    [Annual Report of the U.S. Department of Health, Education, and Welfare, 1953]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    OF THE
    U. S. DEPARTMENT OF
    HEALTH, EDUCATION, and WELFARE
    1953
    285159
    LIBRARY
    OF THE
    U. S. DEPARTMENT OF
    HEALTH, EDUCATION, and WELFARE
    1953
    For sale by the Superintendent of Documents, U. S. Government Printing Office
    Washington 25, D. C. - Price $1
    f/v
    U. S. DEPARTMENT OF
    HEALTH, EDUCATION, AND WELFARE
    As of May 1954
    Oveta Culp Hobby, Secretary
    Nelson A. Rockefeller, Under Secretary
    OFFICE OF THE SECRETARY
    Chester S. Keefer . .
    Russell R. Larmon . .
    Roswell B. Perkins .
    Parke M. Banta . . .
    Harry G. Haskell . .
    Donald M. Counihan .
    Frederick H. Schmidt .
    Harlan L. P. Wendell
    J. Stewart Hunter
    Rufus E. Miles, Jr
    Special Assistant /or Health and Medical Affairs.
    Assistant Secretary for Federal-State Relations.
    Assistant Secretary for Program Analysis.
    General Counsel.
    Secretary to the Departmental Council.
    Legislative Liaison Officer.
    Director of Security.
    Special Assistant to the Secretary for Public
    Relations.
    Acting Director of Publications and Reports.
    Director of Administration.
    SOCIAL SECURITY ADMINISTRATION
    John W. Tramburg.................
    William L. Mitchell . . . .
    Victor Christgau . . . .
    Jay L. Roney . . , , .
    J. Deane Gannon , . .
    Martha M. Eliot . . . ,
    Commissioner of Social Security.
    Deputy Commissioner of Social Security.
    Director, Bureau of Old-Age and Survivors
    Insurance.
    Director, Bureau of Public Assistance.
    Director, Bureau of Federal Credit Unions.
    Chief, Children’s Bureau.
    PUBLIC HEALTH SERVICE
    Leonard A. Scheele . . . .
    W. Palmer Dearing.................
    Jack Masur.....................
    Charles E. Burbridge .
    Otis L. Anderson . . . .
    W. H. Sebrell, Jr ... .
    Surgeon General.
    Deputy Surgeon General.
    Chief, Bureau of Medical Services,
    Superintendent, Freedmen’s Hospital.
    Chief, Bureau of State Services.
    Director, National Institutes of Health.
    OFFICE OF EDUCATION
    Samuel M. Brownell .... Commissioner of Education.
    James K. Little..................... Deputy Commissioner of Education.
    FOOD AND DRUG ADMINISTRATION
    Charles W. Crawford . . . Commissioner of Food and Drugs.
    George P. Larrick................. Deputy Commissioner of Food and Drugs.
    ii
    OFFICE OF VOCATIONAL REHABILITATION
    Mart E. Switzer......................... Director of Vocational Rehabilitation.
    Donald H. Dabelstein . . . Assistant Director.
    SAINT ELIZABETHS HOSPITAL
    /
    Winfred Overholser .... Superintendent.
    FEDERALLY AIDED CORPORATIONS
    Finis Davis ..............................Superintendent, American Printing House for
    the Blind.
    Albert W. Atwood................. President, Columbia Institution for the Deaf.
    Mordecai W. Johnson. . . . President, Howard University.
    REGIONAL DIRECTORS
    Lawrence J. Bresnahan . . .
    Joseph B. O’Connor.................
    Michael J. Shortley . . . .
    Richard H. Lyle ......................
    Vacancy .......................................
    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.
    285159
    iii
    ft
    Letter of Transmittal
    Department of Health, Education, and Welfare,
    Washington, D. C., December 2,1953.
    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 30,1953.
    Respectfully,
    Secretary.
    The President,
    The White House,
    Washington, D. C.
    V
    ALASKA HAWAII
    Contents
    Page
    The Secretary's Report.............................................................. 1
    Social Security Administration............................................... 9
    Public Health Service................................................................ 83
    Office of Education..................................................................... 159
    Food and Drug Administration.............................................. 199
    Office of Vocational Rehabilitation.......................................... 229
    Saint Elizabeths Hospital......................................................... 253
    American Printing House for the Blind................................ 266
    Columbia Institution for the Deaf........................................... 267
    Howard University.................................................................... 269
    Appendix Tables........................................................................ 279
    {A detailed listing of the contents of this report, by}
    {topic headings, will be found on pages 285 - 298}
    vii

    The Secretary’s
    Report
    On April 11, 1953, President Eisenhower signed legislation enacted
    by the 83d Congress creating the Department of Health, Education,
    and Welfare.
    In bringing together the somewhat loosely knit units that, since
    1939, had made up the Federal Security Agency the President and the
    Congress assured permanent and continuing representation of the
    Agency’s programs at the highest councils of the Executive Branch
    of the Government.
    This action was undoubtedly the single most important event of
    fiscal 1953 with respect to the health, education, and welfare programs
    of the Federal Government.
    It came about as a result of Reorganization Plan No. 1 which was
    submitted by the President to the Congress on March 12, 1953, and
    represented translation into fact of action first recommended as longago
    as the Administration of President Warren G. Harding.
    In an historical sense, the creation of the Department may also be
    thought of as a landmark in a concept that runs deep in American life.
    It is a concept embodied in the Preamble to the Constitution, and later
    made explicit in the body of that great document.
    The purposes of the Constitution are defined in the Preamble as
    “to form a more perfect Union, establish justice, insure domestic tranquility,
    provide for the common defense, promote the general welfare,
    and secure the blessings of liberty to ourselves and our posterity.”
    Among the duties of the Congress defined under Article I, Section 8,
    are the “power to lay and collect taxes, duties, imposts, and excises
    to pay the debts and provide for the common defense and general welfare
    of the United States.”
    It is significant to point out, however, that this concept is stated in
    broad terms. While affirming the responsibility of Government, it
    1
    2 Department of Health, Education, and Welfare, 1953
    presumes that the specific measures through which application of this
    broad principle would be made would be the responsibility of succeeding
    generations.
    It is significant also to note that the establishment of each of the
    major units of the Department is traceable to specific periods in our
    history when provision for the national welfare emerged as national
    needs.
    The Public Health Service, to take the earliest example, was established
    by Congress in 1798 to care for merchant seamen and help
    keep disease from the shores of the young Republic. As an outgrowth
    of the turbulent years of the Civil War, Congress founded Howard
    University in 1865, when there was a felt national need to establish
    higher education opportunities in an institution which made no distinction
    on admissions because of race, creed, or color. Recognition
    of the importance of formal education in developing well-informed
    and responsible citizens also gave rise to the formation of the Office
    of Education in 1867.
    In 1906 the first Federal Food and Drug Act was passed, acknowledging
    the fact that in an increasingly complex economy, Americans
    were becoming more dependent on manufactured food products and
    means to ensure their safety and purity were needed. In 1912 the
    special importance of the problems of children and youth to the future
    of the Nation was signalized by the creation of the Children’s Bureau.
    In 1935, with overwhelming bi-partisan support, the old-age insurance
    and public assistance programs of the Social Security Administration
    were authorized by the Congress.
    Other significant dates in the history of the Department include:
    the establishment of Saint Elizabeths Hospital for mental illness in
    1855; the founding of the Columbia Institution for the Deaf in 1857;
    the start of Federal support of the American Printing House for the
    Blind in 1879; and the first grants to the States to encourage the vocational
    rehabilitation of physically disabled civilians, in 1920. The Office
    of Vocational Rehabilitation was founded in 1943 to carry on an
    expanded program in the latter field.
    The establishment of the Department of Health, Education, and
    Welfare is, of course, itself an example of response to new needs and
    challenges in our society.
    As the Nation has grown and changed, the Congress has altered
    or expanded the responsibilities of these specialized organizations
    that comprise the Department. The Public Health Service, for
    example, now administers a very great variety of programs. Sometimes
    the original purpose for which these programs were established
    has been virtually eclipsed by the rush of events and the consequent
    process of amendment and improvement by Congress. Certainly their
    The Secretary’s Report 3
    functions and activities will continue to respond to changing circumstances,
    as the will of our people is made known through the Congress.
    Another aspect of the historical development of the programs of
    health, education, and welfare is noteworthy. It is the fact that, by
    and large, the choice of the American people for action in these fields
    has been through what can be described as multiple partnerships
    rather than exclusively through governmental action. The notable
    improvements that have been achieved in public health, in education,
    and in welfare in our history have thus been the result of the efforts, for
    example, of voluntary associations and private philanthropic institutions
    working alone or with local and State governments as well
    as the Federal Government for the general welfare.
    This pattern of action, to which this Department whole-heartedly
    subscribes, is based on traditions of self-reliance and neighborliness
    that are part of the fabric of American life.
    The present administration of the Department assumed responsibility
    on January 20 of 1953.
    Two immediate tasks were undertaken. One was a thoroughgoing
    review of the basic legislation, policies and programs of the Department.
    The second was a comprehensive review of the organization,
    staffing pattern and procedures necessary to carry out the Department’s
    varied programs.
    It was necessary to ask, it was felt, whether the legislation the Department
    was called on to administer was sufficient for the needs of
    the Nation in this decade of the fifties and beyond. Furthermore,
    it was necessary to ask whether the Department was equipped organizationally
    to carry out the programs that had been entrusted to it
    by the Congress.
    To that end initial steps were taken in setting up task forces within
    the Department for each of the major subdivisions to study the programs
    and their administration. These task forces included representatives
    of the Secretary’s Office, the heads of the subdivisions and a
    staff of technicians—some from within the Government itself, others
    from outside Government who were able to bring to the studies objectivity
    and a wealth of experience.
    As a first step toward improved internal administration of the
    Department came the establishment of a Departmental Council. This
    is made up of the heads of the constituent units of the Department and
    members of the Secretary’s immediate staff. It now meets weekly to
    consider questions of importance concerning both the machinery of
    operations and matters of policy.
    A thoroughgoing internal security program was ordered by the
    President for every agency of the Government. A new Director of
    Internal Security was appointed by the Department and regulations
    4 Department of Health, Education, and Welfare, 1953
    were issued to carry out Executive Order 10450, and a staff was recruited
    to see that security measures, which would safeguard both
    the Department and the individuals concerned, were instituted and
    enforced.
    By the close of the year covered in this report considerable progress
    had been made in carrying out the provisions of the Executive Order.
    The reorganization as a result of the establishment of the Department
    during the early months of 1953 had, as additional guiding
    principles, the need for an economy in operations which would be
    brought about without disruption of the many services for which the
    Department is responsible to the American people.
    The opportunity for effecting economies in the departmental budget
    is considerably limited by the fact that the Federal contribution to
    public assistance—that is for cash payments to the needy aged, the
    needy blind, dependent children, and the disabled—is fixed by law.
    Of the total budget for fiscal 1954 of $1,786,528,000 which had been
    recommended by the previous Administration, $1,340,000,000, or 75
    percent, was made up of these “uncontrollable” items.
    It was possible, however, to achieve a sizeable reduction in the onequarter
    of the Department’s budget that represented “controllable”
    expenses. Whereas the previous Administration had requested Congress
    to appropriate $486,000,000 for the 1954 fiscal year (exclusive of
    the public assistance grants-in-aid mentioned above), it was possible
    to reduce this request by slightly more than 13 percent, to $382,000,000.
    The Congress subsequently appropriated $468,691,261 for this “controllable”
    portion of the Department’s budget for the fiscal year 1954.
    Although every constituent of the Department was responsible in some
    measure for the saving achieved, there was no arbitrary cut “across
    the board.” The effective functioning of the Department remains
    unimpaired.
    As a result of these reductions and other measures of economy and
    efficiency, it was possible to bring about the reduction of the number
    of employees of the Department. At the end of the fiscal year the
    staff of the Department numbered 36,739 full-time employees—1,315
    fewer than at the end of the preceding year. Of this decline, 1,192
    separations became effective from March through June 1953. Approximately
    three-fourths of the reduction came as the result of
    normally occurring resignations and retirements. Through close
    scrutiny of vacancies that occurred, with replacements made only in
    instances of clear necessity, it was possible to achieve this reduction
    without hardship to the great majority of the Department’s personnel.
    This reduction was accomplished despite the necessity for initial
    staffing of the new Clinical Center of the Public Health Service.
    When fully manned, this unique research facility itself will account
    for at least 2,000 of the Department’s employees.
    The Secretary’s Report 5
    Although the workload in the old-age and survivors insurance offices
    increased continuously, a decrease was also achieved in the staff of the
    Social Security Administration through instituting more modern
    techniques and procedures.
    Further savings by this method appear possible through the use of
    electronic equipment in keeping the record of earnings of the millions
    of employees in the Old-Age and Survivors Insurance system. As
    an example, one device that is being studied can scan documents electronically
    and automatically prepare punch cards. If it can be utilized—
    and it seems likely that it can be—additional savings will
    amount to about $800,000 a year.
    Personnel of the Department were also encouraged to exercise individual
    initiative in making contributions toward the ends of economy
    and efficiency. During the year, 46 cash awards amounting to $4,850
    were made to employees for outstanding efficiency. Two of these were
    group awards to 22 persons. By the end of the year a saving of
    nearly $68,000 had resulted from the suggestions of these employees.
    In addition, 178 staff members were given salary increases for
    superior accomplishment and 432 cash awards totaling $8,759 were
    made for worthy suggestions by individual employees. The resulting
    improvements in management are estimated at approximately $69,000
    for the first year alone.
    Several important legislative developments during fiscal 1953 are
    noteworthy. They represented largely responses to immediate and
    pressing problems that faced the Department.
    The first was the restoration of the power of inspectors of the Food
    and Drug Administration to inspect factories engaged in the production
    of foods, drugs and cosmetics. Under a ruling of the Supreme
    Court, in which the language of the Act was ruled as insufficiently
    clear, the power of the Food and Drug Administration to conduct
    these inspections was declared unconstitutional. Legislation to close
    this loop-hole in the law was, therefore, recommended to the Congress
    by the President. The measure passed by the Congress was subsequently
    approved on August 7, 1953.
    The second was legislation providing for continuing the program
    of Federal assistance to the States for construction and for operation
    of schools in areas in which the influx of workers to man Federal
    installations, largely of a defense nature, had placed inordinate strain
    on local school facilities. Legislation recommended by the President
    was passed which extended this aid through June 30, 1955 for school
    construction and through June 30, 1956 for school support.
    Between the date of the institution of this program in 1950 and
    the close of the fiscal year, the Office of Education approved construction.
    of 1,330 school building projects, located in 44 States, Hawaii,
    6 Department of Health, Education, and Welfare, 1953
    Alaska, and Puerto Rico. New classrooms added, according to the
    Office of Education, will house 350,000 children.
    The third development—although it did not result in actual legislative
    proposals until after the close of the fiscal year—was an intensive
    study to carry out the recommendation of the President in
    his State of the Union Message, for prompt extension of the old-age
    and survivors insurance program to include many millions of Americans
    not covered under existing law. As an initial step, the Secretary
    sought the advice of a group of consultants on social security
    with wide experience in the fields of banking, insurance, education,
    social work, farm and labor organizations, and industry.1
    This group devoted the spring of 1953 to a careful study of a number
    of possible ways in which old-age and survivors insurance coverage
    could be extended to additional workers. Their recommendations
    were contained in a report transmitted to the Secretary near the close
    of the fiscal year.2 Subsequently, at the request of the President,
    the views of the consultants were embodied in a bill submitted to
    the Congress shortly after the close of the fiscal year.
    An important milestone in national progress in medical research
    was passed with the completion of the Clinical Center at the Public
    Health Service’s National Institutes of Health. It was constructed
    to serve as a center of cooperation between the clinician—the bedside
    physician—and the laboratory investigator.
    The Clinical Center is in fact a combined hospital-laboratory to
    serve physicians and patients throughout the Nation and to forward
    research in cancer, mental illness, arthritis, heart disease, and other
    chronic illnesses. With facilities for 500 patients—who will be admitted
    from all parts of the country on the basis of the significance
    of their illness to the Nation as a whole, the Center offers promise
    of new knowledge that can be turned to the early prevention and
    control of the most hazardous and least understood diseases that attack
    the people of the Nation.
    The Center was dedicated by the Secretary on July 2, 1953, 2 days
    after the close of the fiscal year, and admitted its first patients 4 days
    later.
    1 Reinhard A. Hohaus, New York, N. Y., Vice President and Chief Actuary, Metropolitan
    Life Insurance Company, Chairman ; Thomas H. Beacom, Chicago, Ill., Vice President in
    Charge of Trusts, First National Bank of Chicago; Eveline M. Burns, New York, N. Y.,
    Economist and Professor of Social Work, New York School of Social Work, Columbia
    University; Robert P. Burroughs, Manchester, N. H., President and Treasurer of R. P.
    Burroughs Company, Pension and Profit Sharing Plans; Leonard J. Calhoun, Washington,
    D. C., Attorney-at-law; Nelson H. Cruikshank, Washington, D. C., Director of Social Insurance
    Activities, American Federation of Labor; Wallis B. Dunckel, New York, N. Y., Vice
    President, Bankers Trust Company; Loula Dunn, Chicago, Ill., Director, American Public
    Welfare Association; Katherine Ellickson, Washington, D. C., Secretary, Social Security
    Committee, Congress of Industrial Organizations; Hugh F. Hall, Washington, D. C., American
    Farm Bureau FederationLloyd C. Halvorson, Washington, D. C., The National
    Grange; and A. D. Marshall, Schenectady, N. Y., Manager of Employee Benefits, General
    Electric Company.
    a For a delineation of the recommendations, see pp. 14-29, “Old-Age and Survivors
    Insurance.’’
    The Secretary’s Report 7
    As is indicated in the report of the Public Health Service one of
    the outstanding achievements of the country during the last half
    century has been the lengthening of the life span from 47.3 to 68.5
    years. The inevitable result has been a consistent expansion of the
    number and proportion of older people in our population. While the
    population of the country has doubled within the past 50 years, the
    number of men and women between the ages of 45 and 65 has trebled.
    The number who are 65 or older has quadrupled; and today there are
    approximately 13.5 million men and women who are beyond 65.
    To study, report on, and work with the States on matters associated
    with the problem, the Department maintains, in the Office of the
    Secretary, a Committee on Aging and Geriatrics. In addition to
    developing and disseminating information, the Committee seeks to
    aid in stimulating the development of public and private services for
    older people.
    During the year, for example, a conference of State commissions
    and committees on the aging was held. Delegates from 15 State agencies
    took part officially and the Governors of 18 other States sent
    observers to the conference.
    Another Departmental responsibility which should be mentioned
    concerns the use of surplus property belonging to the Federal Government.
    The various laws relating to the disposal of such property assign
    three major responsibilities to this Department. They are: allocation
    of surplus personal property to the States for distribution to educational
    and public health institutions; arrangements for the disposal
    of surplus real property for education and public health purposes;
    and protecting the Federal interest by ensuring that surplus property
    that is supplied to the States is properly used and may be recovered for
    use during national emergencies.
    During fiscal 1953, surplus personal property with an original acquisition
    value of $63 million was allocated to State agencies for
    distribution. New transfers of real property were made to 105 such
    institutions which acquired 233 buildings and 369 acres of land valued
    at almost $2.9 million.
    The surplus property program of the Department also supervised
    the return of real property valued at $50 million that had previously
    been transferred to the States for educational or public health use.
    Since the properties were required for permanent Federal use, re vestment
    of title in the Federal Government was obtained in the amount
    of $20 million.
    Machine tools previously donated to educational institutions were
    returned to defense production at savings of $4.5 million. Other
    general items of personal property, costing $2 million, were returned
    from institutions and placed in defense use. The Department of
    8 Department of Health, Education, and Welfare, 1953
    Defense was also notified of the availability of electronic equipment
    valued at almost $2.5 million. In the course of these activities, cash
    receipts totaling $1.8 million were deposited with the Treasurer of
    the United States.
    One of the duties of the Department is to assist the Department
    of State when an expert knowledge of the fields of health, education,
    or welfare is required in the development of the foreign policy of the
    United States. The Department is also a participant in the day-to-day
    work of the United Nations; in the bilateral programs of foreign
    technical assistance and exchange of persons supervised by the Department
    of State; and in the programs of the Foreign Operations
    Administration in health, education, and welfare.
    For the Secretary of State, the Department drafts “position papers”
    in the fields of its special competence, to serve as guide lines in determinin^
    the official attitude of our Government regarding these matters.
    Senior officials of the Department frequently are appointed by the
    President to represent the United States at important meetings of
    international organizations, while others serve in an expert capacity
    on technical committees of the United Nations, its specialized agencies,
    and various regional international organizations.
    The Department cooperates in developing the health, education,
    and welfare aspects of the technical assistance programs in 34 of the
    free nations to which the United States is extending foreign aid. To
    this end, 426 technicians were recruited during the year for foreign
    assignments. Through its appropriate constituents, the Department
    also supervised the programs of approximately 205 United Nations
    Fellows who were sent to the United States for study and training
    during the fiscal year. All told, approximately 3,500 foreign visitors
    received training planned and supervised by the Department.
    The foregoing pages have consisted of a description of certain highlights
    in the work of the Department during fiscal year 1953. The
    following pages contain the reports of the major sub-divisions and
    other institutions over which the Department exercises either direct
    supervision or has responsibilities in connection with their administration.
    Taken together, they represent a report, reasonably detailed, of the
    the work of the Federal Government as authorized by the Congress
    in the important fields of health, education, and welfare.
    Their continuing objective, in essence, is the great and humane task
    of helping the American people help themselves toward a healthier,
    increasingly more enlightened, and more secure world for themselves
    and, in this measure, for mankind.
    Social Security
    Administration
    Social Security in 1953
    During the past year the social security program has continued to
    grow and to provide protection and benefits to increasing numbers of
    people. Early in his administration, President Eisenhower reaffirmed
    his belief in the value and general acceptance of contributory social
    insurance as the basic program through which the people of this
    country can together provide for their own retirement income and the
    support of their dependents. The Social Security Administration has
    continued to review the operations of the existing social security programs
    and to appraise the effectiveness with which they are achieving
    their goal.
    Old-age and survivors insurance has, from the beginning, been recognized
    as the basic income-maintenance program for aged persons and
    for orphans and their widowed mothers. Because it provides only for
    those who have had an opportunity to work in covered employment,
    and because, up to the present time, coverage has not extended to all
    employments, the program has only gradually begun to reveal its full
    potential effect.
    The number of persons receiving old-age and survivors insurance
    benefits has increased from fewer than 250,000 at the end of 1940, the
    year benefits first became payable, to about 5.6 million in June 1953.
    Of these, 1.3 million were children and their mothers. Since 1944 the
    number of orphans receiving survivor insurance benefits has been
    larger than the number receiving public assistance through the program
    for aid to dependent children. Life insurance protection under
    the old-age and survivors insurance program is acquired after a relatively
    short period (a year and a half) in covered employment. This
    293171—54------2 9
    10 Department of Health, Education, and Welfare, 1953
    part of the program, therefore, very quickly became effective for
    workers in the industries covered.
    Except for workers already close to or past age 65 at the time the
    program was started (or when coverage became effective for additional
    employments at the beginning of 1951), the eligibility requirements
    for old-age benefits call for substantial periods of covered employment
    and contributions. Many persons still living had already
    retired when the program began or had depended on the earnings of
    persons already out of the labor force. The number of aged persons
    receiving old-age and survivors insurance benefits first exceeded the
    number on old-age assistance in February 1951. Since that time the
    insurance program has continued to grow, and the number receiving
    old-age assistance has declined slightly. As a result, by June 1953, 32
    percent of the aged population were being supported wholly or partly
    by old-age and survivors insurance while less than 20 percent were
    receiving assistance. About 3 percent were getting both insurance
    benefits and supplementary assistance payments.
    Chart 1.—WHERE AGED PERSONS GET THEIR CASH INCOME
    Percent of persons 65 years and over with income from specified sources,1 December 1952
    1 Some get income from more than one source; 4.5 percent also get income from private pension plans.
    2 Includes wives of employed persons.
    8 Includes railroad retirement, government employee retirement, and veterans compensation and pension
    programs.
    4 Represents persons with income from investments and/or cash income from children and other
    relatives, and those with no cash income at all.
    Social Security Administration 11
    Thus, the old-age and survivors insurance program is taking its
    intended place as the basic source of income for retired persons and
    their families and for orphaned children and their widowed mothers.
    It is of interest also that by June 1953 the number of persons drawing
    old-age and survivors insurance benefits (5.6 million) was larger than
    the number (5.3 million) receiving public assistance under the four
    federally aided public assistance programs—old-age assistance, aid to
    dependent children, aid to the blind, and aid to the permanently and
    totally disabled—and the State and local programs of general assistance.
    In addition, something over 1 million aged persons and close to
    1 million widows under age 65 and orphans receive benefits under the
    special programs for railroad workers, for Federal, State, and local
    government employees, and for veterans. About 250,000 persons who
    are permanently and totally disabled receive insurance benefits from
    the railroad or Federal, State, and local government employee retirement
    systems—compared with 179,000 persons who now receive assistance
    under the aid to the permanently and totally disabled program.
    A few groups, notably farmers and certain self-employed persons,
    are still without social insurance protection. The Social Security
    Administration has for a number of years recommended that old-age
    and survivors insurance coverage be made universal. A group of
    consultants appointed by the Secretary of Health, Education, and
    Welfare in the spring of 1953 reviewed the question and recommended
    immediate extension of coverage to practically all employment except
    that of railroad workers, now covered by a coordinated system, and
    employees of the Federal Government under existing retirement systems.
    The consultants deferred consideration of coverage for these
    two groups because special studies of their retirement protection were
    initiated in the preceding year by Congress. The recommendations of
    the consultants are described in the chapter on old-age and survivors
    insurance.
    There are various circumstances in which the community must come
    to the aid of families who are in difficulties that are beyond their
    control—circumstances not sufficiently widespread or predictable to
    be appropriately met through the insurance method. Need resulting
    from broken homes and deserting parents now brings more children
    to the aid to dependent children rolls than does the death of the
    breadwinner. During the past year the Social Security Administration
    has continued, through its Bureau of Public Assistance and the
    Children’s Bureau and with the State agencies which administer the
    programs, to work toward the more adequate relief of children and
    families that are in need of income or other help, and toward the
    more effective provision of health and welfare services that lay a
    sound foundation for wholesome development of children.
    12 Department of Health, Education, and Welfare, 1953
    Juvenile delinquency, commonly one of the consequences of war and
    of persistent adult fears and tensions, has received special attention
    from many groups during the past year. The efforts which have been
    made by the Social Security Administration to study the problem
    and to bring together the many social, educational, legal, civic, and
    parental groups with a special concern and interest in it are described
    in the chapter on the special children’s programs.
    Federal credit unions again took several strides forward. During
    the year under review, the number of Federal credit unions in existence,
    their membership, and their total assets reached new high levels.
    The Bureau of Federal Credit Unions is now on a completely selfsustaining
    basis, deriving its operating income from the services of
    supervision and examination which it provides to individual credit
    unions.
    Program Administration in 1953
    On April 11 the Department of Health, Education, and Welfare
    came into being, with all the functions formerly carried by the Federal
    Security Agency. The legislation establishing the Department made
    no change in the responsibilities and functions of the Social Security
    Administration, but it abolished the position of Commissioner for
    Social Security, providing that henceforth a Commissioner of Social
    Security should be appointed by the President with the advice and
    consent of the Senate.
    With the termination on April 10 of his appointment as Commissioner
    for Social Security, Arthur J. Altmeyer completed nearly 18
    years of service with the Social Security Administration. Appointed
    one of the three members of the Social Security Board in August 1935,
    he was Chairman of the Board from February 1937 to July 1946,
    when he was appointed Commissioner for Social Security in the Social
    Security Administration, which superseded the Board. On Mr. Altmeyer’s
    retirement, William L. Mitchell, Deputy Commissioner since
    1946, became Acting Commissioner.
    Other administrative changes daring the fiscal year included the
    resignation, on May 8, of Oscar C. Pogge as Director of the Bureau of
    Old-Age and Survivors Insurance and the retirement on June 14 of
    Claude R. Orchard, Director of the Bureau of Federal Credit Unions.
    On June 15, J. Deane Gannon was appointed Director of the Bureau
    of Federal Credit Unions.
    During the fiscal year, all bureaus and offices of the Social Security
    Administration continued their efforts to improve procedures and organizational
    structure in order to maintain a high level of efficiency
    in carrying increasing workloads. At the end of June the staff totaled
    14,623, of whom 5,602 were departmental and 9,021 were in field, area,
    Social Security Administration 13
    and regional offices. The departmental staff had 473 fewer persons
    than at the end of the 1952 fiscal year. This drop occurred almost
    entirely in the Bureau of Old-Age and Survivors Insurance and had
    to be absorbed at a time when the volume of claims to be processed
    for benefits was about twice the normal level. To maintain effective
    operations in the 512 field and 6 area offices, where claims for benefits
    are received and much of the work of determining claimant eligibility
    and benefit amount is carried on, the staff was increased by 282 during
    the year.
    Progress was especially gratifying during the year in extending
    the “team” approach developed so successfully by the Bureau of
    Public Assistance and the Office of Vocational Rehabilitation when
    the program of aid to the totally and permanently disabled went into
    operation in 1950. Several conferences were held in different parts of
    the country during the year to coordinate the services of related State
    agencies in the rehabilitative aspects of aid to the disabled.
    In its international activities the Social Security Administration
    shares with other countries its experience and knowledge in the fields
    of social insurance and social welfare and in return gains valuable
    knowledge and insight from the two-way interchange. Experts and
    visitors who come to this country under United Nations or United
    States auspices are referred to the Administration for guidance in
    planning and carrying out their technical training in the social
    security field. The Administration also recruits technicians from its
    own staff and from other agencies for special overseas assignments in
    social welfare projects, at the request of foreign governments and in
    cooperation with the United States technical assistance program concerned.
    During the fiscal year, training programs were planned for almost
    1,000 experts and visitors from other countries. Some 60 were longterm
    trainees (here for periods ranging from 6 months to 2 years)
    sponsored by the United Nations and the World Health Organization.
    The long-term trainees under United States auspices included 43 who
    were sponsored by the Point Four program and by the Mutual Security
    Agency. In addition, many short-term visitors are referred or
    come to the Social Security Administration for periods ranging from
    a week to several months. Their major interests include various
    aspects of social insurance, public assistance, or child health and welfare
    services, social work education, and in-service training.
    Through the Point Four program, 24 technical experts from the
    Administration and four recruited from other agencies were working
    overseas on projects administered or contracted for by the Technical
    Cooperation Administration. Thirteen specialists were assigned
    to projects in Latin America, nine were in Egypt, Iraq, or Lebanon,
    three were in India, and one in Pakistan.
    14 Department of Health, Education, and Welfare, 1953
    Old-Age and Survivors Insurance
    In the President’s message of April 1, 1953, transmitting to the
    Congress his recommendations for extension of old-age and survivors
    insurance coverage to additional workers, he said: “Retirement systems,
    by which individuals contribute to their own security according
    to their own respective abilities, have become an essential part of our
    economic and social life. These systems are but a reflection of the
    American heritage of sturdy self-reliance which has made our country
    strong and kept it free . . . The Social Security program furnishes,
    on a national scale, the opportunity for our citizens, through that
    same self-reliance, to build the foundation for their security . . . The
    systematic practice of setting aside funds during the productive years
    to build the assurance of basic retirement benefits when the productive
    years are over—or to one’s survivors in the event of death—is
    important to the strength of our traditions and our economy. We
    must not only preserve this systematic practice, but extend it at every
    desirable opportunity.”
    Under old-age and survivors insurance the covered worker earns
    security as he works, just as he earns his wages. Through the payment
    of old-age and survivors insurance taxes, the worker shares
    directly in meeting the cost of the protection furnished to himself
    and his family. Because benefit payments vary according to the
    individual’s record of earnings and of contributions, they are—in a
    country where earnings and standards of living vary widely as between
    individuals—a more meaningful and effective foundation of security
    than they could be if they were a flat amount and supported by a flat
    contribution.
    The individual who has earned the right to protection under the
    insurance program through covered work receives his benefits, on retirement,
    without regard to other resources he may have. In this way
    the program provides a foundation of security on which the person
    may build through the addition of income from private savings and
    insurance. In building upon his old-age and survivors insurance
    benefits, he earns for himself and his family a higher standard of
    living. Thus, his thrift, his planning, and his work bear fruit after
    as well as before his earnings cease.
    The Social Security Administration believes that the contributory
    system of old-age and survivors insurance, with benefits related to
    earnings and paid as a matter of right, should continue to be the
    basic method of protecting American workers and their families
    against dependency in old age or on account of death.
    Social Security Administration 15
    The Significance of the Program
    BENEFICIARIES AND BENEFIT AMOUNTS
    In June 1953 about 5.6 million people were receiving benefits under
    the program. Some 4.3 million of these beneficiaries were aged 65
    and over—3.0 million of them retired workers and 1.3 million the
    wives and dependent husbands of retired workers and the widows,
    dependent widowers, and dependent parents of workers who had died.
    Of the remaining 1.3 million, some 300,000 were young widows and a
    million were children.
    Chart 2.—WHO RECEIVED OLD-AGE AND SURVIVORS INSURANCE BENEFITS, JUNE 1953
    Chart 3.—AVERAGE MONTHLY FAMILY BENEFITS, JUNE 1953
    16 Department of Health, Education, and Welfare, 1953
    In June 1953, the average insurance benefit paid to a retired worker
    who had no dependents also receiving benefits was $48.20 a month.
    When the worker and his wife both received benefits, the average for
    the family was $83.60. Families consisting of a widowed mother and
    two children averaged $108.80.
    These figures reflect only partially the generally higher benefit
    amounts payable under the 1950 and 1952 amendments in cases in which
    the worker has had at least 6 quarters of coverage (roughly 18 months
    of covered work) after 1950. Benefits computed under the new formula
    applicable in such cases averaged $63.10 a month for a retired
    worker with no dependents receiving benefits, $104.30 for a retired
    worker and wife, and $152.40 for families consisting of a widowed
    mother and two children. Twenty-nine percent of all retired men
    on the benefit rolls whose benefits have been computed under the new
    formula are receiving benefits at the maximum amount of $85 a month.
    THE PROTECTION PROVIDED
    Some 90 million people living on January 1, 1953, had worked in
    covered employment and made contributions under the program at
    one time or another during the first 16 years of its existence. About
    three out of four had enough wage credits to be fully insured under
    the program; for one out of four the insurance protection was
    permanent.
    Of the 13.3 million people aged 65 or over in the United States in
    December 1952, 4.1 million were working or married to men who were
    working. Probably 1.9 million of them can now count on receiving
    monthly benefits under old-age and survivors insurance when their
    income from work stops. Of the population under 65 years of age,
    62 million were insured under the program at the beginning of the
    calendar year 1953. Some 21 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 41 million
    were insured but would have to continue in covered work for an additional
    period to make their insured status permanent. Four out of
    five 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.
    THE COVERAGE OF THE PROGRAM
    During the calendar year 1953 an estimated 62 million persons will
    work in employment or self-employment covered by old-age and survivors
    insurance and will earn credits toward their insurance protection.
    At the end of the 1953 fiscal year, about 80 percent of the
    Nation’s paid civilian jobs were covered by the program. An addiSocial
    Security Administration 17
    tional 7 percent were covered by retirement systems of Federal, State,
    and local governments. About 13 percent of the Nation’s gainful
    workers—most of them farmers, self-employed professional people, or
    farm or domestic workers who are not regularly employed by a single
    employer—have no coverage under any public program. Members
    of the Armed Forces are not covered by old-age and survivors insurance,
    but Congress has enacted legislation granting wage credits of
    $160 for each month of active military service during the period after
    September 15,1940, and before July 1,1955.
    CONTRIBUTIONS AND DISBURSEMENTS
    Benefit payments during the fiscal year amounted to $2,627 million;
    with administrative expenses of $89 million, the total outgo amounted
    to $2,717 million. Contributions totaled $4,097 million, and interest
    received on investments was $387 million, bringing total receipts to
    $4,483 million. The difference of $1,766 million represents the increase
    in the trust fund during the year. At the end of June 1953, the fund
    totaled $18.4 billion held and invested for the benefit of the contributors
    to the program.
    Chart 4.—THE OLD-AGE AND SURVIVORS INSURANCE DOLLAR
    Distribution of income to the trust fund, fiscal year 1953
    On June 30, all assets of the fund, except $549 million held in cash,
    were invested in United States Government securities as required by
    law; $2.3 billion was invested in public issues (identical with similar
    bonds owned by private investors), and $15.5 billion was invested in
    special certificates of indebtedness bearing interest at the average rate
    paid on the total interest-bearing Federal debt at the time they are
    18 Department of Health, Education, and Welfare, 1953
    issued. The average interest rate on all investments of the trust fund
    at the end of the fiscal year was about 2.4 percent.
    ADMINISTERING THE PROGRAM
    Although the budget for the fiscal year 1953 was curtailed, the workload
    of the Bureau of Old-Age and Survivors Insurance increased 17
    percent over that in the fiscal year 1952; the claims load was at a level
    some 39 percent above the 1952 load. A sharp increase in the volume
    of claims received occurred immediately after July 1, 1952. Potential
    claimants who could have filed earlier had delayed filing until that
    date to take full advantage of the new computation formula provided
    by the 1950 amendments. July and August were crucial months.
    Peak weekly claims were very close to the record highs established in
    September 1950 immediately after the 1950 amendments were enacted.
    Another critical situation developed when changes had to be made
    in the payment rate of approximately 4.6 million beneficiaries receiving
    monthly benefits, to put into effect the increases provided in the
    1952 amendments. This had to be accomplished between July 18,
    when the amendments were enacted, and the date the benefit checks
    for September were issued. The work was completed on schedule by
    detailing personnel from other jobs, working overtime, and utilizing
    machine methods to the maximum. The systematic approach employed
    enabled the Bureau’s area offices to keep reasonably current in
    their regular operations while completing the conversion to new rates.
    The regular fiscal year appropriation of $60,500,000 was insufficient
    for the workload resulting from the combined effects of the 1950 and
    1952 amendments. The Bureau accordingly submitted a request for
    a supplemental appropriation. Pending congressional action on this
    request, the Bureau was authorized to spend at the annual rate of
    $64.5 million. In the second half of the fiscal year, Congress voted only
    $2 million of the Bureau’s supplemental request of $4.4 million. Since
    spending had been at an accelerated rate, immediate action was necessary
    to reduce expenditures to an absolute minimum. All overtime
    authorizations were cancelled, recruitment was stopped, and drastic
    curtailments were made in expenditures for items other than salaries.
    The necessity for these cut-backs came at a time when the pending
    claims load in field offices was exceptionally high. Normally the pending
    claims load is about 65,000, but by the end of January it was at
    143,700, and emergency measures were required to keep the backlog of
    work from increasing. By June 30,1953, the pending claims load was
    reduced to 92,000. This reduction, however, was achieved only at some
    sacrifice of quality and service to the public, by the temporary elimination
    or curtailment of essential functions and expenditures, and
    through voluntary, unpaid overtime.
    Social Security Administration 19
    Administrative costs in the fiscal year 1953, including costs incurred
    by the Treasury Department for the collection of social security taxes,
    were approximately $90 million, or 2.2 cents out of each dollar of contributions
    collected. Costs within the Department of Health, Education,
    and Welfare were approximately $66 million, or 1.6 cents out of
    each dollar of contributions.
    MANAGEMENT IMPROVEMENT ACTIONS
    One of the noteworthy aspects of the Bureau’s management
    improvement efforts during the year was the degree to which savings
    were the result of cooperative action with other agencies. For
    example, a plan was adopted by the General Services Administration
    and the Bureau to transfer a portion of the inactive claims records to
    the Federal Records Centers operated by the General Services Administration.
    The initial transfer of these records resulted in a saving
    of approximately $100,000; an additional transfer to be completed in
    the coming year will save an estimated $210,000; and annual savings
    are estimated at $34,000 per year after 1955.
    As a second example, methods were worked out with the Veterans
    Administration to use its files in developing old-age and survivors
    insurance claims filed by Philippine citizens, after a study had revealed
    that more than 90 percent of these claimants had already filed claims
    with the Veterans Administration. The use of these files not only
    permitted maximum economy and prevented duplication of work on
    the part of both the claimant and the Bureau, but also ensured greater
    accuracy by enabling the Bureau to use the results obtained by the
    substantial investigatory staff maintained by the Veterans Administration
    in the Philippines.
    Perhaps the management improvement action of greatest potential
    scope was contained in a proposal made by the Internal Revenue
    Service of the Treasury Department to integrate old-age and survivors
    insurance wage reporting with annual reporting of withholding taxes.
    This proposal, which contains significant possibilities for savings to
    the Government and to employers, as well as improvements in the
    enforcement of tax legislation, is being carefully studied by the
    Internal Revenue Service and the Bureau of Old-Age and Survivors
    Insurance. Legislation changing certain provisions of law would be
    necessary before the plan could be put into effect.
    The Bureau’s wage record operation has also furnished additional
    areas for administrative simplifications and economies. Last year’s
    report cited the plan for a new wage record certification procedure
    that would reduce to a minimum detailed checking of wage records
    back to 1936. This procedure was installed early in 1953 with excellent
    results. Recent analysis indicates that the procedure has reduced
    20 Department of Health, Education, and Welfare, 1953
    by approximately 30 percent the cases where detailed checking of the
    wage record is necessary for information on earnings from 1936
    to date.
    Research into the use of electronics in the Bureau’s wage record and
    statistical operations has been still another activity which is expected
    to yield large long-range savings. Possibilities of adaptation to the
    Bureau’s needs of a device which will scan printed material electronically
    and will automatically prepare punch cards from such material
    are being vigorously explored. If such a device can be perfected and
    installed to take the place of manual punching operations, it will eliminate
    a significant portion of the costs now involved in processing
    reports of employee earnings. In addition, tests are being run on the
    Bureau of Census electronic machine to determine the feasibility of
    carrying on some of the Bureau of Old-Age and Survivors Insurance
    statistical operations by electronic methods. The Bureau is also exploring
    the longer-run possibilities of high speed “random access”
    files using electronic storage media. The development of such files
    would make it possible to carry on the major part of the Bureau’s
    record operations with electronic rather than punch card equipment,
    with the possibility of annual savings running as high as several million
    dollars.
    The development of personnel and the maximum use of their
    capacities continues as a major management objective. The grouping
    of positions into “job families” to facilitate the movement of employees
    among positions throughout the Bureau was cited in last year’s
    report. During the 1953 fiscal year, additional job families were
    developed and this work was supplemented by the preparation of the
    first portion of a Job Information Handbook. This Handbook will
    contain detailed job information designed to acquaint Bureau employees
    with the facts about Bureau jobs so that they can make the
    most of career opportunities in the Bureau, with maximum contributions
    to the program.
    The Senate Subcommittee on Federal Manpower Policies in its
    report on S. 3493, a bill to “provide greater economy in the use of
    manpower, money, and materials by the development of more effective
    methods for selecting supervisory personnel in the Government
    service,” gave special commendation to one of the Bureau’s divisions
    for its planned program for selecting supervisors.
    Congress has appropriated funds to prepare for “construction of
    an office building and appurtenant facilities for the Bureau of Old-
    Age and Survivors Insurance, including equipment, acquisition of
    land (including donations thereof), and preparation of plans and
    specifications.” At present the Bureau occupies more than 600,000
    square feet of space, at an annual rental of over $700,000 in nine scatSocial
    Security Administration 21
    tered buildings, seven in Baltimore and two in Pennsylvania. Construction
    of the new building will result in savings and improved
    efficiency through making possible the elimination of doubleshift
    operations, double-deck files, work transportation and communication
    difficulties, and costly work layouts forced by restrictive, widely separated
    and inadequate space.
    ADMINISTRATIVE PLANNING FOR THE DISABILITY WAIVER-OF-PREMIUM
    PROVISION
    The Social Security Amendments of 1952, enacted July 18, 1952,
    included a provision to preserve the old-age and survivors insurance
    rights of persons who become permanently and totally disabled before
    reaching retirement age. The provision stipulated that applications
    for disability determinations could not be accepted before July 1,1953,
    and further that the amendment would cease to be in effect at the
    close of June 30, 1953. The statement of the Managers on the part of
    the House of Representatives contained the following explanation:
    The action recommended by the conferees will permit appropriate steps to be
    taken for the working out of tentative agreements with the States for possible
    administration of these provisions. It is the intent of the conferees that hearings
    will be held on this entire matter early in 1953 and at that time the congressional
    committees will go into the administrative and other provisions. It
    is intended to obtain the views at that time of interested groups on the methods
    of obtaining evidence of disability, under what circumstances and by whom
    determinations should be made, and whether or not these provisions or any
    modification thereof should be enacted into permanent law.
    Since Congress took no further action in this matter, the amendment
    expired at the close of the fiscal year.
    The provisions of this amendment would have authorized the Federal
    Security Administrator to negotiate an agreement with each
    State, under which a State agency would determine whether or not
    individuals are under a disability as defined in the law and the date
    such disability began or ceased.
    Before it became clear that the amendment would expire, the Social
    Security Administration was under the obligation to conduct preliminary
    explorations based on the possibility that hearings might be held
    on the provisions for entering into agreements with the States to make
    disability determinations. Accordingly, policies and methods for
    evaluating permanent and total disabilities were outlined which would
    be suitable for this type of program and acceptable to the States.
    Tentative standards were developed for measuring disability, as
    defined in the amendment, and methods for requesting and receiving
    decisions on claims were explored with several States. The Social
    Security Administration obtained the advice of technical consultants
    from a number of State agencies on the administrative problems that
    22 Department of Health, Education, and Welfare, 1953
    would be involved in the type of Federal-State agreements called for
    under the terms of the tentative law. These consultants were experienced
    in administering one or another of the three types of State disability
    programs with which agreements might have been made: public
    assistance to the permanently and totally disabled, workmen’s compensation,
    and vocational rehabilitation. A substantial body of standards
    and methods was produced and significant problem areas
    requiring possible legislative clarification were identified.
    Improving the Program
    While the basic characteristics of old-age and survivors insurance
    are sound, the program does have defects and gaps that need to be
    corrected. In order to ensure that proposals to correct these deficiencies
    would be carefully developed, a thorough and intensive review
    of the program was undertaken in the second half of the fiscal year.
    Much progress has already been made in the development of proposals
    for improving the program. The problem of what groups the program
    should cover, for example, was thoroughly explored, and specific
    legislative proposals for extending the coverage were presented to
    Congress shortly after the close of the fiscal year. Other problem
    areas are in process of exploration and legislative proposals in these
    areas are being developed.
    COVERAGE
    In the President’s Message on the State of the Union, he recommended
    that “the provisions of the old-age and survivors insurance
    law should promptly be extended to cover millions of citizens who
    have been left out of the social security system.” As a first step toward
    carrying out this recommendation, the Secretary of Health, Education,
    and Welfare appointed a group of consultants on social security.
    The group included persons with a wide variety of experience in the
    fields of banking, insurance, education, social work, farm and labor
    organizations and industry. Under the chairmanship of Reinhard A.
    Hohaus, Vice President and Chief Actuary of the Metropolitan Life
    Insurance Company, the group devoted the spring of 1953 to a careful
    consideration of various alternative proposals for extending old-age
    and survivors insurance coverage to additional groups of current
    workers. The recommendations of the group were contained in a
    report transmitted to the Secretary on June 24,1953, and provisions to
    carry out the recommendations were subsequently embodied in proposed
    legislation.
    Enactment of these recommendations would go a long way toward
    making old-age and survivors insurance a more effective retirement
    Social Security Administration 23
    program for all of the Nation’s gainfully employed workers. The
    coverage of the program would be extended to some 10 million additional
    persons, who in the course of a year work in jobs not now covered,
    and an over-all improvement would be made in the method of
    computing benefits, which would have the result, among others, that
    individuals in the newly covered groups would be able to qualify for
    full benefits.
    One of the largest groups which would be brought into old-age
    and survivors insurance is that of the Nation’s farm operators. About
    3 million self-employed farm operators with annual net incomes of
    $400 and over would be covered by old-age and survivors insurance on
    essentially the same basis as most persons in urban self-employment
    are now covered.
    Additional hired farm workers would also be brought into the
    program. Under present law a farm worker, to be covered, must be
    “regularly employed” by one employer and receive cash wages of $50
    or more in a calendar quarter from that employer. Under this provision,
    in general, a farm worker who has worked for one employer
    continuously for an entire calendar quarter is covered in succeeding
    quarters if he works full time for that employer on at least 60 days
    during the quarter and is paid at least $50 in cash. Only about 15
    percent of all hired farm workers and 70 percent of the persons whose
    major job is farm work meet these requirements. The recommendations
    would change this provision to a simple cash wage test; all hired
    farm workers who are paid $50 in cash by an employer in a calendar
    quarter would be covered. Under this cash wage test, about 70 percent
    of all persons employed as hired farm workers during a year would
    be covered, including practically all whose major activitiy is farm
    work for hire.
    Domestic workers in private homes also must meet a restrictive
    test of regularity of employment to be covered under present law.
    Only those household workers are covered who work for a single employer
    on each of 24 days during a calendar quarter and are paid
    at least $50 in cash in the quarter. In general, a household worker
    must work regularly for an employer on at least 2 days a week to
    be covered. The day test is an unnecessary complication that excludes
    many workers from coverage and gives others coverage for part but
    not all of their domestic work. The test would be eliminated by the
    recommendations so that all domestic workers who are paid $50 in cash
    by an employer in a calendar quarter would be covered. This provision
    would extend coverage to between 100,000 and 200,000 workers
    in addition to those covered under present law.
    Another sizable group excluded from old-age and survivors insurance
    at present are the 500,000 or so self-employed people in certain
    24 Department of Health, Education, and Welfare, 1953
    specified professions. It is recommended that coverage be extended
    to these persons on the same basis as that for the other nonfarm selfemployed
    who are now covered.
    On the basis of their study of the coverage provisions of old-age
    and survivors insurance the consultants also proposed the removal of
    limitations on the coverage of several comparatively small groups of
    workers, including internes in hospitals, certain employees in the fishing
    industry, and certain American seamen and airmen.
    More than 4 million persons during the course of a year are employed
    in positions covered by retirement systems of State and local
    governments. Under the present law an employee in a position
    covered by a retirement system on the date when the group to which
    he belongs is brought into the old-age and survivors insurance program
    cannot be covered by that program.
    Most retirement systems of State and local governments do not
    provide adequate survivor protection. Furthermore, since the systems
    were designed chiefly for the person whose career is spent under the
    system, those who leave the service before retirement usually lose their
    retirement protection. Persons who shift from other employment to
    State and local government employment are in much the same position
    because they often lose all or part of their protection under
    old-age and survivors insurance. Extension of old-age and survivors
    insurance to this employment would fill these gaps in present protection.
    The option of coverage under Federal-State agreements is recommended
    for employees in positions covered by State and local
    government retirement systems.
    Special provisions of the present law permit coverage of lay employees
    of religious, educational, and similar nonprofit organizations
    at the option of the employees and the employing organization. Since
    the adoption of these provisions in 1950, it has become apparent that
    many church groups now want the opportunity of electing coverage for
    ministers on a similar basis. A change in the law to provide such
    opportunity is recommended. If these recommendations are enacted
    in the next session of Congress, approximately 90 percent of all paid
    civilian jobs will be covered by old-age and survivors insurance, either
    actually or, in the case of employment for nonprofit organizations or
    State and local governments, potentially. Of the 10 percent that would
    still remain excluded, roughly two-thirds would be those of persons
    in the employ of the Federal Government, including both civilian and
    military service. Thus old-age and survivors insurance would be
    established as the basic retirement protection for practically all except
    F ederal employment.
    The consultants on social security did not consider extension of
    coverage to Federal employees because that question is currently beSocial
    Security Administration 25
    ing studied by a Committee on Retirement Policy for Federal Personnel,
    established by Public Law 555, Eighty-second Congress, and
    consisting of the Secretary of the Treasury, the Secretary of Defense,
    the Chairman of the Board of Governors of the Federal Reserve System,
    the Director of the Bureau of the Budget, and the Chairman of
    the Civil Service Commission, with a Committee Chairman appointed
    by the President. This Committee is expected to report to Congress
    early in 1954. The Social Security Administration believes that extension
    of coverage to all Federal employees—both civilian and military—
    would improve the protection now afforded these employees.
    Another matter under study during the year was that of the coordination
    of the railroad retirement program with old-age and survivors
    insurance. The Joint Congressional Committee on Railroad Retirement,
    created by S. Con. Res. 51 of the Eighty-second Congress, conducted
    a study of the railroad retirement program and its relation to
    old-age and survivors insurance, and completed its report early in
    1953. In its report the Committee reviewed the positions of interested
    agencies and organizations and analyzed various factors relating to
    the matter, without making any recommendations, however. The
    Social Security Administration recognizes that, while the present
    coordination has improved the protection of railroad workers, it is
    somewhat complicated and might perhaps be improved.
    THE RETIREMENT TEST
    Old-age and survivors insurance benefits are intended primarily as
    a partial replacement of earnings which are lost when a worker retires
    or dies. In general, therefore, monthly benefits are not payable to
    otherwise eligible persons who are engaged in work covered by the
    program. The only exception to this provision is for beneficiaries aged
    75 and over, relatively few of whom continue in regular employment.
    Their benefits are payable without regard to the amount of covered
    work they do.
    Basically, the principle of the retirement test is sound, and it is
    important that such a test be retained in the program. If there were
    no retirement test, benefits would be payable not only to those who had
    retired, but also to those older workers who are still employed and who
    have no loss of earnings. The additional benefits that would be paid
    out to employed workers and their dependents would add substantially
    to the cost of the system, and would not increase the security of those
    beneficiaries unable to work or unable to find employment. About 1.9
    million beneficiaries would be immediately added to the benefit rolls,
    and the cost of their benefits would amount to $1.4 billion for the fiscal
    year 1954 alone. Over the long run, total money expenditures for the
    program would rise by about 15 percent.
    293171—54----- 3
    26 Department of Health, Education, and Welfare, 1953
    From surveys of old-age insurance beneficiaries conducted by the
    Bureau of Old-Age and Survivors Insurance, it seems clear that the
    retirement test is not a major factor in most people’s decisions to retire
    from full-time jobs. These surveys have consistently shown that a
    great majority of beneficiaries retire either because they are in ill
    health or because they lose their jobs. Only about 5 percent retire
    voluntarily while still able to work. Among beneficiaries drawing
    benefits at a given time, a very large proportion are disabled. In the
    1951 national survey of aged beneficiaries, almost two-thirds of the
    old-age insurance beneficiaries drawing benefits as retired workers at
    the end of the year reported themselves unable to work. Four-fifths
    of the aged widows who are beneficiaries said they could not work.
    At the same time, the retirement test in its present form does not
    fulfill its function in an entirely satisfactory way. For example, the
    present monthly test for wage earners probably tends to some extent
    to discourage retired persons from engaging in part-time employment.
    Beneficiaries do not want to accept jobs paying somewhat more than
    $75 a month if the amounts they would earn would not be as high as
    the benefits they would lose. Moreover, short-term or seasonal employment
    during the year can cause loss of benefits for some months even
    though the beneficiary is essentially in retirement status and his work
    earnings for the year are relatively low. In this respect the retirement
    test operates more satisfactorily for the self-employed than it does for
    the wage earner, since up to $900 of self-employment earnings are
    allowed in the course of a year before benefit payments are suspended.
    The present retirement test also has anomalous results in some situations.
    At the present time it applies only to earnings in work covered
    by the program, and not to earnings outside the coverage. This makes
    it possible for some persons to receive social security benefits in addition
    to full-time employment earnings by entering noncovered employment.
    This situation would to a large extent be automatically resolved
    by the extension of the program to cover most types of employment.
    But short of completely universal coverage, the problem will not disappear
    altogether. Another anomaly in the retirement test is that
    some persons enjoy a “double exemption” of their work earnings—one
    for wage earnings and one for self-employment earnings. A person
    who has both wage earnings and self-employment income may earn up
    to $900 a year from self-employment income and up to $75 a month in
    wages without the loss of any benefits.
    The Social Security Administration believes that the retirement test
    can and should be redesigned so as to remove anomalies and reinforce
    incentives to productive work. Methods of accomplishing this are
    now under study.
    Social Security Administration 27
    BENEFIT AMOUNTS
    Similarly, the basic question of whether the benefit amounts provided
    under old-age and survivors insurance assure individuals and
    families an adequate measure of security needs to be carefully examined.
    Recommendations for program changes already made will
    result in increasing benefit amounts payable in many cases in the
    future. The extension of coverage, in addition to enabling many
    people to qualify for benefits who could not otherwise have done
    so, will also result in the payment of higher benefits to individuals
    whose working life is split between employment covered at present
    and that recommended for coverage.
    Another provision, recommended in connection with the proposal
    for extension of coverage, will also increase benefits payable in the
    future. This recommended provision would permit the omission of
    the three or four years of lowest or no earnings—depending on the
    date of coverage extension—from the computation of the individual’s
    average monthly wage under the program. This amendment is designed
    to remove the handicap in benefit computation which newly
    covered workers would otherwise suffer because of their late entrance
    into the system. Equally important, however, it will give to those
    already covered the advantage of some future protection against the
    lowering of the average monthly wage because of periods of unemployment,
    disability or low earnings.
    Thus the measures already recommended for improving the program
    would increase its effectiveness in terms of benefits payable. The
    recommended extension of coverage, in particular, would in the long
    run greatly improve the effectiveness of the program in rural areas
    and thereby reduce the need for public assistance. Further evaluation
    of the benefit provisions is necessary, however. Study must be given
    to such questions as what income from other sources and savings aged
    individuals and survivor families may be expected to have; and what
    levels of benefits must therefore be paid under old-age and survivors
    insurance so that retired workers and families that have lost the earner
    through death will not need to apply for public assistance to supplement
    the insurance benefits. Analysis is also needed of the results of
    the present benefit provisions, including the benefit formula, the maximum
    on annual creditable wages, and the method of computing the
    average monthly wage.
    Continuing study is being devoted to these problems, as well as to
    other aspects of the program. In a dynamic economy such as ours no
    social insurance program can be expected to maintain a reasonable
    relationship to the economy of the Nation without constant study,
    review, and change.
    28 Department of Health, Education, and Welfare, 1953
    FINANCING THE PROGRAM
    Congress has made clear its intent that the old-age and survivors insurance
    program be self-supporting, and has set the contribution rates
    of the program at levels calculated to attain that objective. Congressional
    committees, however, in determining the contribution rates, have
    recognized the difficulties involved in making exact predictions of the
    status and operations of the program that reach into the distant future.
    For example, the Committee on Ways and Means of the House of Representatives,
    in its report on H. R. 6000 dated August 22,1949, page 31,
    stated:
    . . . Your committee has recommended a tax schedule which it believes will
    make the system self-supporting (or in other words, actuarially sound) as nearly
    as can be foreseen under present circumstances. Future experience may differ
    from the estimates so that this tax schedule, at least in the distant future, may
    have to be modified slightly—either upward or downward. This may readily be
    determined by future Congresses after the revised program has been in operation
    a decade or two.
    As economic and other conditions change it is essential that new cost
    estimates for the insurance program be prepared from time to time in
    order to take into account the latest operating experience and other
    newly available information. It is to be expected, of course, that any
    new estimate will differ somewhat from previous estimates.
