4,396
    410
    89
    Microbiology activities____ __ . ______ -18 6 41
    Neurology and blindness activities. 104
    Working capital fund, narcotic hospitals
    Service and supply fund. __ ____ __
    * 419 28 37 2,116 13 2,129
    4,974
    1,538
    1,913
    591
    Construction of research facilities_____ 4,974
    23
    3, 061
    Research facilities, National Institute
    of Dental Research... -23
    Payments to States for surveys and
    programs for hospital construction.. . -291 -291 -291
    Grants for hospital construction_______ 65,000 34, 637 99, 637 74, 081 25, 556
    Grants, water pollution control ___
    Buildings and facilities, Cincinnati,
    Ohio.. _______ ____________ . . • -2 25 23 23
    Operation of commissaries, narcotic
    hospitals. __________ _____ 214 15 229 188 41
    Salaries and expenses, Bureau of
    Prisons .. _ ___ ___ 1, 239
    49
    7 1,246
    49
    1,245
    49
    1
    American Sections, International Commissions,
    State __________________
    Refugee Relief, Executive. _ _ . . 188 188 181 7
    Research, Navy (allocated working
    fund to HEW, PHS)_______________ 16 16 8 8
    Research and development, Army
    (allocated working fund to HEW,
    PHS)______________________________ 465 465 282 183
    Naval working fund (allocated working
    fund to HEW, PHS) ..A 32 32 28 4
    Maintenance and operations, Air Force
    (allocated working fund to HEW,
    PHS)____ ... . _. . 30 30 30
    Research and development, Air Force
    (allocated working fund to HEW,
    PHS)______________________________ 43 43 33 10
    Operating expenses, Atomic Energy
    Commission (allocated working fund
    to HEW, PHS)____________________ 20 20 6 14
    Working fund, PHS. 176 176 166 10
    Consolidated working fund, PHS.. -42 37 -5 -5
    Total . _____________ . 210, 619 1,131 15,117 39, 846 266, 713 235, 416 31, 297
    Public Health Service 165
    Table 2.—Commissioned officers and civil service personnel as of June 30, 1954
    Part time (civilian)
    5o
    S i ; r ; H ’
    : : i ; i i
    : : : : i :
    g i : iswg'*‘ l
    :;i i
    Hi i
    00
    I 1
    Without
    compensation
    I " I i H i : i
    ill
    s i i ig !5W !5
    r i i
    : i i
    3
    : hl
    When
    actually
    employed
    ! : : : : : i : i ; i :
    5 i;
    i i
    i i i
    i Hi
    : : : :
    e -s 1
    1 II
    Total
    parttime
    L
    _9________
    860 ‘8 s
    ! ! ' co ! : : i : i
    it! ! I
    s i i
    161
    2
    286
    5
    12’
    s i HI
    i :
    Full t me
    Civilian
    Soo
    ■g sis
    s I
    ; i i ; ; ; ;
    ■Hi: i i
    5 i > CO i OS । । । s i !5S
    ; i 1 1 1
    States
    7, 280
    22
    1 ;
    i i i i
    ! i 1 'S2 '2 ' i” iR. i H
    i i i i
    §
    i
    i
    ! i
    I 1
    Washington
    metropolitan
    area
    5, 415
    406
    12
    “’Sggg i
    i
    3 g
    o
    Eh
    12,851
    428
    12
    i
    1
    Commissioned
    officers
    2,464
    41
    4
    r-4 1 iQ (M CO CD 1 — 3S2
    1
    g
    Grand
    total
    fulltime
    1 15, 315
    469
    ;^883 SS 1
    Public Health Service___________________________________________________
    Office of the Surgeon General____________________________________________
    T m m o H ia fn O ffin n n f fh o .Q iirom n n d -o n o r a l
    Division of Civilian Health Requirements___________________________
    Division of Finance__________________________________________________
    Division of Administrative Services__________________________________
    Division of Personnel________________________________________________
    Division of Public Health Methods__________________________________
    Offices other than divisions (Health Emergency Planning, Information,
    Executive)__________________________________________________
    Details to other agencies_____________________________________________
    Bureau oi Medical Services______________________________________________
    Office of the Chief____________________________________________________
    Division of Administrative Management_____________________________
    oi i-ienim xvesouices________________________________________
    Division of Foreign Quarantine______________________________________
    Division of Hospital Facilities_______________________________________
    Division of Hospitals________________________________________________
    Freedmen’s Hospital_____________________________________________
    Division of Nursing Resources_______________________________________
    Details to other agencies_____________________________________________
    Bureau of State Services_________________________________________________
    Office of the Chief____________________________________________________
    Division of Dental Public Health____________________________________
    Division of General Health Services_________________________________
    HhH
    ■ i i ! H
    ::::::
    HHH
    1
    H!
    0 0-0.20°
    lillli
    166 Department of Health, Education, and Welfare, 1954
    Table 2.—C om m ission ed officers an d civil service person n ol as o f Ju n e 30, 1954—Continued
    5
    S rH CO CO T-H Xfi 1 '
    : i :
    (civilian)
    Without
    compen-
    8 iH it* i
    : i :
    1 S CO CO CO (Mr— 1 1rQ—1 CO CO CO r-t 1»
    I ■
    lii
    S “SS05'^”'0*000 1
    Outside
    United
    States
    IIIHHIIII
    I
    s
    i i ~ i j
    3
    I1
    5
    g?SgaS8gs§ ;
    Commissioned
    officers
    Grand
    total
    fulltime
    is
    f June 1954.
    I
    j H • • H : H i
    : : : : :::::: :
    o
    i
    ic Diseases_____
    and Blindness..
    reserve officers,
    aid during the m
    ts and special age
    ;
    ritis and Metabol
    ;al Research____
    ;al Health______
    •ological Diseases
    its______________
    fleers and 1,253 B
    employees not p;
    ng epidemiologisi
    M og--g,3ooo§J'§ ;g
    ii 1
    Institutes of
    x of the Direc
    ional Cancer ]
    ional Heart Ir
    ional Institute
    ional Institute
    ional Institute
    ional Institute
    ional Microbic
    ision of Resea
    lical Center...
    ails to other a;
    dudes 1,211 R
    eludes those r
    dudes 2,335 co
    1
    >-< c*»
    03
    Public Health Service 167
    Table 3.—Payments for research grants, research fellowships, and field investigations
    and demonstrations, fiscal year 1954
    Research grants Research fellowships Field investigations
    and demonstrations
    State or country
    Number Amount Number Amount Number Amount
    Alabama _______________________ 20 $179, 502
    13,700
    84,797
    3,123,183
    331,373
    685,376
    2 $8,602 1 $9,817
    Arizona ______________________ 4 1 1,680
    8,000
    135,557
    Arkansas __ _ 13 1
    California_________________________ 241 43 178,743 9
    Colorado 34 1 13,880
    Connecticut______________________ 68 19 76, 566 2 30,838
    Delaware 1 12,600
    596,784
    216, 208
    269,930
    13,721
    2,108, 401
    237,379
    District of Columbia_______________ 59 7 27,853 3 30,078
    Florida 29 1 3,900
    Georgia___________________________ 31 3 14, 400 2 16,625
    Idaho 2
    Illinois____________________________ 210 23 95, 589 6 137,424
    Indiana___ ______________________ 31 5 15,563 1 15,000
    Iowa 35 263,377
    345, 527
    2 5,949
    Kansas _____________ .. ____ 45 3 13,483 2 30,000
    Kentucky 14 97,652
    Louisiana 48 527,775
    227, 537
    1,039,015
    4, 234,101
    864, 828
    1 4,950
    5,250
    72,569
    Maine 16 1
    Maryland . _______________________ 89 16 2 31,105
    Massachusetts .. _______________ - 333 88 387,842 5 66, 406
    Michigan ..____ ..__ ___ 75 5 25,450 1 15,000
    Minnesota 75 803, 746
    12,919
    765,992
    11 44,496
    Mississippi 2
    Missouri.____________ ____ _________ 80 11 50,173 5 49,280
    Montana 4 47,377
    Nebraska 15 101,415
    Nevada _
    New Hampshire 3 50,012
    113, 795
    30,903
    5,297,016
    613,624
    14,933
    1,151,069
    223, 490
    208,373
    1,948,034
    59,681
    77,015
    36,114
    400,597
    New Jersey 19 2 9,246
    New Mexico 5
    New York________________ ______ 444 80 364,100 12 139, 579
    North Carolina 68 10 42,940
    North Dakota 3
    Ohio __________ ___________________ 123 21 90,201 3 20,785
    Oklahoma _______________________ 28 5 20,953
    Oregon 24
    Pennsylvania______________________ 207 22 91,614 7 85,644
    Rhode Island 10 2 5,387
    South Carolina 12 1 6,426
    South Dakota 7
    Tennessee______________________.. 49 1 4, 250 7 108, 508
    Texas ____________________________ 66 472,834 7 27,946 5 51,990
    Utah ___________________________ 28 474,967 8 31,812 3 39,073
    Vermont_________________________ . 11 75,055 1 5, 250 1 14,931
    Virginia _______________ ___________ 31 215,538 2 9,465 1 2,338
    Washington_________ _______________ 58 539;169
    6,000
    12 51,786 1 14,800
    West Virginia 1
    Wisconsin 58 523; 944 13 59,438
    Wyoming
    Alaska
    Hawaii 2 11,450
    Puerto Rico 8 41,859 2 8,032
    Virgin Islands
    Canada 2 18,000
    35,000
    8 38, 728
    British Isles 2 20 96,368
    Israel . __ ____________.. _____ 1 15i 000
    26,000
    6,534
    12,500
    18,000
    7,965
    5,292
    17,118
    1 6,780
    France 3 2 7,800
    Denmark_______ _________________ 1 9 40,114
    Argentina 2
    Peru 2
    India 1
    South Africa 1
    Y ugosla via 1
    Netherlands ______ ____________ 1 9,800
    Japan 1 5,133
    31,415
    10, 519
    2,000
    6,675
    39,454
    Sweden ... 8
    Switzerland _____ 2
    Germany 1
    Belgium 1
    Fellows in Government institutions. 10
    Totals...................................... .. 2,855 29,951,150 490 2,132,004 85 1,091,344
    168 Department of Health, Education, and Welfare, 1954
    Table 4.—Payments for teaching grants, traineeships, and training grants,
    fiscal year 1954
    State or country
    Teaching grants Traineeships Training grants
    Number
    Amount Number
    Amount Number
    Traineeships
    provided for
    under grant
    Amount
    of grant
    Total___ - . _______ 323 $5,894,184 488 $7, 444,832 251 818 $4, 222,806
    Alabama__________________ 4 70,000 4 70,000
    Arizona_________ ________
    Arkansas.._______________ 3
    18
    2
    4
    64,991
    332,800
    50,000
    79,894
    3
    31
    69
    64,991
    452, 391
    99,069
    147,364
    California______ ___________ 19
    48
    62
    27
    23
    273,318
    103,811
    121,810
    Colorado _ _______________
    Connecticut _ ___ _
    Delaware ..__ ______
    District of Columbia______ 14
    37
    246,643
    50,000
    152,660
    18
    4
    7
    297,697
    58,000
    125, 400
    91
    4
    41 195,818
    8,000
    43, 660
    Florida ________________
    Georgia___________________ 7
    Idaho _. ... .. ____
    Illinois____________________ 20
    2
    7458
    397,104
    29, 968
    135, 059
    79, 050
    76,916
    150,000
    29
    78
    13
    9
    13
    485,820
    76, 555
    129,027
    147,115
    122,705
    187,513
    16
    63946
    59
    14
    14
    15
    7
    26
    293,899
    77,088
    62,394
    99,065
    64,872
    90,313
    Indiana_________ ________
    Iowa. ___________________
    Kansas __ ____ _ ____
    Kentucky_______________
    Louisiana.____ ____
    Maine _ _______________
    Maryland.. _________ _____ 10
    16
    99
    3
    18
    213, 558
    244,124
    139,819
    141,844
    25,000
    311,940
    14
    36
    14
    11
    3
    24
    233,808
    463,525
    179, 506
    157,834
    25,000
    405, 242
    5
    35
    5
    10
    14
    120
    16
    44
    58, 750
    572, 801
    67,727
    179,176
    Massachusetts.__________
    Michigan _________ ____
    Minnesota __________
    Mississippi_____ - ____
    Missouri _______________ 6 22 110,736
    Montana. _____ ____
    Nebraska__ ______ . 8 125,000 11 146,708 3 3 27, 290
    Nevada. - ____________
    New Hampshire___ - 1 5,000 1 5,000
    New Jersey________________
    New Mexico ___________ _
    New York. ____ __________ 34
    13
    2
    13
    34
    26
    659, 534
    220, 280
    20,000
    237, 641
    65,000
    68,999
    470,112
    51
    19
    2
    21
    34
    39
    832, 483
    259,050
    20,000
    327,634
    65,000
    68, 999
    592,793
    24
    11
    84
    27
    487,032
    North Carolina________ 273, 285
    North Dakota ________
    Ohio____ _____ ___ ______ 12 33 221,963
    Oklahoma _________
    Oregon _____ ___
    Pennsylvania__________ 23 78 332, 222
    Rhode Island______ ____
    South Carolina 2
    2
    10
    84464
    2
    8
    50,000
    18, 200
    183,862
    135,868
    78,000
    65,650
    102,990
    69,948
    19,958
    255,772
    33
    16
    12
    747
    8
    27
    55,000
    31,200
    253, 777
    155,152
    98,115
    65,650
    119,902
    146,345
    19, 958
    197,088
    1 5, 000
    South Dakota .. _____
    Tennessee _________ ______ 754
    41
    25
    216,345
    25,084
    30, 498
    Texas______ ------
    Utah. __________________
    Vermont
    Virginia ____________ _____ 34
    3
    16
    31,612
    Washington.. . ._ ____ 78,337
    West Virginia__
    Wisconsin. . ... 3 15 65,484
    Wyoming__
    Alaska. _
    Hawaii _______________ 1
    3
    5,416
    51,000
    1 5, 416
    Puerto Rico 3 51,000
    Virgin Islands
    Public Health Service 169
    Table 5.—Payments to States, fiscal year 1954
    [In thousands]
    State
    Venereal
    disease
    special
    projects
    Tuberculosis
    control
    General
    health
    Mental
    health
    activities
    Cancer
    control
    Heart
    disease
    control
    Hospital
    construction
    Community
    facilities
    Total1_________ ______ 2 $3,105 $4, 274 3 $10,693 $2,308 $2,213 $1,054 $88, 219 $4,125
    Alabama___________ -_______
    Arizona_____________________
    131
    24
    101
    49
    305
    75
    52
    11
    58
    13
    29 1,791
    851
    96
    Arkansas___________________ 90 72 198 31 38 25 2,026 81
    California----- ---------- ------------ 20 246 537 135 139 50 2, 312 282
    Colorado___________________ 19 34 100 18 23 16 433—
    Connecticut.------------------------ 9 56 88 23 27 18 526—
    Delaware __---------------- -------
    128
    19 18 18 5 11
    District of Columbia________ 41 37 18 11 8 100
    Florida_____________________ 277 86 219 44 47 27 951 517
    Georgia-------------------------------- 189 123 310 56 60 33 2,762 537
    Idaho_______________________ 15 16 60 18 13 14 7 45
    Illinois_____________________ 142 216 413 108 121 37 3, 453 531
    Indiana_____________________ 80 201 52 43 25 2,438 25
    Iowa_______________________ 16 38 160 36 41 23 1,694
    1,821
    ----- _------
    Kansas_____________________ 20 43 131 27 31 19 —
    Kentucky---------------------------- 63 114 260 42 43 24 3,590 61
    Louisiana----------------------------- 229 86 231 43 42 22 2, 831—
    Maine_______________ _______ 26 75 18 1 / 6
    Maryland___________________ 56 81 136 33 33 21 425
    Massachusetts______________ 7 132 250 63 71 25 1,962
    Michigan___________________ . 60 133 346 83 75 37 3,081
    Minnesota__________________
    179
    55 190 37 45 22 1, 586
    3,020
    —
    Mississippi__________________ 90 263 40 48 29
    Missouri____________________ 81 101 251 57 64 29 2,705—
    Montana____________________
    (4)
    19 52 18 13 13 190 ----- - ---- -
    Nebraska___________________ 19 100 14 12 12 938—
    Nevada---------------- --------------- 10 30 13 5 8 184 35
    New Hampshire........ ............ -. 14 39 18 11 206 ----- - ------
    New Jersey_________________ 36 113 245 66 63 29 1,837 7
    New Mexico_________ ____ 18 32 74 18 14 14 389 217
    New York__________________ 95 367 669 189 203 57 3, 330
    North Carolina_____________ 136 119 370 62 69 28 3,186 517
    North Dakota______________ 6 28 58 18 14 14 247—
    Ohio________________________ 62 182 429 108 112 42 5,262
    1,519
    —
    Oklahoma__________________ 52 64 176 33 37 19 —
    Oregon_____________________
    106
    37 109 20 18 9 557 94
    Pennsylvania_______________ 236 585 145 116 54 5, 415—
    Rhode Island_______________
    223
    24 42 18 12 4 256
    South Carolina_____________ 86 210 36 39 23 3,851 1,079
    South Dakota-.-.......................
    164
    19 61 18 10 11 125 ----- _------
    Tennessee__________________ 122 281 46 39 17 3,454
    Texas_______________________ 221 167 541 116 108— 4, 726 2
    Utah_______________________ 9 12 64 17 7 11 297—
    Vermont___________ ________ 17 35 18 9 5 13 181
    Virginia____________________ 74 116 247 51 52 9 2,130—
    Washington________________ 52 138 32 27 17 1, 415—
    West Virginia_______________ 44 56 156 30 32 20 2,316 ----- - ------
    Wisconsin___________________ 49 199 42 36 17 1,525—
    Wyoming___________________ 4 11 38 5 8 5 132—
    Alaska______________________ 1 51 602 18 5 10 594 ----- - ------
    Hawaii_____________________ 36 35 18 7 13 99—
    Puerto Rico________ ____ ... 92 171 248 34 35 23 3,493 ----- - ------
    Virgin Islands______________ 4 8 5 18 (4) 3 —
    1 Any discrepancy in total is the result of the rounding process.
    2 Includes $940,848.49 in services and supplies furnished in lieu of cash.
    2 Includes payment of $564,000 to Alaska for disease and sanitation investigation and control activities.
    4 Received less than $1,000.
    6 Vermont allotment paid to Vermont Heart Association.
    339010—55—12

    Office of Education
    I. Introduction
    The Basic functions of the Office were defined by Congress in 1867,
    when the Office was established. These functions are:
    1. To “collect such statistics and facts as shall show the condition and
    progress of education.”
    2. To diffuse “such information [on education] as shall aid the people
    of the United States in the establishment and maintenance of efficient
    school systems,” and
    3. “Otherwise [to] promote the cause of education.”
    These responsibilities are fulfilled in many ways, but basically by
    studies and research on many aspects, both quantitative and qualitative,
    of education in America, and, to some small degree, on education
    abroad. Findings are made available by or through dozens of major
    publications, by means of conferences and workshops in Washington
    and over the country with both professional and citizen groups, by
    means of answers to more than half a million inquiries annually, and
    through two periodicals—School Life and Higher Education.
    The second aspect of the work is that of administering a variety of
    programs for which the Office of Education has become responsible
    through the years. For example, the Office budget in 1954 amounted
    to $2,911,402 for its basic services ($1,411,042 of which was for administration
    of grants) and $228,213,092 in grants administered. It
    administered $197,350,000 in payments to school districts for the construction
    and operation of schools in what have come to be known as
    “federally affected” areas. Likewise, it administered $25,811,591 for
    vocational education in local communities and disbursed $5,051,500
    for colleges of agriculture and mechanic arts.
    171
    172 Department of Health, Education, and Welfare, 1954
    In addition, it spent $469,360 administering programs for tlie>
    Foreign Operations Administration and the State Department
    amounting to $1,929,184.
    The Office of Education is guided by the following principles:
    First, that the schools are the people's schools. And by “the people”
    is meant all the people: parents, nonparents, teachers, and children.
    AU have a stake in education and all share in the responsibility for
    making the schools the best possible.
    Moreover, the Office of Education holds that the schools must be
    accessible. Sound practice, responsiveness to the citizenry, and
    democracy require this. Schools should not be controlled to perpetuate
    any political party, nor any organized group in society—including the
    teaching profession—nor any special interest. In effect, the schools
    must serve all the people, and they must be responsible to all the people.
    In calling the schools “the people’s schools,” it is clear that varying
    local, State, and national interests in educational policies, in procedures,
    and in organizational methods must recognize and provide
    for relating their diverse interests effectively.
    For its part, the Office of Education respects the pattern of 48
    independent State school systems which delegate much responsibility
    and give freedom in operation to local school units. It accepts the
    role of the Federal Government as that of assisting and strengthening
    the 48 State systems and their local school units with a view to helping
    them to carry on their responsibilities without Federal domination,
    control, or interference.
    A second cardinal principle which guides the Office of Education
    is that it should demonstrate belief in democratic process and in education
    as it carries out its responsibilities of national leadership.
    It tries to do so by getting the facts and interpreting their significance
    objectively so that they can be understood and put to use by those
    responsible for the schools—the American citizenry.
    The Office seeks to discharge its national responsibilities also by
    administering efficiently the programs for which it is responsible.
    It seeks also to present to the people’s representatives—the administration
    and the Congress—all the pertinent facts regarding education,
    as well as proposals for strengthening it that are consistent with
    the principles which guide it. In a real sense its responsibility is
    a teaching one—to study, to interpret, and to ask and to answer
    questions.
    To strengthen its services to education, the Office, during 1954,
    requested, as a part of the administration’s legislative program, and
    was granted by Congress, with approval by the President, on July
    26, 1954, the following:
    A. Funds and authority for educational conferences in each State
    and for a White House Conference on Education, to stimulate inOffice
    of Education 173
    creased State and local action to meet present and impending
    educational needs.
    B. Authority to increase educational research. Authority was
    granted the Office of Education to engage in cooperative research
    with colleges, universities, and State departments of education. Also
    an Advisory Committee on Education was authorized to identify
    major problems in education needing commission-type studies and
    to recommend appropriate action to implement findings of such
    studies.
    The Office of Education program is shaped in part by congressional
    action and at times by decisions of the Supreme Court. It is therefore
    perhaps appropriate to note briefly congressional acts and a
    Supreme Court decision in 1954 of special consequence to the Office
    of Education and to education in the United States.
    Public Law 731, approved August 31,1954, an amendment to Public
    Law 815, 81st Congress, provided for a 2-year extension of the program
    of assistance to school construction in federally affected areas
    under title III of that act.
    Public Law 732, approved August 31,1954—an amendment to Public
    Law 874, 81st Congress—postponed the effective date of the
    3-percent “absorption” requirement for 1 year.
    Other items of educational interest include the following: Public
    Law 325, approved April 1, 1954, provided for the establishment
    of the United States Air Force Academy; Public Law 610, approved
    August 20, 1954, extended the period during which certain veterans
    educational and training benefits may be offered; Public Law 733,
    approved August 31, 1954, authorized the Commander of the Air
    University, under certain conditions, to confer advanced degrees upon
    students in the Resident College of the U. S. Air Force Institute
    of Technology; Section 37 of Public Law 591, approved August 16,
    1954 (Internal Revenue Code of 1954), liberalized taxes on retirement
    income so as to give most retired teachers tax credit of $240
    on that income; and Public Law 719, approved August 30, 1954,
    granted the consent of Congress to certain New England States to
    enter into a compact relating to higher education and establishing
    the New England Board of Higher Education.
    The year 1954 was made notable also by action in another area
    which has far-reaching implications for America’s schools and colleges
    ; namely the decision of the United States Supreme Court in the
    school segregation cases. These cases had been argued before the
    Court in the 1952 session, but no decision was handed down. They
    were, however, restored to the docket for reargument, which took
    place in December 1953,
    On May 17, 1954, the Court handed down a decision that racial
    segregation in the public schools is unconstitutional, on the ground
    174 Department of Health, Education, and Welfare, 1954
    that it deprives the children of a minority group of equal educational
    opportunities.2 Later the cases were again restored to the docket and
    the parties were requested to present further argument concerning the
    implementation of the Court’s decision by specific decrees. Argument
    for this purpose was scheduled by the Court for December 1954.
    During fiscal year 1954, three persons served as Commissioner of
    Education. The first was Dr. Lee M. Thurston, who became the 12th
    U. S. Commissioner on July 2,1953. He brought to this office experience
    as public school teacher, school superintendent, college professor
    and head of the State Department of Public Instruction of Michigan.
    He conducted the Office program, in the new Department of Health,
    Education, and Welfare, with such vigor and understanding that, after
    a span of only 2 months, he had won the confidence and support of
    colleagues and the profession. A heart attack brought about his untimely
    death on September 4, 1953.
    The responsibility of acting commissioner was assigned to Dr. Rail
    I. Grigsby, Deputy Commissioner, who served until Dr. Samuel Miller
    Brownell took the oath of office as the 13th U. S. Commissioner of
    Education on November 16, 1953. Dr. Brownell came to the position
    from a professorship of educational administration in the Yale
    University Graduate School and from the presidency of New
    Haven (Conn.) State Teachers College. He also brought earlier
    experience as a public school teacher, high school principal, and school
    superintendent.
    IL Major Educational Problems Confronting the
    United States in 1954
    All Americans are aware of the importance of education to the
    strength and vitality of our Nation. The security of this country and
    the hopes of the free world depend in great measure upon the character,
    the ideas, the ingenuity, and the competence of each successive
    generation of young people. The complexities of today’s world call
    for broader knowledge, greater skill, and deeper understanding.
    Hence, education, whether at home, at church, or in our schools, is
    more important than ever before to the continued well-being of the
    Nation.
    Our national security and well-being depend in large measure on
    the education of Americans to fulfill their responsibilities in a free
    society. President Washington recognized this need when he wrote:
    The mass of citizens in these United States mean well, and I firmly
    believe that they will always act well whenever they can obtain a right
    understanding of matters; but * * * it is not easy to accomplish this
    ’ Brown v. Board of Education, 74 Sup. Ct. 686 (1954).
    Office of Education 175
    * * * when the inventors and abettors of pernicious measures are infinitely
    more industrious in disseminating their poison than the welldisposed
    part of the community to furnish the antidote.
    These comments are especially fitting under today’s world conditions.
    They highlight the need to provide the best possible education
    for each and every American.
    President Eisenhower referred to our present needs in his State of
    the Union Message when he said: “Youth—our greatest resource—is
    being seriously neglected in a vital respect. The Nation as a whole
    is not preparing teachers or building schools fast enough to keep up
    with the increase in our population.”
    Vigorous efforts are being made by many States and local communities
    to provide better educational opportunities, but the statistics
    on present enrollment, on projected enrollment, on our classroom
    shortage, on teacher shortage, on school dropouts, and on inadequate
    education make clear the needs for prompt and constructive action.
    In facing these problems, State by State, it would seem appropriate
    to have evidence gathered and presented which would demonstrate to
    what extent and in what ways it is possible to meet the needs by combined
    use of State and local resources as presently constituted or as
    modifications might be made.
    ENROLLMENT GROWTH IS AND WILL BE GREATLY INCREASED
    One of the specific challenges facing America is the need to educate
    new millions of students. We have approximately 11 million young
    people in the 15- to 19-year-old age group; approximately 16 million
    children in the 5- to 9-year-old age group; and about 17 million youngsters
    in the group under 5 years. These rising waves in the school-age
    population are clear calls to action.
    The impact on elementary schools, high schools, and colleges is obvious.
    In the academic year 1954-55 we shall have approximately 38
    million students in school and college. Looking ahead to 1960 we
    can forecast at least 46 million enrolled at all levels of the educational
    system, provided that housing and staff facilities are available. Moreover,
    this estimate of future enrollment is a conservative one. If the
    trend for a larger percentage of 5-, 6-, and 7-year-olds to be in school
    and for a larger percentage of 16-, 17-, and 18-year-olds to stay in
    school continues, then the estimate of 46 million in 1960 will have to
    be revised upward. A rise in enrollment after 1960 is also to be
    expected in view of the larger number of family units which will
    develop in the 1960’s.
    If we are to meet the individual and collective challenge that these
    millions of young people constitute, we must provide the kind of education
    which develops in each youth the skills and insights to make him
    a productive citizen in a free republic.
    176 Department of Health, Education, and Welfare, 1954
    Chari 1.—INCREASED SCHOOL ENROLLMENT, 1930-54, AND PROJECTED ENROLLMENT,
    1954-60
    *Elementary-Kindergarten through grade 8.
    THE NEED FOR MORE PREPARED TEACHERS AND MORE BUILDINGS
    IS ACCENTED BY A BACKLOG OF DEFICIENCIES
    Past inaction complicates the task of providing necessary school
    buildings and equipment. Today we do not start “at scratch.” We
    have instead a deficit problem on our hands.
    The Office of Education’s Report of the Status Phase of the School
    Facilities Survey reveals that in September 1952, the Nation was short
    312,000 public elementary and secondary classrooms and related facilities.
    It is estimated, that for the school year 1954-55, the classroom
    deficit will be approximately 300,000. The construction rate in 1953-
    54 of approximately 55,000 classrooms a year will have to be significantly
    increased if we are to provide adequate and satisfactory school
    housing for American boys and girls.
