this year. The number examined at ports of arrival increased from 1,609,655 to 1,671,885. Aliens certified for excludable diseases numbered 3,037, about twice the figure for 1953. In the farm placement program, 180,871 labor recruits were examined in Mexico under supervision of Public Health Service officers; 5,854 were rejected for physical or mental conditions. At border stations 231,904 examinations were made, with 3,593 rejections. A new Mexican-United States agreement, signed March 10, 1954, permits recruitment of some laborers at the border; they are given complete examination at border stations. SPECIAL PROBLEMS More than 36,000 aircraft arriving in our country were treated for control of mosquitoes and other insects capable of transmitting disease. Entomological surveys were conducted in airport areas, and control measures were applied or recommended when necessary. Many ships arriving at United States ports were also inspected for the presence of mosquitoes. Psittacosis (parrot fever) was contracted by a quarantine inspector and an airline employee, apparently transmitted by three birds imported from Mexico. Diagnosis was made from blood cultures, and both persons responded well to antibiotic treatment. Two more ports adopted radio pratique (quarantine clearance by radio), thus simplifying operations for the ships concerned. SERVICES FOR TRAVELERS The international vaccination certificate form is now issued with the passport application, rather than with the passport itself. This will encourage travelers to be vaccinated early enough to have maximum immunity during their journey. A new edition of the booklet, "Immunization Information for International Travel," brought up to date the statement of vaccination requirements for entry to various countries. Thirteen additional yellow fever vaccinating centers were designated by the Service in conformance with World Health Organization requirements. There are now 49 of these centers in medical facilities of private industry and 31 within the Service. Hospital Survey and Construction The Division of Hospital Facilities administers the hospital survey and construction program established by Congress in 1946. The objective of the program is to assist States, local communities, and nonprofit organizations in the construction of hospital facilities and public health centers. Under the law, construction grants are made by the Public Health Service on the basis of plans submitted by official State hospital agencies. The appropriation for construction grants in 1954 was $65 million. In its 7 years of operation, the program has helped expand the Nation's health plant. On June 30, 1954, 2,283 projects had been approved, providing 109,200 hospital beds and 483 health centers. About two-thirds of the projects were in operation. The total cost of construction was estimated at $1,849,000,000 toward which the Federal Government contributed one-third ($618 million) and State and local sources, two-thirds. When all projects thus far approved have been completed, 82,974 beds will have been added to general hospitals; 12,193 beds for mental patients; 7,889 for tuberculosis patients; and 6,151 for chronic disease patients. It is estimated that the 59,200 general beds already in operation would provide for 10 percent of the total patients admitted to general hospitals in the course of a year. A large portion of the grant program is directed toward areas with few previous hospital facilities or none at all. Over three-fourths of the 891 hospitals which are entirely new are located in areas which previously had no acceptable facilities. Of the new facilities approved, 56 percent are located in communities of less than 5,000 population and only 10 percent in cities which exceed 50,000 population. Of the new hospitals, 57 percent have fewer than 50 beds and only 21 percent have 100 beds or more. MEETING PRESENT AND FUTURE NEEDS The bed deficit of the Nation is still large. Current State hospital plans indicate that 812,000 additional beds are required. The greatest remaining need is for beds in mental and chronic disease hospitals, which require 337,000 and 266,000 beds, respectively. The aging of the population has intensified the need for more beds for chronic illness. The average number of days of hospital care required by persons over 65 is twice that of persons under 65. Many older people who now occupy beds in general hospitals could be cared for in nursing homes and chronic disease hospitals at one-third the cost. Facilities for early diagnosis and treatment of ambulatory patients would also reduce the demand for general hospital beds. In urban areas, this need could be met by expanded outpatient departments in hospitals or by new diagnostic and treatment centers. To meet these needs, the Congress passed the Medical Facilities Act of 1954 (Public Law 482), which was approved by the President on July 12, 1954. The broadened program authorized annual allotments for the construction of chronic disease hospitals, diagnostic and treatment centers, rehabilitation facilities, and nursing homes. Funds amounting to $2 million were also authorized to assist the States in surveying their needs for these additional medical facilities, as a prelude to statewide plans for a construction program. Nursing Resources The Division of Nursing Resources continued to develop new methods and materials to aid hospitals and nurses in making better use of nursing time and skills, and to study basic questions affecting the supply of nurses. TRAINING OF NURSING AIDES The Division carried forward a program, begun in 1952, to improve the training of nursing aides in hospitals. The program has been developed in cooperation with hospital and nursing organizations throughout the country. During the year, the first illustrated handbook, with instructor's guide, for the training of nursing aides was completed by the Division, and published by the American Hospital Association. National and State Leagues for Nursing sponsored regional institutes to train instructors, in cooperation with hospitals, State