    Normally, several different estimates are prepared, combining different
    assumptions as to low and high employment, low and high cost
    factors, and various interest rates. No one of the estimates is considered
    to be the most probable for the long run. Each simply represents
    a reasonable set of assumptions tending in one direction or the other.
    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 of course 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. Congressional committees, in the past, therefore, in determining
    the contribution schedules, have adopted the practice of relating
    the contribution rates to the “intermediate” cost estimate based on the
    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.
    In the fiscal year 1953 the seventh set of actuarial estimates of the
    cost of the program was issued. These new estimates, based on recent
    Social Security Administration 29
    operating experience and current population data, show the cost of
    the program to be different from that shown in previous cost estimates.
    According to the last previous estimates made in 1952 (which were projected
    through the year 2000 and assumed to be level thereafter) the
    level-premium cost of the program as amended in 1952, on an intermediate
    cost basis, was 5.93 percent of covered payroll, which was very
    close to the level-premium equivalent of the graded contribution schedule.
    According to the new estimates, the level-premium cost of the
    program projected through the year 2000 on an intermediate basis is
    expected to be 6.09 percent; projected through the year 2050 it is
    expected to be 6.58 percent. Thus the new estimates show a higher cost
    than the last previous set of estimates.
    It should be pointed out that, if somewhat different assumptions had
    been used in developing the estimates, different figures would have resulted.
    For example, assumption of a higher interest rate would show
    lower costs. The interest rate used in developing the level-premium
    cost figures indicated above was 2(4 percent; present interest rates are
    somewhat above this figure.
    It should be remembered too, that there are a number of factors
    which could change the picture considerably—a further rise in interest
    rates, for example, or less improvement in mortality than has been assumed,
    or further increases in wage levels, any of which would result
    in lower costs. (It is worth noting that the experience in this country
    over the years has been that wage levels have risen, and the general
    view is that this trend will continue.)
    Thus it must be emphasized that no single set of cost estimates is, or
    can be, “final.” Experience over the last 15 years has been considerably
    more favorable than was anticipated in the cost estimates prepared
    when the system was established. Despite the fact that the program
    has been liberalized substantially since it was originally established,
    the cost of the program as a percentage of payroll for 1955, for example,
    is expected to be very close to, and perhaps somewhat below, the
    cost estimated for the year 1955 in the early days of the system.
    Public Assistance
    The number of persons receiving assistance continued to go down
    during the fiscal year, as it has since 1950. In June 1953, for the
    first time since the Social Security Act was passed, fewer people were
    receiving assistance than were receiving benefits under old-age and
    survivors insurance. For most children of incapacitated and separated
    parents, however, and for most disabled and blind persons, there
    is no insurance coverage, and public assistance is the primary support
    for needy persons in these groups.
    30 Department of Health, Education, and Welfare, 1953
    Although more aged persons received insurance benefits than
    old-age assistance as early as 1951, the total number of recipients under
    all assistance programs at the beginning of 1953 still exceeded the
    total number of insurance beneficiaries by nearly a million. However,
    the continuing decline in the number of assistance recipients,
    coupled with a substantial increase in insurance beneficiaries, had
    reversed the position of the two programs by the end of the fiscal
    year 1953. The shift in programs for the aged was especially marked.
    In June 1953, 32 percent of the population aged 65 and over were
    drawing insurance benefits, and less than 20 percent of the aged were
    receiving assistance.
    Thus, while old-age and survivors insurance is beginning to fulfill
    its long-term role as the basic income maintenance program, public
    assistance helps to provide a minimum level of living to needy persons
    who are not eligible for this social insurance program or whose
    insurance benefits and other resources are too low to meet their minimum
    needs. Today, more than 5 million persons, whose eligibility has
    been determined by State and local welfare agencies under the provisions
    of the States’ own laws, are dependent on public assistance for
    the primary essentials of daily living.
    As more retired persons and the dependents and survivors of insured
    workers become eligible for social insurance benefits, the proportion
    of persons receiving assistance because of disability, or because they
    are children deprived of parental care, has risen sharply. This shift
    in the composition of the assistance caseload emphasizes the need for
    further development of social services in public assistance agencies
    as well as the need for effective working relationships with other
    community agencies providing health and rehabilitative services.
    Federally, this shift of emphasis has been reflected this year in closer
    working relationships between the Bureau of Public Assistance and
    other programs of the Department, such as vocational rehabilitation,
    public health, and child welfare services, and also in more cooperative
    work with outside agencies, particularly national agencies carrying
    standard-setting responsibilities for institutions.
    Case Load and Expenditures 1
    About 200,000 fewer persons received public assistance at the end
    of the 1953 fiscal year than a year earlier. From 5.5 million in June
    1 For old-age assistance, aid to dependent children, aid to the blind, and aid to the
    permanently and totally disabled, data on payments now Include payments to the suppliers
    of medical care, and data on recipients include persons who received no money
    payment but on whose behalf vendor payments for medical care were made. In previous
    issues of the annual report, data on average payments included only cases receiving money
    payments and the amount of such payments. Data for earlier years have been adjusted
    for comparison with 1953 data. For general assistance the data continue to exclude
    vendor payments for medical care and the number of persons on whose behalf only such
    payments are made.
    Social Security Administration 31
    1952, including those receiving general assistance, the total number
    declined to 5.3 million in June 1953. This represented a drop of about
    3^ percent during the year, and a total reduction since June 1950 of
    about 14 percent. High levels of employment and the increase in
    the number of old-age and survivors insurance beneficiaries continued
    to be the primary factors contributing to the decline in caseloads,
    though more restrictive eligibility provisions in some States were also
    a factor.
    The 1952 amendments to the Social Security Act, which made additional
    funds available to the States for public assistance, and the continued
    efforts of States to meet need on a more nearly adequate basis
    account in large measure for a 5.4 percent increase in total expendi-
    Chart 5.—HOW ASSISTANCE PAYMENTS ARE FINANCED1
    1 Payments In the fiscal year 1953 foi old-age assistance, aid to dependent children, aid to the blind,
    aid to the permanently and totally disabled, and general assistance.
    tures for assistance payments during the fiscal year 1953. An increase
    of $130.2 million raised total Federal, State, and local expenditures
    from $2,392.6 million in 1952 to $2,522.8 million in 1953.
    Effective October 1952, the amendments raised the maximums on
    the amounts of individual payments in which the Federal Government
    can participate and increased the Federal share within these
    maximums. Increases in monthly payments of $5 per recipient under
    old-age assistance, aid to the blind, and aid to the permanently and
    totally disabled and $3 per recipient under aid to dependent children
    were possible in States that continued to spend as much per recipient
    from State and local funds as they had spent in the preceding month.
    32 Department of Health, Education, and Welfare, 1953
    Since October 1, 1952, for old-age assistance, aid to the blind, and
    aid to the disabled, Federal funds pay four-fifths of the first $25
    (raised from three-fourths of the first $20) of the average monthly
    assistance payment per recipient, plus half the balance of all expenditures
    up to $55 a month for individual payments (raised from $50).
    For aid to dependent children, Federal funds pay four-fifths of the
    first $15 (raised from three-fourths of the first $12) of the average
    monthly payment per recipent, plus half the balance up to $30 for
    the needy adult caretaker, $30 for the first child, and $21 for each
    additional child (raised from $27, $27, and $18, respectively).
    With the additional Federal funds and the general decline in caseloads,
    some States with maximums on assistance payments raised
    them; other States that had been making percentage reductions in
    payments because of insufficient funds reduced or eliminated these
    cuts, or determined need under more nearly adequate standards in relation
    to current living costs. Several States that had adjusted payments
    before October 1952, however, to reflect increased living costs,
    made no further adjustments in payments or made only minor adjustments
    in their standards.
    As a result of the 1952 amendments, the amount of Federal funds
    used to finance assistance payments in the last 9 months of the fiscal
    year increased by an estimated $144 million. Between the first and
    second quarters of the year, the percent of Federal participation rose
    from 51.5 for both old-age assistance and aid to dependent children
    to 56.9 and 58.3, respectively; in aid to the blind the change was from
    45.6 to 50 percent; and in aid to the permanently and totally disabled
    from 47.8 to 52.9 percent.
    In summary, at the end of the year about 5.3 million persons, about
    1 in 30 in the population, were receiving public assistance. Total
    assistance expenditures from Federal, State, and local funds amounted
    to $2,523 million, or 1 percent of personal income payments in the
    Nation in the calendar year 1952. The Federal share of this expenditure
    was $1,278 million.
    The aggregate cost of public assistance appears high, yet many individuals
    dependent upon public assistance payments are existing on a
    level of living far below a reasonable standard of decency and health.
    The large numbers of persons dependent on public assistance, in spite
    of general prosperity, are mainly those groups unable to take advantage
    of employment opportunities—the aged, the disabled, the blind,
    and young children. Moreover, the two largest of these groups that
    are most likely to be dependent—the aged and young children—are
    increasing more rapidly than the total population.
    Old-age assistance.—The 2,609,000 aged persons receiving assistance
    in June 1953 represented a decrease of 2.3 percent from the number in
    Social Security Administration 33
    Chart 6.—PURCHASING POWER OF ASSISTANCE PAYMENTS TO THE AGED AND CHILDREN 1
    1 Beginning June 1951 includes payments to suppliers of medical care to recipients.
    2 Based on Bureau of Labor Statistics consumers’ price index for moderate-income families in large
    cities.
    June a year earlier, and were about 201,000 fewer than the number
    aided in the peak month of September 1950. The caseload in 44 States
    decreased during the year. For all States combined, the recipient
    rate—that is the number of recipients in proportion to the total population
    aged 65 and over—was 191 per 1,000 in June 1953 as compared
    with 202 in the preceding June. The average monthly payment was
    $51.08 as compared with $47.11 in June 1952.
    Aid to dependent children.—The number of families receiving aid
    to dependent children in June 1953 was 564,000. These families included
    about 1.5 million children, or less than 3 percent of the child
    population. This was the lowest number of children aided since September
    1949 and 92,000 fewer than in the peak month of October 1950.
    The recipient rate for all States was 28 per 1,000 children in the population
    under 18 years. In 35 States, the number of families also decreased.
    The average monthly payment per family in June 1953 was
    $83.98 (or $23.69 per person) as compared with $77.32 per family (or
    $22.36 per person) in June 1952.
    Aid to the permanently and totally disabled.—The still relatively
    new program for aid to the permanently and totally disabled continued
    to grow. Georgia was added to the States receiving Federal funds for
    this program. The total number of recipients in the 39 States now
    administering programs with Federal financial participation was
    34 Department of Health, Education, and Welfare, 1953
    179,000 in June 1953, as compared with. 148,000 in 38 States in 1952.
    The average monthly payment was $53.72 as against $50.34 in June
    1952.
    Aid to the blind.—The number of recipients of aid to the blind
    increased by 1,000 during the year to 99,000 in June 1953. With the
    addition of Nevada, which first began to receive Federal funds for its
    program during the year, all jurisdictions are now administering aid
    to the blind with Federal financial participation. The average monthly
    payment in June 1953 was $55.53 as compared with $51.26 in June 1952.
    General assistance.—General assistance, financed entirely from
    State and/or local funds, was affected by high 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 255,000 cases receiving general assistance in June
    1953 was the smallest number since November 1945. From June 1952
    to June 1953 the caseload declined 13 percent. The national monthly
    average payment per case was $47.16 in June 1953 as compared with
    $45.95 a year earlier.
    Effect of Old-Age and Survivors
    Insurance on*Public*Assistance S
    Despite the expansion of old-age and survivors insurance since
    September 1950, many people are still getting old-age assistance because
    some of the insurance benefits are not sufficient to meet minimum
    needs for those who have no other resources, or for those with unusual
    expenses, such as costly types of medical care. In February 1953
    about 11 percent of the aged insurance beneficiaries received public
    assistance to supplement their benefits. They represented 16 percent
    of the old-age assistance caseload for that month. It is likely that,
    as the number of beneficiaries continues to increase, the number requiring
    supplementary assistance will also grow. This would be especially
    likely to happen if the cost of living remains high. Of all
    paternal orphans under age 18 in the general population, about half—
    911,000 in June 1953—received survivor benefits under the insurance
    program. Nearly 6 percent of the families with children receiving
    insurance benefits also received supplementary assistance. They represented
    5 percent of the families receiving aid to dependent children.
    The death of the father is the reason for dependency for about onesixth
    of the children getting aid to dependent children, and at least onethird
    of these children are receiving survivor benefits based on the
    wage record of the father. A few additional families may include a
    person getting insurance benefits—for example, an aged retired father.
    The other families receiving aid to dependent children—about fiveSocial
    Security Administration 35
    sixths of the total—do not include any person eligible for old-age and
    survivors insurance.
    Because the insurance program does not cover all the risks that
    create dependent families, the expansion of the insurance program
    does not tend to reduce the aid to dependent children caseload to the
    same extent that it reduces the old-age assistance caseload. Likewise,
    Chart 7.—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.
    few recipients of aid to the permanently and totally disabled and aid
    to the blind are potentially eligible for insurance benefits. A special
    study of recipients of aid to the permanently and totally disabled made
    by 30 States in 1951 indicated that there were fewer than 400 insurance
    beneficiaries among 93,000 assistance cases. A report for September
    1950 showed that 1,300 recipients of aid to the blind received both
    types of payments.
    36 Department of Health, Education, and Welfare, 1953
    Chart 8.—GROWTH IN SOCIAL INSURANCE PROTECTION FOR ORPHANS
    Number of orphans receiving benefits or assistance in a given month in each year
    By providing income to a large number of aged persons, however,
    the insurance program has prevented further increases in assistance
    costs. In addition, the aged beneficiaries now receiving assistance to
    supplement their insurance benefits need less aid than if they had been
    totally dependent on assistance.
    Program Developments
    The Bureau gave special attention during the year to the development
    of the following aspects of its program.
    INSTITUTIONAL CARE FOR THE AGED, BLIND, AND DISABLED
    A Social Security Act amendment, effective July 1, 1953, and designed
    to protect the health and safety of needy persons in institutions,
    provided an impetus for a Nation-wide movement to raise standards of
    institutional care.
    Although public safeguards have long been established in many
    States for hospitals and institutions caring for children, comparable
    protection has not been given to aged and infirm adults in many institutions.
    Substandard institutions for adults exist in many parts of the
    country. In the past 4 years, for example, 184 aged persons in institutions
    in five different States were burned to death. Many others have
    Social Security Administration 37
    been subjected to inhumane care. Many public assistance recipients,
    because of their limited economic circumstances, live in substandard
    institutions.
    The standard-setting amendment to the Social Security Act, enacted
    in 1950, was intended to assure adequate standards of care and protection
    against hazards threatening the health and safety of residents of
    institutions. It requires that a State that makes federally aided assistance
    payments available to needy aged, blind, and disabled persons in
    institutions must designate one or more authorities to establish and
    maintain standards in such institutions.
    Since most States already had authorities that set standards for some
    institutions, this amendment meant an extension of coverage in many
    instances rather than the establishment of a new activity. 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. The Federal Government does not specify the content of
    the standards, only the scope.
    Wide variation exists among States in the kind of authority carrying
    this responsibility for establishing and maintaining standards. Some
    have a special licensing and inspection authority. Others have one
    agency responsible for fire regulations, another for health, another for
    welfare. Or responsibility is divided by type of institutions—the
    health department, for example, setting standards for medical and
    nursing institutions and the welfare department for old people’s
    homes.
    An advisory committee helped the Bureau define and interpret its responsibilities
    under this amendment. This committee included representatives
    of leading national fraternal, religious, charitable, and commercial
    organizations with responsibility for institutions caring for
    the aged, blind, and disabled; and representatives of the Public Health
    Service and of State departments of public assistance and health. The
    committee suggested methods of assisting State agencies in obtaining
    necessary legislation to establish or designate a standard-setting authority
    ; how the State agencies could participate in improving the general
    quality of institutional care; and how they could use the experience
    and secure the participation of private groups and others in the
    community interested in the development and maintenance of standards.
    The minutes of the advisory committee meetings were sent to
    all State public assistance agencies to keep them informed of current
    developments in this area. Representatives of some of the organizations
    included on the national advisory committee also served on similar
    advisory committees of State and local agencies administering the
    program.
    Voluntary and public welfare agencies in all parts of the Nation
    have worked cooperatively in developing plans for carrying out this
    38 Department of Health, Education, and Welfare, 1953
    amendment. The Bureau of Public Assistance has continued its work
    with the Public Health Service and Children’s Bureau in planning for
    and evaluating developments under this amendment. The National
    Social Welfare Assembly’s National Committee on Aging, and its subcommittee
    on standard setting for institutions, both of which included
    representatives of the Bureau, prepared several publications particularly
    helpful to people working in this field. The publications included
    a bibliography, a digest of State legislation on standard setting
    authorities, and pamphlets on “Standards of Care for Older People in
    Institutions” and “Methods for Establishing and Maintaining Standards
    in Homes for the Aged and Nursing Homes.” The National Committee
    on Aging is also planning regional conferences at which regional
    and State staff of private and public agencies, as well as institution
    operators and others in the area concerned with standard-setting, can
    come together to plan ways for securing improved standards. The
    National Council of the Churches of Christ in the United States of
    America published an article supporting the standard-setting amendment,
    and the Bureau furnished the Council of State Governments
    with suggestions for State laws on this subject which were published,
    together with explanatory notes, in the document “Suggested State
    Legislation 1953.”
    The Bureau also has been helping the State agencies by interpreting
    the amendment as a guide to legislation, since most State legislatures
    were in the process of amending their laws during the year in order
    to meet the requirements of the Federal amendment by July 1, 1953.
    The majority of States were able to meet this requirement without
    difficulty. When problems were encountered, they were of three major
    types. The first was that of obtaining legislation to provide for complete
    coverage of all types of institutions in which assistance payments
    were currently being made. The second problem, occurring in States
    where legislation did not provide for the establishment of a standardsetting
    authority for all institutions, was to ensure that the present
    laws gave the authority to exclude payments to persons in institutions
    not covered by the standard-setting authority. The third problem was
    that of assuring that the authority was responsible not only for setting
    standards but also for maintaining them.
    PUBLIC INSPECTION OF THE PUBLIC ASSISTANCE ROLLS
    Since 1951, when a provision of the Revenue Act made it possible
    for States to permit public inspection of the names of persons receiving
    assistance under the federally aided programs, 28 States have
    passed legislation opening their public assistance lists for public inspection.
    Twenty of these States passed legislation this year.
    The experience of most of the States has as yet been too limited to
    Social Security Administration 39
    evaluate the effectiveness of the measure in reducing the size of caseloads
    and the cost of assistance. Many interested individuals and
    groups, however, are making follow-up studies and analyzing the
    experience of individual States.
    NOTICE TO LAW-ENFORCEMENT OFFICIALS
    One of the 1950 amendments that became effective July 1, 1952,
    requires that law-enforcement officials be notified when children who
    have been deserted or abandoned by a parent are receiving aid to
    dependent children. The intent of this amendment was to reduce the
    cost of assistance by enlisting the cooperation of law-enforcement officials
    in obtaining support from the deserting parent.
    About one-fourth of the cases receiving aid to dependent children
    in June 1952 were affected by this amendment—about 375,000 children
    in 160,000 families. Its full effect cannot be determined until sufficient
    time has elapsed for law-enforcement officials to take appropriate
    action on notices submitted to them. As an immediate result, about
    5,000 families including about 9,000 children had their cases closed or
    their payments reduced because the remaining parent did not wish to
    have the notice sent. This represents a little more than 3 percent of
    the 160,000 cases affected by the amendment but less than 1 percent of
    the total aid to dependent children caseload in June 1952. As a result
    of these withdrawals the total reduction in payments was $165,000 a
    month or about of 1 percent.
    Of 97,000 parents who were brought to the attention of the lawenforcement
    officials in 34 States, one-third were known to be in the
    State and 18 percent were known to be in another State. Nothing was
    known of the whereabouts of the others—almost half of the total number.
    About 40 percent of the absent parents had been away for 5 years
    or more. A slightly higher proportion—45 percent—had been gone
    from 1 to 5 years. About 10 percent had been away from 3 months to a
    year. Only 2 percent had been absent for less than 3 months.
    There appears to be little assurance that law-enforcement officials
    can take immediate action against absent parents whose whereabouts
    are unknown and those who are known to be outside the State. Two
    out of three absent parents are in these groups. Although most States
    have recently passed laws for uniform reciprocal enforcement of support,
    the effectiveness of this type of legislation in obtaining support
    from deserting parents has yet to be widely tested.
    Some State agencies have reported that the development of working
    relationships with law-enforcement officials has given an opportunity
    for joint consideration of plans of action best suited to the
    individual family situation. More experience under the amendment
    and further study are needed, however, to evaluate the results.
    40 Department of Health, Education, and Welfare, 1953
    AID TO THE PERMANENTLY AND TOTALLY DISABLED
    By June 1953, 2% years after Federal grants were made available
    to States for aid to needy adults who are permanently and totally disabled
    by a physical or mental condition, 39 States were administering
    programs with Federal financial participation. Four other States had
    passed legislation permitting them to establish such programs. The
    number of recipients, 179,000, was 22 percent higher than a year
    earlier.
    During the year, State agencies improved and strengthened their
    services to the disabled as they gained experience in working with
    the complex factors of “permanent” and “total” disability. Disability
    is usually not static and it affects each individual differently. It is not
    possible to determine disability in the same way as age or residence, for
    example. Determination of the eligibility factors of permanent and
    total disability need to be made by professionally competent persons
    acting cooperatively—doctors, social workers, and other technical staff
    as required. In most States, the technical staff operates as a review
    team. The team usually consists of a physician and professional social
    worker, and often includes a vocational rehabilitation counsellor or
    other representatives of the State rehabilitation agency who have had
    experience in evaluating the rehabilitation potentialities of disabled
    individuals. Consultants from related fields—psychology, psychiatry,
    employment counselling, and various medical specialties—may be
    called on when needed and available.
    Changes in the program during the year indicate a trend toward
    an increasingly effective use of the team, progress in clarifying the
    kind of information needed for determining permanent and total disability,
    and a broadening of the scope of programs in States that
    initially restricted their programs to the completely helpless.
    The Bureau’s cooperative relationships with the Office of Vocational
    Rehabilitation that were established when the State programs began
    operation have been strengthened with increased advantage to both
    agencies. Joint planning has continued to emphasize the desirability
    of coordinating the services of these related State agencies in such a
    way as to strengthen the rehabilitation aspects of aid to the permanently
    and totally disabled and other public assistance programs.
    These cooperative efforts have also been reflected in professional consultation
    to State agencies and, when appropriate, in written interpretation
    of policy.
    An example of this type of cooperative activity is presented by a
    conference held in Gearhart, Oregon, in December 1952. This conference,
    planned jointly by staff of the Bureau of Public Assistance,
    the Office of Vocational Rehabilitation, and the Public Health Service,
    was attended by representatives of county and State health, welfare,
    Social Security Administration 41
    and rehabilitation agencies in the States of Washington and Oregon,
    and by regional staff of the three Federal services. The discussion of
    specific cases at the conference demonstrated both weaknesses and
    strengths in program administration as well as in interagency relationships.
    It opened the way for better working agreements between
    agencies and focused attention on the needs of those whom the agencies
    were organized to serve.
    Other conferences were held in Texas, Georgia, and Missouri. As
    a result of the meeting in Austin, the public assistance agency in
    Texas, which does not have a program of aid to the permanently
    and totally disabled, initiated a series of meetings between State vocational
    rehabilitation and public assistance personnel aimed at the
    provision of greater service to handicapped persons generally. The
    Kansas City conference focused on the medical and rehabilitative
    aspects of the aid to the disabled program and the responsibilities of
    the technical staff for findings and recommendations in these areas.
    Emphasis on the rehabilitative aspects of the program is beginning
    to show concrete results in many States. For example, in one
    State the assistance agency, as a result of intensive cooperative work
    with the State rehabilitation and employment agencies, studied 1,080
    cases involving handicapped persons. Through the combined agency
    services, 99 persons were placed in jobs and 33 are in training for employment.
    Only 149 were deemed definitely unrehabilitable; the rest
    are still under consideration. The Office of Vocational Rehabilitation
    reported that, of the 64,000 disabled persons under their programs who
    were returned to employment during the 1953 fiscal year, 11,000 to
    12,000 persons had previously been receiving assistance. Gainful employment
    for these individuals means not only a reduction in assistance
    costs; it also means reestablishment of self-confidence and a better
    chance at living a useful and happy life.
    SOCIAL WELFARE SERVICES TO PUBLIC ASSISTANCE RECIPIENTS
    Economic need is frequently associated with the need for rehabilitative
    and other social services. The public assistance agency has not
    only a humanitarian interest but a financial stake in providing effective
    social services.
    Many of the individuals receiving assistance show the results of
    neglected health and personal problems that sharply point up the need
    for services. The nature of some of these problems indicates that, if
    professional services had been available at the time of crisis, a great
    deal of individual and family breakdown might have been prevented.
    For example, it is estimated that in more than half of the families receiving
    aid the father has deserted or is not married to the mother or
    the parents are divorced or separated. A study of desertion in aid to
    293171-54-----4
    42 Department of Health, Education, and Welfare, 1953
    dependent children made in one State showed that nearly half the
    fathers deserted before the birth of the youngest child or before the
    youngest child was 1 year old, and that 90 percent of the fathers reported
    on had shown earlier evidences of instability that might have
    responded to family casework services or psychiatric help. Other
    State studies show the need for counselling and other services available
    at the time of crisis.
    Similarly, many of the 179,000 disabled persons receiving aid to
    the permanently and totally disabled in June 1953 might have been
    helped to greater self-dependence if necessary rehabilitative services
    had been made available to them earlier. A study of the characteristics
    of disabled recipients in 1951 showed that most of them had had
    their major impairments for a relatively long time; for 40 percent,
    the impairment had occurred 10 years or more before the study was
    made. Fewer than 3 percent had impairments of less than a year’s
    duration.
    The evidence revealed from these and other studies made by State
    agencies and other interested groups indicates the need for strengthening
    the public assistance program to provide professional service
    within the scope of its responsibilities, as well as for community planning
    in the development and coordination of other services, private
    and public, so they can be made available to individuals at the time
    they are most needed. This is particularly true in the substantial
    number of localities where the public welfare department is the only
    organized social agency in the community.
    The Bureau has long emphasized the need for development of public
    and private agency resources to augment the services available through
    public assistance agencies. A working group composed of staff from
    the Children’s Bureau and the Bureau of Public Assistance was established
    to explore ways in which the two bureaus could help State
    agencies provide more effective services to families and children receiving
    aid to dependent children. The Bureau has continued its
    close working relationship with the Office of Vocational Rehabilitation
    and the Public Health Service and with other public and private
    agencies, in an effort to bring to public assistance recipients the best
    advice and skills that have characterized the work of other rehabilitation
    programs.
    Staff limitations.—The Bureau has also been encouraging State
    agencies to devote the staff and the time necessary to provide social
    and medical services to enable needy people to become self-supporting
    or independent of the care of others to the greatest extent possible.
    Many problems must be solved, however, before this objective can be
    achieved. The lack of staff with sufficient technical qualifications is
    one of the most serious problems. A program that deals intimately
    with the lives of many people, including young children, mothers, the
    Social Security Administration 43
    aged, and the handicapped must be staffed with skilled professional
    workers if an effective job is to be done.
    On the skill and judgment of some 30,000 staff members in State and
    local public welfare agencies, of whom 70 percent are caseworkers, rests
    the responsibility for dealing with more than 5 million persons dependent
    on public assistance, many of whom have serious personal problems.
    Yet most of these caseworkers have little professional training for
    their jobs.
    The solution of this problem is also complicated by the inadequate
    salaries. The median salary of caseworkers, for example, was $2,569 in
    1950. Also, in many States the caseloads carried by these workers are
    quite high. Wide variation exists in the size of caseloads—workers in
    some States carrying two to three times as many cases, on the average,
    as those in other States. The volume of work carried by individual
    workers has a close relation to efficiency of operation, especially in the
    determination of need for assistance and the provision of necessary
    services.
    Developments in helping recipients of public assistance become selfsupporting.—
    Despite the serious obstacles of staff limitations, State
    and local public welfare agencies have exerted great effort to provide
    needed social services and to use effectively other community resources,
    especially those which provide medical care, vocational training, and
    family and child welfare services. Such resources are utilized to help
    recipients of assistance develop their capacities for independent living
    and self-support. In New York City and Chicago, for example, special
    staffs have been employed to provide consultation or give direct service
    to clients, and to aid caseworkers in utilizing agency and community
    resources. In addition to help in obtaining needed correction of physical
    defects, help is also given recipients in preparing for employment
    and in finding job openings. Many recipients are found to lack any
    marketable skills, and training has been arranged through facilities in
    the community or through training programs developed within the
    agency.
    In Chicago the local agency has been working with mothers whose
    children are nearing the age when they will no longer need or be eligible
    for the assistance payments. The agency is also working with
    mothers who, because their children do not require their full-time care,
    are seeking opportunities to become financially independent. An excellent
    training program for work as nurses’ aides and institutional
    helpers is available, and mothers have been helped to take advantage of
    this resource as well as other training and employment opportunities.
    In New York City the public welfare agency has a training program
    for domestic service that is a cooperative activity in which the city
    board of education furnishes trained teachers and the welfare department
    supplies quarters, equipment, and administrative supervision.
    44 Department of Health, Education, and Welfare, 1953
    In both cities the public welfare agencies use employment counsellors
    to supplement services available through the regular public employment
    offices. The welfare agencies have found that many recipients
    have to learn how to utilize placement facilities.
    Several States have been experimenting with the assignment of
    small caseloads to skilled workers who have time to provide intensive
    casework services. In Salt Lake City a professionally trained worker
    demonstrated successfully the human and financial savings that could
    be achieved through skilled work. In a California county a faculty
    member from a school of social work also demonstrated, in a small
    number of families, what could be done with intensive skilled service
    for the incapacitated father to help him regain self-confidence and
    again be able to work. The county is continuing work on this basis by
    special assignments to certain members of its regular staff. Florida
    has been conducting a similar demonstration of intensive casework
    service with a small caseload. In Louisiana an interesting and successful
    experiment was tried in preparing persons for employment who
    had previous mental illnesses, utilizing psychiatric, psychological, and
    social services in an integrated approach.
    Illinois has also developed a selective program of summer employment
    for teen-age children in recipient families. The objective is not
    only to increase the family income and decrease the need for aid, but
    also to give the young people a desirable work experience that will be
    helpful in guiding later vocational choices.
    The legislature in Kentucky authorized an annual appropriation of
    $100,000 for the use of the State public assistance agency in the development
    of services in the aid to dependent children program. At the
    request of the State agency, Bureau staff have been working with the
    agency to develop the content of services in aid to dependent children,
    and to explore its implication for the State’s total assistance program
    particularly in relation to organization, supervision, staff training, and
    use of advisory committees.
    The various methods used in these experiments are not entirely new,
    but their increased application in public welfare administration demonstrates
    the possibilities that exist for conserving and increasing the
    Nation’s human resources.
    State agency planning for tetter trained staff.—Carrying out the
    provisions of the public assistance programs in a State calls for an
    understanding of laws and agency regulations, discriminating judgment
    in collecting and evaluating information, and a knowledge of
    medical and rehabilitation resources available to help needy persons.
    It also calls for skill in helping people to realize all their potential
    abilities for self-direction and self-support. In view of the fact that
    the education of 83 percent of the public assistance caseworkers included
    no professional preparation for social work, it is particularly
    Social Security Administration 45
    important that as much help as possible be given workers through
    training on the job. In 1952, 21 State agencies had a full-time person
    on their staff whose job it was to plan and carry out training activities;
    36 agencies had a staff member who carried staff development responsibility
    along with responsibility for other activities.
    To help meet the need for professionally trained workers, a number
    of States have plans for granting educational leave. Twenty-nine
    State agencies reported that they granted educational leave to 158
    workers during the year ending August 31, 1952. In 23 of these
    agencies some payment along with the leave was made to 101 of tne
    158 workers.
    There is convincing evidence that the cost of some types of dependency
    can be reduced by providing services and facilities. Skilled
    casework service, often in combination with medical, psychiatric, and
    vocational rehabilitation services, has proved successful in putting
    people back on a self-supporting basis. Even when self-support is
    impossible, expensive care in hospitals and institutions can often be
    avoided by providing services, friendly visitors, golden age clubs,
    visiting housekeeper and nursing services, and the like, which enable
    people to remain in their own homes.
    Research to determine what combination of social services and other
    resources can contribute to the reduction of dependency has been limited.
    Further studies are needed to determine:
    1. The amounts and kinds of training and the personality factors
    that public assistance workers need to have in order to give successful
    service.
    2. What types of dependency problems will respond to casework
    service and what other services and resources are needed to supplement
    the services of public assistance workers.
    3. What kinds of working conditions, size of caseloads, types of
    supervision, and administrative policies are desirable in order to make
    the best use of the skills of trained social workers.
    Such research would promote efficient organization of public assistance
    services, economical staffing of welfare agencies, the planning of
    training for caseworkers in graduate schools of social work, and the
    development of on-the-job training programs.
    Services provided by professionally trained workers might increase
    “administrative costs” but probably would ultimately lead to a reduction
    of assistance costs.
    Program Operations
    PUBLICATIONS AND STUDIES
    Characteristics of State public assistance plans—A new issue of
    “Characteristics of State Public Assistance Plans” was prepared and
    46 Department of Health, Education, and Welfare, 1953
    published during the year. This publication, which has been issued
    by the Bureau from time to time since 1936, presents in chart form
    information on 15 selected substantive provisions of State programs.
    As a general source of information about State programs, it is of
    special use to State agencies, legislatures, research groups, educational
    institutions, voluntary social agencies, and business organizations.
    Characteristics of recipients of old-age assistance.—The Bureau
    undertook, in cooperation with State agencies, a study of the requirements,
    incomes, resources, and other pertinent characteristics of
    recipients of old-age assistance. The study was made in response to
    the growing concern of many public and private groups and agencies
    about the welfare of aging persons and the need for current data about
    aged assistance recipients. Such information will be helpful administratively
    in evaluating the current program and in future planning.
    To make the study’s findings also of maximum value to State agencies
    and other organizations and groups concerned with the aged, an advisory
    committee with representation from State public assistance
    administrators, State directors of research and statistics, home
    economists, and Federal agencies gave the Bureau advice and consultation
    on the content of the study. The Bureau of Old-Age and
    Survivors Insurance also participated in its planning to ensure as
    much comparability as possible with the national survey of old-age
    and survivors insurance beneficiaries, conducted in 1951.
    Financial support of parents by adult children.—Work is nearing
    completion on a summary of support laws and of old-age assistance
    plan provisions on responsibility of adult children for aged parents
    with whom they do not share living arrangements. Policies frequently
    differ for children living in the State and those living outside. The
    types of provisions, used separately or in combination in the States,
    may be roughly classified in these three groups:
    (1) Provisions that are intended to encourage contributions from
    children able to contribute, but that do not include any means of seeking
    to compel support from children who do not contribute voluntarily.
    (2) Provisions that seek to compel support, by some type of court
    action initiated by the agency or by the recipient, from children who
    have been determined by the agency to be able to support, but whose
    expected contribution the agency is not under obligation to consider
    as a resource affecting the recipient’s need unless or until the contribution
    is actually received.
    (3) Provisions that take into account, in determining eligibility
    and the amount of the assistance payment, contributions that the
    agency determines the children are able to make, whether or not the
    contributions are actually received,
    Social Security Administration 47
    About half the States use income scales to determine whether the
    adult children are in a position to contribute and the amount of the
    contribution to be expected.
    Most of the recent changes have been in the direction of tightening
    and making more explicit the plan provisions on responsibility of the
    adult children for the support of their parents.
    TECHNICAL ASSISTANCE TO STATES
    The legislatures of 49 jurisdictions were in session during the year,
    and many changes were made in State welfare laws as a result of the
    1950 amendments to the Social Security Act. In response to requests
    from State agencies, Bureau staff advised on the development of proposed
    legislation and plan material. Technical assistance was also
    given State agencies in examining their policies for clarity, reviewing
    their procedures for workability, and providing suggestions for
    improving operating methods based on the experience of many States.
    At the request of specific States, consultation was also given on Statewide
    standards and policies governing resources, plans for obtaining
    medical care for public assistance recipients, the use of the medicalsocial
    team in aid to the permanently and totally disabled, statistical
    and research problems, staff development, and administrative
    procedures.
    Procedural surveys conducted by the Bureau at the request of several
    State agencies have resulted in economies through the adoption
    of simplified and more effective administrative and fiscal procedures
    in some States. Recommended procedures and techniques in fiscal and
    administrative management were developed for use by State agencies,
    and consultation on organization and administrative management was
    provided to individual States, on request, and to groups of States
    through regional conferences.
    In May a 5-day sampling clinic was held in Colorado for the primary
    purpose of increasing the knowledge and skills of State public
    assistance agency personnel in the effective use and interpretation of
    sampling techniques specifically applicable to administrative statistics
    and research in the public assistance program. Through the use of
    sampling techniques, States are able to develop basic information
    quickly and at relatively low cost. In all, 57 persons from the western
    half of the country participated in the sessions. A similar clinic for
    State public assistance agency personnel in the eastern half of the
    country is planned for the fiscal year 1954.
    ADMINISTRATIVE REVIEW OF STATE AND LOCAL OPERATIONS
    During the year, State-wide reviews, conducted on a sample basis,
    were utilized for the purpose of determining whether recipients were
    48 Department of Health, Education, and Welfare, 1953
    eligible for the payments they receive. This form of review was carried
    out in nine States.
    Other methods of review were also used to analyze special problems
    and requirements of the Social Security Act other than eligibility.
    Reviews relating to disability determinations in the aid to the disabled
    program and to the absence of fathers from the home in the aid
    to dependent children program were completed in six States. Reviews
    were carried out in 11 additional State agencies, making a total of 25
    of the 53 jurisdictions in which State and local operations were studied
    during the year.
    More than half the States carry on some type of planned review
    process. The Bureau continued to assist States, on request, in planning
    and strengthening these reviews.
    OTHER PROGRAM DEVELOPMENTS
    The Committee on Training and Personnel, which is an advisory
    committee to the Children’s Bureau and the Bureau of Public Assistance,
    met in Washington on March 9 and 10, 1953. This Committee
    was established in 1936, at the request of representatives of schools of
    social work and national voluntary welfare agencies who felt the need
    for a medium of communication between their groups and the two
    Bureaus concerned with welfare services. The Committee has devoted
    its attention mainly to recommending standards of selection and
    training of welfare workers which would increase the efficiency and
    effectiveness of personnel in child welfare and public assistance
    programs.
    The major recommendations of the Committee this year were that
    a national representative committee be created, outside the two Bureaus,
    to help bring about agreement on long-term minimum qualifications
    for professional and administrative staffs in public welfare,
    and that, as a part of such a program, a plan be developed for financing
    social work education for the public welfare services.
    An advisory committee was established early in the year to advise
    the Bureau on its informational program. In addition, several internal
    organizational changes were made to give sharper functional
    focus to key aspects of the Bureau program and to assist the Bureau
    in carrying an increased workload with staff decreased during the
    year from 289 to 255 because of budget limitations.
    Children’s Bureau
    The fiscal year 1953 continued to be a period of apprehension and
    uncertainty for many families and their children. The cost of living
    continued upward and more mothers went to work. Children’s
    Social Security Administration 49
    agencies faced by increased costs were forced to cut back services.
    The upward trend in delinquency is continuing. More children who
    are seriously disturbed emotionally are coming to the attention of
    State agencies.
    Happily the United States is rich in children. There are now about
    50 million children under 18 years of age. Right now, as a Nation,
    we are growing young faster than we are growing old. During the
    period 1940-52, while the population 65 years of age and over increased
    45 percent, the population under 5 years increased 63 percent. This
    has many implications for health, welfare, and education programs
    for children and youth.
    The Bureau Continues Its Program
    The Children’s Bureau operates under two mandates. The first,
    to investigate and report “upon all matters pertaining to the welfare
    of children and child life among all classes of our people” comes
    from the 1912 act creating the Bureau. The second, the responsibility
    of making grants to States to extend and improve services for promoting
    the health and welfare of children, especially in rural areas
    and in areas of special need, is contained in the Social Security Act.
    Since its personnel and budget are limited, the Bureau must be
    selective in what it does for children, focusing its efforts upon the
    greatest needs and in areas where its own contribution will multiply
    through help to public and private agencies.
    RESEARCH
    For more than 40 years the Bureau has been gathering facts about
    children and ways of caring for them. Because it has had to be
    selective, the main target of its investigations has been the plight
    of disadvantaged children: babies who die in infancy; children who
    are beyond the reach of good health services; infants born to unmarried
    mothers; children who have lost their parents or whose parents
    are unable to carry responsibility for them; juvenile delinquents;
    crippled and handicapped children.
    The pressure on the Bureau for more and more facts has grown
    with the years. A multitude of questions and problems have come
    out of service programs—and these are becoming more difficult to
    answer as people become more sensitive to children’s emotional needs.
    ADMINISTRATION OF GRANTS UNDER THE SOCIAL SECURITY ACT
    In fiscal 1953, grants payments totaling $31.5 million were made
    to the States. A State’s share in this money is worked out by various
    specified formulas intended to channel relatively larger sums to States
    with the largest rural child populations. Of the $31.5 million paid
    50 Department of Health, Education, and Welfare, 1953
    to States, $13.3 million was for maternal and child health activities,
    $11.8 million for the medical care of crippled children, and $6.4
    million for child welfare services.
    To take full advantage of the Federal money for these services, each
    State must pay part of the costs of these services. States use some
    of the unmatched funds for maternal and child health and crippled
    children’s services for projects and demonstrations that have special
    significance for the region in which the State is located and often
    for the whole Nation. Because of the broad provision in the Social
    Security Act, States have a great deal of leeway in planning for the
    use of these funds, and the programs vary widely from State to State.
    The total amounts of State and local funds made available are much
    greater than the Federal sums received.
    COOPERATING WITH VOLUNTARY ORGANIZATIONS
    An effective program of health and welfare services for children
    must rest upon the solid foundation of many people and many agencies
    working together. This report includes many examples of how State
    and local health and welfare departments and workers in child health
    and child welfare are cooperating with voluntary agencies.
    The Bureau works closely with many national voluntary agencies
    in behalf of children. These organizations run the gamut from civic
    organizations, such as the General Federation of Women’s Clubs and
    the American Legion, to professional organizations, such as the
    American Association of Social Workers and the American Academy
    of Pediatrics.
    New Emphasis in 1953
    Children in this country are on the whole making gains but some
    groups—juvenile delinquents, mentally retarded children, and children
    in migrant families—seem to be in special jeopardy. There are
    others, of course, but in 1953 the Bureau gave special attention to
    studying the situation affecting these groups.
    JUVENILE DELINQUENTS
    An estimated 350,000 boys and girls came to the attention of the
    juvenile courts of the country in 1951 because of delinquent behavior.
    For the courts reporting to the Children’s Bureau, a 17 percent increase
    occurred in the number appearing before these courts between 1948
    and 1951. Although figures for 1952 are not yet complete, those available
    show that the increase from 1951 will be around 10 percent. This
    increase is occurring in less densely populated areas as well as in big
    cities. The 1951 figures from courts serving jurisdictions of less than
    Social Security Administration 51
    100,000 show a 29 percent increase over the 1948 figures compared with
    the 17 percent for the country as a whole.
    During the year a number of significant developments on a national
    basis occurred in activities relating to juvenile delinquency programs.
    The United States Senate authorized a Senate Committee to study the
    extent, character, and causes of juvenile delinquency and the adequacy
    of the existing provisions of law dealing with delinquents and youthful
    offenders.
    A Special Juvenile Delinquency Project, financed by various foundations
    and others interested in the problem, was initiated in July
    1952. The staff of this Project have cooperated with the Children’s
    Bureau in its juvenile delinquency program. The Project’s purpose is
    to focus public concern on the problems of juvenile delinquency and to
    stimulate action leading to the improvement of services for delinquent
    youth.
    Early in the year the Project and the Bureau sponsored five meetings
    with representatives of about 90 national organizations to discuss
    the problem of juvenile delinquency and ways in which the organizations
    and their local affiliates might cooperate with the Bureau in a
    solution. The groups represented health and welfare agencies, educational
    organizations, and civic groups. One meeting was with representatives
    of the major national organizations directly concerned with
    controlling j uvenile delinquency or with child welfare. These included
    the American Public Welfare Association; the Administrative Office
    of the United States Courts; the Bureau of Prisons, Department of
    Justice; Child Welfare League of America; International Association
    of Chiefs of Police; National Association of Training Schools and
    Juvenile Agencies; National Council of Juvenile Court Judges; National
    Midcentury Committee for Children and Youth; National Probation
    and Parole Association; and the Osborne Association. The
    Bureau of Public Assistance, the National Institute of Mental Health,
    and the Office of Education also participated.
    The Project has worked with the Bureau in formulating a series of
    guides to practices in the treatment of delinquent children. These
    include recommended guides or standards for training schools, juvenile
    courts, police work with juveniles, and the training of personnel for
    work in the delinquency field. Specialists from many parts of the
    country have worked together on these guides. The Project also prepared
    a series of pamphlets on juvenile delinquency and made them
    available for publication by the Children’s Bureau. These were
    planned particularly for use by national and local organizations and
    other groups in stimulating action and support for better services.
    The National Probation and Parole Association has established an
    Advisory Council of Judges with a criminal courts section and a ju52
    Department of Health, Education, and Welfare, 1953
    venile and domestic relations courts section. This Council will develop
    standards for these courts, foster a public education program, and
    work to improve probation and related services. A step toward the
    development of a single strong membership organization in the training
    school field occurred with the merger of the National Association
    of Training Schools and the National Conference of Juvenile Agencies.
    The Louisiana Department of Public Welfare has made juvenile
    probation services available on a State-wide basis. The National
    Probation and Parole Association is studying juvenile delinquency in
    New Mexico and detention in California. In Texas and Oklahoma
    the child welfare divisions are assigning staff to the training schools
    for casework service. The Governor of Puerto Rico appointed a
    special commission to study juvenile delinquency.
    Virtually all agencies serving delinquent children and youth are
    experiencing a sharply increased workload. The majority of training
    schools for delinquent youth are serving numbers in excess of
    normal capacity. Caseloads of probation and aftercare personnel
    have increased. Police officers require better training in their work
    with juveniles.
    MENTALLY RETARDED CHILDREN
    Each year the Bureau receives many requests for help with problems
    growing out of mental retardation in children. Bureau consultants
    on group care and training schools have been asked for
    consultation on the standards and plans for group care in institutions
    for mentally retarded children and youth. The Bureau’s regional
    staff also have been receiving many requests for information and consultation
    from a variety of community groups planning for mentally
    retarded children.
    Consultation is also requested on program planning, standards of
    care, and licensing of facilities for such retarded children. Many institutions,
    recognizing that custodial care is not sufficient, are reevaluating
    their programs. Requests for consultation are received as
    to the best plans for treatment, training, and rehabilitation of children
    in the institution.
    Many State training schools for delinquent youth, institutions for
    dependent, neglected, and emotionally disturbed children, have problems
    in planning for mentally retarded children committed to the
    institutions. They are asking about the possibility of using foster
    family or special group care for certain of them.
    It is estimated that about 1 person per 100 is mentally defective and
    that about 750,000 children of school age are of very low intelligence.
    Educators are giving much attention to these children’s needs but their
    problems go beyond schooling. The extension and improvement of
    health and welfare services for children are greatly needed.
    Social Security Administration 53
    Parents’ groups in local communities are becoming more outspoken
    about what they want for mentally retarded children and are taking
    leadership in attempts to get better facilities, training, and treatment
    programs.
    Grant-in-aid funds for child welfare services are being used for
    social services and foster care for mentally retarded children. Some
    workers paid from funds for child welfare services are giving help to
    families with mentally retarded children.
    Although for some children and some families, institutional placement
    for the child seems the best solution, the emphasis is on keeping
    the child in his own family and community. Many more children
    could develop best at home if the community offered educational opportunities
    and help to the family and the child through casework and
    counseling services.
    Institutions for the mentally retarded child cannot meet the present
    demands for institutionalization—particularly for young children and
    those in families with low or moderate incomes. Frequently all types
    of services—health, education, social welfare, and training—are
    inferior.
    Welfare federations and community councils have established
    special committees to study the problem. State and local interagency
    committees have been established in a number of States. All these
    developments make mental retardation one of the crucial problems
    with which the Nation must deal.
    CHILDREN IN MIGRANT FAMILIES
    Children of migratory agricultural laborers have been the concern
    of the Children’s Bureau for a long time. No group faces greater
    jeopardy.
    The President’s Commission and numerous surveys and studies have
    produced volumes of evidence on their low economic status, poor housing,
    and lack of educational opportunity, medical care, day care, recreation,
    etc. Many other children lack these things too but the migrant
    has the added disadvantage that nobody feels responsible for him.
    His is an “inter-State” problem.
    As the stream of migrants moves each year from south to north following
    the ripening of the crops, it passes into and through one State
    after another. No one State feels that it can take the responsibility
    for the health, welfare, and education of the children. Somehow,
    States have to work out joint plans for sharing responsibility.
    Through the Interdepartmental Committee on Children and Youth,
    the Bureau is already working closely with other Federal agencies
    concerned with the problems of migrants. States often call on regional
    representatives and special consultants in the Bureau for help
    with the problems of these children.
    54 Department of Health, Education, and Welfare, 1953
    If efforts to improve the situation for these families are to be effective,
    not only must the several agencies involved within a community
    and a State work together, but States must learn to work together
    cooperatively. Spots where community action has been successful
    must be studied—and the benefit of this experience brought to other
    communities and other States.
    State and local health and welfare departments, which have the
    basic organization to do the job, should take responsibility for administering
    health and welfare services for migrants. Migrants should
    not be set off from the rest of the population, but should participate in
    all community services as much as possible.
    One of the basic handicaps in providing help for migrants is that
    the areas through which they move lack local health units or child welfare
    services or school facilities for the children during the school season.
    For this reason, States and communities must strengthen local
    health units, have child welfare workers in key places, and plan for
    adequate school facilities. Since both the parents and the older children
    in these families usually work, young children are often left on
    their own. A few States provide some day care service, but this type
    of care is sparse indeed.
    Research
    During 1952, as reported last year, the Bureau analyzed its past
    research, examined its present activities, and decided that its studies
    should focus (1) on children whose health and welfare are in jeopardy
    and (2) on the social, psychological, economic, and health conditions
    that put children in this position.
    Within the broad scope of a projected research program, the Bureau
    had to decide where to start and what problems to choose for study
    now and in the near future. The following criteria for selection of
    subjects were determined upon:
    The problem should be one that involves a large number of children or affects
    a small number seriously.
    The problem should be of nationwide importance; findings from the study,
    even though a local one, should be widely applicable.
    The problem should have implications for both health and welfare activities
    relating to children.
    The investigation should call for the kinds of contacts, the access to data, or
    the coordination of the contributions of various organizations that a Federal
    agency is in a strategic position to secure.
    The investigation should deal with some aspect of the work to which grantsin-
    aid are made by the Bureau.
    The investigation should deal with a question not adequately studied by other
    organizations, governmental or private.
    Th© Bureau decided to concentrate its research efforts on evaluating
    how well the child health and welfare programs and activities that are
    Social Security Administration 55
    supported by Federal, State, and local funds achieve their purposes
    and whether children, parents, and the public generally are well served
    by them.
    Carrying on such evaluative studies is a huge and long-range task,
    involving many organizations and agencies. With its present small
    research staff, the Bureau can not undertake large-scale studies of its
    own, but it can arouse interest in others in this kind of study, promote
    common planning, coordinate the efforts of widely scattered research
    workers, and give a certain amount of consultative service. Certain
    parts of the evaluative job, especially the development of methodology,
    the Bureau can do.
    The following evaluative studies were under way in the Bureau
    during 1953:
    1. A review and analysis of evaluative studies in health, welfare, and other
    fields, and the preparation of a report on methods of conducting such
    investigations.
    2. A pilot study, conducted in the metropolitan Washington area, to evaluate
    practices of social agencies with respect to the age at which they place infants
    for adoption.
    3. A study to test several methods for determining a community’s need for day
    caro services.
    4. An analysis of findings of a “vision-testing study,” conducted by the Bureau
    in cooperation with several other agencies, to determine the relative effectiveness
    of various methods of screening school children for defective vision.
    5. A review and analysis of studies evaluating the results of programs aimed
    at reducing delinquency.
    6. A compilation of available information about the health and welfare of
    the children of migrant agricultural workers—to serve as a base for further
    evaluation of what is needed.
    During the year, the Bureau collected and analyzed statistics on
    various health and welfare services for children, and gathered together
    and presented statistical data about adoptions and juvenile delinquency
    and various aspects of maternal and childhood mortality. The findings
    of some of these studies are presented in other sections of this
    report. Through the Clearinghouse for Research in Child Life, the
    Bureau also collects and publishes reports of continuing research
    projects so that investigators may know of other studies in their area
    of special interest.
    The Bureau Works With the States
    Because of its responsibility to study and observe and to keep abreast
    of current knowledge on matters relating to child health and welfare
    programs, the Bureau brings to State agencies a Nation-wide picture
    of children’s programs and receives from them current information
    on their own programs.
    56 Department of Health, Education, and Welfare, 1953
    THROUGH ITS ADVISORY AND CONSULTATION WORK
    Many child health and welfare agencies turn to the Bureau for
    help and advice in planning for and strengthening their services. The
    Bureau receives many more requests for this help than its small staff
    can meet within the limitations of travel funds and staff time.
    Field consultation is provided, at the request of State and local
    public and voluntary agencies and community groups, on the methods
    and techniques of providing services, administration and program
    planning, research and studies of the needs of children and the effectiveness
    of programs, staff development, training, professional education,
    State legislation, and community and public interpretation of
    the needs of children.
    THROUGH GATHERING INFORMATION ON PROGRAMS
    Reports from State agencies indicate a general upward trend in
    maternal and child health services since the end of World War II.
    Although there were decreases in several of the services provided in
    1952, compared with the preceding year, most of the drops were slight.
    The principal decreases occurred in medical and nursing service for
    mothers and in nursing services for infants. Other health services
    continued on their upward course.
    Chart 9.—MORE MOTHERS AND CHILDREN ARE GETTING HEALTH SERVICES
    State and local maternal and child health programs, calendar years 1943—52
    Social Security Administration 57
    In 1952, 181,000 mothers attended prenatal clinics, 8,000 fewer than
    the peak year, 1951. Most medical services provided by State agencies
    to children reached their highest levels. Almost 436,000 infants, 8
    percent more than in 1951, were brought to well-child clinics. Clinic
    service was provided for 578,000 other children below school age. In
    all, 258,000 women were given antepartum nursing service through
    647,000 home and office visits. Nursing service in homes and in health
    departments was given to 688,000 infants and 749,000 children below
    school age, slightly fewer than in 1951; and to 2,533,000 school
    children.
    Some 238,000 children are estimated to have received physicians’
    services in 1952 under State crippled children’s programs, aided by
    Federal grants. The 4 percent increase from 1951 in the number of
    children served continues an upward trend begun in 1943. Hospital
    and convalescent home care accounted for a major portion of expenditures
    under the programs; 43,000 children received 1,360,000 days of
    in-patient care in hospitals, and 4,900 children had 473,000 days of
    care in convalescent homes—representing an average hospital stay of
    about a month and an average convalescent-home stay of a little over 3
    months per child. In addition, 191,000 children received clinic service,
    an average of about two visits each. More than half of those served in
    1952 had congenital malformations, diseases of the bones and organs
    of movement, or poliomyelitis.
    Under the child welfare program in 1953, more than a quarter of a
    million children (260,000) were reported as receiving casework services
    from State and local departments of welfare in the 53 jurisdictions.
    In three States not reporting completely, an additional 24,000
    children were probably receiving services. In the 50 States reporting
    completely for the final quarter of 1952, 41 percent of the children were
    living with parents or other relatives, 42 percent in foster family
    homes, and 17 percent in children’s institutions or elsewhere.
    Statistics for the fiscal year ending June 30, 1952, showed 4,866
    State and local employees devoting full time to the public child welfare
    program, 5 percent more than during the preceding year. In the
    past 6 years, the number of full-time child welfare personnel increased
    65 percent. Fifty percent (1,599) of the 3,187 counties of the United
    States are receiving service from full-time child welfare caseworkers
    assigned exclusively to one county or serving several counties.
    The States Are at Work for Children
    The grant-in-aid programs for maternal and child health, crippled
    children, and child welfare under the Social Security Act help the
    States carry out their objectives for children and the day-by-day prO-
    293171—54—5
    58 Department of Health, Education, and Welfare, 1953
    grams for their care. They provide States with an opportunity to
    extend, improve, and strengthen their services to children.
    MATERNAL AND CHILD HEALTH SERVICES
    As infant mortality has declined and the leading causes of infant
    deaths have changed, States have increased their work for newborn
    infants, particularly those born prematurely. The majority of States
    during 1952 continued their assistance to hospitals in improving their
    1 acilities and services for the newborn by enabling nurses and physicians
    to secure additional training in the care of newborn and premature
    infants and through special studies.
    Interest in the possibilities of preventing fetal deaths and premature
    births has increased. North Carolina, the District of Columbia,
    and West Virginia started studies of fetal wastage. During the past
    year, studies of infant deaths, limited almost exclusively to the neonatal
    group, made considerable progress. The Chicago health department
    made a report showing progress in preventing needless neonatal
    deaths during the last 14 years.
    The University of Colorado Medical School has begun to code all
    available data on premature infants cared for in the premature center,
    a method that will make it possible to relate all aspects of prematurity
    and of premature care to illness, abnormalities, or complications of
    pregnancy occurring in the mother. The Colorado State Health
    Department and the University of Colorado are making a study in
    Leadville and Lake County on the effect that living at high altitudes
    has on the incidence of prematurity. A certificate of fetal death has
    been developed from which the State can get considerable information
    as to cause of death. Tulane University completed a study on the nursing
    care of premature infants.
    Studies of infant mortality show that many counties in the Southwestern
    and Southeastern States still have high infant mortality rates.
    But such high rates are not limited to the South; even the Midwestern
    States with low average rates have counties with very high
    rates.
    Of unusual interest is the study being made at the Harvard School
    of Public Health by Dr. Gerald Caplan, who is attempting to develop
    a method of screening mothers bringing their infants to the child
    health conference so as to identify those who have or may develop
    emotional problems in relation to their infants.
    Of importance to the further development of school health services
    were the conferences held during the year by inter-agency State committees.
    For example, two inter-agency workshops were held in Oklahoma.
    A school health conference in Williamstown, Massachusetts,
    included representatives of the State education and health departments
    and the medical and dental associations.
    Social Security Administration 59
    Despite problems of budgets and recruiting, State agencies have
    increased the size of their nutrition staffs somewhat even though fewer
    nutritionists are being trained each year than could be placed. About
    200 nutritionists are employed by State health departments; 16 departments
    employ a full-time dietary consultant, and at least three
    employ more than one such worker. An encouraging trend has been
    the increase in the number of local health departments, chiefly in large
    metropolitan areas, that employ one or more nutritionists. They now
    number 35.
    SERVICES FOR CRIPPLED CHILDREN
    State crippled children’s agencies are continuing to broaden their
    programs to include more kinds of handicapping conditions and are
    experimenting with new types of services.