    Maintaining an adequate supply of well-prepared teachers is one
    of our most pressing responsibilities. Unfortunately, we cannot buy
    able and devoted teachers, as we can buy classrooms.
    We shall begin the school year 1954-55 with a shortage of about
    120,000 prepared teachers for grade and high schools. A large proportion
    of that number are needed to eliminate one-half day sessions;
    the others are needed to replace those teachers having less than standaid
    ceitification which in one State is only high school graduation
    including some special “normal training.”
    Office of Education 177
    Chart 2.—PUBLIC SCHOOL CLASSROOM SHORTAGE, 1930-60
    Assuming 1954—55 rate of construction and 1952-60 estimates of need based on preliminary results of
    State school facilities survey
    THOUSANDS OF
    CLASSROOMS
    Chart 3.—ELEMENTARY TEACHER SHORTAGE, 1954-60
    We must recruit more teachers, and we must take steps to see that
    every teacher is used as effectively as possible by such means as eliminating
    one-room schools with few pupils or very small high schools;
    and keeping teachers in the profession for a longer period of time.
    In the years immediately ahead, we face increasing teaching needs
    at the high school and college levels. Unless we take steps now to
    178 Department of Health, Education, and Welfare, 1954
    develop our teacher resources we run the risk of shortchanging a whole
    generation of students and the future of our Nation.
    SHORTAGES OF TEACHERS, SCIENTISTS, NURSES, AND OTHER TRAINED
    PERSONNEL IS AGGRAVATED BY THE LOSS OF POTENTIAL
    RESOURCES
    If education had been adequately financed in the past, we should
    not now be facing the tragic wastes of manpower which arise from
    illiteracy and dropouts from school.
    We have a shortage of trained manpower in many fields; we need
    more scientists, we need more doctors and dentists, we need more
    teachers. At the same time, we need educated citizens who can
    contribute fruitfully to the complex demands a free society imposes
    on men of good will to act wisely for the common good.
    Chart 4.—INADEQUATE EDUCATION: 1950
    PERCENT Oi
    25-34 YE/
    PERCENT OF STATE POPULATION
    30
    LESS THAN
    FIVE YEARS
    OF SCHOOLING
    20
    12% TO 20%
    10 • 19% NAT. AV
    4% TO 12%
    5% NAT. AV.
    UNDER 4%
    0
    5
    STATES STATES STATES
    QUALIFICATION
    TEST
    REJECTED BY
    SELECTIVE SERVICE
    FOR FAILURE TO
    PASS ARMED FORCES
    33* 49*
    STATES
    includes the District of Columbia.
    And yet in 5 States, from 12 to 18 percent of the population between
    the ages of 25 and 34 years have fewer than 5 years of schooling.
    These people are what we call functionally illiterate. In 11 other
    States, the percentage is from 4 to 11 percent in the same age group.
    Our concern nationally about this situation is highlighted when we
    note that, in 5 States, Korean war draft rejections caused by failure
    on the Armed Forces Qualifications Test run 43, 45, 47, 48, and 58
    percent against an overall national average of 19.2 percent. This
    Office of Education 179
    constitutes an appalling national waste. It confronts all States with
    greater demands on their manpower.
    Significant progress has been made in fundamental and literacy
    education, particularly in the education of Negroes. Since 1940 the
    number of functional illiterates 25 years old and over has been reduced
    by 650,000. However, when we face the fact that there are,
    according to the 1950 census, 9.5 million functional illiterates 25 years
    old and over, we can understand the seriousness of this problem in
    terms of our need for trained manpower.
    The extent to which potential trained manpower in the Nation has
    been lost is also revealed by the school retention record of the children
    entering public school 5th grade in 1943. By the end of the 8th grade
    nearly 200 of every 1,000 in this class had left school; by the end of
    Chart 5.—SCHOOL DROP-OUTS: HISTORY OF ONE CLASS
    Rate of drop-outs per 1,000 children entering grade 5 in 1943
    the 10th grade, 200 more. About 100 dropped out in the 11th and
    12th grades. In other words, just about 500 of the 1,000 children
    who were fifth-graders in 1943 finished high school.
    Although there is a close relationship between dropouts and functional
    illiteracy, delinquency, social and economic competence, and
    military service, figures show that those who drop out of school are
    not necessarily the least able ones. We lose each year hundreds of
    thousands of able youngsters. This loss is a serious national handicap.
    National and State groups are cooperating to correct the “dropout”
    situation; progress is being made, as is indicated by more than a
    25-percent increase in the holding power through high school graduation
    since 1946. This is, however, a continuing problem which
    requires continuing attention.
    180 Department of Health, Education, and Welfare, 1954
    Our national needs for citizens trained to fulfill their civic and
    technological responsibilities indicate that we must take positive steps
    to enlarge our educational opportunities and to provide each American
    youth with the best education possible.
    The responsibility of facing and meeting these problems is that
    of our Nation as a whole. No agency, no group, no individual, nor
    any fragmentary collection of these can successfully meet the challenges
    outlined. They call for devoted and energetic action by an
    informed and enlightened citizenry. The Office of Education seeks
    to strengthen such efforts. It does so in many ways. Some of these
    are outlined in later pages of this report. Others have been mentioned
    briefly in terms of the contributions the State and White House Conferences
    can be expected to make to education, and those that legislation
    strengthening the research functions of the Office can effect.
    Under Public Law 530, a series of State and Territorial conferences
    on education were authorized, to be followed by a White House
    Conference on Education late in 1955. The preliminary conferences
    are to enable educators and interested citizens in each State to discuss
    the educational problems of their State and make recommendations
    for appropriate action at local, State, and Federal levels. An appropriation
    of $700,000 for the State conferences is to be allotted among
    the States on the basis of their respective populations, but with no
    State receiving less than $5,000. In accepting its allotment, each
    State agrees to report the findings and recommendations of its State
    conference for the use of the White House Conference.
    The White House Conference on Education, scheduled to be held
    in Washington, D. C., November 28-December 1, 1955, will be a conference
    broadly representative of educators and other interested citizens
    from all parts of the Nation. It will consider and report to the
    President on significant and pressing problems in the field of education.
    An appropriation of $200,000 for fiscal 1955 was made available
    for this Conference. The Commissioner of Education is authorized to
    accept and use funds, equipment, and facilities donated for the purposes
    of the Conference.
    The White House Conference will be planned and managed by a
    committee of citizens and educators appointed by the President as
    representative of varying political, religious, racial, educational, and
    nonschool interests. The committee operates as an independent agency
    directly responsible to the President. It is not a part of the Office
    of Education, although it is assisted by the resources of that Office.
    The committee will determine the agenda for the Conference, its
    plan of organization, and participation in Conference matters by representatives
    from the States. The committee will also be responsible
    for followup reports to the Nation at the conclusion of the Conference.
    In a letter to the State Governors, President Eisenhower indicated
    Office of Education 181
    that he viewed the Conference as an opportunity to determine what
    steps Americans can take at local, State, and national levels to insure
    the best possible education for American youth.
    A bill enacted as Public Law 531, approved July 26, 1954, authorized
    the Commissioner of Education to enter into contracts or jointly
    financed cooperative arrangements with universities and colleges and
    State educational agencies for the conduct of research, surveys, and
    demonstrations in the field of education.
    Public Law 532, approved July 26, 1954, provided for the establishment
    within the Department of Health, Education, and Welfare of
    a National Advisory Committee on Education, to supply the “advice
    of a group of representative citizens on the initiation and conduct of
    studies of problems of national concern in the field of education and
    on appropriate action as a result thereof. * * *” The Committee is
    to be composed of nine members, a majority of whom shall be other
    than professional educators. The Commissioner of Education is to
    be, ex officio, a nonvoting member of the Committee. An appropriation
    of $25,000 was made available for the expenses of the Committee
    during the fiscal year 1955. The Committee is to meet not less often
    than three times each calendar year.
    III. Services to Education in the United States
    One of the major and traditional functions of the Office of Education
    is to provide information, consultation, and advisory service
    concerning the operation of State and local school systems throughout
    the Nation.
    The major organizational units in the Office share in carrying out
    this responsibility. Highlights of these services in 1954 are in the
    sections which follow.
    A summary which attempts to highlight activities of an organization
    tends to catalog observable achievements such as publications
    issued, money disbursed, conferences held, and the like. This summary
    is typical in that respect. However, the listings that follow
    can only suggest the services rendered. The significance of these
    services lies in less tangible elements. If these publications, if this
    money, if the conferences and other activities caused citizens and
    educators to provide children with more effective, more efficient educational
    experiences they were wise activities, and publications, and
    conferences. This summary does not attempt to produce evidence of
    the value of Office activities. It points out, however, an awareness
    that activities are means to an end, not ends in themselves. It comments
    that the Office is concerned with the significance of its services
    rather than with compiling a record of documents and activities.
    182 Department of Health, Education, and Welfare, 1954
    STATE AND LOCAL SCHOOL SYSTEMS
    The vastness of the American educational enterprise (26 million
    elementary school children in 134,000 schools and 7 million secondary
    school children in 27,000 schools in 1953-54) and the long tradition
    of State and local control of education have led the Office to rely very
    heavily upon the departments of education in the various States as
    intermediate points of contact. During recent years much of the
    work of the Office has been carried on in close collaboration with the
    State departments, including many joint conferences and parallel
    activities on educational problems of common interest and concern.
    The services provided by the Office to State and local school systems
    are widely diverse and varied. Yet they are all directed at the
    common statutory objective of aiding “the people of the United
    States in the establishment and maintenance of efficient school
    systems.”
    State School Administration
    The research program in State school administration during fiscal
    1954 was focused on two major areas: (1) State educational organization,
    and (2) State educational records and reports. A series of
    studies was initiated on The State and Education, Part I of which
    it is entitled The Structure and Control of Public Education at the
    State Level. This study was designed to provide information for
    States which will embark on the task of reorganizing and revitalizing
    their State educational administration machinery in the immediate
    years ahead. This study will be printed in fiscal 1955.
    Continued progress was made in implementing The Common Core
    of State Educational Information, Handbook I, of the State Educational
    Records and Reports Series. A companion pamphlet was
    completed in cooperation with State department of education representatives
    entitled, Suggested Program for Putting Into Practice
    Handbook I, The Common Core of State Educational Information.
    In addition, the data-collection program of the Office of Education
    was revised to correspond with Handbook I beginning with the
    Biennial Survey for the school year ending in June 1954. Work was
    initiated on Handbook II, Financing Accounting for Local and State
    School Systems. Considerable basic research was conducted as a necessary
    prerequisite to this second phase of the nationwide financial
    accounting project.
    Local School Administration
    Information was collected from 16 States as part of a study involving
    intensive investigation of the reorganization programs in 16
    States where redistricting activity, involving participation by local
    Office of Education 183
    people, is currently, or has been recently, underway. Work on the
    study has involved identification and evaluation of a wide variety of
    factors influencing local people in establishing more effective school
    districts. These factors include: (1) the reorganization legislation,
    (2) State leadership and services, (3) local techniques and procedures,
    and (4) school finance provisions.
    Descriptions of the redistricting programs were prepared for six
    of the States participating in the project and were checked for completeness
    and accuracy with State department of education personnel.
    Analyses of the State-by-State descriptions are being prepared for
    each of the four areas noted above. These analyses will be used as the
    basis for developing statements of policies and procedural steps which
    should characterize a sound redistricting program.
    School Finances
    Expenditures for Education at the Midcentury was distributed near
    the end of December 1953. In this study the average expenditure
    per classroom unit was determined for 63,402 separate school districts
    in the 48 States and the outlying parts of the Nation. The median
    for the Nation was $4,391, and the medians for the low and high States
    were $1,451 for Mississippi and $7,627 for New York, respectively.
    The report provides information designed to be useful to legislators
    and educators in planning the improvement of State and local systems
    for financing the public schools.
    A supplement to Expenditures for Education at the Midcentury
    was published and distributed in March 1954. Twelve States were
    included in this supplementary study because they had separate data
    for white and Negro children.
    A study of Federal funds for education was completed during fiscal
    1954. In preparing this report on Federal funds, the Office analyzed
    data and provided descriptions of 56 different programs. Amounts
    expended and allocation procedures are given along with public law
    citations authorizing the Federal expenditures. The report was published
    as Office of Education Bulletin 1954, No. 14, and entitled,
    Federal Funds for Education, 1952-53 and 1953-54.
    Another report entitled, Public School Finance Programs of the
    United States, was issued as 1954, Misc. No. 22. It gives estimates of
    revenue for the 1953-54 school year, describes the various State funds
    allocated to local school districts, and indicates procedures by which
    boards of education obtain local taxes for public education.
    School Legislation
    At the request of the Study Commission of the National Council of
    Chief State School Officers, a comprehensive summary on The Legal
    184 Department of Health, Education, and Welfare, 1954
    Status of State Supervision Over Nonpublic Schools was prepared.
    This was used as basic data by the Commission in its workshop conference
    on that subject at the December meeting in Chicago.
    School Facilities
    During fiscal 1954 the Office published the Report of the Status
    Phase of the School Facilities Survey. Work was continued on the
    long-range planning phase of the Survey, and a report will be published
    in fiscal 1955 on the projected plans for school facilities to
    replace unsatisfactory, facilities, to relieve overcrowding, and to
    accommodate enrollment forecasts up to 1960.
    A brochure was published on Good and Bad School Plants showing
    contrasting school facilities in use throughout the country, and a
    manuscript was completed on Planning and Designing the Multipurpose
    Room in Elementary Schools. A study was started relative to
    functional facilities for the changing programs of secondary
    education.
    The Office continued throughout the year to prepare and release data
    on school building costs and estimates of school construction and to
    maintain liaison with and serve as a clearinghouse among governmental
    and nongovernmental technical agencies, school architects, and
    the educational profession.
    The study of the Functional Body Measurements of School-Age
    Children was continued in cooperation with the University of Michigan.
    A series of 55 measurements was made on a representative
    sample of 3,300 public-school children, from kindergarten through
    grade 12, in the Detroit area. From these basic measurements a total
    of 120 different functional measurements will be derived, which are
    needed for designing school furniture and equipment and for planning
    school buildings and facilities. The results of this study will be
    published in 1955.
    Elementary Education
    The Eighth Annual Conference on Elementary Education brought
    together leaders of approximately 60 lay and professional organizations
    to discuss action programs for meeting the problems of children
    of elementary school age. Completed during this year was the study
    Educating Children in Grades Seven and Eight, which describes good
    practices based on research findings concerning children of these ages.
    Begun was a study of good practices in conservation education to be
    initiated by personal visits to selected States and communities.
    This year marked the first conference held for elementary supervisors
    in large city schools. The conference discussion was centered
    Office of Education 185
    on problems such as crowed classes, shortages of teachers, half-day
    sessions, and similar current difficulties.
    Attention has been given to stimulating State and local groups to
    develop ways to encourage school attendance and to provide good
    school experiences for migrant children. This has been done in a
    number of ways. Packets of materials describing good practices
    have been sent periodically to key State and local groups. A bulletin
    was prepared jointly with the Interdepartmental Committee on Children
    and Youth which tells how to plan community programs for
    migrants. An east coast migrant project was started to develop ways
    of solving interstate problems related to the welfare of migrants.
    A conference of representatives from 10 East Coast States was held
    to develop plans for carrying on this pilot project.
    Staff members gave much time to the planning of itineraries for
    international visitors. In addition to the more than 100 persons in
    groups at the beginning of the school year, groups of approximately
    14 persons from Thailand and 25 persons from Viet-Nam were each
    given several days’ time. There was also increasing demand for
    recommendation of persons to go on assignment to missions abroad,
    to evaluate the qualifications of those who were going, to meet and
    advise persons about to leave on such missions, and to provide service
    to them through correspondence once they had arrived at their
    destination.
    Secondary Education
    Completed during the year was A Look Ahead in Secondary Education,
    the report of the Second Commission on Life Adj ustment Education
    for Youth. It reviewed efforts of States to provide education
    for all American youth with particular attention given to organizational
    procedures, publications, and studies of school holding power.
    Unsolved problems which stand in the way of universal secondary
    education were described and suggestions were made for future experimentation.
    Another publication, Teaching Rapid and Slow
    Learners in High Schools, reported adaptations made in a sample of
    800 large high schools to provide different teaching methods for fastand
    slow-learning pupils. A third publication, Factors Affecting
    the Improvement of Secondary Education, is a report of a roundtable
    discussion dealing with the important experiments and investigations
    carried on in secondary education from 1920-50.
    Published during the year were numerous publications useful to
    teachers, for example, Free and Inexpensive Aids for the Teaching
    of Mathematics ; Resources for T caching English; Selected References
    on the Supervision of Instruction; Advantages and Disadvantages
    of Junior High Schools; Materials Helpful in Character Education;
    339010—55------ 13
    186 Department of Health, Education, and Welfare, 1954
    Core Curriculum References; and Undergraduate and Graduate
    Professional Preparation in Health Education, Physical Education,
    and Recreation.
    The Education of Exceptional Children
    Progress on the nationwide study, “Qualification and Preparation
    of Teachers of Exceptional Children,” resulted in preparation for
    publication of State Certification Standards for Teachers of Exceptional
    Children and College and University Programs for the Preparation
    of Teachers of Exceptional Children.
    Visual Education
    Systematic cataloging continued of information about the motion
    pictures and filmstrips of all Government agencies which are available
    for public use in the United States. By June 30,1954, descriptive
    copy had been prepared on 4,228 such firms for 3- x 5-inch catalog
    cards being printed and issued by the Library of Congress. A special
    catalog of Government films cleared for television use was compiled
    and published in January 1954 and a directory of loan and rental
    sources of Government films was issued in the spring of 1954. Work
    was started during the latter part of the year on the preparation of an
    omnibus catalog of all Government films containing an exhaustive
    subject index and instructions for borrowing, renting, and buying
    each film. This catalog, to supersede the 1951 Office catalog, 31$5
    Government Films, will describe some 5,000 motion pictures and
    filmstrips. Publication is scheduled for 1955.
    The Visual Education Service also continued to serve as the primary
    point for the release of Government films for educational use
    and to administer the overall GSA Government contract covering the
    sale of copies of such films. At the end of the year, 2,925 films of 22
    different agencies were being sold under the GSA contract, an increase
    of 175 over the total a year ago.
    In cooperation with the audiovisual directors in State and Territorial
    departments of education, a study was started of the functions,
    organization, and services of these departments in the area of audiovisual
    education. The survey findings will be published in 1955.
    Libraries
    Completed for publication as part of the Biennial Survey of Education
    in the United States, 1950-52, was the report of the nationwide
    statistical survey of libraries in over 1,800 institutions of higher
    education for the academic year 1951-52. This project yielded data
    on library resources, use, personnel, and expenditures for the use of
    executives and governing boards of higher educational institutions,
    Office of Education 187
    librarians and students of librarianship, publishers, and others concerned
    with library administration and development.
    Manuscript was prepared on education for library service to be
    included in the forthcoming bulletin, Professional Education in the
    United States, to be issued by the Division of Higher Education.
    This provides a review of the current nationwide pattern of professional
    education for librarianship, including curriculums offered, admission
    and degree requirements, and opportunities for graduate
    study. A bulletin, School Library Standards, 1954, summarizes, by
    State, the current standards or requirements for the training of school
    librarians, for budgets, for books and periodicals, for library quarters,
    and other pertinent items.
    HIGHER EDUCATION
    Major Consultative Services
    The Office made its annual inspection of Howard University dealing
    especially with the college of liberal arts and with general university
    administration. Also, with the assistance of outside specialists in
    higher education, the Office conducted a survey of higher education
    in Arizona, dealing with all the State institutions of higher education.
    This study was conducted under the auspices of the Board of Regents
    of the University and State Colleges of Arizona.
    Conferences
    A special conference was held on “Federal Policy With Respect to
    the Granting of Academic Degrees by Federally Sponsored Institutions.”
    This Conference of 15 consultants, broadly representing educational
    administration, industrial training programs, and the scholarly
    areas of direct interest to Federal agencies, resulted in the preparation
    of recommendations for a general governmental policy with
    respect to the granting of academic degrees by Government-supported
    and operated institutions.
    A second conference, attended by 24 persons who represented nongovernmental
    groups interested in the accreditation of higher education
    institutions and the relationship of the Office of Education to this
    process, asked the Office to make two studies: (1) A study of the use
    made by State approval agencies of the Commissioner’s list of “nationally
    recognized accrediting agencies and associations”; and (2) a comprehensive
    study of the status, practices, and procedures of accreditation
    of institutions of higher education, this to be done in cooperation
    with interested groups.
    College Housing Loan Advisory Program
    The college housing program is administered by the Housing and
    Home Finance Agency, and by formal agreement the Office of Educa188
    Department of Health, Education, and Welfare, 1954
    tion advises on all educational phases of the program. Under the
    program colleges and universities submitted new applications during
    the year in the amount of $74 million. About $13 million in college
    housing bonds were purchased by private investment houses during
    1954. Of the $300 million authorized for the program, $150 million
    was released for loans through 1954. Applications are on file for
    funds in excess of $350 million.
    Publications
    (1) Higher Education, published monthly, September through
    May, which reaches a high percentage of the people in the colleges
    and universities, educational associations, and State departments who
    determine higher education policies. Copies also reach ministries
    of education and colleges and universities in other countries.
    (2) Educational Directory: Higher Education, which listed 1,851
    institutions of higher education, their principal officers, and provided
    information on the accreditation status, control, and enrollment of
    each institution.
    (3) Engineering Enrollments and Degrees, 1953, which gave the
    1953 fall enrollments in this field and the number of degrees conferred
    during the year ended June 30, 1953. The data are reported by institution,
    educational level, and branch of engineering.
    (4) A series of bulletins under the general title of General and
    Liberal Educational Content of Professional Curricula was initiated.
    Two of these bulletins were published, Pharmacy and Engineering. A
    third on Forestry was submitted for publication. Also published was
    a bulletin titled Cooperative Education in the United States.
    (5) A series of articles on education for the professions previously
    published in Higher Education and additional new articles have been
    put into book form and will be published under the title, Education for
    the Professions.
    (6) Two additional studies which have been published include one
    on the 3-2 plan of engineering education and a study of the organized
    efforts to improve the supply and utilization of specialized manpower.
    Studies in progress during the year include one on the costs students
    incur in attending college. This study involved 16,000 students in
    103 institutions. Another study is on the causes of the withdrawal of
    students from programs of instruction they undertook. This study
    involves 13,500 students who entered the freshman class in the fall of
    1950 at 161 colleges and universities. A study of the nature and extent
    of educational programs of less than bachelor’s-degree length will be
    completed during the fiscal year 1955.
    Office of Education 189
    VOCATIONAL EDUCATION
    Improvement of supervision of vocational instruction was emphasized
    in agricultural and home economics education. In the trade and
    industrial education programs special attention was given to the problems
    of providing related and supplemental vocational instruction to
    apprentices and the use of representative advisory committees.
    In distributive education the preparation of master plans of State
    program development was a principal activity.
    In home economics, assistance was given to a group of States studying
    the success and failure characteristics of home economics teachers
    and their attitudes towards children.
    Significant publications include:
    1. Thr ee-Dimensional Teaching Aids for Trade and Industrial
    Instruction.
    2. Guiding High School Students of Vocational Agriculture in
    Developing Farming Programs.
    3. Homemaking Education in Secondary Schools in the United
    States.
    INTERNATIONAL EDUCATION
    During the past year 400 teachers were brought to this country for
    training and observation of American schools. These trainees visited
    over 8,000 schools, made 12,000 speeches about their countries, visited
    in 10,000 American homes, and met or talked with over a million
    United States citizens.
    Arrangements were made for the interchange of 150 American
    teachers with an equal number of elementary and secondary school
    teachers from Austria, Australia, Belgium, Canada, France, Germany,
    Norway, and the United Kingdom. Another 121 American teachers
    were selected to teach in various other countries.
    Technical training programs were administered for approximately
    550 trainees sponsored by the Foreign Operations Administration.
    These included four high-level French teams, Directors General in
    Education from Cambodia, Haiti, and Thailand, as well as numerous
    provincial superintendents and directors. More than 100 colleges and
    universities cooperated as primary training centers.
    The Office prepared itineraries and programs for 145 leaders from
    47 countries. These included college presidents, professors, representatives
    of ministries of education, staff members of the West
    German Parliament, and specialists in a great variety of educational
    fields.
    On July 1, 1954, the Department of State transferred the responsibility
    for the leader program to the American Council on Education.
    Since these various exchange and training programs began, the
    190 Department of Health, Education, and Welfare, 1954
    Office has arranged teaching assignments or training programs for
    almost 8,000 foreign educators from 60 countries.
    The Office of Education was represented during the year in the
    delegations to meetings of five international groups: (1) The Public
    Education Conference of the International Bureau of Education and
    UNESCO; (2) the meeting of the Technical Committee of ILO on
    Salaried Workers; (3) the conference called by UNESCO to draft
    plans for an experimental project on teaching about the U. N. and
    Specialized Agencies; (4) the Caribbean Commission’s meeting of a
    special committee on education and small-scale farming, and of the
    Commission’s Research Council; and (5) the Second International
    Study Conference on the Atlantic Community of the North Atlantic
    Treaty Organization. In connection with participation in these conferences
    the Office of Education proposed reports of United States
    position or practice in the areas discussed.
    A publication, Education in Pakistan, was added to the series of
    basic studies of education in other countries. This study is based on
    data gathered in Pakistan in 1952 and supplemented through
    documentation.
    Assistance was given to colleges and universities through the
    evaluation of credentials of 2,472 students from 96 countries; service
    was supplied the Veterans Administration in the review of the level
    of instruction of 166 foreign institutions applying for approval to
    train veterans under Public Law 550.
    Approximately 1,100 textbooks and 350 curriculum materials were
    added to the Educational Materials Laboratory. This laboratory in
    addition to serving teachers in this country has special use and significance
    to the teachers who come to the United States from other
    countries.
    The Office of Education Committee on Foreign Language Teaching
    assisted in many projects concerned with foreign language instruction
    in United States schools and with the teaching of English abroad.
    Examples of such assistance are: (1) participation in a seminar on
    language and culture sponsored by the Modern Language Association
    of America, and (2) orientation of exchange teachers of foreign
    languages from abroad.
    Approximately 100 persons were recruited and nominated to the
    FOA for educational positions in technical assistance programs overseas.
    Thirty-three countries in Latin America, the Near East, Europe,
    Africa, and Far Eastern and Southern Asia are cooperating in such
    programs and make requests for specialists.
    During the year FOA delegated to the Office of Education the responsibility
    for recruitment and professional and technical support of
    staff for the Latin American area.
    Office of Education 191
    ASSISTANCE TO SCHOOLS IN FEDERALLY AFFECTED AREAS
    During 1954 new legislation (title III of Public Law 815) permitted
    school districts to claim assistance in constructing school buildings
    needed to house increases in Federal pupils occurring between June 30,
    1952, and June 30,1954. Legislation also provided school construction
    aid to needy school districts overburdened by Federal activity because
    of large numbers of pupils residing on Federal property, primarily
    Indian reservations. A total of $140 million was approved by the
    Congress in fiscal years 1954 and 1955 to finance the Federal share
    of projects approved under these two new titles.
    A supplemental appropriation of $55 million was also enacted
    during the fiscal year 1954 to be prorated among districts which had
    remaining unpaid entitlements under the previous legislation.
    More than 2,500 local districts and 21 federally operated on-base
    projects were determined to be eligible for approximately $72 million
    in Federal funds. This amount was paid on behalf of about 920,000
    pupils reported as federally connected. These pupils represent almost
    one-fifth of the enrollment in the schools which they attend;
    and the schools which they attend enroll about one-fifth of all publicschool
    children in the Nation.3
    RESEARCH AND STATISTICAL SERVICES
    The Research and Statistical Standards Section carries major responsibility
    for the basic statistical reports from the Office of Education
    in the fields of elementary, secondary, and higher education.
    The Section is also responsible for special statistical studies and reports
    on current educational problems, and for providing statistical
    information to a wide variety of persons and groups, including congressional
    committees, officials of Federal and State agencies, foreign
    ministries of education, educational and other organizations, professional
    societies, newspapers and magazines, and the general public.
    In addition, the Research and Statistical Services Section provides
    consultative and advisory services in the area of research methodology
    and statistics to other Divisions of the Office and to other governmental
    agencies (such as the National Science Foundation) ; it provides
    technical statistical services to other Divisions of the Office; and
    it serves in a liaison capacity between the Office of Education and other
    Federal statistical agencies. Following are some publications from
    the Research and Statistical Standards Section during the fiscal year:
    Statistics of Public Secondary Day Schools, 1951-52; Fall Enrollment
    in Higher Educational Institutions, 1953; Earned Degrees Conferred
    3 For a more detailed discussion of the operations of this program under Public Laws
    815 and 874 (81st Cong.), as amended and extended by Public Laws 246, 248, 731, and 732
    (83d Cong.), see Fourth Annual Report of the Commissioner of Education concerning the
    administration of Public Laws 874 and 815.
    192 Department of Health, Education, and Welfare, 1954
    by Higher Educational Institutions, 1952-53,' Current Expenditures
    per Pupil in Public School Systems in Large Cities, 1952-53; and in
    Small- and Medium-Sized Cities, 1952-53; Engineering Enrollments
    and Degrees, 1953 (with the Division of Higher Education); and
    Statistics of Special Education for Exceptional Children, 1952-53
    (with the Division of State and Local School Systems).