health departments, vocational education departments, and other organizations. By the end of June, 10 States had held teacher-training institutes and about 250 hospitals and nursing homes, employing 12,000 aides, had used the handbook in their training programs. STUDIES OF NURSING ACTIVITIES A manual was developed to help hospitals determine whether nursing time is diverted from actual care of patients to duties that other employees can perform. The method, which adapts industrial worksampling techniques to the problems of utilization of hospital personnel, has been tested in three hospitals. Results showed that staff nurses were actually spending only about half of their time in caring for patients, the remaining time being spent on tasks that could be assigned to clerks, maids, and messengers. A study of sources of recruitment for new hospitals was undertaken in collaboration with the Division of Hospital Facilities and the administrators of 500 small general hospitals and the 3,000 nurses on their staffs. The study showed the extent to which inactive nurses are a potential source of personnel for a new local hospital and suggested ways of attracting inactive nurses into active practice. The Medical College of Virginia and the Virginia State Hospital Association assisted in a study of clinical experience for student nurses. The evidence indicated that small hospitals can furnish students a broad variety of clinical experience, a fact of special importance to nursing educators. Substantial progress was made on a study of costs of nursing education, conducted by the Divisions of Nursing Resources and Public Health Methods in cooperation with the National League for Nursing. Six colleges and universities have participated. The project is designed to provide a method by which educators, schools of nursing, and their associated hospitals and agencies may develop long-needed base figures and cost-finding techniques. Rapid progress was made on a study of patients' opinions of the nursing care they receive in hospitals, requested by the Commission on Nursing of Cleveland, Ohio. Preliminary work was completed on a job satisfaction study undertaken jointly with the Division of General Health Services. The purpose of both projects is to develop methods any hospital can adapt to make its own study. Dental Resources The Division of Dental Resources studies the utilization of dental services and the availability of dental manpower. It gives technical assistance to other parts of the Public Health Service, and serves as a center for information on dental health needs and resources. UTILIZATION AND SUPPLY OF DENTAL SERVICES An analysis of nearly a quarter of a million dental examinations of Public Health Service beneficiaries revealed the cumulative effect of dental disease in adults. In a study of dental care received by patients who were members of a prepaid medical care plan, it was found that the time required for initial dental care was from 2 to 3 times that required each subsequent year. The Division compiled a directory of dental clinics in the United States during 1954, and continued a study, in cooperation with the Division of Public Health Methods, of dental health manpower distribution in the United States. Two additional studies were initiated during the year, one in collaboration with the American Dental Hygienists' Association and the other in collaboration with the Council on Dental Education of the American Dental Association, relating to problems of distribution of dental hygienists and the ability of students in dental and dental hygiene schools to meets the costs of their education. SPECIAL DENTAL STUDIES During the year an investigation was carried out to determine whether customary radiographic methods used in examination of patients could be simplified and adopted for wider use in apparently healthy population groups. In addition, studies on dentofacial morphology were continued and an analysis of data from approximately 8,000 human profiles, ages 6 through 24, was undertaken. The Division participated in several conferences dealing with cleft palate rehabilitation and field training for public health dentists. Medical Services for Federal Agencies The Public Health Service has the legal responsibility for providing medical services to certain other Federal agencies. Through the Bureau of Medical Services, medical, dental, psychiatric, and nursing personnel are assigned on a reimbursable basis to those agencies requesting assistance in the operation of medical programs. OFFICE OF VOCATIONAL REHABILITATION Since 1943, when medical services were incorporated by Federal law as services provided to disabled persons through the public vocational rehabilitation program, the Public Health Service has detailed medical officers to assist in the administration of the program's medical aspects. During the year, both the chief medical officer and the consultant on rehabilitation centers for the Office of Vocational Rehabilitation were on detail from the Public Health Service. A description of the vocational rehabilitation program is contained in the section of the Department's Annual Report devoted to the Office of Vocational Rehabilitation. BUREAU OF EMPLOYEES' COMPENSATION, DEPARTMENT OF LABOR The medical care program of the Bureau of Employees' Compensation is staffed by medical officers of the Public Health Service. Approximately 90,000 cases reported to the Bureau during the year, of which 30,000 required medical or dental care, hospital services, prosthetic and orthopedic appliances, or transportation. Public Health Service hospitals were utilized in about 50 percent of the 4,200 cases requiring hospitalization. When Public Health Service hospitals and clinics are not available, designated private physicians provide the necessary medical services. Special examinations and review of case records by qualified specialists are also provided for in the medical care program. During 1954, a special study of hearing loss cases was initiated at one of the large military proving grounds. Periodic medical |