COMMISSION ON ORGANIZATION OF THE EXECUTIVE BRANCH OF THE GOVERNMENT APPENDIX B FEDERAL HEALTH ACTIVITIES AND PROGRAMS COMMITTEE ON FEDERAL MEDICAL SERVICES Howard M. Kline, Ph.D., Staff November 1948 Table of Contents I. SUMMARY OF HEALTH ACTIVITIES AND PROGRAMS 1 1. Hospital Care and Construction . 6 2. Outpatient Care. ........... 10 3. Research ... 12 4. Preventive Medicine and Public Health, . 16 5. Education and Training ........ 19 6. Medical Supply 23 II. BENEFICIARIES OF MEDICAL CARE 26 A. Veterans 31 B. Federal Civilian Employees and Military Personnel .... 38 1. Military Personnel 38 2• Qua si-mi lit ary Employees 41 3. Civilian Employees 42 ... » * * - C. Dependents 44 1. Dependents of Army and Air Force ............ 44 2. Dependents of Navy and Marine Corps. ........ • 46 3. Dependents of Public Health Service and Others .... 47 4* Dependents of Indians 48 D. Merchant 49 ■ E. Wards of the Federal Government and Special Classes ... 50 ■ 1* Indiana. ». . . !. . 50 2* Prisoners 51 3. Pacific Island Natives ............ . !. . 52 4. Immigrants . 52 5. Narcotics and Lepers . .......... . 53 ' 6. Insane , 53 III. SUMMARY OR PRESENT HEALTH ACTIVITIES BY AGENCY 55 A, Major Federal Agencies, . . . . . 57 1. Veterans Administration. . . ........ 58 a. Organization ................... 59 1). Services . ♦ . . 62 1) Outpatient 62 2) Hospitalization. ............... 64 3) Domiciliary Care .......... 65 c. Future Patient Load g7 d* Hospital Construction . » » - - gg e» tTpW Regime. , , nni f. wests and f , • . . ♦ • • • * • . • 76 2* Department of the Army, Including Air Force 77 1) Organization. * 78 2) Functions ..... 81 3) Personnel • 82 4) Cost. ............. ...... . 84 2i, Air Force Medical Department. ............ 85 3. Public Health Service 87 4. Department of the Navy. ............... 95 B, Other Federal Agencies 100 !• Executive Office of the President 102 a. National Security Resources Board ........ 102 b. Interdepartmental Committee on Scientific Research and Development. 103 c. Bureau of the Budget 104 2. Department of State ................. 105 a. Office of International Trade Policy. 105 b. Office of the Foreign Service 105 c. Institute of Inter-American Affairs 106 3. National Security Establishment ... 108 a. Research and Development Board 108 b. Department of Navy. , . . . 109 Office of Naval Research 4. Department of Justice . . « 110 a, Bureau of Prisons 110 b. Immigration and Naturalization, ......... Ill 5. Department of Labor ..... 112 a. Bureau of Labor Standards 112 6. Department of Treasury. 112 a. Bureau of Narcotics ............... 112 b. Coast Guard ....... ...... 113 7. Department of Commerce. ............... 113 a. Civil Aeronautics Administration, ........ 113 8. Department of Agriculture .......... 114 a. Agricultural Research Administration, ...... 114 b. Farmers Home Administration ............ 116 c. Farm Credit Administration. . . . . 117 d. Production and Marketing Administration 117 e. Cooperative Extension Service . 117 f. Bureau of Agriculture Economics ......... 118 g. Office of Personnel . . 118 9. Department of Interior. ......... 118 a. Bureau of Indian Affairs, . . T . . 118 b. Fish and Wildlife Service ............ 119 c. Bureau of Mines ................. f 120 d. Bureau of Reclamation ............. , , 121 1) Hoover Dam. . . , 121 2) G-rand Coulee Dam. .............. , 122 10* Federal Security Agency 123 a. Bureau of Employees* Compensation ...... . . 123 b. Food and Drug Administration. ......... ., 124 c* Office of Vocational Rehabilitation 125 d. Howard University and Freedmen*s Hospital .... 126 e. Social Security Administration, Children1 s Bureau • . . 127 f. St. Elizabeths Hospital .... . . . . ..... 128 g. Office of Education ............ . • . 128 11. Tennessee Valley Authority. . , . . . . . , . . . . 129 12. Federal Trade Commission. . . . . . . ....... ., . 130 13. Civil Service Commission. .. .,131 14. Atomic Energy Commission. . . ... .. ., .,132 15. Maritime Commission ♦ 133 16. Federal Works Agency. . . . . . . . . .... 134 17. War Assets Administration,. ...... 136 18. Selective Service System • . ....... 137 19. Post Office Department .,138 20. Housing and Home Finance Agency ........... 138 APPENDICES Appendix I 1. DISCUSSION OF TEEMS .. 140 2. 'TREND IN NUMBERS OF HOSPITAL BEDS AND PATIENTS a. Army and Air Force 144 b. > Navy . ... .147 c. Public Health Service 149 d« Veterans Administration 154 3. 'BENEFICIARY STATUS OF PATIENTS IN FEESRAL HOSPITALS a* Army pnd Air Force 159 b. Navy 161 c. 'Public Health Service 163 d. - St. Elizabeths Hospital ., 166 e. Veterans Administration 167 4. BEDS AND PATIENTS IN EACH FEDERAL HOSPITAL p. Summary, by Agency 172 b. Detail for each hospital 175 Page Appendix II NET/ HOSPITAL CONSTRUCTION PROGRAM OF VETERANS ADMINISTRATION A, Hospitals for Which Principal Construction Contracts Have Been Awarded .............. 189 B, Hospitals in Various Stages of Planning 191 C, Summary of Veterans Administration New Hospital Construction Program as of October 11, 1948 .. 194 Appendix III OBLIGATIONS OP FEDERAL AGENCIES FOR MEDICAL,. HOSPITAL, AND RELATED SERVICES ., . 196 Appendix IV OUTPATIENT SERVICES Of THE FEDERAL GOVERNMENT GOVERNMENT 206 I. Summary of Health Activities and Programs II. Beneficiaries of Medical Care III. Summary of Present Health Activities hy Agency I. SUMMARY OF HEALTH ACTIVITIES AND PROGRAMS Forty-six federal agencies of the United States Government spent almost $1.25 “billion for health and medical services in the fiscal year 1948. This was an increase of $166 million over fiscal year 1947 and an increase of more than 600 percent over the $201 million expended during fiscal year 1940. The principal agencies and their 1948 expenditures are:—/ TOTAL', ALL AGSDCISS $1.246,315.746 Veterans Administration 759,748,289 Federal Security Agency 184,263,060 Department of Army (including Air Force) 161,409,391 Department of Navy 88,384,982 Atomic Energy Commission 15,119,455 Department of Agriculture 16,528,243 All Others 20,862,326 Obligations for health and medical services have “been in- creasing, both proportionately and absolutely. In 1910 an estimated $3.5 million, or 0.4 percent of a total budget, of $836 million, and in 1925 an estimated $50 million, or 1.5 -percent, of a federal budget of $3,267 million, was spent for all health and medical activities. It has now reached 3-*r percent in a period of huge federal budgets ($38 billion in 1948). While a considerable part of the expenditures for medical services affect the geperal population indirectly, as, for example, grants to states for public health work, the direct beneficiaries have increased from 10 to 24 million, mostly veterans of World War II# l/ Appendix III contains the complete detail of obligations by func- tion and -agency for fiscal years 1940, 1947, 1948 and 1949# 2 This means that one person in every six in the present population is at least contingently eligible for some medical services at federal expense. Current beneficiaries include an estimated 18.5 million veterans, nearly 1.5 million members of the armed forces and 1.35 million dependents of armed forces personnel, two million civilian employees of the federal government, nearly one-half million Indians, 250 thousand officers and men engaged in maritime employments and public health services, (and the dependents of the latter) and per- haps as many as a half million other persons of miscellaneous groups. Federal agencies now operate about 200,000 beds in 499 hospitals dispensaries and domiciliary homes. This represents about 14 percent of the nation’s total hospital beds. Although the total number of nonfederal hospital beds has been increasing constantly, at an even faster rate than the general population, the total number and per- centage of federal beds has been arising even faster. The federal agencies had a total of 109,000 beds in 1940 (8.9 percent of the total in the country); these increased to 551,000 beds in 1944 (31.8 percent of the total) at the peak load of war casualties. By 1948, however, the military facilities had been reduced and the present 14 percent federal beds is not expected to decline in the near future under existing policies and organization. The federal agencies now hire nearly 16,000 (full-time or equivalent) physicians., more than 3,000 dentists, nearly 22,000 nurses, and 158,000 other employees to deliver these health and medi- cal services. It is estimated that the total number of physicians in federal employment has risen from 1,750 in 1910 to 4,500 in 1925 to its present 15,594. The federal agencies now employ the equivalent 3 of 8.2 percent of the nations estimated total of 189,946 active physicians, 4.3 percent of the 75,645 dentists, and 7.8 percent of the 280,500 nurses. The principal employing agencies, together with estimates of the national totals follow: FEDERAL AND NATIONAL MEDICAL PERSONNEL July 1948 Agency Physicians Dentists Nurses ALL FEDERAL 15.594-/ 3.221-/ 21.822 Army and Air Force 4,350 1,025 4,317 Navy 2,711 956 2,091 Veterans Administration 6,969 1,016 12,397 Public Health Service 1,289 202 1,951 Indian Affairs 95 13 480 Other 180 9 586 National totals estimated , , to be in active -practice d/ 189,946—' 75,645 280,500—/ &/ All salaried personnel are shown, both civilian and military* Salaried part-time personnel are shown in full-time equivalents. Per diem and fee-for-service personnel are not included. Most data are for July 1„ 1948 and other data are for the nearest date thereto, b/ Residents and interns included. c/ Figures for other agencies involve certain estimates and possibly certain duplications, but the error is not great enough to affect the totals significantly, d/ Includes those in federal service, e,/ Estimate of February 15, 1948 by American Medical Association. fj Computation for summer of 1948 by American Nurses Association. 4 Nearly three-fourths ($859 million) of the total 1943 expenditures was devoted to hospital care and hospital con- struction.. More than two-thirde of the cost of hospital care and construction was for hospital services in facilities oper- ated hy the several agencies* More than three-fourths (83.1 *. percent)■of all those employed in health and medical services were engaged in hospital care and construction, including two-thirds (68*8 percent) of all full-time (or equivalent) physicians and nearly all (98*8 percent) nurses. All activities in preventive medicine, public health and research accounted for 11,2 percent of the total expendi- tures and only 3.2 percent of all personnel. Barely four percent of all federal physicians, 2,5 percent of the dentists, and 1,6 percent of the nurses were utilized for preventive measures and research. 5 The following table shows the total expenditures by all federal agencies hy major urogram category for fiscal year 1948.