    Table 1.—Grants to States: Office of Education, fiscal year 1954 1
    States, Territories, and
    possessions Total
    Colleges for
    agriculture
    and the mechanic
    arts
    Cooperative
    vocational
    education
    Survey and
    school c onstruction
    Maintenance
    and operation
    of
    schools
    Total_____________$_2_0_5,7_6_1_,959 $5,051,500 $25,321,340 2 $105,265,046 $70,124,073
    Alabama_______________________ 6,354, 596 100, 541 670, 987 4,577, 918 1,005,150
    Arizona_________________________ 5,060,963 77,477 170,153 4, 222, 208 591,125
    Arkansas_______________________ 3, 514,814 89,048 491,997 2, 299, 703 634,066
    California_______________________ 30,084,059 175, 599 1,222,094 15, 536,857 13,149, 509
    Colorado_______________________ 4,672, 223 83, 218 217,420 2, 752,129 1,619,456
    Connecticut____________________ 1,925,482 90,023 255, 287 371,819 1,208,353
    Delaware_______________________ 261,724 73,173 158,654 18,042 11,855
    Florida_________________________ 4, 598, 548 97,644 393, 203 2,711,288 1,396,413
    Georgia_________________________ 8,872,654 104, 360 720,644 5, 435,386 2,612, 264
    Idaho___________________________ 1,721,424 75,872 168,583 1,001,360 475,609
    Illinois__________________________ 4,170,345 156,906 1,098,786 1, 444,264 1,470,389
    Indiana_________________________ 2,998,934 109,245 655,604 1,255,800 978,285
    Iowa____________________________ 1,607,379 96,146 555,178 662,687 293,368
    Kansas.._____ __________________ 5, 498, 760 89,006 366,810 2,371,701 2,671,243
    Kentucky______________________ 3,765,948 99,375 680,790 1,422,670
    964, 454
    1,563,113
    Louisiana_______________________ 1,997,677 96,769 491,851 444,603
    Maine__________________________ 1,057,787 79,115 154,934 393,469 430,269
    Maryland_______________________ 8, 590, 237 93,372 282, 568 6, 552,684 1,661,613
    Massachusetts__________ :_______ 1,349,269 116, 789 499,933 58,864 673,683
    Michigan_______________________ 5, 528,305 133, 559 889,109 2,930,350 1,575,287
    Minnesota______________________ 1,224, 943 99,751 571,955
    614,315
    420,915 132,322
    Mississippi______________________ 2, 551,600 91,735 1,322,185
    1,615, 407
    523,365
    Missouri________________________ 3,360,287 109, 448 695,773 939, 659
    Montana________________________ 1.069,841 75,895 154,625 636,604 202, 717
    Nebraska_______________________ 1,867,190 83, 222 287, 991 689,774 806, 203
    Nevada_________________________ 1,664,385 71,597 132,435 764,977 695,376
    New Hampshire________________ 568, 296 75,319 153,503
    927,027
    339, 474
    New Jersey_____________________ 2, 530,481 118, 233 500, 499 984, 722
    New Mexico____________________ 5,003,917 76,795 167,431 3,697,805 1,061,886
    New York______________________ 6, 257,332 217,934 1,561,705 2,462,955 2,014, 738
    North Carolina_________ ________ 4,144, 454 110, 518 958,134 1,949,731 1,126,071
    North Dakota__________________ 511,483 76,181 202, 404 84, 698 148, 200
    Ohio____________________________ 7, 298, 688 149, 269 1,109,584 3,325, 643 2, 714,192
    Oklahoma______________________ 5, 290,873 92, 278 438,879 2,075, 596
    274, 547
    2,684,120
    Oregon_________________________ 894, 549 85,176 263,375 271,451
    Pennsylvania___________________ 3, 450,529 174, 720 1,242, 328 1,012,091 1,021,390
    Rhode Island___________________ 918, 390 77, 899 111,959 165,112 563,420
    South Carolina_________________ 3, 299,902 91,118 492, 257 1,663,090 1,053,437
    South Dakota---------------------------- 983,059 76, 511 201,546 173, 338 531,664
    Tennessee______________________ 2,802, 786 102,835 715, 420 1,438,657 545,874
    Texas___________________________ 11,572,124 146, 921 1,248, 752 5,446, 642 4,729,809
    Utah___________________________ 2, 753,794 76,872 165, 983 1,800,535 710, 404
    Vermont________________________ 331,685 73, 768 158,258 45,199 54,460
    Virginia________________________ 15,150,157 103,104 643,318 9,078,078 5,325,657
    West Virginia___________________ 544, 963 90, 006 414,354 6,615 33,988
    Washington_____________________ 8, 522, 481 93, 731 362,316 4,826,126 3, 240,308
    Wisconsin_______________________ 1,150,359 104, 260 615, 079 120,338 310,682
    Wyoming_______________________ 1,257, 060 72,898 158,654 901,146 124,362
    Alaska__________________________ 1,453,362 71, 283 64,327— 1,317,752
    District of Columbia------------------ 96,162
    74,986
    96,162
    Hawaii_________________________ 2, 550,991 158,654 1,356,562 960. 789
    Puerto Rico____________________ 1,019,717 50,000 479, 789 489,928
    Virgin Islands__________________ 34,991 __ ------------- 34, 991
    1 On a checks-issued basis. Does not necessarily agree with allotments or expenditures for a given fiscal
    year.
    2 Does not include $4,950,000 paid to Housing and Home Finance.
    Food and Drug
    Administration
    Food, D>rug, and Cosmetic Act
    The Responsibilities of enforcing the Food, Drug, and Cosmetic
    Act are constantly increasing. Growth of population causes a normal
    expansion in the volume of the regulated industries. At the same
    time there is a continuing trend away from home and local production,
    toward the processed, packaged products of interstate and international
    commerce. Rapid technological advances are being made to
    meet the demand for greater volume and for the ready-to-use products
    which are replacing articles that require final preparation in the
    kitchen or local pharmacy. The increasing complexity of production
    increases the inspection task, as well as introducing more points where
    law violations may occur. Amendments enlarging the scope of the
    law have likewise brought new enforcement obligations.
    In the drug field at least half of the drugs in prominent use today
    were unknown when the Food, Drug, and Cosmetic Act was enacted.
    All of the antibiotics and all but one of the sulfonamides have achieved
    their present widespread use since 1938. Whereas 10 million dollars’
    worth of endocrines were produced in 1939, the output had grown to
    $90 million in 1952, and new products such as cortisone and ACTH had
    entered the picture. Such drugs are most effective but their potency
    can also make them harmful unless their composition and use are
    adequately controlled.
    Many classes of food on the current market have been converted
    from raw agricultural and fishery products to items ready to eat or to
    put into the pan or oven without additional preparation in the home.
    Their laborsaving and storage qualities have steadily increased the
    demand for such items to the point that revolutionary changes have
    developed in food processing plants. With this shift, the housewife
    193
    194 Department of Health, Education, and Welfare, 1954
    is increasingly entrusting her former control over the sanitation of
    processing operations and the fitness of ingredients to commercial
    plants and regulatory agencies.
    New pesticides have become available faster than scientific knowledge
    could be acquired as to how to identify their residues and measure
    their potential hazards. We are at a transition stage where much is
    to be learned about how the public may benefit from these products
    without attendant injury.
    The enforcement staff in the fiscal year 1954 was substantially the
    same in number as that in the fiscal year 1940, when the 1938 act
    became fully effective. New amendments have been enacted meanwhile
    which have added immeasurably to consumer welfare but have
    also added significantly to the responsibilities of enforcing the statute.
    The Food and Drug Administration has attempted to employ its
    limited facilities for the maximum protection of public welfare.
    Project plans were reevaluated in August 1953, after a substantial
    cut in appropriations necessitated a reduction in staff and general
    operating expenses. Health considerations were given priority—drug
    work and prevention of contamination of foods came first. Little time
    was left for violative foods that would be a burden on the consumer’s
    pocketbook, though otherwise wholesome—such as short-weight items
    and foods adulterated with inferior ingredients.
    In all of the food work, attention has been focused on the types of
    violations consumers could not detect by their own observations, and
    on inspection of conditions in factories and storage houses. Gross
    adulteration, such as visible filth or decay, has been left largely for
    detection by the consumer.
    To check the soundness of these policies and how they are being
    carried out, and to explore the possibilities of better means toward
    greater public protection, the Secretary of the Department of Health,
    Education, and Welfare recommended to Congress that a citizens’
    committee be appointed to investigate Food and Drug Administration
    operations—to be composed of consumer, industry, scientific,
    and legal representatives. The observations of such a group will be of
    inestimable value in an area affecting the welfare of the entire Nation.
    ON THE FOOD FRONT
    Potential Health Hazards
    Fish.—The first large-scale radiological examination of food ever
    carried out by the Food and Drug Administration began in March
    1954, when reports were received that tuna suspected of being radioactive
    were being landed in Japan following atomic blasts in the
    Pacific.
    Food and Drug Administration 195
    All entries of Japanese fish were checked with Geiger counters in
    a continuous, round-the-clock monitoring program set up to meet
    the emergency. Examination of every fish unloaded at the docks
    continued until early in May. This demonstrated that monitoring
    operations by the Japanese Government were effective so that during
    the remainder of the fiscal year FDA monitoring was reduced to spotchecking
    all cargoes offered for entry. These examinations of more
    than 35 million pounds of frozen tuna and 245,000 pounds of frozen
    shark were designed to prevent even the remote chance that dangerous
    fish might be received in American canneries.
    Tuna canned in Japan after the blast and offered for importation
    to the United States was also examined, and no radioactive lots were
    encountered.
    A byproduct of these precautionary radioactivity tests was the
    experience under practical field conditions that FDA inspectors and
    chemists and cooperating city health officials received in the use of
    the survey meters developed and purchased for civil defense use. As
    the work progressed, many refinements in monitoring technique were
    developed.
    Seizures.—The number of seizures to remove potentially dangerous
    foods from the market each year is small, but of such consequence to
    public health that immediate action is required.
    In volume, more than 300,000 pounds was seized because of contamination
    with poisonous or deleterious ingredients. Included were
    coffee beans accidentally contaminated with lead ore during shipment,
    soft drinks containing a quaternary ammonium compound as a preservative,
    cheese that absorbed lead from boiled linseed oil rubbed on
    the rind, canned blackeyed peas containing glass, and oats that had
    been treated with a mercurial compound for seed use and later entered
    food channels. (For actions against contaminated baby foods, see
    Products of Special Dietary Significance.)
    Foodborne Infections.—Complaints that salmonella poisoning of
    several hospital patients had been traced to brewers-type dry yeast
    were investigated, and the manufacturer voluntarily recalled a number
    of codes found to be contaminated. While use in baked products
    would normally kill salmonella organisms, a large quantity of this
    yeast is consumed without any heat treatment and its contamination
    would be particularly hazardous to elderly people and infants.
    Although any food subjected to handling by people and not subsequently
    sterilized by heat constitutes a potential medium for harmful
    bacteria, fresh crabmeat in recent years has seldom been implicated
    in outbreaks of food poisoning. Some years ago, the Food and Drug
    Administration and several State agencies began to conduct campaigns
    to improve the sanitary handling of crabmeat and the industry
    196 Department of Health, Education, and Welfare, 1954
    as a whole has become sanitation-conscious. In the summer of 1953,
    however, investigation of nine outbreaks of food poisoning implicated
    crabmeat shipped from the Southeastern Atlantic States. Sanitation
    surveys conducted in the producing areas revealed diarrhea outbreaks
    among the employees of one plant and insanitary conditions and poor
    handling practices conducive to contamination in several others.
    Twenty-two consignments of crabmeat were seized because of fecal
    pollution or production under filthy conditions, and prosecution
    actions were filed against four shippers.
    State and local agencies and the producers of the area immediately
    took action to correct the situation, and during the last 9 months of
    the fiscal year there was a marked improvement in the sanitary quality
    of the crabmeat shipped from that area.
    Pesticides.—The problem of how to protect food crops from insects
    without endangering consumers of the foods has been troublesome
    since the 1920’s when lead and arsenic compounds were the principal
    insecticides used for fruits. Lethal as these poisons were, their
    chemistry and toxic effects were well known, and a joint educational
    and regulatory campaign resulted in removal of excess residues from
    the fruit before shipment.
    A global war brought the rapid development of new pesticides,
    particularly preparations to protect the armed forces exposed to
    insect-borne diseases in the tropics. The Food and Drug Administration
    helped test the safety of such pesticides. Those found suitable
    for emergency use were released while tests for chronic toxicity were
    still under way, that is, tests to determine whether minute quantities
    consumed over a long period would cause any harmful effects.
    When the end of the war made supplies of the most effective of these
    wartime insecticides available for civilian use, they were rapidly employed
    as substitutes for the older poisons before the testing of their
    chronic toxicity could be completed. In addition, new formulations
    were rapidly developed for which chemical methods of measurement
    were required before their potential toxicity could be studied.
    The 1938 act provides formal procedures for the establishment of
    official limits to the residues of poisonous or deleterious ingredients
    that may remain on or in food, when these substances are required in
    production of the food. Public hearings are provided for the presentation
    of evidence of the need to use the substance, data on its
    toxicity, and the amounts safe to the public, with due consideration
    to all other foods that may contain the same substance.
    Data on the new insecticides were finally assembled by the Food and
    Drug Administration, various units of the Department of Agriculture,
    State agricultural schools and extension services, and various manufacturers,
    and a public hearing began in January 1950. The comFood
    and Drug Administration 197
    plexities of the entire problem prolonged the hearing, with occasional
    recesses, until September 1950. Testimony recorded totaled 9,000
    pages and nearly 1,300 exhibits.
    While this voluminous record was being reviewed preparatory to
    drafting proposed regulations, formulas for many of the pesticides
    under consideration were changed and new products were introduced
    into commercial channels.
    To correct the cumbersome method required by law for the control
    of preparations that might have a detrimental effect on public health,
    a new procedure was recommended to the Congress by the pesticide
    industry and the Food and Drug Administration. It was enacted
    in July 1954. (See Legislation.) This amendment launches a new
    era in control of foods exposed to pesticides. It gives promise of
    greater public protection in a period of rapid technological advances
    which are essential to the production of an abundant food supply at
    the lowest possible cost to consumers.
    To Keep Food Clean
    As a result of reduction in the inspection force, food factory inspections
    dropped 24 percent from the number conducted in the fiscal
    year 1953. In volume, food seized because it was filthy or decomposed
    totaled 2,544 tons. Actions against such products constituted 84 percent
    of all food seizures and prosecutions. (See Table 1, page 219.)
    Inspection operations under the factory inspection amendment described
    in the 1953 report have been largely uneventful, even in plants
    which previously had refused to permit inspection. The required
    written reports to management on insanitary conditions observed
    during inspections have in some cases been more conducive to cleanups
    than the informal comments given verbally by inspectors under the
    former procedures. This is particularly true in the case of large
    concerns with distant branches, some of which were formerly unaware
    of critical comments made to the branch management,, but now require
    the written reports to be forwarded to the parent firm.
    Inspection time is allocated each year to the various food industries
    after a careful study of how well each group is keeping unfit products
    from the market, and whether special problems have developed which
    require concentrated attention.
    The New England fishing industry, for example, has reduced the
    time between catch and freezer, with a corresponding reduction in the
    possibility for decomposition. During the same period, however, a
    new product, the fish stick, has had phenomenal growth. Frozen
    breaded foods such as these are popular especially because they reduce
    the time required for food preparation in the home, but this new type
    of product offers an opportunity for bacterial contamination and
    198 Department of Health, Education, and Welfare, 1954
    decomposition unless the industry and the Food and Drug Administration
    are continually on guard against insanitation and careless
    handling.
    The inspection time formerly given to the baking and confectionery
    industries, on the other hand, was reduced because no new problems
    had appeared and because there has been continued improvement as
    a result of industry-sponsored' sanitation programs. There were exceptions.
    One involved one of the oldest and largest manufacturers
    of chocolate products and candy, which was found to be operating a
    seriously infested factory, with resultant contamination of raw materials,
    equipment, scrap for candy reuse, and finished products
    awaiting packing. Seizures were made of finished chocolate and
    confectionery products heavily contaminated with rodent and insect
    filth. Prosecution action is under consideration.
    Fruit and vegetable canneries were given less inspection time, as
    a whole, because of industry-sponsored controls, but here, again, there
    were trouble spots. Notable among these was tomato packing. A
    second consecutive year of poor growing conditions in some areas
    led to cracked tomatoes, maggots, and rot. A number of States have
    been active in helping the growers cope with such conditions and in
    preventing the distribution of unfit products.
    The two largest fines of the year were assessed against creameries
    that had not kept up with the general sanitation progress of the
    industry as a whole. In one case, terminated with a $10,000 fine,
    the firm had been prosecuted on eight occasions for various violations
    involving dairy products. The other firm was operating with unscreened
    openings despite warnings that a serious fly problem existed.
    The buttermaker had become so calloused to the situation that he
    scooped flies from a pasteurizing vat in the presence of FDA inspectors
    and then churned the cream into butter. The firm and its president
    were fined a total of $9,500.
    The chief problem in most dairy products plants is still that of
    obtaining clean raw materials. In most areas there is a much smaller
    percentage of milk and cream which is dirty. Much of this improvement
    apparently reflects improved practices in the production and
    handling of these raw materials at the source.
    Vast quantities of dressed poultry move in interstate commerce
    from packing plants in areas throughout the country. Unlike the
    “red meats,” the slaughter and packing of poultry is not subject to
    any compulsory Government inspection. Where regular Government
    inspection exists, it is voluntary on the part of the packers and
    is rendered on a fee basis by the Department of Agriculture. The
    primary responsibility for regulatory supervision of the interstate distribution
    of dressed poultry therefore rests upon the Food and Drug
    Food and Drug Administration 199
    Administration. In cooperation with the U. S. Public Health Service,
    a thorough study is underway of means for better detecting and
    eliminating from food channels diseased or otherwise hazardous birds.
    An improved regulatory program was devised to cope better with
    problems of insanitation, filth, and decomposition.
    Inspections of terminal and country elevators storing food grains,
    and inspections of flour mills, were continued in furtherance of the
    program to insure sanitary storage of grains and manufacturing and
    handling of flour, and to reduce filth contaminations by insects,
    rodents, and birds. Cooperative educational efforts were also continued
    by providing information to trade groups and by having representatives
    of the Food and Drug Administration participate in programs
    of trade associations and industry groups.
    The 17-man Grain Sanitation Committee appointed by the Secretaries
    of Agriculture and of Health, Education, and Welfare made
    comprehensive studies and reviews of the situation and problems during
    the year. The committee submitted a report to the Secretaries
    which is now being studied.
    To correct insanitary conditions disclosed in some city produce
    markets by investigations mentioned in the 1953 report, a regulatory
    program was inaugurated. In cooperation with local health authorities,
    inspections of fresh produce markets were made in a number
    of cities where the previous investigations had revealed the existence
    of inexcusably insanitary conditions.
    Considerable progress in effecting sanitary improvements was reported.
    In one large eastern city, for instance, the active and enthusiastic
    participation of city officials was obtained and extensive
    cleanups of market areas were accomplished. Various departments
    of the city government cooperated—the police department moved in
    to keep the areas clear of the vagrant population which had contributed
    to some of the insanitary conditions, the street department to
    clean up streets and alleyways and arrange for regular maintenance,
    and various divisions of the health department to effect other improvements,
    such as facilities for adequate garbage disposal. Definite
    plans have been made to move the entire produce market from the
    present crowded dilapidated buildings to a modern sanitary terminal
    to be constructed in a better location. As a byproduct, it is estimated
    that the new terminal will save several million dollars annually by
    reducing transportation and handling charges.
    In another city in the south central part of the country, the FDA
    program for market inspection induced the local city health department
    to resume inspections of the market area and brought about immediate
    elimination of certain insanitary conditions threatening the
    contamination of large amounts of fresh produce. Similarly, in 2 or
    200 Department of Health, Education, and Welfare, 1954
    3 other cities, activity under the Federal law gave the local authorities
    the support and backing which they needed for effective and prompt
    enforcement of local statutes which are better designed to remedy
    the existing insanitary conditions than are the sanctions in the Food,
    Drug, and Cosmetic Act.
    Salvage foods.—No major disasters affecting factories or large
    quantities of stored foods occurred within the year, but there were
    numerous localized storms, floods, and transportation wrecks which
    damaged food products. With the material assistance of local agencies,
    such stocks were examined and sorted to prevent the marketing of
    unfit merchandise.
    The major problem in salvage foods was to prevent the storage by
    warehouses of unfit foods and their entry into the market. Two cases
    were particularly noteworthy. In the first, seizures were made in a
    large eastern city warehouse and a foodstore of 300,000 cans of food
    salvaged from a warehouse fire in 1951. The containers were damaged
    by pinholes and rust which resulted in the spoilage of the contents.
    They were being sold to the public “as is,” at reduced prices, with
    many of the labels so obliterated that contents were unidentifiable
    before purchase.
    The second case involved 100,000 pounds of imported chickpeas a
    canner returned to the dealer after a preliminary pack disclosed that
    insects floated to the top. The insect-ridden peas were diverted to
    coffee roasters who wanted an adulterant to cheapen coffee. A number
    of shipments of the coffee containing these chickpeas were seized
    on dual charges of insect infestation and debasement with an inferior
    ingredient. Five large seizures were made of the chickpeas in possession
    of coffee firms and suppliers in the East and Middle West.
    In another salvage case, some 1,800 gallons of choice whiskies and
    2,600 gallons of wine that had been dug out of the contaminated mud
    residues left by the 1951 Kansas City flood were seized and destroyed
    by deputy marshals. The owner had had them removed from two
    taverns to his own residence after the flood, and maintained they were
    for his personal use and were not held for sale. (See New Court
    Interpretations.) This was one of the few formal seizures resulting
    from that devastating flood, and the only one which was contested.
    Pocketbook Protection
    Less than one-third as many seizures were based wholly on economic
    charges as in the previous year. The percentage of inspection time
    devoted to violations in the swindle category was even less, for many
    of the actions were a byproduct of work done on sanitary and health
    violations.
    Among the deliberate cheats were coffee adulterated with spent
    grounds, chaff, and chickpeas; watered turkeys, oysters, and clams;
    Food and Drug Administration 201
    sorghum with added glucose; egg yolk “stretched” with nonfat dry
    milk solids; and fish misbranded with names of more expensive
    varieties.
    The FDA districts received numerous complaints from purchasing
    agents of institutions, individual consumers, local officials, and competitors,
    of substandard and misbranded foods that could not be given
    attention. A western hospital was being furnished fish which sold
    locally for 15 cents a pound below the variety specified in the order.
    A State hospital in the Middle West complained of substandard and
    short-weight canned fruits and vegetables. A coffee roaster was found
    to be making an illegal profit of $1,000 a week by distributing coffee
    2% percent short weight. Potatoes were artificially colored to simulate
    a popular red variety, and others misbranded as originating in a
    State noted for the quality of its potatoes. Strawberry ice cream
    contained no fruit product. The word “imitation” was omitted from
    labels of imitation fruit sirups. State officials w’ho had no correctional
    authority under their own law’s reported that a firm was whipping
    water into oleomargarine to lower the fat content to 77 percent instead
    of the 80 percent required by the standard. The rising price of cocoa
    beans was manifest in the increasingly deceptive packaging of candy
    bars: smaller size bars were packaged in wrappers appearing to hold
    the former quantity. The price of cocoa beans also led some manufacturers
    to substitute vegetable fat for chocolate fat in coatings.
    Seafood Inspection Service
    Shrimp processors and oyster canners wrho meet Government requirements
    for sanitation and controls may apply voluntarily for
    Government seafood inspection service, which is supported entirely
    by fees paid by the participating packers. Ten shrimp packers
    processed 16,267,556 pounds of whole shrimp and 267,383 pounds of
    headless shrimp under continuous Federal inspection. Most of the
    pack was canned. Six of these firms also canned 67,091 cases of
    oysters under inspection.
    Uniform regulations were effective at the beginning of the year covering
    all forms of processed shrimp and providing for collection of
    fees based on the amount of raw shrimp received instead of on the
    yield of the finished product.
    PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE
    New regulations for the labeling of foods offered for use in lowsodium
    diets are discussed under Regulation-Making Activities. The
    need for such labeling, highlighted by trade publicity on the hearing
    and subsequent order, caused many manufacturers to change to the
    new labeling without waiting for the effective date in September. A
    339010—55------ 14
    202 Department of Health, Education, and Welfare, 1954
    regulatory program has been planned to give wide coverage to the
    labeling and accurate measurement of sodium content of such foods
    after the new regulations go into effect.
    An announcement in the Federal Register for February 10 gave
    formal recognition to the fact that folic acid and vitamin Bi2 are
    vitamins that are essential for man. Prior to that time the labels
    for foods making special representations for these two vitamins were
    required by the dietary food regulations to carry a statement that the
    need for these vitamins in human nutrition had not be established.
    Five recalls of foods for special dietary use were required because
    it was discovered after distribution that three were causing illness
    and two were materially below the labeled vitamin content.
    Those causing illnesses were all infant foods. The 1953 report
    contained a preliminary note on the occurrence of convulsions in
    infants receiving a prepared food formulated as a substitute for
    mothers’ milk. The investigation was complete last year, but not
    before reports had been received of more than 130 stricken infants.
    The firm, after its first recall, had replaced stocks with the formula
    that had been used satisfactorily in the past. When additional cases
    of convulsions were reported, it undertook a second recall and replaced
    all of the baby food with one to which vitamin B0 had been added.
    No cases of illness were found in an FDA survey made in January
    or February, and none has been reported since adoption of the new
    formula.
    An acute vitamin deficiency disease that had not previously been
    known to occur in man was brought to light in the course of this investigation.
    The symptoms did not help physicians to establish the
    cause since they had no previous knowledge of the disease. Suspicion
    was directed to vitamin B6 deficiency as the possible cause, by an
    FDA biochemist who had observed the same symptoms in baby rats
    many years earlier. Administration of this vitamin to stricken babies
    promptly cured the convulsions.
    The second recall also involved a preparation used in formulas for
    bottle feeding of babies. It was a spray-dried soya product which
    was contaminated with salmonella organisms, and like the dried egg
    yolk recalled in the previous year, was identified as the source of
    salmonella poisoning of some of the babies who consumed it.
    It is of primary importance that such powder-type preparations,
    which now have a ready market because of their convenience, be clean,
    free from harmful contaminants, and adequate in nutritive value as
    complete formulas for very young babies. During the year all factories
    preparing dried powder or flake products intended for infant
    feeding were given a comprehensive inspection for sanitation. A
    program has been planned for thorough study of the ingredients used
    Food and Drug Administration 203
    and of manufacturing processes which might affect their wholesomeness.
    The third infant food recalled was a strained chicken soup found
    to contain organisms believed to be responsible for digestive disturbances
    suffered by a number of infants. The contamination
    apparently came from well water on the factory premises. It was
    not used directly in foods, but apparently wThen it was used for cooling
    the hot cans some leaked in through faulty seams.
    Fourteen seizures were based on unwarranted therapeutic claims
    for vitamin and mineral preparations.
    DRUGS AND DEVICES
    Clinical Surveys of Drug Reactions
    Two surveys of nationwide scope were made on patient reactions
    possibly caused by antibiotic drugs. The first related to the incidence
    of certain blood disorders that might have a possible drug or chemical
    relationship. Inspectors and other field personnel interviewed physicians
    in every major city in the country and obtained 1,448 case
    reports giving known exposure to preparations under investigation.
    These cases were critically reviewed by FDA physicians and antibiotics
    experts and their conclusions were published in the June 1954
    issue of the journal “Antibiotics and Chemotherapy.”
    The second survey was concerned with a serious and often fatal
    response sometimes caused by antibotic drugs, particularly penicillin—
    “anaphylactoid reactions.” Up to the time the survey was published,
    very few reports had appeared in the medical literature. This investigation
    showed that the incidence of serious reactions to penicillin
    injections, while low, was nevertheless higher than would be anticipated
    from a study of published reports alone, and might be increasing
    with more extensive use of this drug.
    Another investigation confirmed the safety of 5-percent boric acid
    talc as dusting powder for babies. Many mothers had become alarmed
    as a result of widespread publicity to the effect that the use of ordinary
    borated talcum powders on infants frequently resulted in serious
    injury. Although the Food and Drug Administration did not know
    of evidence incriminating borated dusting powders as a cause of
    injury to babies, a comprehensive investigation was made. It included
    animal and chemical studies; a review of medical literature; evaluation
    of clinical studies by experts in this field; and a questionnaire
    survey of dermatologists, pediatricians, and physicians who had reported
    adverse reactions to boric acid of any type.
    This evidence was considered from the standpoint used in the
    evaluation of new drugs, except that data in this case were available
    on mass use of the product by the public over a long period of years.
    204 Department of Health, Education, and Welfare, 1954
    No evidence was found to indicate that talcum powder containing
    5-percent boric acid is unsafe to use as a dusting powder for infants.
    Recalls
    When a manufacturer reports that a defective drug is on the market
    or the Food and Drug Administration discovers it through its own
    activities, confirmed by a prompt check of samples, every effort is
    made to remove the product from use in the shortest possible time. If
    adequate coding and distribution records are available, the firm can
    retrieve all stocks from the market with FDA monitoring to ascertain
    that the recall is thorough. When the product is capable of endangering
    users, specified groups, such as physicians and hospitals, are
    warned.