    Chart 10.—MORE CHILDREN ARE GETTING CRIPPLED CHILDREN’S SERVICES
    State and local programs for crippled children, calendar years 1943—52
    A notable example of this is the development of the regional congenital
    heart disease program to provide care for children with congenital
    heart disease in a center equipped to diagnose and treat
    children from neighboring States that do not have expert medicalsurgical
    services of this type. The program now includes centers in
    Baltimore, Chicago, Dallas, and San Francisco. The great interest in
    60 Department of Health, Education, and Welfare, 1953
    these developments has led to improved hospital facilities and staffs for
    these children in many States. The number of States including congenital
    heart disease in their crippled children’s programs has also
    increased markedly.
    One of the interesting developments in the past few years is the
    concept that the care of the child who has a cleft palate can best be
    carried out through the team approach. The special project at the
    University of Illinois has served to advance this concept. In New
    York two new centers were established, one in Buffalo, one in New
    York City. Through a joint project of the Alabama State crippled
    children’s agency and the University of Alabama’s dental school and
    speech department, a team is providing services to children in Alabama.
    Regular clinics attended by the plastic surgeons, dental
    specialists, faculty members from the University speech department,
    and staff members of the State agency are held to examine, evaluate,
    and plan treatment programs.
    In the District of Columbia, North Carolina, and West Virginia,
    health departments are developing special services for the health
    supervision of the increasing number of premature infants who are
    blinded by retrolental fibroplasia.
    Chart 11.—SERVICES FOR CRIPPLED CHILDREN COVER WIDE RANGE OF CONDITIONS
    Children with orthopedic conditions predominate but the number of children with other
    diagnoses is increasing
    Social Security Administration 61
    More States are developing services for children who have congenital
    or acquired amputations. For example, 68 children found on
    Virginia’s active list, for whom nothing had been done, are now receiving
    the necessary services. The following specialists are involved:
    orthopedist, pediatrician, surgeon, prosthetist (brace and prosthesis
    maker), occupational therapist, physical therapist, and engineer, if
    available. In Michigan, approximately 300 children received training
    in the use of artificial limbs under the amputee training program
    for crippled children.
    In Colorado the State health department furnishes physical therapy
    equipment to rural hospitals and physical therapy treatment centers
    in local health departments. The local chapters of the National
    Society for Crippled Children and Adults, the hospitals, and the
    National Foundation for Infantile Paralysis underwrite the therapists’
    salaries; the State furnishes medical direction and physical
    therapy consultation.
    Some expansion occurred in hearing conservation programs. Plans
    were developed for pilot programs in Louisiana and New Mexico.
    In South Dakota, special project funds have enabled the State agency
    to initiate and expand a hearing conservation program. In Tennessee
    the speech and hearing program received major emphasis during the
    year. A full staff of speech and hearing technicians was employed
    and assigned to the five crippled children’s treatment areas in the
    State. Any child with a hearing loss receives complete diagnostic
    services and, if indicated, treatment to improve or arrest the condition.
    During 1952, 725 children received medical, surgical, and other
    treatment services. Many of the treatment services which are not
    available under the official program can be obtained for children
    through the Speech and Hearing Foundation, a private organization.
    CHILD WELFARE SERVICES
    Social services to children in their own homes are directed toward
    helping parents and children to live happily and responsibly with each
    other, with their neighbors, and with other people in the community.
    Institutes on services to children in their own homes were held at
    regional conferences of the Child Welfare League of America and
    the American Association of Social Workers. Special institutes or
    workgroups for State and local public welfare staffs were conducted
    in several States. A number of national organizations and State conferences
    of social work included this topic in their meetings.
    Interest in protective services for children who are neglected or
    abused has continued, with some indication of a trend toward including
    them in a total program of services for children in their own
    homes. Institutes on protective services have been included in regional
    62 Department of Health, Education, and Welfare, 1953
    conferences of both the Child Welfare League of America and the
    American Public Welfare Association. Representatives of the American
    Humane Association met again this year with representatives of
    the Children’s Bureau, the Child Welfare League of America, and the
    National Probation and Parole Association.
    The interest of both public and voluntary agencies in establishing
    homemaker service programs continues to increase. According to
    the latest information, 88 agencies in 66 cities provide homemaker
    service, 15 under public and the rest under voluntary auspices. Homemaker
    service programs receiving assistance from Federal child welfare
    services funds have continued in Colorado, North Carolina, and
    Hamilton County, Ohio.
    The State public welfare agencies have continued their efforts to
    extend and strengthen services to unmarried mothers. Studies of such
    services were undertaken in Birmingham, Chicago, and Milwaukee,
    in Portland, Maine, and in Minnesota.
    In many parts of the country, group care programs for children
    are moving away from the large isolated congregate institutions toward
    small apartment or cottage units with close access to community
    services. Four services, all given by trained staff, are emerging: indi- 7 c5 *7 7 c? c5 vidual casework for children and parents; constructive group life for
    children; clinical services; and remedial education services. Group
    homes, serving about 7 to 12 children, are being used on an experimental
    basis for special groups, such as dependent adolescents ami
    emotionally disturbed children. Residential treatment centers for
    emotionally disturbed children are being developed in many communities.
    Subsidized foster family homes are used increasingly for
    emergency shelter care.
    The latest statistics available to the Children’s Bureau—those for
    1951-52—show about 170,000 children in foster family homes supervised
    by child welfare agencies. About 125,000 of these were in
    boarding homes; 32,000 in adoptive homes; and 13,000, usually older
    youths, in free, work, or wage homes. Almost 70 percent of these
    children were receiving services from public agencies. Case reviews
    or studies in several States show the need for an evaluation of the
    quality of care provided in foster family homes.
    About 80,000 adoption petitions, the Bureau estimated, were filed in
    the United States in 1951. This was more than double the estimated
    number filed in 1944. Some 48 percent of these children were adopted
    by nonrelated persons. In nearly half of these cases, the children were
    placed in the adoptive home independently, without the aid of a social
    agency.
    Most of the children adopted were young—the median age being 3.3
    years; about two-fifths were under 2. In the independent placements
    Social Security Administration 63
    more than half of the children were less than a month old, which means
    that many were placed directly from the hospital or shortly thereafter.
    In contrast, only 11 percent of the children placed through agencies
    were under one month of age.
    Half the adopted children are born out of wedlock. This group of
    children, most of whom are adopted by nonrelatives, are the ones most
    vulnerable to “black” or “gray” market practices.
    Chart 12.—SOME CHILDREN DO NOT GET ADEQUATE CHILD WELFARE SERVICES
    3 IN 10 CHILDREN LIVE IN COUNTIES
    WHICH ARE WITHOUT THE SERVICES OF
    A FULL-TIME CHILD WELFARE WORKER
    Data for 1952
    THESE CHILDREN LIVE IN
    COUNTIES WHICH HAVE
    WORKERS PAID FROM
    FEDERAL, STATE,AND
    LOCAL FUNDS
    I THESE CHILDREN LIVE
    ■ IN COUNTIES WHICH
    J HAVE ONLY WORKERS
    I PAID FROM FEDERAL
    FUNDS
    The gap between needs and resources for group care for special
    groups of children is of grave concern to planning bodies and parents
    seeking services for their children. At least a dozen metropolitan and
    county areas report unused institutional facilities for dependent children
    and lack of such facilities for physically, mentally and emotionally
    handicapped children, dependent adolescents, and children in minority
    groups. Additional day care facilities for children of employed
    mothers are still needed in various parts of the country.
    The Bureau and the States Work Together in Training
    Workers
    If services for children are to be of value, they must be manned by
    competent workers. But the demand for these workers far exceeds
    the supply. For this reason, States are investing a substantial part of
    their funds to increase the number of skilled workers through special64
    Department of Health, Education, and Welfare, 1953
    ized courses in training centers, on-the-job staff development programs,
    work groups and institutes, and stipends for advanced training
    of staff members.
    CHILD HEALTH
    The increased demand for professional personnel in child health has
    speeded the development of training facilities for specialists in
    nursing, medical social work, physical therapy, and nutrition. During
    the year State agencies developed more opportunities for advanced
    training in special fields relating to the care of children. States also
    have recognized the importance of integrating better understanding
    of the emotional needs of the child into the basic training courses for
    professional workers as well as into graduate work, by providing funds
    for this purpose as well as grants for training programs.
    This year, for the first time, the States provided fellowships for
    physicians taking master of public health degrees at Harvard, North
    Carolina, Johns Hopkins, and the University of California. With the
    funds available, only one fellowship could be provided each school.
    Training programs in the medical specialties relating to maternal and
    child health and crippled children’s services continued to make an important
    contribution to the development of new programs. This was
    particularly true of funds for fellowships granted for training in rheumatic
    fever, epilepsy, and audiology.
    A development with great potentialities for the State programs is
    the increased interest on the part of medical schools in finding ways to
    teach “comprehensive medicine” to medical students. The medical student,
    assigned to a family as a “health adviser,” follows this family
    throughout his four years. Physicians and medical social workers
    work closely together in supervising these students through formal
    conferences, and classroom instruction. Prenatal clinics and wellbaby
    clinics are the major sources of families in this plan.
    The University of California School of Public Health has added
    faculty members in nutrition, medical social work, and nursing, completing
    the academic team for the course in maternal and child health.
    New schools of physical therapy have been opened at the University of
    Connecticut, the Charity Hospital, New Orleans, the University of
    Michigan, and Baylor University. Two of these offer 4-year degree
    courses; the other certificate courses.
    Advanced programs for nurses in maternity and pediatrics are being
    integrated into an over-all program of maternal and child care, including
    the care of crippled children. Boston and Syracuse Universities
    are planning to employ nutritionists full time in their schools of nursing
    next year. Boston University and the University of Cincinnati
    have developed seminars, including a social worker, nutritionists, pediatrician,
    and child psychiatrist, where nursing students have an opporSocial
    Security Administration 65
    tunity to participate in case discussions during their field work. An
    experiment in extended field practice in maternity nursing is being
    carried on at Johns Hopkins Hospital in cooperation with Teachers
    College, Columbia University. The Department of Maternal and
    Child Health at the Harvard School of Public Health gave a 2-week institute
    for nurses on child growth and development in November.
    The New York Hospital Premature Infant Care Institute provides
    an outstanding course for physicians and nurses. The University of
    Colorado’s 4-week course in prematurity for nurses offered during the
    winter and spring quarters had more applicants than could be handled
    and had to be repeated in May. The School of Medicine and the State
    health department conducted a 2^ day postgraduate course for physicians
    on prematurity. The premature center at Jackson Memorial
    Hospital in Miami offered nurses in the State 2 weeks of intensive
    training in the care of premature infants.
    Short courses for physicians in obstetrics and pediatrics (including
    prematurity) were held at the universities of Iowa, Nebraska, and
    Kansas. State health departments sponsored numerous institutes and
    workshops covering many aspects of maternal and child health and
    crippled children’s services, including group feeding of children in
    institutions, maternity nursing, implications of hospitalization for
    children, care of the polio patient, prematurity, school health services.
    CHILD WELFARE
    The program of educational leave for professional training for child
    welfare personnel has remained steady.
    During the year the Children’s Bureau and the Bureau of Public
    Assistance introduced to the States an annual reporting plan coveringindividuals
    granted educational leave by public welfare agencies. Reports
    from nearly all participating States show that more than 500
    persons connected with the public child welfare program were on educational
    leave that terminated during the year ended August 31, 1952.
    The majority were taking their first year of graduate social work;
    some were completing their second year. Most of these persons received
    agency stipends from Federal child welfare services funds.
    Steady progress has been made in expanding staff development
    programs for child welfare personnel. States vary in the programs
    offered, which range from some plan for staff development to welldefined,
    comprehensive programs with one or more staff development
    supervisors or consultants. The public welfare agencies continue to
    use work groups, institutes, attendance at conferences, and observational
    visits as media for staff development. Many of the institutes
    and workshops are open to personnel from voluntary agencies.
    Joint activities between the public child welfare agencies and the
    schools of social work increased. Agency-school committees were es66
    Department of Health, Education, and Welfare, 1953
    tablished to consider educational leave, selection of staff, development
    of teaching materials, and other topics. The Children’s Bureau and
    the Child Welfare League of America are working together on a report
    on the content of child welfare material for use by schools of social
    work in planning the curriculum and for teaching purposes. Interest
    is growing in strengthening the criteria used in the selection
    of staff and developing, under the merit system, a selection process
    that includes the assessment of personal qualities. During the year,
    schools of social work developed a Nation-wide plan to establish a
    pool of interviewers for selection of students.
    Training of personnel for work in the correctional field is receiving
    increased attention. During the year, the Bureau called together
    leaders in social work for a 2-day meeting to develop a program for
    such training.
    Interdepartmental Committee on Children and Youth
    The Interdepartmental Committee on Children and Youth has completed
    its fifth year of activity. This Committee is an advisory body
    with members from departments, agencies, and bureaus whose work
    relates to children and youth.
    Since the Midcentury White House Conference on Children and
    Youth, the Interdepartmental Committee on Children and Youth has
    had a liaison relationship with the National Midcentury Committee for
    Children and Youth and its two Advisory Councils. The affairs of
    the National Midcentury Committee were wound up in 1953 and this
    link to the State committees and national organizations was gone.
    The Interdepartmental Committee worked out an agreement for a
    working relationship of “mutual assistance” with one of the advisory
    councils, the National Advisory Council on State and Local Action
    for Children and Youth.
    A 2-day seminar on services to children of migratory agricultural
    workers held in November 1952 developed a plan of action focussed on
    preparation of materials useful to local communities. Among other
    areas considered by the Committee were juvenile delinquency, care of
    American and American-related children outside the United States,
    and research in the Federal Government on problems of child life.
    The Bureau’s International Activities
    The international work of the Bureau is of three kinds, all of which
    were represented in the activities during the past year. They are (1)
    recruitment and assignment of child welfare and child health
    specialists for projects in other countries through the Department of
    State’s Point Four program for technical assistance (now in the
    Social Security Administration 67
    Foreign Operations Administration); (2) planning for trainees coming
    from other countries to study child health and child welfare and
    for foreign visitors; and (3) work with the United Nations, the UN
    International Children’s Emergency Fund, and the World Health
    Organization.
    During the year, 15 professional people were working abroad, five
    in child welfare and 10 in maternal and child health. The maternal
    and child health workers included two physicians, six nurses, and two
    medical social workers. The Bureau provides these workers with
    technical advice and help on their programs, and the workers make
    technical reports to the Bureau.
    One new development this year was recruiting and assigning a team
    of four specialists—a pediatrician, two nurse-midwives, and a pediatric
    nurse—for a maternal and child health demonstration and teaching
    project in rural Iraq which will provide training for physicians,
    nurses, nurse-aides, and midwives. In addition, a medical social
    worker went to Panama to develop medical social services in the Children’s
    Hospital, and a child welfare worker went on a short-term
    assignment to El Salvador, to consult on children’s institutions.
    The Bureau also carried responsibility for programs of observation
    and study in this country for 67 long-term trainees and 264 shortterm
    visitors. The long-term trainees came through the United Nations
    Secretariat, World Health Organization, Mutual Security
    Administration, Point Four, the leaders program of the Department
    of State, and private sources. Thirty-four of the long-term trainees
    were in the field of health; and 33 were in child welfare. They came
    from 30 countries.
    The Chief of the Bureau serves under a Presidential appointment
    as representative of the United States on the Executive Board of the
    International Children’s Emergency Fund.
    Federal Credit Unions
    Federal credit unions are voluntary, democratically controlled associations
    organized under provisions of the Federal Credit Union Act
    to “promote thrift among their members and create a source of credit
    for provident and productive purposes.” Any group of 100 or more
    persons who have a community of interest based on common employment,
    membership in an association (such as a church or labor union),
    or residence may apply for a Federal credit union charter. If the
    group is found to be eligible, a charter is granted by the Bureau of
    Federal Credit Unions. The Bureau provides manuals and instructions
    for newly chartered Federal credit unions and examines and
    supervises them after they are established.
    68 Department of Health, Education, and Welfare, 1953
    Each Federal credit union is operated by a group of officials elected
    by and from the membership; each is required by the terms of its
    charter to limit its thrift and loan services to the group specifically
    defined in its charter and bylaws.
    At the end of June 1953, Federal credit unions were operating in
    every State and in the District of Columbia, Alaska, Hawaii, the Canal
    Zone, Puerto Rico, and the Virgin Islands. Of the 6,316 in operation,
    5,251 were serving employee groups, 915 were serving associational
    groups, and 150 were serving residential groups. Their total assets
    amounted to $753.1 million, of which $502.9 million was outstanding
    in loans to 1.4 million members. The total potential membership of
    those in operation was 7.2 million and actual membership was 3.1 million.
    Average savings per member in Federal credit unions as of
    June 30, 1953, was $221. Federal credit unions had average assets of
    $119,238 and an average membership of 489 on that date.
    During the fiscal year 1953 the number of operating Federal credit
    unions increased 654; their total assets increased $184.0 million, and
    their membership increased 419,060. Growth in numbers of Federal
    credit unions, as well as in their activity in terms of thrift promotion
    and loans to members, has been particularly marked since 1948. Their
    assets have more than doubled in the past 3 years.
    Program Operations
    During the fiscal year 1952 the Bureau had a budgeted staff of 155
    positions—21 departmental and 134 field; during the fiscal year 1953
    it had a budgeted staff of 211—23 departmental and 188 field. The
    substantial increase in the field staff was made up primarily of examiners,
    whose number nearly doubled in the first half of the fiscal year.
    This increase was one step in the plan to make the Bureau self-supporting
    from fees collected from Federal credit unions.
    In the period July through October 1952, when most of the new
    examiners were being trained, the number of examinations completed
    and examination fees collected were substantially below the average
    for the year. During the rest of the fiscal year, the number of examinations
    and revenue from this phase of the Bureau’s program increased
    each month as the new examiners and the senior examiners
    who were their trainers got into full production. By the end of
    December, 2,458 examinations were completed as compared with 3,077
    during the second half of the fiscal year. The total of 5,535 was’the
    largest number of Federal credit unions examined in any year since
    the program started. Of this number, 102 were final examinations of
    Federal credit unions that had completed liquidation, and 69 were
    examinations made in cases of suspected or actual defalcations. Of
    Social Security Administration 69
    the Federal credit unions chartered prior to the end of 1952, 5,051 or
    84 percent were examined in the 1953 fiscal year.
    Examinations in cases of suspected or actual defalcations accounted
    for 1.2 percent of the total number of examinations made during the
    year, but the time devoted to them accounted for 8.2 percent of total
    field examiner time on examinations. In the preceding fiscal year,
    such examinations accounted for 1.7 percent of the total number of
    examinations and 10 percent of total examination time.
    In the year ended June 30, 1953, 814 Federal credit union charters
    were approved. This was the largest number of new charters in any
    12-month period since 1936; it has been exceeded only twice since the
    Federal Credit Union Act was passed in 1934—in 1935 with 828 and
    in 1936 with 956. The increase in the tempo of chartering Federal
    credit unions is attributed to the high level of economic activity in
    the country and to the Nation-wide advertising program sponsored
    and financed by the Credit Union National Association. Of the 814
    charters granted in the fiscal year 1953, 680 resulted from applications
    prepared by volunteers and employees of State and national
    credit union organizations. The remaining 134 were issued on the
    basis of charter applications prepared with the direct assistance of
    Bureau personnel. Field examiners devoted approximately one percent
    of their official work time to the chartering phase of the Bureau’s
    program during the year.
    A particularly significant development in the administration of
    the Federal Credit Union Act culminated during the fiscal year.
    Through a series of increases in the examination fee schedule, beginning
    in April 1949, revenue from this source increased until it now
    covers approximately the total cost of the examination program.
    Before April 1949, each Federal credit union paid an examination fee
    of 25 cents per $100 of assets or $25.72 per examiner day, whichever
    was lower, with a minimum charge of $2.50. Since July 1951, when
    the latest increase became effective, the fees paid have been computed
    at 50 cents per $100 of assets or $56 per examiner day, whichever is
    lower, with a minimum of $5.00 per examination. The total revenue
    from the 5,535 examinations made during the fiscal year 1953 was
    $861,990, as compared with $556,736 received from 3,999 examinations
    during the preceding fiscal year. Revenue from the new annual supervision
    fee schedule, which became effective through an amendment of
    the Federal Credit Union Act in April 1952, amounted to $200,128.
    Under the schedule previously in effect—an annual fee of $10 per Federal
    credit unit regardless of size—revenue from this source would
    have been $54,490. From charter fees the Bureau obtained $20,775.
    Total fee revenue deposited during the fiscal year 1953 amounted to
    $1,110,252, as compared with a total of $644,294 in the fiscal year 1952.
    70 Department of Health, Education, and Welfare, 1953
    In addition, the Bureau had an appropriation of $200,000 to help
    finance its total operations. The Bureau’s budget for the fiscal year
    1954, however, contains no appropriation. Thus the plan to make
    the Bureau self-supporting from fees collected from Federal credit
    unions was accomplished in 4 years, between April 1949 and June
    1953.
    In the fiscal year 1954, the Bureau will have the use of a workingcapital
    loan of $250,000 from the United States Treasury. This loan
    must be repaid with interest over a period of 10 years beginning in the
    fiscal year 1956. The long-range budget planning for the Bureau contemplates
    the repayment of the loan and the building of a revolving
    working-fund reserve to replace the borrowed capital within the prescribed
    period. It is estimated that revenue from fees during the fiscal
    year 1954 will total $1,373,555. This estimate is based on the assumption
    that the staff of field examiners will be increased and examination
    work will continue to be the major emphasis of the Bureau.
    Strengthening Credit Unions
    Federal credit unions have grown in size and numbers far beyond
    tlie most optimistic expectations of those who helped draft the law.
    At the end of June 1953, there were 285 Federal credit unions with
    assets in excess of $500,000 each. In recent years it has become apparent
    that certain revisions should be made in the law so that larger Federal
    credit unions will have greater flexibility in their administrative
    operations. A comprehensive plan for revision will be preferable to
    a series of changes over a period of time. The determination of the
    provisions of the law which need to be revised, as well as the nature of
    changes best suited to the present-day needs of Federal credit unions,
    should be based on the consensus of credit union officials, representatives
    of the organized credit union movement, and members of the
    Bureau’s staff. It is hoped that the exploratory and developmental
    work already under way can be completed within the near future.
    Since central agencies to provide funds for credit unions in those
    cases where members’ demand for loans exceeds available capital may
    be important to the future development of the credit union movement,
    the Bureau believes that every effort should be made to obtain evidence
    from all interested groups within the credit union movement as
    to the need for such agencies and the type of organizational structure
    that will most effectively serve the need.
    For more than 10 years, the question of insuring members’ shareholdings
    (savings) in their Federal credit unions has been discussed.
    During this period several bills designed to provide such insurance
    have been introduced in Congress. Two such bills were introduced
    Social Security Administration 71
    following the discovery of large defalcations in Federal credit unions,
    one in Pennsylvania during 1951 and one in Maryland during 1953.
    Federal credit unions are now the only federally chartered institutions
    accepting savings or deposits that are not insured by a governmental
    instrumentality or otherwise guaranteed by the Federal
    government.
    There is a difference of opinion among credit union leaders as to
    whether insurance of savings in credit unions would be desirable. The
    opponents of this type of insurance contend that insured credit unions
    would be required to adopt more restrictive loan policies; that chartering
    policies would be made more restrictive through the influence the
    insurance agency would exert on the agency that grants credit union
    charters; that insurance would be too expensive; and that insurance
    against losses would encourage credit union officials to be lax in carrying
    out their management responsibilities. Those who favor insurance
    contend that losses on loans and operations in the past would not warrant
    the imposition of unduly restrictive regulations and that the cost
    of the insurance would be more than offset by increased participation
    by members who would have more confidence in an insured credit
    union. The proponents also point out that the quality of management
    of insured banks and insured savings and loan associations has not declined
    in the nearly 20 years they have had insurance of deposits and
    savings accounts.
    72 Department of Health, Education, and Welfare, 1953
    Table 1.—Social Security Administration: Funds available and obligations
    incurred, fiscal years 1953 and 1952 1
    [In thousands; data as of June 30,1953]
    Item
    Funds availablei 2 3 * Obligations incurred
    1953 1952 1953 1952
    Total____ ___ _ __ - $1,435,928 $1, 245, 841 $1,434,457 $1, 267, 017
    Grants to States______________ ________________ _ _____ 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
    1,181, 500
    1,150, 000
    1,150,000
    31, 500
    12, 524
    11,386
    7, 590
    64,341
    331
    59, 927
    1,653
    1,585
    845
    1,367, 571
    1,338,989
    f 903,241
    J 33,017
    1 343,321
    [ 59,410
    28, 582
    12, 729
    11,482
    4,371
    66,886
    291
    62,332
    1,576
    1,532
    1,155
    1, 202, 886
    1,171,387
    801.137
    29, 205
    301, 979
    39,066
    31,499
    12, 523
    11,386
    7, 590
    64,131
    330
    59, 727
    1,648
    1,581
    845
    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 <________________________
    Bureau of Old-Age and Survivors Insurance 5 6 *______
    Bureau of Public Assistance_________________________
    Children’s Bureau 9_________________________________
    Bureau of Federal Credit Unions____________________
    i 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.
    < Appropriations by Congress from general revenues accounted for approximately 65 percent of the
    administrative expenses of the Office of the Commissioner in 1952, and approximately 63 percent of such
    expenses in 1953; balance from old-age and survivors insurance trust fund.
    6 For administration of the old-age and survivors insurance program which involved benefit payments
    of $1,982,000,000 in 1952 and $2,627,000,000 in 1953.
    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.
    Social Security Administration 73
    Table 2.—Financing social insurance under the Social Security Act: Contributions
    collected and trust fund operations, fiscal years 1951—53
    [In millions]
    Item 1953 1952 1951
    Contributions collected under:
    Federal Insurance Contributions Act1_________________________ $4,097 $3, 594 $3,120
    Federal Unemployment Tax Act2_____________________________ 276 259 234
    State unemployment insurance laws 3 4________________________ 1,368 1,432 1,365
    Old-age and survivors insurance trust fund:
    Receipts, total_________________________________________________ 4, 483 3, 932 3, 411
    Transfers and appropriations 5_____________________________ 4,097 3, 598 3,124
    Interest and profits on investments________________________ 387 334 278
    Expenditures, total____________________________________________ 2, 717 2,067 1, 569
    Monthly benefits and lump-sum payments 6----------------------- 2,627 1,982 1,498
    Administration 7___________________________________________ 89 85 70
    Assets, end of year_____________________________________________ 18, 366 16, 600 14, 736
    State accounts in the unemployment trust fund:
    Receipts, total_________________________________________________ 1,555 1,606 1, 510
    Deposits 4__________________________________________________ 1,371 1,439 1,363
    Interest... .. _____ ... _ _________ ____ ..._______ _____ 184 167 148
    Withdrawal for benefit payments______________________________ 913 1,000 848
    Assets, end of year_____________________________________________ 8, 563 7,920 7,314
    1 Contributions paid by employers and employees on wages up to and including $3,000 a year through
    Dec. 31,1950, and up to and including $3,600 a year beginning Jan. 1,1951: 1H percent each. Contributions
    paid by the self-employed on Income earned after Jan. 1,1951, up to and including $3,600 a year: 2J4 percent.
    Includes deposits by States under voluntary agreements for coverage of State and local employees beginning
    May 1951.
    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 State experience-
    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; corrected to Aug. 1953.
    4 Contributions and deposits by States usually differ slightly, primarily because of time lag in making
    deposits.
    5 Includes amounts collected under the Federal Insurance Contributions Act and transfers from the
    general fund of $3,694,000 for fiscal year 1951, and $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; beginning May 1951, includes deposits by States under voluntary agreements
    for coverage of State and local employees.
    6 Represents checks issued.
    r Data do not reflect actual expenses in the respective years because of bookkeeping adjustments.
    Source: Compiled from Daily Statement of the U. S. Treasury and State agency reports.
    293171 — 54----- 6
    74 Department of Health, Education, and Welfare, 1953
    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 1953 and 1952
    [In thousands, except for average benefit; data corrected to Nov. 12,1953]
    1 Benefits of children were being withheld.
    Family classification of beneficiaries in
    current-payment status
    June 30,1953 June 30,1952
    Number
    of
    families
    Number
    of
    beneficiaries
    Average
    monthly
    amount
    per
    family
    Number
    of
    families
    Number
    of
    beneficiaries
    Average
    monthly
    amount
    per
    family
    Total _ ________ 4,009.1 5,573. 6 3,278. 4 4, 593.8
    Retired worker families - -__ ____- - - -- 2, 977. 5 3,887. 6 2, 372. 3 3,109.8
    Worker only___ _______ __ 2,137. 7 2,137. 7 $48. 20 1,691.4 1,691.4 $40.10
    Male _ - 1, 443.1 1,443.1 52.10 1,194.1 R 194.1 43.20
    Female. _ . ... __ ' 694. 6 ' 694. 6 40.10 497.3 ' 497. 3 32.80
    Worker and wife aged 65 or over________ 781. 6 1, 563. 2 83.60 633.5 1,267.0 70.10
    Worker and wife under age 65 1 _ _ - - - . 6 1.2 93. 50 . 5 1. 0 61.00
    Worker and aged dependent husband____ 5.6 11.2 74.00 3.4 6.8 62.10
    Worker and 1 child.. . _____________ 7.8 15.6 75.30 7.5 15.0 62. 00
    Worker and 2 or more children ... . 5.4 18.9 82. 40 5.1 17.5 69. 50
    Worker, wife aged 65 or over, and 1 or more .9 2.9 98.10 .8 2.5 79. 50
    children.
    Worker, wife under age 65, and 1 child----- 24.4 73.2 92.80 19.5 58.5 77. 40
    Worker, wife under age 65 and 2 or more 13.5 63.7 87. 60 10.6 50.1 70. 30
    children.
    Survivor families - - - - - -- -___ -- 1,031.6 1, 686.0 906.1 1,484. 0
    Aged widow. ... . _ __ __ 498.1 498.1 40.80 421.1 421.1 36. 00
    Aged dependent widower . . __ _ .6 .6 33. 90 .4 .4 30.00
    Widowed mother only 1 ._ ... 2.9 2.9 43.40 3.5 3.5 35. 80
    Widowed mother and 1 child 109.2 218.4 88. 30 95.3 190.6 77. 60
    Widowed mother and 2 children 71. 9 215. 7 108. 80 63.3 189. 9 93.80
    Widowed mother and 3 or more children.. 60.9 286.1 104.80 52.0 242.8 91.90
    Divorced wife and 1 or more children____ .2 .5 101. 50 .2 .5 92. 90
    1 child only___ _____ ____ 160.3 160.3 41.80 152.9 152.9 36.10
    2 children __ . . ___ ....... 64.4 128.8 71.30 57.8 115.6 61.20
    3 children 22.7 68.1 86. 90 20.3 60.9 78.10
    4 or more children ... . ... 19. 5 84.0 90. 90 20.2 85.2 80.70
    1 aged dependent parent-------------------------- 19.3 19.3 42. 00 17.6 17.6 36.80
    2 aged dependent parents________________ 1.6 3.2 81.40 1.5 3.0 71.50
    Social Security Administration 75
    [In thousands, except for average taxable earnings; data corrected to Sept. 29,1953]
    Table 4.—Old-age and survivors insurance: Selected data on benefits, employers,
    workers, and taxable earnings, by State, for specified periods, 1951—53
    State
    Monthly benefits
    in current-payment
    status, end
    of fiscal year 1953 1
    Payments certified, fiscal
    year 1953 1
    Employers
    reporting
    taxable
    wages,
    July-
    September
    1952 1 2
    Calendar year 1951
    Workers
    with
    taxable
    earnings
    3
    Amount of taxable
    earnings 4 5
    Number
    Amount Total Monthly
    benefits
    Lumpsum
    payments
    Total
    Average
    per
    worker
    Total_______ 5, 573. 6 $232,999 $2, 748,099 $2, 671,831 $76,268 3,630 58,000 $120,110, 000 $2,071
    Alabama _ - 82.0 2, 729 32, 560 31, 554 1,006 50 870 1,357,000 1, 560
    Alaska 2.9 109 1,289 1,247 42 3 60 ' 113' 000 1', 883
    Arizona 23.8 924 10,932 10, 613 319 17 250 380,000 L 520
    Arkansas 46.0 1,497 17', 593 17,135 458 30 500 621,000 1,242
    California ___ 454.3 19,632 230,886 224, 973 5,913 283 4,620 9,694, 000 2,098
    Colorado 45.4 1'803 21'218 20, 671 547 36 540 850, 000 1'574
    Connecticut______ 98.0 4,666 55.019 53,600 1,419 57 1,050 2,383,000 2,270
    Delaware 12.9 556 6, 585 6, 392 193 10 170 295,000 1,735
    District of Columbia
    - ______ 20.9 868 10,305 9,962 343 27 510 871,000 1,708
    Florida- -__ - 131. 0 5,400 62,908 61, 468 1,440 81 1, 040 1,508,000 1' 450
    Georgia - - 82.8 2,715 32,474 31' 334 1,140 70 1,210 1, 788,000 1,478
    Hawaii ___ ____ 13.1 485 5, 684 5, 582 ' 102 9 190 349, 000 1'837
    Idaho ______ 17. 5 641 7^532 1, 330 202 14 220 364,000 1, 655
    Illinois - 341.0 15,154 179,272 173,857 5,415 222 4,200 8,994,000 2, 141
    Indiana _____ 160. 9 6,669 78, 519 76, 375 2,144 85 1, 770 3, 588,000 2,027
    Iowa - _____ 78. 7 3,006 35; 087 34,219 868 72 840 1, 501,000 1,787
    Kansas 56. 7 2,141 25,082 24, 391 691 47 620 962,000 1, 552
    Kentucky_____ _ 88.5 3^ 120 36, 912 35, 907 1,005 50 810 1,417,000 1,749
    Louisiana -__ - 65. 5 2,307 27, 550 26,632 918 53 820 1, 352,000 1' 649
    Maine____________ 49.2 L 964 23,006 22, 520 486 24 370 584,000 L578
    Maryland________ 76.7 3,201 38,170 36,863 1,307 59 950 1, 730,000 1,821
    Massachusetts.----- 251.4 11,464 134,785 131, 549 3,236 117 2,150 4,247,000 1,975
    Michigan-------------- 246.6 11,167 131,217 127, 576 3,641 136 2,870 6,695,000 2,333
    Minnesota.----------- 94.6 3,866 45,321 44,129 1,192 69 1,030 1, 760,000 1,709
    Mississippi_______ 37.7 1,140 13, 596 13,138 458 31 460 552,000 1,200
    M issouri 139. 8 5, 670 66,805 64, 768 2, 037 94 1, 640 3,010, 000 1,835
    Montana_________ 18.7 739 8,736 8j 465 '271 17 210 360, 000 1,714
    Nebraska_________ 33.6 1,261 14, 750 14, 332 418 34 450 728,000 1,618
    Nevada..-------------- 5.6 233 2, 746 2, 667 79 5 80 123,000 1, 538
    New Hampshire... 29.8 1,251 14,698 14, 336 362 16 260 459,000 1,765
    New Jersey----------- 217.8 10,078 119, 309 115, 721 3,588 132 2,260 4,828, 000 2,136
    New Mexico._____ 13.6 445 5, 289 5,132 157 15 190 266,000 1,400
    New York________ 637.1 28, 581 337,160 327, 741 9, 419 466 7,500 16,146,000 2,153
    North Carolina___ 93.3 3,099 36, 991 35,816 1,175 70 1,330 1,979,000 1,488
    North Dakota____ 9.4 326 3,813 3,699 114 13 140 188,000 1,343
    Ohio ...__ 340.0 14, 978 176, 952 171, 924 5, 028 178 3, 760 8,112,000 2,157
    Oklahoma________ 58.8 2' 122 25', 004 24,289 ' 715 45 '730 1,303,000 1,785
    Oregon___________ 71.2 2, 988 34,992 34,206 786 43 660 1,250, 000 1,894
    Pennsylvania_____ 474.0 21,116 250,080 243,038 7,042 228 4,620 9, 713,000 2,102
    Puerto Rico. .. . 3.6 99 1,092 1,048 44 16 240 184, 000 767
    Rhode Island-------- 42.7 1,935 22,689 22, 211 478 19 400 744, 000 1,860
    South Carolina___ 48.5 1,535 18, 398 17, 732 666 40 660 1,036,000 1,570
    South Dakota____ 12.2 435 5,104 4,960 144 16 180 245,000 1,361
    Tennessee.__ ___ 82.7 2,805 33, 312 32, 308 1,004 62 1, 050 1, 673, 000 1, 593
    Texas 178.0 6,350 75,444 73,017 2, 427 192 2,860 4, 750,000 1, 661
    Utah _ _ _ 20.3 784 9, 294 9' 027 267 13 220 390,000 1, 773
    Vermont 16. 5 658 i, 721 7, 540 181 11 150 260,000 1,733
    Virginia. 90. 7 3, 314 39, 322 38,116 1,206 70 1,110 1, 785, 000 1, 608
    Virgin Islands____ .1 2 20 20 (’) (6) (6) (6) (6)
    Washington . 107.8 4,658 54, 508 53,333 1,175 55 980 1, 916, 000 1, 955
    West Virginia___.. 82.0 3,179 37, 614 36, 738 876 33 680 1,298, 000 1,909
    W isconsin_____ __ 130. 7 5, 530 64, 977 63,165 1,812 87 1, 390 2, 928,000 2,106
    Wyoming ______ 7.3 288 3,397 3, 297 100 8 140 204,000 1,457
    Foreign7 . . 30.1 1,317 IL 380 14i 168 212 (8) 40 81,000 2, 025
    Maritime9 _____ (8) 70 194,000 2, 771
    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 Less than $500.
    6 Too few workers in sample to give sufficiently reliable estimates.
    7 Benefit 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 in a business operated by
    an American employer.
    8 Data not available.
    8 Relates to employment of officers and crews of American vessels.
    76 Department of Health, Education, and Welfare, 1953
    Table 5.—Old-age and survivors insurance: Selected data on benefits, employers,
    workers, and taxable earnings for specified periods, 1951—53
    [Corrected to April 30,1954]
    Item
    Benefits in current-payment status (end of period):
    Number___________________________________________
    Old-age________________________________________
    Wife’s or husband’s____________________________
    Child’s________________________________________
    Widow’s or widower’s_________________________
    Mother’s______________________________________
    Parent’s_______________________________________
    Total monthly amount____________________________
    Old-age_______ _________________________________
    Wife’s or husband’s____________________________
    Child’s________________________________________
    Widow’s or widower’s_________________________
    Mother’s_______________________________________
    Parent’s_______________________________________
    Average monthly amount:
    Old-age________________________________________
    Wife’s or husband’s____________________________
    Child’s________________________________________
    Widow’s or widower’s_________________________
    Mother’s_______________________________________
    Parent’s_______________________________________
    Payments certified during period:
    Monthly benefits__________________________________
    Old-age________________________________________
    Supplementary________________________________
    Survivor_______________________________________
    Lump-sum payments______________________________
    Estimated number of living workers with wage credits
    (midpoint of period-Jan. I):1
    Total______________________________________________
    Fully insured__________________________________
    Currently but not fully insured________________
    Uninsured_____________________________________
    Estimated number of employers reporting taxable
    wages, 1st quarter fiscal year_______________________
    Estimated number of workers with taxable earnings
    (in thousands)_______________________________________
    Estimated amount of taxable earnings (in millions)____
    Average taxable earnings_______________________________
    1953 1952 1951
    Fiscal year
    5, 573,594 4, 593,801 4,033, 583
    2,977,476 2,372,308 2,090, 668
    826, 599 668,297 596,098
    1,003,281 896, 820 787,311
    498,967 421,730 350,343
    244,809 214,030 192, 357
    22,462 20, 616 16,806
    $232, 998,645 $161, 739, 397 $143,708, 778
    $150,124,169 $99, 591, 517 $89,000,025
    $22,050,253 $15,169, 588 $13,674,014
    $30, 540, 694 $24,008,878 $21,282,368
    $20,332,424 $15,161, 777 $12,683.323
    $9,014,935 $7,053,163 $6, 452,784
    $936,170 $754,475 $616, 264
    $50.42 $41.98 $42. 57
    $26,68 $22.70 $22.94
    $30.44 $26.77 $27.03
    $40. 75 $35.95 $36.20
    $36.82 $32.95 $33. 55
    $41.68 $36.60 $36.67
    $2, 671,830,603 $1, 976,302,716 $1,564, 557,990
    $1,706, 768,787 $1, 221, 993,921 $961, 559, 867
    $265,681,059 $198,803,036 $159, 616,144
    $699,380,757 $555, 505, 759 $443, 381,979
    $76,267,982 $58,270,100 $45,473, 616
    90, 500,000 87, 800,000 82, 500,000
    66, 600,000 62, 600,000 59,800,000
    (1 2) (2) (2)
    24,000,000 25,200,000 22,700,000
    3,630,000 3,635,000 2, 768,000
    Calendar year
    (3) 60,000 58,000
    (3) $128,000 $120,110
    (3) $2,133 $2,071
    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.
    3 Not available.
    Social Security Administration 77
    Table 6.—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 1953 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___________ $13,299.9 $6, 582.3 $6,717.6 $11,814.8 $5,691.9 $6,122.9 $6,388.4
    Alabama---------------------------------- 506.3 140.5 365.8 454.2 130.1 324.1 243.9
    Alaska________________________
    Arizona_____________________ -
    112.6
    136.0
    51.6
    70.0
    61.0
    66.0
    169.7 50.2 119.5 35.6
    50.8
    Arkansas__________________ _ 272.4 97.9 174.5 342.0 97.6 244.4 181.2
    California--------------------------------- 515.7 317.4 198.3 375.5 256.5 119.0 228.0
    Colorado______________________ 207.9 83.9 124.0 109.7 77.4 32.3 75.0
    Connecticut----------------------------- 142.5 92.7 49.8 175.8 86.8 89.0 70.1
    Delaware_____________________ 92.1 55.8 36.3 45.8 26.4 19.4 41.5
    District of Columbia---------------- 172.7 69.5 103.2 151.2 60.7 90.5 30.8
    Florida________________________ 279.3 115.6 163.7 220.3 106.3 114.0 107.3
    Georgia_______________________ 492.7 150.3 342.4 449.9 137.1 312.8 153.2
    Hawaii________________________ 153.0 63.3 89.7 151.9 60.4 91.5 34.6
    Idaho_________________________ 91.6 65.3 26.3 84.9 62.7 22.2 21.6
    Illinois________________________ 327.7 255.9 71.8 328.8 214.3 114.5 178.6
    Indiana_______________________ 262.6 151.3 111.3 131.9 95.7 36.2 76.9
    Iowa__________________________ 123.8 118.8 5.0 262.2 105.8 156.4 160.6
    Kansas________________________ 143.5 95.9 47.6 136.5 88.9 47.6 116.4
    Kentucky-------------------------------- 402.7 131.5 271.2 413.2 122.5 290.7 245.4
    Lousiana______________________ 347.1 130.8 216.3 288.6 116.3 172.3 179.4
    Maine_________________________ 104.2 71.8 32.4 91.0 68.3 22.7 76.2
    Maryland-------------------------------- 374.9 106.7 268.2 292.2 98.2 194.0 85.7
    Massachusetts________________ 316.2 152.9 163.3 209.8 140.5 69.3 91.6
    Michigan_____________________ 401.5 220.6 180.9 409.1 189.9 219.2 223.7
    Minnesota____________________ 231.1 129.0 102.1 218.3 115.0 103.3 162.3
    Mississippi------------------------------- 375.3 120.8 254.5 277.3 108.4 168.9 227.1
    Missouri______________________ 254.8 141.5 113.3 306.1 130.0 176.1 180.3
    Montana______________________ 113.7 64.6 49.1 128.6 61.3 67.3 65.7
    Nebraska_____________________ 94.5 72.5 22.0 89.0 60.4 28.6 21.5
    Nevada_______________________ 73.8 53.6 20.2 70.9 48.9 22.0 32.6
    New Hampshire---------------------- 79.4 58.8 20.6 100.1 58.9 41.2 51.9
    New Jersey___________________ 179.7 155.0 24.7 146.5 140.1 6.4 72.4
    New Mexico__________________ 111.3 71.5 39.8 100.5 66.5 34.0 73.2
    New York____________________ 466.3 379.1 87.2 354.3 327.3 27.0 118.3
    North Carolina________________ 622.9 166.4 456.5 328.5 156.8 171.7 337.5
    North Dakota-------------------------- 92.6 66.2 26.4 85.4 63.4 22.0 15.2
    Ohio__________________________ 441.4 256.1 185.3 413.9 215.2 198.7 95.1
    Oklahoma_____________________ 184.5 102.4 82.1 291.2 100.8 190.4 150.0
    Oregon________________________ 112.7 86.5 26.2 118.2 80.2 38.0 53.7
    Pennsylvania_________________ 526.9 294.7 232.2 320.8 267.1 53.7 278.0
    Puerto Rico___________________ 400.9 141.9 259.0 373.9 123.3 250.6 195.7
    Rhode Island_________________ 95.9 65.8 30.1 74.9 37.5 37.4 41.6
    South Carolina------------------------- 267.8 112.1 155.7 258.3 57.9 200.4 109.5
    South Dakota_________________ 83.3 65.7 17.6 91.1 63.4 27.7 76.6
    Tennessee_____________________ 520.6 138.9 381.7 383.8 129.9 253.9 241.8
    Texas_________________________ 609.2 270.2 339.0 611.4 232.2 379.2 244.6 Utah__________________________ 120.7 71.0 49.7 117.1 66.3 50.8 61.3
    Vermont______________________ 87.6 57.9 29.7 100.0 56.3 43.7 55.4
    Virgin Islands_________________ 79.2 48.7 30.5 79.5 48.4 31.1 32.2
    Virginia_______________________ 362.4 139.0 223.4 375.2 127.0 248.2 167.1
    Washington___________________ 193.0 109.9 83.1 149.8 97.9 51.9 116.8
    West Virginia____ _____________ 237.0 105.5 131.5 210.9 100.0 110.9 189.3 Wisconsin_____________________ 192.8 138.9 53.9 288.1 123.8 164.3 180.7 Wyoming_____________________ 109.6 88.1 21.5 57.0 35.1 21.9 32.9
    1 Based on checks issued.
    Table 7.— Special types of public assistance under plans approved by the Social Security Administration: Number o f recipients and
    average payment, June 1953, and total payments to recipients, by program and State, fiscal year 1953
    [Includes vendor paym ents for medical care an d cases receiving only such paym ents]
    [Corrected to Oct. 16, 1953]
    78 Department of Health, Education, and Welfare, 1953
    en tly and
    )led
    ©
    co
    pi ,ients
    T otal,
    fiscal year
    (in th o u sands)
    $1,472, 544
    1,487,605
    1,581,052
    21, 340
    1,122
    8,935
    20, 720
    225,042
    50,036
    14,210
    771
    1,689
    33, 277
    39, 708
    956
    5, 792
    72,611
    21,831
    30,950
    24,683
    22, 491
    73,643
    7,158
    L-age assist!
    P aym
    recip
    Average
    paym ent,
    June
    $44. 39
    47.11
    51.08
    27.50
    58.13
    55. 53
    32. 25
    69.39
    78.70
    76.40
    38.39
    54.07
    43.36
    36.56
    38.56
    54.39
    53.83
    44.96
    56.85
    61.58
    35.17
    51.19
    46.25
    O
    N um b er
    of recipients,
    June
    2, 748,827
    2,670,165
    2,608,898
    68,190
    1,642
    13,889
    56,205
    271,116
    52,243
    15, 293
    1,709
    2,705
    66, 562
    95,021
    2,036
    9,063
    106, 502 ,
    40,142
    45, 531
    36,363
    55, 478
    119, 733
    13,175
    S tate
    Fiscal year:
    1951_________________
    1952_________________
    1953_________________
    i i i i i i । । ।
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    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 I 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 1 1 1 1
    1 1 1 1 1 1 ' p* (£ 1 ' ! 1 1 J 1 d 1
    2o § cs 2 §
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    Social Security Administration 79
    WOOrH
    ■ ■« S§™™82
    ! r-T l ! rH r-7 gT of CO of r-T *O r-7 of
    : gjs
    1 Includes as recipients the children an d 1 p aren t or o th er a d u lt relative in families in 2 No approved plan in operation,
    which the requirem ents of a t least 1 a d u lt were considered in determ ining the am o u n t 3 Average p aym en t n o t computed on base of less than 50 recipients,
    of assistance.
    sss
    ss’s
    :§S§ : is SSSS3S8SS8 382
    338 2 2828828^?“ 8SS
    i
    1
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    35S82 SS8
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    r-t r-t <-T Cf ■*■ cl cf Cf Os' H co
    88228838 8 S82882883S 8223S8S 23 sss
    sasdsssses S3S38S223^ S8323S3£S2 g’sd
    |^S880§Sg §§^§228838 §§S
    _~WWCO*CO~ CO'cf U5*rf W CO® w r?rt
    ™3§S8£ g Sgggg^cSgg gS8328§323 823
    wogtCafro^cfef^rf ® -*cf -frf cfro >*cfro~ ^■ro'cfcf^” “’S 22
    SS8S2288 8 238382K8;S§ S8828S28SS £32
    8883^28S££ £88283838” g?2822SS*28 383
    88383228 S 28ro3821o®®” 3588888288 332
    828288S8S3 228IS2SSS805 23S88S2288 S§|
    28825^0 2§§3883£8£ gggSs^sIs §33
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    iilsiili S ilismSSS §™§ss^ sis
    2283-^3282 s£“k£2" 88 83~
    BsBU g^sBifi Sgg|Sg|8^g §28
    ® moU^ocsTcU-'w .*®w®wcf£ro-rog ro~®cfa£cfw rf® tfoo
    ^igg^iOS ass
    -£3828^2-* 3-32-2228” ^jo^^^oro «g- ®^of
    SSS8^88S88 S38332S5S3 S55JSS82SS8 SSS
    SESSSS&iSSS? g^ggSSSS^’^ 2§S^8S<5S8§ SSS
    'hBgg^is oiggiima Ss^isii §§8
    28SS882S-- S22*S«88SSS rf^S2^ &~S 83^
    ill:
    jvLiuiiesuva______________
    Mississippi______________' M issouri________________ M o n tan a________________
    N eb rask a_______________ N ev ad a_________________
    New H am p sh ire ________
    New Jersey _____________
    New Mexico____________
    N ew Y ork______________
    N o rth C arolina_________ N o rth D ak o ta___________
    Ohio____________________
    Oklahom a_______________
    Oregon__________________ P en n sy lv an ia___________ P u erto Rieo __________
    R hode Islan d ___________
    South C arolina__________
    South D ak o ta___________
    :
    h
    1) QJ
    U ta h ____________________
    V erm ont________________
    Virgin Islan d s___________
    ;
    £
    W yom ing_______________
    80 Department of Health, Education, and Welfare, 1953
    tes and
    e pcrmay
    and
    lisabled
    Percent
    from
    Federal
    funds
    385 2 x S3 SsX§ 3 S
    1
    Table 8.— Special types o f public assistance under plans approved by the Social Security Administration: Federal grants to Sta
    total expenditures and percent from Federal funds, by program and State, fiscal year 1953
    [Includes vendor paym ents for medical care; am ounts in thousands; d ata corrected to October 16, 1953]
    E xpenditures for assistance an d adm in istratio n
    Aid to th
    nentl; to tally c
    Am ount
    § s ig.i |l8| g g Sgs I
    ci-cT-t 1
    Aid to the blind
    P ercent
    from
    Federal
    funds
    O 00
    333 SSSSSS5338 88X3
    Am ount
    gg?
    saS ci- -7 « roww THr-t W-tr-t
    Aid to dependent
    children
    P ercent
    from
    Federal
    funds
    00 o 05 sss
    OOOOO^iONOOQ NiOCOOCCO'OCl QO^H 00*0 00 05
    ggSfcSXsXSJS §S3333s3s3 S358
    Am ount
    ass
    P- or cfof ^c^oooo^^ oogo
    Old-age assistance
    P ercent
    from
    Federal
    funds
    SSS
    00 *Q r—< CO 00 (N Tt< 05 CO 00 CD 00 O 00 CO 00 CO 00 05 00 03 CO r-<
    sXXksssXss 83S833X833 5388
    Am ount
    -X «XX8
    F ederal grants to S tates 1
    Aid to
    th e p erm
    an en tly
    and
    to tally
    disabled
    $17,017
    45,165
    59,410
    1 s § s §§§ i
    Aid to
    the blind
    885
    Aid to dependent
    children
    ggsj
    I# to cfco-jococf -too tCci'rtt-rui'roN'o’cfof wToojgxf
    Old-age
    assistance
    gStf
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    Fiscal year:
    1951_________________________
    1952_________________________
    1953_________________________
    A lab am a____________________________
    A lask a_______________________
    Colorado____________________________
    C onnecticut_________________________
    D elaw are____________________________ D istrict of C o lum b ia________________ F lo rid a______________________________
    Georgia______________________________
    H aw aii______________________________ Id a h o _______________________________
    Illinois______________________________ In d ia n a ______
    I
    i !
    5g
    M ary lan d ___________________________
    M assachusetts_______________________
    M in n eso ta___________________________
    Social Security Administration 81
    i । 0 00 00 00 00 CO 04 0 r-< CD CO ■
    ■) ’*> S3383S33S8 383 i
    ,04 00 0 1-^ r- 04 IQ
    SS88S 533
    ‘ Based on checks issued; differ slightly from fiscal year expenditures from F ederal s P rogram approved M ay 25, 1953, effective w ith th e q u arter beginning April 1, 1953,
    funds reported b y States. w ith Federal participation in adm in istrativ e costs being available from April 1, 1953,
    a N o approved plan in operation. an d in assistance paym ents from M ay 1, 1953.
    835 i i” mi^iggg 882 i
    1 : ww-gci cocowo.-^- N I
    gi«
    WOOHOO 04 r—< IQ 00 00 00 CD 00 © 0 CD^OH^OCODOCT 1Q 0 lQ
    338328 3838353338 3388853383 83S
    r-7 O4~ xF of of of o sSSr-fI COs S^IS 8r-s7 - r—1
    OOCOrHCQ 0 NcD0NCCCDcDHiQCD OHCOXOOO^OiOCM 0 b-
    3£S8£3 3832338333 3£32£388fd3 835
    §§3§ s §£§Bra s§g
    rfujNn€« NVjHNnfflfV^ ^coNcgNco on con
    ClCDrH’fCDO o 04 Xt< o 1Q 00 CD 00 CD 0 © CO CO 00 0 04 0 0 IQ Q
    £83883 5533588338 5238538823 £38
    3§§28S £^32838
    466 3,636 3,631 5
    Diseases and sanitation investigations
    and con trol A laska 1,107 1,090 17
    Salaries, expenses, and grants, National
    Heart Institute —55 11,945
    1,650
    11,398 547
    Dental health activities - ___ 1,595 55
    Engineering, sanitation, and Industrial
    hygiene _ 122 3,822 3,798 24
    Salaries’and expenses, hospital constrnotion
    services 12 6 1,218 1,206 12
    Working capital fund, narcotic bospitals
    - ______ - _________ 375 $19 394 365 29
    Service and supply fund __ __ _____ 1,069 40 1,109 1, 095 14
    Construction and research facilities 8,026
    27, 597
    20
    8,026
    102, 597
    3,052 4,974
    Grants for hospital construction____ 75,000 67,602 34,995
    Grants water pollution control 20 20
    Research facilities, national Institute
    of Dental "Research 13 11 24 24
    Grants to States, municipalities, etc.,
    for plan preparation, water pollution
    control - -_____ _______ 200 200 200
    Buildings and facilities, Cincinnati,
    Ohio -___ - - 300 —245 55 31 24
    Defense public works, community
    facilities, General Services Administration
    —52 41 -11 -11
    Operation of commissaries, narcotic
    hospitals _____ _ __ - __ - 226 7 233 224 9
    Salaries and expenses, bureau of prisons
    _ -- -______ ____ 1,304
    55
    9 1,313 1,311 2
    American sections, international commissions.
    State 55 55
    Salaries, expenses, and loans, displaced
    persons - __ -- ___ - 17 17 9 8
    Program "expenses, Europe, Mutual
    Security Agency - __ ____ 114 80 194 126 68
    Program expenses, Asia and Pacific,
    Mutual Security Agency - _ __ -199 629 430 388 42
    Administrative "expenses, Mutual
    Security Agency _ - ________ 54 54 44 10
    Working funds, PH S _________ 292 1 293 254 39
    Total ______ _ .. - - _______ 221,607 989 11,719 36,688 272,003 226,950 44,053
    1 Adjusted to eliminate unearned reimbursements.
    2 Does not include liquidating cash.
    293171—5' •11
    154 Department of Health, Education, and Welfare, 1953
    Table 2.— Commissioned officers and civil service personnel as of June 30, 1953
    Public Health Service 155
    I
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    =23^2^5” |
    1 Includes 1,265 R egular officers an d 1,291 Reserve officers.
    2 Excludes those p art-tim e employees n o t p aid during the m o n th of Ju n e 1953.
    a Includes 3,947 collaborating epidemiologists an d special agents.
    Im m ed iate Office of th e Chief________________________________________1 THxriairm AHminist.r9.fivo Monoromont
    HH
    ; ; : ;
    Hi! III
    ill
    I
    ;jjj
    iOQ[§£
    “3 •S'S'S
    ! § § § §
    D ivision of Occupational H e a lth _____________________________________
    D ivision of P u b lic H ealth E d u catio n ________________________________
    D ivision of P u b lic H ealth N u rsin g ___________________________________
    i 1
    i i
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    III
    ■S'S'S
    ggg
    555
    D ivision of W ater P o llu tio n C o n tro l_________________________________
    N atio n al Office of V ital S tatistics--------------------------------------------------------
    Arctic H ealth Kesearcn c e n te r______________________________________
    Com m unicable Disease C en ter______________________________________
    JCjJLL V ll U U U lU llL ill JCWcll Lil OC11LU1------------------------------------------------------------------------------------------
    Regional Offices_____________________________________________________
    D etails to other agencies----------------------------------------------------------------------
    N atio n al In stitu tes of H ealth --------------------------------------------------------------------
    Im m ed iate Office of th e D irecto r_____________________________________
    Office of th e D irecto r________________________________________________ N atio n al Cancer In stitu te ___________________________________________
    N atio n al H eart In stitu te _____________________________________________
    IN cl LI CHI ill AllbLILULU U1 AVI L illi Lio Cl 11 LI 1VJLU LCkWUllv JLA1OCCIOCO - _______________ N atio n al In stitu te of D en tal R esearch------------------------------------------------
    N atio n al In stitu te of M en tal H e a lth _________________________________
    NTn4-izvr>nl Tnc’fifiii-za r\f NTalirnlr-icrinal D ic n d c n c onH RlinHriOCQ
    N atio n al Microbiological In stitu te ___________________________________
    Division of Research G ran ts_________________________________________
    Clinical C en ter______________________________________________________
    :
    !