—/ OBLIGATIONS OF FEDERAL AGENCIES FOE MEDICAL HOSPITAL AND RELATED SERVICES IF THE UNITED STATES FISCAL YEAR 1948 Function Total Ohliarations Amount Percent of Total total $1,246,315,746 100.0 IMPATIENT CARS 859,013,279 68.9 Within Own Facilities Outside Own Facilities 583,127,088 45,379,263 46.8 3.7 In Federal Hospitals In Nonfederal Hospitals 29,026,780 17,352,^83 2.3 X.4 Construction (Bed and Non-Bed Producing Projects Only) 229,506,928 18.4 OUTPATIENT CARE 172,801,578 13.9 Within Own Facilities Outside Own Facilities 102,383,147 70,418,431 8.2 5.7 RESEARCH 48,261,049 3.9 ALL OTHER PROJECTS RELATED TO PUBLIC HEALTH • 110,759,881 8.9 EDUCATION AND TRAINING 19,148,931 1.5 GENERAL ADMINISTRATION 36,331,028 2.9 l/ A complete fiscal breakdown by program and agency appears in Appendix III to this statement. HEALTH FUNCTIONS OF FEDERAL AGENCIES EXECUTIVE OFFI CE OF THE PRESIDENT STATE JUSTICE AGBIC. INTERIOR MILITARY TVA FTC TREASURY FWA MC A EC CSC VA FSA compter HOUSING AND SELECTIVE SERVICE SYSTEM FUNCTION Executive h^Pr^I. Office for. Bergen cy Mnagorect nt. Con. on ties A Devel. . Depsr tnent of St ste Dept. ustice Dept. Agi;c. Department of Interior N*ti™ al Military Ea tablisbnent Tenn Valley Aath Fed. Tr. Com. Depurtaant of Treasury Federal Works Agency Com Atomic Energy g* ■Civil Service* “ Com Ads Federal Security Agency Civil Aero. Anth. HOME FINANCE AGENCY Budget at’l. Sec. Res. Bd. Usets A9 percent for care in agency facilities and 5.4 percent for purchase of care in the facilities of other agencies and of nonfederal agencies. The remaining 26.7 percent went for hospital construction, nearly all for Veterans Administration hospitals. Nearly three-fourths (72 percent) of the total cost of hospi- tal care and construction were Veterans Administration expenditures, followed hy Army, including Air Force, 15 percent, Navy, six'percent and the Federal Security Agency six percent as follows; TOTAL $859.013.279 100.0$ Department of Army (including Air Force) 132,552,691 15.4 Atomic Energy Commission 1,887,000 0.2 Federal Security Agency 49,077,793 5.7 Bureau of Employees Compensation 2,784,780 0.3 Freedmenrs Hospital 2,296,760 0*3 Office of Vocational Rehabilitation 1,311,226 0*2 Public Health Service 34,658,066 4.0 St. Elizabeths Hospital 8,026,961 0*9 Federal Works Agency 257,041 - Department of Interior 8,270,781 1.0 Bureau of Mines 511,.873 0.1 Fish and Wildlife Service 28,739 - Bureau of Indian Affairs 7,.632,127 0.9 Bureau of Reclamation 98,042 - Department of Justice 638,672 0.1 Immigration and Naturalization Service 95,325 - Bureau of Prisons 543,347 0.1 Maritime Commission 109,895 - Department of Navy 49,668,174 5.8 Tennessee Valley Authority 10,971 - Veterans Administration 616,540,261 71.8 FEDERAL HOSPITALS IN THE UNITED STATES. JUNE 30. 1948 LEGEND AIR FORCES ARMY VETERANS ADMINISTRATION PUBLIC HEALTH SERVICE NAVY INDIAN SERVICE 7 The federal agencies maintained about 200,000 hospital beds in 499 hospitals and homes in which there were 155,230 patients on June 30, Three of these agencies (Army, Navy, Public Health Service) with a gross total of 68,368 beds and 39,983 patients in continental United States have been engaged in providing medical and hospital care for nearly 150 years, whereas the Veterans Admin- istration which now has the largest gross total of beds and patients, has entered the field only within the last 25 years* On June 30, 1948 the Veterans Administration had 117,851 patients under care* Of this total 105,565 were in 137 veterans facilities (91,290 in 125 hospitals end 14,275 in 12 domiciliary houses), 7,808 in hospitals of other federal agencies, and 4,478 in nonfederal hospitals. Of this total, 81,377 (69*2 percent) had nonservice-connected disabilities. The decline in the nation-wide total of federal hospital beds from 551,000 in 1944- to 213,000 in 1947, largely because of the closing of military hospitals, obscures the fact that the total number of beds for veteran patients has actually been increasing* Between 1 944 and 1948, there was a net increase of 31 veterans hospitals and 31,621 beds, most of which were acquired from the armed forces. The total building program of the Veterans Administration, as of July 23, 1948, contemplated 89 new hospitals with 51,261 beds and 11 additions to existing hospitals with 2,749 beds.—/ Thus, l/ Appendix I, Table 13 contains list of each federal hospital and pertinent data concerning them, Zl Appendix II has detail on Veterans Administration construction program* 8 54,011 veterans teds are either "being planned or under contract at present. Because 20,849 existing veterans beds are located in 28 temporary structures taken over from the military and presumably to be surrendered when permanent construction is available, the net increase in veterans beds, according to present plans, will be approximately 3?,000. Many veterans hospitals are poorly located from the critical point of view of securing adequate numbers of qualified staff for full-time employment and for consultation. Half of the existing Veterans Administration facilities — including those built for the Veterans Administration after World War I, the inherited military hospitals and the homes and hospitals absorbed from the National Homes — are located in areas where it has proven difficult to get adequate staff. Despite this experience with existing hospitals, 42 of the 89 proposed new veterans hospitals will be located in known ”staff problem” areas. Twenty hospitals are already under contract (4,621 beds, contract cost of $126.7 million) and 22 other (9,300 beds, estimated cost of $220.8 million) are in advanced plan stages and are being rushed to completion for advertisement as promptly as possible.- The armed forces are also contemplating a hospital building / program principally for the replacement of wartime cantonment- type structures, many of which were originally constructed for five-year use and which have now outrun that period and require heavy repair and maintenance costs*- Approximately 85 percent of 9 all hospital beds in the Air Force are located in such temporary structures. The Navy has five and the Army four hospitals in immediate contemplation with a total of 7,100 beds at an antici- pated cost of at least $175 million; other projects for family and nurse quarters and adjunct facilities, as funds become available, are also being planned. Although the Public Health Service and Bureau of Indian Affairs are also planning alterations and some additions to existing facilities, these are relatively inconsequential in comparison with the Veterans Administration and the armed forces building programs. Although 18 federal agencies spent in fiscal year 1948 $859,013,279 for construction and operation of federal hospitals and for the purchase of hospital care, the Veterans Administration is planning to spend $616 million for construction alone in fiscal year 1949. At the same time that the federal government is building and maintaining this extensive hospital system, it is also spending up to $75 million per year for building community hospitals in areas which need them. These two building programs are in conflict with each other. The nearly 22 million federal beneficiaries (excluding federal civilian employees) who are eligible for care in federal hospitals are by reason of that fact withdrawn from the population which would normally support community hospitals. Federal hospitals, particularly veterans hospitals, are being located without particular regard to the state-wide hospital plans which have been formulated. 10 Moreover, scarce personnel are drained off from community hospitals, hecause the federal pay scale for nearly all types of medical and ancillary personnel Is significantly higher than that In com- munity hospitals. 2* Outpatient -Care Although the volume of outpatient service is known to he tremendous* it cannot he expressed quantitatively because the agencies do not collect the same types of information and in cases there is neither standard- ization of definitions nor effective policing of the reporting systems. For example, only in the Veterans Administration and Public Health Service are medical and dental care separated; in the Army and Air Force reporting is on the basis of "individuals seen and treatments given1'; .fend in the Navy "total visits'1 are reported only for dependents. Each of these -plans has some merit but the variations of what is reported are such that the result- ant data do not -permit the separation of examinations,- vaccina- tions and Inoculations or the separation of individuals from treatments in any manner which would permit an over-all summary. Eoughly, four out of five individuals seen under the Veterans Administration outpatient program are dven medical rather than dental examination or treatment. In Army and Air Force outpatient -programs, 40 percent of the total treatments are for non-military -personnel, whereas 20 percent of the total visits to Navy outpatient facilities are by dependents. 11 It is estimated by 12 federal agencies that the total out- patient program in fiscal year 1948 cost $172,801,578, as follows: TOTAL, ALL AGENCIES $172.8Q1.578 Department of Agriculture 417,321 Department of Army (including Air Force) 20,489,900 Civil Service Commission 13,421 Federal Security Agency Office of Vocational Rehabilitation 1,299,208 Public Health Service 3,945,412 Federal Works Agency 12,311 Department of Justice 925,995 Immigration and Naturalization Service 16,654 Bureau of Prisons 909,341 Maritime Commission 137,438 Department of Navy 24,349,790- Tennessee Valley Authority 229,233 Department of Treasury: Coast Guard 600,426 Veterans Administration 120,481,123 Seventy percent of this total was expended by the Veterans Admin- istration. No other agency purchased a significant portion of their outpatient services from outside sources, but almost 60 per- cent ($68,703,911) of the total expanded for veteran outpatient care was for the contract purchase of service. Expressed in terms of the volume of outpatient services, the Veterans Administration purchased 21 percent of its medical examinations and 39 percent of its medical treatments, but 60 percent and 92 percent respectively, of dental examinations and dental treatments. The Array, including the Air Force, had almost twice as many eligible active duty personnel and eligible dependents as the Navy,, yet the Navy expenditures for outpatient service were nearly 20 percent greater than those of the Army. 12 3. Research The determination of the actual expenditures for research in the medical and biological sciences is made difficult in the absence of any general agreement on the precise definition of research, . Depending upon the specific activi- ties which are included it is possible to obtain varying totals up to $53 million. The work is described by a, multiplicity of equally ambiguous terras such as investigative, developmental, applied, funda- mental, laboratory, and other kinds of research. For example, on such inclusion or exclusion hinges substantial expenditures and pro- grams such as those in research in animal and plant diseases in the Department of Agriculture, in human nutrition in several agencies, . especially the Quartermaster Corps and the Department of Agriculture, in communicable disease control in the Public Health Service and the Tennessee Valley Authority, in control measures incident to regula- tory activities, and