    Thirty-two drug recalls were monitored by the Food and Drug Administration
    within the year, 15 of which were voluntarily undertaken
    by the manufacturers. Twelve involved antibiotics which were
    not certified as required, or were substandard or mislabeled. Four
    were new drugs marketed before their safety had been established.
    Four bore names that would confuse them with other products; at
    least one serious incident resulted from one of these when a 5-percent
    concentration intended for topical application was injected instead
    of the 1-percent injection solution, which was similarly packaged.
    Although the 5-percent solution was labeled “For Topical Use Only,”
    this legend was not prominent enough to serve as a warning.
    Other defects were nonsterility in injection drugs, low potency, decomposition,
    failure of tablets to disintegrate, a labeling mixup, and
    contamination with glass particles. There were no drug recalls in
    1954 requiring press and radio warnings against use of dangerous
    items in possession of the general public.
    Federal Court Actions
    Prescription Drug Sales.—Illegal sales of prescription drugs were
    charged in 131 of the 152 drug and device prosecutions instituted. In
    the previous year there were 115 out of a total of 150. The increase is
    attributed to the larger number of complaints FDA received, rather
    than a greater laxity on the part of pharmacists; most members of
    the pharmacy profession refuse to sell dangerous drugs without the
    authorization of a physician. Public consciousness as to the impact
    of promiscuous sales of dangerous drugs on community welfare is
    steadily growing.
    “Pep pills” have been definitely implicated as being used by kidnapers,
    counterfeiters, and other criminals to remove inhibitions
    against antisocial practices. They have also been contributing to
    Food and Drug Administration 205
    highway accidents by stimulating drivers to keep on despite fatigue.
    In cooperation with organizations promoting highway safety, FDA is
    seeking to warn drivers against use of such stimulants.
    The problem of detecting illegal sources of dangerous drugs becomes
    increasingly complex. Often they are peddled through channels not
    authorized to dispense prescription drugs. In 1954 such drugs were
    found in a luggage and jewelry store, a general store, in “flophouses,”
    and in the possession of “pushers” in bars and on the street. Some of
    the manufacturers of these drugs, which are of undisputed usefulness
    under suitable medical supervision, have cooperated with FDA in
    identifying their products. Skillful imitations of nationally distributed
    brands are creating a problem along such lines, however.
    Penalties assessed for illegal sales or refills included 7 jail sentences
    of from 3 months to 1 year required to be served, 20 suspended jail
    sentences, and fines ranging from $1 to $7,000. The latter included
    $6,000 against the pharmacy and $1,000 against one of the partners
    who was the pharmacist. This case was presented to the court soon
    after barbiturates were found in the wreckage of a private plane in
    which the pilot and three others lost their lives after an erratic takeoff.
    Investigation of the drugs found in the plane showed they had been
    secured as an unauthorized refill from this store. FDA already had
    the firm’s sales practice under observation because of complaints that
    sales were made to known addicts.
    While some States do not have laws permitting actions against unauthorized
    sales, or do not provide any enforcement manpower, a few
    have been active in this field. There is an increasing tendency on the
    part of State boards of pharmacy to revoke or suspend licenses of
    persons convicted of violating their own or Federal laws governing
    prescription drug sales.
    Adulterated or Misbranded Drugs and Devices.—Of the remaining
    21 drug and device prosecutions filed, 4 were based on shipments of
    substandard drugs and one on a product that became contaminated
    while being held for sale. All of the other violations involved false
    and misleading claims in labeling or products whose labeling did not
    bear adequate directions for use in conditions for which they were
    recommended by the vendors.
    Herb and vitamin preparations were most numerous among the
    products the Government charged the defendants to be promoting
    falsely. Three mail-order promoters of sex “rejuvenators” were
    enjoined from further shipments. One was distributing a potent
    hormone product which would injure the user if used as directed;
    it failed to bear the prescription legend. The other two products
    were combinations of inert glandular substances and vitamins labeled
    with grossly misleading claims.
    206 Department of Health, Education, and Welfare, 1954
    One of these injunctions halted an elaborate scheme to sell the
    drug as a “miracle” product imported from Germany. Prospective
    customers received a sales letter on a Frankfurt-am-Main letterhead,
    prepared in California and sent to the London “sales office” for mailing
    to the United States. Included were an envelope and order blank
    addressed to the California “sole distributor.” Actually, all foreign
    addresses were false, and impressive pictures of the “German manufacturer”
    featured on the literature and bottle labels had been posed
    by a professional model in Los Angeles.
    Another injunction restrained shipments of a liquid garlic preparation
    promoted for tuberculosis, hypertension, typhoid, colitis, and
    other disease conditions requiring rational medical treatment. Also
    restrained from further shipment was a product represented as a
    stomach and duodenal ulcer treatment, conditions for which selfmedication
    is not safe: delay or improper treatment may result in
    hemorrhages or malignancy. The enjoined preparation was a yellow
    ointment composed of petrolatum, salt, honey, and antacids. An
    injunction order also was granted to prevent further shipments of
    pharmaceuticals from a factory without production controls.
    Two devices were the subject of injunction actions in March 1954.
    The first was to restrain further shipments of 13 electrical devices
    misbranded with therapeutic and diagnostic claims. The court’s
    decree also banned interstate shipment of “blood specimen carriers”
    for use in the diagnostic machine maintained in the firm’s headquarters
    office. The parent “foundation” sold a blood diagnostic
    service based on the theory that any ailment can be diagnosed by
    examining a dried blood spot on sterile paper. Practitioners who
    mailed in the blood spots received, for a fee, a diagnosis blank filled
    in with diseases each patient was supposed to have, their location in
    the body, and the recommended dial settings for the various treatment
    devices the foundation sold. FDA inspectors found the diagnostic
    machine incapable of distinguishing the blood of man and animal,
    or of the living from the dead. Laboratory tests of the treatment
    devices showed them worthless for any therapeutic use, whereas the
    foundation recommended them for use in anemia, angina pectoris,
    cancer, coronary thrombosis, ulcers, etc. The foundation decided not
    to contest the Government’s charges and consented to the decree, but
    still has the opportunity of having the case tried on its merits.
    The devices involved in the second action did not depend upon electricity
    for their “curative” powers, but upon “orgone energy” accumulated
    from the atmosphere and stored in insulated boxes. “Accumulators,”
    “shooter boxes,” “funnels,” and “blankets” were sold for use
    in cancer and other serious conditions to practitioners and private
    patients. The promoter, stating that neither the Food and Drug
    Food and Drug Administration 207
    Administration nor the court were capable of understanding the principles
    of “basic natural law” on which the powers of these devices were
    based, did not appear in court to defend his devices. Also banned
    from shipment were books, pamphlets, and other promotional materials
    claiming the existence and therapeutic powers of “orgone energy.”
    Many devices formerly distributed by both firms are still in the
    possession of practitioners. After the injunction orders were signed,
    the Food and Drug Administration undertook to alert State medical
    boards, chapters of the American Cancer Society, and other affected
    groups concerning these court cases.
    The second decree ordered the defendants to recall all “orgone energy”
    devices currently rented to out-of-State practitioners and
    patients. A group of practitioners has requested a stay of this order,
    claiming that it would adversely affect their practice. After the close
    of the fiscal year the court denied the petition and an appeal from
    this decision is pending.
    Sixteen criminal prosecution cases terminated in the courts were
    based on drugs that failed to meet the standard of composition or
    purity claimed for them. Fines ranged from $50 to $3,200, the latter
    assessed against a firm and one of its officers for the shipment of adhesive
    bandages that were not sterile. Suspended jail sentences and
    fines were imposed on the owner and operator of an oxygen company
    for furnishing a hospital a cylinder of carbon dioxide labeled
    “oxygen.” A patient died during the administration of the mislabeled
    gas. As a result of this incident, the firm is no longer in the
    medicinal gas business.
    In 9 other drug actions and in 3 device cases terminated within
    the year, the defendants pleaded or were found guilty of misbranding
    their products with unwarranted therapeutic claims, or of making
    promotional claims without giving buyers adequate labeling directions
    as to how to use the product. The highest fine in this group was $2,000
    levied against a firm claiming that its violet ray devices would relieve
    all pain and congestion, stimulate the circulation, restore vigor and
    youth, ensure a clear complexion, prevent baldness, and be effective
    for numerous disorders.
    Many of the products involved in these actions promised to improve
    the physical well-being of the user, often by emphasis on symptoms
    that might be indicative of serious disorders. Some made definite
    claims for the cure or successful treatment of such specific conditions
    as diabetes, cancer, deep-seated infections (including venereal diseases),
    epilepsy, heart trouble, and kidney and liver malfunctions.
    Of the 218 drugs and devices seized, approximately 25 percent failed
    to meet the labeled standard of composition or were contaminated by
    impurities. The remainder were misbranded with extravagant medical
    claims in labeling, or in collateral promotion.
    208 Department of Health, Education, and Welfare, 1954
    Among the multiple seizure campaigns undertaken during the year,
    the most far reaching was against an antacid preparation, the labeling
    of which was interpreted in newspaper advertising as a treatment for
    stomach ulcers. After it was established through a contested seizure
    action that the product was not effective for such purposes and the
    labeling failed to show how the product should be used in treating
    ulcers, the manufacturer continued his advertising campaign. Fortyfour
    additional seizures resulted.
    Another multiple seizure activity was undertaken against a vitamin
    preparation promoted with claims for the treatment of deafness. Included
    in the seizures were several tons of collateral literature misbranding
    the products. In volume it resembled the results of a scrap
    paper drive.
    An epidemic of alfalfa seed mixtures recommended for treatment
    of arthritis, rheumatism, and related ailments brought other seizures.
    One firm destroyed its advertising and misbranding literature and
    went out of business. Another lost a substantial amount of its finished
    product and is attempting to devise labeling that will comply with the
    act. A third, having lost its stocks by seizure, took them out under
    bond and sold them to a feed mill.
    New Drugs
    New-drug applications submitted during the year numbered 432.
    Of these, and those under study at the close of the previous fiscal year,
    326 were allowed to become effective—226 drugs for human use and
    100 for veterinary use.
    Evaluation of the manufacturer’s evidence of safety often does not
    end with the initial marketing of the drug. Up to this time the
    preparation has been produced in small quantities and restricted to the
    use of investigators qualified to perform the scientific testing necessary
    to establish its safety. If it is widely accepted by the medical profession,
    a whole series of supplemental applications may be submitted as
    a result of expansion and improvement of manufacturing facilities
    and experience in widespread use which may require labeling changes.
    In the fiscal year, 441 supplemental applications went into effect.
    Among the significant products given consideration during the year
    were preparations intended for use in the treatment of leukemia; for
    motion sickness; for nausea and vomiting; for the symptomatic treatment
    of Parkinson’s disease; for cholangiography and cholecystography
    ; long-acting estrogens and androgens; antispasmodics; various
    products for hypertension; an antiepileptic; a preparation for use as
    a diuretic in congestive heart failure; an anticoagulant injection; a
    local anesthetic; a compound for lead and other heavy metal poisoning
    ; a preparation for use in hypotensive surgery; a treatment for cerFood
    and Drug Administration 209
    tain systemic mycotic infections; and a drug for prevention of attacks
    of angina pectoris.
    COSMETICS AND COLORS
    Analysis of 55 cosmetic samples investigated following reports of
    injury to users, did not disclose any preparations of dangerous or
    faulty composition requiring regulatory actions or recalls. Even
    though a cosmetic may have caused dermatitis or other difficulty in
    isolated individuals, if it is used safely by the public as a whole under
    ordinary conditions, it complies with the safety requirements of the
    law.A criminal action terminated in September resulted in an $850 fine
    assessed against the manufacturers who gave a false guaranty that an
    eyelash dye and a hormone product complied with the requirements of
    the Food, Drug, and Cosmetic Act. The lash dye contained a noncertified
    coal-tar color.
    Some cosmetic preparations, such as articles bearing misleading
    claims for the prevention or cure of baldness, were seized under the
    drug provisions of the act.
    CERTIFICATION SERVICES
    Coal-Tar Colors.—All coal-tar colors used in foods, drugs, and cosmetics
    (except hair dyes) must be from batches certified by FDA. In
    1954, 4,185 batches, representing 4,665,945 pounds, were certified, and
    29 batches, representing 18,910 pounds, were rejected.
    Insulin.—The statute provides for predistribution testing and certification
    of insulin and certain antibiotic drugs that cannot be controlled
    adequately under usual regulatory procedures. Examination
    of 296 samples resulted in the certification of 46 materials for use in
    making batches of insulin-containing drugs and of 70 batches of insulin,
    68 of protamine zinc insulin, 46 of globin zinc insulin, and 65 of
    NPH insulin. One trial mixture of NPH insulin was refused approval
    because it did not meet the requirements of established tests.
    Antibiotics.—Tetracycline, a new, broad-spectrum antibiotic derived
    from chlortetracycline (Aureomycin), was added to the certifiable
    antibiotics list in November 1953. Bacitracin ointments, penicillin
    troches, and buffered crystalline penicillin were removed from
    the list in December because it was determined that certification was
    no longer necessary to ensure safety and efficacy of use.
    Examinations of 20,135 batches of penicillin, dihydrostreptomycin,
    tetracycline, bacitracin, chlortetracycline, streptomycin, and chloramphenicol
    resulted in certification of 20,025. The remaining 110 batches
    were rejected for certification for failure to meet the following standards:
    Potency (39), sterility (37), moisture (19), pyrogens (10),
    210 Department of Health, Education, and Welfare, 1954
    toxicity (2), packaging (1), syringeability (1), and residual streptomycin
    in dihydrostreptomycin (1). In addition, manufacturers recalled
    47 batches from the market because they had become subpotent
    or otherwise defective. Seven of the drug seizures involved 16 batches
    of antibiotics that were uncertified, of low potency, or misbranded
    with false and misleading therapeutic claims.
    CHANGES IN THE LAW AND REGULATIONS
    Legislation
    The last report discussed two bills that were pending at the end of
    the fiscal year but enacted before adjournment of the first session of
    the 83d Congress. Public Law 217 gave specific authority for factory
    inspection. The second, Public Law 201, amended the certification
    provisions to substitute the generic name “chlortetracycline” for the
    trade name “Aureomycin.”
    On April 15,1954, the procedure prescribed by the Food, Drug, and
    Cosmetic Act for the promulgation of food standards was amended.
    The amendment, Public Law 335, was sponsored by the Food, Drug,
    and Cosmetic Law Section of the New York State Bar Association,
    and was endorsed by food manufacturers and the Secretary.
    Under the new provisions, any interested person may file a petition
    proposing the issuance, amendment, or repeal of food standards. If
    the petition establishes reasonable grounds for the action sought, the
    proposal is published in the Federal Register and all interested persons
    are invited to comment. Proposals may similarly be initiated by
    the Department. After this, the Secretary publishes an order which
    becomes effective without hearing unless someone who would be adversely
    affected files objections and requests a public hearing.
    When a hearing is held, procedure follows that provided before the
    amendment, except that only the points of the proposal singled out by
    the objections filed will be covered. This procedure should result in
    a more expeditious handling of most proposals dealing with food
    standards.
    An amendment, Public Law 518, to provide new procedures for the
    setting of safety limits for pesticidal residues in or on raw agricultural
    commodities, was passed by the House in April 1954 and was
    finally enacted on July 18, 1954. It provides for a determination by
    the Secretary of Agriculture of whether the pesticide is useful in the
    production of food crops, and the promulgation by the Secretary of
    Health, Education, and Welfare of safe tolerances for residues retained
    by the foods, after the review of toxicity tests conducted by the
    manufacturers, and such other investigations as may be in the public
    interest. Proposals for tolerances may be reviewed by an impartial
    committee of scientific experts, at the request of anyone affected by
    Food and Drug Administration 211
    the proposed limitation, or of the Secretary if such review is deemed
    desirable.
    Congress stipulated that these activities should be supported by fees
    paid by those requesting official tolerances for new pesticides, or by
    those who, by filing objections, require further consideration through
    either review by the committee of experts or public hearings. The
    procedures for establishing tolerances became operative on passage
    of the amendment.
    Two bills passed by Congress toward the end of the second session
    were not approved by the President. S. 2033, to control the sale
    and serving of foreign-produced trout, was disapproved because the
    Tariff Act and the Food, Drug, and Cosmetic Act already provide
    for necessary labeling of imported products, and the restaurant provisions
    would be too costly to enforce, discriminatory and oppressive
    against foreign trade, and invade the field of local regulation and
    enforcement.
    The second was H. R. 9728, a recodification of the acts enforced by
    the Food and Drug Administration, and certain food and drug laws
    enforced by the Departments of Agriculture and Treasury. The
    President, in a memorandum of disapproval, pointed out substantive
    changes that might seriously affect the administration of the Food,
    Drug, and Cosmetic Act, which “should not be placed in the statute
    books without extending to the responsible enforcing agency, the
    great industries affected, and the consumer public, the full opportunities
    for hearing and discussion afforded by the usual operation of
    the legislative process * *
    He pointed out that the most important substantive change was
    to so restrict multiple seizure powers that there would be the possibility
    of fraud and material deception continuing unabated until the
    validity of the labeling involved is definitely settled by the courts.
    He also took exception to the subjecting all of the Food and Drug
    Administration’s “activities” to the Administrative Procedure Act.
    This would be an extension of that act beyond the Food and Drug
    Administration’s rule making and adjudication practices to which
    it already applies.
    Regulation-Making Activities
    The last two reports discuss investigations of the manner and
    accuracy of labeling of low-sodium foods, which are used in the management
    of certain heart conditions. The general confusion found
    in terminology and declaration of sodium content led to the formulation
    of regulations providing that products purporting to have a
    low-sodium content bear label declaration of the sodium present in
    terms of milligrams per 100 grams of food, and, in addition, a statement
    of milligrams of sodium in an average serving.
    212 Department of Health, Education, and Welfare, 1954
    At a public hearing in December 1953, the proposed regulation was
    supported by representatives of the American Heart Association, the
    National Heart Institute, and the American Dietetic Association, and
    packers of such foods did not object. The regulations were promulgated
    by the Secretary on June 25,1954, to become effective September
    29. They should enable physicians, dietitians, and patients to
    calculate sodium intake more accurately.
    Shortly after enactment of the Food, Drug, and Cosmetic Act, a
    list of coal-tar colors was established, after public hearings, as meeting
    the law’s requirements that they be harmless and suitable for use
    in food. Toxicological reevaluation of some of these colors, through
    oral toxicity studies completed recently, gave evidence not available
    when the original hearings were held, that three colors are capable
    of serious injury to animals on long-time use in small concentrations,
    although these concentrations are greater than those ordinarily found
    in food. A hearing was held in January 1954 to amend the regulations,
    to remove these three colors—FD&C Red No. 32 and FD&C
    Orange Nos. 1 and 2—from the certifiable list. The record of the hearing
    and the attendant briefs were still under consideration at the close
    of the fiscal year.
    Food Standards.—Food standards operations were curtailed because
    of the decrease in funds available. (See also Scientific
    Investigations.)
    A hearing was held on a proposal by the Pacific Coast Oyster
    Growers Association to amend the standards for raw Pacific oysters
    with respect to the terms used for different sizes. The final order,
    issued by the Secretary, adopted the proposal of the association.
    Standards were also amended to remove the flavoring coumarin,
    as an optional ingredient in several chocolate products. The proposal
    was initiated by the Secretary after manufacturers reported
    that recent pharmacological investigations had shown it to be toxic
    to animals.
    The first proposal, published under the simplified standards procedure
    described earlier in this chapter, was to amend the standards
    for tomato catsup to make corn sirup an optional ingredient without
    declaration of its presence on the label. The petition was filed by
    the National Canners Association and a notice of proposed rule making
    w’as published by the Secretary on May 11 inviting comment. The
    matter was pending at the close of the fiscal year.
    NEW COURT INTERPRETATIONS
    The Supreme Court did not review any cases under the Federal
    Food, Drug, and Cosmetic Act during the fiscal year 1954. It denied
    certiorari in one case in which a cancer clinic under injunction petitioned
    the Supreme Court to review the decision of the United States
    Food and Drug Administration 213
    Court of Appeals for the Fifth Circuit denying the clinic permission
    to intervene in a mandamus proceeding.
    A district court, in assessing trial costs in a contested seizure action
    against the claimant, limited mileage costs for Government witnesses
    to 100 miles from the place of trial, following what it deemed to be
    the Federal Rules of Civil Procedure. The Government appealed,
    and the United States Court of Appeals for the Tenth Circuit vacated
    the judgment of the lower court, holding that the Food, Drug, and
    Cosmetic Act empowered the lower court to issue subpenas, and it
    was within its discretion to determine whether the attendance of
    witnesses from points beyond 100 miles was necessary to establish the
    Government’s case. It remanded the case to the trial court to permit
    it to use its discretion in assessing the costs.
    Last year’s report mentioned the Supreme Court’s affirmation of a
    decision of the Court of Appeals for the Ninth Circuit that the act
    does not require manufacturers to permit inspections. Thereupon, a
    number of defendants in prosecution actions in various district courts
    throughout the country filed motions for dismissal and suppression
    of evidence obtained during inspection, claiming the acquisition of
    such evidence was illegal. Another appealed his conviction. The
    courts in deciding the motions and the appeal uniformly rejected the
    defendants’ contentions. Typical of the manner in which the courts
    resolved the issue are the two instances cited below:
    (1) The United States Court of Appeals for the Ninth Circuit sustained
    the conviction of a corporation and its president for shipping
    filthy food prepared under insanitary conditions. The court rejected
    the argument that evidence obtained during a factory inspection made
    before the factory inspection section was amended was illegal, since
    it was clear that permission to inspect had been granted by the company’s
    sales manager. The appellate court characterized defendant’s
    claim that the sales manager lacked authority to give permission as
    “in the last degree technical.”
    (2) The District Court for the District of New Jersey denied a
    motion for suppression of evidence, including Government samples
    and shipping records, obtained from the defendant during an investigation
    of his drugstore. The defendant contended the evidence had
    been obtained in violation of the fourth amendment and that he had
    earned immunity under section 703 of the act by his furnishing the
    evidence to the inspectors. In dismissing the motion, the court held
    that since the evidence was voluntarily turned over to the Government
    by the defendant, neither the fourth amendment nor section 703 of
    the act was applicable.
    The United States Court of Appeals for the Second Circuit reversed
    a lower court in its dismissal of a seizure of tomato paste. The lower
    court in its dismissal had held that proof of adulteration due to de214
    Department of Health, Education, and Welfare, 1954
    composition must also include evidence that the article is unfit for
    human consumption or deleterious. The court of appeals held that a
    showing of decomposition alone is sufficient for condemnation of the
    goods.
    The United States Court of Appeals for the Sixth Circuit reversed
    a lower court which granted a motion for summary judgment in favor
    of the Government in a seizure of canned tomatoes produced in 1951.
    The Government’s motion for summary judgment was based on the
    principle of res judicata, since in a prior injunction suit a district
    court in its findings of fact had stated that all of the claimant’s 1951
    output of canned tomatoes was adulterated. The court of appeals,
    noting the claimant’s contention that the goods under seizure were
    shipped before the injunction proceeding started and that there was
    no evidence the seized goods were packed at the same time as the goods
    involved in the injunction, held that the question of whether the
    seized tomatoes were adulterated 'would have to be tried by the district
    court and could not be settled by summary judgment.
    The District Court for the Western District of Missouri, in interpreting
    the clause in the seizure section of the act, “while held for sale
    after shipment in interstate commerce,” held that the provision is
    primarily jurisdictional and that the Government is not compelled to
    prove an actual sale or an intended sale in order to seize an article.
    The article in question was a large stock of alcoholic beverages which
    after shipment in interstate commerce had become contaminated by
    floodwaters while stored in the cellars of two taverns. After the floodwaters
    had receded the liquor was moved from the taverns to the home
    of the owner. The owner contended that having closed his tavern
    because of the imminence of the flood the liquor was not being held
    for sale when the flood struck. Later, the liquor was brought to his
    home for safekeeping and no other purpose, and was not being held
    for sale. The court rejected these contentions, holding that the closing
    of the taverns on the day of the flood, so that no sales were subsequently
    made, did not remove the liquor from the reach of the act.
    Last year’s report discussed a district judge’s refusal to issue an injunction
    decree requested by the Government to restrain a cancer clinic
    from shipping its medicines in interstate commerce. The judge, who
    then was under court of appeals mandate to issue the injunction, held
    that the Government’s proposed decree was too broad and signed an
    emasculated decree proposed by the defendant. The Court of Appeals
    for the Fifth Circuit, on appeal of the Government for a stay and
    reversal of this virtually useless decree, found the decree to be in direct
    conflict with its mandate. In so holding, the court of appeals said of
    the judge’s actions, “Instead, however, of signing the fGovernment’s]
    order as presented, he added to it language which had the effect of
    emasculating, if not of completely nullifying the mandate. * * *
    Food and Drug Administration 215
    Thus reasserting the correctness of his judgment, which this court had
    reversed, and the incorrectness of our judgment reversing it, the respondent
    [the judge] instead of confessing error in not accepting and
    giving effect in his decree to the judgment of reversal, defends the
    reinstatement of his own judgment. * * * This he may not do.”
    Thereafter the judge signed the decree proposed by the Government.
    The cancer clinic appealed again to the appellate court to dismiss this
    decree, but the appeal was denied.
    SCIENTIFIC INVESTIGATIONS
    Food and Drug professional employees specialize in one or more
    of a variety of basic sciences required to evaluate and test the products
    subject to the act, such as chemistry, biochemistry, medicine, bacteriology,
    microscopy, pharmacology, pathology, physics, pharmacy, and
    sanitary engineering. All of their research and scientific studies are
    devoted to investigations directly applicable to regulatory activities
    and the certification services rendered.
    The regulated industries are continuously devising new products
    and new processing methods. Seldom can these be anticipated—
    therefore, enforcement tools are characteristically a step behind commercial
    practices. It is a responsibility of regulatory agencies to
    keep this step short enough to be within reach of any situation which
    develops that requires public protection by immediate action or longrange
    precautionary measures.
    Studies of practicable methods for the detection and measurement
    of pesticide residues on foods and their toxicity and fate in the animal
    body are continuing. Chemical studies are progressing in the Washington
    and field laboratories. To facilitate the testing of large numbers
    of food samples for insecticides, a biological technique has been
    adapted and is being improved for sorting out contaminated samples
    from those not affected. It is based upon the occurrence of toxic
    symptoms in goldfish when a steam distillate from the suspected food
    is added to the water containing the fish.
    In the study of the toxicity of food additives, flavoring agents were
    long neglected because they had been in use for many years, many were
    of natural origin, and relatively low concentrations were used. Such
    studies were in their early stages when commercial investigations disclosed
    the toxicity of coumarin, mentioned in the 1953 report. Some
    20 chemical compounds, representative of the various classes used in
    flavors, are being studied for possible toxic properties.
    Another investigation of possible contamination of food with chemical
    agents covered a number of anticorrosives added to boiler water
    for steam lines used for food processing. Steam from these lines is
    often passed directly into cooking kettles. Pharmacological studies
    on three anticorrosive compounds showed that one did not retard
    216 Department of Health, Education, and Welfare, 1954
    growth of experimental animals or affect their vital organs, the second
    retarded growth but produced no pathological changes, and the third
    retarded growth at high concentrations in the diet but not in low and
    led to changes in the small intestines and adjacent lymph nodes.
    Although the food that comes in contact with these anticorrosives is
    customarily prepared for local consumption and the anticorrosives do
    not come under the jurisdiction of the act, the use of those found toxic
    was discouraged.
    The available analytical methods for detecting certain chemical
    warfare gases were adapted into practical rapid tests for measuring
    the safety of foodstuffs exposed to enemy attack on civilians. Key field
    chemists were instructed on use of the tests, and special equipment
    and materials needed to apply them were distributed to all field
    laboratories.
    Another civil defense activity was to draw plans to test the effect
    of atomic explosion upon foodstuffs. The test will be conducted in
    the fiscal year 1955, in cooperation with the Federal Civil Defense
    Administration, the U. S. Department of Agriculture, and several
    groups representing the food processing industry. Tests on a representative
    group of drugs were conducted in the fall of 1953 by exposure
    at varying distances from an atomic-bomb explosion. The
    drugs were tested for deterioration, and a report submitted to the
    Atomic Energy Commission.
    Drug investigations comprise safety studies and new or improved
    methods of testing by bioassay and chemical analysis. When they
    can be devised, chemical tests are the most practicable for regulatory
    purposes, since they are ordinarily less costly of time and materials
    and can be employed in the district laboratories throughout the country.
    FDA bioassays are limited to the pharmacology and nutrition
    laboratories at staff headquarters in Washington.
    A total of 189 samples of various antibiotics, comprising all of the
    formulations now available in various dosage forms, were studied to
    determine the rate and extent of absorption into the circulation after
    administration. The new antibiotic, tetracycline, and the newer dosage
    forms of older wicle-spectrum antibiotics were given particular
    attention as to evidences of toxicity and other undesirable side effects,
    as well as efficacy. These studies included one requested by the United
    Nations of an injectable penicillin preparation to ascertain compliance
    with specifications.
    The announcement that 5-percent boric acid dusting powders for
    infants were found safe was discussed in the “Drugs and Devices”
    chapter. Tests on borated preparations were continued to study the
    absorption and excretion of various concentrations when applied to
    untact and damaged skin.