    2
    156 Department of Health, Education, and Welfare, 1953
    Table 3.—Payments for research grants, fellowships, and training stipends,
    fiscal year 1953
    State
    Research grants Research fellowships Training stipends
    Number Amount Number Amount Number Amount
    Alabama . __ ____.. ._ 14 $143,076 5 $18,349 1 $3, 675
    Arizona.______ _ ._____ 2 12', 800
    Arkansas _____ .... _. __ 5 31, 255 2 3,300
    California .. ___ 185 1,998,611 56 201, 284 75 166,405
    Colorado _ ___ . .... 25 ' 218i 934 34 66; 865
    Connecticut ___ . . 46 461, 556 32 94,332 28 62, 210
    District of Columbia ____ ______ 45 395;484 6 22; 781 43 95; 517
    Florida ____ _________ _ _ __ 22 177; 395 1 3; 248
    Georgia ______ __ ________ ___ 23 22< 776 3 10, 375 8 28,830
    Idaho_______ __ _ _ _______ 3 16; 536
    Illinois _______ ______ _ _____ 175 1, 602,380 38 130,440 60 133,240
    Indiana . _____ __ 18 ' 124; 207 6 12; 664 10 27,818
    Iowa ___ ______ . . .. 25 169', 282 6 23', 078 7 12; 000
    Kansas ___ _____ . ______ 38 311,741 4 14,340 18 44, 875
    Kentucky . . _____ _ . ____ 9 69; 365 2 7,040 8 15’, 934
    Louisiana ._ _ _ ._ ____ ________ 44 326', 740 1 4,000 24 52,250
    Maine __ _____ .. . _______ 13 188, 213 2 8; 627
    Maryland .. ________ .. 71 609', 499 20 76,382 26 76, 205
    Massachusetts _ ._ __ 229 2,747,894 82 304, 737 108 293,242
    Michigan .... 59 ' 571, 774 6 17,915 29 55, 018
    Minnesota ___ _ __________ 64 661', 559 8 23; 704 57 120; 708
    Mississinpi _________ .______ 1 10; 724
    Missouri . _________________ _ _. 53 497,196 13 53, 214 38 82, 684
    Montana. ____ ._ _ _ ________ 2 35', 000
    Nebraska _ . _______ . ____ 12 85,715 6 7,733
    New Jersey _ ..._______ .. 15 110 ', 611 1 6,000 2 4; 800
    New Mexico_________ . .. _____ 3 22; 258
    New York .. .. . . .. 354 3, 992,749 96 364, 838 139 358,120
    North Carolina ... 62 ' 516,822 16 547,81 34 73; 860
    North Dakota ____ _ _ __ 3 19; 538
    Ohio . ..... 100 991, 779 21 71,423 34 85, 533
    Oklahoma ___ __ ____ 16 133; 276 1 3; 600
    Oregon . _____ 15 92, 208
    Pennsylvania . . __________ 157 1,507; 896 32 107, 887 100 228,322
    Rhode Island . 11 54,893
    South Carolina__ _____ ____ 8 58, 834 2 6,825 2 7, 200
    South Dakota ... ___ 5 27,003 1 2,550
    Tennessee _______ 38 280,378 5 12,916 18 42, 355
    Texas..____ _ _ __ _ _ 42 305; 593 2 10; 309 10 22; 974
    Utah . ______________________ 27 273; 954 6 20,388 3 6; 567
    Vermont 6 59; 411
    Virginia __ _ 23 180, 522 5 17, 615 6 17, 600
    Washington . ______ _ 39 358, 544 12 40, 398 16 27; 648
    West Virginia ____ 1 4,000
    Wisconsin .. .. . 43 316; 569 16 42, 233 2 4,400
    Hawaii 2 lb 450
    Puerto Rico ____ 8 42; 425
    Research grants Research fellowships Training stipends
    Country
    Number Amount Number Amount Number Amount
    Africa .. _________ _ ___ 1 $3, 600
    Argentina ... _ ______ ___ 2 12; 500
    Australia. _____________ _____ . .. 1 $4,762
    Belgium 1 4; 534
    British Isles_____ ____ .. .. _______ 1 10, 000 16 69, 799 1 $3,600
    Canada. 6 64,882 5 22,497
    China (Formosa) __________________ 1 2; 986
    Denmark _ _ 4 21, 775 7 32, 689
    Finland . ..___ .. _ ___________ 1 3, 600
    France ... . ______ 3 26', 000 4 15,343
    Guatemala_________ 1 42, 700
    Israel . . ... . . . __ 1 15; 009
    Lebanon.._ _. . 1 2; 000
    Netherlands.. . _ _______ 2 10, 650
    Peru..__ ... . . 2 39, 600
    Sweden... __ _ . ___ ______ 5 22, 672
    Switzerland .. _ ___ _ L047
    U. S. Government institutions . 15 46; 321
    Total__________________________ 2,185 $21,297, 068 562 $2, 014,987 950 $2,235,088
    Public Health Service 157
    [In thousands]
    Table 4.—Payments to States, fiscal year 1953
    State
    Venereal
    disease
    control
    Tuberculosis
    control
    General
    health
    Mental
    health
    activities
    Heart
    disease
    control
    Cancer
    control
    Hospital
    survey
    and
    planning
    Hospital
    construction
    Other
    Total______________ 1 $7,166 $5, 300 2$13,537 $3, 050 $1,348 $2, 897 $98 $109,204 3 $1,113
    Alabama_________________ 301 126 400 72 47 73 7 3,026 _______
    Arizona__________________ 66 57 96 6 2 13— 819—
    Arkansas-------------------------- 146 88 252 33 25 50 4 3,191—
    California________________ 151 288 665 181 70 182— 4,020 4 58
    Colorado_________________ 46 44 128 26 18 32 506
    Connecticut_____________ 35 75 125 34 22 37 8 761 —
    Delaware________________ 1 / 20 23 20 12 6— 205—
    District of Columbia_____ 137 49 48 19 14 14— 411—
    Florida__________________ 418 114 266 58 34 59— 2,332
    Georgia---------------------------- 505 163 403 77 47 80— 3, 591 4119
    Idaho____________________ 36 17 76 20 15 18 _______ 28 _______
    Illinois___________________ 285 260 533 147 45 147— 5,731 4 103
    Indiana---------------------------- 103 104 293 64 29 68— 4, 922 4 181
    Iowa_____________________ 54 46 208 49 20 55 1,640—
    Kansas__________________ 36 56 170 34 25 38 2 1, 307—
    Kentucky------------------------ 194 14 / 345 66 42 71— 5, 093 —
    Louisiana________________ 432 106 297 57 29 57— 3, 412—
    Maine___________________ 15 29 97 18 5 21 4 192
    Maryland------------------------ 129 106 171 44 16 38— 1,139—
    Massachusetts___________ 46 172 313 88 35 95— 2, 481 —
    Michigan________________
    Minnesota_______________
    143
    25
    173
    71
    447
    247
    118
    57
    40
    29
    103
    53
    6 2,801
    3, 751
    —
    Mississippi---------------------- 396 120 340 55 41 65— 1,635
    Missouri_________________ 187 126 317 74 37 83 1,8 i 9—
    Montana________________ 18 22 68 20 15 17— 457—
    Nebraska________________ 26 31 128 14 11 26 2 907—
    Nevada---------------------------- 21 10 38 10 7 7— 87—
    New Hampshire_________ 12 16 50 20 11 1 84
    New Jersey______________ 79 134 309 90 38 73— 3, 213—
    New Mexico-------------------- 36 40 97 19 5 7— 543—
    New York_______________ 310 431 825 264 90 274 _______ 4,731
    North Carolina---------------- 319 155 473 81 32 60 5,057 4 129
    North Dakota___________ 25 37 75 20 15 18— 441
    Ohio-------------------------------- 179 230 550 151 61 149 9 4, 942 «6
    Oklahoma_______________ 101 82 223 46 29 46 6 699 31
    Oregon__________________ 26 48 138 28 14 21 — 836 31
    Pennsylvania____________ 242 270 756 201 78 184 28 5,359—
    Rhode Island____________ 15 29 56 20 16 3 321 —
    South Carolina---------------- 249 115 274 49 21 50— 2,475 4 420
    South Dakota____________ 18 23 77 19 11 11 1 528—
    Tennessee_______________ 215 154 354 68 42 55 _______ 4,288
    Texas____________________ 624 193 692 157 148 8 6,105 4 83
    Utah____________________ 17 18 86 19 9 16 2 423—
    Vermont_________________ 14 18 45 11 6 12 12— 2&3—
    Virginia_________________ 169 154 327 70 5 33 — 2, 295—
    Washington_____________ 30 67 172 44 26 43— 891 3 3
    West Virginia____________ 114 71 203 41 27 43— 4, 069
    Wisconsin_______________ 39
    Wyoming________________
    25
    15
    67
    12
    259
    49
    65
    7
    28
    5
    57
    11 1
    2, 088
    338
    Alaska___________________ 17 67 586 19 5 - 111 _______
    Hawaii__________________ 17 49 44 19 14 10— 381—
    Puerto Rico_____________ 316 191 317 42 35 51 6 2,409—
    Virgin Islands___________ 14 9 6 19 3 1 —
    1 Includes $2,528,312 in cash and $1,121,390 in services and supplies for rapid treatment facilities and
    special venereal disease projects. Does not include expenditures of federally operated center in Hot Springs,
    Arkansas.
    2 Includes payment of $537,000 from special appropriation for Alaska disease and sanitation investigation
    and control.
    3 This amount represents $1,093,193 for construction of community facilities in defense areas and $20,223
    for industrial waste studies. Excludes $2,500 paid to Interstate Commission on the Potomac River Basin
    for industrial waste studies.
    4 Payment for construction of community facilities in defense areas.
    5 Payment for industrial waste studies.
    ’ Vermont allotment paid to Vermont Heart Association.
    158 Department of Health, Education, and Welfare, 1953
    Table 5.—Number of nurses employed for public health work in the United
    States on January 1 of specified years, by type of employing agency
    Agency 1938 1943 1948 1953
    Total1________________ . _____________ _____________ 19, 502 20, 772 22, 605 25, 990
    State agencies _ _ _ . _________ 827
    8,702
    3, 887
    5,963
    886
    10, 731
    3,786
    5,156
    1, 003
    11,171
    5,019
    5,057
    133
    1,355
    12, 476
    2 6, 860
    4,512
    217
    87
    483
    Local official agencies. _ ________ _
    Local boards of education __ __ . ____
    Local nonofficial agencies___________
    Schools of nursing. ____ _____ __ ..____
    Colleges and universities (nonnursing)__
    National agencies and universities...__ ____ __ _ 123 213 222
    1 Excludes nurses employed by Industry.
    2 Includes District of Columbia school nurses for 1953 only.
    Office of Education
    I. Introduction
    THE YEAR 1953 was in many respects a landmark year for the
    Office of Education and for American education generally. With the
    creation on April 11, 1953, of the U. S. Department of Health, Education,
    and Welfare, the word “education” has come to appear for
    the first time in American history as a part of the title of a cabinetlevel
    department of the Federal Government. A new cabinet Department
    and a new Secretary have entered the American scene: the
    Department—and the first Secretary—of Health, Education, and
    Welfare.
    The true long-range significance of this development—significance
    for the American people and for the strengthening and improvement
    of their schools and colleges—is something which must unfold with
    the years. It is much too early to attempt any definitive evaluation.
    At the minimum, however, a voice for education at the cabinet level
    has been achieved, and the problems—and opportunities—of American
    education are assured of sympathetic consideration in the highest
    councils of the Executive Branch.
    The year 1953 was significant also as a period of re-examination
    and re-evaluation. It was a time for stocktaking, and the charting
    of new directions—in education as in many other areas of human
    activity. What are the strengths and weaknesses of America’s schools
    and colleges? How can they be strengthened and improved to meet
    the ever-increasing needs of mid-twentieth century America? Are
    the educational facilities and practices of earlier years adequate to
    the demands of the new technology of jet propulsion and nuclear
    fission? Are we training enough scientific, professional, and technical
    manpower—and womanpower—to meet the challenge of a
    159
    160 Department of Health, Education, and Welfare, 1953
    divided world? How can the resources of the Federal Government
    best be applied toward the development of solutions to major national
    educational problems, while at the same time the values and benefits
    traditionally associated with State and local control of education are
    safeguarded ? These are the sorts of questions with which the Office
    of Education and the Department of Health, Education, and Welfare
    were concerned during the fiscal year 1953—questions which must be
    of concern to all Americans alike in 1954 and beyond.
    EDUCATION AND THE BUILDING OF AMERICA
    If it be true, as has been said, that America is built upon faith,
    then one important element of that faith is the faith of the American
    people in education. Among the early English colonists the first community
    undertaking in each settlement—with the possible exception
    of the church—was the colonial school. This was no accident. The
    colonists believed firmly, as succeeding generations of Americans have
    believed after them, that the political freedom which they sought
    could be made secure only through widespread popular education.
    Said Thomas Jefferson, “If a nation expects to be ignorant and
    free ... it expects what never was and never will be.”
    This basic idea—that only the educated man can be truly free, and
    that self-government is possible only with an educated citizenry—pervades
    all early American history and underlay all of the deliberations
    of the Constitutional Convention. It is not surprising, then, that one
    of the first acts of the young Republic was the reservation and dedication
    of the sixteenth section of every township of land in the newly
    opened Northwest Territory to educational purposes. As a part of
    the Northwest Ordinance of 1787 the Congress made the clear declaration
    of policy that—
    . . . religion, morality, and knowledge being necessary to good government
    and the happiness of mankind, schools and the means of education shall
    forever be encouraged.
    Implicit in the Northwest Ordinance and subsequent similar legislation
    is the recognition of a valid national interest in the promotion
    and encouragement of education, a national interest which may at
    times transcend the more limited interests of the individual States.
    At the same time it is equally clear that the framers of the Constitution
    intended to leave strictly to the States and the local communities
    the control of their own educational institutions, since there is no reference
    to “education” in the delegation of powers under the Constitution,
    and the Tenth Amendment provides that the “powers not
    delegated to the United States . . . are reserved to the States respectively,
    or to the people.”
    On these two foundation stones—State and local control, with Federal
    assistance and support where the national interest requires—has
    Office of Education 161
    been built an educational system—or systems—which is unique in the
    truest sense of the word. Avoiding on the one hand the extreme
    centralization found in many ministries of education abroad, where
    education is literally “handed down from above”—and on the other,
    the evils that would be inherent in a “do-nothing” Federal policy
    concerning national educational problems—there has evolved a cooperative
    local-State-Federal partnership in education, the key to which
    is found not in competition among jurisdictions, but in collaboration
    among equals in the larger interest of the Nation as a whole.
    For the past 86 years, the principal arm of the Federal Government
    concerned with the well-being of the American educational system
    as a whole has been the United States Office of Education, now an
    integral part of the new Department of Health, Education, and Welfare.
    As the central educational agency of the Federal Government,
    the Office was established originally in 1867 for the purpose of
    . . . collecting such statistics and facts as shall show the condition and
    progress of education in the several States and Territories, and of diffusing
    such information respecting the organization and management of schools
    and school systems, and methods of teaching, as shall aid the people of
    the United States in the establishment and maintenance of efficient school
    systems, and otherwise promote the cause of education throughout the
    country.1
    From time to time during the intervening years, the Congress has
    responded to recognized national needs by authorizing further programs
    of Federal assistance and support in certain specialized areas
    of education where the national interest has required. Thus, when it
    became clear in the latter 1800’s that the national interest required a
    kind of college or university less bound by the classical academic curriculum,
    the Congress passed the two Morrill Acts (1862 and 1890)
    through which each State was led to establish at least one college to
    provide instruction in agriculture and the mechanic arts.
    Similarly, during the early 1900’s it became clear that the typical
    high-school program was too exclusively academic and collegepreparatory
    in character, and that modification of the program in the
    direction of better vocational education would be in the best interest
    of the Nation. In response to this recognized need, Congress passed
    the Smith-Hughes (1917) and related acts, providing Federal funds
    on a matching basis to the States in support of improved vocational
    education.
    More recently the Congress has acted to provide Federal assistance
    to local communities in meeting another educational need which would
    otherwise have been beyond the resources of these communities. This
    is the program of assistance to school districts in areas where Federal
    activities have resulted in an increase in school enrollments and a de114
    Stat. 434.
    162 Department of Health, Education, and Welfare, 1953
    crease in the local tax base through Federal property acquisition. Assistance
    in school construction in such areas has been provided under
    Public Law 815 and assistance in school operation and maintenance
    under Public Law 874 (81st Congress, Second Session). Further discussion
    of this program, as well as others in which Congress has
    authorized Federal assistance in response to recognized national needs,
    is found in succeeding sections of this report.
    LEGISLATION AFFECTING EDUCATION DURING FISCAL ’53
    Legislative developments affecting education during the period July
    1, 1952, to June 30, 1953, may be grouped conveniently into two categories;
    namely, those associated with the latter portion of the 82d
    Congress, on the one hand, and those associated with the incoming
    Eisenhower administration and the first session of the 83d Congress
    on the other.
    The principal piece of legislation affecting education which was
    passed in the latter days of the 82d Congress was the “Veterans’ Readjustment
    Assistance Act of 1952” (P. L. 550, 82d Congress, Second
    Session, approved July 16, 1952) which has become better known as
    the “Korean GI Bill.” Under this Act the Commissioner of Education
    was assigned three new statutory responsibilities: (1) the publication
    of a list of nationally recognized accrediting agencies or associations
    for the guidance of State-approving agencies in approving
    or disapproving training courses under the veterans educational program
    ; (2) advice to the Administrator of Veterans Affairs concerning
    the system to be used in approving veterans training courses; and
    (3) service ex officio as a member of the statutory Advisory Committee
    to the Veterans Administrator on educational and vocational assistance
    under the Act. The functions being performed in carrying out these
    responsibilities are described elsewhere in this report.
    With the inauguration of President Dwight D. Eisenhower on January
    20, 1953, the new administration began at once to turn its attention
    to some of the major problems confronting American education.
    In his State of the Union Message on February 2, President Eisenhower
    touched upon some of these problems in the following language
    :
    Our school system demands some prompt, effective help. During each
    of the last 2 years, more than 1% million children have swelled the elementary
    and secondary school population of the country. Generally, the
    school population is proportionately higher in States with low per capita
    income. This whole situation calls for careful congressional study and
    action. I am sure you share my conviction that the firm conditions of
    Federal aid must be proved need and proved lack of local income.
    One phase of the school problem demands special attention. The school
    population of many districts has been greatly increased by the swift growth
    Office of Education 163
    of defense activities. These activities have added little or nothing to the
    tax resources of the communities affected. Legislation aiding construction
    of schools in these districts expires on June 30. This law should be
    renewed; and, likewise, the partial payments for current operating expenses
    for these particular school districts should be made, including the
    deficiency requirement of the current fiscal year.
    In addition, President Eisenhower indicated that he expected to
    send to the Congress shortly a reorganization plan defining new administrative
    status for all Federal activities in health, education, and
    social security, as well as recommendations for establishing a commission
    to study the proper relationships among Federal, State, and local
    programs.
    On March 12,1953, the President transmitted to the Congress Reorganization
    Plan No. 1 of 1953, proposing the creation of a Department
    of Health, Education, and Welfare as one of the executive departments
    of the Federal Government, to which would be transferred
    the various components of the then Federal Security Agency, including
    the Office of Education. The plan reserved to the Office of Education,
    or to the Commissioner, the professional and substantive responsibilities
    vested in them by law, and also specifically provided
    that the Commissioner of Education (as well as the heads of the other
    major constituent organizations) should have direct access to the Secretary
    of the new Department.
    The President also included in his message transmitting the plan
    to the Congress, although not as a part of the plan itself, a recommendation
    for the establishment, by statute, of a special advisory body to
    the Secretary on problems of education. Said the President:
    There should be in the Department an Advisory Committee on Education,
    made up of persons chosen by the Secretary from outside the Federal
    Government, which would advise the Secretary with respect to the educational
    programs of the Department. I recommend the enactment of legislation
    authorizing the defrayal of the expenses of this Committee. The
    creation of such a Committee as an advisory body to the Secretary will
    help insure the maintenance of responsibility for the public educational
    system in State and local governments while preserving the national interest
    in education through appropriate Federal action.
    Following approval by both Houses of the Congress, Reorganization
    Plan No. 1 was signed by the President as P. L. 13 on April 1,
    1953, and the new Department came into being 10 days later, as provided
    by the law, on April 11, 1953. Plans for the Advisory Committee
    on Education proposed by the President are being developed
    currently.
    Legislation to carry out the President’s State of the Union Message
    recommendation for a commission on Federal-State-local govern164
    Department of Health, Education, and Welfare, 1953
    mental relations was introduced by Senator Taft on April 1, 1953, as
    S. 1514, a bill to establish a commission on governmental functions and
    fiscal resources. With certain modifications, this bill was enacted as
    Public Law 109 2 providing for the establishment of a 25-member
    Commission on Intergovernmental Relations. This Commission is
    responsible for studying the proper role of the Federal Government
    in relation to the States and their political subdivisions in all fields
    involving intergovernmental relations, including the field of education,
    and the Commission is required to submit a report and recommendations
    to the President and the Congress concerning the allocation
    of governmental functions to their proper jurisdiction and the
    adjustment of intergovernmental fiscal relations among the various
    levels of government. The act specifies that the report and recommendations
    of the Commission shall be submitted not later than
    March 1,1954.
    A related measure is the act providing for the establishment of the
    “new Hoover Commission,” known officially as the Commission on
    Organization of the Executive Branch of the Government.3 This 12-
    member Commission is charged with the responsibility of studying
    and investigating the organization and methods of all Government
    instrumentalities, including those operating in the field of education,
    for the purpose of proposing to the Congress such changes as may be
    necessary in the interest of economy, efficiency, and improved service
    in the transaction of the public business. The Commission is to submit
    a comprehensive report of its activities and the result of its studies to
    the Congress on or before December 31,1954.
    The principal substantive legislation of the First Session of the
    83d Congress specifically relating to the field of education was the
    extension for 2 years of the program of school assistance in federally
    affected areas, as recommended by President Eisenhower in his State
    of the Union Message and elsewhere. Developments pertaining to this
    program are discussed in section II of this report.4 5 Other items of
    educational interest from the First Session included Public Law 226,°
    which granted the consent of the Congress to certain Western States,
    Alaska, and Hawaii to enter into a compact relating to higher education
    in the Western States and establishing the Western Interstate
    Commission for Higher Education; and Public Law 141,6 which
    authorized “book rate” postage for the transmittal through the mails
    of educational films and related educational materials.
    2 Approved July 10, 1953.
    3 Public Law 108, 83d Congress, approved July 10, 1953.
    4 See also Third Annual Report.
    5 Approved August 8‘, 1953.
    8 Approved July 20, 1953.
    Office of Education 165
    PROGRESS AND PROBLEMS
    The American people are today doing more than they have ever done
    before for the education of their children. Individually, and through
    such organizations as parent-teacher associations and lay citizens
    groups, they are working ever more actively for better schools and improved
    educational programs. PTA’s throughout the country now
    have nearly 8 million members—nearly double their membership in
    1946. Furthermore, during the fiscal year 1953, American citizens
    taxed themselves approximately $500 million more to provide for their
    schools than during fiscal 1952. They spent about $7.8 billion in
    fiscal 1953 alone to operate public elementary and secondary schools
    and to put up new buildings.
    Major credit for these gains rests with the thousands of local communities
    and the millions of interested citizens who, in accordance
    with the long-established tradition of State and local control of education,
    are carrying the principal responsibility for the management of
    their local schools. The vigor and vitality of this tradition is a, source
    of continuing strength to mid-twentieth century America.
    Encouraging as this record of progress may be, however, it is clear
    that the year 1953 is no time for complacency. Many States and local
    communities are struggling with educational problems which extend
    far beyond their boundaries or beyond their available resources, but
    which still require prompt and workable solutions. And experience
    indicates that educational problems which are unsolved or imperfectly
    solved in the States and local communities have a way of becoming
    national problems as the national interest itself becomes imperiled.
    Among the major educational problems being faced in varying
    degree across the Nation at the present time, the following are perhaps
    the most widespread and the most urgently in need of solution. The
    best collaborative efforts of all our citizens—individually and in
    groups—and all our organizations—public and private, local, State,
    and national—will be needed if American education is to meet the
    challenge, and rise to the opportunities, which these problems present.
    The need for more and better schools.—School construction is not
    keeping pace with classroom needs. The United States is short right
    now more than 340,000 public elementary and secondary school classrooms.
    Furthermore, increased enrollments (see chart 1), building
    deterioration and obsolescence will create the need for more than
    400,000 classrooms by 1960. Three classrooms out of every five are
    overcrowded. One out of every five pupils across the country is going
    to school in a schoolhouse which does not meet minimum fire safety
    conditions.
    166 Department of Health, Education, and Welfare, 1953
    Chart 1.—ENROLLMENT IN PUBLIC ELEMENTARY AND SECONDARY DAY SCHOOLS, 1920-60
    (DATA FOR 1952 AND LATER ARE ESTIMATES BASED ON NUMBER OF ACTUAL BIRTHS
    THROUGH MARCH 1953)
    SCHOOL YEAR
    The need for more and better teachers.—The number of persons
    being prepared for and entering the teaching profession is inadequate
    to meet teacher needs. This shortage is particularly acute in the elementary
    schools. For the fall of 1953, a minimum of 118,000 new public
    elementary teachers was needed—53,000 to take care of increased enrollment
    (1.6 million), and 63,000 to replace teachers leaving the profession.
    Since only some 45,700 qualified graduates for elementary
    teaching came out of the colleges, there was a net teacher shortage for
    the fall of 1953 of over 72,000.
    The uneducated; what to do about illiteracy.—There are 10 million
    adults in the United States who are functionally illiterate, i. e., who
    have completed fewer than 5 years of schooling. During World War
    JI over 600,000 men were rejected for military service because of
    functional illiteracy. Three hundred thousand were rejected for the
    same cause during the first year of the Korean conflict. With one out
    of every 12 American adults functionally illiterate, the drain upon
    the Nation’s strength and productive capacity is incalculable.
    The financing of education.—Rising operating costs have placed new
    pressures upon all educational institutions, public and private, elementary,
    secondary, and higher. Among the Nation’s 1,900 higher
    educational institutions, the private liberal arts colleges have been
    particularly hard-pressed to stretch their income from endowment
    Office of Education 167
    and tuition to meet increased operating expenses. At the same time
    steadily rising tuition and living costs are making it increasingly difficult
    for children of low-income families to obtain the benefits of a
    college education.
    Educational television.—The full potentiality of television as a
    medium of instruction and communication—and thus of education—
    is perhaps still difficult to comprehend. There has been enough
    research, experimentation, and operating experience to date, however,
    to make it clear that an important new dimension has been added
    to proven educational techniques. The creation of a climate in which
    this new educational medium can flourish—without being overshadowed
    or thwarted by the rapid and vigorous growth of its commercial
    counterpart—presents many issues of public policy of the
    broadest import.
    The “drop-out” problem; curriculum adjustments.—-Less dramatic
    than educational television, though perhaps equally significant in its
    long-range implications, is the problem of curriculum adjustments at
    the secondary school level, more specifically curriculum adjustments
    designed to meet the needs of those children who otherwise tend to
    drop out of school when past the age of compulsory school attendance.
    Since 1890, high-school attendance in the United States has risen from
    only 7 percent of the eligible youth to nearly 80 percent. Under these
    circumstances the problem of shaping the high-school curriculum and
    keeping it sufficiently flexible to meet the needs of pupils of widely
    varying intellectual levels and capacities is a continuing one.
    Educational benefits of returning veterans.—Under the Servicemen’s
    Readjustment Act of 1944 (the so-called “GI Bill of Rights”)
    more than five million young men and women in all returned to school
    or college. Under the Veterans Readjustment Assistance Act of 1952
    (known as the “Korean GI Bill”) some 50,000 veterans were enrolled
    in colleges and universities in January 1953, and there are many more
    to come. The Nation as a whole has a real stake in seeing that these
    veterans receive the full value of their educational benefits on returning
    to civilian life.
    The role of education in technical assistance abroad.—With increasing
    frequency, American educators and educational institutions are
    being called upon to help in the program of technical and economic
    assistance throughout the world. The implications of these relationships
    for improved international understanding and for the strengthening
    of the Free World are very great. Much pioneering remains
    to be done if the potentialities of international education as a part
    of an enlightened foreign policy are to be fully realized.
    Citizen understanding and support of the schools.—Underlying all
    other problems, and perhaps the most basic of all, is the problem of
    broadening and strengthening public understanding and support of
    168 Department of Health, Education, and Welfare, 1953
    the educational institutions of America. As guardians of the finest
    traditions of the past, as bulwark against the totalitarian assaults
    of the present, and as symbols and guarantors of our highest hopes
    for the future, the Nation’s schools and colleges are pre-eminent among
    the free institutions on which our way of life depends. They deserve
    the full and undivided support and allegiance of all Americans interested
    in a brighter future for their children.
    IL Assistance to Schools in Federally Affected Areas
    In reviewing educational problems and issues in his State of the
    Union Message on February 2, President Eisenhower singled out one
    particular program for special attention and specific recommendation
    to the 83d Congress. This was the program of assistance to schools
    in federally affected areas, for which the President specifically requested
    renewal. Congressional hearings on the subject began shortly
    thereafter.7
    Although the problem of local school districts being overburdened
    by adjacent Federal activities dates back at least to World War I,
    it was not until after World War II that the Congress gave systematic
    attention to the matter. Following expiration of the program for
    World War II emergency aid for school construction under the Lanham
    Act, the 81st Congress conducted extensive hearings on the subject
    and shortly thereafter passed Public Laws 815 and 874, the first
    comprehensive legislation providing for Federal assistance to schools
    in federally affected areas.8 It was this legislation which President
    Eisenhower recommended be extended—Public Law 815 through June
    1954 and Public Law 874 through June 1956. These terminal dates
    were selected in order to provide the new Commission on Inter-governmental
    Relations an opportunity to consider these programs in relation
    to other grant-in-aid programs of the Federal Government.
    In Public Law 874, Congress had declared it to be the policy of the
    U. S. Government to provide financial assistance (for the operation
    and maintenance of schools) to local educational agencies upon which
    the United States has placed financial burdens where (tz) the revenues
    available from local sources are reduced because the Federal Government
    acquired real property in the district; (&) the school districts
    provide education for children living on Federal property or whose
    parents are working on Federal property; or (c) there has been a
    sudden and substantial increase in school attendance as the result of
    Federal activities. The law established eligibility requirements for
    assistance, defined the categories in which federally connected children
    7 Public Laws 246 and 248, 83d Congress, First Session; both approved August 8, 1953.
    8 Public Law 815, 81st Congress, Second Session, approved September 23, 1950; and
    Public Law 874, 81st Congress, Second Session, approved September 30, 1950.
    Office of Education 169
    should be grouped, and fixed the formula basis for calculating the
    amount of the Federal payment.
    Public Law 815 in Title II9 declared it to be the policy of the
    United States Government that it would bear the cost of constructing
    needed school facilities in areas in which Federal activities have been
    or are being carried on, in the manner and to the extent provided under
    the terms of the Act. Payments were authorized to be made to local
    educational agencies as specified in the Act where children live on
    Federal property, their parents are employed on Federal property, or
    the increased attendance results from activities of the United States
    carried on either directly or through a contractor.
    Responsibility for the administration of both laws was placed by
    statute in the Commissioner of Education. Each Act also required
    the Commissioner to submit a report to Congress annually concerning
    the administration of the program.10
    Experience has shown that the laws as originally enacted were
    basically sound. Without financial assistance of this character, many
    of the local school districts would have been unable to provide elementary
    and secondary education for the children whose families had
    moved into the federally affected areas. With the changes to be
    brought about by Public Laws 246 and 248 it is expected that further
    progress will be made in the direction of simplifying and facilitating
    the entire school assistance program.
    III. Services to State and Local School Systems
    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. This function has its origin in the basic Act of
    1867, which specifies that one of the purposes for which the Office
    was established was that of
    . . . diffusing such information respecting the organization and management
    of schools and school systems, and methods of teaching, as shall aid
    the people of the United States in the establishment and maintenance of
    efficient school systems . . .
    One of the major organizational units in the Office which are responsible
    for the carrying out of this responsibility is the Division of State
    and Local School Systems.
    In providing these statutory services, both the vastness of the American
    educational enterprise (25 million elementary school children in
    135,000 schools and 7 million secondary school children in 27,000
    0 Activities under Title I of Public Law 815 are treated in Section III of this report.
    10 For a detailed discussion of the operations of this program under Public Laws 815 and
    874 (81st Congress); as amended and extended by Public Laws 246 and 248 (83d Congress,
    First Session), see pages 171-173.
    293171—54------12
    170 Department of Health, Education, and Welfare, 1953
    schools in 1952-53) 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 an intermediate point of
    contact. Thus, 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 mutual interest and concern. The work of the
    National Council of Chief State School Officers has been particularly
    significant and useful in facilitating the development of these cooperative
    Federal-State relationships in education.
    The services provided by the Office to State and local school systems
    are widely diverse and varied in character. 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.”
    SCHOOL ADMINISTRATION
    During the year a considerable amount of attention was given to a
    study of State legislative provisions designed to promote statewide
    school district reorganization which would result in the establishment
    of more effective local school districts. This study involves an analysis
    of the principal legislative features in the respective States which
    embody statewide plans for school district reorganization. From a
    study of such laws and their respective results, it is hoped that an
    evaluation may be made which will indicate the type of legislation
    likely to produce the best results in other States which seek to improve
    local school district organization.
    In the area of local school administration a study relating to reorganized
    school districts established in recent years was completed.
    Information obtained from this study is now available in two new
    bulletins. One of these bulletins gives an analysis of various size
    and sociological features of 552 reorganized local administrative units
    in eight States. The other sets forth some of the major changes made
    by these districts in improving their educational programs.
    A related study was initiated which involves an intensive investigation
    of the redistricting programs in 16 States to identify and evaluate
    factors which influence local communities to take favorable
    action in establishing more effective school districts. A considerable
    amount of information was collected on factors relating to reorganization
    legislation, school finance provisions influencing reorganization,
    the State leadership and services provided, and the local
    community procedures involved.
    A major activity in the area of State school administration during
    the year was related to improving basic statistical information for
    American education. Educators and others have long recognized the
    Office of Education 171
    need for nationwide comparability of educational information.
    During 1953, American education moved a long way forward toward
    its goal of establishing comparability of educational information.
    One of the results of the year’s undertaking was the completion of
    Handbook I, The Common Core of State Educational Information,
    which contains the basic items of educational information, with definitions,
    that every State should have available annually.
    The National Council of Chief State School Officers has officially
    accepted the Handbook as the fundamental guide for State educational
    record and reporting systems and has urged all of the States to incorporate
    the Handbook information into their State systems. Handbook
    I is the first of four handbooks planned in the Office of Education
    series to establish comparability of educational information. Similar
    handbooks are planned in financial, personnel, and property
    accounting.
    Closely associated with the project for improving basic statistical
    information throughout the Nation was the study of the annual and
    biennial reporting practices of State boards of education and chief
    State school officers, completed in 1953. This study was a joint enterprise
    conducted with the Study Commission of the National Council
    of Chief State School Officers which culminated in the publication,
    The State Department of Education Report.
    In the area of school finance, the study, Expenditures for Education
    at the Midcentury, was completed and the printed bulletin will be available
    shortly. In this study, data were included for 63,402 school
    administrative units which operate schools in all the States and outlying
    areas. The report discusses variations in levels of expenditures
    per classroom unit, showing ranges both within and among the States
    and other areas. Charts, tables, and discussions also pertain to
    financing basic State programs of education, evaluation of educational
    equalization, ability and effort to support public schools, and progress
    in financing education during the past 10 years.
    Work on another report supplementary to the expenditure study
    was also started near the end of the fiscal year. This supplementary
    report will include data for the 12 States which reported separate
    data for white and Negro children. The report will present expenditure
    levels for classrooms of Negro children so they may be compared
    with State averages and with corresponding levels for white children
    in these 12 States. Comparisons will be presented showing the situation
    for the 1949-50 school year in contract with that for 1939—40.
    SCHOOL FACILITIES
    During fiscal 1953, leadership and consultative services were provided
    to State and local school systems relative to the Nation’s largest
    annual school building program in history.
    172 Department of Health, Education, and Welfare, 1953
    The status phase of the School Facilities Survey (Title 1, Public
    Law 815, 81st Congress) was completed in 43 States, and, at year’s end,
    this phase of the study was still in progress in other States. Progress
    reports have revealed some alarming shortages and unsatisfactory
    conditions in the public-school plants of the Nation (see charts 2
    and 3).
    Chart 2.—PERCENT OF PUBLIC ELEMENTARY AND SECONDARY SCHOOL PUPILS HOUSED IN
    BUILDINGS RATED BY THE STATES IN 1951 ACCORDING TO DEGREE OF FIRE SAFETY
    (DATA FROM 42 STATES ENROLLING 19,002,362 PUPILS IN 1949-50)
    ELEMENTARY
    SECONDARY
    COMBINED:
    ELEMENTARY,
    SECONDARY
    ALL SCHOOLS
    PERCENT
    0 20 40 60 80 100
    ACCEPTABLE FEwJ POSSIBLY ACCEPTABLE ■■■ NOT MEETING FIRE
    AS TCI FIRF SAFFTY E-fflSH AS TO FIRF SAFETY ■■■ SAFETY CONDITIONS
    Chart 3.—PERCENT OF PUBLIC ELEMENTARY AND SECONDARY SCHOOL PUPILS HOUSED IN
    SCHOOL PLANTS RATED BY THE STATES IN 1951 AS SATISFACTORY, FAIR, AND UNSATISFACTORY
    (DATA FROM 43 STATES ENROLLING 20,156,045 PUPILS IN 1949-50)
    Office of Education 173
    The forthcoming Report on the Status Phase of the School Facilities
    Survey will give the first nationwide comprehensive picture of the
    schoolhousing situation and the funds required to provide adequate
    schoolhousing. During fiscal 1953, many of the States started the longrange
    planning phase of the survey which will be substantially completed
    during fiscal 1954.
    Assistance to school officials and architects on layout patterns was
    continued by a cooperative study of the space and facilities of elementary
    classrooms, resulting in the first of a series of brochures on the
    functional layouts of specific areas of the school plant. Continued
    studies of functional patterns of school furniture and equipment included
    a study of the body measurements of school-age children, thus
    providing basic data for the design of school furniture and equipment.
    Specific services were provided to State and local school systems
    relative to school plant management problems including preservation
    of school property, plant operation and maintenance programs, safety,
    and community and summer use of school plants. Attention was given
    to school plant services in the State departments of education, especially
    in connection with the development of codes and regulations, school
    building surveys, and functional-planning service to local districts.
    The Office also developed construction estimates, school building cost
    analyses, and technical data, and made this information available
    through school plant planners and architects, professional magazines,
    and the daily press.
    SERVICES TO ELEMENTARY EDUCATION
    During the year two members of the Elementary Education staff
    worked as members of the Mid-Century Committee on Outcomes for
    Elementary Education. Many others assisted as the work of the Committee
    progressed. The published report is now in print.
    Emphasis is being continued on helping school people improve their
    ways of helping children learn to read, write, think, and develop
    creativity. This is being accomplished through publications, consulting
    with leaders of more than 60 lay and professional organizations,
    conferences, speeches, and advising teacher groups who seek help in
    these phases of their school program.
    The staff is continuing to give leadership to lay and professional
    organizations directed to a better articulation of effort, closer collaboration
    on programs, and an evaluation of gaps in educational services
    to children. As an example, staff members assisted the Girl Scouts in
    working out a comprehensive program of Scouting for girls of
    migrant families. Several organizations were drawn in to articulate
    their programs along with that of Scouting. This pilot effort was
    begun in the State of California in June of 1953.
    174 Department of Health, Education, and Welfare, 19o3
    Staff members worked with the Department of Labor on materials
    to emphasize the importance of children returning to school in the
    fall. The Elementary Section and the Children’s Bureau also worked
    together during the year on two projects of long-range significance:
    programs for State Training Schools and ways to improve extended
    school services for children of working mothers.
    A considerable amount of staff time during the year was spent in
    helping to orient, advise with, and develop visitation programs for
    foreign educators. Individual and group conferences were held and
    visits to public schools were arranged.
    A number of American educators, going to missions abroad, were
    also assisted. They were advised on ways of working, appropriate
    professional books were recommended, and lists of suitable instructional
    materials for developing educational programs in underdeveloped
    countries were prepared. Reports of educational projects were
    studied, activities evaluated, and recommendations for certain
    improvements were proposed.
    Five members of the staff continued to serve a clearinghouse function
    of sending helpful information and descriptions of good practices
    to local school people faced with the migrant farm family problem.
    Cooperative relationships were strengthened with other Federal agencies
    and lay organizations. Leadership and assistance were given to
    the personnel of about 23 State departments of education helping them
    to render better service to local communities in regard to the educational
    problems of migrants. A major part of a seminar report on
    the problems of migrants was written and published. Well over three
    hundred requests for materials were filled.
    SERVICES TO SECONDARY EDUCATION
    A study, Statistics of Public Secondary Day Schools, 1951-52, was
    completed during this fiscal year. Some of the significant highlights
    of this study were “The number of high schools with extremely large
    enrollments is decreasing as is also the number of high schools with
    extremely small enrollments. . . . The trend toward reorganized high
    schools has been accelerated since 1946. In 1952 reorganized high
    schools constituted about three-fifths of the entire number of high
    schools in the Nation and enrolled about three-fourths of all public
    high school pupils. ... In 1952 men constituted 48 percent of the
    total professional staff . . . the highest proportion reached during
    the last 30 years.”
    A pressing and continuing problem in the high schools involves
    the difficulty in teaching pupils with widely varying interests and
    abilities in the same school and often in the same class. A questionnaire
    study has been launched to find out the practices actually used
    in dealing with fast and slow learners in eight different aspects of
    Office of Education 175
    school work. From a sample of 1,200 high schools, 850 questionnaires
    were completed and returned. These replies are currently being tabulated
    and analyzed. The purposes of the study are (1) to determine
    present practices and (2) to identify schools unusually effective in
    this regard so that they may be studied more carefully.
    “Pupil Appraisal Practices in Secondary Schools” was the theme
    of the fifth national conference sponsored by the Office of Education
    and the Commission on Life Adjustment Education for Youth. In
    attendance were approximately 200 participants who were nominated
    by chief State school officers, State directors of secondary education,
    and members of the Commission.
    Consultative services were provided for many educational programs
    which are operated by other Government agencies. For example,
    2 specialists spent 2 weeks each helping the Army to improve
    its literacy education program (reading, writing, and arithmetic)
    for draftees. One specialist spent 3 months, at the request of the State
    Department, advising the Ministry of Education in Turkey. For the
    foreign teachers, trainees, and leaders interested in secondary education
    who were routed through the Office, the entire staff was involved
    in group orientation conferences, individual counseling, and cooperation
    with State and local educators in planning study activities.
    Staff members also cooperated with numerous professional associations
    by serving on committees, speaking at meetings, and writing for
    yearbooks and magazines. The Office and the American Association
    for the Advancement of Science jointly planned, conducted, and
    reported (in an Office publication) a conference on identifying and
    teaching pupils who are talented in science and mathematics.
    EXCEPTIONAL CHILDREN AND YOUTH
    A major project during the year was the continuation of the study,
    Qualifications and Preparation of Teachers of Exceptional Children.
    The project will continue during 1954 and from it much information
    should be obtained which will be useful in reevaluating the college
    programs for the training of teachers and in establishing realistic
    qualifications for teachers in the various fields.
    Collaborative efforts with the Children’s Bureau continued on the
    production of materials for public-school personnel concerning the
    control and prevention of juvenile delinquency. A new bulletin in
    this field is ready for publication and eventual distribution to the
    State and local schools.
    A complete review and summarization of legislation adopted by the
    various States concerning tire education of exceptional children was
    made and the results published in School Life. This review brought
    up to date the original publication of 1949 and indicated a rapidly
    176 Department of Health, Education, and Welfare, 1953
    developing legislative program in which 46 of the 48 States participate.
    In cooperation with the Research and Statistics Section, statistics
    of public-school special education facilities were collected during the
    year. These data will form the basis for the first such report that
    has been made available since the statistics for 1947-48 were published.
    They will appear in bulletin form as a part of the Biennial Survey
    of Education early in fiscal ’54.
    VISUAL EDUCATION SERVICE
    The Visual Education Service continued during the year its systematic
    cataloging of information about motion pictures and filmstrips
    of all Government agencies which are available for public educational
    use in the United States. Descriptive copy on 1,070 such films
    was prepared for the Library of Congress to use in printing and issuing
    its catalog cards. A special catalog of 528 Government films
    cleared for television use has also been prepared. Cooperation with
    the Library of Congress continued in the formulation of definitive
    rules for cataloging films leading to the issuance, in March 1953, of
    a revised edition of such rules. The Chief of the Visual Education
    Service served as manager, then as observer of a UNESCO conference
    on international standards for film cataloging held in Washington
    during May 1953.
    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 GSA contract covering the sale of copies of such
    films. During the year, 166 films were released for sale, while 7 were
    withdrawn from sale. At the end of the year, 2,750 motion pictures
    and film-strips of 22 different agencies were being sold under the GSA
    contract.
    The 1951 directory of 2002 film libraries was revised and sent to
    the Government Printing Office as a 1953 directory of 2,660 film libraries.
    This State and city directory of 16mm loan and rental sources
    was prepared, as were previous editions, with the cooperation of the
    American Library Association, Association of Chief State School
    Audio-Visual Officers, Educational Film Library Association, National
    Audio-Visual Association, and the National Education Association.
    SERVICES TO LIBRARIES
    About 100 years ago, the first public library, as we know the term
    today, was founded in the United States. A survey just completed
    by the Office of Education shows, among other things, that 7,477 public
    libraries are now operating in the United States; and that these institutions
    own some 149 million volumes, circulate about 413 million volumes
    annually, and spend $109 million yearly. The data also show
    Office of Education 177
    that 60 percent of the Nation’s public libraries have annual budgets
    of less than $4,000 per year and that some 30 million people are still
    without any local public library service.
    Standards for school libraries are important instruments for checking
    upon the effectiveness of the library in the total school program.
    With this in mind, an analysis was made during the year of the standards
    formulated by State departments of education and four regional
    accrediting associations. The findings show: an almost universal
    adoption by State departments of education of library standards or
    recommendations for secondary schools; a widespread extension of
    library standards or recommendations to the elementary school; and
    greater emphasis on the functions and services of the library than on
    purely quantitative library requirements as was formerly the case.
    The results of this study appeared in the Bulletin of the School Library
    Association of California for May 1953 and in School Libraries, official
    publication of the American Association of School Librarians, for
    July 1953.
    The current widespread shortage of trained, competent librarians
    renders acute the problem of adequate opportunities for library education.
    To provide college and university executives, school administrators,
    public librarians, and prospective students with an impartial
    and timely review of the current pattern of professional education for
    librarianship, research has been undertaken to ascertain the number
    of course offerings, curriculum changes, and admission and degree requirements.
    It was found that more than 500 institutions of higher
    education now offer courses in librarianship in an effort to meet current
    library needs.
    Rises in operating costs and generally static incomes in the last 5
    years have caused university and college executives and librarians to
    view critically the adequacy and efficiency of library resources, use,
    expenditures, and personnel required in higher educational institutions.
    To provide objective data on these points a nationwide statistical
    survey was undertaken covering the fiscal year 1951-52, and is
    now nearing completion.
    RADIO AND TELEVISION SERVICES
    The fiscal year just ended was one of transition, in several respects,
    for the Radio and Television Services Section.
    Up to late spring of this year, educational institutions in each of
    the 242 local areas where the Federal Communications Commission
    had tentatively designated a TV-channel for educational station assignment
    had been concerned primarily with the legal, technical, and
    fiscal aspects of building stations. However, by the year’s end, 3
    educational TV stations had been built and 2 of them were in operation.
    Furthermore, construction permits for 17 others had been
    178 Department of Health, Education, and Welfare, 1953
    granted and 47 applications were on file with the Federal Communications
    Commission awaiting processing. Satisfied with this showing,
    the Federal Communications Commission announced that the 242
    channel reservations for education would be continued indefinitely.
    Relieved of pressure for immediate station construction, educational
    station planners are now including all aspects of programing and
    station operation in their planning activities.
    In the meantime the Radio-Recordings Program which was started
    15 years ago to give teachers an opportunity to explore the educational
    potentialities of recorded instructional materials, was judged
    to have performed its pioneering function and was accordingly discontinued.
    This library of educational program recordings is now
    in process of being distributed among the various State, regional, and
    city schools, as well as among the instructional materials distribution
    centers that have grown up in this field in recent years. A small new
    Reference Resource Materials Library has been established in the
    Office in recognition of the desirability of retaining a representative
    sample of instructionally useful material in the broadcast media field
    for study by instructional materials specialists and educational program
    producers.
    The principal focus of the work-study program of the Joint Committee
    of the Office of Education and the Radio-Electronic-Television
    Manufacturers Association on the use of communications equipment
    in education has shifted during the year from equipment to teaching.
    The three earlier studies of the Committee each dealt with a single
    class of communications equipment and undertook to discover and describe
    all the instructionally useful things schools were doing with it.
    However, its fourth study started with actual instructional jobs the
    schools must perform and undertook to discover how their accomplishment
    might be facilitated through the imaginative use of various
    types of communications equipment. Thus, the Committee’s latest
    information booklet, Teaching with Radio, Audio, Recording, and
    Television Equipment, identifies a number of instructional and activity
    objectives, and explains various combinations of equipment and
    instructional procedures by which each can be accomplished.
    IV. Services to Vocational Education
    The responsibility for vocational education as a function of the
    Office of Education has its origin in the Smith-Hughes Act, which
    provides Federal funds to assist the States in the promotion of vocational
    education. This act and subsequent Federal vocational education
    statutes recognize that the welfare and economy of the Nation are
    based on the productive capacity of its workers. The program of vocational
    education is a Federal-State cooperative educational endeavor.
    Office of Education 179
    States and local schools have the responsibility for planning and operating
    the programs. The Office of Education through its Division of
    Vocational Education has the responsibility for (1) administering the
    Federal Vocational Education Acts, and (2) assisting States in the
    promotion and further development of their programs.
    The chief purpose of vocational education is to fit youth for useful
    employment. It develops not only job skills but also the abilities,
    understandings, attitudes, work habits, and appreciations which are
    necessary for a productive and satisfying life.
    Federal funds appropriated for vocational education programs
    in the several States and Territories in fiscal 1953 amounted to
    $25,811,590.90. Allotments of these funds to States were for the purpose
    of assisting them in providing vocational education in agriculture,
    home economics, trades and industry, distributive occupations,
    and the training of vocational teachers in these occupational fields.
    The scope of the program in 1953 may be measured by the fact that
    more than two-thirds of the high schools of the Nation provided
    vocational training in one or more fields, i. e., agriculture, distributive
    occupations, homemaking, and trades and industries. Over 3.1 million
    youth and adults were enrolled in these vocational classes.
    Much of the time of the Division staff wTas devoted to activities required
    in the administration of the Federal appropriation of $25.8
    million, which was allotted to the States and matched by State and
    local expenditures of more than $120 million. Other activities of the
    Division during 1953, directed toward the further development and
    improvement of the program, included work such as that described
    below.
    REAPPRAISAL OF PROGRAMS OF VOCATIONAL EDUCATION
    Because each State board for vocational education has final responsibility
    for the vocational education program in its respective jurisdiction,
    the work of the Division of Vocational Education in the Office
    of Education is largely with the professional staffs of the State boards.
    During 1953 the Division gave special attention to assisting States
    in developing their leadership with the idea that States should assume
    more responsibility for maintaining standards and for extending and
    improving the program. This emphasis was exemplified by the work
    of the Division with a committee consisting of four chief State school
    officers and four State directors of vocational education, and known
    as The Commissioner’s Advisory Committee for the Further Development
    and Improvement of Vocational Education. The purpose of
    this Committee is to study the entire field of vocational education of
    less than college grade and to make suggestions and recommendations
    which would, in the opinion of the Committee, result in the further
    development and improvement of this phase of education.
    180 Department of Health, Education, and Welfare, 19o3
    The staff of the Division also gave a great deal of attention to analyzing
    its own activities in relation to objectives and purposes which the
    staff believes should be achieved in the next 5 or 10 years in the field
    of vocational education. This involved defining the unique responsibilities
    of various members of the staff for coordination, for leadership
    in program development, for administration, and for analysis of
    the special needs for vocational education in the United States. Statements
    of philosophy, procedures, and activities were developed for use
    both within the Division and in work with States. Special emphasis
    was put on techniques for finding out what problems in each State
    should be given special attention in subsequent field work of the staff.
    Division policies, procedures, and objectives in holding conferences
    of State personnel were reexamined with the objective of achieving
    greater effectiveness in the development of State leadership through
    such conferences.
    SERVICES IN EVALUATION AND SUPERVISION
    Special emphasis was given to assisting States in their evaluation
    of vocational education programs. Staff members of the Division provided
    leadership for State personnel in developing and using criteria
    for use in evaluating training, in evaluating programs for the training
    of vocational teachers, and in reexamining and reorganizing the
    administrative operations at State and local levels.
    Consultative service was provided also to States in developing procedures
    for improving their programs of supervision. Specifically,
    assistance was given to a committee representing several States in
    developing a guide for evaluating and supervising, and in considering
    ways to improve State supervisory programs. In another instance,
    staff members worked with professional personnel from 8
    States to study ways of improving supervision, and to consider such
    problems as (1) setting up research programs to determine effectiveness
    of supervision in the State, and (2) finding ways of evaluating
    different procedures and devices used in the supervisory programs.
    In still another instance, the staff of the Division assisted in developing
    a manual and guide for the use of State and local supervisors in
    reviewing and evaluating local programs. Several States are now
    using adaptations of this manual with a high degree of success.
    A bulletin, The Operation of a Local Program of Trade and Industrial
    Education with Emphasis on Improving Instruction through
    Supervision (Vocational Division Bulletin No. 250), was published
    and has had extensive use in improving supervision.
    These and other efforts of the Office grew out of the States’ interest
    in developing improved supervisory procedures to provide maximum
    aid to local schools with the ultimate idea of developing criteria
    against which a local community could measure its own program.
    Office of Education 181
    SERVICES TO YOUTH ORGANIZATIONS
    With, the increased necessity for young people to develop the ability
    to carry specific responsibilities, the Division assisted State staffs in
    further strengthening leadership training programs for youth organizations
    whose members are enrolled in vocational classes in agriculture
    and homemaking—Future Farmers of America, New Farmers
    of America, Future Homemakers of America, and New Homemakers
    of America. These organizations have a combined membership of
    approximately 815,000.
    SERVICES IN TEACHER EDUCATION
    Because of the shortage of teachers and other leaders for vocational
    programs, particularly in the field of home economics, the Division
    worked with the National Association of State Directors of Vocational
    Education in developing criteria to guide State boards and
    colleges and universities which train home economics teachers to
    reexamine their programs for the selection and training of such
    teachers to the end that more and better teachers may be available.
    SERVICES IN INTERNATIONAL EDUCATION
    Although the Division does not have direct responsibility for bringing
    groups of educators from other countries to study our vocational
    education program, or for assigning vocational educators to assist
    other nations in developing vocational education, much time and
    effort was spent in this work. Activities consisted of recommending
    standards for selecting persons to be sent on foreign assignments in
    vocational education, in securing lists of persons who were interested
    in such assignments, in briefing such persons before their departure,
    and in interviewing them upon their return. Even more time and
    effort was devoted to working with foreign visitors; specifically in
    making arrangements with State and local schools for their visits,
    planning and conducting programs of orientation for visiting groups,
    interviewing individuals preliminary to their observation of vocational
    education in States and local communities, and again interviewing
    them before their return to their own countries.
    SERVICES IN PRACTICAL NURSING
    In cooperation with the Public Health Service, the Office of Education
    gave special assistance during the year in the development of
    courses for training practical nurses. The growth of this program
    is indicated by the fact that in fiscal year 1952 there were approximately
    160 communities providing such training under public-school
    supervision, whereas in fiscal year 1953 the number had increased to
    approximately 185 communities. Part of this increase was due to the
    182 Department of Health, Education, and Welfare, 1953
    participation and support of nursing, medical, and hospital organizations
    and part to the need for more help of a semiprofessional
    nature in hospitals. Schools of all types are now graduating about
    3,000 practical nurses a year, most of whom are graduates of the
    courses conducted under the vocational education program.
    SERVICES IN RESEARCH AND NEW AREAS OF WORK
    Supplementing the assistance given to States through conferences
    and visits to the States by staff members, the Office of Education stimulated
    research on emerging problems during the year by publishing
    the following printed bulletins relating to vocational education:
    With Focus on Family Living-: The Story of Four Experiments In Community
    Organization for Family Life Education. Vocational Division
    Bulletin No. 249.
    Summaries of Studies in Agricultural Education. Vocational Education
    Bulletin No. 251.
    Home, School, and Community Experiences in the Homemaking Program-.
    Vocational Division Bulletin No. 252.
    V. Services to Higher Education
    During the fiscal year 1953 the Division of Higher Education used
    its resources:
    1. To assist in an orderly expansion of facilities and programs
    in higher education
    2. To provide information on program costs and student expenditures
    3. To clarify policies and procedures relating to college accreditation
    and licensure in the professions
    4. To administer Federal grants for resident instruction in the
    land-grant colleges, and otherwise to serve these institutions,
    and
    5. To further international understanding.
    Some of these functions were the responsibility primarily of one of the
    Division’s three Branches: College and University Administration,
    General and Liberal Education, or Professional Education; others
    involved two or all three Branches.
    EXPANSION OF FACILITIES AND PROGRAMS IN HIGHER EDUCATION
    Facilities—The present enrollment in colleges is approximately the
    same as the enrollment in secondary schools was in 1920. There are
    now approximately 8,500,000 persons 18 to 21; by 1970 there will be
    about 14,250,000 persons in this age group, an increase of 67 percent.
    Fewer than half the States have any systematic means of determining
    Office of Education 183
    what facilities are needed for higher education and where they should
    be located.
    During preceding fiscal years the Division had undertaken a comprehensive
    study of existing space and of needed additional facilities
    at the college level. This study was reported in the bulletin, College
    Building Needs. The data in this report have been kept current
    through the program of rationing controlled materials which the Office
    of Education conducted as the agent of the National Production
    Authority. The data have been expanded through the continuous
    inventory of the physical facilities and staff resources of this country’s
    colleges and universities. The purpose of this inventory is to determine
    the facilities and resources possessed by each institution of higher
    learning that might be used to train technical, professional, and other
    specialized personnel required to meet the Nation’s obligations at home
    and abroad. The inventory has been widely used by Federal and State
    agencies and by voluntary organizations having a stake in the planning
    and the development of programs of higher education.
    College housing loan program.—An agreement between the Administrator
    of the blousing and Home Finance Agency and the U. S. Commissioner
    of Education enables the Division of Higher Education to
    provide an educational advisory service on the College Housing Loan
    Program under the provisions of Title IV of the Housing Act of 1950
    (P. L. 475). In carrying out this advisory function liaison is maintained
    with such organizations as the American Council on Education,
    the Land-Grant College Association, and the National Education Association.
    Staff members meet with groups of educators in National,
    regional, and State conferences to consider ways of providing urgently
    needed housing.
    During the past fiscal year 116 applications for college housing loans
    were reviewed. The total value of loans requested was $69,362,887.
    Of this amount $63,124,745 was recommended for approval. Most of
    these applications were from institutions in which a backlog of housing
    need had existed for 10 years or more. In each instance the institution
    was required to justify the proposed housing project on the
    grounds that it was defense-related or made necessary by the college’s
    location in a defense area characterized by a critical shortage of
    housing.
    At the end of fiscal year 1953 the sum of $86.5 million of the total
    amount of $300 million authorized by Congress for loan purposes, had
    been committed. Facilities completed or under construction will accommodate
    some 600 student and faculty families and 25,661 single
    students.