statistical surveys and analyses of health problems in a dozen agencies. Each of the major federal agencies carries on or sponsors some medical research work. In the pgregate approximately equal sums (48.7 percent for each) were obligated during 1948 for self-conducted research and for contractual agreements, and only a small propor- tion (2,6 percent) of the total funds was devoted to research fellow- ships, Slightly more than $8.8, million was expended by the principal research unit of the Public Health Service, The National Institutes of Health, 13 OBLIGATIONS OF FEDERAL MEDICAL AGENCIES FOR RESEARCH l/ TOTAL $52.570.068 100.0$ X. Purpose of Obligation, All Agencies Self-Conducted Research 25,585,878 48.7 Contracts 25,622,600 48.7 Fellowships 1,361,590 2.6 2. Obligations, by Agency Public Health Service Total 24,746,783 47.1 t Hational Institutes of Health 23,865,824 45*4 Other 880,959 1.7 Atomic Energy Commission 12,832,455 24.4 Department of the Navy 5,698,605 10.8 Departments of the Army and Air Force 5,269,183 10.0 * Veterans Administration 3,099,567 5*9 Department of Agriculture 923,475 * 1.8 1/ Obtained from Report of Subcommittee on Medical Research, Appendix J. 14 Each of the major medical agencies maintains one or more research laboratories or installations, as exemplified by the Naval Medical He search Institute at Bethesda, the Army Medical Research and Graduate School at Walter Heed Hospital in Washington, D.C., and the National Laboratories of the Atomic Energy Commission* In addition to these centers, the federal agencies subsidize rather sub- stantially individual investigators, in nonfederal research centers, principally in the universities and teaching hospitals* During 1948 through grants-in-aid and contracts, the federal agencies distributed a total of nearly $26 million to these scientists. Many of the problems studied v/ere applied problems of importance to agency oper- ations (principally in the armed forces), whereas many other problems were formulated by the applicant scientists and v/ere supported pri- marily in the general interest of the scientific knowledge and as encouragement to scientific workers. In an effort to help to alleviate the nation-wide shortage of scientific investigators, the Public Health Service has inaugurated a fellowship program under which the graduate and postgraduate edu- cation of promising research scientists is financed in institutions and fields of their own choice. These fellowships yield only a modest return and fellows are under no obligation to the sponsoring agency upon completion of the training. In fiscal 1948, 303 fellows v/ere supported at an estimated cost of $884,390. Beginning in fiscal year 1949 the National Research Council will administer a fellowship 15 program for the Atomic Energy Commission on which an estimated $l;l million will he spent annually* In addition there is an unknown volume of investigation in progress in federal hospitals which has not been formalized as re- search for budget or personnel purposes but is conducted by staff members in their spare time with small amounts of operating funds and equipment* This was particularly true of veterans hospitals in which research per se was not officially authorized until recently. In addition to these acknowledged research activities in medicine and biology, further sums were spent in fiscal year 1948 for a wide variety of study, survey, demonstration and test projects and studies which are classified as research by the agencies* Eor example, each major health agency has a unit engaged in statistical analysis of special morbidity and mortality experience of its prin- cipal beneficiaries* The staff of Food and Drug Administration; incident to its routine testing and inspectional work, is constantly seeking improved methods of testing and greater standardization of existing methods. The Public Health Service, and the Tennessee Authority, the Armed Forces and the Department of Agricul- ture are all engaged in laboratory study and field testing of insecticides., fungicides and rodenticides:; and a half dozen agencies are studying various aspects of nutrition.. There are many more such instances. The total commitments in personnel and funds are large-. 16 ®he preventive medicine and public health activities of the federal agencies are largely of three kinds, either preventive measures for direct beneficiaries, grants-in-aid to state governments, or regulations in aid of general health. These activities cost approximately $110.8 million—/ in fiscal year 1948. This was almost 10 percent of all federal expenditures for health and nearly 13 percent of the cost of hospital care and construction.. 4. Preventive Medicine and Public Health The direct beneficiaries of federal preventive health v/ork are primarily the active duty personnel of the armed forces and, incidentally, their dependents and those living near mili- tary installations. The nreventive program consists largely of sanitary measures in military installations and adjacent areas and of close medical supervision, including examinations, inoculations and vaccinations, of those on active duty. The programs are very intensive and involve close suuervlslon over both active duty personnel and their environment* The other direct "beneficiaries of federal preventive health measures cannot "be more clearly defined than the "general population" 1/ This total of $110.6 million is at variance with the $208,261,000 total for public health activities in "functions and Activities in field of Health", as submitted by Brookings Institution, because the latter figures includes medical care and research expenditures by the several agencies and does not include expenditures by the Armed forces and the Veterans Administration* 17 "because the programs consist largely of grants-in-aid to state governments, regulatory activities in aid of health, and the pro motion of the general health. Gtants-in-aid to states for public health work include not only conditional grants of money for general health work and specific ("categorical") health work in such areas as maternal and child health, veneral disease, tuberculosis, mental hygiene, and others, but also the loan of services of technical experts to advise states on program content and method and to conduct allot or demon- stration projects. In fiscal year 1948 financial grants-in-aid total $81.6 million; the value of technical services loaned is not segregable. The regulatory activities in aid of general health include programs for the suppression of false and misleading advertisement of and the distribution of unsafe foods, drugs and cosmetics, and the prevention of the importation of narcotics, diseased persons, birds or animals, including the stringent power of quarantine. For these programs nearly $18 million was spent in fiscal year 1948, An increased amount of effort in recent years has been given to health promotion and health planning. Programs have included health education, in collaboration with states and with voluntary health agencies, analyses of the health needs of special population groups, such as rural residents, including migratory agricultural workers, the promotion of nutrition consciousness, and concepts of the importance of international health work. 18 Outside the intensive preventive health measures for Armed Forces personnel and some regulatory activities in the Department of Agriculture, most public health work is carried on hy units of the Federal Security Agency, including the Public Health Service, Children's Bureau, Office of Vocational Rehabilitation, and Food and Drug Administration. Perhaps the most significant characteristic of all the health work in the Federal Security Agency is that there are relatively few direct operational activities, except in quarantine work and in demonstrations. Nearly the entire effort has been to stimulate and assist state and local governments and private volun- tary health agencies in their work. The federal agency with the largest health and medical obli- gations — whether measured in budgets, patients, personnel or hospitals — namely, the Veterans Administration, is forbidden by law, as interpreted by the legal staff, to engage in preventive health measures. The results of preventive health activity on the part of public and private agencies in the last half century are very persua- sive. There has been a great reduction in mortality with resultant increase in the length of life and in the number of productive years; there has been a sharp dron in the incidence and prevalence of illness; there have been great strides in the alleviation of main and suffering. There has been an accompanying expansion in the concept of public health to encornnass a wider range of illnesses and diseases and an intensification of health activities; these may be illustrated by the 19 acceptance of mental hygiene and rehabilitation as public health activities. The pressure on both public and private agencies to bring the findings of research to. bear on a community-wide basis, as distin- guished from an individual patient basis, has increased so much that research per se is now recognized as an integral part of public health. These expanding concepts are justified, not only on humanl tarian grounds of ameliorating pain and lengthening life, but also on the grounds of national security —. to make the nation strong. . 5. Education and Training During the fiscal year 1948 the four major medical agencies were conducting organized educational training programs on a broad basis. In the agencies (Army, including Air Eorce., Navy, Veterans Adminis- tration, Public Health Service, including Hospital) at least five types of educational programs were in progress, as follows; 1. Training; nrograms for interns and residents in medicine and dentistry; 2* Training programs for other medical and ancillary person- nel in civilian schools or in private, municipal or state, or other federal institutions; 3. Training urograms (for other than interns, and residents) within the agency’s installations, utilizing civilian lecturers and consultants; 4. Medical training aids, including medical motion pictures and other audio-visual aids; and 5. On-the-job or in-service training programs for all kinds of medical and ancillary personnel. 