    Food and Drug Administration 217
    Among the drug assay methods improved was that for basopressin,
    a pituitary hormone used in the treatment of excessive production of
    urine.
    The absence of a simple assay of adrenocorticotropic hormone
    (ACTH) continues to present a problem. A method was developed
    to assay cortisone and hydrocortisone, based on their color formation
    with isonicotinic acid hydrazide. An observation of hydrocortisone
    in the blood of guinea pigs injected with ACTH indicates a promising
    new approach to the problem.
    A chemical procedure for the estimation of four of the chief steroid
    hormones in adrenal cortex extracts brought results in good agreement
    with those obtained by bioassay.
    Other drug analytical studies completed brought: The identification
    of all currently used antibiotics; a procedure for the detection and
    estimation of norepinephrine in epinephrine preparations; and a new
    rapid technique for separating the constituents of mixtures, such as
    phenobarbital, aspirin, phenacetin, and caffeine tablets, elixir of
    strychnine and quinine, tablets combining various sulfonamides,
    estrogens in oil, and combinations of barbiturates.
    In the field of therapeutic devices, a plan was devised for the field
    testing of calibrated ultrasonic devices, which were permitted in interstate
    commerce to qualified practitioners. Factory inspections were
    undertaken of all manufacturers of radon and radium seeds. Other
    activities on therapeutic devices are noted in the chapter “Drugs and
    Devices.”
    Investigational studies in the field of bacteriology included work
    toward the development of improved methods for the isolation of
    salmonella organisms, on staphylococcus food poisoning, on bacterial
    spoilage of shell eggs, and the bacteriology of frozen precooked poultry
    products.
    Microanalytical studies on foods included methods for the identification
    of types of insect infestation by microscopic study of the insect
    parts, and the improvement of methods for the extraction of filth
    contaminants from food by the use of surface-active and complexing
    agents.
    In the chemical analysis of food for decomposition a study of tuna,
    initiated several years ago, was in its final stages as the year closed.
    Experts can evaluate the condition of mo§t other fish by the odor
    of the canned product, but the steaming process of cooking tuna,
    before canning, drives off the odors normally accompanying spoilage.
    The newly devised method permits detection of the end products of
    decomposition by chemical analysis. Such methods were improved
    during the year to include other fishery, dairy, and egg products.
    339010—55------ 15
    218 Department of Health, Education, and Welfare, 1954
    Paper chromatographic techniques for the identification of dyes,
    pesticidal residues, and vitamin C components were developed and
    published. _ Work is continuing on the application of the new rapid
    chromatographic technique to pharmaceuticals.
    Laboratory work connected with the formulation of food standards
    was severely restricted for financial reasons. No new studies were
    undertaken but programs in which substantial investment had already
    been made were continued. Among these were studies to develop
    standards of identity for two new types of cheese, a standard of fill
    of container for grated cheese, and standards of identity and quality
    for frozen peas and asparagus. An objective test for measuring
    fibrousness in frozen asparagus was developed. Other investigations
    included fill of container for canned pineapple, canned peaches, and
    canned tuna.
    Enforcement of Other Acts
    A record total of 124,700,472 pounds of tea was examined under
    the Tea Importation Act. This contrasts with totals of approximately
    102 million in the fiscal year 1953 and 83 million in 1952. The
    increase was apparently due in part to the high price of coffee.
    Rejections for failure to measure up to the standards set by the
    U. S. Board of Tea Experts totaled 96,839 pounds, or 0.07 percent.
    Two rejections were appealed to the U. S. Board of Tea Appeals,
    which upheld the decision of the FDA examiner.
    A sodium hydroxide preparation for clogged drains and a hydrochloride
    bowl cleaner were seized for failure to comply with the
    labeling provisions of the Caustic Poison Act.
    No permits were issued for importations of milk from Canada
    under the Import Milk Act, and no violations of the Filled Milk Act
    were encountered.
    Enforcement Statistics
    The seizure actions shown in table 3 are usually terminated before
    the end of the year, except for a few in which court contests are
    pending. In some cases, criminal prosecutions and injunctions instituted
    in one fiscal year are not actually terminated in Federal court
    until the following year or even later. The number of samples on
    which actions are based always exceeds the number of actions. A
    variety of articles may be seized in a single shipment, while criminal
    actions are usually based on a number of counts and each count usually
    represents a single shipment.
    Food and Drug Administration 219
    In the 280 criminal actions terminated (or terminated for some
    defendants) in the Federal courts during 1954, the fines paid, or
    assessed in cases pending on appeal, totaled $209,604. The heaviest
    fine in a single case was $10,000. In 70 actions the fines were $1,000
    or more. Jail sentences were imposed in 33 cases involving 43 individual
    defendants. The sentences ranged from 4 hours to 5 years,
    and averaged 8 months and 24 days. Twelve individuals were required
    to serve the imposed sentences, and for 31 individuals the jail
    sentences were suspended, on condition that violative practices be
    discontinued.
    Records of actions terminated in the Federal courts were published
    in 1,522 notices of judgment issued during the year.
    Table 1.—Actions on foods during the fiscal year 1954
    Projects Seizures
    Criminal
    prosecutions
    instituted
    Injunction
    petitions
    Total________________________________________________________ 2
    Beverages and beverage materials__________________________________
    Bakery and macaroni products_____________________________________
    Cereals and grain products:
    Human use____________________________________________________
    Animal use____________________________________________________
    Chocolate, confectionery, and other sugar products_________________
    Dairy products:
    Butter_________________________________________________________
    Cheese and other dairy products_______________________________
    Eggs and egg products_____________________________________________
    Flavors, spices, condiments_________________________________ ______
    Fruits and fruit products___________________________________________
    Meat products and poultry______________________________.__________
    Nuts and nut products_____________________________________________
    Oils, fats, and oleomargarine_______________________________________
    Seafood____________________________ ____ ___________________________
    Vegetables and vegetable products_________________________________
    Miscellaneous foods and food adjuncts______________________________
    Food for special dietary uses_______________________________________
    Violative serving of oleomargarine----------------------------------------------------
    24
    21
    157
    2
    43
    22
    17
    20
    21
    105
    40
    54
    3
    148
    103
    24
    32
    1
    16
    55
    7
    12
    15
    424760
    10
    92
    1
    2
    1
    0
    00
    0
    0
    0
    0000
    010
    00
    0
    0
    Table 2.—Enforcement activities during the fiscal year 1954
    Item
    Percentage
    distribution
    of enforcement
    time
    Number of
    establishment
    inspections
    Number of
    samples
    collected
    Domestic__ ._________ 90.2 •13,827 21,455
    Foods _______ ______ 56.4 11,061 11, 227
    Drugs and devices. _________________ ______ . _____ ____ 41.1 2, 419 9' 968
    Cosmetics and colors __________________ . . _____ 2.1 ' 285 191
    Other acts and miscellaneous_________ .4 62 69
    Import.__ __________________________ -. . 9.8 0 10,922
    •Includes 10,119 factory inspections and 3,708 warehouse surveys.
    220 Department of Health, Education, and Welfare, 1954
    Table 3.—Number of samples on which criminal prosecutions and seizures
    were based and number of court actions instituted during the fiscal year
    1954
    Item
    Total Criminal prosecutions
    instituted
    Seizures accomplished
    Injunctions
    Violative requested
    samples Actions Violative
    samples Actions Violative
    samples Actions
    Total_______________2,6_3_4_ 1,333 1,057 260 1,577 1,057 16
    Foods. .. .. . __________ 1,565 946 338 108 1,227 836 2
    Drugs and devices ... __ _ 065 384 719 152 346 218 14
    Cosmetics and colors__ ______ 2 1 0 0 2 1 0
    Caustic poisons________________ 2 2 0 0 2 2 0
    Table 4.—Import inspections and detentions during the fiscal year 1954
    Item Total
    Inspected
    and refused
    entry
    Inspected
    and released
    Total.. - ________ _ ------ _____ ____ 25,105 4,459 20,646
    Foods______ ______ _________ _____ _______ __ __ 21,936
    3,007
    162
    3,154
    1,271
    34
    18,782
    1,736
    128
    Drugs and devices __ ___________________ .. _________
    Cosmetics, colors, and miscellaneous___________________________
    Office of
    Vocational Rehabilitation
    A New Era in Rehabilitation
    The close of fiscal year 1954 marked the dawn of a new era in vocational
    rehabilitation. As the year drew to an end, the Congress was
    in the final stages of considering a sweeping new law to carry out the
    President’s recommendations for a greatly improved program to
    restore disabled people to productive work. The Vocational Rehabilitation
    Amendments of 1954, passed unanimously by both Houses of
    the Congress, were signed into law on August 3, 1954. Other legislation
    of vital concern to the rehabilitation program had been approved
    on July 12 when the Medical Facilities Survey and Construction Act
    of 1954 became law.
    Against the year’s backdrop of extensive preparation for strengthening
    public services for the disabled, the State-Federal program
    rehabilitated nearly 56,000 disabled men and women. Most of these
    individuals are now regularly employed with incomes adequate for
    self-support. An estimated 11,000 of them were receiving public
    assistance either at the time of acceptance for services or during their
    rehabilitation. State agencies for vocational rehabilitation reported
    that greater emphasis on serving the severely disabled, together with
    higher costs of medical and other services purchased for those who
    were rehabilitated, account for the decline of 9 percent from last year’s
    total of 61,000 in the number restored to useful work.
    The immediate goal set by the President for the State-Federal
    vocational rehabilitation program calls for a progressive expansion
    of services over the next 5 years. The ultimate aim is to rehabilitate
    those persons who, by reason of illness, injury, or congenital causes,
    come to need vocational rehabilitation each year. Many thousands
    of handicapped persons will be brought to the attention of State voca-
    221
    222 Department of Health, Education, and Welfare, 1954
    tional rehabilitation agencies as a byproduct of the operation of the
    1954 Social Security Act amendment to preserve the rights to old-age
    and survivors insurance benefits during disability. Achievement of
    the goals contemplated in the new legislation will require greatly
    increased financial support for the program by the Federal Government
    and by the States.
    THE NEW VOCATIONAL REHABILITATION LAW
    The Vocational Rehabilitation Amendments of 1954 provide for
    continuation of the existing State-Federal program, with certain basic
    changes and additions which are summarized under the headings
    which follow.
    New Grant System
    The act provides for a three-part grant structure consisting of
    grants for the support of basic vocational rehabilitation services,
    grants for extension and improvement of these services, and grants
    for special projects.
    Support grants will be allotted to the States on the basis of population
    weighted by per capita income. The law provides for maximum
    and minimum allotments through an allotment formula similar to
    that embodied in the Medical Facilities Survey and Construction Act,
    which authorizes Federal aid for the construction of hospitals, rehabilitation
    facilities, and other medical facilities. Application of the
    formula will result in establishing both a minimum and maximum
    increase in Federal funds each year to all States as compared with
    1954, provided that the Federal appropriation for support grants
    each year exceeds $23 million.
    Extension and improvement grants will be allotted to the States on
    the basis of population, with provision for a minimum allotment of
    $5,000 or such other sum as the Congress may specify in making appropriations.
    This type of grant will comprise funds to be used for
    extending and improving rehabilitation services incorporated in the
    State plan. A Federal share of 75 percent is authorized for each
    State, limited to 3 years for any one project.
    Special project grants include :
    (1) Grants to States and public or other nonprofit organizations
    and agencies for paying part of the cost of projects for research,
    demonstrations, training and traineeships, and projects for the establishment
    of special facilities and services which hold promise of
    making a substantial contribution to the solution of problems in vocational
    rehabilitation that are common to several States.
    (2) Grants for 1955 and 1956 to aid in a substantial nationwide
    expansion of rehabilitation programs in the States. Public Law 565
    does not specify any rate at which grant recipients must match
    Office of Vocational Rehabilitation 223
    Federal funds, but appropriation language, subsequently enacted,
    does require that the Federal share of a grant not exceed two-thirds
    of the total.
    Those States which have separate agencies serving the blind are
    given complete latitude in dividing the allotments between the agencies
    serving the blind and those serving the sighted disabled, except for
    that portion of their support grants which constitute their base allotments.
    This will be divided as the 1954 allotment was divided. Separate
    Federal shares for matching the base allotment will be used
    until the new matching provisions are fully in force in 1963.
    The amounts authorized for grants in the law are $30 million for
    1955, $45 million for 1956, $55 million for 1957, $65 million for 1958,
    and such sums as the Congress may determine for each succeeding year.
    The amount for each type of grant is to be specified in the annual
    appropriation act, except that the first $23 million of the aggregate
    appropriation will be reserved for basic support grants.
    Expansion of Types of Services
    The new law continues the entire range of rehabilitation services
    now authorized (see p. 227), and provides for some services that
    are new. The new features include authority for Federal participation
    in expanding, remodelling, or altering existing buildings to render
    them suitable for use as public or nonprofit facilities for rehabilitation
    of the severely disabled, or for sheltered workshops for training and
    employment of the severely disabled. Under the new law, Federal
    funds may be used to provide initial equipment and—in the case of rehabilitation
    facilities—to provide the staff during the first year of
    operation. This feature of the new law will supplement provisions
    for construction of rehabilitation facilities under the Medical Facilities
    Survey and Construction Act of 1954.
    Training Professional Personnel
    The shortage of trained personnel to work with the disabled constitutes
    one of the most serious problems in rehabilitation. To meet
    this problem, the new law authorizes Federal participation in the
    training of professional personnel in the varied specialized skills
    demanded in this field. Specific provision has been made for teaching
    grants and traineeships.
    State and Local Administration
    The law relaxes previous requirements that responsibility for administering
    the program must be borne by State boards of vocational
    education. Henceforth, the States may, at their own option, either
    continue their rehabilitation programs under their boards of vocational
    education or place them under separate agencies concerned
    primarily with rehabilitation.
    224 Department of Health, Education, and Welfare, 1954
    In each State which has a separate agency serving the blind, this
    agency henceforth may function as the sole State agency responsible
    for administering that part of the State plan relating to rehabilitation
    of the blind.
    Further flexibility is provided under the new law in authority for
    the States to decentralize administration of their rehabilitation programs
    to county, municipal, or other governmental agencies. When
    such decentralization is effected, however, supervision will be exercised
    by the State agency for vocational rehabilitation.
    Coordination Among Public Agencies
    The new law encourages strong cooperative relationships between
    State agencies for vocational rehabilitation and all other agencies—
    such as public employment services—which provide services needed
    in the vocational rehabilitation and job placement processes.
    Within the Federal Government, coordinated planning is a requirement
    of the new law. The Secretary of Labor and the Secretary of
    Health, Education, and Welfare are directed to develop and recommend
    to appropriate State agencies policies and procedures which will
    promote the employment of disabled men and women who have received
    services under the rehabilitation program. In addition, the
    Secretaries of these two Departments are directed to work with the
    Chairman of the President’s Committee on Employment of the Physically
    Handicapped in developing methods to secure the maximum use
    of services of the Committee and its cooperating State and local
    organizations in promoting employment opportunities for the
    disabled.
    Federal Administration
    The new law continues, with even greater emphasis, the responsibilities
    of the Department of Health, Education, and Welfare for the
    exercise of leadership in the rehabilitation program. The Department
    is required to make studies, investigations, demonstrations, and reports
    on various aspects of the needs and abilities of handicapped people;
    to conduct demonstrations of new rehabilitation techniques and
    methods; to provide technical assistance to the States; to disseminate
    public information regarding the program; and otherwise to promote
    the cause of rehabilitation and employment of disabled people.
    Amendments to the Randolph-Sheppard Act
    The new legislation also strengthens the program of licensing the
    blind to operate vending stands in Federal buildings. Amendments
    to the Randolph-Sheppard Act of 1936 extend provisions of that act
    Office of Vocational Rehabilitation 225
    to Federal property as well as Federal buildings, and give preference
    for the establishment of vending stands to licensed blind vending-stand
    operators. These amendments require heads of Federal agencies in
    control of Federal property, after consultation with the Secretary of
    Health, Education, and Welfare and with the approval of the President,
    to prescribe regulations designed to assure such preference. The
    assignment of income from vending machines also must be made in a
    manner to achieve and protect this preference.
    HIGHLIGHTS OF 1954
    Total expenditures for the public rehabilitation program during
    1954 amounted to $35.4 million. Of this sum, $23 million was supplied
    by the Federal Government, and $12.4 million came from State and
    local sources.
    It is estimated that the disabled persons rehabilitated for gainful
    work during the year are now paying Federal income taxes on their
    earnings at a rate of $8.5 million a year. Thus, in less than 3 years
    they may repay the equivalent of the entire Federal investment in the
    program during 1954.
    The cost of operating the program during 1954 amounted to $634
    per individual rehabilitated.
    Of the 55,825 disabled men and women restored to productive work
    during the year, 6,500 had substantial visual defects, including 3,300
    who were blind.
    At the close of the year, 126,770 disabled men and women were receiving
    services from the 88 State agencies for vocational rehabilitation.
    About 3,000 of the men and women rehabilitated during the year
    entered professional fields such as education, medicine, and engineering.
    More than 7,000 of them are in the skilled trades, and about 5,200
    are employed in agriculture.
    The Nation has gained another 86 million man-hours a year of productive
    effort through the restoration of this year’s group of disabled
    men and women to gainful employment.
    The disabled people who were rehabilitated during the year increased
    their combined annual earnings from an estimated $15 million
    prior to their rehabilitation to an annual rate of $102 million after
    their placement in jobs.
    More than 41 percent of the $21.2 million used for the purchase
    of services for disabled beneficiaries of the program during the year
    was spent for medical services, which included examinations, treatment,
    hospital and convalescent care, and prosthetic appliances.
    226 Department of Health, Education, and Welfare, 1954
    Facilities and Services for the Disabled
    THE STATE-FEDERAL PARTNERSHIP
    Ever since the implementation of the first Vocational Rehabilitation
    Act in 1920, public services designed to preserve or restore the
    ability of disabled people to work have been provided by a partnership
    of the Federal Government with the States. Today vocational
    rehabilitation services are provided by all of the States and Territories
    except the Virgin Islands. In 35 of the States and in Hawaii,
    separate agencies serve the blind. There are 88 State agencies (including
    those in the Territories and the District of Columbia) which
    work in this field in conjunction with the Office of Vocational
    Rehabilitation.
    Each public agency for vocational rehabilitation operates its program
    in accordance with a State plan that is designed to meet as fully
    as possible the needs of the States, and to conform with Federal laws.
    The Office of Vocational Rehabilitation assists the States in developing
    and improving their plans, and in providing services to the disabled
    in conformity with these plans.
    The Vocational Rehabilitation Act Amendments of 1943 provided
    that Federal grants-in-aid made to the States for vocational rehabilitation
    would cover all of the necessary costs of administration, counseling,
    and placement, and half the costs of other services provided to
    disabled people. The result of this legislation was to increase substantially
    the Federal share of the cost of the program. By 1953, the
    Federal share had leveled off at about two-thirds.
    The law did not control the Federal proportion of the costs of the
    program, and provided for no specific limitations upon the Federal
    obligation. Federal expenditures were conditioned upon State expenditures.
    The Federal appropriations thus were “open end” appropriations,
    and the funds appropriated by the Congress for
    rehabilitation in a given year were used in part to pay Federal
    obligations predicated upon State expenditures during the preceding
    year.
    Beginning with the 1948 fiscal year, Federal funds appropriated
    for rehabilitation during any 1 year have not been sufficient to meet
    the Federal share of State expenditures defined as reimbursable by
    law. This had the effect of imposing a limit on the amount of
    Federal funds which could be granted to the States without lessening
    Federal obligations under the act.
    To correct this situation, appropriation language enacted during
    1954 in effect closed the open-end feature of Federal appropriations
    for vocational rehabilitation. The provisions under which the program
    operated during the fiscal year limited the obligation of the
    Office of Vocational Rehabilitation 227
    Federal Government to any State for that year to an amount which
    did not exceed the amount of Federal funds apportioned to the State
    for vocational rehabilitation. In this way a legal limitation was set
    upon Federal expenditures for this purpose apart from the previous
    limitation based only on State expenditures. The new Vocational
    Rehabilitation Act of 1954, described above, incorporates the concept
    of closed end appropriation on the part of the Federal Government
    and thus provides for sound fiscal policies and management.
    SPECIFIC SERVICES FOR THE DISABLED
    The services of vocational rehabilitation are designed for one major
    purpose—to preserve, develop, or restore the ability of disabled men
    and women to perform useful work. Each disabled person served by
    the program is provided with the combination of services which meets
    his or her individual need, in accordance with a rehabilitation plan
    worked out by the State agency.
    Of the services that follow, those numbered 1, 2, 8, and 9 are furnished
    without cost to the disabled individual. Training (item 5)
    generally is furnished without cost. Public funds are used for the
    others to the extent that the individual is unable to pay for them.
    The nine services are:
    (1) Medical diagnostic services to learn the nature and degree of
    disability and to help determine eligibility for services, the need for
    additional medical services, and the individual’s work capacities;
    (2) individual counsel and guidance, including psychological testing,
    to help select and attain the vocational objective; (3) medical, surgical,
    psychiatric, and hospital services to remove or reduce the disability;
    (4) artificial limbs and other prosthetic appliances; (5) training,
    including occupational training and adjustment training for the
    blind; (6) maintenance and transportation during treatment or training;
    (7) tools, equipment, or licenses if these are necessary to give the
    individual a fair start; (8) placement in a job commensurate with
    the individual’s highest physical and mental capacities; (9) follow-up
    to insure that the rehabilitated person is successful and that both he
    and the employer are satisfied.
    PHYSICAL RESTORATION
    The physical restoration of the disabled, which has been a service
    of the vocational rehabilitation program since 1943, continues to
    absorb a substantial proportion of the rehabilitation dollar. More
    than 100,000 disabled individuals served by the program received
    medical examinations for diagnosis and determination of eligibility.
    Many of these individuals also received other medical attention. The
    total expenditures during 1954 for medical services and examinations
    amounted to $8,696,010.
    228 Department of Health, Education, and Welfare, 1954
    In recent years, increasing emphasis has been placed upon the
    rehabilitation of the more severely disabled. Striking evidence of
    the fact that State agencies for vocational rehabilitation are serving
    persons with more serious disabilities than in the past is revealed
    by a comparison of the numbers hospitalized and the cost of their
    hospitalization during 1954 with corresponding figures for 1949. In
    the latter year, 13,031 persons were furnished with hospital and
    convalescent care at a total cost of $1,832,494. During the 1954 fiscal
    year, 15,411 persons were furnished with these services at a total cost
    of $2,886,842.
    It should be borne in mind that expenditures for physical restoration
    by State agencies represented only a portion of the total cost of
    this type of services to clients of the vocational rehabilitation program.
    In many instances, the clients themselves were able to bear a portion
    of the cost of medical services. In other cases, all or part of the costs
    were borne by other public or voluntary agencies.
    To promote the best possible medical services within the rehabilitation
    program and at the same time to assure the best use of funds spent
    for this purpose, the Office of Vocational Rehabilitation and associated
    State agencies benefited from consultation and guidance from
    some of the Nation’s leading medical authorities.
    The Office of Vocational Rehabilitation this year became an Advisory
    Member of the National Health Council, and participated in
    the National Health Forum considering problems of personnel
    shortage in the health field.
    Progress in Meeting Unsolved Problems
    There are many unsolved problems in vocational rehabilitation that
    relate to specific categories of disability. Some of these problems are
    largely medical; some are primarily vocational; still others are essentially
    psychological. How can epilepsy be controlled more effectively?
    What must be done to win vocational acceptance for the
    cerebral palsied? How can we more surely prevent emotional disturbance
    arising from the realities of severe physical disablement?
    Perhaps complete solutions never will be found. But as medical
    science advances, and as the combination of experience and research
    in the social sciences leads to better techniques in the physical restoration
    of the disabled, improvement is achieved. Progress comes from
    multipronged attacks launched in several sciences against common
    problems.
    Nowhere is this more evident than in the establishment of work
    classification units for evaluating as scientifically as possible the work
    capacity of persons with heart disease. By bringing together a basic
    team consisting of a physician, a social worker, and a vocational counOffice
    of Vocational Rehabilitation 229
    selor, these units exemplify the team approach to the problems of
    disability.
    Work classification units in this country increased from only 8 in
    1952 to about 30 in mid-1954. This increase is important to
    the efforts of State agencies for vocational rehabilitation in meeting
    the needs of clients disabled by heart disease. One factor in the increase
    was the 1952 agreement between the American Heart Association,
    the Public Health Service, the U. S. Employment Service, and
    the Office of Vocational Rehabilitation. Local affiliates of the American
    Heart Association have assumed maj or responsibility for organizing
    work classification units.
    In another problem area—that of mental or nervous system disability—
    State rehabilitation agencies continued their emphasis upon
    expanding their services. Approximately 3,800 individuals in this
    category were restored to useful and productive lives during the fiscal
    year.
    In spite of the growing interest on the part of State agencies in the
    possibilities offered by intensive work with persons who have psychiatric
    disabilities, small inroads have as yet been made against the problem.
    Urgent needs of State agencies to meet the challenge posed by
    this category of disability are now widely recognized. These include
    specially trained personnel who can assume responsibility for the
    work, and consulting psychiatrists readily available to all State rehabilitation
    agencies. There is also a great need for more research,
    and for a more far-reaching program of information and education
    directed toward the general public, employers, and physicians.
    Rehabilitation Centers
    Louisville, Miami, Grand Rapids, Akron, Philadelphia, Chicago,
    Ann Arbor, and Detroit joined the growing list of communities in
    which the integrated facilities of comprehensive rehabilitation centers
    are available for meeting the extensive requirements of the severely
    disabled. Most of these centers, like many of them which have been
    operating in the past, will be used as regional facilities serving severely
    disabled drawn from wide geographic areas.
    Other communities—such as Orlando, Knoxville, and Savannahhave
    begun planning for rehabilitation centers. Still others, along
    with several universities, have undertaken studies looking toward the
    eventual establishment of rehabilitation centers. This group includes
    Oakland, Mobile, and Tacoma. Surveys are underway at Leland
    Stanford University, the University of North Carolina, the University
    of South Carolina, Western Reserve University, and the University
    of Washington.
    Obstacles relating to financing, staffing, and similar requirements
    must be overcome before a center can be established. This accounts
    230 Department of Health, Education, and Welfare, 1954
    for the relatively few rehabilitation centers added each year despite
    the growing interest in them and the recognition of their worth. The
    Office of Vocational Rehabilitation has furnished extensive help to
    State vocational rehabilitation agencies, medical schools, and community
    leaders in solving practical problems encountered in the planning
    of rehabilitation facilities. Techniques and practices in this rapidly
    developing field have been widely publicized by this Office through
    professional media. Close cooperation with the National Conference
    of Rehabilitation Centers has made it possible for this Office to collect
    information on the experience of many centers in all parts of the country,
    and to make this experience available to all who are concerned
    with operating or planning rehabilitation centers.
    An encouraging trend is evident in the expansion of facilities and
    capacity among well established centers. The Kessler Institute for
    Rehabilitation, the St. Paul Rehabilitation Center, the Delaware
    Curative Workshop, and the Georgia Warm Springs Foundation are
    examples. Universities with medical schools are showing increasing
    interest in the establishment of rehabilitation centers as part of their
    programs. Development of rehabilitation facilities in teaching institutions
    ultimately will help solve the critical shortage of trained personnel—
    physicians, physical therapists, occupational therapists, vocational
    counselors, psychologists, social workers, and prevocational instructors—
    which at present is a great barrier to the creation of the
    rehabilitation centers that are needed.
    Rehabilitation centers for the blind continue to be needed in almost
    every part of the country. Only one new such center was established
    this year, located in New England. Two well-established centers, the
    Rehabilitation Center for the Adult Blind in Topeka and the Rehabilitation
    Center for the Blind in North Carolina, have found it
    necessary to expand their facilities. Very large areas of the country,
    particularly in the Western States, still have no rehabilitation centers
    for the blind available for use by State rehabilitation agencies.
    It is estimated that up to 20 percent of the disabled persons to be
    served under the expanded rehabilitation program could benefit from
    the services rendered in rehabilitation centers. In addition, many
    disabled children and elderly persons need such services but will not
    be served directly by State vocational rehabilitation agencies because
    they are not within the age brackets of employment.
    Services to the States
    STRENGTHENING THE PROGRAM
    In large measure, the quality of the services provided to disabled
    beneficiaries of the public rehabilitation program is conditioned upon
    Office of Vocational Rehabilitation 231
    the professional skill of staff members and consultants of the State
    agencies. While many of the techniques of rehabilitation are well
    established, others are subject to dynamic changes which characterize
    progress in such areas as physical restoration and psychological
    services. In such a program, it is natural that staff development is a
    function of paramount importance. It is also natural that the Office
    of Vocational Rehabilitation, charged with the responsibility of furnishing
    leadership for the program, should take a leading part in
    this effort.
    Continuing a series that was begun in 1952, four 1-week courses in
    “Rehabilitation Practice” were sponsored by the Office of Vocational
    Rehabilitation at the Institute of Physical Medicine and Rehabilitation,
    New York University-Bellevue Medical Center in New York
    City. Forty physicians and 28 other professional workers in rehabilitation
    from all parts of the country attended these courses.
    To increase understanding of possibilities for rehabilitation of individuals
    with mental illness or emotional disturbance, three 1-week
    mental health workshops were held for counselors at San Jose Teachers
    College in California, at the Menninger Foundation in Kansas,
    and at Columbia University in New York. These courses, constituting
    a follow-up of the series inaugurated in 1953, were sponsored
    jointly by the Office of Vocational Rehabilitation and the National
    Institute of Mental Health.
