[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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1954
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U. S. DEPARTMENT OF
HEALTH, EDUCATION, and WELFARE
1954
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Washington 25, D. O. - Price 75 cents
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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
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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
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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
Social Security Administration 87
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
nnw«2«®« -*con™ 'a'”-'Sg'~”~-1 ->'“sa-ss”8S ”-‘”'as“- M s'”
§85§588888 8383§5§§85 8§88538§38 §8“
-§88882^-^ 2^82^2823^ “S' “8"
8288288828 8838828883 8828883888 888
5338288885 883888833- 8838585258 838
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
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 till
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Illi
iii i i i i i i i i i i i i i i i i i i i iiii III 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 I 1 1 1 Illi
iii i i i i i i i i i i i i i i i i i i i iiii
III 1 I 1 I 1 I I I H 1 I I I 1 I I I I 1 l IIII
**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
i i i i i i i i i i i-hr i i i i i i i i i t i i-*-* i i
CO i i i i i 1+5 i i i i i i i t i । i '•£? i i
' 1 • 5 '' I 1 1 1 I....................... SE • '
8 S os e 3 B’S §? go « -2d Iwg e Willi yil
Social Security Administration 99
SsS i i3 33335S33SS t*£«
ij§ i i- §8K§§”§§2§
rd gcf cChhV
$IS3 !§§*§!
:
|Js
8§£K|§5”^ 83” 1
^3§SSg|g|
ro^gg-U'mc»cfg*rH cfccw-g-jJ-ci-
888
dscal-
year expenditure
inning Jan. 1,1954.
§88§S§
S3”---
838^3§B§
^ggfeocs
§§
r-’g'-f
§g^fg
S^W^SS^ S5S EfS”'
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
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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
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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