20 On-the-job training is omitted here because it is not a separable part of employees1 normal duties and separate budget or personnel allocations are not made. Based on the number of men in training and on the commitments made for the fiscal year 1949, the estimated net cost of these educa- tional and training programs will be $20-odd million and will require the teaching services of an incalculable number of professional and technical staff* The four major medical agencies will train 1,326 interns and 3,906 residents at a gross salary cost of. $25.4 million, will spend an estimated $2.5 million for lecturers1 and consultants1 fees., $1.5 million for medical motion pictures, and $1.75 million for tuition costs for professional staff of all kinds. This is a total of $31 million. There, is no general agreement on how to allocate the cost of training interns and residents to training per se and how much to the care of pat lent sf It seems widely assumed that all or nearly all of interns1 time is in training. The Bureau of Budget estimates the quantitative value of residents' services as one-half that of a full- time staff physician, and the Veterans Administration counts them as seven-tenths. Adjustment can be made only for those who take intern- ships or residencies in agency hospitals; if the training is taken elsewhere, the full salary cost must be charged to training together with the added costs of engaging consultants to supervise and insure the training program. If a generous allowance is made (charging none of the salaries of interns and 50 percent of the salaries of residents 21 who train in agency hospitals), the adjusted salary costs still exceed $14 million* When all other related expenses are added, the adjusted total reaches the magnitude of $25-30 million for intern and resident and other training expenditures. The authorized internships and residencies, by agency, together with average annual salaries are: Total Internships Average T otal Re sidencies Avera Intern- Agency Other Annual Re si- Agency Other Annua ships Hospital Hospital Salary dencies Kosp, Hosp, Salar; total 1326 776 550 — 3906 3481 425 Army 600 300 300 $5000 802 502 300 $6932 Navy 550 300 250 5000 425 300 125 6225 Public Health Service 154 154 5000 149 149 5476 I’reedmen's Hospital 20 20 — 1560 30 30 2173 Veterans Ad ministration (Authorized to begin in Ff 1950)2500 2500 3300 The Civil Service salary scale, as reflected in the allowances for interns and residents at Preedmen's Hospital, stands in sharp contrast to the special nay scale of the Veterans Administration and the pay and allowances of commissioned officers of the other three services. The salaries of interns in the commissioned corps reflect a rank comparable to that of a Pirst Lieutenant in the Array; there is no standardization in residents1 salaries. All veteran residents in the Veterans Administration hospitals receive the same salary ($3300) and at present a very few are non-veterans. The high average salary of other residents reflects the fact that nearly half of all Army 22 residents are at the rank of Major or above, 40 percent of all Navy residents are at least Lieutenant Commanders, a,nd one-fourth of all Public Health Service residents are at the rank of Surgeon (comparable to Major) on above* Ho commitment for further service is required of Army, Navy* and Public Health Service interns who take their training in the agencies1 hospitals but those who are assigned to outside institu- tions are required to serve an equivalent period on active duty. All agencies which have residents, except the Veterans Administra- tion and Preedmen's Hospital, exact a period of obligated service upon the completion of resident training. Ho future service commit- ment is required of Army residents who took their training in Army hospitals but they only assign career Army officers (also true of Public Health Service) to such hospitals; for Army residents trained elsewhere, an equivalent period of active duty is required. The Navy has even more exacting requirements. Residents trained in Navy hospitals are obligated to remain in the Navy for a period equivalent to the duration of the residency. Service commitments of three years are required of residents receiving six to twelve months training in affiliated institutions and one additional year of service is required for each consecutive six months of residency training beyond the one year. There is clearly some disagreement, or confusion, in the philosophy of the obligation which residents owe to federal agencies for their training-. The Veterans Administration are training 2500 23 residents on the theory that they will help carry the huge load of veteran patients, particularly in areas like psychiatry, where there is a nation-wide shortage of qualified personnel, and that a number of them will continue to serve either as full-time staff physicians or as part-time consultants. On the contrary, the Armed Forces and Public Health Service seem to have used the opportunity for residency training as a recruitment device to attract young men (and hold them in service obligation) and to send off their ca.reer officers in order to improve the quality of care in their own hospitals. 6. Medical Supply At present four major federal medical services are directly involved in the pro- curoment, storage and distribution of medical equipment and supplies* The se agencies are the Amy, including the Force, Havy, Veterans Administration, and Public Health Service* Each supply agency main- tains separate procurement, storage and distribution facilities. The Army and Navy have consolidated certain activities, namely, cataloging, specifications, standards, procurement, laboratory testing, equipment development and certain inspection activities; they have not been able to arrange joint warehousing or distribution. Each agency main- tains a system of depots throughout the continental United States, and the Armed Forces also have depots overseas* The Public Health Service has only one depot. Veterans Administration ha s the largest medical supply activity in volume, with the Army, Navy and the Public Health Service following in that order. 24 Except for the Veterans Administration, medical supply activities are administratively under the control of the chief medi- cal officer. In the Veterans Administration medical supely is a part of the general supply system and not under medical control* In addition to the medical supply activities of the four major agencies, the Bureau of Federal Supply of the Department of the Treasury is involved in the procurement of medical equipment and supplies on a small scale. Federal agencies must procure through this agency certain items which lend themselves to open contracts for mass buying. Several smaller federal medical services such as Freedmen’s Hospital, the Bureau of Indian Affairs, and the Tennessee Valley Authority mrchase some medical equipment and supplies locally a.nd obtain others from other federal medical supply services and the of Federal Supply, The medical supply units of the Veterans Administration and the Public Health Service have been adopting in varying degrees the supply system of the and the nomenclature and cataloguing of the Army-Navy Medical Procurement Office. The standards and speci- fications developed hy the Army-Navy Medical Procurement Office are increasingly utilized by the other agencies. There are marked variations in the levels of stock held by the four federal medical services. The Army maintains a 90-day stock at depots and a 60-day stock at stations. The Navy maintains a 180 day stock level at depots and, officially, 90 days at stations. The Veterans Administration maintains 180 days at depots and 90 days 25 at stations* Public Health Service maintains a 120-day level at its one depot and a 90-day level at stations* The official attitude with reference to local procurement ranges from one of great liberality in the Public Health Service to one of close restriction in the Veterans Administration. All local procurement in the Army and Navy must be within the special money allowances established for stations; in special cases . authority may be obtained from the central office for excess purchases. The five major agencies employed 2,901 Persons (246 mili- tary, 2,655 civilian) in the expenditure of $81 million in central and local procurement of medical supplies and equipment in fiscal year 1948. The gross value of stocks on hand in all agencies totaled $177 million. 1/ See Appendix K of Report of Committee on Federal Medical Services. 26 II. BENEFICIARIES CE MEDICAL CARE The United States G-overnment has assumed firm or contingent responsibility for providing some medical or hospital care, or both for an estimated 24 million of its citizens- The 18*5 million veterans, who, served their country in its several wars, constitute the largest single group but the two million civilian employees, for whom only martial health services are provided, the 1.5 million members of the armed forces and their 1.35 million dependents also represent sizeable obligations. Class of Beneficiary Estimated Number of Eligible Beneficiaries June 30, 1948 TOTAL, ALL BENEFICIARIES 23.978.600 Army and Air Force Personnel Dependents 940.000 914.000 Navy and Marine Corps Personnel Dependent s 480.000 432.000 , Veterans American Merchant Seamen 18,500,000 178,400 Coast Guard, Coast & Geodetic Survey, and Public Health Service Personnel Dependents and Others 38,100 38,600 Federal Civilian Employees 2,000,000 Indians 400,000 Prisoners 17,500 All Others (Leners,. Narcotic Addicts,, Residents of D.C--, etc,.) Indeterminate 27 Some of the present 'beneficiaries, such as American merchant seamen, have had a long tradition of entitlement to free medical care, whereas others, such as federal civilian employees, do not yet have a fully organized prograjn because of the newness of the authorizing legislation (Randolph Act of 1947). In some instances the federal obligation is spelled out quite clearly in legislation, as in the case of Navy dependents (Public Law 51, 78th Congress) whereas in the case of Army dependents the obligation is construed from language in an 1684 appropriateions act supported by long continued budgetary acquiescence. Similarly, the full intent of Congress with respect to veterans’ care and Indian care is not clearly stated in existing legislation. The eligibilitj?