    Education for the professions.—The professions render highly
    specialized services to society which can be provided only by persons
    who have had prolonged training at a high intellectual level. They
    184 Department of Health, Education, and Welfare, 1953
    include about 6 percent of the working force of this country—upward
    of 4 million persons. The day-to-day functioning of the Nation depends
    heavily upon professional people.
    The Division of Higher Education has begun a long-term study of
    professional education in the United States. During the past fiscal
    year a series of articles on professional education has been appearing
    in the periodical, Higher Education. Among the fields covered were
    engineering, forestry, journalism, law, librarianship, medicine,
    nursing, optometry, pharmacy, theology, veterinary medicine, public
    health, business administration, home economics, and hospital administration.
    These articles, in revised form, together with additional
    material, are being prepared for publication in an Office of Education
    bulletin, Professional Education in the United States. There is a
    great need for a publication which brings together the principal facts
    about professional education.
    Health professions.—In recent years several groups of professional
    schools have shown collective interest in improving the quality of
    teaching. Among these have been the schools of dentistry and the
    colleges of pharmacy. The staff of the Division has assisted both of
    these groups in the conducting of conferences and seminars designed
    to improve instruction in these two fields.
    Engineering.—The annual study of Engineering Enrollments and
    Graduates, made jointly with the American Society for Engineering-
    Education, was published during the year as Office of Education Circular
    No. 364. Data were also gathered to make possible a revision
    of tables in Bulletin 1949, No. 15, A Survey of Cooperative Engineering
    Education. The up-to-date information is included in Office of
    Education Circular No. 368. An article on “Engineering As a Career,”
    was also prepared for the January 1953 issue of School Life. This
    article contains the kind of information about the profession and the
    qualifications and abilities needed by prospective students of engineering
    that should be brought to the attention of interested high-school
    students.
    Teacher education.—During the past year the most significant development
    in the field of teacher education has been the organization of
    the National Council for Accreditation of Teacher Education. The
    organization of this Council constitutes the first effort to bring to
    bear the major forces in teacher education on the problem of accreditation.
    Only 274 of the 1,217 institutions that prepare teachers are
    accredited by an agency national in scope. It is hoped that the Council
    can increase that number and also keep standards high. This new
    Council is made up of 21 members representing State departments of
    education, colleges and universities that prepare teachers, classroom
    teachers and administrators, and boards of education. The Division
    Office of Education 185
    of Higher Education has assisted in organizing this Council and is
    represented on its panel of consultants.
    As a part of the movement to raise standards in teacher educa- ♦
    tion, the Division cooperates with the National Education Association
    in the biennial publication of a description and an analysis of the
    teacher certification requirements in each of the 48 States and the
    Territories. During the fiscal year a revision of this publication was
    issued, entitled A Manual on Certification Requirements for School
    Personnel in the United States.
    Specific help was given to three States during the year on their
    problems relating to teacher education. Consultant help has been
    provided to the public-supported colleges in Virginia on their curriculum
    for the education of teachers. Similar assistance has been
    provided to institutions in Arkansas, where a special experiment under
    Ford Foundation sponsorship is in progress. Consultant service on
    the problem of teacher supply and demand for the next 10 years in
    the State of Maryland has also been provided. This project has
    resulted in a redistribution of the functions of teacher education
    among the public and private institutions in that State.
    Shortage of teachers.—In the fall of 1952, data were collected from
    State departments of education showing the number of qualified
    teachers needed to staff the schools in each State and the number of
    teachers not fully qualified to whom temporary or emergency certificates
    had been issued. Comments were also invited from State departments
    of education as to the outlook for an adequate supply of
    teachers.
    General education.—General education seeks to prepare young people
    to become good citizens and to deal effectively with contemporary
    problems. It is concerned with the needs students have in common
    rather than with their specialized cultural or professional needs. The
    increasing compartmentalization of American higher education and
    the increasing number of students seeking a college education help to
    explain why the development and administration of adequate programs
    of general education present many difficulties. The importance
    and difficulty of building adequate programs of this kind also
    are reasons why the Division of Higher Education has concerned itself
    with the problems of general education.
    During the fiscal year 1953 visits to eight representative institutions
    of higher learning (Colgate, Colorado, Columbia, Denver, Oklahoma
    A and M, Princeton, Rochester, Syracuse) afforded first-hand
    impressions of their programs of general education as well as of programs
    for the preparation of teachers for the broad field of general
    education. Conferences with individual staff members and with faculty
    committees gave an insight into problems of curriculum develop-
    293171—54------13
    186 Department of Health, Education, and Welfare, 1953
    ment and instruction, and into types of services which are needed by
    institutions experimenting with programs of general education.
    * The need for a clearinghouse for information about the availability
    of curriculum materials and of reports of experimentation in general
    education was clearly established. So also was the need for a list of
    leaders who could be consulted about programs in their own institutions
    and the development of new programs elsewhere. The Division
    of Higher Education, therefore, has proceeded to collect information
    of this kind from institutions having substantial programs of general
    education. Data have been received so far from about 20 institutions,
    and the cooperation of other colleges will be sought in the fall.
    The information already received has been published in a loose-leaf
    circular and has been distributed to institutions of higher learning
    and interested professional organizations. Provisions are being made
    for periodic follow-up to keep this information service up to date.
    Continuing education.—The Ford Fund for Adult Education has
    made possible a study of certain phases of continuing education. This
    project is reported in A Study of Urban Public Adult Education Programs
    of the United States, National Education Association, 1952.
    The Office of Education cooperated in this study, and the section on
    “Continuing Education for Adults in the Public Junior College” was
    prepared by a staff member of the Division of Higher Education.
    Data on meeting the cost of adult education programs were gathered
    by staff members of this and another Division, and published in the
    Office of Education Bulletin 1952, No. 8, Financing Education in
    Selected Schools and Community Colleges.
    Equality of educational opportunity.—A study has been completed
    by a member of the staff of this Division which bears on the problem
    of equality of educational opportunity for white and non-white youth
    in the District of Columbia and the 17 States maintaining segregated
    school systems. Data have been compiled on the number of youth in
    each group enrolled in high school, graduating from high school, enrolled
    in college, and graduating from college. Information from the
    1950 Census on the number of white and non-white youth of schoolgoing
    age in these States makes possible comparisons that reveal the
    extent of present disparities.
    A study has been begun to discover trends in the provision for
    higher education of Negroes. When completed it will provide up-todate
    information on one phase of the educational status of a group
    which constitutes an important reserve of manpower. Of particular
    importance is information about the total number of Negro college
    students and the courses they are taking, the increased number of
    Negroes enrolled in Southern institutions of higher learning formerly
    closed to them, and the removal of racial restrictions in the employment
    of teachers and other professional personnel.
    Office of Education 187
    A staff member has cooperated with 13 private colleges for Negroes
    in the development of a cooperative testing program to facilitate the
    admission of qualified students, the awarding of scholarships, etc.
    More than 2,800 students were tested the first year.
    INFORMATION ON PROGRAM COSTS AND STUDENT EXPENDITURES
    Cost of Going to College.—There is a growing concern about the
    continuing rise in the cost of higher education. Such concern is
    expressed by college administrators, professors, boards of trustees,
    professional organizations, members of State legislatures, State and
    Federal governmental agencies concerned with education, as well as
    by the students themselves and their parents. There is a well-founded
    fear that rising costs are making it difficult if not impossible for
    children of low-income families to go to college, thus depriving the
    Nation of the leadership potential of a substantial segment of its
    youth. A proposal frequently made for bridging the gap between
    costs and the ability of students to pay is to provide increased aid
    through a statewide or nationwide plan of scholarships. At the present
    time, however, information is not available which would enable
    legislators or philanthropists to decide what is the best way to aid
    needy college students.
    For the reasons given, the Division of Higher Education has undertaken
    to collect information on a nationwide scale about the costs students
    incur in college, how these costs are met, and the relationships
    which exist among the various cost factors, the sources of funds, and
    the size of family income. A questionnaire has been devised to obtain
    this information, and data are being obtained from about 30,000 fulltime
    undergraduate students enrolled in 100 institutions of higher
    learning. In the published findings, names of students will not be
    disclosed, but institutions will be identified. It is planned to provide
    tabulations that take into account geographic location, age, sex, veteran-
    status, number of siblings, college class, program of study, and
    type of housing and boarding accommodations.
    Student withdrawals.—During fiscal year 1953 the Division of
    Higher Education began a study of the effectiveness of colleges in
    retaining students admitted to various programs of study until these
    programs are completed. Some 20,000 students in about 175 colleges
    are included in this investigation. Field work on this project will not
    be completed until the class of 1954 graduates in June of next year.
    In a period when there is a dearth of trained manpower the Nation
    can scarcely afford to have colleges retain to graduation fewer than
    half of the students they admit. The current investigation should determine
    some of the primary factors responsible for excessive withdrawals
    and provide a basis for initiating remedial measures. This
    project is the first of a series of studies dealing with student popula188
    Department of Health, Education, and Welfare, 1953
    tion. Other studies will deal with the selection and admission of
    students, and the effectiveness with which college graduates are
    absorbed into the Nation’s working force.
    POLICIES AND PROCEDURES RELATING TO COLLEGE ACCREDITATION
    AND LICENSURE IN THE PROFESSIONS
    Nationally recognized accrediting agencies and associations.—During
    the last quarter of fiscal year 1953 the function of the U. S. Commissioner
    of Education under Section 253 (a) of the Veterans Readjustment
    Assistance Act of 1952 (P. L. 550—82d Congress) was
    assumed by the Division of Higher Education. This portion of the
    Act requires the Commissioner of Education to publish a list of
    “nationally recognized accrediting agencies and associations which
    he determines to be reliable authority as to the quality of training
    offered by an educational institution.”
    Under this authority the Commissioner had issued in August 1952
    the first provisional list of such accrediting agencies which included
    the 6 regional accrediting associations and 22 national professional
    accrediting associations. On October 4, 1952, the Federal Register
    ii published the criteria in terms of which applications of all accrediting
    agencies and associations seeking inclusion on the Commissioner’s
    list should be evaluated.
    During the past fiscal year the staff members assigned to this work
    have processed the applications of 16 agencies and associations. They
    have recommended the addition of but one of these agencies to the
    Commissioner’s list of nationally recognized accrediting agencies.
    State boards of dental examiners.—The American Association of
    Dental Examiners, in connection with its annual meeting, holds a
    seminar on dental examinations. The staff of the Division has been
    active in these seminars from their beginning in 1949. They have
    resulted in a marked improvement in the practices of State boards of
    dental examiners. They are also producing a better understanding
    between the boards and the schools of dentistry.
    ADMINISTERING FEDERAL GRANTS AND SERVING LAND-GRANT
    COLLEGES
    The staff of the Division has carried on activities related to the
    administration of Federal grants for resident instruction in the landgrant
    colleges and universities in accordance with the Morrill-Nelson
    and Bankhead-J ones legislation. Consultative services concerning the
    appropriations, the institutions, and legislation have been provided.
    FURTHER INTERNATIONAL UNDERSTANDING
    During 1951 and 1952 staff members at nearly 500 institutions cooperated
    with the Office of Education in a study of “Methods Used by
    Office of Education 189
    College Social Science Departments To Improve Students’ Understanding
    of Post-World War II International Tensions.” During
    fiscal year 1953 a publication with the same title (Circular No. 362)
    and based on the data thus obtained was written and distributed to
    respondents, deans of colleges of liberal arts, and to departments of
    social science not included in the sample.
    In 1950-51 UNESCO held three international educational seminars
    dealing with the improvement of instructional materials and the teaching
    of history and geography. The findings of these seminars and
    problems raised by the participants have continued to be of interest
    to American teachers and to educators responsible for the preparation
    of teachers. A member of the Office staff took part in two of these
    UNESCO seminars and has served on a Panel on the Improvement
    of Instructional Materials of the U. S. National Commission for
    UNESCO. During the past fiscal year the staff cooperated with the
    Department of State by providing consulting services at regional
    conferences concerned with the problems discussed at the international
    seminars. These were held on the campuses of the University
    of Denver, the University of Florida, and George Peabody College.
    The staff has also provided consultant services to the UNESCO International
    Conference on Museum Education, held in Brooklyn last
    September.
    During the year, two staff members helped to rewrite The Story of
    the Declaration of Independence, a pamphlet published and sold by
    the Government Printing Office. Complete responsibility was assumed
    for the section on historical background and the biographical sketches,
    and major responsibility for the preparation of teaching aids.
    A member of the staff served as a member of the American delegation
    to the International Study Conference on the Atlantic Community,
    held at Queens College, Oxford University, England,
    September 6-13, 1952. He was named Chairman of the Interim
    Committee for the development of a program in this country in
    support of the North Atlantic Treaty Organization. More recently
    a permanent organization, the American Council on NATO, has been
    established with a representative of the Office as Vice Chairman.
    VI. International Educational Activities
    Education is an essential key to international understanding and
    peace. The Office of Education has been engaged in international
    educational activities since its establishment in 1867. The first report
    of the first U. S. Commissioner of Education—Henry Barnard in
    1868—included a section on educational developments abroad, and an
    Act of 1896 11 reaffirmed this function as a specific statutory respon-
    11 29 Stat. 140.
    190 Department of Health, Education, and Welfare, 19o3
    sibility of the Office. More recently, the work of the Office in the
    international field has taken on new significance as the services of
    American education have been enlisted in support of the foreign policy
    of the United States.
    The Office of Education has been called upon to play a leading role
    in these developments through its Division of International Education.
    Its varied program includes research; the preparation and exchange
    of school materials; the exchange of experts, specialists, professors,
    teachers; programs for visiting trainees; the coordination and development
    of educational programs for underdeveloped areas; the recruitment
    of educational specialists to serve in education missions
    overseas.
    The functions of the Office in internal education may be summarized
    as follows: (1) services to American education; (2) services to other
    Federal agencies, and national and international organizations; (3)
    services to education in foreign countries in accordance with international
    agreements; (4) services for the mutual benefit of education in
    the United States and in foreign countries. The first function has
    been the responsibility of the Office since its beginning and has always
    been financed through direct appropriation to the Office. The second
    function is an expanding one because of the current interest in international
    affairs, and it also is one for which the Office must make direct
    budgetary provision. The third and fourth functions, relating to the
    implementation of our foreign policy, are delegated to the Office by
    the Department of State and the Foreign Operations Administration,
    and are financed by transfers of funds originally appropriated to those
    agencies.
    COMPARATIVE EDUCATION
    In carrying out one of its basic responsibilities as a service to American
    education, studies were published in comparative education during
    the year—Education in Sweden and Education in Turkey. The
    manuscript of another study, Education in P akistan, was completed,
    and a study of Norway’s education system is in preparation. In addition
    to these studies, Comparative Education News Notes, a mimeographed
    circular issued at irregular intervals, helps keep the Office
    staff and comparative education specialists throughout the country
    abreast of recent developments in this field.
    The Division supplied an advisory service to American educational
    institutions in interpreting the prior educational experience of some
    2,600 students who came to the United States during the year from
    101 countries. This involved the use of some 29 foreign languages.
    Services to American schools and colleges were expanded during the
    year by the inauguration of a series of Teaching Aids for Developing
    International Understanding. Analyses of the educational programs
    Office of Education 191
    of some 600 faculties and schools abroad were also made in order to
    advise the Veterans Administration concerning the status of certain
    courses in foreign institutions in which American veterans proposed
    to enroll.
    Cooperation with international agencies concerned with educational
    problems gave rise to a considerable volume of activity during the year.
    Typical functions in this area included the review of various reports
    and documents submitted by international organizations and the preparation
    of official “position papers” for international conferences.
    Officers of the staff, at the invitation of the Department of State,
    participated in several of these conferences as members of the American
    delegation and advisers on educational affairs.
    Considerable attention was given during the year to the role of
    foreign languages in the American schools. A 2-day national conference
    on this subject was held in January 1953, in response to widespread
    interest in the expansion and improvement of foreign language
    teaching. More than 350 educators and lay leaders from 31 States
    attended.
    With the cooperation of the American Textbook Publishers Institute,
    an Educational Materials Laboratory was established during the
    year, bringing together in one spot reference copies of most of the
    school textbooks presently available through regular publishing channels.
    Through this Laboratory the Office is able to provide an unusual
    and valuable reference service to foreign visitors and to United States
    personnel working in technical assistance programs abroad, as well as
    to educators in this country who wish to examine the latest educational
    materials and texts.
    TECHNICAL ASSISTANCE IN EDUCATION
    In providing professional advice and assistance to the Technical
    Cooperation Administration (now a part of the Foreign Operations
    Administration), the Division proposed and gained acceptance for
    the development of technical assistance programs in education based
    essentially on three types of education: community education—basically
    functional education, concerned with improving all aspects of
    living in the community; fundamental education—basically community
    education where there is no formal school system or the formal
    school is wholly inadequate; and technical education—concerned with
    helping the individual to acquire the knowledge, skills, and attitudes
    necessary for increased productivity. Members of the staff visited a
    number of the underdeveloped areas to advise the TCA and foreign
    Ministries of Education in the application of modern ideas and techniques
    to the solution of urgent educational problems.
    Additional services rendered to what is now the Foreign Operations
    Administration included recruitment of education specialists to
    192 Department of Health, Education, and Welfare, 1953
    fill positions in technical assistance missions overseas. For the technical
    assistance program, the Office employed 43 educators and assigned
    them to 12 countries in the Near East, Africa, and South Asia.
    The Office also recommended qualified personnel for employment by
    the Mutual Security Agency to fill 18 educational positions in American
    missions in Southeast Asia.
    Professional advice or technical evaluation has been supplied on
    request from the education personnel in the field concerning education
    programs, equipment, and materials. This service has included review
    of lists of vocational school shop equipment and textbooks prepared
    in the field, examination of lists of instructional materials and
    supplies proposed for use in elementary and secondary schools, preparation
    of bibliographies designed to meet particular needs, and review
    of project agreements proposed to be signed as a basis for establishment
    of education programs in several of the participating countries.
    TEACHER AND LEADER PROGRAMS
    During the past year, the Division planned and arranged programs
    of instruction, study, and travel for almost 800 foreign education leaders,
    teachers, and trainees. Individual programs were planned for 142
    trainees. They came from 22 countries and were brought to the United
    States for technical training in diverse fields. Also, programs were
    planned for 312 teacher education grantees under the Fulbright and
    Smith-Mundt Acts. The teacher grantees were assigned for the first
    3 months to 1 of 12 participating colleges and universities where special
    coordinators devoted their full time to arranging a balanced educational
    and cultural program. These teachers were then sent in
    smaller groups to work for a week with a State department of education,
    and then for 4 weeks in the schools of a single community in 1 of
    19 States. In addition, the German Teacher Education Program
    brought 111 teachers from West Germany this past year.
    Under the leader and specialist program, plans were made for 195
    leaders. This program, which has been the responsibility of the Office
    since early in 1952, provides for visits of key people in education from
    many countries. Visitors represent all fields of education and include
    representatives of Ministries of Education; college presidents; superintendents
    of schools; directors of rural education; and a variety of
    others, many of whom are in policy-making positions in their own
    countries.
    A number of specialists were recruited for a “Workshop on Modern
    Psychologies and Education,” which was held in Frankfurt, Germany.
    Another program administered by the Division arranges for
    the exchange of teaching positions between American and foreign
    teachers, and recruiting teachers to serve abroad. During the past
    Office of Education 193
    year, 244 teachers were placed—141 in interchanges and 103 in one-way
    appointments.
    McCARRAN ACT
    Under the provisions of the Immigration and Nationality Act of 1952
    (Public Law 414, the so-called McCarran Act), the Attorney General
    of the United States was directed to consult with the Office in carrying
    out his responsibility for the approval of schools for study for nonimmigrant
    aliens coming to this country under student visas. During
    the year, the Office consulted with representatives of the Office of the
    Attorney General relative to the approving of 523 “Petitions of Approval
    of Schools for Students.” The Office also cooperated in the
    development of statements of policy, operating instructions, and sets
    of criteria for the orderly processing of these petitions.
    INTER-AMERICAN SEMINAR ON VOCATIONAL EDUCATION
    In cooperation with the Pan American Union, the Institute of InterAmerican
    Affairs, the International Labour Office, and the University
    of Maryland, the Office functioned in August and September 1952, as a
    co-sponsor of an Inter-American Seminar on Vocational Education,
    which was held at the University of Maryland. The seminar group
    was composed of official representatives, specialists, and observers
    from 19 of the 21 countries comprising the Organization of American
    States. A total of 141 official representatives, specialists, and observers
    were registered in the seminar from these countries. Principles and
    practical procedures for the sound development of vocational education
    in the Pan American countries were discussed and agreed upon.
    These principles now constitute an important contribution to the further
    development of vocational education in the Americas. Follow-up
    and liaison techniques and procedures are being developed by the
    sponsoring agencies to support continuing growth in vocational education
    throughout the membership of the Organization of American
    States. The success of these international programs was due in large
    measure to the willingness on the part of educational institutions and
    organizations throughout the country to cooperate with the Office in
    making local arrangements for the visitors.
    SUMMARY
    During the first year of the existence of the Division of International
    Education a number of problems in administration and professional
    relationships began to be resolved. A management survey resulted in
    the establishment of a new divisional structure. Competent specialists
    were recruited to staff the Division. Important evaluative studies
    were made. Procedures have been reviewed and refined. An out194
    Department of Health, Education, and Welfare, 1953
    standing achievement was the establishment and maintenance of
    cordial and effective working relationships with Federal agencies,
    with State and local school systems, and with private educational institutions
    and organizations throughout the country. One evidence of
    achievement is the following resolution adopted in June 1953, by the
    National Council of Chief State School Officers:
    A basic need in the defense of the free world and in the ultimate attainment
    of a just and lasting peace throughout the world is the development
    of international understanding. We commend the U. S. Office of Education
    for its effective administration of the several programs which contribute
    to this end and for its establishment within the Office of an international
    branch, which doubtless facilitates the discharge of its many
    responsibilities in this area.
    VII. Research and Statistical Services
    Research and the systematic collection and interpretation of the
    pertinent facts are by general consent the basis for solving many of
    our educational problems. The Research and Statistical Standards
    Section is the principal unit through which the Office of Education
    collects, assembles, and prepares statistical data.
    This Section provides research and statistical services to the various
    specialized divisions of the Office and serves in an advisory capacity
    in determining the feasibility of proposed research projects and the
    manner in which such projects can best be carried out. It also provides
    information, advice, and assistance requested by State and local
    educational agencies and by individual schools and institutions of
    higher learning.
    State departments of education, city school systems, school principals,
    college officials, and others are the principal sources of statistical
    information. The Office relies upon their voluntary cooperation in
    the gathering of data. These sources of information are at the same
    time recipients of the benefits of research to which they have contributed.
    Thus the Office acts as a clearinghouse for the gathering,
    analysis, and dissemination of the facts that school officials and educational
    institutions want and need in their efforts to cope with the Nation’s
    educational problems.
    The Research and Statistical Standards Section prepares special
    surveys which are of great importance to the areas they serve. Some of
    these surveys are produced in collaboration with other divisions of the
    Office and other agencies of the Government. Such projects present
    valuable compilations of basic data for educational statesmanship.
    The usefulness of this information-gathering function has been especially
    well illustrated during fiscal 1953. Periodic data from the
    Biennial Survey of Education, the Survey of Fall Enrollment, and
    a special survey of Korean Veterans in College in the Fall of 1952
    Office of Education 195
    were used to provide tables for House hearings on Public Law 550
    (Veterans Readjustment Assistance Act of 1952). The periodic data
    were also basic in making two important forecasts: (1) a projection
    to 1960 of enrollment in elementary and secondary schools, by grade,
    for the third report of the School Facilities Survey; and (2) a projection
    to 1964 of the production of scientists by colleges and universities
    in the United States.
    Extensive liaison and staff services were rendered on such subjects
    as: child-care needs in the city of Wichita, Kans., a cooperative study
    by the Children’s Bureau, Women’s Bureau, and the Office of Education
    ; qualifications and training of teachers of exceptional children;
    costs incurred by students attending college; special provisions for
    rapid and slow learners; retention and withdrawal of college students;
    the common core of State educational information.
    Among the major statistical publications of the year was included
    the Directory of Secondary Day Schools, 1951-52. Some 25,000 public
    and non-public schools are listed in this study, with statistical and accreditation
    data for each school. (The data on accreditation in this
    publication are based exclusively on reports from recognized accrediting
    agencies; the Office does not itself accredit any schools.) This
    Directory has a unique value because of the extent of its coverage,
    its completeness, its uniformity, and its convenient size and format.
    With improved methods of compiling data and technological changes
    in printing, the volume was produced much faster than previous
    editions, with a substantial reduction in the cost of printing and
    publication.
    A noteworthy response-rate of over 99 percent was achieved in
    compiling data for the study on Statistics of Special Education for
    Exceptional Children. Since sampling was neither desirable nor
    feasible in this type of specialized survey, the data were gathered
    by direct mail inquiry. The survey included, for the first time, all
    types of public-school systems. (Previous studies were restricted to
    city school systems.) The all-inclusive direct coverage of this survey
    is a landmark among statistical studies of the Office.
    In order to expedite the publication of data relating to small- and
    medium-sized cities, plans were made to divide the annual report on
    Current Expenditures Per Pupil in City School Systems into two
    parts. This procedure was employed also to hasten the publication
    of Statistics of Higher Education.
    Because of the increase in the number of cities between the 1940
    and 1950 Censuses, a partial sample technique has been used to reduce
    by 40 percent the number of cities handled for Statistics of City School
    Systems. Only 2,335 of the 3,786 cities are to be used in the study.
    However, in order to provide for a reasonably adequate number of
    comparisons among cities within each State, sampling has been
    196 Department of Health, Education, and Welfare, 1953
    restricted to certain States, and to cities within certain size categories.
    Each year the Office faces the problem of slow reports from some
    of the State departments of education. This delay has frequently
    led to late publication of the report on Statistics of State School
    Systems. In an attempt to meet this problem in fiscal year 1953, a
    reasonably prompt estimate of United States totals for the 48 States
    was published (Circular No. 352) on the basis of data received from
    the first 24 States reporting.
    VIII. Reports and Technical Services
    The Reports and Technical Service Section is an Office-wide service
    authorized “to promote the cause of education throughout the
    country” through publications, the press, radio, television, and other
    media which reach the educational profession and the public in general.
    This Section performs a wide variety of regular and special
    services for the various Divisions of the Office, other agencies of
    Government, and organizations concerned with problems of education.
    Publications mirror all of the diverse activities of the Office and
    serve to illustrate the program of the Office as a whole to the educational
    world and to the general public. They are the chief means for
    the dissemination of Office research findings and other significant
    data. They represent the most important avenues of service to school
    systems, educators, and all others interested in the problems and
    progress of education.
    As part of the statutory function to diffuse information concerning
    education, two official periodicals—School Life and Higher
    Education—are published monthly and semimonthly, respectively,
    during the school year. Higher Education—which is produced in
    collaboration with the Division of Higher Education—provides information
    on Federal activities and policies related to college and university
    education, reports studies of higher education made by the
    Office, includes materials from institutions of higher learning and
    from educational organizations on their policies and activities, and
    lists new Government publications on education and non-government
    publications on higher education. School Life keeps its readers
    informed of important trends in American education. It summarizes
    research projects of the Office, presents pertinent statistics, reports on
    Federal activities in education, and offers much additional information
    useful to educators and the public. All new publications of the
    Office of Education are announced in School Life each month.
    As an economy measure, the free list of School Life was reduced
    during fiscal 1953 from 10,000 to 2,000 copies. There are approximately
    6,300 paid subscriptions. It is expected that this figure will
    increase during the coming year.
    Office of Education 197
    In addition to 40 major publications, 125 processed materials were
    issued during the year, including bibliographies, a special series of
    bulletins for the elementary and secondary schools, etc.
    Approximately 36,000 pieces of correspondence were handled during
    the year. Of these, some 4,700 were letters on educational matters
    addressed to the White House and referred to the Office for reply.
    Major cooperative projects undertaken during the fiscal year
    included:
    1. Cooperation with the Atomic Energy Commission and the Federal
    Civil Defense Administration in preparing a special issue of
    School Life on the theme “Citizenship for the Atomic Age.” This
    was issued as a supplement to volume 35, September 1953. Sixty
    thousand copies were printed and distributed.
    2. Planning of arrangements for the selection of the 1954 Teacher
    of the Year in cooperation with the National Council of Chief State
    School Officers, McCall's Magazine, and the National School Public
    Relations Association.
    3. Direction of the Joint Workshop of the Educational Press Association
    of America and the Department of Classroom Teachers of the
    National Education Association on improving the effectiveness of
    educational publications.
    4. Planning with the National Education Association, the National
    Congress of Parents and Teachers, and the American Legion for the
    1953 observance of American Education Week.
    5. Planning and arranging for the 1953-54 Better Schools Campaign
    in cooperation with the Advertising Council and the National
    Citizens Commission for the Public Schools.
    6. Cooperation with the National Association of Radio-Television
    Broadcasters, the Junior Chamber of Commerce of the United States,
    and the Radio Manufacturers Association in the annual Voice of
    Democracy contest.
    IX. Termination of Civilian Education
    Requirements Program
    With the close of fiscal year 1953, the functions of the Office of Education
    as the claimant agency for education under the Defense Production
    Act of 1950 came to an end.
    These functions, undertaken first under Executive Order 10161 of
    September 9, 1950, and Department of Commerce Order No. 127 of
    November 20, 1950; and subsequently expanded under Executive
    Order 10200 of January 3, 1951, and appropriate delegations from the
    Defense Production Administration and the National Production
    Authority, ultimately included full responsibility for the operation
    198 Department of Health, Education, and Welfare, 1953
    of the claimant agency program with respect to schools, libraries,
    museums, and higher educational institutions.
    A special Division of Civilian Education Requirements was established
    in September 1951 to carry out these responsibilities and functioned
    in this capacity until June 30, 1953. The operations of this
    program were a major factor in maintaining essential educational
    services throughout the country during a period of critical shortages
    of construction materials, equipment, and supplies for school construction,
    operation, and maintenance.
    Food and Drug
    Administration
    Fifteenth Anniversary Year
    This report marks the fifteenth year of the present Federal Food,
    Drug, and Cosmetic Act of June 25, 1938, which replaced the original
    “Wiley pure food law” of 1906.
    When the act was still in its infancy, its administration was transferred
    to the Federal Security Agency because its basic purpose was
    to promote the individual welfare of our citizens. The objectives of
    the Food and Drug Administration are today identical with those
    outlined by the President when he recommended to Congress the creation
    of the Department of Health, Education, and Welfare.
    Appropriately—a look backward will show the progress of the law
    since its enactment, while a look at current problems will show unfinished
    tasks which remain for the years ahead.
    The law was a nonpolitical enactment with bipartisan support, primarily
    to protect the consumer’s health and pocketbook, but also to
    foster fair competition among the regulated industries. Five years of
    legislative consideration had eliminated practically all disagreement
    regarding its various provisions. Legal authorities have praised the
    act as a model of technical legislation.
    As it stands today the law has been strengthened by both legal interpretation
    and legislative action. Two defects in the original language
    were disclosed by Supreme Court decisions, both of which led
    to prompt corrective amendments by the Congress.
    The first of these amendments, adopted by the 80th Congress, made
    clear that the jurisdiction of the law applies to regulated products all
    the way from the point of origin throughout their interstate movement
    and on through distribution until such products reach the ultimate
    consumer.
    199
    200 Department of Health, Education, and Welfare, 1953
    The second, adopted by the present (83d) Congress (see p. 217 of
    this report) established the right of inspection of all regulated products
    and the premises where they are manufactured, transported, or
    held for sale, without advance notice or permission from the owner,
    operator, or agent in charge.
    The 82d Congress enacted an amendment simplifying controls over
    the illegal sale of dangerous drugs. Testing and certification of
    insulin and specified antibiotic drugs which could not be controlled
    adequately by post-shipment sampling, were established by earlier
    amendments.
    The courts strengthened the law in numerous decisions reflecting the
    principle that a statute designed to protect the public should not be
    read with strained and technical construction that would defeat its
    purpose.
    Considering that it was enacted on the verge of an era of unprecedented
    technological change in the food, drug, and cosmetic industries—
    change accelerated by the greatest war in world history—the
    1938 law has been a remarkably adequate and effective statute.
    Particularly fortunate was a provision which required the filing of
    scientific data to establish the safety of new drugs prior to marketing.
    This provision anticipated unparalleled advances in chemotherapy
    which have virtually revolutionized medical practice. Instead of oldfashioned
    shotgun medication to alleviate symptoms, patients can now
    be provided with high-powered bullets which cure disease when properly
    used but which can also do great damage when misused. Manufacturers
    are constantly striving to improve these new drugs: every
    change requires an amendment to the original file and a new evaluation.
    The work load and the responsibility have become greater year
    by year.
    The need for the new-drug provision of the 1938 act had already
    been demonstrated at the time of its passage, but post-war changes in
    the technology of foods and cosmetics could hardly have been anticipated
    at that time. Would the daily consumption of new ingredients,
    hitherto unknown for food use, endanger the public ? An entire new
    group of pesticides, tested only for war use under specialized conditions,
    became available to every food producer and handler, while the
    scientists were still seeking to learn more about their toxicity.
    Today the housewife buys “ready-to-heat” and “ready-to-eat” food,
    prepared mixes, and washed fresh vegetables in sealed bags. Never
    before has so little of the actual preparation of the family fare been
    done in the home kitchen. Control of its wholesomeness and quality
    have been relinquished to factory management and “pure food”
    officials.
    The increase in consumption of packaged and shipped food products,
    coupled with a 25 percent increase in the population since 1938,
    Food and Drug Administration 201
    is bringing growing complexities in food manufacture, shipping, and
    storage. The known toxic preservatives in wide use at the turn of
    the century were quickly abandoned when the 1906 law went into
    effect, and their use had to be declared on the label. The current additives
    to foods cannot be handled so simply.
    Apart from provisions for the promulgation of food standards, the
    food law is corrective rather than preventive. It depends upon investigation,
    detection, and legal action after products appear on the
    market, and frequently after large amounts have been consumed.
    Cooperative efforts of industry and Government to protect the public
    from potentially harmful food ingredients are entirely on a voluntary
    basis.
    The situation in regard to new cosmetic ingredients is similar.
    The disfiguring products of the past have gone, but new, complex
    chemicals are being employed, sometimes without adequate tests of
    their safety.
    All such developments have increased the need for new and comprehensive
    studies and for facilities adequate to deal with a vast expansion
    in the volume of regulated products.
    The report that follows describes some of the activities of the Food
    and Drug Administration in the fiscal year 1953 to enforce the law
    controlling domestic products valued at $50 billion annually, and
    import products with an invoice value of almost $3 billion. The direct
    cost was 3y2 cents per capita—or about 1/100 of a percent of the value
    of the goods subject to the Food, Drug, and Cosmetic Act. On
    July 1, 1952, the Food and Drug Administration enforcement staff
    numbered 890. At the close of the fiscal year it had dropped to 862 and
    faced a further reduction of 52 positions because of appropriation
    cuts.
    The Food and Drug Administration will not slacken activities in
    protection of health. This will mean decreased coverage in the economic
    field, and to some extent in sanitation. Since many of the economic
    and sanitary violations are difficult for consumers to detect,
    the self-interest of the regulated industries to secure a maximum of
    voluntary law observance will be of increasing importance.
    Food, Drug, and Cosmetic Act
    ON THE FOOD FRONT
    Health Hazards
    Seizures of dangerously contaminated foods averaged 37 tons a week
    in 1953 and 14 manufacturers recalled foods and feeds from dealers
    because of hazards discovered after they were distributed.
    293171—54----- 14
    202 Department of Health, Education, and Welfare, 1953
    One thousand eight hundred and seventy-five tons of the food seized
    was wheat treated with a poisonous mercurial compound for seed use
    and later intermingled with untreated wheat and shipped to flour
    mills. In the summer of 1952 this grain was colored pink by the
    compound employed but in June 1953 a carload was seized containing
    mercury-treated seed that was colorless. Millers who had been rejecting
    deliveries of the “pink wheat” could not detect the new treatment
    by visual examination. The seized wheat was placed under bond and
    some lots used for the manufacture of non-food products. Other carloads
    received a scouring treatment under FDA supervision; the
    unfit scourings were destroyed and the cleaned part released for mill
    use.
    One packer’s entire output of Alaska frozen clams, amounting to
    more than 10 tons, was seized upon arrival in Seattle because it contained
    a toxin produced by microscopic marine organisms which is
    capable of causing paralysis and death in human beings. Due to the
    incidence of these toxin-producing organisms in many parts of
    Alaskan waters, there had been practically no packing of fresh or
    frozen hard shell clams in Alaska for the past 5 years.
    Three seizures were made of a meat preservative containing thiourea
    to prevent discoloration. This chemical, which was not declared
    on the label, could have caused thyroid disturbances and other
    injuries to consumers of the treated meat.
    Two of the recalls involved specialized infants’ foods (see Products
    of Special Dietary Significance).
    The four principal manufacturers of coumarin, on their own initiative,
    discontinued soliciting sales for food use of this artificial
    vanilla flavor after they had received reports that it injured the livers
    of experimental animals. Coumarin has been used extensively in
    commercial bakery products, packaged cake mixes, ice cream, and
    chocolate products. The decision to discontinue its sale in food channels,
    although no case of injury to humans had been reported, is worthy
    of commendation and indicative of the manufacturers’ integrity and
    high sense of responsibility.
    Another recall took place when 66 college students became ill after
    eating imitation grape jelly. Investigation disclosed a fluoride contamination;
    the source was not determined, but the use of salvaged
    foods in the processing was suspected. The manufacturer recalled
    and destroyed 9 tons of the jelly.
    Seizure was effected of decomposed eviscerated turkeys destined for
    school lunch use after illnesses at a number of points were reported.
    The trouble apparently originated with long delays in transit from
    the dressing plant to a freezer some distance away. The U. S. DepartFood
    and Drug Administration 203
    ment of Agriculture placed a hold order on all distributions from this
    plant for sale to the Government under the school lunch program.
    To Keep Food Clean
    In volume, nearly 6,000 tons, or about 111 tons a week, of decomposed
    or filth-contaminated food was removed from consumer channels.
    Of this, about one fourth had become unfit after it had been
    shipped by the producer.
    Table 1.—Actions on foods during the fiscal year 1953
    Projects 1
    Total___________________________________________
    Beverages and beverage materials_____________________
    Bakery products______________________________________
    Cereals and grain products:
    Human use_______________________________________
    Animal use-------------------------------------------------------------
    Chocolate, confectionery, and other sugar products____
    Dairy products:
    Butter____________________________________________
    Cheese____________________________________________
    Miscellaneous_____________________________________
    Eggs and egg products________________________________
    Flavors, spices, condiments___________________________
    Fruits and fruit products_____________________________
    Macaroni and noodle products________________________
    Meat products and poultry___________________________
    Nuts and nut products________________________________
    Oils and fats__________________________________________
    Oleomargarine_______ ________________________________
    Seafood_______________________________________________
    Vegetables and vegetable products____________________
    Miscellaneous foods and food adjuncts________________
    Food for special dietary uses__________________________
    Seizures
    Criminal
    prosecutions
    instituted
    Injunction
    petitions
    Import
    shipments
    denied
    entry
    1,239 190 6 4, 030
    23 8 0 151
    13 18 0 63
    220 14 0 19
    16 9 0 3
    49 13 0 261
    51 17 0 0
    11 12 0 92
    5 0 0 5
    16 3 0 0
    74 5 0 2,213
    83 8 1 493
    19 7 0 16
    77 27 0 7
    95 1 1 105
    3 5 3 6
    0 7 0 0
    190 8 1 506
    259 12 0 79
    3 0 0 6
    32 16 0 5
    1 Each project under which action was taken is reported. The total number of food seizures is 1,220 and
    of criminal prosecutions is 177. (See table 3.) Each of these totals is less than the totals reported above
    because table 3 reports combined seizure actions, particularly of warehouse merchandise, and criminal
    prosecutions against firms that ship foods classified in more than 1 group.
    Food factory inspections were cut approximately 3 percent. This
    was due mainly to the smaller number of available inspectors rather
    than to refusals to permit inspection after the Supreme Court ruled
    in December 1952 that the law did not require manufacturers to grant
    such permission. After this decision there was an immediate response
    from large segments of the food industry with invitations to continue
    factory inspections in their plants. While the number of refusals
    was substantial, the percentage of the total was small. One food
    manufacturer refused on the grounds that it was not convenient,
    proper help was not available, “and besides the plant needs cleaning.”
    Two days later the inspector returned and the manufacturer said:
    “All right, go ahead. I have cleaned up since you were here—no
    objections.”
    The extent of examination of raw materials in factories and of
    samples of finished foods in interstate commerce is planned each year
    204 Department of Health, Education, and Welfare, 1953
    with a view to the widest possible coverage of foods most likely to
    decompose or be attacked by insects and rodents. Adverse growing
    conditions which affect the fitness of raw materials frequently require
    an adjustment of these plans.
    The summer of 1952 was a poor season for tomatoes. Heat, blight,
    and alternating drought and excessive rains brought rot and heavy
    insect infestation. Few tomatoes had been packed in many areas by
    late summer. A State canners association expressed the fear that some
    canners, desperate because they depended completely on the tomato
    pack for their income, would be driven to using unfit tomatoes.
    Activities of a number of State agencies to control selection of
    packing stock and keep unfit lots from distribution held Federal
    seizures to a normal number. More lots were seized because of fly eggs
    and maggots, in comparison with decomposition from mold, than in
    previous years.
    There has been an improvement in the sanitation of poultry dressing
    plants and the handling of slaughtered birds. Many of the operators
    have participated in industry-sponsored poultry improvement meetings
    and demonstrations. The Food and Drug Administration joined
    State agencies in assisting in this educational program, and also spent
    considerable time during factory inspections in pointing out to plant
    managements the precautions necessary to assure an acceptable
    product.
    The most serious problems found in poultry shipments arose from
    the inexperience of new operators, and from the slaughtering of
    diseased and cull birds, which frequently appear on the retail market
    as cut-up pieces. Other avenues of distribution of diseased and cull
    poultry have been public eating houses and soup factories that were
    not careful to reject unfit birds. Recently when a number of soup
    manufacturers changed their buying policy, merchants of unfit poultry
    complained that their market was seriously hurt.
    The fish industry is one of the most noteworthy examples of change
    in consumer buying habits. Before the quick-freeze era, the housewife
    customarily purchased fish “in the round” and had it dressed.
    Today a large portion of the fish on the market is dressed and frozen
    at the packing plant. Technical men in the industry have shown an
    increasing tendency to correct conditions that might result in the
    freezing of decomposed fish.
    There was a materially reduced pink salmon catch in Alaska resulting
    in heavy importations from British Columbia, which had lost
    many of its usual European markets. Early importations showed a
    high incidence of decomposed fish, requiring detention of 5,000 cases
    of the first 35,000 imported. Corrective measures were taken promptly,
    and later shipments were free from decomposition.
    Food and Drug Administration 205
    Canned salmon packed in Alaska is subject to voluntary industry
    control which has been generally effective in keeping decomposed lots
    from the market. In 1953, however, the system did not adequately
    control the output of an Alaskan cannery jointly operated by three
    firms. Great confusion as to the identity and location of various code
    lots impeded supervision by the industry of code lots ordered destroyed,
    and a mixture of decomposed and good cans valued at more
    than $126,000 was seized. The lots were subsequently segregated under
    bond and the decomposed cans destroyed.
    One Gulf Coast firm was enjoined from shipping unfit crabmeat,
    after several warnings by inspectors that employees were contaminating
    the meat by their insanitary habits.
    There was continued improvement in the sanitation of crude vegetable
    oil mills, discussed in the last report in connection with regulatory
    work on oleomargarine. A number of mills, however, persisted
    in using raw materials contaminated with rodent and human filth.
    Two mills enjoined from shipping crude oils made from unfit soybeans
    and cottonseed have taken measures to divert large stocks of contaminated
    raw materials to non-food use, and to provide storage protection
    for new material received.
    Another injunction was granted against shipment of pecan oil contaminated
    by curculio insects, cigarette butts, and other extraneous
    matter. Still another prevented shipment of peanut oil and peanut
    butter made from 3,000 tons of peanuts contaminated by insects and
    rodents. The injunction listed under fruit and fruit products restrained
    a vinegar plant from distributing in interstate commerce
    314,300 gallons of vinegar and apple juice made from apples containing
    rot, insects, and worms.
    The heaviest fine of the year was $10,000 assessed against a macaroni
    firm and its president for shipping macaroni which was insect infested
    and prepared in an insanitary plant. Both defendants had pleaded
    guilty to similar charges in 1947 but they vigorously contested this
    case in a 3-day trial, and have filed an appeal.
    Heavy import detentions were made of pepper which arrived at
    U. S. ports, contaminated by insects not previously found in pepper.
    The infestation was traced to wheat shipments to famine-striken India
    from points throughout the world; the overtaxed transportation and
    storage facilities had been contaminated by many new kinds of insects
    that were not exterminated before subsequent use for the pepper and
    other spices.
    Detentions of insect-damaged coffee beans also increased during
    the year, as a result of high prices which encouraged salvaging of beans
    that would have been discarded in previous years.
    206 Department of Health, Education, and Welfare, 1953
    Educational and Regulatory Programs
    Programs designed to effect major improvement in the selection,
    processing, and handling of raw food materials can best be carried
    out with the cooperation of industry leaders and various agencies
    in local, State, and Federal governments. Such programs entail widespread
    preliminary investigations to evaluate the extent of the problems
    involved and the corrective facilities available, followed by educational
    programs to acquaint all groups concerned of the objectives
    and the procedures planned to achieve them.
    Wheat and Wheat Flour Program.— Die extensive investigational
    and educational programs conducted in cooperation with grain trade
    and milling representatives, the U. S. Department of Agriculture,
    and the Fish and Wildlife Service of the U. S. Department of Interior
    during 1950 and 1951, and the regulatory program on wheat and
    wheat flour inaugurated in the spring of 1952, were discussed in the
    last annual report. The objective of the program was to reduce filth
    contamination of food grain by rodents, insects, and birds; eliminate
    such contaminated grain from milling and other food channels; and
    reduce the agricultural losses due to the depredations of insects and
    animals.
    Inspections were made of terminal and country elevators to check
    on sanitation of storage facilities. This activity was continued during
    fiscal year 1953 and brought about many improvements in storage
    facilities and in the protection of wheat in storage. Through the cooperation
    of trade groups and other Government agencies the slogan
    “Grain Is Food—Keep It Clean,” was brought to the attention of
    farmers, grain dealers, and millers via widely circulated publications,
    posters, and pamphlets and through meetings of trade and agricultural
    groups. Representatives of the Food and Drug Administration
    appeared on scores of programs of grain and milling trade associations
    and farm groups to explain and discuss the grain sanitation program.
    The sampling of cars to check for rodent filth contamination was
    begun in the fall of 1952 and resulted in seizure and subsequent diversion
    for animal feed use of 45 cars of contaminated wheat. Examination
    of wheat for insect infestation was postponed pending development
    of practicable testing methods.
    In the spring of 1953 the Secretaries of Agriculture and of Health,
    Education, and Welfare appointed a 17-man committee composed of
    representatives of the Departments of Agriculture and of Health,
    Education, and Welfare; the Fish and Wildlife Service; land-grant
    colleges; grain producers and dealers; millers and bakers; and sanitarians
    to make a comprehensive study and review of the problem
    and to make recommendations to the Secretaries with respect to
    the grain sanitation program. Further work on sampling cars of
    Food and Drug Administration 207
    wheat has been postponed pending the report of this Grain Sanitation
    Committee, which met in August 1953 and was organized into subcommittees
    to study and report on various phases of the problem.
    Cream and Butter Program.—Activities in previous years have
    brought about many improvements in sanitation in creameries and
    other plants manufacturing dairy products and have caused more
    care to be exercised in the acceptance of cream and milk for use in
    manufacturing food products such as butter and cheese.
    Further progress in eliminating filthy and decomposed cream and
    milk from food channels requires improved techniques in detecting
    filth contamination and decomposition. During the fiscal year, studies
    by FDA inspectors and laboratory scientists were intensified. The
    industry, through a committee sponsored by the American Butter
    Institute, cooperated in developing improved procedures for detecting
    filth contamination in cream. The industry group was also active in
    educational programs to induce producers and dealers to improve the
    handling of milk and cream to prevent contamination and spoilage.
    The ultimate objective of this work will be to replace present sampling
    methods with a test of each can of cream received at the plant, as a part
    of the processing operation. Present testing procedures are widely
    variable as to results. Officials in a number of States arranged meetings
    where representatives of the Food and Drug Administration demonstrated
    the new testing procedures to industry cream graders.
    Fresh Produce Markets.—A series of articles published in Redbook
    Magazine directed public attention to deplorable sanitary conditions
    in fresh produce markets in a number of cities. One of the articles
    was the reporter’s account of investigations by Food and Drug inspectors.
    Further inspections made in cooperation with local health
    authorities, covered produce markets in over 50 cities throughout the
    country. Seriously insanitary conditions that exposed fresh fruits and
    vegetables to filth contamination were found in the markets of some
    localities. In other cities excellent facilities and practices in the handling
    of produce were found. The worst conditions were observed
    in large cities where market facilities had not kept pace with population
    growth. Overcrowded, antiquated buildings and inefficient facilities
    contributed to development of insanitary conditions, such as the
    stacking of produce containers on streets, sidewalks, gutters, and alleyways
    exposed to street dirt and filth, and contamination by animals
    and birds.
    Regulatory action in those localities where serious insanitary conditions
    were found will bring further investigations in cooperation
    with local authorities. Where there are adequate State or city laws
    or ordinances, enforcement of the local statutes will be most effective.
    208 Department of Health, Education, and Welfare, 1953
    Sanctions in the Federal statute on produce from interstate sources
    may be invoked where local statutes are inadequate.
    Pocketbook Protection ।
    In the economic field, the principal problem was to discourage the
    sale of water at food prices. At least a quart was injected into large
    turkeys by adapting hypodermic needles designed for the injection
    of curing solutions in meats.
    September and October inspections of oyster packing establishments
    in the Chesapeake Bay area surprised the owners, who had not
    expected visits until just before the Thanksgiving holiday pack.
    Fifty-nine seizures of watered oysters produced by 24 plants resulted.
    Packers, responding to citations, stated that the industry had decided
    to abandon the competitive practice of adding water to oysters in view
    of the healthier economic situation that had developed as a result of
    regulatory actions on the part of Federal and State agencies, the
    latter imposing their own rigid requirements to protect the locally
    produced oysters. From the first of November until the end of the
    season, seizures of watered oysters from this area were negligible.
    Five prosecutions were instituted for “butterlegging” operations.
    One group, indicted by a Federal grand jury, was reported to have
    handled in excess of a quarter of a million pounds of oleomargarine
    during the past year. They were charged with illegal shipments and
    conspiracy to violate the Federal Food, Drug, and Cosmetic Act.
    FDA inspectors investigating the plant were at first unable to observe
    any suspicious operations. After making a floor diagram and measuring
    the outside of the building, which disclosed unaccounted-for
    space, they persisted with their search and found a concealed room
    fully equipped with machinery for processing the oleomargarine so
    that it could be packaged as butter. The delivery and manipulation
    was usually carried on at night. The “butter” was delivered to a
    multitude of small grocery stores in the New York area. The case
    has not yet been tried.
    A corporation and its owner were convicted of distributing, in sec
    ond-hand bulk butter containers, oleomargarine obtained from one of
    the individuals under indictment. Although the defendant claimed
    that he thought he was obtaining butter, the court fined him and placed
    him on probation for a year with the comment that the defendant
    was aware of the transactions of his supplier.
    Another case, terminated by a fine and a 1-year suspended jail sentence,
    came to FDA attention when an inspector noted one brand of
    “butter” at a food market offered for several cents below the other
    brands in the store. Laboratory tests revealed that it was a mixture
    of colored oleomargarine and butter.
    Food and Drug Administration 209
    Contaminated Animal Feed
    A great economic disaster to the cattle raisers of the south central
    area led to the recall of two brands of cottonseed feed. Investigation
    disclosed that the feed manufacturers were using a lubricant containing
    chlorinated naphthalene which contaminated the cottonseed pellets
    they were processing. Widespread outbreaks of bovine hyperkeratosis
    developed in about 25 percent of the herds fed the pellets. State
    officials monitored the recall and are holding the feed under embargo.
    Sea-Food Inspection Service
    Shrimp and oyster canners who meet Government requirements for
    sanitation and controls are eligible to secure the sea-food inspection
    service, which is supported entirely by fees paid by participating
    packers. During the fiscal year, 12 canners packed canned shrimp
    under inspection; 9 of these also packed oysters. This year’s inspected
    pack was 228,036 cases of shrimp and 79,876 cases of oysters. This
    represents a slight increase of canned shrimp and a marked decrease
    of canned oysters packed under inspection.
    The service has been offered to packers of frozen and fresh iced
    shrimp, but no packers operated under this service during the fiscal
    year. The regulations for inspection of shrimp were revised so that
    in fiscal year 1953 the regulations for canned and frozen and fresh iced
    shrimp were consolidated.
    PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE
    Two of the foods recalled from the market in 1953 were specialized
    products for the feeding of infants. One was canned dried egg yolk
    which had been fed to many babies who developed salmonella poisoning.
    The manufacturers withdrew outstanding stocks and began an
    immediate investigation of the source of the trouble.
    The second was a product formulated as a substitute for mothers’
    milk. When convulsions and other disturbances developed in some
    babies, the manufacturer first attributed the trouble to water in areas
    which had suffered long drought periods. No chemical or bacteriological
    contamination could be detected. Later, FDA chemists noted
    the similarity in symptoms to those observed in feeding experiments
    12 years ago with baby rats whose mothers were on a diet deficient in
    vitamin B6. Later reports by pediatricians provided some confirmation
    of the suggestion that the babies were suffering from a vitamin B6
    deficiency. These investigations focus attention on the need for further
    study on the nutritional adequacy of “complete” infant formulas.
    The last annual report discussed a new investigation into the accuracy
    of labeling of low-sodium dietary foods, which are used in the
    management of certain heart conditions.
    210 Department of Health, Education, and Welfare, 1953
    A. market survey conducted in the past year revealed general confusion
    in the labeling of low-sodium items. Some are labeled “salt
    (or sodium) free,” “low-salt,” “unsalted,” “packed without added
    salt,” “for use in low-sodium diets,” etc. The less than one-third that
    bore label declaration of the amount of sodium in the product deviated
    in terms from milligrams of sodium per 100 grams of food to percentages,
    and there were wide discrepancies above and below the
    labeled declarations.
    To add to the confusion, previously reported sodium values of common
    foods before processing were often in marked disagreement. The
    Food and Drug Administration has been working with a task committee
    of the Food and Nutrition Board of the National Research
    Council to appraise the over-all aspects of low-sodium therapy. It
    has engaged in collaborative work on methods, the checking of diets
    for sodium content, a study of salt substitutes, and an extensive tabulation
    of values reported in scientific literature for the sodium content
    of foods. Those whose reported values were in marked disagreement
    were rechecked by improved methods.
    Over 100 foods with low-sodium declarations were analyzed for
    sodium content and a number were marked for later regulatory action.
    Particularly disturbing was the finding that some individuals who
    were producing foods labeled for low-sodium diets were not aware
    that ordinary table salt does not have to be present to make items
    hazardous to persons whose sodium intake must be kept to a low and
    carefully measured level.
    One product, labeled “unsalted” broth mix, contained enough
    monosodium glutamate to supply each serving of broth with 95 mg.
    of sodium, which is equivalent to about 3 good-sized pinches of salt.
    Many low-sodium diets are restricted to 250 mg. of sodium for the
    total daily intake, and this must include natural sodium contained in
    many foods. Some are so high in natural sodium that they should
    be excluded from such diets, but canned spinach, beets, and celery
    juice, which are outstanding examples of foods with high natural
    sodium content, were found among the “unsalted” foods in the survey.
    Likewise, some manufacturers are apparently not aware that sodium
    must be taken into account when they use numerous products designed
    to leaven baked items; shorten cooking time of cereals; preserve jellies,
    fruit juices, oleomargarine, and candy; process hominy and peeled
    fruits; retard molding in bread and cheese; stabilize ice cream and
    chocolate drinks; and serve other functions adapted to commercial
    processing.
    The drafting of new regulations was undertaken to provide for the
    labeling of these dietary foods in terms of their sodium content, so
    as to enable physicians and heart patients to better calculate the
    sodium intake.
    Food and Drug Administration 211
    The other side of the coin, in regulatory work on special dietary
    products, is control of foods to which health significance is falsely
    attributed. Claims that such products will ward off or cure disease
    without resort to medical treatment have caused much unnecessary
    suffering and loss of life. Twenty-seven seizures were made of vitamin
    and mineral products and foods with unfounded curative claims.
    A heavy expenditure of time is required to cover such violations
    because the promoters are adept at using indirect means, such as lectures,
    magazine articles, and other collateral literature, to persuade
    the public to buy their wares. Direct claims of curative properties
    or directions for use in disease treatment are seldom found on the
    labels.
    DRUG TRAFFIC
    Forty recalls of defective drugs were monitored in 1953. In 16
    instances, the drugs were removed from the market upon the initiative
    of the manufacturers, and in 24, the recalls were upon FDA request.
    Voluntary recalls are increasing, in comparison with those forced when
    defects come to regulatory attention. In many such cases in the past
    there was a tendency to withhold information while superficial
    attempts were made to withdraw defective stocks from distribution
    channels without disclosing the potential dangers involved. Adequate
    records were available in the past year to trace and withdraw outstanding
    lots without the necessity of public warnings by the Food
    and Drug Administration.
    Of the drugs recalled, 13 were below labeled potencies, 9 were nonsterile
    injection preparations, and 6 were misbranded as to content
    or directions for use. Among the other defects were injurious ingredients,
    precipitates, failure to disintegrate (tablets) or melt at body
    temperatures (suppositories), short volume, and poorly attached
    labels.
    Of the 150 criminal actions instituted for drug violations, 115
    (involving 222 defendants) were based on illegal sales of prescription
    drugs. In a large proportion of the cases both the firm and one
    or more salesmen were included in the charges. Some of these actions
    are still awaiting trial. The remainder, and those not tried at the
    end of the previous fiscal year, brought 106 pleas or verdicts of guilty
    in 1953. Three jail sentences were required to be served, two on new
    actions and one for violation of a 5-year probation ordered in 1951
    after a 4-year jail sentence was suspended. Eleven suspended jail
    sentences were imposed in 1953.
    Violations have moved progressively from those of pharmacists
    willing to “take a chance” with customers personally known to them,
    to deliberate actions, carried out with subterfuge and secrecy, usually
    212 Department of Health, Education, and Welfare, 1953
    involving sales to persons who obviously should not use such drugs
    without a physician’s supervision.
    Refusal by an overwhelming percentage of pharmacists to violate
    the ethics of their profession has made it possible to concentrate regulatory
    activities on the fringe operators who are callous to the serious
    consequences of misuse of dangerous drugs.
    Peddling of barbiturates to inmates of a State penal institution and
    in a veterans’ home was disclosed. Reports received from the penal
    institution indicated that the source of supply was cut off by FDA
    prosecution of a drug store not hitherto known to have been supplying
    the smugglers.
    In another case, a pharmacist was making surreptitious sales of
    barbiturates to an addict on street corners at designated times, without
    knowledge of the owner of the store.
    In the same city women seeking to reduce were purchasing amphetamines
    by “speakeasy” methods. They presented a white box with an
    “X” marked in pencil on the top and gave the password “tops.” The
    drug in question should be used only under careful medical supervision.