    This Office works closely and constantly with State rehabilitation
    agencies for increasing the effectiveness of case work supervision in
    the program, and improving standards and procedures for counseling
    the disabled and placing them in employment. The Seventh Annual
    Guidance, Training, and Placement Workshop held in Washington
    was one undertaking to assist State agencies in this field. Thirty-four
    State rehabilitation agencies, including agencies serving the blind,
    participated by sending staff members. Regional sessions designed to
    improve supervision were attended by more than 150 State and
    regional supervisors in the rehabilitation program.
    To improve the highly specialized services necessary for the rehabilitation
    of the blind, 45 counselors from 11 State agencies received
    intensive training conducted by this Office on a decentralized basis
    in 3 regions. In cooperation with the American Foundation for the
    Blind and the National Industries for the Blind, the Office of Vocational
    Rehabilitation conducted a workshop on industrial homework
    to seek better solutions to some of the problems in this area. This
    workshop was attended by 30 individuals from State rehabilitation
    agencies and from public and private agencies interested in developing
    more effective ways in providing employment to disabled persons
    who must remain in their homes. Its consultants included representatives
    from labor and industry.
    232 Department of Health, Education, and Welfare, 1954
    For the first time, a State agency—the Illinois Division of Vocational
    Rehabilitation—assumed full responsibility for organizing and
    conducting its own in-service training program for counselors for the
    blind. A member of the staff of this Office served as coordinator for
    this training program.
    In addition to formal in-service training activities, the Office of
    Vocational Rehabilitation provided extensive consultation to State
    rehabilitation agencies in such specialized areas as physical restoration,
    services for the blind, services for the deaf and hard of hearing,
    and determination of eligibility.
    To insure adequate dissemination of doctrines and useful specialized
    information, the Office of Vocational Rehabilitation published and
    distributed a variety of technical materials designed to aid rehabilitation
    personnel both in the public program and in cooperating voluntary
    and private agencies. Two of those are particularly significant.
    The technical bulletin, “Counselling for Psychological Acceptance
    of Disability,” is a companion piece to an earlier work entitled “Psychological
    Aspects of Physical Disability” published by this Office
    last year. The new publication is being used widely both within the
    State-Federal program and by workers in voluntary organizations.
    The “Counselors Guide, How To Analyze the Rehabilitation Needs
    of Blind Persons on the Farm,” was revised and reissued in printed
    form. This publication, designed to assist counselors in making satisfactory
    placements of blind persons in agricultural work, has had
    wide circulation and use by public and private agencies concerned with
    the rehabilitation and employment of the blind.
    Important help to State rehabilitation agencies in developing more
    accurate and effective standards for measuring the financial ability of
    disabled clients to pay for the cost of their rehabilitation was provided
    during the year. This area is technical and difficult; standards which
    are equitable and which take into account wide differences in individual
    circumstances are needed, and practices must be revised from
    time to time in order to reflect changing costs. A number of State
    agencies have adopted recommendations of this Office for revising
    economic need standards for the disabled individuals they serve.
    STIMULATING EMPLOYMENT OF THE HANDICAPPED
    Despite the advancement of a more enlightened public attitude toward
    the handicapped, resistance still is encountered among employers
    by the rehabilitation counselors and employment service specialists
    who must find jobs for men and women with impairments. This resistance
    stems primarily from lack of understanding of the capabilities
    of the disabled when properly prepared for employment and selecOffice
    of Vocational Rehabilitation 233
    tively placed. To overcome it, the Office of Vocational Rehabilitation
    is working with the President’s Committee on Employment of the
    Physically Handicapped, the Department of Labor’s Bureau of Employment
    Security, and the Veterans’ Administration in a continuing
    joint program of public information.
    This program reaches its peak during National Employ the Physically
    Handicapped Week in October, with the release of carefully
    compiled informational materials timed for wide use by all media of
    communications during the week’s observance. The Office of Vocational
    Rehabilitation prepares suitable materials for use in periodicals
    and over the air, and also furnishes materials to State rehabilitation
    agencies for adaptation and use locally.
    To encourage employment of qualified handicapped workers in public
    service, this Office proposed the establishment by the President’s
    Committee on Employment of the Physically Handicapped an annual
    award to public personnel officials who make outstanding contributions
    to the promotion of job opportunities for the handicapped. This
    award was incorporated in the program of the President’s Committee.
    Working through the U. S. Civil Service Commission, this Office
    provided specific information designed to encourage the employment
    of handicapped individuals—particularly those with hearing loss and
    cardiac conditions—to Federal appointing officials throughout the
    country. Technical assistance also was furnished to the Civil Service
    Commission in the validation of tests designed for use in determining
    the qualifications of blind persons for employment in Federal civil
    service positions.
    The Office of Vocational Rehabilitation in cooperation with some
    of the State rehabilitation agencies has focused the attention of the
    hospital industry on the possibilities of employing selectively placed
    disabled persons as a means of overcoming acute personnel shortages.
    Information on availability and use of handicapped workers has been
    furnished to the entire industry, and assistance has been provided to
    individual hospitals with specific personnel problems in this area. In
    cooperation with the United Mine Workers Welfare and Retirement
    Fund, three State rehabilitation agencies are developing a recruitment
    and training program to supply qualified disabled hospital workers
    for the chain of hospitals now being built by the United Mine
    Workers of America in Virginia, West Virginia, and Kentucky.
    The Vending Stand Program for the Blind
    The upward trend of gross sales and net profits accruing from the
    operation of vending stands for the blind continued into 1954 with
    establishment of another all-time record. The number of vending
    stands operated under the terms of the Randolph-Sheppard Act for
    339010—55——16
    234 Department of Health, Education, and Welfare, 1954
    the benefit of the blind increased from 1,581 to 1,599 during the year.
    Gross sales increased from $20.6 million to nearly $22 million, producing
    net earnings for 1,659 blind operators amounting to more than
    $3.6 million.
    In addition to furnishing a living for the blind men and women who
    operate these vending stands, the program provided a livelihood for
    272 blind employees and 629 sighted assistants, making totals of 1,931
    blind persons and 2,560 persons in all.
    The following table presents detailed figures on the vending stand
    program, and indicates steady progress in the 3-year period during
    which these detailed records have been kept.
    Totals for Vending Stand Program for the Blind, Fiscal Year 1954
    Number of vending stands in Federal buildings________________ 573
    Number of vending stands in non-Federal buildings_____________ 1, 026
    Total number of vending stands____________________________ 1, 599
    Number of operators employed in Federal buildings___________ 591
    Number of operators employed in non-Federal buildings________ 1, 068
    Total number of operators employed________________________ 1, 659
    Number blind assistants employed_________________________ 272
    Number sighted assistants employed_________________________ 629
    Total number employed___________________________________ 2, 560
    Net earnings of operators only_____________________________ $3, 638, 047
    Net earnings of operators and all assistants_________________ $4, 766, 988
    Gross sales______________________________________________ $21, 972, 549
    Money value of program__________________________________ $2, 903, 473
    Cost of management services_______________________________ $855, 422
    Amount of administrative fees collected by agencies for providing
    management services___________________ ._______________ $634,199
    Actual cost to State agencies in operating the program_________ $221, 223
    Number of persons employed in providing supervisory services to
    the operators:
    Full time____________________________________________ _ 149
    Part time____________________________________________ 69
    Total average net income to operators located in Federal buildings_ $2, 531
    Total average net income to operators located in non-Federal
    buildings---------------------------------------------------------------------- $2, 006
    The average net income for all operators in all locations________ $2,193
    Facts and Figures About Rehabilitants
    CHARACTERISTICS OF THE PERSONS REHABILITATED
    Virtually every type of physical impairment is found among the
    disabled men and women rehabilitated through services of the State-
    Federal rehabilitation program. Chart 1 shows the distribution of
    the persons rehabilitated during 1954 among eight broad categories of
    disability.
    Office of Vocational Rehabilitation 235
    Chart 1.— DISABILITIES AND MAJOR OCCUPATIONAL GROUPS
    Percent of rehabilitants, by types of disability at acceptance and by major occupational group at closure, fiscal year 1953
    DISABILITIES MAJOR OCCUPATIONS ’
    236 Department of Health, Education, and Welfare, 1954
    Of these, amputation and impairment together make up the orthopedically
    disabled, accounting for 41 percent of the total. About twofifths
    of the persons with orthopedic disabilities were injured in
    accidents, and about one-fifth became disabled as a result of poliomyelitis,
    arthritis, or osteomyelitis.
    Chart 1 also shows the distribution of the 1954 rehabilitants ajnong
    major vocational fields. There is no significant change in this distribution
    over the preceding fiscal year.
    More than three-fourths of those rehabilitated during the year were
    unemployed at the time they were accepted for services; 13 percent of
    the total group had never worked. About half of those rehabilitated
    were dependent on their families for their major support and, as
    pointed out earlier, an estimated one-fifth were receiving public assistance
    at the time of acceptance or during their rehabilitation.
    Nearly half had dependents, and 63 percent of those rehabilitated were
    men. The average age at the time of disablement was 24; the average
    age at the time services were begun was 34.
    Physicians, health agencies, and hospitals continued to be the most
    important sources of referrals, together accounting for 33 percent of
    those rehabilitated during 1954. Public welfare agencies constituted
    another major source; 14 percent of those rehabilitated during the year
    were referred by these agencies. (An earlier study indicated that 20
    percent of all new referrals, as distinguished from persons rehabilitated,
    were from public welfare agencies.) Eleven percent of this
    year’s rehabilitants sought help of their own volition, and 7 percent
    were referred by State Employment Service offices.
    All of the rehabilitants received counseling and guidance, and most
    of them were placed in gainful employment through services of the
    rehabilitation program. Forty-three percent of them were provided
    with physical restoration, and 31 percent were given training. Ten
    percent received both physical restoration and training.
    Many times in the past this question has been asked: Do the majority
    of disabled individuals restored to useful work through this program
    actually “stay rehabilitated?”
    The publication of a year-long study made by a member of the
    faculty of the University of Washington Graduate School of Social
    Work with the cooperation of the Washington Division of Vocational
    Rehabilitation provides an answer. While this study applies to a
    specific group of rehabilitants in the State of Washington, it is significant
    nationally because its findings are believed to reflect a pattern
    that is common throughout the program.
    The 321 persons included in the study had been rehabilitated in
    fiscal year 1951, and their employment histories since closure of their
    cases were ascertained during the Autumn of 1953. Ninety-two perOffice
    of Vocational Rehabilitation 237
    cent were found to be self-supporting as wage earners, or fulfilling the
    responsibilities of housewives. Whereas 53 percent had been receiving
    public assistance at the time they were accepted for rehabilitation or
    had been referred by welfare departments, only 3 percent were dependent
    on public assistance at the time of followup.
    THEY PROVE THAT REHABILITATION PAYS
    Careful study of the need for vocational rehabilitation, coupled
    with the high returns- paid on this investment of public funds, convinced
    committees of the House and Senate that increased support of
    the nationwide rehabilitation program could be justified even as an
    economy measure.
    Since an estimated 11,000 of the rehabilitants (during 1954) were
    receiving some form of public assistance at the time they were accepted
    for services or at some time during their rehabilitation, and
    since more than 42,000 of the 55,825 rehabilitants were not employed
    when their rehabilitation began, Federal income taxes paid by the
    group could be assumed to be very small. But on their present estimated
    annual earnings, as pointed out earlier, they are paying Federal
    income taxes at an estimated rate of $8.5 million a year. It is estimated
    that, during their working lives, they will pay in Federal
    income taxes $10 for every Federal dollar invested in their rehabilitation.
    Federal tax revenues are by no means the only financial benefits
    which accrue from rehabilitation. The increased purchasing power
    of nearly 56,000 of our people—many of them family heads—will result
    in higher tax revenues to State and local jurisdictions as well.
    Moreover, these tax revenues will continue year after year, whereas
    the cost of rehabilitating the disabled is generally a one-time
    expenditure.
    Studies indicate that, in a substantial portion of the families receiving
    public assistance, physical disability of the breadwinner is a major
    cause of the need for aid. Experience is showing that some of these
    families can be returned to a status of economic independence through
    rehabilitation services which restore the earning power of the wage
    earner. The $634 program cost for each individual rehabilitated in
    1954 is actually less than the cost of maintaining a family on public
    assistance for even 1 year.
    Help for Other Nations
    Vocational rehabilitation was a major item on the agenda of the
    International Labor Organization’s 37th conference at Geneva, and
    the Office of Vocational Rehabilitation had primary responsibility for
    238 Department of Health, Education, and Welfare, 1954
    developing the United States response to requests for information in
    this field which were the basis for conference discussions. The United
    States delegation, which included the assistant director of this Office,
    was successful in having its preamble unanimously adopted by the
    conference.
    The fact that rehabilitation of the disabled can be a constructive
    force in economic as well as social development has gained wide acceptance.
    This is evidenced by the increased number of requests
    from countries for assistance in this field under the Foreign Operations
    Administration and the United Nations Technical Assistance
    programs for economic development. The Office carried responsibility
    for programs of observation and study in this country for
    nearly 100 persons.
    This Office continued its activities in development of materials on
    rehabilitation for use of the Department of State in its work with the
    United Nations Secretariat, the Economic and Social Council, and
    the Social Commission.
    The Republic of the Philippines enacted legislation to establish
    a program for vocational rehabilitation patterned roughly after our
    own. Key personnel from the Philippines had received orientation
    in the United States under the auspices of the Office of Vocational
    Rehabilitation. In Brazil, considerable progress was reported for
    the program inaugurated some time ago in that country with the help
    of the Director of Vocational Rehabilitation from West Virginia,
    who served as a consultant for this Office. Technical help to the
    United States consultant in rehabilitation in Mexico, who was recruited
    by this Office, is being continued.
    The District of Columbia Rehabilitation Service
    The fiscal year ended June 30, 1954, was the last year in which
    the District of Columbia Rehabilitation Service operated as a part
    of the Office of Vocational Rehabilitation. Under the terms of the
    new Vocational Rehabilitation Act, this agency has been transferred
    to the District government.
    During 1954 the Rehabilitation Service restored 284 disabled men
    and women to gainful employment. Approximately 1,000 new applications
    for service were received during the year, and there were
    837 persons in process of rehabilitation at the year’s end.
    Prior to their rehabilitation, the 284 disabled men and women prepared
    for work and placed in jobs during 1954 were earning at an
    aggregate rate of less than $41,000 a year. After their rehabilitation,
    their combined earnings were estimated at more than $644,000 a year.
    Under the provisions of the Randolph-Sheppard Act, the District
    Office of Vocational Rehabilitation 239
    of Columbia Rehabilitation Service (as the authorized licensing
    agency) supervises 58 vending stands operated by blind men and
    women in Federal buildings. These vending stands, providing employment
    for 65 individuals, did a gross business of $1,871,892 during the
    year. Earnings of the operators and their employees totaled $302,698.
    The operators and their assistants are paying Federal income taxes
    at an estimated rate of more than $35,000 a year, and are paying
    District and other taxes amounting to about $5,000 a year.
    The development of a psychological testing program, as an aid to
    improving the quality of rehabilitation, exemplifies the heavy emphasis
    which is being placed on improving services to the disabled.
    This program enables counselors to gain a better insight into the
    interest, aptitudes, and achievement and personality patterns of their
    disabled clients. A total of 829 psychological tests were administered
    during the period.
    The Rehabilitation Service maintains counselors with the staffs
    of two public treatment facilities in order to ensure prompt help
    where this is needed. At the District of Columbia General Hospital,
    the counselor is a member of the Medical Evaluation Clinic. This
    makes it possible for him to participate in medical evaluations which
    uncover potential rehabilitation cases.
    At St. Elizabeths Hospital, the rehabilitation counselor took a leading
    part in the return of 31 clients with mental illness to normal community
    life. The continued hospitalization of these patients would
    have cost more than $55,000 a year.
    240 Department of Health, Education, and Welfare, 1954
    Table 1.—Number of referrals and cases, by agency, fiscal year 1954
    [Corrected to September 15, 1954]
    Agency 1
    Referrals Cases
    During fiscal year
    Remaining
    at end
    of
    year 3
    During fiscal year
    Remaining
    at end
    of
    year4
    Total
    Accepted
    for
    services
    Not
    accepted
    for
    services
    2
    Total
    active
    load
    (receiving
    services)
    Closed from active load
    Rehabilitated
    After
    rehabilitation
    plan
    initiated
    4
    Before
    rehabilitation
    plan
    initiated
    5
    United States, total—
    Alabama __ ___ -__
    232,351 78,045 72, 851 81, 455 211,222 55, 825 7, 552 21,075 126, 770
    6,331
    110
    961
    172
    4, 447
    12, 703
    1,557
    218
    2,309
    128
    935
    58
    1,358
    5,339
    3.059
    21, 785
    1,349
    70
    1,333
    34
    7,191
    2,492
    130
    3,382
    133
    2, 441
    248
    2,838
    3,934
    691
    1,229
    147
    4,073
    3, 785
    301
    6, 848
    339
    4,093
    381
    3,452
    430
    2,525
    398
    1,186
    163
    885
    121
    2,255
    18
    255
    55
    1,402
    2,981
    751
    54
    1,208
    41
    532
    34
    540
    1,867
    273
    4, 926
    145
    45
    175
    11
    4, 519
    1,326
    73
    1,144
    25
    695
    79
    779
    1,595
    147
    339
    23
    1,698
    982
    132
    2,674
    182
    935
    174
    1,485
    234
    1,226
    137
    428
    10
    542
    29
    542
    22
    274
    51
    1,498
    7, 828
    347
    20
    439
    33
    254
    20
    531
    1,597
    1,761
    6,032
    732
    15
    676
    11
    960
    546
    29
    936
    26
    841
    87
    700
    925
    204
    387
    55
    1,194
    1,344
    46
    2,085
    75
    1,383
    112
    856
    128
    826
    122
    342
    112
    129
    36
    3,534
    70
    432
    66
    1,547
    1,894
    459
    144
    662
    54
    149
    4
    287
    1,875
    1,025
    10,827
    472
    10
    482
    12
    1,712
    620
    28
    1,302
    82
    905
    82
    1,359
    1,414
    340
    503
    69
    1,181
    1,459
    123
    2, 089
    82
    1,775
    95
    1,111
    68
    473
    139
    416
    41
    214
    56
    6,783
    103
    574
    103
    3,854
    9,933
    1,564
    143
    3, 388
    142
    1,250
    67
    1,443
    5, 595
    819
    12, 551
    626
    121
    417
    31
    10,455
    4,336
    250
    2,841
    78
    1,786
    172
    2,151
    4, 775
    495
    865
    76
    4, 280
    2,559
    227
    9,164
    435
    3,209
    395
    3,532
    562
    3, 260
    428
    1,077
    62
    1,434
    95
    1,729
    13
    172
    23
    1,113
    2,076
    401
    29
    881
    44
    452
    24
    284
    1,374
    220
    3,954
    172
    24
    132
    9
    3, 568
    1,092
    40
    785
    13
    532
    31
    430
    1,202
    90
    188
    22
    881
    706
    39
    2,666
    116
    598
    77
    956
    131
    1,072
    93
    376
    5
    516
    30
    255
    6
    37
    7
    59
    1,197
    177
    6
    99
    25
    17
    10
    162
    174
    53
    358
    66
    3
    30
    1
    208
    130
    32
    93
    16
    57
    12
    44
    110
    30
    33
    4
    108
    46
    3
    813
    31
    57
    13
    70
    33
    56
    39
    24
    2
    46
    2
    413
    1
    16
    4
    329
    1, 774
    102
    6
    404
    3
    102
    6
    160
    829
    37
    1,376
    10
    8
    18
    2
    670
    502
    12
    262
    2
    171
    16
    250
    295
    52
    90
    2
    589
    185
    15
    293
    43
    84
    26
    311
    19
    500
    13
    45
    5
    21
    1
    4,386
    83
    349
    69
    2,353
    4,886
    884
    102
    2,004
    70
    679
    27
    837
    3,218
    509
    6,863
    378
    86
    237
    19
    6,009
    2,612
    166
    1,701
    47
    1,026
    113
    1,427
    3,168
    323
    554
    48
    2,702
    1,622
    170
    5,392
    245
    2, 470
    279
    2,195
    379
    1,632
    283
    632
    50
    851
    62
    Alaska____________ - - ___
    Arizona:
    General - - __
    Blind _______________
    Arkansas _ _______- __ -
    California__________________
    Colorado:
    General - - - ___
    Blind____ - -- -- -
    Connecticut:
    General - -____ -
    Blind_________________
    Delaware:
    General_________ -
    Blind _______________
    District of Columbia
    Florida:
    General _ -_ __
    Blind- _______________
    Georgia ____ __ -
    Hawaii:
    General - - _____
    Blind _ ___________
    Idaho:
    General ___ __
    Blind _______________
    Illinois _ . ______ - -
    Indiana:
    General __ -
    Blind __
    Iowa:
    General ___ ___
    Blind _______________
    Kansas:
    General _ __ ___
    Blind . ___________
    Kentucky ____________
    Louisiana:
    General _________ -
    Blind_________________
    Maine:
    General ___________
    Blind _______________
    Maryland _ ___
    Massachusetts:
    General-. -- __ _____
    Blind .- ___________
    Michigan:
    General - ______
    Blind - - __________
    Minnesota:
    General
    Blind - -. ______
    Mississippi:
    General _ _______
    Blind .. ___________
    Missouri:
    General, _ ____
    Blind
    Montana:
    General __ ________
    Blind - ___________
    Nebraska:
    General
    Blind__________________
    See footnotes at end of table.
    Office of Vocational Rehabilitation 241
    Referrals Cases
    Table 1.—Number of referrals and cases, by agency, fical year 1954—Con.
    [Corrected to September 15, 1954]
    Agency 1
    During fiscal year
    Remaining
    at end
    of
    year 3 4
    During fiscal year
    Remaining
    at end
    of
    year 6
    Total
    Accepted
    for
    services
    Not
    accepted
    for
    services
    1 2
    Total
    active
    load
    (receiving
    services)
    Closed from active load
    Rehabilitated
    After
    rehabilitation
    plan
    initiated1
    Before
    rehabilitation
    plan
    initiated
    5
    Nevada . __ ______ _____ 138 48 57 33 146 48 37 0 61
    New Hampshire: 1
    General... ... ________ 479 152 170 157 362 95 12 50 205
    Blind____ .. __ 54 30 13 11 84 13 4 16 51
    New Jersey:
    General . ____________ 2,297
    481
    922 748 627 2, 749
    510
    695 146 331 1,577
    Blind _ _ _____ _______ 195 196 90 131 15 25 339
    New Mexico:
    General... ____________ 945 239 325 381 654 217 18 21 398
    Blind________ _______ 117 36 6 75 101 20 9 1 71
    New York:
    General ._ ___________ 11,065
    934
    4,957
    318
    2,537
    205
    3, 571
    411
    13, 394
    797
    3,385
    244
    423 2, 622
    45
    6, 964
    Blind . .. ___ 59 449
    North Carolina:
    General _ _ .... 6, 253
    1,034
    3,399
    423
    1,534 1,320
    181
    7, 577
    1,525
    2,530
    294
    85 591 4,371
    Blind______________ '430 27 123 1,081
    North Dakota. _ _____ 920 189 277 454 603 209 19 37 338
    Ohio:
    General . ____ ___ . 4,068
    479
    1,401
    218
    1,091
    143
    1,576
    118
    3, 306
    735
    1,005
    164
    64 224 2,013
    Blind_________________ 40 50 481
    Oklahoma___ __ _____ 5,736 1,930 2,738 1,068 6,057 1,219 55 689 4,094
    Oregon:
    General___ ___ 4, 768
    149
    898 1,902
    54
    1,968
    k45.
    2, 448
    154
    494 68 278 1,608
    Blind_______________ . 50 29 6 18 101
    Pennsylvania:
    General __ .. ____ 13,387
    1,883
    4,407
    4, 797
    435
    5,482
    808
    3,108
    640
    10,486
    1,416
    2,883
    3,011
    192
    448 1,103
    256
    5,924
    Blind_________________ 66 902
    Puerto Rico__ ____________ 1,142 1,189 2,076 769 82 196 1,836
    Rhode Island:
    General .. ................... 716 290 250 176 912 271 55 34 552
    Blind_________ 30 29 0 1 178] 16 2 16 144
    South Carolina:
    General . ____ ___ 4, 827
    330
    1,628 1,499
    93
    1,700
    117
    4, 563
    262
    1,410 66 237 2,850
    Blind_________________ '120 94 7 21 140
    South Dakota:
    General . .. . ... 586 208 54 324 701 140 17 18 526
    Blind _______________ 108 28 58 22 60 14 3 1 42
    Tennessee:
    General __ ____ _ 4, 529
    650
    1,825
    142
    890 1,814
    379
    4, 351
    569
    1,484
    91
    120 188 2, 559
    Blind________ _______ 129 22 31 425
    Texas:
    General _____ ____ 10,107
    1,340
    1,118
    3,024
    331
    2,284
    410
    4, 799
    599
    9,694
    794
    2,091
    242
    139 925 6,539
    Blind_______________ . 23 48 481
    Utah___________________ 319 300 499 1,082 257 26 26 773
    Vermont:
    General_____ _____ .. 563 219 168 176 471 105 21 45 300
    Blind 55 20 24 11 65 14 8 4 39
    Virginia:
    General _______ .. 9,143
    210
    3,060
    82
    3, 229
    51
    2,854
    77
    6, 531
    132
    1,738
    47
    78 1,028
    3
    3,687
    Blind_____ _________ 6
    Washington:
    General . ____ ____ 5,131
    133
    1,097
    42
    1,592
    32
    2, 442
    59
    3,404
    192
    820 103 230 2,251
    Blind ____________ 26 4 29 133
    West Virginia__ ... 10,894 3,171 3, 502 4, 221 7,377 1,545 59 1,336 4,437
    Wisconsin:
    General . ... 3,129 1,212
    87
    793 1,124
    34
    4,635
    294
    1,087
    67
    168 97 3,283
    Blind__ .. . '186 65 34 8 185
    Wyoming__________________ 880 152 354 374 462 121 54 0 287
    1 In States which have 2 agencies, the agency under the State board of vocational education is designated
    as “general,” and the agency under the State commission or other agency for the blind is designated as
    “blind.”
    2 Service declined, services not needed, individual not eligible, individual needing services other than
    vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc.
    3 Eligibility for rehabilitation not determined.
    4 Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabilitation
    services but never reached the point of employment because of personal factors, illness, aggravated
    disability, etc.
    8 Closed prior to initiation of rehabilitation plan, because of indifference of individual; probable increase
    in degree of disability; loss of contact, etc.