- of Indians and their dependents, though virtual wards of the federal government for education, land management, and medical and hospital services, among other things, is entangled in numerous treaties with individual tribes and scores of uncorrelated pieces of supple- mentary legislation. The eligibility of veterans is confused by distinctions between service-connected and nonservice-connected disabilities, between those veterans who have and who have not had war service, and between those who have, disability claims from the Veterans Administration and those who are on retirement pay from the military services. The public policy reasons for extending medical care to bene- ficiaries have varied widely. Veterans and military personnel were made eligible for care because of their military service. Medical 28 care for those injuries and illnesses directly attributable to military service was provided in order to restore veterans to their pre-service condition of health insofar as possible and to recognize their patriotic services in the nation1s defense. Medical care for those injuries and illnesses not directly related and quite unrelated to military service are on much less clear public policy grounds, nominal limitation to those instances in which beds are avail- able and in which the veteran cannot afford to pay, are not important limitations when, in response to other considerations, the ability to pay clause is not enforced and three times the number of beds necessary to accommodate service-connected disabilities are main- tained and thousands more being built* Active duty military personnel have always been provided with complete medical care incident to other necessities of life. De- pendents of military uersonnel were included in an earlier day because of the remote location of many military installations both in conti- nental United States and abroad; more recently, medical and hospital care has come to be regarded as a perquisite in lieu of adequate pay* Medical care is extended to immigrant aliens and federal prisoners including narcotic addicts, prisoners of war, and internees, because of the necessity of insuring their retention under law, to Indian members of recognized tribes and their dependents because of existing treaty obligations, and to federal civilian employees because of the desire of the government to be a model employer and because of the established savings of industrial hygiene-type services. Medical 29 care was originally extended to merchant seamen because of the protest from and inadequacy of local charities in maritime communities to provide for diseased and injured seamen, who were left in port by foreign flag and -privately owned vessels. Special categories of insane patients were admitted to the one federal mental institution because the individuals were otherwise federal responsibilities and there was no other institution for their care, A miscellany of other beneficiaries, including such groups as accredited foreign military and diplomatic personnel and their dependents, visiting dignitaries, Congressmen and other high government officials, Pacific Island natives, American Red Cross and other welfare workers while on duty at military installations, special study patients, and emergency cases, are provided with medical care for humanitarian, diplomatic and other reasons. Throughout the history of the extension of medical and hospi- tal care with the exception of a short uncertain interval over 40 years ago in connection with merchant seamen, the trend has been wholly in the direction of increasing not only the categories of beneficiaries but also the roster of specific services for which the several groups are eligible. Only in relatively recent years, particularly since the high standards achieved in the armed forces in World War II, has substantial attention been given to the quality of service which beneficiaries receive. Free hospital care is provided only to primary 'beneficiaries — and not to all of them* Array enlisted personnel, for example, receive free care not only in Array hospitals hut also in any other 30 federal hospital (or nonfederal hospital in event of an emergency)* Army officers and "both Army and Navy dependents must pay a token rate, called the subsistence rate., of $1*35 per diem (at present). This rate is adjustable from time to time and is supposed to be equivalent to the average cost of the raw rations consumed by a patient in a single day, plus an allowance for overhead* The Navy rate, called a ration rate, which must be paid by all Navy dependents is now $1,75 ner diem. No charges are made for outpatient care for dependents, and no charges are made to Navy officers for either inpatient or outpatient care# All services rendered by one agency to the direct benefici- aries of another agency are billed at a standard rate fixed by the Bureau of the Budget of $9,75 ner diem (fiscal year 1949) for inpatient care and $1.75 for outpatient care. Thus, for identical services in the same hospital, a federal agency will charge nothing for its own personnel, either $1.35 (Army) or $1,75 (Navy) for dependents of its own personnel, or $9.75 for either personnel or dependents of another agency. The system of charges merely reflects the prevailing attitude that each agency has a. separate set of beneficiaries for whose care an independent system of hospitals and dispensaries has been created. All are in fact beneficiaries, not of any agency but of the federal government, and all agencies seek both authority and funds for the management of such facilities from the same source. 31 All federal beneficiaries may be grouped for convenience into five classes; namely, veterans, federal civilian employees and mili- tary personnel, dependents, merchant seamen, special wards and miscellaneous others. 1/ A. Veterans Historically, no provisions were made for medical care for veterans until 1811 when the United States Naval Home was established in Philadelphia. A Soldiers1 Home was authorized in Washington, D»C» in 1851. An institution, now. St. Elizabeths Hospital, for the care of the insane of the Army and Navy and residents of the District of Columbia was- authorized in 1855, and in 1865 Congress enacted legislation creating the National Homes for Disabled Volunteer Soldiers. These were domiciliary homes with some hospital facilities. Shortly after the entrance of the United States into World War I (in October, 1917) Congress provided that men with service- connected disabilities (including those who served during peace as well as those who served during period of war) could be furnished with reasonable medical, dental, and hospital care in addition to compensation benefits. When in 1921 the newly established Veterans Bureau superceded the Public Health Service in the control of all hospitals furnishing care to veterans, the medical treatment of veterans was disassociated from medical treatment of other eligible groups and associated with other benefits extended specially to veterans. l/ Tables 5-11 in Appendix II show beneficiary status of patients in federal hospitals on June 30, 1948. 32 The really grea.t liberalization of veterans1 medical benefits came in the World War Veterans Act of 1924 (Public Law 242, 68th Congress) with the extension of hospital privileges to all veterans of any war, military occupation or military expedition since 1897 to the extent of existing facilities. The need for economy in 1933 (Public Lpw 2, 73rd Congress) brought about the repeal of the Act of 1924 but by March 1934, the conflict between economy and veterans* needs was resolved by a compromise which provided (Public Law 141, 73rd Congress) for the reinstatement of medical and hospital care to the extent of available facilities if applicants were unable to defray the expenses thereof. The final landmark came in 1943 (Public Law 10, 78th Congress) when veterans of World War XI were put on a full 'oarity with the veterans of World War I. An additional exten- sion is clearly in sight at this time involving those now being inducted by Selective Service who are presently entitled only to the benefits of ex-members of the Regular Establishment (veterans of peacetime military service). This rapid extension of medical and hospital benefits coincides closely with the creation of a special clientele agency for veterans, beginning with the Veterans Bureau in 1921, and with the emergence of veterans organization, as an identifiable political force in the population. According to present law and regulations, veterans who are eligible for medical benefits are divided into those who have had war service and those who have not had war service. The eligibility 33 of those who have not had war service depends upon whether the veteran was an officer or an enlisted man* An enlisted man who did not serve during a period of war is not eligible for medical care unless he either has been discharged from the military service as the result of a disability incurred or aggravated in line of duty or is receiving compensation for a service-connected disability* If a veteran was a regular Army (U.S.A.) officer now retired and receiving disability retirement pay from the Army, he is not entitled to medical care unless he elects to claim compensation for his service-connected disability from the Veterans Administration and surrenders a corresponding part of his retirement pay* If the veteran was a reserve Army (A»U*S.) officer now retired, he is eligible for medical benefits only if he has been certified to the Veterans Administration for disability retirement pay in which event he would receive disability retirement pay from the Veterans Admin- istration rather than from the Army, This does not apply to Navy officers, for whom medical care and disability compensation are provided by the Navy Department directly. The eligibility of all veterans who have had war service is identical. Priority in entitlement to medical and hospital care gives the highest priority to the veteran seeking care for a service- connected disability, the next for a veteran who has a service-connected disability but who is seeking care for a nonservice-connected dis- ability, and the lowest to the veteran who has no service-connected disability and who is seeking care for a nonservice-connected dis- ability. . A veteran who is under treatment for a nonservice-connected disability and who also has a service-connected disability, is considered and treated as a veteran with a nonservice-connected dis- ability. A veteran with a disability rating for a specific condition is not by that fact eligible for care for conditions arising wholly since service. There is no known population of veterans who may be classed as service-connected. There is only a group who have been legally decided to have service-connected conditions. This decision is a function of the Claim Service of the Veterans Administration and not of the Department of Medicine an<3 Surgery*- In summary, all veterans of any war, military occupation or military expedition are entitled now to complete inpatient and out- patient medical, dental and hospital care for any service-connected disability, and all veterans of like experience are entitled to inpatient care (including domiciliary home care) for any nonservice- connected disability if beds are available and if they are unable to pay for the care needed. An exception to the prohibition against outpatient ca.re for nonservice-connected disabilities is made for any physical examination to determine medical condition for reinstate- ment of life insurance, or for a disability claim, need for hospitali- zation or domiciliary care, or for any examination and treatment of a veteran who is receiving a vocational rehabilitation support when the ailment is likely to interfere with the continuation of his training. Members of the Regular Establishment who did not serve during a time of war are eligible for hospitalization for disabilities incurred in service, and those with service-connected disabilities 35 are also eligible for inpatient care for disabilities which may he nonservice-connected. On June 30, 1948, 103,263 veterans were hospitalised in either Veterans Administration facilities or under contract in other federal and nonfederal hospitals and 14,275 veterans were in Veterans Admin- istration domiciles, as follows: Ho spi t al Veteran Patients June 30, 1948 TOTAL VETERAN PATIENTS 117.538 In Hospitals 103.263 Civilian Voluntary 2,574 ,, State and Municipal 1,899 , Army 2,675 Navy 3,568 . Marine 1,347 St. Elizabeths 212 ; Veterans Administration 90,983 . Canal Sone 5 In Veterans Administration Domiciles 14.275 Tv/o-thirds (68,39l) of