    One drug store fined for illegal sales could not account by prescription
    records for 172,552 barbiturate capsules received from wholesalers
    or manufacturers.
    Again in 1953 a physician was convicted of aiding and abetting
    illegal sales. He had furnished a druggist with signed blank prescriptions,
    and whenever the supply of these ran out he signed the
    prescriptions retroactively.
    Two operators of “treatment centers” were prosecuted for deliveries
    of misbranded drugs to be transported for out-of-State use.
    One was an illiterate herb man convicted by a Federal jury after a
    6-day trial. He had been treating people from many States for cancer,
    diabetes, sinus infections, cirrhosis, and other diseases, and sending
    them home with his herb mixtures. The defendant claimed he had
    learned the secret of herb medication from his mother, an Osage
    Indian. At the trial, outstanding authorities in the fields of medicine
    and pharmacology testified that dependence on his mixtures of mint
    leaves, boneset leaves and flowers, sunflower and dogwood leaves, and
    parts of several other plants, supplemented by castor oil and buttermilk,
    would endanger the lives of those who depended upon them to
    treat serious diseases.
    The jury heard testimony about a woman whose physician, a cancer
    expert, had recommended surgery for a small breast cancer in 1947,
    assuring her of an excellent chance of complete cure. Instead, she
    went to the herb “doctor” and took his preparations for 4^ years. At
    the time of the trial, her lungs and spine were cancer-ridden and she
    was paralyzed from the hips down. She died soon after the trial. The
    Food and Drug Administration 213
    defense presented 20 “living testimonials” who told the jury, without
    scientific evidence, that they had received benefits from real or imaginary
    diseases. The “herb doctor” was sentenced to serve a year in jail.
    The second case, terminated with a fine, was against an unlicensed
    operator of a treatment center who depended largely on walnut bark
    and mild laxatives for his “brew.” He suggested that when the patients
    got their medicine home they add a fifth of whiskey to the 4 quart jars
    of bark extractives they took with them—for its preservative effects.
    Hoping to avoid complications with Federal drug laws, he refused to
    ship refills but referred patients to “runners” who were transporting
    people to his place and would obtain additional medicine for them.
    Several appellate courts have ruled, as did the trial court in this case,
    that the Food, Drug, and Cosmetic Act is violated when the medicine
    is offered for interstate transportation, even though the “doctor” did
    not personally make the shipment.
    Last year’s report discussed an injunction to restrain a cancer clinic
    from shipping its medicines in interstate commerce, misbranded with
    cancer claims, which was ordered by an appellate court after the trial
    court had refused to grant it. In February 1953 the Supreme Court
    refused to rehear the case and the court of appeals sent an injunction
    mandate to the district court. The judge refused to issue the injunction
    decree submitted by the Government, stating that it was too broad.
    Instead he issued a decree submitted by the defendant’s attorney, which
    ■would permit marketing the preparations with labeling declaring that
    there is a difference of competent medical opinion as to the therapeutic
    value of these medicines in treating cancer. The Government has
    petitioned the court of appeals to stay and reverse this decree. (In
    October the appellate court ruled that the language of the decree was
    in direct conflict with its mandate, and the judge signed the decree
    originally submitted by the Government.)
    A permanent injunction was granted to restrain a mail order house
    from shipping a barbiturate treatment for epilepsy. Competent
    medical authorities agree that an epileptic cannot be adequately
    treated without personal supervision of a physician.
    Another permanent injunction was granted against further shipments
    of a product, consisting essentially of rubbing alcohol, which
    was represented as an effective treatment for arthritis and sciatica.
    For violating an injunction against interstate traffic in an herb
    preparation, the operator of a “sanitarium” was fined. Proceedings
    were instituted for another injunction violation after the apprehension
    of the defendants, who disappeared for more than a year after
    citation, but still continued shipments of a worthless diabetes remedy
    consisting of saltbush, a desert weed. The injunction had been granted
    in 1941, after futile attempts had been made for many years under
    the 1906 law to stop traffic in this product which could cost the lives
    214 Department of Health, Education, and Welfare, 1953
    of diabetics. The case charging contempt of the injunction has been
    set for trial.
    An injunction against further traffic in a drug and device combination
    for the diagnosis of cancer is discussed under “Therapeutic
    Devices.”
    A veterinary remedy seizure, contested by the claimant, involved a
    preparation that had been relabeled after previous seizures on charges
    of false and misleading claims for the treatment of bloat in farm
    animals. The new labeling dropped the direct bloat claims but told
    farmers it was for “feeding to sheep and cattle while pasturing in
    green alfalfa, clover, or in corn and wheat fields.” The Government
    charged that this meant the same thing to farmers, and the Federal
    court upheld seizure of the relabeled product.
    New Drugs
    Determination of the safety of new drugs before they are permitted
    to go on the market is determined by evaluating records of pharmacological
    and clinical studies submitted by the producers. During the
    fiscal year 1953, drug manufacturers filed 508 new-drug applications
    for human and veterinary preparations. Four hundred and fifty-four
    applications went into effect during the year, including a number
    received late in the previous fiscal year. No applications were rejected,
    but 13 were withdrawn by the manufacturers.
    Among the important drugs considered during the year were the
    antibiotics—erythromycin, neomycin, fumagillin, viomycin, and magnamycin;
    preparations used in the treatment of hypertension—
    hexamethonium, various purified products of Veratrum and Rauwolfia
    serpentina; the hormones—hydrocortisone and purified corticotropin
    (ACTH) ; a number of antispasmodics used in the treatment
    of peptic ulcer, such as Antrenyl Bromide, Probanthine Bromide, and
    Famine Bromide; an antimalarial—Daraprim; some local anesthetics
    including Cyclaine, Ophthaine, Ravocaine, and Dorsacaine; succinylcholine
    chloride useful for relaxing skeletal muscle during anesthesia;
    a sulfonamide—Thiosulfil; and two drugs for the treatment of systemic
    mycotic infections—stilbamidine and ethyl vanillate.
    THERAPEUTIC DEVICES
    An injunction in November restrained further shipments of a cancer
    diagnosis kit, consisting of a test tube and two bottles of well-known
    chemicals labeled “Reagens I and II.” Directions were given to add
    Reagens I (hydrochloric and nitric acid) to a sample of the patient’s
    urine, heat and cool it, add Reagens II (ether), and if a color change
    occurred in an hour the patient was doomed as a cancer victim. The
    kit was employed by many alleged practitioners of the healing arts
    Food and Drug Administration 215
    who had little medical training and no specialized training in the
    diagnosis or treatment of cancer.
    The danger to public health of such a scheme is emphasized by the
    fact that controlled tests with this kit showed negative results in 59
    of 76 cases known to be malignant, and positive results in many healthy
    medical students. Retesting on the same group produced varying
    results. FDA based its injunction request on the fact that the only
    reliable cancer test is the microscopic examination of suspected tissue
    by a qualified pathologist.
    Of the 48 device shipments seized, 35 were promoted by false and
    misleading claims for the prevention or cure of diseases or for weight
    reduction. Simplest in construction were bags and pads filled with
    crushed ore from uranium mines abandoned because the radioactivity
    of the ore was too low for profitable mining operations. “Ballyhoo”
    made these mines popular as treatment centers, and more than 100,000
    arthritic sufferers paid fees to spend time in the cold, dank shafts
    seeking to have their ailments cured by the purported radioactive
    emanations. As long as the operations were localized, they were not
    subject to the act, but three firms extended their operations to enable
    patients to “take the cure” without journeys to Montana. Seizures
    were made of cabinets, bags, and pads containing the ore, destined
    for home use and treatment centers in urban communities outside of
    the State. The radioactivity of the seized ore was less than that from
    an ordinary luminous-dial watch, and without value in treating
    arthritis.
    The most elaborate device seized was a pendulum contraption which
    the manufacturer claimed would swing to the proper position to diagnose
    any patient’s disease and thereby point to a treatment from
    among some 90 preparations, mostly vitamin, herb, or vegetable products,
    including black walnut and violet leaves, poke and sarsaparilla
    roots, pumpkin seed, citrus peel, juniper berries, yeast, garlic extract,
    and various dehydrated plants and vegetables, many with a liberal content
    of chlorophyll.
    Among the other extravagantly promoted devices was an ineffective
    hearing aid represented as a scientific marvel of the century.
    Salesmen were instructed to compare it to the miracle drugs. It consisted
    of a piece of wire twisted to resemble a miniature tuning fork,
    placed in rubber discs with perforated centers, to be inserted into
    the ears.
    Devices were seized because of false and misleading claims to remove
    cataracts and treat other eye conditions; shoes to ward off disease
    by dispersing the electricity the body generates; violet ray instruments
    to prevent or cure baldness; and various types of massagers and
    vibrators to remove excess fat, tone the system, and protect against
    or cure numerous diseases.
    216 Department of Health, Education, and Welfare, 1953
    The electrical vibrator purporting to do the most for the ills of mankind
    was claimed to be an effective treatment for polio, goiter, diabetes,
    angina pectoris, appendix pain, locomoter ataxia, cardiac asthma,
    drowning, sun stroke, hay fever, cold in the head, and excess fat.
    Seizures continued of “magnetic ray” instruments and ozone generators
    that have been the subject of court actions for the past decade.
    While no new sources of supply have been located, distribution of
    such devices for restoring and preserving health is apparently too
    lucrative to be discouraged easily, despite seizures, prosecutions, and
    injunctions to restrain interstate shipments. Ordinarily, air purifiers,
    humidifiers, and vacuum cleaners do not come within the jurisdiction
    of the Food, Drug, and Cosmetic Act. When their labeling or sales
    promotion includes claims for the prevention of disease, however, they
    become therapeutic devices. Seizures were made of a “room conditioner,”
    a “room humidifier,” and a vacuum cleaner for unwarranted
    health claims of a general nature, and a “germicidal” lamp to be
    installed in furnace air ducts to kill polio germs.
    Thirteen seizures covered defective or dangerous devices: clinical
    thermometers that failed to register accurately, rubber prophylactics
    with holes, feminine hygiene devices that would endanger the user,
    and ultrasonic devices without meters to indicate the energy output
    or adequate means of preventing overexposure.
    The first seizures of ultrasonic devices were also based on false
    and misleading claims for a wide range of diseases. The physiological
    effect of the forces produced by ultrasonic devices is not fully
    understood. The Food and Drug Administration took the position
    that distribution should be limited to specialists in the field of physical
    medicine who alone are competent to conduct the scientific investigations
    required to establish the efficacy of such treatment and the precautions
    necessary to protect the patient. Following preliminary
    studies by these investigators, sufficient information was obtained to
    permit the distribution of properly constructed and calibrated ultrasonic
    devices to practitioners licensed to use such equipment. There
    has been no agreement to the broad claims originally made for these
    devices; shippers have been advised to offer them simply as an adjunct
    in the treatment of osteoarthritis and bursitis.
    COSMETICS AND COLORS
    One cosmetic preparation was voluntarily recalled from the market
    by the manufacturer. It was a liquid eye cream which irritated the
    eyes of some users. The five cosmetics seized included two with false
    claims of beautification, two alleged to be misbranded as to ingredients,
    and one containing non-certified coal-tar colors. Seizure of a
    product labeled “shampoo, plus egg” is being contested by the manuFood
    and Drug Administration 217
    facturer. The Government charged this name to be misleading on a
    shampoo containing only %80th °f an egg in each application.
    The only cosmetic prosecution charged shipment of an eyelash
    preparation containing coal-tar colors. Such products caused irreparable
    eye injury before cosmetics were brought under regulatory
    control and most of them were driven from the market during the
    early days of enforcement of the 1938 Act.
    One coal-tar color was recalled by a manufacturer because it had
    been distributed without certification. Another manufacturer was
    fined $500 for shipment of uncertified colors to food manufacturers,
    under the false labeling “certified.” The firm had been repeatedly
    warned that this practice was illegal.
    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 1953, 4,220 batches, representing 4,661,394 pounds, were certified,
    and 34 batches, representing 30,805 pounds, were rejected.
    Insulin.—Predistribution testing and certification of certain drugs
    which cannot be controlled adequately under usual regulatory procedures
    are provided by four amendments to the act. One of these
    amendments covers insulin preparations. Examination of 272 samples
    resulted in the certification of 43 materials for use in making batches
    of insulin-containing drugs and of 72 batches of insulin, 71 of protamine
    zinc insulin, 36 of globin zinc insulin, and 50 of NPH insulin.
    Antibiotics.—Three of the amendments cover the antibiotics, penicillin,
    streptomycin, dihydrostreptomycin, chlortetracycline (Aureomycin),
    bacitracin, and chloramphenicol. Examinations made of
    17,401 batches resulted in the certification of 17,279. The remaining
    122 batches were rejected for certification for failing to meet the following
    standards: Sterility (55), potency (47), moisture (8), pyrogens
    (7), syringeability (3), volume (2). Examinations of 964 official
    samples of certifiable antibiotics and antibiotic-containing feeds led to
    manufacturers’ recalls of 41 batches from the market for loss of
    potency, excessive moisture, formation of a precipitate, or short
    volume.
    LEGISLATION AND REGULATION-MAKING ACTIVITIES
    No amendments to the Food, Drug, and Cosmetic Act were enacted
    during the fiscal year, but two bills on which hearings were held in
    the spring of 1953 were passed before the adjournment of the First
    Session of the 83d Congress.
    One was enacted to correct the defect in the language of the Act
    disclosed by a Supreme Court decision on authority for inspection.
    293171—54----- 15
    218 Department of Health, Education, and Welfare, 1953
    Remedial legislation was urged by the President in his State of the
    Union address to Congress and a bill was recommended by the Secretary.
    When finally enacted on August 7, the measure contained provisions
    going beyond the Department-sponsored bill, including
    requirement for a written comment by the inspector on conditions
    observed during sanitary inspections, and a laboratory report on analyses
    of samples collected at the plant to determine whether they are
    decomposed or contaminated with filth.
    An attempt by the Senate to define the scope of inspections of
    druggists’ prescription files was rejected by the House. This legislative
    history makes it clear that prescription files are exempt from
    inspection except through search warrant proceedings.
    The second bill to be enacted substituted the generic chemical name
    “chlortetracycline” for the trade name “Aureomycin” in the certification
    provisions of the act. At the time this antibiotic was brought
    under certification, its chemical structure had not been established.
    Hearings were held on three other bills, without enactment in
    the First Session. Included were a proposal to simplify procedures for
    the establishment of food standards, a requirement that public eating
    places give adequate notice of the serving of foreign trout, and a
    bill to afford better protection to public health and to simplify procedures
    for establishing tolerances for poisonous pesticidal residues
    in foods. The Department endorsed the food standards proposal in
    full and the pesticidal bill in principle, but suggested that the latter
    be modified to improve its effectiveness. Department representatives
    testified against enactment of the trout bill on the grounds that the
    expense of enforcement would not be justified by its potential public
    benefit.
    Other bills proposing changes in the Food, Drug, and Cosmetic
    Act or its administration, which did not reach the hearing stage,
    included two bills to control new substances in foods and cosmetics,
    one designed to outlaw imitations of foods for which definitions and
    standards of identity have been established, bills to provide for the
    establishment of a district office at Detroit, several concerning the
    repacking of fresh vegetables and potatoes, one to extend controls
    over exports, and one to ban the addition of artificial color to citrus
    fruit.
    An amendment to the drug regulations issued in July 1952 provides
    for more informative labeling of prescription-only drugs than was
    formerly permitted, restricts distribution of such drugs to those trade
    channels which regularly serve licensed physicians and pharmacists,
    and requires more informative labeling on bulk packages which will
    make it possible for pharmacists to repackage the chemical with appropriate
    labeling. The regulations also exempt certain habit-formFood
    and Drug Administration 219
    ing drugs from the prescription class when they are used in combinations
    that are not hazardous.
    The only other regulations issued, apart from food standards which
    follow, were changes in fees for certain services rendered by FDA, a
    consolidation of the shrimp inspection regulations, and technical
    changes in the antibiotics regulations.
    Food Standards
    The bread order establishing standards of identity for five kinds of
    bread and rolls became effective in August 1952, except for the exclusion
    (by omission from the list of optional ingredients) of “softeners”
    containing polyoxyethylene monostearate. On petition of three suppliers
    of these compounds, two circuit courts of appeal had granted
    stays on this part of the order, pending rulings on their appeals against
    this exclusion from the ingredients permitted by the standard. One
    court affirmed the order, the Supreme Court refused to review the
    decision, and the case was finally dismissed in the other circuit. The
    stays were removed and by the end of the year the bread standards
    were in effect in all respects.
    A final order became effective amending the definition and standard
    of identity for oleomargarine, permitting the use of citric acid and
    certain citrates to combat development of undesirable flavor in oleomargarine
    and the optional use of synthetic vitamin A and vitamin A
    from certain other sources not previously permitted. It also increased
    the minimum level from 9,000 units to 15,000 units of vitamin A per
    pound when used for vitamin fortification, and established “margarine”
    as an alternate name for oleomargarine. During the year a
    petition for review was made on application of a firm selling vitamin
    A from fish oil, but the court dismissed the petition on its merits.
    A final order, amending the standard of identity for canned mushrooms,
    permitting as optional ingredients only salt and a limited
    amount of ascorbic acid, and establishing a standard of fill of container
    for canned mushrooms, became effective in December 1952.
    The ice cream hearing, part of which was held in 1941, and which
    was reopened in January 1951, was in session intermittently until
    December 31, 1952. The hearing was greatly prolonged by testimony
    concerning the safety and suitability of the polyoxyethylene type of
    emulsifiers for use in ice cream and related products.
    NEW COURT INTERPRETATIONS
    The Supreme Court affirmed a decision of the Court of Appeals for
    the Ninth Circuit that the act does not require manufacturers to permit
    inspections. Corrective legislation is discussed on p. 217.
    220 Department of Health, Education, and Welfare, 1953
    Petitions for certiorari were denied by the Supreme Court in five
    cases. Two were similar decisions by the Courts of Appeals for the
    Ninth and Tenth Circuits that the sale and delivery of a misbranded
    article to a person whose purpose to take it to his out-of-State home is
    known, constitutes delivery for introduction into interstate commerce,
    as prohibited by the statute.
    The Supreme Court also declined to review the decision of the Court
    of Appeals for the Fifth Circuit reversing a U. S. district judge who
    refused to enjoin a “cancer clinic” and its operators from shipping
    drugs misbranded with false cancer claims.
    Court decisions on the exclusion of certain softeners from use in
    standardized breads are discussed under “Food Standards.”
    The fifth denial of certiorari was on a petition by dealers convicted
    of misbranding horsemeat as “chucks” and “shanks” after its receipt
    in interstate commerce. The Court of Appeals for the Seventh Circuit
    upheld the conviction, overruling the defendants’ claim that since they
    had already sold the meat the offense was not committed while the
    product was being held for sale. The court held that the test was not
    of ownership, but whether the article had reached the ultimate consumer.
    It also ruled that barrels are packages within the meaning of
    the act.
    The Court of Appeals for the Eighth Circuit upheld the conviction
    of a pickle processor for insanitary plant operations. It held that the
    act clearly defines what shall constitute a crime and that the terms “insanitary
    conditions” and “contaminated” are descriptive terms, commonly
    used and understood. The court also held that, despite the fact
    that the shipments were made shortly before the Government’s factory
    inspections, the evidence justified the inference that the insanitary conditions
    noted in the factory were of a continuing nature.
    In upholding an order amending the oleomargarine standard, the
    Court of Appeals for the Second Circuit held that a consumer could be
    adversely affected by an administrative regulation and therefore had a
    right to ask for its judical review.
    The Court of Appeals for the Fifth Circuit reversed a district
    judge’s decision upholding seizure of a drug alleged to be misbranded.
    The appeals court held that the trial court abused its discretion in
    denying the claimant’s motion for removal of the case to a district
    of reasonable proximity to its principal place of business without
    showing good cause for denying the motion, as required by the act.
    Another appellate decision was based on methods of analysis used
    to establish the failure of a drug to meet the potency declared on its
    label. The product was not recognized in the U. S. Pharmacopeia at
    the time of shipment but was included in the next revision of that
    compendium. The Court of Appeals for the Ninth Circuit affirmed
    the conviction, holding that since the drug was not recognized in the
    Food and Drug Administration 221
    U. S. P. at the time of shipment, the Government was not restricted
    to the U. S. P. method.
    The first court interpretation of the scope of the provision of the
    act dealing with imitation foods was handed down by the District
    Court for the Northern District of New York. It found a frozen
    dessert to be misbranded because it was similar to ice cream in all
    respects except that it contained soy fat and protein instead of milk
    fat and protein, but its label did not declare it to be “Imitation Ice
    Cream.”
    The District Court of New Jersey ruled that cigarettes are drugs
    if therapeutic representations are made in the labeling. The court,
    in condemning the cigarettes as misbranded by an accompanying leaflet,
    held that the “clear import of the leaflet is at least that the smoking
    of the cigarettes will make it less likely that the smoker will contract
    colds or other virus infections. This is enough to bring the
    product within the statutory meaning of ‘drug.’ ”
    Enforcement of Other Acts
    Tea imports examined under the Tea Importation Act again passed
    100 million pounds, after a drop in volume in 1952. Of the 102,171,858
    pounds examined, only 18,606 pounds were rejected for failure to
    measure up to standards set by the U. S. Board of Tea Experts. This
    amounts to less than 0.02 percent in comparison with 0.05 percent the
    previous year. Five appeals were entered in protest of these rejections
    but the U. S. Board of Tea Appeals sustained the FDA examiners’
    decision in each case.
    Six caustic poisons were seized, including drain openers, bowl cleaners,
    and a solder solvent. These products failed to bear the word
    “poison” on the labels or bore it in letters smaller than prescribed by
    the Caustic Poison Act. One of the drain openers had been properly
    labeled originally but an advertising offer had been attached to the
    container so that it covered the poison warning and the directions for
    treatment in case of accidental injury.
    No violations were discovered under the Filled Milk Act. No permits
    were issued for importations of milk from Canada under the
    Import Milk Act. One application was denied because Canadian
    veterinary officials reported unsatisfactory sanitary conditions on the
    dairy premises of the applicant.
    Scientific Investigations and Some of Their Applications
    The Food and Drug Administration’s intensive scientific investigations
    are limited to the development of new or improved regulatory
    222 Department of Health, Education, and Welfare, 1953
    tools and sounder and more specific knowledge of the products under
    its jurisdiction.
    The work of the scientific divisions is integrated to employ whatever
    specialized techniques and skills are required for each problem
    to be attacked. Often, two, three, or more divisions are working on
    different aspects of the same subject. Analysts in food, drug, or cosmetic
    laboratories devise methods to isolate measurable quantities of
    new ingredients in products, or to produce more precise methods for
    older components. When such action is indicated, the isolated substances
    are tested on experimental animals in nutrition and pharmacology
    laboratories, whose experts, along with the medical officers,
    evaluate the results in terms of public benefit or potential harm attendant
    to their use. If it is determined that the use of such substances
    is a violation of the act, the analytical methods are used for enforcement
    purposes.
    An example in 1953 was work on emulsifiers of the polyoxyethylene
    types. The chemists developed a method for the determination of
    the polyoxyethylene compounds in bread, to assist in the enforcement
    of the new bread standards which exclude such compounds because
    of lack of evidence of their safety. Pharmacologists, in continuing
    studies of the effects on experimental animals, found that rats fed
    a polyoxyethylene emulsifier show a reduction in intestinal flora and
    reduced growth. Nutritionists correlated retardation of growth and
    detectable tissue changes with alteration in the proportions of nutrients
    in the diet. There were marked effects on male animals on a diet
    with a substantial increase in fats. Chronic 2-year feeding tests using
    large numbers of rats in the control and experimental groups are still
    under way.
    Tests are progressing in the pharmacology laboratories to re-evaluate
    the safety of certifiable coal-tar colors, as to both direct toxicity
    and that resulting from metabolic changes through which colors may
    go. A new analytical tool, paper chromatography, has found application
    in the separation of coal-tar dyes under investigation.
    Studies of insecticidal residues and methods for their detection have
    received major attention in both chemical and biological laboratories.
    Not only are consumers affected by the use of such pesticides on growing
    crops, but there has been a relatively recent development in the
    use of vaporizers to disseminate pesticides in enclosed places where
    food may be stored, such as warehouses, restaurants, and in the home.
    It was found that lindane, when dispensed as a vapor, penetrates
    multiple layers of wax paper, kraft paper, and plastic film, and is
    toxic to test animals.
    Many insecticides owe their value (and also their toxicity to man)
    to the inhibiting effect they exert on a life-essential enzyme of the
    body, cholenesterase. Different insecticides have a wide range of inFood
    and Drug Administration 223
    hibiting power. A test to gage the toxicity of various residues is
    being developed with good progress.
    The decision of manufacturers to stop selling coumarin for food
    use was discussed in the section “On the Food Front.” FDA chemists
    devised new techniques by paper chromatography for a rapid test for
    the presence of coumarin, or any of four other commonly used vanillalike
    flavoring substances. To meet other new situations it was necessary
    to improve methods of analysis for mercury to detect seed wheat
    treated with colorless mercury compounds; likewise to improve methods
    for pesticidal residues in vegetable oils, and to determine the
    diphenyl absorbed by citrus fruit from wrappers impregnated to
    retard spoilage.
    Chemical and microanalytical work to detect spoilage and filth
    contamination, like many other FDA scientific studies, can never be
    considered finished. It is a continuous process of adding bit by bit
    to the knowledge already acquired until the sum total can be used
    effectively as a regulatory tool, to be improved when advances in precision
    equipment and added studies permit. Work of this type continued
    in many fields in 1953, including tests for filth in cream for
    butter making, fish packs showing progressive decomposition, spoiled
    frozen eggs, insect infestation of corn, rot and fly damage to tomatoes,
    and vitamin C deterioration. Bacteriological studies continued on
    the isolation and identification of food poisoning bacteria, spoilage in
    shell eggs, and frozen pre-cooked foods.
    Enforcement of the economic provisions of the food law also requires
    continuous improvement of analytical methods. Such studies must
    be deferred, however, when methods are needed to meet some health
    problem. Methods developed or improved in 1953 included a simpler
    and more rapid test to determine compliance with the egg content
    requirements of standards for noodles, salad dressings, etc.; to detect
    the components of admixtures of cream and cheaper fats in frozen
    desserts; and to detect adulteration of lemon oil with cleverly
    manipulated cheapening agents.
    Studies toward the formulation of new food standards have
    been made on fill of container for canned tuna, the composition of
    citrus and citrus-base beverages, canned pineapple, and a number
    of frozen foods. Fill-of-container standards for canned fruits are
    under review. Standardization investigations require work in areas
    of commercial production so that all factors that have bearing on workable
    standards can be given due weight. Such investigations are timeconsuming
    and expensive. Reduced appropriations will curtail a
    major part of this program.
    Among the drugs investigated were barbiturates with built-in antidotes
    which would serve as emetics in cases of over-dosage. As had
    been established earlier for ipecac, it was found in 1953 that zinc sul224
    Department of Health, Education, and Welfare, 1953
    fate is too toxic to justify its use in barbiturates. This chemical produces
    hypochronic anemia and has toxic effects on bone marrow,
    kidney, and liver.
    Clinical studies of the effects of new drugs when they become widely
    used—in comparison with results in carefully controlled experimental
    investigations before they are released for distribution—have been
    limited by the resources available. This work is an essential part, however,
    of establishing the safety of new drugs, to which FDA is diverting
    increasing man hours in a period when work must be curtailed in
    many other areas. To aid in the interpretation of clinical studies,
    doses of chloramphenicol larger than those used in human therapy
    were fed to experimental animals for an extended time. This produced
    granulocytopenia and anemia, with the depression of the
    erythroid element of bone marrow and the development of fatty livers.
    Similar studies are under way for other wide-spectrum antibiotics.
    A study of the incidence of antibiotic-resistant staphylococci in hospital
    patients and the general population is being carried out in cooperation
    with members of other organizations.
    FDA antibiotics specialists and veterinarians joined with the U. S.
    Department of Agriculture and interested manufacturers in an extensive
    project to determine the presence of antibiotics in the edible portions
    of poultry and hogs fed antibiotics at various concentrations in
    some of the new feeding schedules, in eggs from such poultry, and in
    the milk of cows treated with antibiotics for mastitis. The studies are
    planned to show how much antibiotics get into the food and how long
    they remain after feeding or treatment is discontinued. Methods for
    the determination of antibiotics in animal feeds have been improved.
    The new methods can be easily adapted for the detection of small
    quantities of antibiotics in blood, tissue, and body fluid.
    Routine examination of liver injections led to the observation that
    the vitamin Bi2 content of 1 cc. vials deteriorated rapidly while
    samples of the same lot of liver injection in 5 and 10 cc. vials did not.
    This called attention to an important problem and the industry has
    now made marked progress in its solution.
    Chemical, bioassay, and microscopic methods are used for drug testing.
    The field laboratories, which do a large portion of the chemical
    testing of drugs, do not have animal laboratories and other equipment
    required for bioassays, which are all made in Washington. For
    this reason, and because animal tests are usually slower, more costly,
    and do not always differentiate between various components of preparations,
    work to replace them with chemical methods is continually in
    progress.
    In 1953, chemical methods were completed for water-soluble conjugated
    estrogens and for epinephrine to replace the bioassay tests
    Food and Drug Administration 225
    formerly employed. In each, case the new method gives more complete
    information about the product being tested.
    Work on chemical methods to correlate the composition and therapeutic
    response of adrenal cortex extracts is in progress. These
    extracts are complicated mixtures of steroids which may cause several
    different responses. Methods have been developed for the determination
    of four of the active steroids present, and methods for other active
    compounds are under study.
    A new and more reliable chemical procedure was developed for the
    analysis of digitoxin tablets. The U. S. P. method was unsatisfactory
    because it did not distinguish between digitoxin and some of the other
    glucosides that might be present. The new procedure is being modified
    and applied to other preparations of purified digitalis glucosides.
    A chemical method was developed for measuring the amounts of
    each ingredient in mixtures of neomycin and dihydrostreptomycin.
    The bioassay of tubocurarine has been modified to promote the rapid
    recovery of assay animals and allow their frequent reuse for testing
    this drug.
    In the microanalytical field, studies were conducted on opticalcrystallographic
    methods to identify 16 of the newer drugs.
    Studies of lubricating jellies containing the proportion of formaldehyde
    suggested by some manufacturers showed that it was not
    safe in those concentrations and the quantity of formaldehyde used
    must be lowered to protect daily users of the jellies from mucous
    membrane irritation.
    Investigation of the mucous membrane toxicity (particularly irritation
    of the eye) of the new compounds known to be currently used
    in cosmetics for their emulsifying, antiseptic, and detergent effects
    continued, and the concentrations that are well tolerated were determined
    for many substances. The tests were extended to skin toxicity
    of these new components and safe concentrations for certain classes
    of agents were determined. Variations of individual members of
    other classes were so great that safe concentrations ranged from 1 to
    100 percent.
    Continued investigation of thioglycolate hair waving preparations
    showed a derangement of carbohydrate metabolism when these preparations
    penetrate the skin. Diabetic rats exhibited marked respiratory
    and urinary changes when thioglycolates entered the circulatory
    system through skin abrasions.
    Enforcement Statistics
    The percentage of time to be devoted to each class of products is
    determined tentatively at the beginning of the fiscal year under a
    226 Department of Health, Education, and Welfare, 1953
    planned project system of operations. The seriousness and extent of
    violations anticipated in each industry, and its volume of output, are
    the controlling factors in the apportionment of enforcement effort.
    Unexpected events may require modification of the percentage of time
    allocated to different projects.
    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.
    In the 276 criminal actions terminated during 1953, the fines paid
    or assessed in cases pending on appeal, totaled $146,578. The heaviest
    fine in a single case was $10,000. In 45 actions the fines were $1,000 or
    more. Jail sentences were imposed in 17 cases involving 19 individual
    defendants. The sentences ranged from 2 months to 1 year, and
    averaged 8 months and 8 days. For 15 defendants the jail sentences
    were suspended and they were placed on probation.
    Records of actions terminated in the Federal courts were published
    in 1,373 notices of judgment issued during the year.
    Table 2.—Enforcement activities during the fiscal year 1953
    Item
    Percentage
    distribution
    of enforcement
    time
    Number of
    factory inspections
    Number of
    samples
    collected
    Domestic _________ _________ -__ _______ __ - - - - 90.3 12, 502 23 361
    Foods___ ____________ . _____________ . - 65.3 9, 982 15’ 297
    Drugs and devices ____ ______ _. . _ _ ______ 31.4 2,176 7 616
    Cosmetics and colors____ ___ ________________ __________ 2.7 274 315
    Other acts and miscellaneous_______ ____ __ _______ _ 0.6 70 133
    Import _______ _ __ - - ______ __________ 9.7 0 13 159
    Table 3.—Number of samples on which criminal prosecutions and seizures were
    based and number of court actions instituted during the fiscal year 1953
    Item
    Total Criminal prosecutions
    instituted
    Seizures accomplished
    Injunctions
    reViolative
    quested
    samples Actions Violative
    samples Actions Violative
    samples Actions
    Total_______________3,3_0_5_ 1,782 1,137 329 2,168 1,442 11
    Foods___ _______ _____ _ _ _ _ 2,234 1,403 583 177 1 651 1 220 0
    Drugs and devices__________ __ 1,043 366 540 150 503 ’ 211 5
    Cosmetics and colors__________ 11 6 5 1 6 5 0
    Caustic poisons________________ 17 7 9 1 8 6 0
    Food and Drug Administration 227
    Table 4.—Import inspections and detentions during the fiscal year 1953
    Item Total
    Inspected
    and refused
    entry
    Inspected
    and released
    Total.__ _________________ . . 31,971 5,087 26, 884
    Foods____ _ ______ _____________ ______ 29,450
    2,364
    157
    4,030
    1,022
    35
    25,420
    1,342
    122
    Drugs and devices____________________ ________
    Cosmetics, colors, and miscellaneous ____ .

    Office of
    Vocational Rehabilitation
    A Summary of Progress
    For the third successive year, the State-Federal program for the
    vocational rehabilitation of disabled civilians prepared more than
    60,000 substantially handicapped Americans for work and placed them
    in useful occupations. The vast majority of these men and women
    are now completely self-supporting.
    The return of this year’s group of disabled individuals to productive
    work brings to more than a half million the number of disabled
    civilians rehabilitated since 1943, when the present range of services
    was established by law. It brings to 738,000 the total number of rehabilitations
    during the 33 years in which vocational rehabilitation
    services have been available to Americans as a service of their State
    and Federal governments.
    The consequences of physical and mental disability constitute a
    growing problem of serious economic and social implications. Not
    the least of these is the dependency of large numbers of handicapped
    people upon relatives, philanthropy, or public assistance. Dependency,
    in the simplest terms, means a loss of financial independence.
    To the individual, it means—at the very least—damaged morale and
    impaired living standard. To the family, all too often, it means dissolution
    of the home and destruction of the family unit. To the Nation
    as a whole, it means social and economic waste and a heavier tax
    burden which must be distributed among all who are gainfully
    occupied.
    Vocational rehabilitation is a concerted, systematic, and economically
    feasible counter-measure against disablement and the resulting
    dependency. Prevention and reduction of dependency due to physical
    or mental disability continue to be major aims of the State-Federal
    229
    230 Department of Health, Education, and Welfare, 1953
    program for helping the disabled. A brief consideration of public
    dependency, involving public assistance payments made necessary because
    of disability, gives some measure of the effectiveness of vocational
    rehabilitation in achieving its aims.
    Nearly 1 out of every 5 disabled persons rehabilitated during the
    fiscal year ending June 30, 1953, was receiving public assistance at the
    time services were begun, or at some time during the course of rehabilitation.
    To maintain these disabled recipients of public assistance on
    relief for just one year would cost an estimated $8.7 million. But the
    cost of their rehabilitation was only about $6.4 million. This expenditure
    is less than three-fourths of what it would cost to maintain these
    disabled people at public expense for only one year.
    Since many of these individuals undoubtedly would have needed
    public assistance over an extended period of time, the savings made
    possible by their rehabilitation—which is generally a one-time expenditure—
    are cumulative. Disabled people who are receiving public
    assistance year after year consume taxes, whereas rehabilitated people
    who are working pay taxes every year of their working lives.
    Although 11,355 of the 61,308 disabled individuals rehabilitated
    during the year were recipients of public assistance, many more would
    have become public charges if they had not been rehabilitated into
    gainful employment before the effects of disability and enforced idleness
    had exhausted their resources. There is no way to measure the
    dollar savings from preventing public dependency by restoring disabled
    people to self-support before they become completely impoverished
    by their inability to earn.
    Regardless of whether or not the disabled people who are served
    by vocational rehabilitation repay in one way or another the cost of
    the services made available to them, our society—under the American
    tradition of a fair chance to all—has an obligation to restore to them
    the capacity and opportunity for self-support. However, the economic
    facts of rehabilitation—as illustrated by the achievements of the program
    during the past year—give strong support to the proposition
    that vocational rehabilitation is an investment in human welfare that
    is wholly self-liquidating. As an investment, it pays high returns in
    dollars as well as in social betterment.
    HIGHLIGHTS OF 1953
    The Federal income tax payments which will be made by the disabled
    men and women rehabilitated during 1953 are estimated at $10
    million a year. Thus the $30 million in Federal income taxes that
    these rehabilitated workers are expected to pay in the next three years
    exceeds the entire 1953 Federal grants for vocational rehabilitation
    program by more than 30 percent.
    Office of Vocational Rehabilitation 231
    The cost of operating the program for the year was $564 per person
    rehabilitated. This is substantially less than the cost of maintaining
    a disabled individual on relief for just 12 months.
    The combined annual earnings of the disabled men and women rehabilitated
    during the year were estimated at $17 million when they
    became clients of the program. After their rehabilitation, their combined
    earnings were estimated at $114 million a year.
    An estimated 100 million man hours a year have been added to the
    Nation’s productive effort by this group of disabled men and women.
    Many of them have acquired new skills which are in short supply and
    which are vitally important to the Nation’s preparedness effort. More
    than 8,000 went into the skilled trades, and about 5,200 more became
    farmers or agricultural workers. More than 2,400 entered professional
    occupations in such fields as education, medicine, and engineering.
    In addition to the 61,308 disabled persons who were fully rehabilitated,
    the State-Federal program placed 13,491 more in jobs. This latter
    group, although gainfully employed, will not be counted as rehabilitated
    until follow-up counseling has been completed to ensure
    that they are successful in their new careers.
    When the fiscal year closed, 133,173 disabled men and women were
    receiving services designed to restore their ability to work. These
    services were being provided by the 88 State agencies for vocational
    rehabilitation which receive Federal grants-in-aid under this program.
    Expenditures by the States on the public program for vocational
    rehabilitation during the fiscal year totaled $34,583,138. Of this,
    $22,947,581 comprised Federal grants to the States, and $11,635,557
    was from State sources.
    COMBATING DEPENDENCY
    We are becoming a Nation of older people, with all of the physical
    and social problems that this implies. The question of how to deal
    with dependency is therefore becoming increasingly important. Man’s
    average life expectancy at birth has increased from 49 to 68 years
    since the turn of the century. The ratio of productive workers to
    those who are not working is declining. Larger numbers of aged,
    chronically ill, and disabled people must be supported by those who
    work.
    Many of these persons could never become employable because of
    advanced age, extreme severity of disability, or other reasons. There
    are, however, an estimated 2 million disabled men and women of
    working age who could—if provided with vocational rehabilitation—
    join or participate to a greater extent in the Nation’s productive enterprises.
    These are persons with substantial employment handicaps resulting
    from impairments or diseases, who are not now in the labor
    market (or are only marginal workers), but who could be helped
    232 Department of Health, Education, and Welfare, 1953
    through the State-Federal program. Their number is maintained at
    this high level by the estimated quarter of a million persons each year
    who, because of accidents, diseases, or congenital conditions, come
    to need vocational rehabilitation in order to work.
    For public assistance payments to support the disabled and their
    dependent children, it is estimated that disability is costing the American
    taxpayers nearly $500 million a year. This huge outlay is
    spent for the medical care and maintenance—at a very meager standard
    of living—of more than a half million disabled men and women
    and 370,000 children who are dependent upon disabled breadwinners.
    Experience has shown that many of these disabled recipients of public
    assistance could be made employable through vocational rehabilitation.
    Moreover, in many cases, rehabilitation offers the only hope for
    restoring these disabled individuals to economic independence, thereby
    lessening the tax burden of public dependency.
    It already has been pointed out that a substantial portion—18.5
    percent—of the disabled men and women rehabilitated during the year
    were dependent upon public assistance for all or part of their support.
    The restoration of these men and women to productive work is the
    result of unprecedented teamwork on the part of the State-Federal
    program for vocational rehabilitation and public welfare agencies.
    Throughout the country, State rehabilitation and public assistance
    agencies are cooperating closely in such efforts as screening disabled
    recipients of assistance to determine which of them could be rehabilitated
    and in examining the possibilities of rehabilitation for individuals
    who apply for aid to the permanently and totally disabled.
    Jointly conducted demonstration and study projects are underway
    to develop the most effective methods for rehabilitating disabled recipients
    of public assistance. Methods of referral are being studied,
    tested, and improved.
    During 1953, 14.1 percent of the disabled men and women rehabilitated
    were referred for service by public welfare agencies. This was
    a slight drop from the preceding year.
    Federal-State Cooperation
    OBJECTIVES AND SERVICES OF VOCATIONAL REHABILITATION
    Vocational rehabilitation is a public service to preserve or restore
    the ability of disabled people to achieve economic independence
    through useful work. The goal of the great majority of those who
    benefit from its services is gainful employment. About 52,000 of the
    disabled men and women rehabilitated in 1953 are working for pay.
    The others are contributing to the Nation’s economy in other ways.
    In almost every family in which there is a handicapped member,
    at least one other member is greatly restricted in activity because of
    Office of Vocational Rehabilitation 233
    the care needed by the disabled individual. When the wife and mother
    in a family is substantially disabled, her ability to meet the family’s
    needs as a homemaker may be impaired to the extent that the economic
    well being—and the very continuance of the family unit—is seriously
    threatened. Interference with the earning power of the breadwinner
    is a common result of the disablement of a housewife. For these economic
    reasons, as well as for obvious humanitarian considerations, the
    State-Federal program is rehabilitating about 5,300 disabled housewives
    a year.
    In this program, no disabled individual is considered rehabilitated
    until he has been placed in suitable employment after being provided
    with substantial rehabilitation services. In most cases, the criterion
    is successful accomplishment in paid employment, verified by personal
    follow-up. In some cases it is the ability to perform the important
    work of making a home.
    The services which are provided under the public program for vocational
    rehabilitation are geared to the specific needs of the individual,
    with due regard to the nature of his disability, his interests and aptitudes,
    and his goals for a career.
    There are 9 services in all: (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 the right job objective; (3) medical,
    surgical, psychiatric, and hospital services to remove or reduce the
    disability; (4) artificial limbs and other prosthetic appliances to increase
    work ability; (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 ensure that the rehabilitated man or
    woman is successful and that both he and the employer are satisfied.
    ORGANIZATION OF THE PROGRAM
    The services of vocational rehabilitation are available to men and
    women of working age who have disabilities that are handicaps for
    employment. Federal responsibilities for the program are discharged
    by the Office of Vocational Rehabilitation for the Department of
    Health, Education, and Welfare. These responsibilties consist of disbursing
    grants-in-aid to State agencies, and supporting the efforts of
    these agencies with leadership and technical assistance which can be
    provided most economically on a national basis.
    The program is operated in every State and Territory except the
    Virgin Islands. General agencies for vocational rehabilitation are
    293171—54----- -16
    234 Department of Health, Education, and Welfare, 1953
    components of State boards of education. In 35 of the States and in
    Hawaii, separate agencies provide rehabilitation services for the blind.
    In the District of Columbia, services are provided by an element of
    the Office of Vocational Rehabilitation.
    Each public agency for vocational rehabilitation operates its program
    in accordance with an approved State plan that meets the provisions
    of Federal law. These plans are developed by the State agencies
    with the cooperation of the Office of Vocational Rehabilitation.
    The evaluation, improvement, and approval of these plans constitute
    a continuing Federal responsibility. To ensure the best possible service
    to the disabled and the most efficient utilization of Federal funds,
    the Office of Vocational Rehabilitation staff works closely with State
    agencies in keeping State plans abreast of current needs. During the
    past year, 160 revisions in State plans were reviewed and approved.
    In order to ensure that rehabilitation services are provided in conformity
    with approved State plans, and that the Federal portion of
    the funds is being spent properly, the Office of Vocational Rehabilitation
    conducts periodic reviews of the operation of all State rehabilitation
    agencies. In the course of these reviews individual case records
    are studied, methods of administration are reviewed, and agency
    staffs benefit from evaluations of services to disabled individuals.
    These reviews reveal trends within the program, the manner in which
    State and Federal policies are applied, and the needs and accomplishments
    of the State agencies. During the past year, 30 periodic
    reviews of agency operations were completed.
    The Vocational Rehabilitation Act provides that Federal grantsin-
    aid for the program shall cover all necessary costs of administration,
    counseling, and placement, and shall cover half the costs of the
    other services (known as “case services”) provided to disabled individuals.
    Since the beginning of the 1948 fiscal year, Federal funds
    appropriated for this purpose in any one year have not been sufficient
    to meet the Federal share of State expenditures defined as reimbursable
    in the Act. This situation has added considerably to the complexity
    and difficulty of granting funds equitably under the Federal
    law.
    ASSISTING STATE REHABILITATION AGENCIES
    Of equal importance with the administration of grants-in-aid to the
    States is the obligation of the Office of Vocational Rehabilitation to
    provide national leadership to the public program for vocational
    rehabilitation. In meeting its obligation to State agencies, the Office
    of Vocational Rehabilitation provides extensive assistance of a technical
    nature in every aspect of rehabilitation. Specialists on the staff
    are constantly in the field working with State personnel to solve
    Office of Vocational Rehabilitation 235
    mutual problems and improve the services to the Nation’s handicapped
    citizens.
    No organization can be any better than the men and women who
    make up its personnel. This applies to rehabilitation agencies exactly
    as it applies in industry and throughout government. Both State
    and Federal partners in the rehabilitation program fully appreciate
    the importance of bringing the best qualified people obtainable into
    their organizations. In addition, they recognize that professional
    competency is not static; that progress is a product of continuous
    staff development; and that positive steps must be taken to add to the
    knowledge of the men and women who bring the services of vocational
    rehabilitation to the disabled.
    The key figure in the public program for vocational rehabilitation
    is the counselor. It is he who represents the program to the disabled
    individual. It is he who brings out the ambitions of the handicapped
    client, marshalls the resources of the community in his behalf, and
    coordinates the services of this program into an effective instrumentality
    for overcoming disability as a job handicap.
    Joining with State agencies, the Office of Vocational Rehabilitation
    contributes in a substantial way to the dissemination of useful
    information on the latest developments in the field that will be of
    value to the counselors in making their help to the disabled ever more
    effective. Since vocational rehabilitation cuts across a number of professional
    lines, developments in such diverse fields as medicine, education,
    placement techniques, and psychology are of great importance
    to counselors.
    A major accomplishment of the past year was the compilation and
    nationwide distribution to rehabilitation counselors of a comprehensive
    published work on the psychological aspects of physical disability.
    This material, much of which had never before received systematic
    printed treatment, was developed by 17 nationally recognized
    authorities in as many disability areas. It constitutes a valuable guide
    and reference not only to counselors in the State-Federal program,
    but to professional rehabilitation workers in general.
    Other publications which were completed or begun during the year,
    and which will aid counselors, include a guide book on Government
    employment for college-trained deaf persons and a handbook on small
    business enterprises which can be conducted by individuals with severe
    disabilities. Technical literature and related materials covering a
    wide variety of information important to rehabilitation workers were
    sent to the State agencies. More than 30 issuances were made during
    the year. The subject matter included information on specific disability
    conditions, employment, training, and counseling techniques.
    236 Department of Health, Education, and Welfare, 1953
    One of the major projects of the year in which the Office of Vocational
    Rehabilitation joined with State agencies was the Sixth Annual
    Guidance, Training, and Placement Workshop. Under the leadership
    of the Office of Vocational Rehabilitation, 53 public agencies—
    setting a record for participation—sent representatives to this workshop.
    Its purpose was to develop more effective casework supervision
    and improved standards and procedures for the rehabilitation of the
    severely disabled, including the emotionally disturbed and the mentally
    retarded.
    Extensive assistance in staff training was provided during the year
    at the request of individual State directors, and organized consideration
    was given to the problems of administrative supervision at five
    bi-regional conferences.
    At the request of a group of State directors of agencies serving the
    blind who had completed an analysis of the needs of the program,
    the Office of Vocational Rehabilitation conducted in-service training
    for professional personnel concerned with the rehabilitation of the
    blind. Sixty-one counselors and supervisors from 30 States attended
    the two workshops on rehabilitation of the blind convened at Newark
    and Denver.
    To develop employment opportunities in industry for blind persons
    who can be rehabilitated, many agencies serving the blind employ
    staff members who are themselves totally blind. The methods and
    techniques used in this work are highly specialized, and require the
    ability to demonstrate the capacities of blind persons to prospective
    employers on actual jobs in their own plants. Consequently, it is
    imperative that staff members who do this work be kept abreast of
    technological advances in industry.
    To meet this need, refresher training for experienced industrial employment
    counselors for the blind, who are themselves blind, was provided
    by the Office of Vocational Rehabilitation at a meeting of these
    counselors in Philadelphia. Emphasis was placed upon methods for
    visiting industrial plants, salesmanship, vocational training for the
    blind, employment counseling, and industrial jobs currently being
    filled by blind workers. Authorities in the fields of selling, industrial
    management, labor relations, personnel relations, workmen’s compensation
    and insurance, and employment counseling assisted in the
    training.
    Similar in-service training was provided for sighted and partially
    sighted counselors for the blind at an institute on placement conducted
    by the Office of Vocational Rehabilitation at Cincinnati. This
    institute was attended by 28 counselors from eight States, and dealt
    with techniques for placing blind persons in competitive employment.
    In addition, five State agencies serving the blind received extensive
    technical assistance from the Office of Vocational Rehabilitation durOffice
    of Vocational Rehabilitation 237
    ing the year in providing specialized training for their counseling
    staffs.
    To inform psychologists and other guidance personnel of adaptations
    necessary to make psychological testing and evaluating methods
    suitable for use with blind persons, the Office of Vocational Rehabilitation
    developed a film strip illustrating exact procedures. Produced in
    color with sound, this teaching aid is now available commercially. It
    is widely used in the training of professional personnel in universities
    and in public and voluntary agencies concerned with rehabilitation.
    Serving America’s Disabled
    PHYSICAL RESTORATION
    The importance of medical service to disabled people served by the
    State-Federal program for vocational rehabilitation is evident from
    the substantial proportion of State and Federal funds spent by the
    program in 1953 for the purchase of medical examinations and treatment.
    During the 1953 fiscal year, more than 40 percent of the program’s
    total case service expenditures were made for medical diagnoses,
    medical treatment, hospital care, and prosthetic appliances.
    Over the past 5 years physical restoration services have absorbed
    a steadily increasing proportion of the case service expenditures from
    State and Federal funds. This is a reflection of the greater emphasis
    being placed upon the rehabilitation of the more severely disabled,
    and on efforts to remove or reduce disabilities when this is feasible.
    During the year, medical and psychiatric examinations were purchased
    for 101,074 disabled persons at a total cost of $1,249,270. Medical
    treatment was purchased by public rehabilitation agencies for
    26,068 disabled individuals at a cost of $2,710,280. Hospital and convalescent
    home care was purchased for 16,237 persons at a cost of
    $2,858,499. Prosthetic appliances, costing $2,032,710, were purchased
    for 17,837 clients of the program. The total expenditures for all medical
    services, including physical examinations, amounted to $8,850,759.
    As a large purchaser of medical services from practicing physicians,
    hospitals, and other facilities, the State-Federal program has a continuihg
    need for medical guidance to ensure that the best possible use
    is being made of available medical resources, and that expenditures for
    this service produce maximum benefits to the disabled. All State
    rehabilitation agencies employ medical consultants to advise State
    directors and their staffs on medical policies and on the advisability
    of undertaking physical restoration in specific cases. In 16 States,
    local medical consultants have been appointed to make medical advice
    more accessible to counselors in local offices.
    Federal responsibilities to the program in this field consist of formulating
    medical policies, providing technical consultation to State agen238
    Department of Health, Education, and Welfare, 1953
    cies, and encouraging cooperation with public and voluntary agencies
    concerned with rehabilitation.
    The rehabilitation of individuals with epilepsy, heart disease, mental
    and emotional disturbances, hearing loss, and some other severe
    disabilities often require special consideration from the medical standpoint.
    To improve service in these areas of disability, the Office of
    Vocational Rehabilitation secured technical advice from six of the
    Nation’s leading medical authorities in these specialties. During the
    year consultative services on the medical and psychiatric aspects of
    State programs were provided to 16 State agencies.
    Through its Division of Medical Service, the Office of Vocational
    Rehabilitation has continued to work closely with the Public Health
    Service, the American Heart Association, the National Society for
    Crippled Children and Adults, the American Psychiatric Association,
    and similar organizations, for the promotion of community-sponsored
    services for rehabilitation. In addition the Office of Vocational
    Rehabilitation collaborated with the Social Security Administration’s
    Bureau of Public Assistance in shaping policies and standards
    for determining permanent and total disability in cases of mental illness
    and retardation.
    Among the important services rendered to State rehabilitation agencies
    during the year was that in connection with staff development in
    the medical aspects of rehabilitation. This took the form of courses
    for physicians who are consultants to State agencies, and extensive
    assistance to groups of counselors to increase their understanding of
    human personality, mental illness, and emotional disturbances.
    Fifty-three physicians from 35 States, most of whom are private
    practitioners serving as part time consultants to rehabilitation agencies,
    attended three one-week courses conducted by the Office of Vocational
    Rehabilitation and devoted to the clinical aspects of rehabilitation.
    Participating in these courses were physicians from the Public
    Health Service, Veterans Administration, Bureau of Indian Affairs,
    National Foundation for Infantile Paralysis, Commission on Chronic
    Illness, Goodwill Industries, State crippled children’s services, and
    State public welfare programs. The courses were held at the New
    York University-Bellevue Medical Center, Institute of Physical Medicine
    and Rehabilitation, where participants benefited by actual observation
    of the most advanced techniques of physical medicine and
    rehabilitation.
    Three mental health workshops for counselors were held during
    the year under joint sponsorship of the Office of Vocational Rehabilitation
    and the National Institute of Mental Health of the Public
    Health Service. The workshops were held at San Jose Teachers’ College
    in California, the Menninger Foundation at Topeka, Kansas,
    and Columbia University in New York City. Conducted to further
    Office of Vocational Rehabilitation 239
    rehabilitation of the mentally ill, these workshops were financed
    principally by grants from the National Institute of Mental Health
    to each cooperating institution. Similar projects are planned for the
    coming year.
    In some States, medical consultants to the rehabilitation agencies
    have participated in the in-service training of counselors. They have
    been active in promoting an understanding of the objectives and the
    operations of the public rehabilitation program to the private physicians
    from whom diagnostic and treatment services are purchased, and
    have been instrumental in securing more accurate appraisals of physical
    capacities of the clients. In several States, medical consultants
    assisted in obtaining cooperation of hospitals and other health agencies
    on behalf of beneficiaries of the program.
    Although all State agencies for the blind have medical consultants,
    these physicians are, for the most part, ophthalmologists concerned
    chiefly with eye conditions and with certifying that blindness exists.
    Case reviews in agencies serving the blind have indicated a great need
    for more comprehensive medical and psycho-social evaluation.
    For the past year and a half the Kansas State agency for the blind,
    in cooperation with the Menninger Foundation at Topeka, Kansas, has
    been conducting studies in the psychological aspects of blindness.
    Group therapy sessions are conducted by a psychiatrist from the Menninger
    Foundation at the Topeka Adjustment Center for the Blind,
    and individual psychotherapy is provided in some cases.
    For consultation on rehabilitating the mentally ill and emotionally
    disturbed, and for advice on the emotional needs of physically disabled
    persons, six State agencies employ consultants in psychiatry. Eighteen
    State agencies in 16 States utilize medical and psychiatric social
    work personnel in a consultative or social casework capacity.
    REHABILITATION CENTERS
    The rehabilitation center is a relatively recent development in response
    to the need for providing more effective and more comprehensive
    services in the rehabilitation of the severely disabled. Although
    there are not now enough of these centers in the United States to fill
    existing needs, they are increasing in number and are constantly improving
    the quality of services that they offer.
    Most rehabilitation centers, like most hospitals, are under voluntary
    auspices. Some are privately operated, and a few are under State
    auspices. Since the State-Federal program for vocational rehabilitation
    is a large user of rehabilitation centers, the Office of Vocational
    Rehabilitation is vitally concerned with their number, distribution,
    and range of services.
    Largely for the benefit of State rehabilitation agencies, the Office of
    Vocational Rehabilitation has become a clearing house for information
    240 Department of Health, Education, and Welfare, 1953
    on. these centers and their services. A full time consultant on the staff
    keeps the centers informed as to the needs of the program and advises
    State agencies on the services that centers make available.
    Rehabilitation centers use the team approach in bringing to disabled
    people the special skills of such professional personnel as physicians,
    therapists, social workers, psychologists, and counselors. Their services
    are coordinated and furnished on an intensive basis which accelerates
    rehabilitation. These services make possible the rehabilitation
    of many severely disabled people who otherwise could not be
    restored to useful living. Thorough diagnosis of all of the problems
    associated with disability is a distinctive feature of rehabilitation
    centers. It is through the integrated services of these centers that some
    of the most spectacular accomplishments in vocational rehabilitation
    are made possible.
    The past year saw the first nationwide meeting of rehabilitation
    center directors, which was held under the joint auspices of the Office
    of Vocational Rehabilitation and the National Society for Crippled
    Children and Adults. This meeting dealt with such problems as procurement
    of personnel to staff new and expanding centers, development
    of effective professional and community relations, and means for
    improving the services offered. The conference established a continuing
    committee directed to make further studies of standards, services,
    and fee schedules.
    Three publications of the Office of Vocational Rehabilitation, which
    are of value to personnel within the State-Federal program as well
    as to those concerned with rehabilitation centers, are based upon the
    work of this conference. These are the first directory of rehabilitation
    centers to be compiled in the United States, a comprehensive
    description of the services of 40 rehabilitation centers located in 20
    States, and the proceedings of the conference committees.
    During the past year new centers were established in Iowa, California,
    and Ohio. In addition, groups in 14 States received advice or
    technical assistance from the Office of Vocational Rehabilitation with
    respect to planning or operating rehabilitation centers. Consultative
    service was given to rehabilitation centers for the blind in four States.
    SPECIAL PROBLEMS IN REHABILITATION
    The State-Federal program for vocational rehabilitation is concentrating
    greater effort than ever before on bringing its services to
    the severely disabled who need help the most. While there are strong
    humanitarian considerations in the continuing emphasis on serving
    the severely disabled, there is also even stronger economic justification
    for channelling a greater part of the program effort in this direction.
    Rehabilitation of the severely disabled, as a rule, is more costly
    than the rehabilitation of individuals with less handicapping disOffice
    of Vocational Rehabilitation 241
    abilities. This is particularly true when extensive physical restoration
    and vocational training are necessary.
