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 serving in 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. The average ration cost for the year approximated 83¢. A program of

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.

Table 1.-Patients, admissions, and discharges, fiscal years 1935–53

Table 2.-Movement of patient population, fiscal year 1953

Table 3.-Consolidated statement of movement of patients, by classification, fiscal year 1953

Reimbursable patients

Nonreimbursable patients

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.

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