    6 In process of rehabilitation on June 30,1954.
    242 Department of Health, Education, and Welfare, 1954
    Table 2.—Total program expenditures from Federal and State funds for vocational
    rehabilitation by State boards of vocational education, fiscal year
    1954 1
    State or Territory
    Federal and State funds Classification of
    expenditures
    Total Federal State
    Administration
    and vocational
    guidance and
    placement
    services
    Purchased
    services
    Total___________________________ $31,314,797 $19,359,926 $11,954,871 $12, 214,859 $19,099,938
    Alabama____ _____ . _____ ___ ... 935,030 555,965 379,065 348,785 586, 245
    Arizona____ __ _____ - ___ 156i 637 89, 587 67,050 53,725 102,912
    Arkansas _ __ ____ 519; 383 354,156 165,227 203,027 316; 356
    California__ .. - . ______ 2,649; 786 1,639; 864 1,009,922 1,173,295 1,476,491
    Colorado.. .. .... 201,755 129,894 7L861 97, 294 104,461
    Connecticut . . . ___ 396; 338 261;805 134', 533 178,238 218; 100
    Delaware .. . ____ ____ ___ 186', 541 117; 634 68,907 82,313 104, 228
    Florida_____________ . _____ ___ 867,908 540,348 327,560 302, 511 565,397
    Georgia.__ ___ . __ 2,500,673 1,375,435 1,125, 238 735,836 1,764,837
    Idaho___ 71,711 46; 036 25; 675 25; 336 46; 375
    Illinois_____ _________ _____ ______ 1,804,682 1,173; 496 631,186 643,178 1,161,504
    Indiana___ ' 485; 844 ' 313,337 172,507 184,488 301,356
    Iowa______ ___ _________ _____ 454; 959 251i 951 203,008 186,121 268,838
    Kansas_____ . _____ 266,367 170,442 95,925 98,362 168,005
    Kentucky.. __ ... ____ __ 219,896 137; 663 82,233 103,909 115,987
    Louisiana__ ___ 657; 593 400', 952 256,641 307, 550 350; 043
    Maine.. .__ 114; 561 73; 288 4i;273 43; 356 71,205
    Maryland 541,597 319; 759 221,838 259,659 281,938
    Massachusetts. . . ..... 403, 945 213, 598 190,347 188, 423 215,522
    Michigan.__ 1,358, 253 867; 442 490,811 553,332 804, 921
    Minnesota . ___ _ __ 399,951 246, 523 153, 428 143,392 256,559
    Mississippi__ _____ ... __ __ .. 596; 096 279; 617 316', 479 212, 536 383, 560
    Missouri ____ . ... 543,872 34i; 471 202,401 230,400 313,472
    Montana____ __ ... 179; 280 114,873 64; 407 87,314 91,966
    Nebraska _ . . _______ ____ _____ 247,318 152; 219 95,099 80,643 166,675
    Nevada___ ___ ... . __ 33,606 24,028 9,578 14,617 18, 989
    New Hampshire 62,920 39', 885 23; 035 22,863 40,057
    New Jersey ... _____ 520,354 322,957 197,397 232,003 288,351
    New Mexico.. 142; 578 85; 156 57; 422 41', 076 101,502
    New York.______ ------ __ 1,860,925 1,189; 386 671,539 847,961 1,012,964
    North Carolina ____ 937,791 533,064 404,727 264,113 673, 678
    North Dakota ... _ . __ 147; 324 86, 329 60,995 43,171 IOC 153
    Ohio__________ ... _____________ 490;730 339; 171 151,559 211,295 279,435
    Oklahoma___ _ ____________________ 754; 215 468; 720 285,495 280, 402 473,813
    Oregon.______ 364,607 252, 504 112,103 159,541 205,066
    Pennsylvania ..... 1,955; 470 1,330,960 624; 510 770, 378 1,185, 092
    Rhode Island 127,835 81,625 46, 210 48,722 79,113
    South Carolina _ - _ 616; 827 432,136 18< 691 264', 871 351,956
    South Dakota. ____ __ 105; 029 60; 497 44,532 29, 529 75; 500
    Tennessee______ . . ___ 822; 257 497; 167 325,090 293; 068 529,189
    Texas_________ ___ _ 1, 290, 204 774; 054 516,150 459,828 830,376
    Utah ... _________________ ' 140, 796 108', 254 32; 542 76,698 64,098
    Vermont__ ..... 12i; 152 76; 038 45,114 38,676 82,476
    Virginia_________ ____ ____ ___ 724; 123 440,145 283', 978 269,493 454,630
    Washington_____ _ _ __ 725; 165 434; 438 290; 727 33L 822 393,343
    West Virginia . ______ __ 818,058 491,829 326, 229 315,092 502, 966
    Wisconsin_______ __ 692; 782 435,823 256,959 269, 294 423,488
    Wyoming __ ______ _ __ _________ 114,995 80; 288 34,707 45, 704 69, 291
    Alaska___ ... ___ 64,808 39,165 25,643 26,219 38,589
    District of Columbia. . 251,763 166,763 85,000 135,259 116, 504
    Hawaii ___________ . . . 220; 406 126; 409 93', 997 69,059 151,347
    Puerto Rico__________________________ 448; 101 275,780 172; 321 131,082 317,019
    1 Based on reports from States, subject to audit.
    Office of Vocational Rehabilitation 243
    Table 3.—Total program expenditures from Federal and State funds for vocational
    rehabilitation of the blind by State commissions or agencies for the
    blind, fiscal year 1954 1
    State or Territory
    Federal and State funds Classification of
    expenditures
    Total Federal State
    Administration
    and vocational
    guidance and
    placement
    services
    Purchased
    services
    Total___________________________ $3, 586,811 $2, 401, 755 $1,185,056 $1,933,321 $1, 653,490
    Arizona_______________ ____ ____ 43,420 28, 685 14,735 22,141 21, 279
    Colorado _________.___ .. __ __ 38,190 29, 801 8,389 25,830 12, 360
    Connecticut____ ____ _________________ 42; 001 2L 397 14, 604 27,047 14, 954
    Delaware_____________________ ____ 47,937 29,622 18; 315 21,019 26, 918
    Florida_________ .. ___ . __ 267,965 168,924 99,041 158; 499 109,466
    Idaho___________ ___________________ 14; 361 12; 325 2', 036 10,289 4, 072
    Indiana_________ .. __ _________ . 47, 622 41, 424 6,198 35; 226 12,396
    Iowa____________ ____________ __ _ 23; 357 18', 479 4,878 13, 601 9,756
    Kansas_________ ___ . __ ______ 80, 597 46, 593 34,004 44,217 36,380
    Louisiana.. ___ ________________ .. 85, 648 70; 914 14, 734 65,392 20, 256
    Maine. ____ _____ _ __ __ ___ 30, 444 16,673 13, 771 21, 517 8, 927
    Massachusetts__ __________________ 50,872 34; 071 16, 801 30, 765 20,107
    Michigan________ . . .. ___ 137, 590 86; 229 5i; 361 84, 849 52, 741
    Minnesota______ . ... 132,956 62,961 69,995 75, 996 56, 960
    Mississippi . ______________ 153, 561 90', 162 63,399 83,235 70,326
    Missouri_____________ ______ 122; 386 93,189 29,197 69, 282 53,104
    Montana . . __ .. _________ 26, 861 16,848 10,013 18,165 8,696
    Nebraska_____________ ... . 50; 016 33, 283 16; 733 23,093 26, 923
    New Hampshire . ______ ____ 23,385 io; 396 12,989 12, 637 10,748
    New Jersey________ . . ___ 125,048 93; 830 31, 218 70; 844 54,204
    N ew Mexico _ _____ 29, 318 2i; 581 7,737 13,845 15,473
    New York.________ ____. .. _____ 372, 958 232, 782 140; 176 145; 529 227,429
    North Carolina________ .. __________ 317, 538 226', 263 91, 275 134,987 182, 551
    Ohio_______________ .. .. ______ 176,180 126, 258 49,922 110,005 66,175
    Oregon .. .. .. _ . ____ 57,104 37, 650 19,454 21, 724 35, 380
    Pennsylvania_____ . . _____ __ 374,309 237,367 136; 942 183, 092 191, 217
    Rhode Island.. _. ____ -__ _ ______ 30; 875 22; 992 7,883 20,183 10, 692
    South Carolina__________ . 49, 224 39, 549 9,675 35,419 13, 805
    South Dakota____ ___ . - . ___ 26; 894 16, 590 10; 304 13, 659 13, 235
    Tennessee__________ _____________ 166, 029 122,816 43, 213 81,880 84,149
    Texas________________ - ______ 204; 274 146; 537 57; 737 116, 636 87, 638
    Vermont ______ ______________ ___ 19; 793 14,961 4,832 13, 963 5,830
    Virginia_____________ _______ - - 42, 058 28,768 13, 290 15,478 26, 580
    Washington... _ _____ _ _______ 48, 608 29, 799 18,809 40, 097 8, 511
    Wisconsin. .____ _________ ____ . . 84,823 59; 622 25,201 53, 279 31, 544
    Hawaii_______________________________ 42, 609 26,414 16,195 19,901 22,708
    1 Based on reports from States, subject to audit.

    Saint Elizabeths Hospital
    The Primary responsibility of the hospital is the proper care of
    the patient. The entire organization of the institution revolves about
    him. Medical care of the patient in Saint Elizabeths Hospital is
    assigned to the three Clinical Branches and the Medicine and Surgery
    Branch, the latter including the tuberculosis service. All of the other
    activities of the hospital, such as social service, nursing, dietetics,
    construction and maintenance, are auxiliary to these four Branches.
    Division of Medical Services
    The program of psychiatric and general medical care and treatment
    of patients carried out in the various branches of this Division during
    the year is outlined below.
    CLINICAL BRANCHES
    Each Clinical Branch, comprising 2,000 or more patients, is in
    charge of a Clinical Director. The activities of these Clinical
    Branches deal primarily with the psychiatric treatment and care of
    the patient as well as the education and research activities of a clinical
    nature. These services have been maintained at an acceptable standard
    during the year, despite still growing difficulties of overcrowding and
    shortages of personnel, as previously reported.
    Problems of overcrowding have been mentioned in previous reports,
    but they are continuing and are pressing. The same may be
    said of the shortages of professional and ward personnel. The unpleasant
    fact is that the number of patients, despite all efforts to discharge
    them promptly, is growing; furthermore, the average age of
    the patients is increasing and the tendency of these patients is to
    remain in hospital longer. Although new buildings have been author245
    246 Department of Health, Education, and Welfare, 1954
    ized recently, they have been accompanied by the required destruction
    of other patient space; thus the net result has not been an increase in
    proper bed capacity of the hospital. The Geriatric Building, for
    example (in which one ward is still vacant), replaced the so-called
    semipermanent buildings which actually had a capacity of slightly
    more than the Geriatric Building.
    The proper bed capacity of the hospital at present stands at 6,276,
    there having been opened during the year one ward of 63 beds in the
    Geriatric Building which had on account of lack of personnel lain
    idle since that building was occupied. There were actually in the
    hospital on June 30,1954,7,229 patients, an excess of 953, or 15 percent
    over the actual bed space. Rather than having overcrowding, there
    should be at least 10 percent vacant beds available at any time in order
    to have the proper mobility of patient load. It may be added that the
    proportion of ward personnel has not increased with the patient
    population; the ratio is approximately 25 percent below that considered
    proper by the American Psychiatric Association.
    During the year an attempt was made to lighten somewhat the load
    of the overworked staff members by adding general practitioners and
    externs. They have been very helpful with carrying out some of the
    routine medical activities on the wards, and have freed some of the
    time of the clinical staff as planned. The staff has been energetic,
    efficient, and devoted in its work and deserves high praise.
    It was reported last year that it was necessary to establish a waiting
    list of prisoners found mentally ill. This has been due to the
    fact that crowding cannot well take place in Howard Hall, the maximum
    security section. The situation is not at all as it should be and
    it is hoped that speed may be shown in providing a new maximum
    security section, funds for the preliminary planning of which will
    become available at the beginning of the new fiscal year. Every
    effort is being made to reduce the waiting list as far as possible consistently
    with the safe administration of the maximum security section.
    Howard Hall contains some of the most serious problems among the
    entire male population of the hospital, and crowding and understaffing
    are particularly dangerous in dealing with this group.
    The program in Howard Hall should be mentioned briefly, as it
    represents the culmination of several years of a new approach to the
    care of patients of this type. Every effort is made to cultivate an
    atmosphere which is reasonably permissive. Patient self-government
    is in operation; smokers are held regularly at which guest speakers
    address the patients in attendance. Each new patient is taken on a
    tour of Howard Hall by another patient (accompanied by an attendant)
    for the purpose of orienting him and introducing him to the
    other patients. Entertainments have been carried on.
    Saint Elizabeths Hospital 247
    A very active art program has been underway. A journal is
    published regularly. The results have been most gratifying and have
    demonstrated that even though Howard Hall is technically for more
    serious problems the atmosphere need not be unduly repressive and
    that a progressive therapeutic program gives ample reward.
    The difficulties in filling medical positions in the hospital continue
    to exist. In the first place, the number of internships and residencies
    available in this country exceeds considerably the number of graduates
    from medical school and the number of graduates desiring to take
    up postgraduate study in special fields. Furthermore, the financial
    returns from the private practice of psychiatry are most tempting,
    the result being that very few of the residents care to stay in hospital
    work once their training is completed. It is obvious that the Government
    can never expect to equal the financial return that the successful
    private practitioner of medicine might make in the community.
    There are, of course, other factors which operate in making governmental
    work in a hospital attractive. Finances, however, cannot be
    overlooked, and once again it is pointed out that the fact that another
    agency of the Government is permitted by statute to pay a salary
    premium of 25 percent to diplomates of specialty boards puts Saint
    Elizabeths Hospital in a position in which it cannot compete on an
    equal footing with that agency. Certainly it seems absurd that one
    agency of the Government should be put at such a disadvantage in
    competing with another agency which is doing similar medical work.
    The elderly patient continues to be a serious and growing problem.
    Approximately 40 percent of the patients admitted now are 60 years
    of age or older, and there is no prospect that this proportion will
    decrease. In fact there is every reason to think that it will increase
    as the number of aged in the community continues to rise. Every
    effort has been made during the year to find homes for these patients
    outside of the institution when continued psychiatric care was not
    necessary and a considerable number have been sent to the District of
    Columbia Village, as it is now known (formerly the Home for the
    Aged and Infirm). Several clinical studies have been made on
    patients in the Geriatrics Building, and the building itself continues
    to attract a large number of visitors from this and other countries.
    The number of patients admitted to the hospital voluntarily continues
    to rise; during the year 111 patients were received in this
    manner.
    The number of so-called sexual psychopaths committed under the
    “Miller Act” showed a very slight increase over last year, there being
    eight admissions of this sort. Up to date, 69 persons have been
    admitted under this act, and of them 43 have been discharged. The
    hospital is prepared to recommend certain changes which will make
    248 Department of Health, Education, and Welfare, 1954
    the act more flexible and probably on the whole considerably more
    useful.
    During the year the hospital has been honored by the visits of
    physicians, social workers, and other interested persons from no less
    than 25 countries. Visitors from other countries as well as visitors
    from other parts of the United States are always most welcome, and
    their visits are a stimulating influence upon the staff as giving recognition
    to the fact that the hospital enjoys a good reputation throughout
    the psychiatric world. During the year one psychiatrist from
    the Netherlands spent several months as an observer, and a psychiatrist
    from Japan, sent by his government, has spent nearly the entire year
    studying particularly the activities of the maximum security section
    of the hospital.
    During the year the patients gave two dramatic performances, one
    a Christmas program and the other a very clever and good-natured
    satire on the hospital entitled “Hotel St. Elizabeths,” this latter production
    being conceived, staged, and acted by the patients. The performance
    was a remarkable one, especially from the fact that it
    emanated from the patients themselves. A large number of visitors
    from the community attended, to the great pleasure of the patients.
    During Mental Health Week an “open house” was held and at least
    500 persons from the community visited the institution. This public
    interest is most gratifying and illustrates the growing understanding
    by the public of the aims and aspirations of mental hospitals.
    The hospital still attempts to follow an eclectic approach in the
    line of treatment, and is ready to utilize any new methods of treatment
    which appear to offer help to the patient without incidental harm to
    him. The hospital has no undue devotion to any preconceived
    notions as to psychopathology or treatment and no devotion to what
    Isaac Ray, one of the fathers of psychiatry in this country, was wont
    to term “ultraisms.” An active program of individual psychotherapy
    is carried on, and likewise the same is true of group therapy. There
    are many groups under therapy in various parts of the hospital and
    with great benefit to them. During the year the psychodrama program
    was resumed when the psychodramatist who had done much
    to develop the work before his leaving returned to the hospital. The
    rehabilitation program has been developed still further with great
    assistance from the District of Columbia Rehabilitation Service. The
    Board of Education of the District of Columbia has provided a visiting
    teacher for some of the young patients of the hospital. Recreational
    and occupational therapies have been extended. The hospital
    has no idea that electroshock is a panacea, but in selected cases its use
    exhibits striking effect. Subshock insulin and hydrotherapy continue
    to be used. The hospital is convinced that hydrotherapy still has
    an active place, despite the views (we think mistaken) of some that
    Saint Elizabeths Hospital 249
    it has been superseded by the so-called shock therapies. We continue
    to look upon prefrontal leucotomy, or lobotomy, as an operation only
    of last resort, and it is employed only after all of the known applicable
    forms of therapy have been tried without benefit. Only 13 lobotomies
    were performed during the year. The transorbital variety of lobotomy
    is not employed at the hospital at all.
    Hearings on petitions for writs of habeas corpus continue to occupy
    a substantial share of the time of staff physicians. During the year
    41 hearings were held on such petitions, and 11 orders to “show cause”
    had to be answered. Altogether, 29 of the patients were remanded,
    and 5 withdrew their petitions.
    MEDICINE AND SURGERY BRANCH
    This Branch functions through the Medical, Surgical, Neurological,
    Syphilological, and Clinic Services. The hospital is still the only
    public mental hospital in the United States which is approved by the
    American Medical Association for rotating internship. It is also
    approved for a period of residency training in surgery and for internship
    in dentistry. The services of this Branch are available to the
    patients of the hospital who are in need of medical or surgical attention
    of a specialized nature and to those employees who become ill or
    are injured while on duty. During the year, 2,233 patients were
    admitted to the wards of the Branch, while a total of 53,226 visits to
    the clinics were made. In addition to the extensive work done in the
    laboratory, over 12,000 laboratory examinations were made in the
    Medical and Surgical Branch. The plan developed last year by which
    two fourth-year residents in surgery from George Washington University
    Hospital cared for the surgical needs of the institution has
    worked excellently. These residents are supervised by daily visits
    of the various members of the surgical teaching staff of that hospital,
    and the surgical attention given to the patient is of a high order.
    The Neurological Service is in a state of suspended animation except
    for the attention which an occasional visiting neurologist can give
    it. In the treatment of tuberculosis it has been found that surgery
    is not so frequently necessary as was thought a few years ago, the
    effects of the antibiotics being most satisfactory. Various clinical
    studies have been carried on in conjunction with other Federal medical
    agencies. The training program for the interns has been augmented.
    The dental program has suffered somewhat by the lack of dental
    interns and available staff dentists.
    PSYCHOTHERAPY BRANCH
    During the year the psychodrama was reactivated, with the return
    of the former psychodramatist. The program of rehabilitation psy-
    339010—55------ 17
    250 Department of Health, Education, and Welfare, 1954
    chodrama instituted last year has continued. An extensive program
    of group psychotherapy is under way throughout the hospital, supervised
    by a visiting consultant. Individual psychotherapy is carried
    on by several members of the branch, as well as by various other staff
    members. The art and dance sessions have continued to do much for
    the resocialization of patients by giving them opportunities for selfexpression.
    The exhibit of Art in Psychotherapy, prepared a year
    ago, has continued on tour, and has attracted wide and favorable attention.
    The contributions of those in charge, Miss Marian Chace and
    Mr. Prentiss Taylor, are truly unique.
    The Psychology Section continues to function actively. During
    the year, 2,684 tests were given, to patients, attendants and other
    personnel. In addition, lectures have been given to residents, nurses,
    psychiatric aides, and groups of students from nearby colleges. Vocational
    testing and counseling and some individual psychotherapy have
    been carried on.
    The training program is likewise important. Two residents and
    four interns have been supervised during the year, besides a number
    of field students and volunteers. Five research programs are under
    way.
    LABORATORY BRANCH
    This Branch continues to be very thoroughly occupied by the demands
    from the Medical and Surgical and the Clinical Branches. As
    yet there is no trained encephalographer, but various changes have
    been made in the staff and organization of the laboratory which will
    take effect soon after the beginning of the next fiscal year. The
    autopsy rate has continued fairly high. During the year there were
    416 deaths with 223 autopsies, or a rate of 53.6 percent. An active
    program of lectures for the benefit of the residents and the rest of
    the staff has been carried out and a number of researches are underway,
    among them studies of brain chemistry and the effects of thorazine
    and serpasil.
    The work of the year may be summarized as follows:
    Bacteriology (cultural studies of autopsies and exudates, examination of
    smears, etc.)________________________________________________ 6,284
    Serology (blood typing and cross matching, etc.)__________________ 16,110
    Urine analyses_________________________________________________ 40, 111
    Blood and feces examinations___________________________________ 13, 608
    Biochemistry (blood analyses and tests, functional tests, including electrocardiograms
    and basal metabolisms)__________________________ 11, 068
    Electroencephalograms_________________________________________ 187
    Histopathology (surgical pathology and post-mortem pathology)______ 6,628
    Autopsies (percentage of deaths 53.6 percent)______________________ 223
    Photography--------------------------------------------------------------------------- 7,568
    Saint Elizabeths Hospital 251
    NURSING BRANCH
    During the year a program of training for psychiatric aides has
    been inaugurated, and 25 carefully selected employees of the Hospital
    have started in this course. Eight schools of nursing are sending their
    affiliate students to the hospital, and during the year 215 affiliates have
    been trained. In addition a group of Navy corpsmen has been under
    training. Eighteen practical nurses completed their training during
    the year. In addition, opportunities for field service have been given
    to the Graduate School of Nursing of Catholic University.
    OCCUPATIONAL THERAPY BRANCH
    The work of this Branch has continued actively, and the ward
    programs have been substantially expanded. Some of the recreational
    activities were transferred during the year to the Special Services
    Branch. The Branch continues to care for the recreational activities
    in Howard Hall, and has carried on a number of very desirable and
    helpful plans there. Five schools of occupational therapy use the
    hospital for field training.
    SOCIAL SERVICE BRANCH
    During the year, 1,649 patients were given services, with a total
    of over 7,841 interviews. Although this shows something of a decrease
    from the year before, much intensive work has been done by the
    Branch, particularly with relation to some of the long-term patients.
    During the year, for example, three patients for whom homes were
    found had been admitted respectively in 1926, 1932, and 1936! This
    activity takes much time, but it is certainly a highly desirable one,
    and is being encouraged. It is this activity, incidentally, which
    accounts in large measure for the increased average stay of patients
    discharged during the year. The branch has worked in close cooperation
    with the rehabilitation service worker and plans are being worked
    out with the Public Assistance Division of the Department of Public
    Welfare to enable patients to obtain payment of the funds due them
    from Public Assistance sources. It should be pointed out that under
    the laws of the District of Columbia a patient who is committed to
    Saint Elizabeths Hospital loses by that fact all of his legal rights,
    and until he is discharged as recovered he is not sui juris. This fact
    operates to the distinct detriment of patients, and it is hoped that
    when the commitment laws of the District of Columbia are finally
    brought up to date this particular feature may be eliminated. There
    is no essential legal reason why commitment to a mental hospital
    should operate as an adjudication of incompetency. One interesting
    activity of the Social Service Branch during the year has been
    252 Department of Health, Education, and Welfare, 1954
    the operation of a relatives’ discussion group conducted weekly by one
    of the social workers. This has proved distinctly valuable in orienting
    relatives to the various activities of the hospital and the various
    reactions which their relatives who are patients may exhibit.
    During the year 10 social-work students from Catholic University
    and Howard University have been under supervision.
    CHAPLAIN SERVICES BRANCH
    Regular services have been conducted for the Catholic, Protestant,
    and Jewish patients. These services have been well attended and
    every effort is made to enable every patient to attend the services, provided
    his physical and mental condition permits. Those patients who
    are unable to attend the services are given such religious attention as
    they desire on their wards. Regular services have been held in Hitchcock
    Hall, Howard Hall, and the Geriatric Building. The Hospital
    has two full-time Protestant chaplains, a full-time Protestant resident,
    a full-time Catholic chaplain, and a regular part-time Jewish chaplain.
    During a part of the year the Catholic chaplain was aided by
    another part-time priest and plans are underway to give him such
    additional assistance as he requires in his duties. The Catholic chaplain
    is also aided to a very considerable extent by the services of seminarians.
    The Protestant chaplain is in charge of the general training
    program for theological students as well as carrying out his duties of
    parochial and sacramental services for the Protestant patients.
    During the year 24 students or ordained clergymen have completed
    the prescribed period of training. This year marks the completion of
    10 years of this training program, a program which has attracted
    wide attention and which has done much toward orienting the clergy
    toward the problems of mental illness and mental health, as well as
    doing much to provide well-trained institutional chaplains.
    The chaplains of the various faiths have worked closely together,
    and a high degree of friendly cooperation has existed among all of
    those who are ministering to the religious needs of the patients. It is
    the general policy of this hospital that every patient admitted should
    be visited by a representative of his faith as soon as possible after his
    arrival at the institution. In addition, any patient may have his own
    clergyman or a clergyman of his own denomination visit him from
    the outside if he so desires. Jewish services have been held regularly
    under the supervision of the Jewish chaplain and with the assistance
    of the Jewish Welfare Board.
    It is a pleasure to report that the interdenominational chapel, the
    need of which has been acutely felt for a number of years, is finally to
    become a reality. Funds have been made available; plans are under
    way. It is possible that during the coming year the building may not
    only be started but completed.
    Saint Elizabeths Hospital 253
    LIBRARY SERVICES
    The Medical Library is operated primarily for the benefit of the
    medical staff. There are also collections in the offices of the Nurses
    Training School, the Medical and Surgical Building, Laboratory,
    Geriatric Building, and Psychology Section. During the year there
    were 535 acquisitions, bringing the total number of volumes to 16,598
    in addition to about 15,000 miscellaneous pamphlets. Periodical subscriptions,
    by purchase or gift, come to 184. About 1,831 volumes were
    borrowed by the staff, and 405 volumes were secured on interlibrary
    loan. The Armed Forces Medical Library, the Library of Congress,
    and the Library of the Department of Health, Education, and Welfare
    have been most helpful. The quarters of the Medical Library are
    seriously overcrowded. Once again it is urged that arrangements be
    effected to permit the use of commercial binders as a saving in time
    and expense.
    The Patients’ Library is in charge of one employee who is assisted
    by about 25 patients. During the year there were 1,459 accessions,
    most of them by gift; there are now 40,355 volumes in the library or
    in the numerous ward collections. The circulation is about 5,500
    volumes per month. Patients visit the library, and those patients
    who are unable to do so are provided with a variety of reading matter.
    Numerous book-review sessions are held at the library; these are well
    presented and attended. The quarters of the library are seriously
    crowded.
    SPECIAL SERVICES BRANCH
    The Special Services Branch, originally set up to take over the
    functions of the Red Cross when that discontinued its services in
    September of 1952, has continued to function most efficiently. It
    has continued to have close relations, not only with the District of
    Columbia Chapter of the American Red Cross but with various other
    agencies, such as the American Legion and the Legion Auxiliary.
    Over 2,824 volunteers served under the direction of this Branch during
    the year, giving a total of 8,193 hours. In December 1953 most
    of the hospital recreational activities were added to the functions of
    this Branch and have been carried on well. The Branch assisted
    admirably in staging the two dramatic performances already mentioned,
    held carnivals and play days, established a chorus and served
    in multifarious ways to provide various recreational activities for
    the patients, both at the Red Cross House, on the grounds, and on
    the various wards. Thanks are particularly offered to the various
    organizations which have served, particularly to the Motor Corps,
    Canteen Service, the Production and Supply Service, and the Gray
    Ladies of the American Red Cross. Many evening parties, dances,
    254 Department of Health, Education, and Welfare, 1954
    and concerts have been conducted, and the Red Cross House has been
    kept open every day, serving 10,000 or more persons every month.
    TEACHING ACTIVITIES
    The hospital continues to carry on an extensive program of teaching
    and training. It is approved for training in psychiatry during the
    three years of residency required by the American Board of Psychiatry
    and Neurology as a prerequisite for diploma. This program
    is in charge of a well-trained psychiatrist, who serves under the First
    Assistant Physician. A schedule of lectures is arranged and individual
    guidance is given to the various residents. The hospital is also
    approved for a rotating internship, and affiliation is provided at the
    District of Columbia General Hospital for the interns and at the
    George Washington University Hospital for the residents. Instruction
    is provided for medical students in the three medical schools of
    the District; namely, George Washington, Georgetown, and Howard
    Universities. Dental interns and residents in surgery are also serving
    in the hospital. The Social Service Branch is actively providing fieldwork
    for the schools of social service of Catholic University and
    Howard University, and students of occupational therapy are likewise
    received for fieldwork. Supervision is given to interns and residents
    in the field of clinical psychology. Affiliation for undergraduate
    nurses and postgraduate nurses is being continued. A special course
    for training psychiatric aides is now underway. The hospital takes
    pride in its contributions in the field of teaching, looking upon them
    as an integral part of the functions of a hospital and as a decided
    stimulus to the staff and the other participants in their daily care of
    the patients.
    General Administration
    The various areas of general administration include the non-medical
    functions which are essential as adjuncts to the psychiatric and general
    medical care and treatment of the patient. These include the
    responsibilities of the Registrar, Dietary, Personnel, Budget and
    Methods, Procurement, Property, Finance, and Administrative Service
    Sections in addition to those concerned with plant maintenance
    and the industries, including the Construction, Electrical, Mechanical,
    Garage, Housekeeping, Farm, Lawns and Grounds, Laundry, and
    Shoe Shop Sections. Though enumeration of these activities may
    serve to indicate the scope of the nonmedical functions entering into
    care and treatment of the patient, it is impractical to report in detail
    as to the work of all during the year. Flowever, a few highlights of
    operations in this field may be given.
    Saint Elizabeths Hospital 255
    The Social Security Administration has continued in close cooperation
    with the Registrar Section in making arrangements to apply for
    social security benefits for eligible patients. Likewise, the auditor
    for the District court has completed arrangements for a more careful
    scrutiny of the manner in which the funds of patients are handled by
    their committees.
    A most important adjunct in treatment of the patient is dietary
    administration. Continuing attention to improvement of meal preparation
    methods and service in addition to the variety and quality of
    foods served and the prevention of waste is being rewarded with
    encouraging results. Regularly scheduled joint inspections of food
    service by the nursing and dietetic staffs, the initiation of which has
    been previously reported, have resulted in demonstrating areas of
    possible improvement which while relatively small in many specific
    instances become of material significance when corrected in the aggregate.
    Understandably, serving problems are presented in many of the
    older buildings which are not equipped with utility lines sufficient in
    capacity or number to accommodate modern service equipment. However,
    the use of heated or insulated conveyers or containers wherever
    indicated does much to overcome this handicap, and the utilities and
    equipment necessary for the most efficient operation are being supplied
    wherever practicable. The raw food ration cost for the year approximated
    86 cents. Orientation classes in diet therapy were held regularly
    for new employees. Additionally, psychiatric aide students were
    given instruction in nutrition and diet therapy.
    In the personnel area nurse recruitment continued difficult. A psychiatric
    aide inservice training program was instituted in midyear and
    the first class is expected to graduate next fall. While it is too soon
    to evaluate results at this time, it is hoped that ward staffing conditions
    will be improved to some extent by continuation of the program.