    However, it is the severely disabled who generally have no earnings
    whatever, or who are the most likely to become dependent upon public
    aid for protracted periods of time. Consequently, their restoration
    to self-sufficiency represents the greatest possible social and economic
    gain. Their rehabilitation will pay the maximum returns on public
    funds invested to convert them into taxpaying producers.
    The rehabilitation of individuals within certain categories of disability
    pose problems which require special arrangements in the organization
    and provision of services. Following is a consideration of
    some of the problems posed by specific disability categories.
    Mental Illness
    One of the most costly and socially wasteful of all types of disability
    is mental illness. All too often, the victim of mental illness
    becomes progressively worse through neglect, until treatment can
    offer little or no hope for his return to society. All too often the individual
    who suffers with mental illness completes his life span in the
    void of institutional confinement, a drain upon the community and a
    loss to himself and to his family.
    In recent years there has been much progress in combating mental
    illness. The possibilities for cure and the economy of treatment as
    opposed to yielding to the inevitability of lifelong confinement have
    received increasing attention. Mounting evidence is showing that,
    in a great many cases, expensive treatment is far less costly in the
    long run than hospitalization.
    Experience has confirmed again and again the importance of the
    contribution which can be made by the public program for vocational
    rehabilitation in effecting the transition of the mentally ill patient
    from the hospital setting to the community, and ultimately to employment.
    Twenty-two State agencies for vocational rehabilitation now
    have well defined programs for the rehabilitation of the mentally ill.
    During the year seven additional State agencies, which had not heretofore
    had specifically defined programs for the mentally ill, assigned
    special counselors to mental hospitals in their States. In 1953 about
    3,000 persons with mental disabilities were rehabilitated under the
    State-Federal program.
    Through a research grant from the National Institute of Mental
    Health, a study is being made at the Boston State Hospital of the
    value of rehabilitation services during the patient’s hospitalization,
    and the nature of those mental illnesses most amenable to vocational
    rehabilitation. The Massachusetts Division of Vocational Rehabilitation
    has assigned a counselor to this project, which will provide valuable
    information for the entire program on methods for dealing with
    problems in this field.
    242 Department of Health, Education, and Welfare, 1953
    Heart Disease
    Much has been written about the increase during the past few decades
    in deaths due to heart disease. In addition to being one of the
    major killers among the chronic illnesses, various forms of heart disease
    disable substantial numbers of people.
    One of the most serious obstacles in the rehabilitation of men and
    women with cardiovascular diseases is the shortage of facilities for
    determining their capacity for work. Cardiac work classification
    units, organized to furnish consulting service to physicians and employers
    and to provide advice on diagnoses, can fill this need. The
    Office of Vocational Rehabilitation and its associated State agencies
    are working closely with the American Heart Association and its
    affiliates, and other voluntary groups, to encourage the establishment
    of these facilities where they are needed.
    During the past year a nationally recognized authority on heart disease,
    serving as a consultant, provided advice and technical assistance
    to four State agencies which undertook to improve their services to
    people disabled by heart diseases. More than 2,600 men and women
    with heart disease were rehabilitated during the year.
    Epilepsy
    While spectacular progress has been made in the diagnosis and
    treatment of epilepsy, the problems faced by the vocational rehabilitation
    counselor extend far beyond getting the necessary medical
    services for the client with epilepsy and seeing that his condition is
    brought under maximum control. The stigma attached to epilepsy
    persists in spite of extensive educational efforts on the part of both lay
    and professional groups. The social and vocational adjustment of an
    adult with epilepsy is dependent in large measure upon the willingness
    of an employer to accept him.
    The counselor must frequently make numerous attempts at placement
    before one is effected. While the medical rehabilitation of a
    person with epilepsy is relatively inexpensive, the time involved in
    making a placement frequently results in a well above average cost
    per case. More than 1,100 men and women with epilepsy were rehabilitated
    during the year.
    If programs for the vocational rehabilitation of persons having
    epilepsy are to expand materially, vocational rehabilitation personnel
    and other informed community groups must make continuous efforts
    to disseminate facts about epilepsy and the possibilities offered by
    modern treatment.
    Blindness
    The vocational rehabilitation of men and women who are blind, or
    who have severe visual impairments, is rendered extremely difficult
    Office of Vocational Rehabilitation 243
    by a general lack of understanding of the potentialities of these individuals.
    This lack of understanding not only shapes public and
    employer attitudes, but also pervades the thinking of some professional
    people whose help is needed to establish blind workers in suitable
    careers. Equally as serious, many of the visually disabled themselves
    fail to realize that vocational rehabilitation can be employed to
    prepare blind persons for paid work and place them in jobs. A major
    task of informing all segments of the public about the rehabilitation
    of the blind faces the Office of Vocational Rehabilitation and State
    agencies serving the blind.
    Of an estimated total of 314,000 blind persons of all ages in this
    country, only about 20,000 of them are gainfully employed. Six
    thousand are estimated to be working competitively in industry, about
    3,700 are in agricultural pursuits, and about 3,000 more are employed
    in sheltered workshops. Men and women without sight are successfully
    working in some 300 different occupations.
    During the fiscal year, more than 7,400 persons with visual handicaps
    were rehabilitated through the State-Federal program. Nearly
    3,700 of these men and women are blind. An estimated 30 percent of
    the blind persons rehabilitated during the year are now successfully
    employed in skilled or semiskilled work, and nearly 17 percent of
    them are filling professional, semiprofessional, or managerial
    positions.
    Continuing its efforts to expand opportunities for vocational training
    for blind persons, the Office of Vocational Rehabilitation conducted
    demonstrations to educators showing methods by which vocational
    school instructors can train blind students in their regular
    classes. Public vocational schools in 19 States so far have accepted
    blind students for training along with the sighted.
    Four publications of the Office of Vocational Rehabilitation that
    are of interest to blind people were reproduced in Braille during the
    year by the Library of Congress, and placed in its 26 regional libraries.
    These publications deal with vocational rehabilitation, employment
    opportunities, and personal and social adjustment.
    New records were established during 1953 by the vending stand
    programs for the blind operated in accordance with the Randolph-
    Sheppard Act. A total of 1,543 vending stands, of which 568 are in
    Federal buildings, provided employment for 1,581 blind operators,
    228 blind assistants, and 507 sighted assistants.
    Net earnings of the operators and their blind employees were
    $3,493,174—the highest income ever recorded-—on gross sales of
    $20,612,277. The money value of the program, including the investment
    in stands, equipment, merchandise, and other assets, was
    $2,774,265 at the year’s end. All of these figures represent gains over
    1952.
    244 Department of Health, Education, and Welfare, 1953
    EXPANDING EMPLOYMENT OPPORTUNITIES FOR THE HANDICAPPED
    Working in close cooperation with the President’s Committee for
    the Employment of the Physically Handicapped, the Office of Vocational
    Rehabilitation contributed substantially to the nationwide
    program for breaking down prejudice against disabled workers and
    encouraging employment of qualified men and women with handicaps.
    The disabled individual selected by the Committee for citation
    by the President for outstanding accomplishment during the past year
    was the head of a unique and successful manufacturing enterprise of
    disabled workers which had been aided by the public rehabilitation
    program.
    To encourage consideration of handicapped job applicants by personnel
    officers in the public service, the Office of Vocational Rehabilitation
    suggested a special citation by the President’s Committee.
    This citation henceforth will be awarded annually to the public official
    or employee who does the most to promote employment of the
    physically handicapped. In cooperation with the Civil Service Commission,
    the Office of Vocational Rehabilitation furnished guidance
    to 15,000 Federal appointing officers in connection with employment
    of handicapped persons in the civil service.
    One of the most formidable barriers in the way of blind persons
    who might qualify for Federal employment has been the lack of suitable
    testing procedures for use in competitive selection. During the
    past year the Office of Vocational Rehabilitation, working with the
    Civil Service Commission, has collaborated in developing special tests
    for blind persons interested in Federal positions. Now in experimental
    use, these tests are expected to open up more employment
    opportunities for the blind.
    To widen opportunities for the blind in industry, the Office of Vocational
    Rehabilitation continued to seek favorable employment policies
    from major employers. During the past year two large industrial
    organizations, with plants in all parts of the country, were added to
    those which permit employment of qualified blind persons.
    The Office of Vocational Rehabilitation is currently assisting the
    United Mine Workers Welfare and Retirement Fund in the development
    of plans for the maximum utilization of qualified handicapped
    personnel in the staffing of the chain of hospitals which are to be built
    and operated by the Fund in Kentucky, West Virginia, and Virginia.
    The Disabled Who Are Served
    CHARACTERISTICS OF THE PERSONS REHABILITATED
    Chart 1, showing the distribution of disabilities of the persons
    rehabilitated during the 1953 fiscal year, indicates that individuals
    with virtually every type of disability can be benefited by vocational
    Office of Vocational Rehabilitation 245
    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
    AURAL / \ / / X / CLERICAL AND SALES
    246 Department of Health, Education, and Welfare, 1953
    rehabilitation. Accounting for 41 percent of the disabilities, amputations
    and other orthopedic impairments together made up the largest
    single disability category. About 20 percent of those with orthopedic
    disabilities became disabled as a result of three major chronic diseases—
    poliomyelitis, arthritis, or osteomyelitis. More than 40 percent
    were disabled in accidents, and the remaining 40 percent had disabilities
    that were congenital or that were the result of other diseases.
    Chart 1 also shows the distribution of occupations in which the disabled
    men and women rehabilitated in 1953 were placed. It is significant
    that 28 percent of them became skilled or semiskilled workers,
    and that 10 percent of them entered professional, semiprofessional, or
    managerial occupations. Only 7 percent of them were placed in
    unskilled work.
    The average age of those rehabilitated in 1953 was 24 at the time
    of their disablement, and 34 at the time they were accepted for service.
    The gradual increase in the average age at the time of acceptance continues
    as a clearly defined trend. Sixty-four percent of those rehabilitated
    were men.
    Of the disabled persons rehabilitated in 1953, 31.1 percent were
    referred by physicians, hospitals, or other health agencies; 14.1 percent
    were referred by public welfare agencies; 11 percent applied for
    help on their own volition; and 8 percent were referred by State
    Employment Service offices.
    Those who received physical restoration accounted for 42 percent of
    the men and women rehabilitated in 1953. Twenty-nine percent were
    provided with training, and 9 percent received both physical restoration
    and training. All received guidance and counseling.
    THEY PAY THEIR OWN WAY
    From the purely economic standpoint, vocational rehabilitation
    enjoys the unique distinction of being a social program that pays for
    itself many times over.
    More than three-fourths of the disabled men and women rehabilitated
    during 1953 were not employed at the time that rehabilitation
    services for them were begun. Twelve percent of the 61,308 persons
    rehabilitated had never worked in their lives. Those who were employed
    were generally working in jobs that were unsafe for them, temporary,
    or otherwise unsuitable.
    The combined earnings of those rehabilitated during the year were
    increased 553 percent by their vocational rehabilitation. Mention
    already has been made of the estimated $10 million a year in Federal
    income taxes which will flow back into the Federal Treasury from this
    group of disabled men and women. It is worth repeating that, during
    their working lives, they will pay in Federal income taxes alone
    more than $10 for every Federal dollar invested in their rehabilitaOffice
    of Vocational Rehabilitation 247
    tion. With their ability to work restored, they pay their own
    way-—many times over.
    Rehabilitation in the Nation’s Capital
    During the past fiscal year the District of Columbia Rehabilitation
    Service, which is administered directly by the Office of Vocational
    Rehabilitation, restored 333 disabled men and women to useful work.
    Twenty-six of these are blind. At the year’s end 903 disabled persons
    were receiving rehabilitation services, of whom 101 are blind.
    Estimates of the annual earnings of the men and women rehabilitated
    prior to the time they were provided with services and after their
    placement in paid employment indicate an increase of 1,700 percentone
    of the highest on record. Before their rehabilitation, these 333
    disabled men and women were earning at an annual rate estimated at
    slightly more than $40,000. After their rehabilitation, their annual
    earnings were estimated at a total of more than $750,000. The 26 blind
    persons who were rehabilitated now earn $57,148 a year.
    The 60 vending stands operated in the District by blind persons
    rehabilitated under the program did a total gross business of $1,821,868
    during the year. They provided employment for 72 blind men and
    women, whose combined income from the stands was $300,238.
    Twenty-one severely disabled patients of the District of Columbia
    General Hospital (formerly known as Gallinger Hospital) were rehabilitated
    during the year, and 120 others were receiving rehabilitation
    services at the year’s end. Thirty of these who are in process of rehabilitation
    are out-patients. Since the cost of a hospitalized patient is
    $14 a day, the program has effected substantial savings at this hospital.
    The Rehabilitation Service has one full time counselor located at
    Saint Elizabeths Hospital, functioning as a member of the professional
    teams which provide treatment and service to mentally ill
    patients. The counselor—a clinical psychologist by training—is able
    to see the patients during the latter stages of their treatment, and help
    prepare them for restoration to the community.
    The 30 patients of the hospital rehabilitated under the program
    during 1953 were costing the taxpayers more than $53,000 a year.
    Work done by this counselor during the past 2 years supports the conclusion
    that the addition of a second counselor and one secretary would
    make possible the rehabilitation of at least 100 patients a year. This
    would be the equivalent of the current annual increment of the hospital’s
    patient population, and would result in savings of more than
    $178,000 a year.
    Improvements effected by the Rehabilitation Service during 1953
    will result in savings in cost and in better service to the disabled. One
    of these is the development of a psychometric unit for administering
    248 Department of Health, Education, and W elf are, 1953
    psychological tests that formerly had to be purchased in the community,
    or given by counselors.
    Better service to the blind, through opportunities for employment
    under sheltered conditions, will result from the expansion of facilities
    for rehabilitation at the Columbia Polytechnic Institute. Rehabilitation
    of the deaf will be benefited by improved facilities for testing
    hearing and fitting hearing aids installed by the Washington Hearing-
    Society.
    The George Washington University Medical School is establishing
    a pilot study to integrate the concept and skills of complete medical
    rehabilitation into its curriculum. A rehabilitation counselor has
    been engaged by the Hospital to provide liaison between the Rehabilitation
    Service, the University, and other agencies in the District which
    can contribute to the rehabilitation of the disabled.
    Helping Our Friends Abroad
    The Office of Vocational Rehabilitation continued to play a leading
    role in developing basic philosophy for the increasing world-wide
    interest in vocational rehabilitation. In cooperation with the Office
    of International Relations of the Department of Health, Education,
    and Welfare; the Department of State; the United Nations; and the
    United Nations Specialized Agencies; it planned and supervised training
    for more than 100 visitors from 25 Nations. The effectiveness of
    this work is borne out by repeated requests from other countries for
    inclusion of additional trainees in later training plans, and by the
    remarkable progress in rehabilitation that some countries have made
    within short periods after their first trainees have returned home.
    As a member of the Interdepartmental Committee on International
    Social Policy, the Office of Vocational Rehabilitation has
    responsibility for developing materials on rehabilitation, health, and
    welfare programs in other countries for use by the Department of
    State in its work with the United Nations Secretariat, the Economic
    and Social Council, and the Social Commission.
    An example of the materials made available to foreign nations is the
    motion picture, “Comeback,” which was produced for the States by
    the Office of Vocational Rehabilitation. Prints of this film were made
    available by the United States Information Agency for distribution
    in 36 countries.
    Office of Vocational Rehabilitation 249
    Table 1.—Number of referrals and cases, by agency, fiscal year 1953
    [Corrected to October 1953]
    Agency 1
    Referrals Cases
    During fiscal year
    Remaining
    at
    end of
    year 3
    During fiscal year
    Remaining
    at
    end of
    Total year 6
    Accepted
    for
    services
    Not
    accepted
    for
    services3
    Total
    served
    Closed
    Rehabilitated
    Unemployed
    4
    Other
    reasons5
    United States, total..
    Alabama___..
    249,372 84,397 77,897 87,078 ’ 221,847 61,308 5, 771 21,069 133,173
    6,352
    162
    946
    272
    4,921
    25,072
    1,509
    209
    2,256
    163
    1,017
    56
    1,735
    4, 926
    3,201
    21,320
    1,322
    83
    1,333
    38
    7,035
    2,804
    154
    3,461
    178
    2,646
    206
    2,670
    3,911
    693
    1, 230
    79
    4,281
    3,801
    321
    7,297
    396
    4, 377
    343
    2,915
    350
    3,280
    336
    1,212
    137
    994
    173
    242
    2,266
    79
    261
    42
    1,691
    4,446
    703
    58
    1,293
    76
    572
    28
    524
    1,893
    323
    5, 359
    250
    47
    185
    12
    4, 595
    1,486
    84
    1,147
    21
    826
    83
    909
    1,538
    134
    342
    23
    1,590
    1,022
    141
    2,899
    237
    933
    151
    1,111
    197
    1,632
    148
    406
    20
    609
    26
    67
    531
    6
    252
    158
    1,541
    16, 412
    383
    11
    365
    48
    341
    17
    824
    1, 455
    1,885
    4, 569
    137
    14
    493
    19
    951
    669
    14
    930
    73
    857
    75
    641
    801
    116
    310
    31
    1,155
    975
    57
    1,793
    84
    1,768
    130
    586
    94
    1,186
    74
    357
    85
    143
    65
    145
    3,555
    77
    433
    72
    1,689
    4, 214
    423
    140
    598
    39
    104
    11
    387
    1,578
    993
    11, 392
    935
    22
    655
    7
    1,489
    649
    56
    1,384
    84
    963
    48
    1,120
    1,572
    443
    578
    25
    1,536
    1,804
    123
    2, 605
    75
    1,676
    62
    1,218
    59
    462
    114
    449
    32
    242
    82
    30
    6,903
    90
    555
    84
    4,207
    12, 406
    1, 534
    147
    3,528
    185
    1,298
    68
    1,408
    5,993
    859
    13,143
    766
    116
    432
    48
    10, 518
    4, 487
    274
    2, 771
    92
    1,891
    163
    2,427
    4,846
    477
    886
    82
    4,288
    2,470
    142
    10,389
    487
    3, 276
    403
    3,148
    499
    4, 226
    465
    1,096
    75
    1,514
    105
    188
    1,756
    5
    180
    30
    1,135
    2,905
    451
    50
    922
    60
    447
    19
    333
    1,318
    237
    3, 914
    198
    28
    149
    9
    3, 812
    1,049
    70
    760
    27
    604
    48
    660
    1,300
    90
    218
    19
    1,001
    712
    41
    3,100
    142
    749
    125
    913
    145
    1,178
    121
    381
    9
    571
    31
    63
    235
    0
    37
    4
    61
    1,005
    42
    0
    92
    14
    31
    10
    64
    150
    42
    335
    71
    0
    23
    14
    170
    81
    13
    47
    12
    45
    11
    23
    66
    5
    31
    9
    109
    41
    0
    485
    32
    67
    0
    38
    10
    128
    28
    98
    28
    2
    0
    374
    0
    18
    2
    553
    1,535
    157
    7
    319
    10
    102
    2
    103
    765
    28
    1,253
    14
    12
    14
    5
    578
    332
    7
    267
    1
    146
    10
    367
    289
    34
    108
    1
    589
    137
    5
    307
    56
    183
    55
    136
    13
    883
    20
    51
    5
    20
    6
    27
    4, 528
    85
    319
    48
    2,452
    6,952
    813
    89
    2,180
    101
    718
    33
    903
    3,728
    546
    7,624
    481
    76
    242
    20
    5,936
    3,010
    177
    1,697
    52
    1,091
    93
    1,372
    3,180
    348
    526
    53
    2,582
    1, 577
    95
    6,490
    253
    2,274
    221
    2,047
    328
    2,034
    291
    649
    52
    892
    66
    98
    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__________________
    Nevada____________________
    See footnotes at end of table.
    293171—54------17
    250 Department of Health, Education, and Welfare, 1953
    Table 1.—Number of referrals and cases, by agency, fiscal year 1953—Con.
    [Corrected to October 1953]
    Referrals Cases
    During fiscal year During fiscal year
    Agency 1 KT-.4- main-
    Ac- ing at
    Re-
    Closed main-
    T1 oottaa1i cefpotre d ceApAt eda eyneda r o,f
    services servjceS2
    Total------------------------ eT1V>f
    SerVe Reba- Unem- Other year ’
    bilitated ployed 4 reasons5 6 7
    New Hampshire:
    General - 529 192 202 135
    Blind. ___ - ____ 59 39 10 10 74 17 0 3 54
    New Jersey:
    General _ _ 2,688 1, 189 964 535 3, 148 887 136 291 1 827
    Blind - ______ 434 172 174 88 475 111 25 19 315
    New Mexico:
    General___ 933 240 311 382 661 213 g 24 415
    Blind -- _________ 104 39 25 40 88 20 1 2 65
    New York:
    General__ 11,561 7,536 2,289 1,736 15,840 4, 114 398 9 887 8 437
    Blind _______________ 972 370 201 401 842 262 65 ’ 36 '478
    North Carolina:
    General__ - - - 6,313 3,009 1,797 1.507 7,523 2,450 §6 805 4 178
    Blind - - - -- -- 1. 171 462 449 260 1,551 299 is 126 f 102
    North Dakota.___ 1,038 282 295 461 686 207 17 42 ' 414
    Ohio:
    General __ 4,225 1,352 1,274 1,599 3,351 1, 154 57 228 1 905
    Blind. . 510 192 128 190 771 165 41 48 ' 517
    Oklahoma . _ 4.018 2,275 887 856 6,053 1,284 41 593 4 129
    Oregon:
    General . _ _ 4,816 831 1,726 2,259 2,521 562 59 345 ] 550
    Blind. __ __ ... 153 43 67 43 161 31 6 21 ' 102
    Pennsylvania:
    General.. _ . . 14, 198 4,681 4,799 4,718 10,670 3,493 106 1 343 5 689
    Blind.. ____________ 2,43 1 521 873 1,037 1.391 218 46 139 981
    Puerto Rico 4, 539 1, 188 1, 264 2,087 2,695 737 56 159 1 741
    Rhode Island:
    General— _ ___ — 878 347 308 223 1,057 317 52 66 622
    Blind.. . ___ ____ 44 40 2 2 181 21 0 7 149
    South Carolina:
    General-. _ __________ 5, 141 1, 801 1. 585 1, 755 4,863 1,580 68 268 2 935
    Blind__________________ 335 128 123 84 276 95 3 35 142
    South Dakota:
    General— . ___________ 522 197 38 287 675 135 1 42 493
    Blind- _ _ _____ — 97 29 22 46 71 22 0 17 32
    Tennessee:
    General.-- _ _________ 4,875 1,997 1,414 1,464 4,536 1,692 95 221 2 526
    Blind__________________ 705 161 186 358 564 98 14 23 427
    Texas:
    General___ __ __ _ 9,906 2.928 2,331 4,647 9,554 2,080 120 663 6 670
    Blind__________________ 1,497 301 652 544 801 260 25 50 ' 463
    Utah ____________________ 1, 170 380 299 491 1,091 290 14 22 763
    Vermont:
    General________________ 558 165 237 156 492 142 23 73 252
    Blind__________________ 60 19 19 22 71 20 2 2 45
    Virginia:
    General________________ 9,291 3,019 3,751 2,521 6,320 1,832 64 929 3,471
    Blind_________________ 202 71 94 37 135 43 31 9 50
    Washington:
    General________________ 5, 278 1, 263 1, 126 2,889 3,600 1,005 84 196 2,306
    Blind__________________ 103 45 23 35 217 31 7 27 150
    West Virginia___ . _ 11,105 2,614 3,179 5,312 7,126 1,655 85 1,171 4,206
    Wisconsin:
    General________________ 3,311 1,505 691 1, 115 4,982 1,333 147 72 3,423
    Blind__________________ s 259 1 2 3 108 89 62 327 80 15 21 207
    Wyoming__________________ 928 181 367 380 510 168 12 18 310
    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 Services declined, services not needed, individual not eligible, individual needing services other than
    vocational rehabilitation, referred to other agencies, migratory shifting of the individual, etc.
    3 Eligibility for rehabilitation not determined.
    4 Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabilitation
    service but never reached the point of employment because of personal factors, illness, aggravated
    disability, etc.
    6 Closed prior to initiation of rehabilitation plan, because of indifference of individual; probable increase
    in degree of disability; loss of contact; etc.
    ’ In process of rehabilitation on June 30, 1953.
    7 The 221,847 total cases served include 526 cases transferred to other agencies.
    3 Adjusted.
    Office of Vocational Rehabilitation 251
    Table 2.—Total program expenditures from Federal and State funds for vocational
    rehabilitation by State boards of vocational education, fiscal year
    1953
    State or Territory
    Federal and State funds Classification of
    expenditures
    Total Federal State
    Administration
    and vocational
    guidance and
    placement
    services
    Purchased
    services
    Total___________________________ $31,126,311 $20,406,115 $10, 720,196 $11, 520, 723 $19,605, 588
    Alabama.- _ 901, 564 579, 855 321, 709 309, 745 591, 819
    Arizona__ .. ___ ___ . 144, 831 94, 770 50, 061 46,485 98, 346
    Arkansas - - ..... 545j 489 364; 259 18i; 230 183; 029 362,460
    California . __ _ __ 2, 487,377 1, 671, 053 816,324 97L 920 1, 515 457
    Colorado__ .. ______________ ' 187^ 842 133, 042 54, 800 89, 812 98,030
    Connecticut _ _ ___ .. 404; 482 276; 952 127, 530 176; 200 228, 282
    Delaware .. . .. . __________ _ 194,193 126, 217 67, 976 79, 406 114, 787
    Florida. . . ----- - . 829, 264 55L 249 278,015 277, 237 552,027
    Georgia - - __ __ . . - 2, 413, 493 1, 486’, 957 926, 536 720', 971 1, 692, 522
    Idaho .- - - __ .. 71, 816 48,392 23, 424 24, 968 46; 848
    Illinois ----- 1, 965, 656 1, 263; 908 70i; 748 645, 384 1, 320, 272
    Indiana . - . - 498, 801 328,106 170, 695 167, 997 330; 804
    Iowa _ . - . . ... 409, 556 275,843 133, 713 164, 791 244, 765
    Kansas__ ___ .. _ 270, 785 182, 845 87,940 94; 904 175, 881
    Kentucky _ _ . 229, 409 146,393 83, 016 108, 977 120, 432
    Louisiana__ 658,398 426, 471 231, 927 304, 989 353, 409
    Maine - -- . .... 113;138 77, 933 35; 205 42; 727 70,411
    Maryland .... 509, 467 315, 293 194,174 241, 781 267, 686
    Massachusetts . . _ 376; 643 226; 599 150; 044 177, 973 198, 670
    Michigan ..... 1, 352,753 932, 245 420, 508 522, 942 829, 811
    Minnesota__ __ ___ _ _ 385; 027 253,416 13L 611 144, 450 240, 577
    Mississippi . _ . . ... 489; 335 299; 530 189, 805 197, 001 292, 334
    Missouri___ . . . . 536; 703 362, 245 174, 458 217, 787 318, 916
    Montana__ _____ 178; 160 124; 351 53, 809 84; 150 94, 010
    Nebraska. ... 248, 008 16L 354 86; 654 81,608 166, 400
    Nevada____ - - ___ 35, 585 25, 975 9, 610 16, 365 19, 220
    New Hampshire... ______________ 62,134 42, 671 19; 463 23, 208 38; 926
    New Jersey___ - _____ _ 498; 977 342, 508 156, 469 22i; 891 277, 086
    New Mexico. . . __ 137; 548 88, 969 48; 579 40; 374 97,174
    New York . __ .. _ 1, 878, 879 1, 236, 749 642,130 811, 209 1, 067; 670
    North Carolina... ... ... ___ . 890; 547 562; 390 328; 157 252; 197 638; 350
    North Dakota. _ _ .. __ 148,057 92, 738 55; 319 43, 840 104; 217
    Ohio __ ___ . . . . . 528,009 366; 408 161, 601 204; 807 323, 202
    Oklahoma 722,167 486, 585 235, 582 256,306 465, 861
    Oregon . __ . . __ . . 461,346 272, 978 188, 368 159; 650 301, 696
    Pennsylvania 2, 234, 942 1, 416, 739 818, 203 714,926 1, 520,016
    Rhode Island.. . ._ ________ . . 128,173 87, 572 40, 601 50, 354 77; 819
    South Carolina ... _ . - 681,633 461, 712 219, 921 248, 275 433, 358
    South Dakota __ . ___ .. 96, 230 63, 448 32; 782 30, 667 65; 563
    Tennessee__ - --__ ____ 777; 578 524; 720 252; 858 283', 754 493; 824
    Texas . - _____ 1, 263,153 834; 438 428; 715 430, 778 832,375
    Utah. ______________________________ 165,159 122,135 43,024 81, 128 84,031
    Vermont ___ - ____ ____ ______ 121, 406 78, 910 42, 496 36, 414 84, 992
    Virginia ____ ______ __________ 675,080 457, 417 217, 663 265,168 409, 912
    Washington ... _____ . _ _ 687; 088 443; 762 243', 326 322; 392 364, 696
    West Virginia__ __ . . ___________ 729,498 504, 613 224, 885 283,115 446,383
    Wisconsin___ ______ _ 706,056 465, 600 240, 456 267, 527 438, 529
    Wyoming___ ______ . ______ - 118, 962 84, 766 34,196 50, 571 68,391
    Alaska . .. _ _______ ... ______ 56,168 41,436 14,732 26,705 29,463
    District of Columbia. 258,374 173,344 85,030 124, 098 134, 276
    Hawaii- _____ ____ - -__ 195; 041 132, 939 62,102 70, 837 124, 204
    Puerto Rico__________________________ 466,331 285,315 181,016 126,933 339,398
    252 Department of Health, Education, and Welfare, 1953
    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 1953
    State or Territory
    Federal and State funds Classification of expenditures
    Total Federal State
    Administration
    and vocational
    guidance and
    placement
    services
    Purchased
    services
    Total___________________________ $3,456,827 $2,541,466 $915, 361 $1,798,822 $1,658,005
    Arizona___ _____________ . _____ 40, 578 28,478 12,100 16,377 24,201
    Colorado__ .. ____ ______ _____ 48,822 35,028 13, 794 29,842 18,980
    Connecticut___________ _______ ____ 35,391 28,608 6,783 23,023 12,368
    Delaware_______________ _____ _____ 42; 076 31,270 10,806 20,464 2i; 61?
    Florida______ _____ _ ___ _____ .. 247,996 182,621 65,375 137, 712 110, 284
    Idaho.. ____ ________________ _ 19,607 14; 760 4,847 9,919 9,68?
    Indiana_________ ____ ___ ____ .. 54,127 43,909 10,218 34,206 19, 921
    Iowa______ ____ ___________ _ 26,502 19,579 6,923 13,026 13,476
    Kansas________ ___ .. ________ 65,859 47, 817 18,042 35,958 29,901
    Louisiana____ _____ ____. 88,142 73,145 14,997 61;043 27,099
    Maine____ _____ _ . . _____ ____ 26,204 16,660 9; 544 17,976 8,228
    Massachusetts_____________ _ .. 44,007 35,864 8,143 27,722 16,285
    Michigan.. . ____ ______ . _________ 129', 281 93,221 36,060 84', 459 44,822
    Minnesota________ . . __ ____ 84j 136 62,651 21,485 45; 624 38,512
    Mississippi___________________________ 124; 868 96; 625 28,243 69,513 55,355
    Missouri____________ . . . . 120,051 95,273 24,778 70,495 49,556
    Montana____ _ . ________ ______ ____ 21,511 17,767 3; 744 15; 133 6,378
    Nebraska_________ . . . . .. .. . 46; 892 35,324 IL 568 25; 052 2i; 840
    New Hampshire . . . __________ __ 18,424 Hi 239 7,185 11,957 6,467
    New Jersey______ .. ._ .. ___ 133; 267 101,437 31,830 81,594 51', 673
    New Mexico___ _ ..__ _____________ 31,110 22,047 9', 063 16,047 15,063
    New York______ ____ __ ... _ . 36/ 512 249,267 118,245 13i; 022 236', 490
    North Carolina_________ ____ _.__ 358. 793 247,969 110,824 137; 145 221,648
    Ohio________________ ...__ _ ______ 189,928 136; 495 53,433 109,267 80, 661
    Oregon__ ____ __________ ______... 59, 435 40, 703 18,732 21,971 37,464
    Pennsylvania____ ___ _ ____ __ 32i; 546 236,365 85,181 166,184 155,362
    Rhode Island______ .. _____ _________ 34,555 24, 792 9,763 23,148 11,400
    South Carolina.. _ . _ ... ... 51; 801 40,422 11,379 31, 779 20,027
    South Dakota__________ ____ _ ______ 22,490 IL 420 5,070 12,350 10,142
    Tennessee__ . . _____ 170,856 128; 106 42; 750 86. 265 84,590
    Texas_______________________ . . . _ 201,668 156; 555 45,113 114,156 87', 511
    Vermont.. ... . _______ 2i; 267 15,471 5,796 10,642 10,622
    Virginia______________ ... .. _______ 52', 589 34,371 18; 218 16,153 36,435
    Washington__ .. _ _ __ _____ 38,010 29,478 8, 532 26, 969 11,046
    Wisconsin_______ _ .. ____ ____ 80; 762 63, 755 IL 007 47,445 33; 311
    Hawaii_______________________________ 36,764 26; 974 9, 790 17,184 19,587
    Saint Elizabeths Hospital
    The Patient is the most important person in the hospital; the entire
    organization of the institution revolves about him. The responsibility
    for the medical care of each of the patients in the Saint Elizabeths Hospital
    is assigned to the three Clinical Branches and the Medicine and
    Surgery Branch, the latter of which includes the tuberculosis service.
    All the other activities, such as the Laboratory, the Dietetic Service,
    the Construction Department, and so on, are auxiliary to these four
    branches.
    A total of 8,795 patients were given hospital care and treatment during
    the year as compared with 8,516 the year before, or an increase of
    279 patients. Of these, 397 were readmissions, that is, patients who
    had been cared for previously in this hospital or in similar institutions.
    Discharges increased also from 814 to 977 or 64.1 percent of admissions.
    The average stay of the 977 patients discharged showed an increase
    over the previous year from 520 to 699 days. On June 30, 1953, 7,382
    patients remained on the hospital rolls, or an increase of 111 over a
    year ago. Patients actually in the hospital at the close of the year,
    7,113, showed an increase of 74.
    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 usual activities of the clinical branches,
    which deal with the treatment and care of patients, education, and re-
    253
    254 Department of Health, Education, and Welfare, 1953
    search, have been maintained at a reasonably acceptable standard during
    the year, although the growing difficulties previously reported on
    account of overcrowding and shortages of personnel have continued in
    increased degree.
    Attention has been given in previous reports to the problems of overcrowding
    of patients and shortages of professional and ward personnel.
    There are opinions in certain circles that the size of the hospital
    should not increase. The fact remains, however, whether or not this
    position be taken, that the number of patients is growing steadily, that
    their average age is increasing, and that the tendency of the older patients
    is to remain longer. Increasing attention to the possibilities of
    finding homes for patients outside of the hospital has resulted in an
    increase this year in the discharges, so that the net gain of patients in
    the hospital during the year was only 111 or 1.43 percent as against 3.57
    percent last year.
    The proper bed capacity of the hospital at the present time is 6,213.
    There were actually in the hospital on June 30, 1953, 7,113 patients,
    an excess of 900 or 14.2 percent over the actual bed space. It is expected
    that one of the two vacant wards in the Geriatrics Building may be
    occupied within the coming year, but the situation is still far from
    ideal. There should be at least 10 percent of vacant beds available at
    any time in order to have proper mobility of patient load. The proportion
    of ward personnel has not increased with the patient population;
    since August 1948 there has been a gain of 135 employees as
    against 886 patients. At present the ratio is approximately 25 percent
    below that considered proper by the American Psychiatric Association.
    In spite of all the difficulties, the staff of the hospital have been
    most energetic in bringing about releases, with a very satisfactory
    result overall for the current year.
    It was reported last year that it was necessary to maintain a waiting
    list of prisoners in Howard Hall, the maximum security section
    of the hospital, and to accept prisoners as patients only as space permits.
    This was a most unfortunate situation, and all possible steps
    have been taken to remedy it. At present the number on the waiting
    list has been substantially reduced, and efforts are under way to
    reduce it still further. The replacement for the present Howard Hall
    is most urgently needed. The hospital’s request for funds for planning
    a new maximum security division has been approved by the
    Bureau of the Budget and is now pending before the Congress. This
    section of the hospital contains the most destructive, violent, assaultive,
    and problem male patients of the entire hospital. Understaffing in
    a division of this type is particularly dangerous.
    Reference has been made during the past several years to the difficulty
    of filling medical positions in the hospital; this condition persists.
    The number of internships and residencies available exceeds
    Saint Elizabeths Hospital 255
    by a considerable degree the number of candidates. For the coming
    year, for example, only 3 interns have been secured for the 12 available
    positions. The number of residents seeking training has tended
    to fall as well. The financial returns in the private practice of psychiatry
    are most tempting, with the result that very few of the residents
    care to stay in the hospital work once their training is completed.
    Another factor is the competition which exists from another agency
    of the Government which is permitted by statute to pay a salary
    premium of 25 percent to diplomates of specialty boards, a privilege
    which is not extended to Saint Elizabeths Hospital.
    The problem of the elderly patient continues to become more serious.
    During the past year there was considerable increase in the proportion
    of women over 60 years of age who were admitted. A year ago
    about 33 percent were in this age category, whereas during the current
    year nearly 41 percent were 60 years of age or older. During the
    year a substantial number of elderly patients who were not in need
    of active psychiatric care and who were relatively quiet and orderly
    was sent to the District Home for the Aged and Infirm, although a
    number had to be returned to the hospital. Every effort is being
    made to send patients to the District institution as facilities permit.
    The Geriatrics Building has been functioning very satisfactorily despite
    difficult conditions of staffing. Several clinical studies have been
    made on patients there, and the building itself has attracted a large
    number of visitors from this and other countries. The number of
    voluntary patients admitted to the hospital appears to be steady; 90
    were admitted during the current year.
    The number of Miller Act patients, that is, the so-called “sexual
    psychopaths,” has shown a distinct drop. This appears to be due to
    the change in policy on the part of the District Attorney’s Office.
    Although since the passage of the act in 1948, 61 such inmates have
    been admitted, the number during the current year was only 5. Of
    the 61 who have been admitted, 33 have been discharged as having
    received the maximum benefit. If it appears likely that the Miller
    Act will be substantially used again, the hospital is prepared to recommend
    certain changes which will make it more flexible and probably
    on the whole considerably more useful.
    As in the past, the hospital has attempted to follow an eclectic
    approach in the line of treatment, holding itself ready to utilize any
    new methods of treatment which seem to offer help to the patient
    without incidental harm and without undue devotion to any preconceived
    notions as to psychopathology or treatment. The number
    of patients receiving individual psychotherapy has been increased
    during the year, and a very active program of group therapy is being
    continued. During the year the psychodramatist left for another
    position, but it is hoped to resume this therapeutic activity again in
    256 Department of Health, Education, and Welfare, 1953
    the near future. It has been used on a modified scale during the current
    year in connection with the rehabilitation program.
    This latter program has been carried out with the aid of the District
    of Columbia Rehabilitation Service, which has been very helpful in
    cooperating with the Social Service Branch. The Board of Education
    of the District of Columbia has provided a visiting teacher for
    the benefit of some of the young patients of the hospital, and the
    recreational and occupational therapy programs are still expanding.
    Electroshock, subshock insulin therapy, and hydrotherapy have
    been actively used, especially the latter. The hospital is not imbued
    with the idea that electroshock is a panacea, but in selected cases it
    seems very effective. Prefrontal leukotomy (lobotomy) is still looked
    upon as only an operation of last resort; very few cases are being
    approved for its use, then only after all other known applicable forms
    of therapy have been tried without benefit. Only 38 lobotomies were
    performed during the year. Transorbital lobotomy has not been
    utilized at all.
    The number of petitions for habeas corpus has been considerably
    less this year than last, there being only 27 such writs issued, in addition
    to 15 orders to show cause. This is a very substantial drop from
    last year, the total number then being 54 writs and 12 orders. Even
    this number, however, represents a very considerable investment of
    the time of the physicians and the ward personnel, particularly when
    (as is sometimes the case) numerous continuances are ordered after
    the patient has been taken to court. During the year only 3 patients
    were released by the court as a result of such proceedings.
    MEDICINE AND SURGERY BRANCH
    This branch functions through the Medical, Surgical, Neurological,
    Syphilological and Clinic Services. This hospital is still the only
    public mental hospital in the United States which is approved by the
    American Medical Association for rotating internship. The hospital
    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 and to those employees who become ill or injured while on
    duty. During the year, 2,468 patients were admitted to the wards of
    the branch and a total of 64,184 visits were made to the various clinics.
    A large staff of visiting physicians and consultants has augmented
    the services of the branch in various special fields, such as dermatology,
    ophthalmology, and so on. During the year it has been
    arranged to have in residence a fourth year resident in surgery from
    George Washington University Hospital who is supervised by daily
    visits of the various members of the surgical teaching staff of that
    hospital. This has resulted in a very substantial increase in the numSaint
    Elizabeths Hospital 257
    ber of operations and in the quality of the surgical service which
    could be rendered to the patients.
    During the year the head of the Neurological Service was called
    to active duty in the Armed Forces and for that reason the Neurological
    Service has been temporarily given up. The inactive cases of
    tuberculosis have been concentrated in R Building, which has recently
    been used as a neurological center. It has been found that although
    the results with some of the antibiotics have been most gratifying in
    the treatment of pulmonary tuberculosis there are sometimes sudden
    flareups which render it highly undesirable to have the so-called inactive
    cases distributed through the hospital with other non-tuberculous
    patients. The number of patients with active syphilis coming
    to the attention of the hospital is falling steadily.
    PSYCHOTHERAPY BRANCH
    This branch carries on a considerable variety of activities. The psychodrama
    section has been considerably less active during the large
    part of the year on account of the absence of the director of that particular
    aspect of the work. Rehabilitation psychodrama activity has
    been carried on in conjunction with the Social Service Branch for the
    purpose of orienting convalescing patients to the problems they are
    likely to face upon their discharge. The group sessions conducted by
    Alcoholics Anonymous have been continued. Individual psychotherapy
    has been carried out both by the members of the branch and by the
    physicians on the ward services. The art sessions offer much pleasure
    and a therapeutic value to the patients who attend them. The dance
    therapy program likewise continues to be of value and interest to the
    patients. Both the art and the dance activities have proven particularly
    useful in the resocialization of patients by giving them the opportunity
    for self-expression. They are quite unusual in many ways and
    have attracted a great deal of attention from visitors to the hospital.
    The psychology section has continued to function actively. A total
    of 2,708 tests were given during the year, both to patients and to attendants
    and other personnel, and a very considerable number of lectures
    has been given by members of this section to residents, nurses, and
    others. The integration of psychology with psychiatry is an old story
    at Saint Elizabeths Hospital. Not only do the representatives of the
    section give the tests but they attend the staff meetings and discuss with
    the physicians the psychological findings and their significance. They
    have likewise done a certain amount of individual and group therapy,
    although the number of personnel in the section do not permit any extensive
    activity along this line as yet. The section is looked upon as an
    important teaching center and is utilized by students from the George
    Washington University and Catholic University.
    258 Department of Health, Education, and Welfare, 1953
    LABORATORY BRANCH
    This Branch continues to be very thoroughly occupied by the demands
    from the Medical and Surgical and the Clinical Branches. It
    has not yet been possible to obtain a trained encephalographer. The
    autopsy rate has continued high; during the year there were 437 deaths
    and 275 autopsies, or a percentage of 62.9. The work of the year may
    be summed up as follows:
    Bacteriology (cultural studies of autopsies and exudates, examination
    of smears, etc.)_____________________________________________ 5, 780
    Serology (blood typing and cross matching, etc.)--------------------------------19, 547
    Urine analyses________________________________________________ 35, 449
    Blood and feces examinations------------------------------------------------------- 13, 607
    Biochemistry (blood analyses and tests, functional tests, including electrocardiograms
    and basal metabolisms)_____________________________ 12, 201
    Electroencephalograms_________________________________________ 125
    Histopathology (surgical pathology and post-mortem pathology)---------- 5, 447
    Autopsies (percentage of deaths 62.9)____________________________ 275
    Photography _________________________________________________ 8,974
    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
    under way, among them studies of cortisone, LSD 29, sodium amytal,
    methedrine, pyricidin, and the use of metrazol in the aged.
    NURSING BRANCH
    The last class of the School of Nursing was graduated in September
    1952. The program for psychiatric aides, a group less intensively
    trained than graduate nurses, will be inaugurated during the coming
    year. Nine training schools send their affiliates to this hospital for a
    12-week course of training, and 132 affiliates have been trained during
    the year. Some training has been afforded to hospital corpsmen of the
    Navy (84), and opportunities for field service have been given to the
    Graduate School of Nursing of Catholic University. A nurse intern
    program with full college credit was carried on during the year with
    American University.
    OCCUPATIONAL THERAPY BRANCH
    Although there have been a number of changes in personnel, the
    activities of this branch have continued at a high pitch, both on the
    wards and in various shops. The recreational program has been further
    developed with softball and tennis. Motion pictures have been
    shown on the wards regularly for the benefit of patients who are
    unable to go to the regular shows in Hitchcock Hall. A very successful
    Play Day for the general group of patients and a Field Day for
    the Howard Hall patients was carried on during the year with great
    success. Several outside entertainments have been brought to the hosSaint
    Elizabeths Hospital 259
    pital through the efforts of the branch. Five schools of occupational
    therapy now use Saint Elizabeths Hospital for field training.
    SOCIAL SERVICE BRANCH
    During the year, 2,097 patients were given service, representing an
    increase of 449 over last year. A great deal of emphasis has been
    placed on discharge activities, and for this reason it has been necessary
    to discontinue the former practice of giving 100-percent coverage
    to incoming patients. The hospital believes, however, that this shift
    in emphasis is well worthwhile, as is shown by the increased number
    of discharges during the year. A particular project under way has
    been that of developing family care, that is, finding families other than
    those of the patient himself where the patient could be cared for. The
    branch is now supervising 14 such patients. It is this family care
    activity and the other discharge activities which account for the fact
    that during the year the discharged patients showed a somewhat
    increased average residence in the hospital. Many of these patients
    had been in the hospital 10 years or more, and the fact that they could
    be replaced in the community after that lapse of time indicates well
    the effectiveness of such a program and its value in adjustment.
    The rehabilitation worker provided by the District of Columbia
    Rehabilitation Service has been extremely effective in connection with
    the Social Service Branch. He has had 90 patients in training during
    the year and at least 50 have been placed in jobs. During the year, 14
    social work students from Catholic University and Howard University
    have been under supervision, 2 doctoral dissertations are in
    progress, and 8 individual theses have been prepared.
    CHAPLAIN BRANCH
    Regular services have been conducted for the Catholic, Protestant,
    and Jewish patients. The 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. Patients who are unable
    to attend the services are given such religious attention as they desire
    on their wards. In addition to the regular services in Hitchcock Hall
    and Howard Hall, services have been conducted regularly in the new
    Geriatrics Building for the benefit of those aged patients who are
    unable to go to the regular services in Hitchcock Hall.
    The hospital has two full-time Protestant chaplains, a full-time
    Catholic chaplain and a full-time Catholic chaplain resident, and a
    regular part-time Jewish chaplain. 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
    to the Protestant patients.
    260 Department of Health, Education, and Welfare, 1953
    During the year, 31 students or ordained clergy have completed
    a prescribed period of training. Since the clinical pastoral training
    program at Saint Elizabeths Hospital began in the spring of 1945,
    165 seminarians or ordained clergymen have received their training at
    the hospital. Of these, 135 have taken a minimum of 3 months’ training
    or longer. Sixty-one have been ordained clergymen and 20 have
    undertaken to work full or part time in the mental hospital chapel
    service. The program has served 11 different churches and denominations
    and has included two Negro clergymen and one foreign
    student.
    The Protestant chaplains work closely with the other chaplains, as
    well as with the various religious representatives in the community,
    and a high degree of friendly cooperation has existed among all of
    those who are ministering to the religious needs of the patients. The
    Catholic chaplain and his resident have conducted a mass in the chapel
    in Hitchcock Hall every day, and, in addition, two masses have been
    said on Sunday in Hitchcock Hall and one in Howard Hall, the
    maximum security section.
    It is the general policy of this hospital that every patient received
    at the hospital should be visited by a representative of his faith as
    soon as possible after his arrival at the institution, so that he may
    know that there is a clergyman who is interested in him. In addition,
    of course, any patient may have his own clergyman or a clergyman
    of his own denomination visit him from outside if he so desires.
    Jewish services have been held regularly under supervision of the
    Jewish chaplain and the assistance of the Jewish Welfare Board.
    For several years attention has been invited to the needs for an
    interdenominational chapel. Funds for this purpose have been provided
    by the Congress and, although they are temporarily impounded,
    it is expected that before long construction may be started on what
    is an extremely urgent need for the spiritual welfare of the patients
    of this hospital.
    LIBRARY SERVICES
    The Medical Library of the hospital is operated primarily for the
    benefit of the medical staff. There are also deposits in the office of
    the Nurses’ Training School and in the doctors’ office of the Medical
    and Surgical Building. Through the year there were 585 acquisitions,
    the total now standing at 16,063 volumes, plus about 14,000 miscellaneous
    pamphlets. Approximately 1,100 volumes were borrowed
    by members of the medical staff, and over 400 volumes were borrowed
    by the library on interlibrary loan. The Armed Services Library,
    the Library of Congress, and the Library of the Department of Health,
    Education, and Welfare have been particularly helpful.
    Saint Elizabeths Hospital 261
    The patients’ library is in charge of one employee who is assisted
    by 20 or more patients. Through the year there were 1,433 accessions,
    the total number of volumes now being 39,079. There has been an
    average circulation per month of approximately 5,200 books, and the
    number of deposits on the various wards has been increased for the
    benefit of the patients who find it inconvenient to come to the patients’
    library. In addition to the circulation of books, there are periodical
    book reviews, informal readings, and plays.
    RED CROSS ACTIVITIES AND SPECIAL SERVICES BRANCH
    Effective September 30, 1952, the National Red Cross found it impossible
    to continue further its services to certain governmental institutions,
    including Saint Elizabeths. Thus, an intimate connection
    with the Red Cross, lasting since the days immediately following
    World War I, by which a Unit was maintained on the grounds, came
    to an end. The Special Services Branch was set up to take over the
    function so far as possible, and the hospital was able to continue the
    services of three of the persons who had been up to that time employees
    of the Red Cross. There was thus practically no external
    appearance of change, except for uniforms, in the whole program.
    The closest of relations have been carried on since that time, by the
    Special Services Branch with the District Chapter of the American
    Red Cross.
    The trips of the patients to the symphony concerts, ball games, and
    other entertainments have been provided, the regular program of
    moving pictures in Hitchcock Hall has continued, and the various
    volunteer services, such as the Motor Corps and of the Production
    and Supply Service of the Red Cross, have been extremely active.
    During the period from October 1 (9 months) 2,169 volunteers have
    contributed a total of nearly 5,000 hours. Many evening parties, concerts,
    and dances have been conducted. The Canteen Service has provided
    refreshments on the wards once a week throughout the year.
    The Red Cross House has been kept open every day, serving well over
    10,000 persons per month.
    TEACHING ACTIVITIES
    The extensive program of teaching and training reported in last
    year’s report has been carried on during the current year. The hospital
    is approved for training in psychiatry during the 3 years of residency
    called for by the American Board of Psychiatry and Neurology
    as a prerequisite for a diploma, and a well-trained psychiatrist acts on
    a half-time basis, serving under the First Assistant Physician. He
    arranges the schedule of lectures and gives the residents guidance and
    supervision. The hospital is approved also for a rotating internship,
    affiliations being provided at the District of Columbia General Hos262
    Department of Health, Education, and Welfare, 1953
    pital for the interns and at the George Washington University Hospital
    for the residents.
    The hospital has close affiliation with the three medical schools in
    the District, namely, George Washington, Georgetown, and Howard
    Universities. Dental interns and residents in surgery are also servingin
    the hospital under the supervision of the respective approving
    organizations. The Social Service Branch is actively providing field
    work for the schools of social service of Catholic University and
    Howard University, and students of occupational therapy are likewise
    received for field work. Affiliation for undergraduate and post-graduate
    nurses is being continued, although the 3-year training course has
    been given up. A special course for training psychiatric aides will be
    put into effect in the near future.
    General Administration
    Many non-medical activities are essential to the discharge of the
    primary function of the hospital, which is the care of its patients.
    This portion of the work is organized under the Division of Administration
    in two Branches. In the Business Management Branch are
    the Registrar, Dietary, Personnel, Budget and Methods, Property,
    Purchasing, Finance, and Administrative Service activities and in the
    Maintenance and Industrial Services Branch are the Construction,
    Electrical, Mechanical, Garage, Housekeeping, Farm, Lawns and
    Grounds, Laundry, and Shoe Shop activities. All of these operations
    contribute more or less directly to the care of the patients, and each
    year the work of some of them, notably the Budget and Methods, seems
    to become more complicated. It is impractical to cover all of these
    activities in detail in an annual report, but a few highlights may be
    given.
    Centralization of patients’ baggage and property storage, a study of
    which was referred to in last year’s report, was commenced during the
    year and at the close of the year was nearing completion. All indications
    are that the change is highly beneficial. A number of improvements
    in property management procedures were made during the year
    including the periodic inspection of all stock rooms throughout the
    hospital, constituting approximately 190 storage areas, to insure equitable
    distribution of supplies. The Guard Force was reorganized so as
    to provide for levels of supervision between the guard captain and the
    guards, in this way making it possible to distribute responsible supervision
    throughout a 24-hour day. Reduction of routine clerical work
    in the ward services is receiving attention.
    Continued effort was extended by the Dietary Section toward the
    improvement of the dietary service and elimination of waste. Hie
    average ration cost for the year approximated 830. A program of
    Saint Elizabeths Hospital 263
    meal inspection by dietitians and nursing service personnel was instituted
    during the year, and under this program regular inspections of
    patients’ cafeterias and dining rooms are made jointly by the immediate
    staff of the Director of Nursing Service, Chief of Staff Dietitians,
    and Ward Service Supervisors for the purpose of providing constant
    surveillance of food service. Matters observed during the inspection
    include the quantity and quality of food, adequacy of service, amount
    of waste, adequacy of amount of help, and general cleanliness of
    dining rooms. Instruction in nutrition was given student nurses by
    the dietetic staff.
    Difficulty is still being encountered in recruitment of medical personnel.
    For the second consecutive year Saint Elizabeths was unable
    to secure its quota of interns. Recruitment of nurses has diminished
    to an extent that at the close of the year the hospital nurse complement
    was 10 percent below quota. The in-service training program
    for psychiatric aides scheduled for the ensuing year may alleviate this
    shortage.
    Funds were made available by the Congress for a new 420-bed
    Receiving Building, and a contract for construction was awarded on
    January 23, 1953. At the close of the year the work was 15 percent
    completed. It is expected that this much-needed building will be
    ready for occupancy by the beginning of 1955.
    Needs of the Hospital
    New maximum security facilities are urgently needed, as are further
    ward buildings in view of the steadily increasing demand for
    space. The cafeteria for Continued Treatment Buildings 7 and 8,
    long since planned, is urgently needed, as are additional boiler facilities
    and a new vault for the patients’ valuables. In view of the damage
    to the silos of the boiler house, the need for further facilities for
    coal handling becomes increasingly urgent. It is strongly recommended
    that consideration be given to statutory permission to pay
    the premium for diplomates’ salaries which is now offered by another
    Government agency. Additional personnel and additional ward
    facilities are urgently needed if the proper care which the patients
    who are entrusted to the care of the United States Government deserve
    is to continue to be provided.
    264 Department of Health, Education, and Welfare, 1953
    Table 1.—Patients, admissions, and discharges, fiscal years 1935—53
    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 1,202 619 51.50 322
    1941 ______________________________ 6,663 1,503 773 51.43 382
    1942 _____________________________________ 6,994 1,797 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. __________________________________ 7,308 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 1,470 861 58.60 446
    1950 ____________________________________ 6,897 lj 648 960 58.25 495
    1951 ______________________________ 7,053 1,412 928 65.72 424
    1952-. __________________________________ 7,172 1,438 814 56.6 431
    1953_______________________________________ L 361 R524 977 64.1 436
    1 63.10 without transfer of 400.
    Table 2.—Movement of patient population, fiscal year 1953
    Total
    Male Female
    White Colored Total White Colored Total
    Total number under care and treatment,
    fiscal year 1953----------------------------------- 8, 795 2,851 1,699 4, 550 2,576 1,669 4,245
    Remaining on rolls lime 30, 1952________ 7, 271 2,361 1, 365 3,726 2,147 1, 398 3,545
    Admitted during year_______________ 1,524 490 334 824 429 271 700
    Total discharged or died________________ 1, 413 492 311 803 397 213 610
    Discharged__________________________ 977 335 239 574 265 138 403
    Discharged as—
    Not insane______________ - 103 58 36 94 4 5 9
    Recovered______________________ 154 39 48 87 48 19 67
    Social recovery__________________ 287 74 75 149 88 50 138
    Improved_______________________ 264 94 50 144 69 51 120
    Unimproved____________________ 169 70 30 100 56 13 69
    Died________________________________ 436 157 72 229 132 75 207
    Remaining on rolls June 30, 1953________ 7.382 2,358 1, 389 3,747 2,179 1, 456 3,635
    On visit or elopement_______________ 269 37 43 80 105 84 189
    In hospital__________________________ 7,113 2,321 1,346 3,667 2,074 1, 372 3,446
    Saint Elizabeths Hospital 265
    Table 3.— Consolidated statement of movement of patients, by classification, fiscal year 1953
    N onreim bursable patients
    sputqsj ujSjia |
    118
    21
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    On rolls, Ju n e 30, 1952________________
    A dm itted , to Ju n e 30,1953------------------
    Separations, fiscal year 1953----------------
    D eath s_______________________________
    Discharges___________________________
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    Changes in classification, fiscal year
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    293171—5. ■18
    American Printing
    House for the Blind
    As the official schoolbook printery for the blind in the United
    States, one of the principal functions of the American Printing House
    for the Blind, in Louisville, Ky., is the extension of its services to the
    schools and classes for the blind through the Federal act “To Promote
    the Education of the Blind.” This act, originally passed in 1879,
    authorizes an annual appropriation to the Printing House to provide
    free school texts, tangible apparatus, and supplementary materials
    necessary in the education of the blind. Allocations of books and
    materials are made to the several schools on the basis of their enrollments.
    Only those pupils may be registered whose vision comes
    within the accepted definition of blindness as follows: “Central
    visual acuity of 20/200 or less in the better eye with correcting glasses,
    or a peripheral field so contracted that the widest diameter of such
    field subtends an angular distance no greater than 20°.”
    The Printing House maintains large catalogs of Braille books,
    Talking Books, Braille music publications, large-type texts, and
    tangible apparatus. The schools for the blind are thereby provided
    with a rich collection of educational material from the kindergarten
    through high school. There are approximately 6,587 blind children
    enrolled in the residential and public school classes for the blind being
    served by the Printing House.
    During the 1953 fiscal year, Braille books, educational periodicals,
    and music made up approximately 60.3 percent of the materials required
    by the schools; Braille slates, Braille writers, maps, and other
    mechanical devices about 12.5 percent; Talking Books about 6 percent;
    and large-type books about 18.9 percent. Approximately 2.3 percent
    was used for miscellaneous items.