the patients in hospitals had nonservice- connected disabilities and 66 percent (25,663,461) of the 38,752,839 patient days of care furnished to veterans during fiscal year 1948 was for men hospitalized for treatment of nonservice-connected dis- abilities. Nine-tenths of the veterans in the Veterans Administration domiciles and 92 percent of the 5,265,541 patient days were provided to veterans with nonservice-connected disabilities. As might be expected from the fact that it has been a relatively short time since 36 they were discharged from service, the percentage of hospitalized World War II veterans being treated for nonservice-connected dis- abilities (56 percent) was much lower than the percentage of World War I veterans (78 percent) or of Spanish American War veterans (97 percent). If current policies and recent experience continue, the relative proportion of World War II veterans who are receiving care for nonservice-connected disabilities will progressively increase. The total number of living veterans of World War II i s now approximately three and one-half times the number of living veterans of all previous wars. Most of the projections of future patient loads are based on the assumption that the 14 million veterans of World War II will have approximately the same illness experience as other veterans. The hospitalization experience of all veterans except those of World War II is that there has been a progressively increasing proportion of all veteran patients with nonservice- connected disabilities, rising from 14.4 percent in 1925 to 76.8 percent in 1948. Moreover, the increase in those needing general medical and surgical care — the most expensive type in terms of personnel and costs — rose from 33.X percent to 95 percent between 1925 and 1948. It has remained at approximately 95 percent for nearly ten years* whereas the percentages for tuberculosis and neuro- psychiatric cases have remained fairly stable at 81 and at 67, respectively, for the same period, as shown in the following chart. PERCENT OF VETERANS REGAINING UNDER HOSPITAL TREATMENT WHOSE DISABILITIES WERE NONSERVICE CONNECTED BY TYPE OF DISABILITY VETERANS OF WORLD WAR I, PRIOR WARS, AND PEACETIME ARMY AND NAVY 38 B, Federal Civilian Employees and Military Personnel The federal government undertakes to provide some kind of medical services to its nearly 3.5 million employees. For convenience and hecause of the character and limitation on the services for which employees are.eligible, they are divided into military personnel, quasi-military employees and civilian employees. 1. Military Personnel Both retired and active duty per- sonnel of the armed forces have traditionally been provided with conrolete medical, dental and hospi- tal care. Medical services are included with other needs, such as food, clothing, and housing, which the armed forces provide for their personnel* Approximately 1,420,000 were on active duty with the armed forces on June 30, 1948, and it is anticipated that the total will reach nearly 1,950,000 "by July 1, 1949* It is likely that it v/ill "become even larger in the following year* Under existing policies all enlisted men in the Army receive medical care free, But officers, while receiving outpatient care without charge, pay a nominal daily subsistence rate while hospital- ized, as do retired enlisted men. This rate, Based on the official Quartermaster ration rate (cost of raw rations) plus 25 percent, averaged $1.35 per diem during fiscal year 1948. Under existing Havy regulations Both officers and enlisted men receive all care free. The Uavy also has a ration rate, averaging $1.05 in fiscal year 1948, But only retired officers, enlisted men not on active duty, and Waves a.hd nurses discharged for pregnancy are required to pay it. 39 On June 30, 1948 nearly 1.5 million members of the armed forces on active duty were eligible for medical care* On June 30, 1948, 29,855 (19,976 Army and Air Donee and 9,879 Navy and Marine Corps nersonnel) were under care, 21,875 in continental United States. During the fiscal year a total of 3,893,996 (2,197,422 in the United States) visits to outpatient facilities were made by Army and Air Donee personnel and they were given 6,475,915 (3,529,376 in the United States) outpatient treatments* Nearly 5,000,000 visits were made by Navy and Marine Corps personnel to Navy outpatient facili*- ties. The active duty military personnel in hospitals on June 30, 1948 is summarized in the following table. 40 hospitalization op personnel in military hospitals June 30, 1948 Total Active Duty Supernumeraries TOTAL AHiiY AND NAVY 42.864 29.855 13. 009 ARMY AND AIR DO ROD Total 27.178 19.976 7.202 United States / Total 18.725 13.243^' 5.482 General Hospitals 12,542 8,521 4,021 Station Hospitals Total 6.183 4.722 1.461 Army 3,600 2,725 875 Air Force 2,583 1,997 586 Overseas 8,453 6,733 1,720 NAVY AND HARIN3 CORPS Total 15.686 9.879 5.807 United States •k/ Total 13.958 8.632—' 5.326 Hospitals 12,800 7,587 5,213 Dispensaries 1,158 1,045 113 Overseas W Total 1*728 1.247-' 481 Hospitals 858 626 232 Hospital Shins 341 341 — Dispensaries 529 280 249 &/ Excludes 2158 patients on convalescent furlough from hospitals in the United States,.-(l,861 from general hospitals, 202 from Army station hospitals and 95 from Air Force station hospitals). h/ Includes 179 active-duty patients on convalescent furlough (two from overseas hospitals) ♦ 41 The officers of the commissioned corps of the Public Health Service * the offi- cers and enlisted men of the Coast Guard, and the commissioned officers, ships officers a-*d crew members of the Coast and Geodetic Survey,’all of whom are normally peacetime civilian employees but who may be absorbed into the armed forces in time of war, are also eligible for medical and hospital care* Also included are civilian employees ahd noncommissioned officers of the Public Health Service at field sta- tions. This care is furnished -primarily in hospitals ahd outpatient clinics of the Public Health Service but may also be provided at other federal or nonfederal facilities on a contract basis* 'Retired officers of all three services are eligible for complete care but it must be taken at Public Health Service Hospitals. ■, 2. Q,up si-military Employee s During fiscal year 1948, 38,136 officers and men from these sendees were eligible for medical care. Numerically this is a fairly static group and, although the total has increased perceptibly over a period of years, it is still small and relatively stable by contrast with military personnel. On June 30, 1948 , 400 were receiving hospital care in'Public Health Service hospitals and more than 60,000 outpatients received over 204,000 treatments and 14,100 physical examinations during the year. These constituted nearly 15 percent of both the total number of outpatients treated and the number of outpatient treatments given by the Public Health Service. 42 Medical services for the approxi- mately two million federal civilian employees include compensation and-treatment for injuries sustained in the performance of duty and the more Conventional industrial- hygiene type of dispensary care. 2 • C ivi 11 an Enroloye e s The liability of the federal government for all services, appliances and supplies prescribed by a qualified physician which are likely to cure, give relief or reduce the degree or period of disability of any employee injured in the performance of duty comes from the Federal Employees1 Compensation Act of 1916 (Public Law 267, 64th Congress),# Dependents are not included# , Injured employees are taken or referred to the hospitals or dispensaries of the Public Health Service, if any are conveniently accessible, or to'any other federal hospital or dispensary#- .If no federal facilities are avail- able, any one of 4,000 designated private physicians will furnish or arrange for the necessary services* The hospital and dispensary care of federal employees is a nonreimbursable obligation of the Public Health'Service* -Other agencies which usually handle only emergencies and their own em- ployees, are reimbursed by the Bureau of Employees1 Compensation at the reciprocal rate fixed by the Bureau of the Budget. Nonfederal hospitals and designated physicians are paid on the basis of a local fee schedule, approximating workmen|;s compensation rates* There were 80,000 injuries (1,,018 fatal) of federal employees during fiscal year 1948.- The Public Health Service, which gives most of the medical care required by BSC patients, provided 145,468 days of 43 hospitalization during fiscal year 1948 and gave 186,000 treatments to 37,100 outpatients and in addition made 20,200 physical examina- tions. These services represented slightly more than eight percent of the number of outpatients treated and about 13 percent of the outpatient treatments given by the Public Health Service. The Bureau obligated nearly three million dollars ($2,892,287) in 1948; nearly one million ($957,962) was in reimbursements to other federal agencies (except Public Health Service) and the remaining nearly two million dollars was oaid to private physicians and hospitals. Although such services are still not uniformly available to all federal employees, particularly field employees, the Bureau of the Budget estimated that expenditures for existing services in fiscal year 1948 totaled $7,318,913, of which over six million dollars represented programs in the Departments of the Array and Navy, Veterans Administration, and Federal Security Agency. Certain federal civilian employees are provided complete medical and hospital care because of the remoteness of their offi- cial stations. Although these include primarily 45,000 (citizens only) in overseas theatres who are cared for by the Array, other workers at isolated military installations and employees of con- tractors at such installations, employees of the Pish and Wildlife Service in the Pribilof Islands, and low-paid employees of the Indian Service,, are also eligible. Red Cross personnel and other welfare workers on duty at military installations receive hosnital care at the ration rate and outpatient care without charge. 44 C. Dependents Dependents of personnel of the Armed Forces have traditionally "been provided complete medical and hosnital care for acute Illnesses without charge or at a strictly nominal fee* These dependents numbered an estimated 1,278,000 on June 30, 1948* The Army has furnished both inpatient and outpatient care to dependents since the days when Army posts were located on the frontier and at other isolated spots. The nearest thing to a statutory authorization for such care is the language of an 1884 appropriation act which pro- vided that ’’the medical officers of the Army and contract surgeons shall whenever practicable attend the families of the officers and soldiers free of charge11. Such language has not been contained in more recent appropriations but Army budget estimates have regularly made provision for the care of dependents. The approval of such budgets by the Bureau of the Budget and by Congress has impliedly sanctioned care for all dependents. Present Army regulations (AR40- 590, para. 62) provide that sick and injured wives or dependent husbands, and dependent children, may be admitted to Army hospitals when suitable facilities are available. No charge is made for out- patient examination or treatment of dependents and onl?j a nominal subsistence charge is made for Inpatient hospital care. The sub- sistence charge for each day of hospitalization is based on the Quartermaster’s official raw ration rate, computed periodically within each Army area, plus 25 percent. At present, this rate varies L. Dependents of Army and Air Force 45 between $1.30 and $1*50 per day and averaged $1*35 per diem during fiscal year 1948.’ At the close of fiscal year 1948 the world-wide strength of the Army and Air Force was 940,000, of which 557,000 was in continental United States.. On the basis of a fire nercent sample of Army and Air Force personnel which showed that dependents approximate 90 per- cent of total strength, slightly more than 750,000 dependents in the United States were eligible for medical care, . The hospitalization rate for dependents in continental United States has recently varied between 3.5 and 4*3 beds per 1,000 and, when allowance is made for the standard Army 20 percent dispersion factor, the number of beds required approaches five beds per 1,000 dependents, Thus, for 750,000 dependents, an estimated 3,750 hospital beds were necessary in fiscal year 1948.' The Army and Air Force hospitalization records do not show dependents as a specific group, but merely include them as an over- all category of 11 civilians excluding veterans”.. Approximately one-sixth of pH patients in Army and Air Force hospitals in the United States on June 30, 1948 were in this category. Most of these were actually dependents. About 45 percent of all outpatients seen and nearly the same percent of all outpatient treatments given during fiscal year 1948 were for nonrailitary patients. The Army has esti- mated that the full time of approximately 350 physicians went for dependent caret. 46 Medical and hospital care for dependents of Navy and Marine Goips personnel was given official sanction by a special act of Congress (Public Lav 51, 78th Congress) which also authorized an additional appropriation ($2*000,000) never appropriated for the expansion of 2, Dependents of Navy end Marine Corps facilities for the hospitalization of dependents* A dependent was defined by the act as including na lawful wife, unmarried dependent child (or children) under 21 years of age, and.the mother or father of a member of the Navy or Marine Corps if in fact such mother or father is dependent on such member". Widows of deceased personnel, not including their dependent children, are also entitled to hospi- tal care* Hospitalization is limited to acute medical and surgical conditions, exclusive of nervous, mental or contagious diseases or those requiring domiciliary care* There is no charge for outpatient care or treatment and the hospitalization per diem remains at $1.75 as fixed by the President in L943 (Executive Order 941l). This figure was a comcromise between the cost of service, excluding the pay of professional personnel, and what the Navy thought men in the lower grades could afford to pay* On June 30, 1948 the world-wide active duty strength of the Navy and Marine Corps was 502,771*. On the basis of recent experience which indicates that dependents approximate 90 percent of troop strength, the total number of eligible dependents was 452,994. In • addition to these dependents of active duty persoiinel. Navy hospitals and dispensaries were providing care to at least 175,000 other 47 eligibles, including 50,041 Fleet Reserve and retired personnel, 55,244 Np.vy civilian employees and contractors overseas, 36,262 dependents of Navy civilian employees and Qf Navy contractors, an estimated 35,000 widows of Navy and Marine Corps personnel, 4,339 dependents of Array and Air Force active duty personnel, and members and dependents of United States embassy personnel at overseas missions. It is estimated that nearly 485,000 of these dependents were in continental United States on June 30, 1948. These dependents numbered 989 or eight percent of the 12,800 patients in Navy hospi- tals and an estimated average daily census of 100 (or nine percent) of the 1,158 patients in dispensaries in the United States. More than 20 percent of the estimated 6.2 million outpatient visits in calendar year 1947 were dependents and 46 percent of these visits were for obstetrical, gynecological and pediatric care. The Navy estimates that 251 physicians in hospitals and dispensaries vrere assigned to dependent care. In addition to these dependents of active duty personnel, an additional 46,000 Fleet Reserve and retired personnel and their dependents are also eligible for medical care. The recodified Public Health Service Act provides that the dependent nenbers of families of Coast Guard, Coast and Geodetic Survey and commissioned officers of the Public Health Service, both active and retired, are entitled to hospitalization at whatever rate the President fixes for the Navy, A dependent is defined in the same 3. Dependents of Public Health Service and Others 48 way as in the Navy Act, except that widows are not included* Depend- ents of other groups of Public Health Service beneficiaries, (e.g. merchant seamen) are not entitled to either inpatient or outpatient care except in emergencies. Prom a total of 38,600 eligible dependents, almost 3500 were hospitalized by the Public Health Service during fiscal year 1948, and the daily average inpatient load approximated 80. Nearly 19,000 dependents were treated as outpatients and received 77,000 treatments; these approximated four percent pf the total outpatients and about 5.5 percent of the treatments in Public Health Service facilities. Existing statutes do not clearly define the meaning of Indian Affairs shall pro- vide medical and hospital 'benefits**1 The regulations provide that all persons of Indian descent who are members of any recognized tribe under federal jurisdiction, all descendents of such members who reside on a reservation and all others of one-half or more Indian blood, are entitled to medical services at fees based on the cost of the services. Preference in admission to hospital is given to those of a higher percentage of Indian blood. The white wife of an eligible Indian is entitled but the Indian dependents of a white mm are eligible only if they maintain a permanent home on the reservation and participate in tribal affairs. All Indian beneficiaries, in- cluding dependents, who can afford it are expected to pay fees based on the cost of services rendered, but because almost all of them are either wards of the government or medically indigent, few collections are made. 4. Dependents of Indians 49 D* Merchant Seamen Medical and hospital care of merchant seamen began with the passage in 1798 of an act levying $.20 per month on seamen’s wages for the establishment and maintenance of a marine hospital, nfor the relief of sick and dica bled seamen”. In 1870 the monthly deduction was raised to $*40, in 1884 the levy on vrages was replaced with a tonnage tax on ships, and in 1905 the tonnage tax was repealed. Since then direct Con- gressional appropriations to the Public Health Service have been the sole support of the marine hospitals. A merchant seaman is eligible for complete medical, dental, and surgical treatment and hospitalization without charges at any marine hospital of the Public Health Service. A merchant seaman, whether or not a United States citizen, is eligible for care for sickness or injury while actually employed in the maritime service on a United States'flag vessel or within 90 days after any such employment of at least 60 days duration. If it is not practicable to receive or to move a seaman to a marine hospital, he may be attended by a designated private physician or receive care in a private or other federal hospital. His expenses are paid by the Public Health Service on a fee schedule or contract basis. The total number of seamen eligible for this care goes beyond the 150,000 seamen employed on vessels documented under federal laws, the 23,750 seamen employed on federal vessels over five tons (Army Transportation Corps and Army Engineer Corps), and the 4,672 enrollees of the Maritime Commission on active duty. Other eligibles include 50 civilian seamen employed on state school ships, cadets at state maritime academies and on state training ships, seamen on vessels of the Mississippi River Commission, and civilian seamen on Navy tankers. Seamen of foreign flag vessels may also receive care through the marine hospitals if accommodations are available but charges for such service (690 men in fiscal year 1948) are made to the master, owner or agent of the ship even in those cases where the seamen is a citizen of the United States. Nearly 200,000 seamen and trainees are eligible for complete medical and hospital care at federal expense. These beneficiaries constituted almost 50 -percent of the hospital load of marine hospi- tals in fiscal year 1948. Of the 28,120 patients who received care in marine hospitals during June 1948, over 90 percent were seamen of the merchant fleet. S. Wards of the Federal Government and Special Classes The federal government insures medical services to an additional group of miscellaneous beneficiaries who are included because of some special relationship which they bear to the federal government or to the general population. These include Indians, prisoners of federal courts or of war, Pacific Island natives, immigrant aliens, narcotic addicts, lepers, and some grouns of insane persons. 