    While there was some improvement over the past year in intern recruitment
    the hospital is still approximately 25 percent short of its
    quota. Medical officers in general practice are difficult to recruit,
    and those trained in psychiatry more so. The condition whereby
    another agency of the Government is able to offer to diplomates of the
    specialty boards a 25-percent premium in salary continues to place
    the hospital in unequal competitive position in recruitment of qualified
    psychiatrists.
    The incentive awards program was productive of a number of suggestions
    for management improvement and effort is made to encourage
    such suggestions. Those adopted included, for example, the use
    of an antifreeze preparation in the solution used to clean the interior
    of deep-freeze storage compartments, eliminating the necessity of
    inactivating the compressor during the process, and also a change in
    mail handling which reduced hospital labor and expedited dispatch
    of the last mail of the day.
    256 Department of Health, Education, and Welfare, 1954
    Centralization of patients’ baggage and property storage, commenced
    last year, was completed. This involved the examination, inventorying,
    transportation and storage of large quantities of patients’
    property theretofore kept in numerous property rooms throughout
    the various services. Results show the undertaking to have been most
    beneficial, affording the advantages of centralized care, control, and
    records.
    More than 22,000 bushels of fresh vegetables were furnished by the
    farm operation in addition to a large quantity of poultry and eggs.
    Before the outset of the planting season the requirements of the hospital
    and the farm output capacity were carefully considered and planting
    schedules planned accordingly. Aside from the uncertainties of
    weather conditions, it is expected that such planning will result in
    the maximum benefits to the hospital from the farm production.
    The new Receiving Building now under construction was 78 percent
    completed at the end of the year. When completed, this building
    will afford intensive treatment facilities which should operate to
    reduce the duration of hospitalization in many cases. Additionally,
    occupancy of the new building will permit evacuation of the old and
    unsatisfactory Oaks and Toner Buildings. Plans and specifications
    for the new interdenominational chapel are in course of preparation,
    and it is expected that these will be completed shortly. This building,
    which will fill a long-standing need, will be erected on a large area
    adjoining Nichols Avenue, formerly the site of the semipermanent
    buildings, evacuated several years ago and now removed.
    With the transfer of the Carpenter, Cabinet, and Mattress Shops to
    the reconditioned old Laundry Building, it was possible to remove the
    old and unsightly building structures formerly housing those activities,
    lessening congestion in the areas involved and also improving the
    view from adjacent patients’ buildings. Also, old and useless buildings
    and feeding pens formerly used in piggery activities were
    removed. These activities were abandoned last year when an epidemic
    of infectious exanthema compelled the extermination of the
    herd. The first section of a planned renovation of the hospital’s water
    distribution system was practically completed, as was the replacement
    of old elevators in the Medical and Surgical Building. With limited
    personnel, day-to-day plant maintenance becomes an ever-increasing
    problem, particularly as regards the older installations which though
    structurally sound require continuous attention to fulfill present-day
    usage requirements. In addition to routine repairs and replacements,
    the hospital maintenance force replaced a dilapidated and inadequate
    blacksmith and welding shop, and commenced construction of an
    adequate ice storage addition to the refrigeration plant. Many additional
    facilities, such as power outlets, heating controls, and communications
    units, were installed during the year.
    Saint Elizabeths Hospital 257
    Needs of the Hospital
    The need for new maximum security facilities remains urgent.
    Funds for the preliminary planning of such a facility are at the
    moment under consideration by the Congress. Further ward buildings
    are needed to relieve the crowding. The cafeteria for Continued
    Treatment Buildings 7 and 8, planned when the buildings were begun,
    is still urgently needed. Once again emphasis is laid upon the
    desirability of placing the hospital on an equal basis with other
    Federal agencies in regard to premium pay for specialists. The need
    of additional personnel is likewise emphasized if the care given to the
    patients is to remain in line with standards which are worthy of the
    Government of the United States.
    Table 1.—Patients, admissions, and discharges, fiscal year 1935—54
    Fiscal year
    Average
    number of
    patients
    on rolls
    Total number
    of
    admissions
    Total number
    of
    patients
    discharged
    Percent discharged
    in
    relation to
    admissions
    Total number
    of
    deaths
    1935 . ________________________________ 5,267 824 396 48.06 304
    1936 .. _____________________________ 5,373 925 552 59.68 298
    1937 ____________________________ 5,538 1,099 490 44.59 332
    1938 . _____________________________ 5, 836 1,029 461 44.80 267
    1939 ________________________ 6,108 1,056 469 44. 41 281
    1940 ___________________________ 6, 395 L 202 619 51.50 322
    1941 ___________________________ 6,663 1,503 773 51.43 382
    1942. . ______________________________ 6, 994 i; 797 1,534 1 84.36 371
    1943 . ____________________ 7,031 2,324 1,491 64.15 420
    1944 . ___________________________ 7,161 2,599 2,056 79.11 441
    1945 _ _________________________________ L 308 2,935 2,299 78.30 460
    1946 _____________________________ 7,044 1,909 2,477 129.75 396
    1947 - _________________________________ 6,484 1,339 891 66. 54 424
    1948 _________________________ 6,621 1,420 856 60. 28 431
    1949 __________________________ 6,701 L470 861 58. 60 446
    1950 - _____________________ 6,897 1,648 960 58.25 495
    1951 . ... _______________________ ____ 7; 053 1,412 928 65.72 424
    1952 .- ________________________________ 7,172 1,438 814 56.6 431
    1953-- . _______________________________ 7,361 1,524 977 64.1 436
    1954------------------------------- --------------------------- 7,392 1,385 921 66.5 416
    ■ 63.10 without transfer of 400.
    Table 2.—Movement of patient population, fiscal year 1954
    Total
    Male Female
    White Colored Total White Colored Total
    Total number under care and treatment
    fiscal year 1954__________________ 8,767 2,783 1,653 4,436 2,635 1,696 4,331
    Remaining on rolls June 30,1953________ 7,382 2,358 1, 389 3,747 2,179 1,456 3,635
    Admitted during year_________________ 1,385 425 264 689 456 240 696
    Total discharged or died_________________ 1,337 436 248 684 416 237 653
    Discharged__________________________ 921 298 188 486 265 170 435
    Discharged as—
    Not insane_____________________ 44 16 26 42 1 1 2
    Recovered______________________ 125 24 38 62 32 31 63
    Social recovery__________________ 291 66 50 116 97 78 175
    Improved_______________________ 271 123 42 165 72 34 271
    Unimproved____________________ 190 69 32 101 63 26 89
    Died___________________ _____________ 416 138 60 198 151 67 218
    Remaining on rolls June 30, 1954________ 7,430 2,347 1,405 3, 752 2,219 1,459 3,678
    On visit or elopement_______________ 201 39 34 73 80 48 128
    In hospital.............................................. 7,229 2,308 1,371 3,679 2,139 1,411 3,550
    258 Department of Health, Education, and Welfare, 1954
    Table 3.—Consolidated statement o f movement o f patients, by classification, fiscal year 1954
    Nonreimbursable patients
    SpUBJSJ UT§JTA
    CICOCOM 1 rH
    rH CO MQ '
    151
    ‘ 151
    MQ
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    eojAjog onqnj cocm MQ
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    55
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    54
    MMQQ
    sjouosjjd GO ! rH OH co
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    33
    *33*
    sjeuosud jerepej
    118
    63
    co Cl MQ
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    144
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    142
    rCHZ)
    i sqjBdoqo^sd xeg cm*^ o O Ci CMQl
    25
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    SIOUOST-ld ’□ ’Q
    292
    63
    CD MO CMDQ C3M V1
    293
    12
    281
    MMQQ CO
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    strape paujajuj '* : I
    eoiAjog uSraioj COCO 1 rH OH MQ rH
    +
    CD rH MQ co
    SHOI^UA J9S9I lUIOpOJ Cl 00 -r O + CD rH
    1
    MO I MQ o
    suxopisoiuou *□ a
    234
    119
    IQ
    O
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    11
    184
    159
    + 6 4
    223
    3
    220
    co
    co
    pjrenf) jsboo 1
    17
    1
    16
    rH
    9U0Z [■BUBO s-l i H Is 00 rH 00 rH r0H0
    9UBSUT UBipBUBQ B”| - Is MCQl s s
    S9UI0H
    ^UOIUN UB9JDH " il - - 1’ ■r MQ
    90TAI9S UOT^BZIfBin
    -^N uonEjSiuiini
    CM ' CM CM CM CM
    uoijBsuadraoo
    (Soa^oidrag naarng
    Cl ! Cl CM CM CM
    jfrajv cm :
    CD MQ rH MQ
    CCMD
    265
    1
    264
    CM
    [Bjojqng
    1,383
    282
    CO
    33
    288
    1,345
    + 6 4
    1,409
    21
    1,388
    1,665 |
    Reimbursable patients
    sjauosud ajBjg-’g °-l i II 1- i rH 1 rH rH
    non
    -BJ^simuipv
    370
    39
    mq
    334
    + 3 4
    367
    7
    360 Ci
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    s emos .sjaipiog -g •£
    40
    20
    2  entered the ministry, 755 the practice of pharmacy; 489 have entered
    into engineering and 264 into the field of social work.
    These graduates are at work in 43 States and 27 foreign countries,
    s. In every population center in the United States they constitute a
    cross section of the leadership of the Negro people. Together, these
    graduates constitute the largest and most diversified group of trained
    Negro public servants related to any single institution in the world.
    In the eight professions of medicine, dentistry, pharmacy, engineering,
    architecture, music, law, and social work, they include a body
    of Negro professional graduates larger than the output of all other
    universities of public and private support combined, in all the Southern
    States.
    SERVICE TO FOREIGN STUDENTS AND IN FOREIGN COUNTRIES
    Howard University has developed a far-reaching service to foreign
    students. Foreign students are now enrolled from 44 foreign countries,
    island communities from the West Indies and the United States
    possessions. It ranks third among American universities in the percentage
    of foreign students enrolled.
    The student body is drawn from four continents of the world. They
    are representative of every race and color in the world. Three thou-
    < sand five hundred and four of them are affiliated with 34 different
    religious bodies—Protestants, Catholics, Jews, Moslems, Hindus,
    Zoroastrians, Buddhists, and Bahaists.
    Howard University students and teachers have associated daily with
    teachers and students representative of every race and color, and
    many of the major creeds of the world. They have learned by experience
    that the common country of the trustable human heart crosses
    and transcends all these boundaries of external differences, and they
    are habituated to a friendly interest in human beings everywhere. In
    recent years many of those teachers and students, as individuals and
    in groups, have traveled on missions to many countries in Europe,
    Asia, and Africa; as now in India, Iraq, and Indonesia, so wherever
    they have gone, they have imparted good will and friendship and they
    have found good will and friendship in return.
    270 Department of Health, Education, and Welfare, 1954
    Again and again the responsible leaders in Government and the
    friends of America have acknowledged their services as being of the
    greatest value to their country and to the cause of democracy in the
    world.
    1
    Detailed Contents
    THE SECRETARY’S REPORT__________________ i
    The Department and Its Work_________________________________ 3
    A New Appraisal______________________________________________ 5
    Developments in Health________________________________________ 5
    Developments in Education_____________________________________ 9
    Developments in Welfare_______________________________________ H
    Developments in Management__________________________________ 14
    Table 1.—Grants to States: Total grants under all Department of Health,
    Education, and Welfare programs, fiscal year 1954_______________ 16
    SOCIAL SECURITY ADMINISTRATION
    SOCIAL SECURITY IN 1954__________________________________ 17
    Program Administration in 1954_______________________________ . 20
    OLD-AGE AND SURVIVORS INSURANCE_____________________ 22
    The Significance of the Program_____________________________ 22
    Beneficiaries and Benefit Amounts________________________________ 22
    The Protection Provided________________________________________ 23
    Coverage of the Program________________________________________ 23
    Contributions and Disbursements_________________________________ 24
    Administering the Program______________________________________ 25
    Improving the Program—The 1954 Amendments_________________ 27
    Coverage_____________________________________________________ 28
    Benefits______________________________________________________ 31
    The Retirement Test___________________________________________ 33
    Disability “Freeze”_____________________________________________ 34
    Financing the Program__________________________________________ 36
    PUBLIC ASSISTANCE________________________________________ 38
    Caseload and Expenditures___________________________________ 40
    Effect of Old-Age and Survivors Insurance on Public Assistance. _ 43
    Program Developments_______________________________________ 46
    Services to Aid to Dependent Children Families_____________________ 47
    Emphasis on Rehabilitation and Self-Care__________________________ 50
    Standards of Institutional Care for the Aged, Blind, and Disabled_____ /_ 53
    Public Inspection of Public Assistance Rolls________________________ 55
    Administrative Operations____________________________________ 55
    Review of State and Local Operations_____________________________ 56
    Studies and Publications_________________________________________ 56
    Technical Assistance to States____________________________________ 58
    Recruitment, Selection, and Training of Public Assistance Personnel___ 59
    271
    272 Department of Health, Education, and Welfare, 1954
    CHILDREN’S BUREAU.
    Page
    61
    Programs of the Bureau_____________________________________ 62
    The Research Program_______________________ __________________ 62
    Grants to the States____________________________________________ 64
    Maternal and Child Health Services___________________________ 65
    Crippled Children’s Services__________________________________ 66
    Child Welfare Services______________________________________ 68
    The Program of International Cooperation_________________________ 70
    Publications___________________________________________________ 71
    Trends Affecting Child Life_________________________________ 72
    Parents’ Groups___________________________________________ 72
    The Whole Child___________________________________________ 72
    Social Services to Children in Their Own Homes_________________ 73
    Adoption_________________________________________________ 74
    Group Care for Children____________________________________ 74
    Children With Special Needs_________________________________ 75
    Juvenile Delinquency___________________________________________ 75
    Mentally Retarded Children_____________________________________ 76
    Children of Migratory Agricultural Workers________________________ 77
    Black Market in Babies_________________________________________ 78
    Fetal and Neonatal Mortality____________________________________ 79
    Training Personnel for Programs With Children_______________ 79
    Child Health__________________________________________________ 80
    Child Welfare_________________________________________________ 82
    Relationships With Other Agencies and Organizations__________ 84
    Interdepartmental Committee on Children and Youth__________ 85
    FEDERAL CREDIT UNIONS_________________________________ 86
    Program Operations__________________________________________ 87
    Strengthening the Program___________________________________ 90
    Table 1. —Social Security Administration: Funds available and obligations
    incurred, fiscal years 1954 and 1953_______________________ 91
    Table 2. —Financing social insurance under the Social Security Act: Contributions
    collected and trust fund operations, fiscal years 1952-1954_ 92
    Table 3. —Old-age and survivors insurance: Estimated number of families
    and beneficiaries in receipt of benefits and average monthly benefit in
    current-payment status, by family group, end of June 1954 and 1953_ 93
    Table 4. —Old-age and survivors insurance: Selected data on benefits,
    employers, workers, and taxable earnings, by State, for specified periods,
    1952-1954_________________________________________________ 94
    Table 5. —Old-age and survivors insurance: Selected data on benefits,
    employers, workers, and taxable earnings for specified periods, 1952-
    1954 95
    Table 6. —Special types of public assistance under plans approved by the
    Social Security Administration: Number of recipients and average payment,
    June 1954, and total payments to recipients, by program and
    State, fiscal year 1954_________________________________________ 96
    Table 7. —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 1954___________________________________________________ 98
    Detailed Contents 273
    Page
    Table 8. —Maternal and child health and welfare services: Grants to
    States for maternal and child health services, services for crippled
    children, and child welfare services under the Social Security Act, by
    program and State, fiscal year 1954_____________________________ 100
    Table 9. —Federal credit unions: Number of members, amount of assets,
    amount of shares, and amount of loans outstanding Dec. 31, 1935-1953. 101
    Table 10. —Federal credit unions: Assets and liabilities, Dec. 31, 1953,
    and Dec. 31, 1952__________________________________________ 101
    Chart 1.—Coverage has been extended to 10 million more persons-------- 24
    Chart 2.—The 1951 relationship between earnings level and the earnings
    base has been restored_______________________________________ 31
    Chart 3.—Benefit levels have been increased_______________________ 32
    Chart 4.—Average monthly assistance payments, June 1954---------------- 39
    Chart 5.—Proportion of population receiving assistance (recipient rates)
    in the United States, June 1954_______________________________ 42
    Chart 6.—Growth in social insurance protection for the aged___________ 45
    Chart 7.—Number of children receiving aid to dependent children with
    father dead and number of survivor children receiving old-age and
    survivors insurance, 1950-1954_______________________________ 47
    Chart 8.—Children in the United States are increasing rapidly_________ 61
    Chart 9.—Children in foster family homes increase as children in institutions
    decrease______________________________________________ 69
    Chart 10.—Juvenile court delinquency cases are rising_______________ 75
    Chart 11.—Prevention of prematurity and better care of premature babies
    would greatly reduce mortality in the first month of life------------------- 81
    PUBLIC HEALTH SERVICE
    HEALTH OF THE NATION___________________________________ 103
    Health Record_________________________________________________ 103
    Births, Marriages, and Divorces__________________________________ 104
    Funds and Personnel_________________________________________ 104
    Health Emergency Planning__________________________________ 105
    Public Health Methods_______________________________________ 106
    Health Manpower Source Books__________________________________ 106
    Health Services and Facilities____________________________________ 106
    Statistical Studies of Illness______________________________________ 107
    NATIONAL INSTITUTES OF HEALTH_________________________ 108
    The Clinical Center__________________________________________ 108
    Clinic and Laboratory___________________________________________ 109
    Research Grant and Fellowship Programs--------------------------------- 109
    General Grants Program________________________________________ 110
    Arthritis and Metabolic Diseases______________________________ 111
    Research Progress______________________________________________ 111
    Research Grants and Some Results________________________________ 112
    Cancer Research and Control_________________________________ 113
    Laboratory and Clinical Studies__________________________________ 113
    Biostatistical Studies____________________________________________ 114
    274 Department of Health, Education, and Welfare, 1954
    Page
    Support of Research and Control_________________________________ 114
    Studies Supported by Grants____________________________________ 114 •
    Dental Research_____________________________________________ 115
    Heart and Circulatory Research______________________________ 116
    Research Advances at NHI______________________________________ 117
    Research Grants Accomplishments________________________________ 118
    Mental Health_______________________________________________ 119
    Research Programs of the Institute_______________________________ 119
    Institute-Supported Research____________________________________ 120
    Mental Health Statistics________________________________________ 120
    Community Services____________________________________________ 121
    Professional Orientation_________________________________________ 121
    Microbiological Research_____________________________________ 121
    Research Grants_______________________________________________ 122
    Neurological Diseases and Blindness__________________________ 123
    Research Grants Accomplishments________________________________ 123
    BUREAU OF MEDICAL SERVICES____________________________ 124
    Hospitals and Medical Care___________________________________ 124
    Volume of Services_____________________________________________ 125
    Special Hospitals_______________________________________________ 125
    Clinical Research_______________________________________________ 126
    Professional Education__________________________________________ 127
    Freedmen’s Hospital____________________________________________ 127
    Health Protection at Ports and Borders_______________________ 128
    Medical Examinations__________________________________________ 128
    Special Problems_______________________________________________ 129
    Services for Travelers___________________________________ 129
    Hospital Survey and Construction_____________________________ 129
    Meeting Present and Future Needs________________________________ 130
    Nursing Resources____________________________________________ 131
    Training of Nursing Aides_______________________________________ 131
    Studies of Nursing Activities_____________________________________ 131
    Dental Resources____________________________________________ 132
    Utilization and Supply of Dental Services__________________________ 132
    Special Dental Studies__________________________________________ 133
    Medical Services for Federal Agencies_______________________ 133
    Office of Vocational Rehabilitation________________________________ 133
    Bureau of Employees’ Compensation, Department of Labor___________ 133
    Bureau of Indian Affairs, Department of the Interior_________________ 134
    Maritime Administration, Department of Commerce_________________ 136
    United States Coast Guard, Treasury Department___________________ 136
    Foreign Service, Department of State______________________________ 136
    Bureau of Prisons, Department of Justice__________________________ 137
    BUREAU OF STATE SERVICES______________________________ 138
    General Health Services_____________________________________ 138
    State Grants Services. __________________________________________ 138
    Detailed Contents 275
    Page
    Public Health Education Services_________________________________ 140
    Public Health Nursing Services___________________________________ 141
    National Office of Vital Statistics_________________________________ 141
    Arctic Health Research Center___________________________________ 143
    Division of Special Health Services__________________________ 144
    Chronic Disease Program________________________________________ 144
    Venereal Disease Program_______________________________________ 145
    Occupational Health Program____________________________________ 147
    Tuberculosis Control Program____________________________________ 147
    Heart Disease Control Program__________________________________ 149
    Sanitary Engineering Services________________________________ 149
    Sanitary Engineering Center_____________________________________ 149
    Radiological Health____________________________________________ 151
    Water Supply and Water Pollution Control_________________________ 152
    Interstate Carrier Sanitation_____________________________________ 153
    General Engineering Activities___________________________________ 153
    Milk and Food Sanitation_______________________________________ 154
    Home Accident Prevention______________________________________ 154
    Hygiene of Housing____________________________________________ 155
    Communicable Disease Center________________________________ 155
    Epidemiologic Services__________________________________________ 155
    Laboratory Services____________________________________________ 156
    Disease Control Activities_______________________________________ 157
    Development of Equipment and Control Methods___________________ 157
    Training Activities_______________________________________________ 157
    Diseases Under Study____________________________________________ 158
    Division of Dental Public Health______________________________ 159
    Consultative Activities___________________________________________ 160
    Field Project Activities___________________________________________ 160
    Division of International Health_____________________________ 161
    Volta River Basin Development____________________________________ 162
    Cooperation with FOA____________________________________________ 162
    Training of Foreign Nationals______________________________________ 163
    Table 1. —Statement of appropriations, authorizations, obligations, and
    balances for the fiscal year 1954________________________________ 164
    Table 2. —Commissioned officers and civil service personnel as of June
    30, 1954____________________________________________________ 165
    Table 3. —Payments for research grants, research fellowships, and field
    investigations and demonstrations, fiscal year 1954_________________ 167
    Table 4. —Payments for teaching grants, traineeships, and training grants,
    fiscal year 1954______________________________________________ 168
    Table 5. —Payments to States, fiscal year 1954___________________ 169
    OFFICE OF EDUCATION
    I. Introduction_______________________________________________ 171
    II. Major Educational Problems Confronting the United States in
    1954_______________________________________________________ 174
    Enrollment Growth Is and Will Be Greatly Increased_________________ 175
    276 Department of Health, Education, and Welfare, 1954
    Page
    The Need for More Prepared Teachers and More Buildings Is Accented
    by a Backlog of Deficiencies__________________________________ 176
    Shortages of Teachers, Scientists, Nurses, and Other Trained Personnel
    Is Aggravated by the Loss of Potential Resources_________________ 178
    III. Services to Education in the United States_______________ 181
    State and Local School Systems__________________________________ 182
    State School Administration__________________________________ 182
    Local School Administration_________________________________ 182
    School Finances____________________________________________ 183
    School Legislation__________________________________________ 183
    School Facilities____________________________________________ 184
    Elementary Education______________________________________ 184
    Secondary Education_______________________________________ 185
    The Education of Exceptional Children_________________________ 186
    Visual Education___________________________________________ 186
    Libraries__________________________________________________ 186
    Higher Education______________________________________________ 187
    Major Consultative Services________________________ 187
    Conferences_______________________________________________ 187
    College Housing Loan Advisory Program_______________________ 187
    Publications_______________________________________________ 188
    Vocational Education___________________________________________ 189
    International Education_________________________________________ 189
    Assistance to Schools in Federally Affected Areas_____________________ 191
    Research and Statistical Services__________________________________ 191
    Table 1.—Grants to States: Office of Education, fiscal year 1954______ 192
    Chart 1.—Increased school enrollment, 1930-54, and projected enrollment,
    1954-60_____________________________________________ 176
    Chart 2.—Public school classroom shortage, 1930-60__________________ 177
    Chart 3.—Elementary teacher shortage, 1954—60____________________ 177
    Chart 4.—Inadequate education: 1950____________________________ 178
    Chart 5.—School drop-outs: History of one class_____________________ 179
    FOOD AND DRUG ADMINISTRATION
    Food, Drug, and Cosmetic Act________________________________ 193
    On the Food Front_____________________________________________ 194
    Potential Health Hazards____________________________________ 194
    To Keep Food Clean________________________________________ 197
    Pocketbook Protection______________________________________ 200
    Seafood Inspection Service___________________________________ 201
    Products of Special Dietary Significance____________________________ 201
    Drugs and Devices____________ 203
    Clinical Surveys of Drug Reactions____________________________ 203
    Recalls____________________________________________________ 204
    Federal Court Actions_______________________________________ 204
    New Drugs________________________________________________ 208
    Cosmetics and Colors___________________________________________ 209
    Certification Services____________________________________________ 209
    Detailed Contents 277
    Page
    Changes in the Law and Regulations__________ ___________________ 210
    Legislation________________________________________________ 210
    Regulation-Making Activities________________________________ 211
    New Court Interpretations______________________________________ 212
    Scientific Investigations_________________________________________ 215
    Enforcement of Other Acts__________________________________ 218
    Enforcement Statistics_______________________________________ 218
    Table 1.—Actions on foods during the fiscal year 1954_______________ 219
    Table 2.—Enforcement activities during the fiscal year 1954__________ 219
    Table 3.—Number of samples on which criminal prosecutions and seizures
    were based and number of court actions instituted during the fiscal year
    1954_____________________________________________________ 220
    Table 4.—Import inspections and detentions during the fiscal year 1954__ 220
    OFFICE OF VOCATIONAL REHABILITATION
    A New Era in Rehabilitation__________________________________ 221
    The New Vocational Rehabilitation Law___________________________ 222
    New Grant System_________________________________________ 222
    Expansion of Types of Services_______________________________ 223
    Training Professional Personnel_______________________________ 223
    State and Local Administration_______________________________ 223
    Coordination Among Public Agencies__________________________ 224
    Federal Administration______________________________________ 224
    Amendments to the Randolph-Sheppard Act____________________ 224
    Highlights of 1954______________________________________________ 225
    Facilities and Services for the Disabled_______________________ 226
    The State-Federal Partnership___________________________________ 226
    Specific Services for the Disabled_________________________________ 227
    Physical Restoration____________________________________________ 227
    Progress in Meeting Unsolved Problems________________________ 228
    Rehabilitation Centers______________________________________ 229
    Services to the States________________________ ,_______________ 230
    Strengthening the Program______________________________________ 230
    Stimulating Employment of the Handicapped_______________________ 232
    The Vending-Stand Program for the Blind______________________ 233
    Facts and Figures About Rehabilitants_________________________ 234
    Characteristics of the Persons Rehabilitated________________________ 234
    They Prove That Rehabilitation Pays_____________________________ 237
    Help for Other Nations_______________________________________ 237
    The District of Columbia Rehabilitation Service_______________ 238
    Table 1.—Number of referrals and cases, by agency, fiscal year 1954___ 240
    Table 2.—Total program expenditures from Federal and State funds for
    vocational rehabilitation by State boards of vocational education, fiscal
    year 1954_________________________________________________ 242
    278 Department of Health, Education, and Welfare, 1954
    Page
    Table 3.—Total program expenditures from Federal and State funds for
    vocational rehabilitation of the blind by State commissions or agencies
    for the blind, fiscal year 1954_________________________________ 243
    Chart 1.—Disabilities and major occupational groups________________ 235
    SAINT ELIZABETHS HOSPITAL
    Division of Medical Services__________________________________ 245
    Clinical Branches______________________________________________ 245
    Medicine and Surgery Branch____________________________________ 249
    Psychotherapy Branch_______________________ ___________________ 249
    Laboratory Branch_____________________________________________ 250
    Nursing Branch_________1_____________________________________ 251
    Occupational Therapy Branch____________________________________ 251
    Social Service Branch___________________________________________ 251
    Chaplain Services Branch________________________________________ 252
    Library Services_______________________________________________ 253
    Special Services Branch_________________________________________ 253
    Teaching Activities_____________________ 254
    General Administration_______________________________________ 254
    Needs of the Hospital________________________________________ 257
    Table 1.—Patients, admissions, and discharges, fiscal years 1935-54____ 257
    Table 2.—Movement of patient population, fiscal year 1954__________ 257
    Table 3.—Consolidated statement of movement of patients, by classification,
    fiscal year 1954______________________________________ 258
    AMERICAN PRINTING HOUSE FOR THE BLIND
    Services to Schools and Classes for the Blind__________________________259
    GALLAUDET COLLEGE
    Kendall School_________________________________________________ 261
    Gallaudet College______________________________________________ 261
    HOWARD UNIVERSITY
    Enrollment of Students__________________________________________ 263
    Geographical Distribution of Students_____________________________ 263
    The Comprehensive Purpose of Howard University__________________ 264
    Highly Significant Service to Negro Students________________________ 264
    Veterans______________________________________________________ 265
    Army and Air Reserve Officers’ Training Corps______________________ 266
    Faculty_______________________________________________________ 266
    Composition of the Faculty______________________________________ 266
    Building Program Goes Ahead____________________________________ 267
    High Caliber of Faculty and Students in the College of Dentistry______ 267
    Graduates_____________________________________________________ 268
    Service to Foreign Students and in Foreign Countries________________ 269
    U. 1. GOVERNMENT PRINTING OFFICE: ISIS