    266
    Columbia Institution
    for the Deaf
    The Columbia Institution for the Deaf is devoted to the education
    of deaf persons whose hearing is so impaired that they are unable to
    progress satisfactorily in schools and colleges for hearing students.
    The Institution is located in Washington, D. C., and is composed of
    four departments: Kendall School, Gallaudet College, the Graduate
    Department of Education, and the Research Department. Its aim
    is to promote the welfare and advancement of deaf persons through
    various educational means and through research.
    KENDALL SCHOOL
    This department provides education for the deaf child from preschool
    age to college entrance. Its student body incorporates all deaf
    children from the District of Columbia and many from surrounding
    States. The oral method of instruction predominates, but when
    children cannot progress orally other methods may be used which will
    bring results. This past year the enrollment was 71, of whom 46
    were from the District of Columbia.
    GALLAUDET COLLEGE
    This department was established in 1864 by act of Congress. A
    liberal arts and science course is offered students who qualify through
    entrance examinations. There is also a preparatory year for those
    who have not completed a full high-school course. This past year,
    students from 40 States, the District of Columbia, the Territory of
    Hawaii, and Canada were admitted, with a total of 244 in the student
    body.
    The curriculum of the College is similar to that of any other American
    college which offers 4 years of work toward a bachelor’s degree.
    267
    268 Department of Health, Education, and Welfare, 1953
    After two years of General Education the student may specialize in
    the work offered by any one of a number of Departments. Many of
    the graduates take up teaching positions in the various schools for the
    deaf and have been very successful in this field.
    GRADUATE DEPARTMENT OF EDUCATION
    This department trains hearing young men and women, college
    graduates, to teach the deaf. The course is 9 months. Its purpose
    is to furnish teachers and administrators in the deaf educational field
    in the 48 States. At present the demand for this type of personnel
    cannot be met from available sources. This past year 9 persons were
    enrolled in this department, 6 of whom were men.
    RESEARCH DEPARTMENT
    This department was created to meet the demand of schools for
    the deaf in the United States for some central point where research
    can be carried on for the advancement of the education of the deaf in
    the Nation. Its primary aim is to develop better techniques in the
    education of the deaf and hard-of-hearing child. During the past
    year analytical studies were made of psychological aspects of deafness
    and of the academic program carried by American schools for
    the deaf.
    Howard University
    Howard University was chartered by Act of Congress on March 2,
    1867. Located in the District of Columbia, the University operates an
    undergraduate college, a graduate school offering the master’s degree,
    and eight professional schools, as follows: medicine, dentistry, pharmacy,
    engineering and architecture, music, social work, law and religion.
    (Religion receives no support from federal funds.)
    ENROLLMENT OF STUDENTS
    During the school year 1952-53 Howard University served 5,378
    students as follows: 3,809 during the regular school year; 973 in the
    summer school and 596 in the evening school. The net total enrollment
    excluding all duplicates was 4,913 students, distributed as follows: 596
    in the evening school and 4,317 in the ten regular schools and colleges,
    as follows: liberal arts, 2,249; graduate school, 320; engineering and
    architecture, 327; school of music, 277; school of social work, 99; college
    of medicine, 298; college of dentistry, 438; college of pharmacy,
    169; school of ] aw, 103; and school of religion, 37.
    HIGHLY SIGNIFICANT SERVICE TO NEGRO STUDENTS
    One of the major purposes of the founders of Howard University
    was the admittance of Negro youth, among others, to all of its educational
    offerings. The institution has pioneered in the offering of professional
    training to Negro youth in medicine, dentistry, pharmacy,
    engineering, architecture, law, music and social work, as well as in the
    teaching profession.
    During the entire period of 88 years from 1865 to 1953, Howard
    University has been the only university of public support in the southern
    states which has offered to a substantial number of Negro youth
    269
    270 Department of Health, Education, and Welfare, 1953
    any approximation of the wide scope of undergraduate, graduate and
    professional studies characteristic of American state institutions.
    Since 1948, however, public institutions in 12 southern states, hitherto
    closed to Negroes, have little by little, opened their doors to Negro
    youth.
    The national importance of Howard University as a trainer of
    Negro professional students is nowhere better illustrated than by reference
    to medicine and dentistry. If Meharry Medical College of
    Nashville, Tennessee, alone be excluded, the enrollment of medicine
    and dental students at Howard University in 1953 exceeded the enrollment
    of Negro students in all the other medical and dental schools in
    the United States. Howard University and Meharry Medical College
    have been the responsible pioneers in the development of medical education
    among Negroes; and, today, they constitute by far, the major
    source of Negro physicians, surgeons and dentists in America and in
    the world.
    GEOGRAPHICAL DISTRIBUTION OF STUDENTS
    Of the net total of 4,317 students enrolled in the ten regular schools
    and colleges there were 4,277 who registered for degrees. Three thousand
    nine hundred sixty-six of these, or 92.7% came from 42 states
    and the District of Columbia, in continental United States, while 311
    or 7.3% were students from countries outside of continental United
    States, including 27 foreign countries and four United States possessions.
    The 3,966 students from the continental United States were distributed
    as follows:
    New England States______________________________________ 89
    Middle Atlantic States____________________________________ 632
    East North Central States__________________________________ 230
    West North Central States_________________________________ 91
    South Atlantic States_____________________________________ 2, 363
    East South Central States__________________________________ 292
    West South Central States_________________________________ 244
    Mountain States__________________________________________ 5
    Pacific States____________________________________________ 20
    3, 966
    The 311 foreign students came from 27 countries and 4 United
    States possessions as follows: I. from five countries in Africa, 68;
    II. from six countries in Asia, 10; III. from Australia, 1; IV. from
    five countries in Europe, 8; V. from Canada, 1; VI. from nine countries
    in Central and South America and the British West Indies, 146;
    and VII. from four United States possessions, 33.
    Howard Vniversity 271
    VETERANS
    There were 578 veterans enrolled in Howard University during the
    school year 1952-53. Of this total 89 were Korean veterans. The
    enrollment of Korean veterans increased from 50 in the first semester
    to 89 in the second semester.
    During the two semesters of the regular school year the veterans
    enrollment was distributed among the ten schools and colleges as follows
    : the graduate school, an average of 22 per semester; the college
    of liberal arts, an average of 247 per semester; in the school of engineering
    and architecture, an average of 66 per semester; the school of
    music, an average of 10 per semester; the school of social work, an
    average of 12 per semester; the college of medicine, an average of 34
    per semester; the college of dentistry, an average of 52 per semester;
    the college of pharmacy, an average of 36 per semester; the school of
    law, an average of 28 per semester; and the school of religion, an
    average of 3 per semester.
    The relationship of the veterans to the total average enrollment in
    these colleges ranged from a minimum of four-tenths of one per cent
    in music to a maximum of 32 per cent in law. During the two regular
    semesters of the school year they constituted an average of 15.5 per
    cent of the total average enrollment of the ten regular schools and colleges,
    and 12 per cent of the total enrollment of the University for the
    entire year.
    ARMY AND AIR RESERVE OFFICERS’ TRAINING CORPS
    Army Reserve Officers'1 Training Corps.—An average of 233 students
    were enrolled in the Army Reserve Training Corps, during the school
    year 1952-53. One hundred thirty of these were enrolled in the first
    and second year basic army courses and an average of 103 in the first
    and second year of advanced army courses.
    Forty-nine students completed the Army R. 0. T. C. requirements
    at Howard University during the year 1952-53. Twenty-nine were
    commissioned Second Lieutenants of the United States Army Reserve.
    Nine others were scheduled to receive commissions as Second Lieutenants
    of the United States Army upon the completion of summer camp
    training. The remaining 11 were scheduled to be commissioned upon
    completion of their four years of college level academic work.
    Air Force Reserve Officers'1 Training Corps.—An average of 417 students
    were enrolled in the Air Force Reserve Officers’ Training Corps
    during the school year 1952-53. Of these an average of 278 were
    enrolled in the first and second year basic courses; 121 were enrolled
    in the first and second year advanced courses; and an average of 18 in
    the accelerated courses.
    272 Department of Health, Education, and Welfare, 1953
    Sixty-five students completed the Air Force R. O. T. C. course
    during the school year 1952-53. Of these 30 were commissioned as
    Second Lieutenants in the Air Force Reserve Officers’ Corps on the
    fifth of June 1953. Twenty-three others were scheduled to be commissioned
    as Second Lieutenants upon the completion of summer
    camp. Three were scheduled to be commissioned during the month
    of August upon completion of courses in summer school. The remaining
    9 were scheduled to be commissioned upon the completion of their
    academic requirements for the bachelor’s degree.
    FACULTY
    The University was served during the year 1953 by 438 regular
    teachers. 262 of these were giving their full time to the University,
    while 176 were serving in various part-time capacities. All together
    they made a total full-time equivalent teaching force of 308.74. Of
    this total 281.82 were in the rank of instructor and above while 27.12
    were below the rank of instructor.
    Forty-eight of the 176 part-time teachers served the University
    without compensation.
    COMPOSITION OF THE FACULTY
    The faculty of Howard University is composed of Negroes and
    whites, northerners and southerners, Jews and Gentiles, Protestants
    and Catholics, persons from Europe and Asia, North, Central and
    South America, and from Africa.
    From the beginning of its work in 1867 it was a major purpose
    of the founders of Howard University to employ Negro teachers,
    among others, on every faculty. Today the Negro members of the
    professional faculties of Howard University, exclusive of religion,
    constitute together a group of Negro professional teachers larger by
    far than all the Negroes so employed in all other American universities
    combined. The existence of this group of Negro university teachers
    at Howard University has been a standing inspiration to the Negro
    people for more than three-quarters of a century, and membership
    on one of these faculties has been the first employment of many of
    the most outstanding Negroes in the public life of America.
    TWO OUTSTANDING EVENTS OF NATIONAL SIGNIFICANCE
    There were two developments of national significance at Howard
    University, during the school year 1953. The first was the completion
    and initial use of the new building for Engineering and Architecture.
    The second was the admittance of the College of Liberal
    Arts to membership in Phi Beta Kappa, the Honorary Scholastic
    Fraternity.
    Howard University 273
    NEW ENGINEERING AND ACHITECTURE BUILDING
    During the school year 1953 the School of Engineering and Architecture
    entered a new and modem building, erected by the Government
    of the United States at a total cost of $2,161,340.
    The new School of Engineering and Architecture building is designed
    to accommodate as many as 400 full-time students approximately
    evenly distributed among the four present degree-granting
    departments of civil, electrical and mechanical engineering and
    architecture.
    The laboratories of each department were designed by members of
    the departmental staff thereof. They represent careful planning over
    a period of more than ten years, including studies, surveys, inspection
    visits to more than forty representative schools of engineering and
    architecture, and especially selected visits to study special features.
    Critical review of the final plans was made by representatives of the
    United States Office of Education and the American Society for Engineering
    Education including Lamme Medalist and Professor Emeritus
    Alexander Graham Christie of Johns Hopkins University, Dean
    S. S. Steinberg of the University of Maryland, Dean Emeritus Frederick
    M. Feiker, George Washington University, and Walter A.
    Taylor, Director of Education and Research, American Institute of
    Architects.
    This was the first modern building ever erected on the soil of the
    former slave states for an accredited school of engineering and architecture
    attended heavily by Negro students. The 327 students of
    engineering and architecture served in this building during 1953
    included the largest body of Negro students of engineering and architecture
    in the United States. Their number exceeded the total enrollment
    of Negro engineering and architecture students in all
    accredited schools of engineering and architecture, public and private,
    in all the southern states.
    ENGINEERING AND ARCHITECTURE BUILDING RECEIVES DISTINGUISHED
    ARCHITECTURAL AWARD
    The new building for engineering and architecture was selected by
    the Washington Board of Trade to receive one of its distinguished
    biennial awards in architecture. The Board of Trade commended
    this building as being “of superior design among the buildings erected
    in the year 1951-52,” awarded a “Diploma of Merit” to the owner,
    the builder and the architect, and indicated that it made this award
    in acknowledgement of the benefit of such superior architecture in
    the City of Washington.
    274 Department of Health, Education, and Welfare, 1953
    PHI BETA KAPPA
    The outstanding event of the year in the college of liberal arts was
    the installation of Gamma Chapter of the District of Columbia of Phi
    Beta Kappa, the Honorary Scholastic Fraternity.
    Howard University was among the nine new colleges admitted to
    membership in Phi Beta Kappa, the Honorary Scholastic Fraternity,
    at their recent triennial convention held at the University of Kentucky,
    Louisville, Kentucky. This action authorized the installation of a
    chapter of Phi Beta Kappa at Howard University as Gamma chapter
    of the District of Columbia—the Alpha and Beta chapters being
    George Washington and the Catholic Universities. This recognition,
    coming after both national and regional inspection of the institution’s
    curriculum, faculty standing, scholastic performance, and plant facilities,
    is notable, along with the similar acceptance of Fisk University,
    as the first such recognition of Negro colleges by Phi Beta Kappa.
    Noteworthy also was the sponsorship of the George Washington and
    Catholic Universities chapters, which will now become sister chapters,
    and the unanimous endorsement of the South Atlantic Phi Beta Kappa
    colleges at a regional conference held last fall at Davidson College,
    North Carolina.
    Participating in the inauguration of the Gamma Chapter of Phi
    Beta Kappa at Howard University were representatives of the original
    chapter at William and Mary College of Virginia and of other
    distinguished institutions of learning in the South and North.
    Together they united in a reverent and glad expression of esteem for
    the high intellectual and spiritual possibilities of the Negro people
    and placed their joint approval upon the eleven seniors at Howard
    and two juniors, to constitute the first student members of the honor
    fraternity. The founders of Howard University would have rejoiced
    to see this day.
    GRADUATES
    During the school year 1952-53 Howard University graduated 616
    students from its 10 schools and colleges. These graduates were distributed
    among the schools and colleges as follows: liberal arts, 259;
    engineering and architecture, 46; music, 33; medicine, 67; dentistry,
    46; dental hygiene, 7; pharmacy, 25; law, 26; religion, 9; graduate
    school, 68.
    The University also awarded three honorary degrees.
    From the beginning of its work, until the end of 1953, Howard University
    has graduated a total of 17,621 persons. These graduates are
    at work in 42 states and 24 foreign countries. In every population
    center in the United States they constitute a cross section of the leaderHoward
    University 275
    ship 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 31 foreign countries.
    It ranks third among American universities in the percentage
    of foreign students enrolled.
    Howard University students and teachers have associated daily with
    teachers and students representative of every race and color, and mayy
    of the 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 these teachers and students, as individuals and in groups,
    have traveled on missions to many countries in Europe, Asia and
    Africa. Wherever they have gone, they have imparted goodwill and
    friendship and they have found goodwill and friendship in return.
    Again and again the responsible leaders in Government and the
    friends of America have acknowledged their services as being of the
    highest value to their country and to the cause of democracy in the
    world.

    Appendix Tables

    Appendix Tables 279
    Table 1.—Grants to States: Total grants under all Department of Health,
    Education, and Welfare programs, fiscal year 195.3 1
    States, Territories,
    and possessions Total
    Social Security
    Administration
    1 2 3
    Public Health
    Service 2
    Office of
    Education 2
    Office of
    Vocational
    Rehabilitation
    American
    Printing
    House for
    the Blind
    Total__________ $1, 745, 777,343 $1,361, 436,602 3 $147,158,086 $214, 753, 562 $22, 244,093 $185,000
    Alabama_____________ 38,350,106 28,171,034 4. 051, 307 5, 522, 786 598, 358 6,621
    Arizona______________ 13, 270, 472 8, 483, 979 1, 058, 796 3, 623,193 103, 454 1,050
    Arkansas____________ 33, 049, 650 23, 486, 025 3, 788, 695 5,430, 852 340, 461 3,617
    California____________ 189, 735, 335 151, 474,193 6,152, 039 30, 513,234 1, 585, 690 10,179
    Colorado_____________ 32,214, 764 27, 321,216 832,110 3, 895, 727 163, 669 2, 042
    Connecticut_________ 13,499, 206 8, 583, 625 1,113,861 3, 504,418 295, 144 2,158
    Delaware_____ _____ 2,016, 130 1. 321, 714 302, 759 230, 975 160, 682
    District of Columbia. _ 4, 732,197 3, 620, 485 842, 695 93, 755 175, 000 262
    Florida______________ 41, 541, 354 32, 919, 220 3, 279, 897 4, 605, 596 734, 308 2, 333
    Georgia______________ 58, 281, 836 40,095, 280 4, 986, 537 11,920, 485 1,274,634 4,900
    Idaho . 6, 848,256 4, 758, 524 210,191 1,819, 471 59 458 612
    Illinois___ _ _____ .. 74, 670, 325 60; 186; 572 7,651, 730 5, 700; 875 1 123,098 8, 050
    Indiana. ... ______ 2L 572^ 407 18,114,010 5, 889, 913 3,177; 197 387, 816 3, 471
    Iowa_________________ 26,196, 934 22, 430,259 2, 072,370 1, 408, 545 282, 318 3, 442
    Kansas______________ 24, 240, 820 17,383, 403 1, 668, 492 4, 953, 682 233,318 1,925
    Kentucky___________ 36, 972, 344 27, 049,108 5, 954,438 3, 817, 363 147, 789 3, 646
    Louisiana____________ 80, 750, 738 72, 890,653 4, 686,149 2, 623, 873 546,213 3, 850
    Maine_______________ 8, 570, 980 7, 458, 787 380, 573 629, 655 101, 965
    Maryland_____ __ 18, 605, 906 9, 732,109 1,642, 079 6, 978, 258 249, 989 3,471
    Massachusetts. ____ 55, 790, 308 50, 961, 269 3, 230, 295 1,342, 220 249; 203 7, 321
    Michigan ____ . __ 62, 344,620 49, 756,883 3, 880,212 7, 678, 762 1,020,159 8, 604
    Minnesota___________ 31, 672, 738 25,488, 431 4,859,643 L 005, 704 31< 789 4,171
    Mississippi____ . _ 25, 833, 903 20,058,033 2, 651,611 2,672, 229 448, 705 3, 325
    Missouri _____ ___ 70, 491, 952 63, 448, 786 2, 703, 091 3,895, 356 440, 577 4,142
    Montana____________ 8, 099, 844 6,190,036 616,893 1,153, 859 138, 444 612
    Nebraska __ .. .. 11,489, 690 8, 879, 941 1,144, 459 1, 272,145 192, 008 1,137
    Nevada... . ___ ... 3,421,019 1, 297, 898 179, 737 1,915, 850 27, 534
    New Hampshire_____ 4, 577.241 3, 789,167 194, 522 541, 588 5L 964
    New Jersey. ___ 19, 239, 576 11, 970, 626 3, 935, 542 2, 913,090 414,076 6, 242
    New Mexico. _. .. 11, 733, 784 7, 646; 326 745, 658 3, 240, 040 99, 660 2,100
    New York___________ 118,804,867 105, 509, 566 7, 823, 928 4, 009, 041 1, 447, 487 14, 845
    North Carolina______ 36, 318, 061 25,089, 583 6,305,262 4. 089, 906 823, 219 10, 091
    North Dakota_______ 6,016, 861 4, 749,106 631, 698 543, 852 91, 330 875
    Ohio _. . .. . . . 62, 894, 710 49, 417,164 6, 597, 379 6, 415,396 455, 817 8, 954
    Oklahoma.__________ 60, 061,475 52, 511,655 1,232, 869 5,838,263 476,180 2,508
    Oregon ... .. .. 13,819, 568 10, 860, 494 1,112, 999 1, 558, 973 285, 265 1, 837
    Pennsylvania . ... ._ 60, 056, 879 46, 770,487 7,424, 528 4, 240, 503 1, 608, 790 12, 571
    Rhode Island „ ____ 7, 474, 771 6, 079, 636 460,163 825,482 109, 490
    South Carolina 27, 245,175 17,363, 825 3,653, 540 5, 730, 780 494,376 2, 654
    South Dakota ___ 7, 811, 479 6,177, 371 688, 214 870, 811 74,062 1, 021
    Tennessee ... 41, 209,474 31,319, 060 5, 302,287 3, 934,033 649, 719 4, 375
    Texas____ . . ... 105, 641,159 82, 291, 739 8,110, 335 14, 264, 200 967, 827 7, 058
    Utah________________ 9, 555,351 6, 740, 661 589, 865 2; 104, 752 119, 111 962
    Vermont____ -.. 3, 824, 588 2, 996, 219 364, 856 372,158 91,355
    Virginia _. . .. . . 27,323, 947 11,064, 068 3, 049, 608 12,697, 967 506,850 5, 454
    Washington __ .. . 45,240, 539 31, 775, 728 1, 276,374 11,650; 140 535, 672 2,625
    West Virginia. ____ 26, 939, 541 21, 292, 696 4, 567, 906 558, 207 517; 990 2, 742
    Wisconsin_____ ... . 26, 285,156 22; 224; 196 2, 598,188 955, 332 502, 511 4; 929
    Wyoming... . . 3, 449, 739 2, 587, 499 438,070 339,162 85, 008
    Alaska_____ _ . 4, 198,113 1,575,151 269,085 2, 316, 850 37, 027
    Hawaii __ _____ 6, 796,047 3, 806,180 533,133 2, 317, 725 138,630 379
    Puerto Rico__ __ _ 8, 623,004 3, 968, 963 3, 368,168 1, 018,142 265,894 1,837
    Virgin Islands_______ ' 372, 404 297, 963 53,337 21,104
    1 On a checks-issued basis.
    2 For detailed figures by programs, see tables 2, 3, and 4.
    3 Includes grants to Universities and local units, for details, see table 3
    280 Department of Health, Education, and Welfare, 1953
    C hild welfare
    services
    $6,388,437
    glSSsslSIS ggtSStSEgg ggSUgSSSsB
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    crippled
    children
    $11,814,776
    (M
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    3
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    services
    $13, 299,919
    SsSISsBsgB sBsggggSB
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    $59,317,125
    2.250,156
    ! o
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    A id to the b lin d
    $32,668,872
    gsgsggma SgSSSaSSsl ggSlssHst
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    A id to dependen
    t children
    $338, 549,221
    aBSSSSSSSS lisgistsSS gBSttS it£8
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    of o'gjT co-ol r-TocTr*^ r-4 tF co oi O co~ oo o o'co" o r-f r-f j cqcq-
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    Old-age assistance
    $899,398,252
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    ,— Grants to
    i
    $1,361,436,602
    8sSs§SS?ai 5§s8I§3e§1 assgSStssS
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    Table 2
    i
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    C o n n ecticu t__________________________________
    D elaw are_____________________________________
    D istrict of C olum bia__________________________ F lo rid a _______________________________________
    Georgia_______________________________________
    Id ah o _________________________________________
    i
    K an sas_______________________________________ K en tu ck y ____________________________________
    M ain e________________________________________ M a ry la n d . - ________________________________
    M in n eso ta ............ ..................... ................... .................
    M issnnr?P ____ . ______________________
    M o n ta n a ------------------- ------- ------------------------------
    N eb rask a_____________________________________
    N ev ad a------------------------------------------------------------
    N ew H am p sh ire______________________________
    N ew Jersey___________________________________
    N ew M e x ic o ............................. —
    Appendix Tables 281
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    Virgin Islan d s________________________________
    282 Department of Health, Education, and Welfare, 1953
    Table 3.—Grants to States: Public Health Service, fiscal year 1953 1
    States, Territories, and possessions Total Venereal disease
    control
    Tuberculosis
    control General health
    Total____________________________ $147,158,086 2 $7,162,260 $5,300, COO $12,999, 970
    Alabama _ _ _ - _ - - ________ _____ 4,051,307 301, 508 125, 595 399, 716
    Arizona . - . L 058i 796 65, 719 57,204 95,491
    Arkansas _________ 3, 788, 695 146,322 87,634 251, 806
    California . _ . .. ___ 6,152,039 150,838 288,454 665,411
    Colorado__________ . ____ 832,110 46,423 44,487 128; 377
    Connecticut 1,113' 861 35,195 74; 781 125; 187
    Delaware ___ _______ ________- 302,759 17,191 19; 839 22, 700
    District of Columbia _______ _____ .. 842, 695 136, 909 49,198 47,731
    Florida ______ - _. -____ 3,279,897 417,626 113,666 265, 679
    Georgia ___ - ____ - - 4i 986; 537 505,318 163,097 402, 814
    Idaho___ ______ -__ 210,191 36,459 17,070 75,857
    Illinois ____ . . _ 7,651,730 285,167 259, 683 533,165
    In diana - ... 5,889; 913 102', 542 103, 743 293,359
    Iowa _________ - ______ 2,072,370 53, 966 46,407 208, 207
    Kansas _____ _. .. ___ 1, 668,492 36,238 56,143 169, 917
    Kentucky________ __ . ... 5; 954,438 190,734 146, 790 345,000
    Louisiana ___ ______ __ 4; 686’, 149 432,032 106,502 296, 938
    Maine. ___ ______ ____ . ___ 380; 573 15; 362 28,671 97,157
    Maryland _____ _ __ 1, 642,079 128, 703 105, 810 170, 538
    Massachusetts .... 3, 230,295 46, 259 172,100 312, 984
    Michigan.. ...... .... . 3,880,212 142, 908 172,624 446, 773
    Minnesota 4,859,643 25,464 70, 514 247,469
    Mississippi . .... 2,651,611 396,052 119,824 340,088
    Missouri____ . 2,703,091 187,058 125,840 317,423
    Montana _. ...__ 616,893 17, 709 22,180 68,205
    Nebraska _____ .. ..__ 1,14< 459 25,898 30, 515 128, 264
    Nevada _. _ ' 179, 737 21,155 10,384 37,971
    New Hampshire . . .. ___ 194; 522 12; 025 16,474 49,984
    New Jersey _ ... 3, 935,542 78, 638 133,847 309, 276
    New Mexico __ . .. ______ ' 745; 658 35, 540 39, 599 96,653
    New York ... 7,823,928 310, 427 430, 585 824, 707
    North Carolina___ ______ _ ____ 6,305, 262 318, 580 155,359 472; 889
    North Dakota_______ .... 631, 698 25, 284 37, 442 75,147
    Ohio _____ .. . 6,597, 379 178, 656 229, 899 550, 033
    Oklahoma._____ _ ..... _ 1, 232,869 100, 689 81, 866 222, 693
    Oregon ............. 1,112,999 25,893 48, 444 137, 604
    Pennsylvania..____ _ . ____ 7; 424', 528 242, 420 269, 536 756,303
    Rhode Island ._ ... .__ _____ ___ 460,163 14,867 29,216 55,867
    South Carolina________ . _. .. ___ 3,653,540 249; 006 114, 565 274,222
    South Dakota - __ ___ 688; 214 17,800 22, 517 77, 223
    Tennessee___ . ... .. __ 5,302,287 214, 846 153, 840 354,179
    Texas__ _ _ ____ ____ _____ 8,110,335 624,146 193, 296 692, 088
    U tah ______ ...___ ' 589,865 16,640 18,198 86,322
    Vermont____ _ ___ _______________ 364, 856 14,228 17,811 45, 282
    Virginia.. _____ . _ __ 3, 049; 608 168, 519 154, 015 326, 592
    Washington ______ .. ___________ i; 276', 374 29,802 67,074 172,236
    West Virginia ___ ________ . . ____ 4; 567,906 112,903 71, 450 203,010
    Wisconsin___ ____ __ ________________ 2; 598', 188 24,910 67,480 258, 905
    Wyoming _. .. . ___ __ 438; 070 15, 253 11,885 48, 661
    Alaska8 _ _____ ._ ________________ 269, 085 17, 246 67, 489 48, 631
    Hawaii .. ____________________________ 533; 133 16, 512 48, 709 44, 060
    Puerto Rico . .. _________________ 3,368,168 316, 211 191, 268 317, 320
    Virgin Islands_________________________ 53; 337 14,464 9,381 5; 856
    See footnotes at end of table.
    Appendix Tables 283
    Table 3.—Grants to States: Public Health Service, fiscal year 1953 1—Con.
    States, Territories, and
    possessions
    Mental
    health activities
    Heart disease
    activities
    Cancer
    activities
    Industrial
    waste studies
    Hospital
    construction,
    survey, and
    planning
    Total_____________________ $3,049,736 3 $3,033,844 3 4 $5,196, 439 5 $1,113,416 $109,302,421
    Alabama ________ - - _____ - 71,634 46,637 72,894 3 033 323
    Arizona- _____ ____ ____________ 5, 786 2' 000 13,155 ’8io’ 441
    Arkansas__________ - - ________ 32,944 24,553 50,258 3 195’ 178
    California________ _______ -- - 180; 602 69; 592 3 719,622 8 57, 555 4’ 019’ 965
    Colorado_ _ ____ ______ _____ 25,602 3 49; 452 31,521 ' 506’ 248
    Connecticut________ ______ 34,178 22; 404 3 52,337 769’ 779
    Delaware __ _____ ___ 19,911 12; 445 5; 487 205 186
    District of Columbia______ ___ 19,286 14,464 3 164,299 41 o’ 808
    Florida_____ _______________ -- 57,603 3< 436 58,946 2,331 941
    Georgia - ________ 77,373 47; 082 79,977 8119,385 3 591 491
    Idaho _ _ 20,021 15,146 17,608 28,030
    Illinois -- - ____________ _____ 147,280 3 445; 101 147,140 6 103,258 5, 730,936
    Indiana _ _ ________________ ____ 64i 104 28,600 3 194,272 8 181,232 4, 922 061
    Iowa ____ _ ________ _____ 49; 120 20', 043 55; 031 1, 639, 596
    Kansas - ________________ - 34,029 24,682 38,419 1 309 064
    Kentucky______________ _ _ __ 66,391 4i; 591 71,161 5, 092, 771
    Louisiana ___ ______ - - 57,220 3 325; 153 56; 507 3 411 797
    Maine ________ -__ ___ 17, 513 5; 000 20,493 196,377
    Maryland __________ - - ____ 43,620 16,196 38; 453 1,138,759
    Massachusetts __ _ ____ 87, 597 35; 068 94; 855 2,481,432
    Michigan __ - __ 117,977 40,262 3 153,094 2,806, 574
    Minnesota ___ ______ _______ 57,341 3 24L 748 3 460,060 3,751, 047
    Mississippi-- ______ --___ 55; 040 40,737 64; 680 1,635,190
    Missouri __ _ _ ____ _____ 73,943 37, 248 82', 634 1,878,945
    Montana_____ - - - __ _ 20; 021 14, 568 17,290 456,920
    Nebraska _ _ ___ - - ______ 14, 474 10,816 25; 570 908,922
    Nevada __ __ 9, 894 6; 536 6,547 87,250
    New Hampshire 19, 583 11,073 85,383
    New Jersey _____ . __ ___ 89, 978 37; 735 73, 496 3,212, 572
    New Mexico _ _ . 18,594 5; 110 6,685 543,477
    New York _____ -- 264,005 3 582,749 3 680,606 4,730,849
    North Carolina _ _ 81,258 32,078 59, 535 8 129,000 5,056, 563
    North Dakota_____ _ __ _____ 20, 021 15,158 17, 926 440; 720
    Ohio ______________ ___ 150,667 60,721 3 47L 031 7 6,000 4,950,372
    Oklahoma__________ ____ 45; 685 29,108 46,402 7 1,201 705,225
    Oregon __ ____-- 28,156 13, 592 21,460 7 1, 500 836,350
    Pennsylvania __ _ _ _____ 20L 103 3 324,359 3 243.845 5,386,962
    Rhode Island 20, 013 16,014 ’ 324,186
    South Carolina- _ ______ 49, 411 21,332 50,076 8 419,811 2,475,117
    South Dakota _ _ _ _ _ __ 18,871 IL 348 11, 207 529; 248
    Tennessee _ ___________ 67,947 42,381 3181,577 4,287, 517
    Texas -___ ____ 157,021 3 248, 378 8 82,952 6; 112; 454
    Utah _________________ 18,628 9,350 15, 799 424, 928
    Vermont _____ __ - -___ 10; 599 12; 315 11, 561 253,060
    Virginia___ -- -___ - - --___ 69, 761 5; 000 31; 000 2,294, 721
    Washington.______ - - ___ 44; 289 25, 648 43,407 7 2,874 891,044
    West Virginia _ _ _ ______ 41,128 27,331 43,489 4,068, 595
    Wisconsin__ -___ 65,311 27; 857 56,915 7 8,648 2,088,162
    Wyoming __ _ ____ 7; 073 4; 724 11,458 339,016
    Alaska • _____ 19,089 5,200 111, 430
    Hawaii 19,389 14,146 9, 749 380, 568
    Puerto Rico _ __ ___ 42,416 34,868 51', 214 2, 414; 871
    Virgin Islands 19,236 3; 101 1,299
    1 On a checks-issued basis.
    2 Includes $748,679 in cash, supplies and services for rapid treatment facilities and $2,897,194 in cash, supplies,
    and services for venereal disease special projects.
    3 Includes grants to universities and local units. Does not include funds for federally operated center in
    Hot Springs, Ark.
    4 Does not include funds paid for special control projects.
    ’ This amount represents $1,093,193 for construction of community facilities in defense areas and $20,223
    for industrial waste studies.
    * Payment for construction of community facilities in defense areas.
    7 Payment for industrial waste studies.
    8 An additional amount of $537,000 was paid to Alaska for disease and sanitation investigation and control
    activities.
    284 Department of Health, Education, and Welfare, 1953
    Table 4.—Grants to States: Office of Education, fiscal year 1953 1
    States, Territories, and
    possessions Total
    Colleges for
    agriculture
    and the mechanic
    arts
    Cooperative
    vocational
    education
    Survey and
    school construction
    Maintenance
    and operation
    of schools
    Total_____________________ $214,753,562 $5,030,000 $25,420,754 2 $118,308,139 3 $65,994,669
    Alabama_____________ _______ 5,522, 786 100,111 670,987 3, 695,279 1,056,409
    Arizona - - - ______________ 3,623,193 77,070 169,933 2, 599,371 776,819
    Arkansas _ ____________________ 5,430,852 88,629 491,667 3,905,429 945,127
    California______________ ______ 30,513,234 175,094 1,019,432 14,223,724 15,094,984
    Colorado - ..__ _____ __ - 3,895,727 82,805 419, 779 1,754,649 1,638,494
    Connecticut____________________ 3,504,418 89,603 248,176 2,326, 538 840,101
    230,975 72,770 158,211 -6
    93^ 755 93,755
    Florida ______________________ 4,605,596 97, 216 393,202 2,966,875 1,148,303
    Georgia ____ _ _ __________ 11,920,485 103,926 720,644 7,909,746 3,186,169
    Idaho _ ~ __________________ 1, 819,471 75,466 153,646 1,346, 574 243,785
    Illinois __ _____________ -- - 5,700,875 156,419 1,098,786 3,064,601 1,381,069
    Indiana ._______ ___________ 3,177,197 108,805 655,676 1,672,648 ' 740,068
    Iowa _ _____ _ - _________ 1,408,545 95,719 555,178 548,171 209,477
    Kansas - - - _______ 4,953,682 88,587 366,801 1,851,098 2,647,196
    Kentucky ______ - - ___ 3,817,363 98,945 678,348 1,425,849 i; 614; 221
    Louisiana - __ ___ _______ 2,623,873 96,342 491,851 1,847,348 188,332
    Maine . . ___________________ 629,655 78,706 156,609 60,906 333', 434
    Maryland__ _ _____ _ __ 6,978,258 92,948 311,936 5,342,279 1,231,095
    Massachusetts.________________ 1,342,220 116,342 499,931 57,646 668,301
    Michigan ______ ____ _____ .. 7,678,762 133,096 889,169 5,770,032 886, 525
    Minnesota._ _____ _____ _______ 1,005,704 99,321 571,955 284,330 50', 098
    Mississippi - _________________ 2,672,229 91,313 614,337 1,451,422 515; 157
    Missouri ______ - ______ 3,895,356 109,009 695, 773 2,268,835 821', 739
    Montana_____________ . .. . 1,153,859 75,490 167,075 671,546 239', 748
    Nebraska.. _____ ____________ 1,272,145 82,809 287,991 247,179 654', 166
    Nevada _______- ____ _ _ 1,915,850 71,195 111,986 1,222,027 510,642
    New Hampshire 541,588 74,914 152,492 314', 182
    New Jersey____ ___ - - - __ 2,913^ 090 117, 785 500; 499 1, 252,981 1,041,825
    New Mexico_______ _____ - - 3,240,040 76,388 166,829 2,430,909 ' 565', 914
    New York.. ___ ___ _________ 4,009,041 217,386 1,561,324 1,430,124 800,207
    North Carolina .___ ___ 4,089,906 110,078 958,134 2,290,523 731', 171
    North Dakota _ . .____ ______ 543,852 75,775 204, 547 73,975 189,555
    Ohio .. .. ___________________ 6,415,396 148, 790 1,109, 584 3,096,957 2,060,065
    Oklahoma______ _______ _______ 5,838,263 91,856 438,879 2,889,012 2,418, 516
    Oregon. . . ____ __ ________ 1,558i 973 84,760 263,330 805, 587 ' 405', 296
    Pennsylvania. _____ ___ ______ 4,240,503 174,215 1,359,966 1,688,753 1,017; 569
    Rhode Island.. ..__ ____ __ 825', 482 77,491 100,529 98,472 548,990
    South Carolina____________ ____ 5,730,780 90,696 492,257 4,189,151 958; 676
    South Dakota___ ______________ 870,811 76,105 201,526 133,679 459; 501
    Tennessee. -____ ___ . __ 3,934,033 102,403 715,420 2,843,418 272,792
    Texas. ________________________ 14,264,200 146,444 1,248,752 7,690,084 5,178', 920
    Utah___________________________ 2,104', 752 76,466 165,983 1,119,978 ' 742; 325
    Vermont______ ___________ . ' 372; 158 73,364 155,887 97,542 45; 365
    Virginia. ______________________ 12,697,967 102,671 643,318 7,144,491 4,807,487
    Washington __________ ______ 11,650; 140 93,307 362,316 8, 516,190 2,678', 327
    West Virginia________________ ' 558', 207 89,586 414; 354 5, 581 48; 686
    Wisconsin_________________ __ _ 955; 332 103,826 615,079 40,345 196i 082
    Wyoming__________ _____ __ .. 339,162 72', 495 158; 654 108; 013
    Alaska _ ____________ ... 2,316,850 70,882 1,306,675 939,293
    Hawaii. ______ __ ______ ______ 2,317; 725 74,581 158,654 ' 636; 811 1,447; 679
    Puerto Rico.. ________________ 1,018; 142 50,000 558, 563 12, 799 396,780
    Virgin Islands_____ _ _________ 2R 104 2i; 104
    1 On a checks-issued basis.
    2 Does not include $9,885,864 paid to Housing and Home Finance.
    3 Includes funds paid Army and Navy to be applied to State projects.
    Detailed Contents
    Page
    THE SECRETARY’S REPORT___________________ 1
    SOCIAL SECURITY ADMINISTRATION
    SOCIAL SECURITY IN 1953_____________________________________ 9
    Program Administration in 1953__________________________________ 12
    OLD-AGE AND SURVIVORS INSURANCE_______________________ 14
    The Significance of the Program________________________________ 15
    Beneficiaries and Benefit Amounts__________________________________ 15
    The Protection Provided__________________________________________ 16
    The Coverage of the Program______________________________________ 16
    Contributions and Disbursements___________________________________ 17
    Administering the Program________________________________________ 18
    Management Improvement Actions_________________________________ 19
    Administrative Planning for the Disability Waiver-of-Prtmium Provision. 21
    Improving the Program__________________________________________ 22
    Coverage_______________________________________________________ 22
    The Retirement Test_____________________________________________ 25
    Benefit Amounts_________________________________________________ 27
    Financing the Program____________________________________________ 28
    PUBLIC ASSISTANCE__________________________________ _____ 29
    Caseload and Expenditures_____________________________________ 30
    Effect of Old-Age and Survivors Insurance on Public Assistance.. 34
    Program Developments__________________________________________ 36
    Institutional Care for the Aged, Blind, and Disabled_________________ 36
    Public Inspection of the Public Assistance Rolls_______________________ 38
    Notice to Law-Enforcement Officials________________________________ 39
    Aid to the Permanently and Totally Disabled_________________________ 40
    Social Welfare Services to Public Assistance Recipients_________________ 41
    Program Operations____________________________________________ 45
    Publications and Studies__________________________________________ 45
    Technical Assistance to States______________________________________ 47
    Administrative Review of State and Local Operations__________________ 47
    Other Program Developments______________________________________ 48
    CHILDREN’S BUREAU_________________________________________ 48
    The Bureau Continues Its Program______________________________ 49
    285
    286 Department of Health, Education, and Welfare, 1953
    Page
    Research_____________________________________________________ 49
    Administration of Grants Under the Social Security Act______________ 49
    Cooperating With Voluntary Organizations_________________________ 50
    New Emphasis in 1953_________________________________________ 50
    Juvenile Delinquents___________________________________________ 50
    Mentally Retarded Children_____________________________________ 52
    Children in Migrant Families____________________________________ 53
    Research____________________________________________________ 54
    The Bureau Works With the States____________________________ 55
    Through Its Advisory and Consultation Work______________________ 56
    Through Gathering Information on Programs_______________________ 56
    The States Are At Work for Children_________________________ 57
    Maternal and Child Health Services_______________________________ 58
    Services for Crippled Children------------------------------------------------------ 59
    Child Welfare Services__________________________________________ 61
    The Bureau and the States Work Together in Training Workers__ 63
    Child Health__________________________________________________ 64
    Child Welfare_________________________________________________ 65
    Interdepartmental Committee on Children and Youth___________ 66
    The Bureau’s International Activities_________________________ 66
    FEDERAL CREDIT UNIONS_________________________________ 67
    Program Operations___________________________________________ 68
    Strengthening Credit Unions__________________________________ 70
    Table 1. —Social Security Administration: Funds available and obligations
    incurred, fiscal years 1953 and 1952------------------------------------------ 72
    Table 2. —Financing social insurance under the Social Security Act: Contributions
    collected and trust fund operations, fiscal years 1951-53--- 73
    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 1953 and 1952-- 74
    Table 4. —Old-age and survivors insurance: Selected data on benefits, employers,
    workers, and taxable earnings, by State, for specified periods,
    1951-53___________________________________________________ 75
    Table 5.—Old-age and survivors insurance: Selected data on benefits,
    employers, workers, and taxable earnings for specified periods, 1951-53-_ 76
    Table 6.—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 77
    State, fiscal year 1953________________________________________
    Table 7.—Special types of public assistance under plans approved by the
    Social Security Administration: Number of recipients and average payment,
    June 1953, and total payments to recipients, by program and
    State, fiscal year 1953________________________________________ 78
    Detailed Contents 287
    Page
    Table 8.—Special types of public assistance under plans approved by the
    Social Security Administration: Federal grants to States and total
    expenditures and percent from Federal funds, by program and State,
    fiscal year 1953______________________________________________ 80
    Table 9.—Federal credit unions: Number of members, amount of assets,
    amount of shares, and amount of loans outstanding Dec. 31, 1935-52__ 82
    Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1952, and
    Dec. 31, 1951________________________________________________ 82
    Chart 1.—Where aged persons get their cash income________________ 10
    Chart 2.—Who received old-age and survivors insurance benefits, June
    1953_____________________________________________________ 15
    Chart 3.—Average monthly family benefits, June 1953______________ 15
    Chart 4.—The old-age and survivors insurance dollar________________ 17
    Chart 5.—How assistance payments are financed___________________ 31
    Chart 6.—Purchasing power of assistance payments to the aged and
    children__________________________________________________ 33
    Chart 7.—Growth in social insurance protection for the aged__________ 35
    Chart 8.—Growth in social insurance protection for orphans__________ 36
    Chart 9.—More mothers and children are getting health services______ 56
    Chart 10.—More children are getting crippled children’s services______ 59
    Chart 11.—Services for crippled children cover wide range of conditions. _ 60
    Chart 12.—Some children do not get adequate child welfare services_____ 63
    PUBLIC HEALTH SERVICE
    HEALTH OF THE NATION__________________________________ 83
    The Mortality Record__________________________________________ 83
    Communicable Diseases_________________________________________ 84
    Communicable Diseases in Other Countries_________________________ 85
    Births and Birth Rate__________________________________________ 85
    Marriage and Divorce__________________________________________ 85
    Emergency Activities_________________________________________ 86
    Gamma Globulin Distribution____________________________________ 87
    Health Conditions and Resources______________________________ 88
    Studies and Services____________________________________________ 88
    Commission on Chronic Illness_______________________________ 88
    Professional Education______________________________________ 88
    Health Manpower__________________________________________ 89
    Illness Rates______________________________________________ 89
    Public Health Reports__________________________________________ 90
    Funds and Personnel_________________________________________ 90
    MEDICAL SERVICES________________________________________ 91
    Hospitals and Medical Care___________________________________ 91
    Reduction of Services___________________________________________ 92
    Special Hospitals_______________________________________________ 92
    Professional Training___________________________________________ 94
    Freedmen’s Hospital____________________________________________ 94
    Health Protection at Ports and Borders_______________________ 95
    Medical Examinations__________________________________________ 95
    Special Problems_______________________________________________ 96
    Revision of Regulations_________________________________________ 96
    288 Department of Health, Education, and Welfare, 1953
    Page
    Hospital Survey and Construction Program_____________________ 96
    The Nation’s Nursing Resources_______________________________ 98
    Trends in Nursing Personnel_____________________________________ 98
    State Nursing Surveys__________________________________________ 98
    Rural Experience for Student Nurses______________________________ 99
    Instruction for Nursing Aides____________________________________ 99
    Dental Resources____________________________________________ 99
    Supply of Dentists_____________________________________________ 99
    Utilizing Dental Manpower and Facilities____________________________ 100
    Dental Epidemiology_____________________________________________ 100
    Medical and Hospital Resources________________________________ 100
    Medical Services for Federal Agencies__________________________ 101
    Office of Vocational Rehabilitation__________________________________ 101
    Training of Personnel_________________________________________ 101
    Facilities and Services________________________________________ 102
    Community Cooperation______________________________________ 102
    Bureau of Employees’ Compensation, Department of Labor------------------- 103
    Studies of Occupation?! Hazards_______________________________ 103
    Bureau of Prisons, Department of Justice__________________________ 104
    Bureau of Indian Affairs, Department of the Interior__________________ 105
    Medical and Hospital Care____________________________________ 106
    Public Health and Preventive Services___________________________ 106
    Nursing Service_____________________________________________ 107
    Sanitation__________________________________________________ 107
    Tuberculosis Control_________________________________________ 107
    Oral Health_________________________________________________ 107
    Maritime Administration, Department of Commerce___________________ 108
    United States Coast Guard, Treasury Department_____________________ 108
    Foreign Service, Department of State_______________________________ 108
    ADVANCING FRONT OF SCIENCE____________________________ 109
    The Clinical Center___________________________________________ 110
    Research Grants and Fellowships______________________________ 111
    Arthritis and Metabolic Diseases______________________________ 112
    Research Accomplishments________________________________________ 112
    Research Grants and Some Results_________________________________ 113
    Cancer Research and Control__________________________________ 114
    Laboratory and Clinical Studies____________________________________ 115
    Studies Supported by Research Grants______________________________ 115
    Applied Research and Development_________________________________ 116
    Support of Research and Control___________________________________ 116
    Dental Research______________________________________________ 117
    New Horizons in Heart Research______________________________ 118
    Research Accomplishments________________________________________ 118
    Research Grants and Some Results_________________________________ 119
    Toward Mental Health________________________________________ 120
    Research Accomplishments________________________________________ 121
    Epidemiology and Statistics_______________________________________ 121
    Grants and Accomplishments______________________________________ 122
    Microbiological Research______________________________________ 122
    Detailed Contents 289
    Page
    Research Accomplishments______________________________________ 123
    Research Grants and Some Results_______________________________ 124
    Neurological Diseases and Blindness_________________________ 124
    Research Grants and Accomplishments____________________________ 125
    PUBLIC HEALTH IN THE WORLD TODAY___________________ 125
    Grants to the States________________________________________ 126
    State and Local Participation____________________________________ 126
    A Ledger of Life and Health________________________________ 127
    Life Tables___________________________________________________ 128
    Birth Registration______________________________________________ 128
    More Efficient Methods_________________________________________ 128
    Health Education of the Public______________________________ 129
    Assistance to States____________________________________________ 129
    Health Education Studies_______________________________________ 130
    Public Health Nursing_______________________________________ 130
    Annual Census of Public Health Nurses____________________________ 130
    Engineers and New Environmental Problems__________________ 131
    Radiological Health____________________________________________ 132
    Hygiene of Housing_________________________________ 132
    Defense Community Facilities_____________________________________ 132
    Interstate Problems in Sanitation______________________________ 132
    Milk Sanitation_________________________________________________ 133
    Protection of Travelers___________________________________________ 133
    Special Projects________________________________________________ 134
    Home Accident Prevention________________________________________ 134
    Research on Environmental Problems_________________________ 134
    Detection of Exotic Chemicals_____________________________________ 135
    Radioactive Wastes____________________________________________ 135
    Field Investigations______________________________________________ 136
    Training and Special Services______________________________________ 136
    Water Pollution Control______________________________________ 136
    Construction of Facilities________________________________________ 137
    Abatement Programs_____________________________________________ 137
    Promoting the Health of Workers____________________________ 138
    Health Services in Industry________________________________________ 138
    Research on Occupational Diseases_________________________________ 139
    Pneumoconiosis____________________________________________ 139
    Excessive Noise______________________________________________ 139
    Technical Services___________________________________________ 139
    New Directions in Venereal Disease Control___________________ 139
    Work in the States_____________________________________________ 140
    Venereal Disease Statistics________________________________________ 140
    Venereal Disease Research________________________________________ 141
    Technical Training Services_______________________________________ 142
    Toward Tuberculosis Control__________________________________ 142
    The X-ray Surveys______________________________________________ 142
    Studies in Tuberculosis Control____________________________________ 142
    290 Department of Health, Education, and Welfare, 1953
    Page
    Chronic Disease Control Projects_________________________________ 143
    Diabetes Projects__________________________________________ 144
    Multiple Screening_________________________________________ 144
    Rehabilitation Demonstration____________________________________ 144
    Communicable Disease Control_______________________________ 144
    Surveillance Program___________________________________________ 145
    Epidemic Intelligence___________________________________________ 145
    Laboratory Services____________________________________________ 145
    Training Activities_____________________________________________ 146
    Resistant Strains of Insects______________________________________ 146
    Disease Investigations__________________________________________ 147
    Dental Health Services______________________________________ 147
    Progress in Fluoridation__________________________________ 147
    Dental Care Studies____________________________________________ 148
    Arctic Health Research______________________________________ 148
    International Health Work in 1953___________________________ 149
    Progress Notes From Overseas___________________________________ 150
    The Fellowship Program________________________________________ 151
    Collaboration With WHO_______________________________________ 151
    Sixth World Health Assembly________________________________ 151
    World Influenza Center_____________________________________ 152
    Table 1. —Statement of appropriations, authorizations, obligations, and
    balances for the fiscal year 1953_______________________________ 153
    Table 2. -—Commissioned officers and civil service personnel as of June
    30, 1953__________________________________________________ 154
    Table 3. —Payments for research grants, fellowships, and training stipends,
    fiscal year 1953_____________________________________________ 156
    Table 4. —Payments to States, fiscal year 1953___________________ 157
    Table 5. —Number of nurses employed for public health work in the
    United States on January 1 of specified years, by type of employing
    agency_____________________________________________________ 158
    OFFICE OF EDUCATION
    I. Introduction__________________________________________ 159
    Education and the Building of America_____________________________ 162
    Legislation Affecting Education During Fiscal ’53____________________ 162
    Progress and Problems__________________________________________ 165
    II. Assistance to Schools in Federally Affected Areas_______ 168
    III. Services to State and Local School Systems______________ 169
    School Administration___________________________________________ 170
    School Facilities________________________________________________ 171
    Services to Elementary Education_________________________________ 173
    Services to Secondary Education__________________________________ 174
    Exceptional Children and Youth__________________________________ 175
    Visual Education Service________________________________________ 176
    Services to Libraries____________________________________________ 176
    Radio and Television Services____________________________________ 177
    IV. Services to Vocational Education________________________ 178
    Reappraisal of Programs of Vocational Education____________________ 179
    Services in Evaluation and Supervision_____________________________ 180
    Detailed Contents 291
    Page
    Services to Youth Organizations__________________________________ 181
    Services in Teacher Education___________________________________ 181
    Services in International Education_______________________________ 181
    Services in Practical Nursing_____________________________________ 181
    Services in Research and New Areas of Work_______________________ 182
    V. Services to Higher Education____________________________ 182
    Expansion of Facilities and Programs in Higher Education____________ 182
    Information on Program Costs and Student Expenditures------------------- 187
    Policies and Procedures Relating to College Accreditation and Licensure
    in the Professions___________________________________________ 188
    Administering Federal Grants and Serving Land-Grant Colleges________ 188
    Further International Understanding______________________________ 188
    VI. International Educational Activities_____________________ 189
    Comparative Education_________________________________________ 190
    Technical Assistance in Education________________________________ 191
    Teacher and Leader Programs____________________________________ 192
    McCarran Act_________________________________________________ 193
    Inter-American Seminar on Vocational Education------------------------------ 193
    Summary_____________________________________________________ 193
    VII. Research and Statistical Services_______________________ 194
    VIII. Reports and Technical Services________________________ 196
    IX. Termination of Civilian Education Requirements Program— 197
    Chart 1.—Enrollment in public elementary and secondary day schools,
    1920-60 (data for 1952 and later are estimates based on number of
    actual births through March 1953)------------------------------------------- 166
    Chart 2.—Percent of public elementary and secondary school pupils housed
    in buildings rated by the States in 1951 according to degree of fire safety
    (data from 42 States enrolling 19,002,362 pupils in 1949-50)---------- 172
    Chart 3.—Percent of public elementary and secondary school pupils housed
    in school plants rated by the States in 1951 as satisfactory, fair, and
    unsatisfactory (data from 43 States enrolling 20,156,045 pupils in
    1949-50)__________________________________________________ 172
    FOOD AND DRUG ADMINISTRATION
    Fifteenth Anniversary Year__________________________________ 199
    Food, Drug, and Cosmetic Act________________________________ 201
    On the Food Front_____________________________________________ 201
    Health Hazards------------------------- 201
    To Keep Food Clean________________________________________ 203
    Educational and Regulatory Programs-------------------------------------- 206
    Pocketbook Protection______________________________________ 208
    Contaminated Animal Feed__________________________________ 209
    Sea-Food Inspection Service__________________________________ 209
    Products of Special Dietary Significance____________________________ 209
    Drug Traffic___________________________________________________ 211
    New Drugs________________________________________________ 214
    Therapeutic Devices____________________________________________ 214
    Cosmetics and Colors___________________________________________ 216
    Certification Services____________________________________________ 217
    Legislation and Regulation-Making Activities_______________________ 217
    Food Standards____________________________________________ 219
    292 Department of Health, Education, and Welfare, 1953
    Page
    New Court Interpretations______________________________________ 219
    Enforcement of Other Acts__________________________________ 221
    Scientific Investigations and Some of Their Applications_______ 221
    Enforcement Statistics_______________________________________ 225
    Table 1.—Actions on foods during the fiscal year 1953_______________ 203
    Table 2.—Enforcement activities during the fiscal year 1953__________ 226
    Table 3.—Number of samples on which criminal prosecutions and seizures
    were based and number of court actions instituted during the fiscal year
    1953_____________________________________________________ 226
    Table 4.—Import inspections and detentions during the fiscal year 1953__ 227
    OFFICE OF VOCATIONAL REHABILITATION
    A Summary of Progress_______________________________________ 229
    Highlights of 1953______________________________________________ 230
    Combating Dependency_________________________________________ 231
    Federal-State Cooperation___________________________________ 232
    Objectives and Services of Vocational Rehabilitation_________________ 232
    Organization of the Program_____________________________________ 233
    Assisting State Rehabilitation Agencies____________________________ 234
    Serving America’s Disabled___________________________________ 237
    Physical Restoration____________________________________________ 237
    Rehabilitation Centers__________________________________________ 239
    Special Problems in Rehabilitation________________________________ 240
    Mental illness______________________________________________ 241
    Heart disease______________________________________________ 242
    Epilepsy__________________________________________________ 242
    Blindness_________________________________________________ 242
    Expanding Employment Opportunities for the Handicapped___________ 244
    The Disabled Who Are Served_______________________________ 244
    Characteristics of the Persons Rehabilitated________________________ 244
    They Pay Their Own Way_______________________________________ 246
    Rehabilitation in the Nation’s Capital________________________ 247
    Helping Our Friends Abroad_________________________________ 248
    Table 1.—Number of referrals and cases, by agency, fiscal year 1953___ • 249
    Table 2.—Total program expenditures from Federal and State funds for
    vocational rehabilitation by State boards of vocational education, fiscal
    year 1953_________________________________________________ 251
    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 1953_________________________________ 252
    Chart 1.—Disabilities and major occupational groups________________ 245
    SAINT ELIZABETHS HOSPITAL
    Division of Medical Services____________________________ 253
    Clinical Branches______________________________________________ 253
    Medicine and Surgery Branch____________________________________ 256
    Psychotherapy Branch__________________________________________ 257
    Laboratory Branch_____________________________________________ 258
    Detailed Contents 293
    Page
    Nursing Branch_______________________________________________ 258
    Occupational Therapy Branch____________________________________ 258
    Social Service Branch___________________________________________ 259
    Chaplain Branch______________________________________________ 259
    Library Services_______________________________________________ 260
    Red Cross Activities and Special Services Branch____________________ 261
    Teaching Activities______________ ,-------------------------------------------- 261
    General Administration_______________________________________ 262
    Needs of the Hospital________________________________________ 263 *
    Table 1.—Patients, admissions, and discharges, fiscal years 1935-53____ 264
    Table 2.—Movements of patient population, fiscal year 1953__________ 264
    Table 3.—Consolidated statement of movement of patients, by classification.
    fiscal year 1953________________________________________ 265
    AMERICAN PRINTING HOUSE FOR THE BLIND
    Services to Schools and Classes for the Blind________________________ 266
    COLUMBIA INSTITUTION FOR THE DEAF
    Kendall School________________________________________________ 267
    Gallaudet College______________________________________________ 267
    Graduate Department of Education_______________________________ 268
    Research Department___________________________________________ 268
    HOWARD UNIVERSITY
    Enrollment of Students_________________________________________ 269
    Highly Significant Service to Negro Students------------------------------------ 269
    Geographical Distribution of Students-------------------------------------------- 270
    Veterans_____________________________________________________ 271
    Army and Air Reserve Officers’ Training Corps_____________________ 271
    Faculty______________________________________________________ 272
    Composition of the Faculty--------------------------------------------------------- 272
    Two Outstanding Events of National Significance------------------------------ 272
    New Engineering and Architecture Building________________________ 273
    Engineering and Architecture Building Receives Distinguished Architectural
    Award________________________________________________ 273
    Phi Beta Kappa_______________________________________________ 274
    Graduates____________________________________________________ 274
    Service to Foreign Students and in Foreign Countries------------------------- 275
    APPENDIX TABLES
    Table 1.—Grants to States: Total grants under all Department of Health,
    Education, and Welfare programs, fiscal year 1953---------------------- 279
    Table 2.—Grants to States: Social Security Administration, fiscal year
    1953_____________________________________________________ 280
    Table 3.—Grants to States: Public Health Service, fiscal year 1953----- 282
    Table 4.—Grants to States: Office of Education, fiscal year 1953--------- 284
    U. S. GOVERNMENT PRINTING OFFICE: 1954