1. Indians A complet health and medical program is pro- vided to Indian wards of the government. The obligations of the federal government toward Indians are scattered through numerous treaties as expressed in literally hundreds of pieces 51 of legislation* The federal government exercises a general trusteeship over approximately 400,000 Indians, including 33,000 Indians, Eskimos, and Aleuts in Alaska. The trusteeship includes a complete health and medical program for all members of recognized tribes under federal jurisdiction, pH descendants of members of recognized tribes who reside on a reservation, and all other persons of half or more Indian blood. Medical and hospital services are provided to all Indian dependents and, although existing regulations require Indians to pay for medical care at "reasonable fees", practically nothing is collected because those using the services are indigent or medically indigent. - Isolated from the rest of the population and from community acceptance in most places, Indians live apart and under sanitary conditions which are generally unacceptable to other groups of the population. The result has been a high incidence of communicable disease, especially tuberculosis. One-third of 2,173 average daily census in the 64 Indian hospitals were tuberculosis cases. During fiscal year 1948, *795,318 inpatient days of care and nearly 750,000 outpatient treatment's were provided to Indians either through the Indian hospitals or through full-time and contract physicians. On June 30, 1948 the 58 Indian hospitals in the United States had 2,049 patients in 3,444 beds and the eight hospitals of the Alaska Native Service had 355 patients (204 tuberculosis) in 420 beds. . * 2♦ Prisoners The federal government provides medical ahd hospital services to all those who are detained hy the nrocesses of federal courts and of the military forces* Pri- soners of war are normally provided medical service hy the military 52 firm- which captured them, through the medical facilities of that service* The total number has been inconsequential sincethe close of the war and all current prisoners are held in overseas facilities of the armed forces. Approximately 18,000 civilian prisoners of the federal courts in fiscal year 1948 were also provided with medical and hospital care incident to their detention* Insane prisoners are held at the. Springfield (Missouri) Medical Center or, if female, transferred to St. Elizabeths Hospital in Washington; tractable drug addicts are cared for at the Public Health Service hospital at Lexington, Kentucky* All chronic cases are sent to Springfield. Medical service is provided in each of the six penitentiaries, five reformatories, eight correctional institutions, two juvenile insti- tutions, five prison canps and a detention center* Since the close of World War II the Navy has provided medical and hospital care to the natives of the Pacific trust territories (Carolinas, Marshalls, Marianas and other islands and island groups)-. This care is incident to military government of the islands hy the Navy, These natives total nearly 101,000. A hospital an They advocated building veterans hospitals only in or near medical centers where qualified specialists were available. They persuaded the Congress to exempt physicians, dentists,,and nurses from the Civil Service laws and regulations (Public Law 293, 78th Congress) so that better salaries could be paid. They inaugurated a residency training pro- gram to increase the supply of scarce specialists, to provide better care, for patients and to raise the sights of the full-time staff# - They placed the technical supervision of both the care of patients and the training program under 45 Deans Committees from university medical and dental schools and other established clinics and founda- tions# They brought lecturers and consultants into the hospitals. After some delay, they got p research program established. ■ By all 75 these means and through the establishment of a “home*.town" medical and dental care program, they convinced a skeptical medical and dental profession. Now many veterans hospitals compare favorably with the best private and university teaching hospitals. Despite this great progress in the short space of three years, the path toward high-quality medical service is still partially blocked* It is blocked by political interference in the location and operation of veterans hospitals, by the diffusion of authority over medical and hospital matters within the Veterans Administration, and by the- acute na,tion-wide shortage of certain types of personnel. Political interference in the location and operation of hospi- tals is illustrated in (l) the location of new hospitals, (2) refusal of permission to close existing hospitals which were either (a) in- herited from the military at the close of World War I or II, (b) built following World War I, or (c) included in the absorption of the National Homes for Disabled Volunteer Soldiers, and (3) refusal of permission to convert existing temporary or permanent hospitals to domiciliary hones. Recent experience abounds with instances of the location of hospitals due to political pressure and the continued operation of hospitals at locations where they cannot be adequately staffed, or which cost 30 to 50 percent more to operate* Within the Veterans Administration the control overraedical and hospital natters continues to be divided between the Department of Medicine and Surgery on the one hand and at least six other departments of equivalent rank, that of Assistand Administrator# Parallel diffusion 76 exists at the Branch Office level, where six Branch Birectors have an equal voice in matters directly affecting the internal manage- ment of veterans hospitals and outpatient clinics. This fractiona- tion of control does not exist in the nation’s better voluntary hospitals. Lastly, the nation-wide shortage of certain types of medical and supportive personnel prevents the delivery of the best possible medical care to veterans* Beyond the over-all shortage of both physicians, and graduate nurses, the need for psychiatrists, neurolo- gists, psychologists, specialists in tuberculosis, psychiatric nurses, physiotherapists, and social workers is particularly acute*. Vacancies for all kinds of workers with psychiatric patients (espe- cially psychiatrists) have necessitated deferment of construction of nearly 6,000 psychiatric beds which-are needed now., All projections point to an even greater future need. f. Costs and Personnel The cost of the medical, dental and hospital program in fiscal year 1948 was estimated by the Veterans Administration at $759,748,289, of which $616,540,251 was for inpatient care, $2,632,458 for research, $828,320 for education and training, $19,266,127 for general adminis- tration,, and $120,481,123 for outpatient services., A total of $1,241,509,688 has been allocated for all medical and hospital serv- ices for fiscal year 1949. 77 To operate this medical program, the Veterans Administration employed on June 30, 1948, 78,332 persons, of whom 3,536 were phy- sicians, 947 dentists, and 11,065 nurses, as follows! PERSONNEL EMPLOYED IE VETERANS ADMINISTRATION MEDICAL- PROGRAM June 30, 1948 All Medi- cal Program Personnel Pull- time Physicians ASTP Resi- V-12 dents Part- time Den- tists Nurses TOTAL 78.322 3.526 75 .1x868 2.872 947 11J m Admi ni s t ra t i ve£./ 1,130 140 - - 96 24 33 Outpatient Clinic & 10,418 1,141 7 32 1,134 554 147 Hospitals 65,370 2,237 68 1,836 1,642 356 10,1 370 Domiciles 1,404 18 - - - 9 8 &■/ Central Office and Branch Offices, b/ In regional offices. 2. Department of the Army Although there was a "beginning of military medicine in the Revolution under a Director General of a hospital, a definite corps of medical officers with a Physician and Surgeon General at its head wa.s not organized until the War of 1812. This corps was made a central "bureau under the title of Medical Department, headed "by a Surgeon General, in 1821* During the period "between the Civil War and the Spanish 78 American War the Army Medical Department pioneered in laboratory research and nreventive medicine, distinguishing itself particularly in cholera and yellow fever e-oidemics* A library, a medical museum and a medical school were established and greatly expanded for more effective work in military medicine, preventive medicine and sanita- tion. Following the turn of the century, separate hospital, nurse, medical reserve, dental and veterinary corps were organized. The necessities of World War X occasioned not only great numerical expansion but increased specialization. l) Organization The organizational position and relation- ships of the Medical Department to other branches of the military have been changed at least three times since the close of World War II.The most recent reorganization (Army Circular 64, March 10, 1948), defined medical service as a technical service comparable in position to the Quartermaster Corps, Corps of Engineers, and Ordnance.Department, and made the Surgeon General responsible to the Chief of Staff through the General and Special Staffs. The relationships between the Army Medical Department and the Air Force, under the provisions of the National Security Act of 1947, are less than clear. At present the Array Medical Department provides the Air Force with all medical personnel (on detail), the procurement, l/ It is understood that still another reorganization, which will place the Surgeon General under the logistics Division of the Department of the Array, is being contemplated and will be announced in November 1948. 79 storage and issue of medical supplies and equipment, and some other administrative services, including hospitalization in general hospi- tals.- The Air Force is now officially seeking authorization for an independent medical corps. The Surgeon General is a technical staff officer of the Head- quarters Department and commands a number of Class medical installations and activities, as follows: Army Medical Center (in- cluding Walter Heed General Hospital and the He search and Graduate School), Brooke Medical Center (including Brooke General Hospital and the Medical Pield Service School), twelve other general hospi- tals, three medical depots, five medical sections of general depots, Army Institute of Pathology, Army Medical library. Army Industrial Hygiene Laboratory, Medical Nutrition Laboratory, and the Medical Department Pield Research Laboratory. Although these installations are under the command of the Surgeon General, the Army Area commanders are responsible for providing such important services as food, laundry and cleaning facilities, repairs and utilities,.and alloca- tion of vehicles. The adequacy of these auxiliary services is a subject of controversy between the commanding officers of these installations and the Area Surgeons.- All other Army medical activities in continental United States are under the command of the commanding generals of the six field armies. These include 42 station hospitals, seven general dispen- saries, and field force medical units.- A Surgeon on the staff of l/ Class I installations are those under the commanding general of an Army or of the Military District of Washington. 80 each Army Commander controls the medical units and medical personnel assigned to that Army. The degree and directness of this control varies with the policy of the Commanders* Although he may, and is encouraged to, communicate directly with the Army Surgeons, the Surgeon General cannot send directives, on medical matters, except after clearance through the General Staff and issuance through com- mand channels, however professional or technical the subject matter. medical activities overseas are under the command of overseas or theatre commanders. The Surgeon General does not have control over Medical Depart- ment personnel. He classifies only medical and dental officers; the Adjutant General classifies veterinary, nurse, medical service, and women's medical specialist officers. The Surgeon General makes the initial assignment of all newly commissioned medical officers, either to specific stations in the Zone of Interior, to major com- mands overseas or on detail to the Air Force, evcept those assigned to Class II installations. At this point control over these medical officers passes into the hands of the Army area commanders, overseas commanders, or the Air Surgeon. Overseas commanders and the Air Surgeon may reassign officers within their command without reference to the Surgeon General. If the Surgeon General wishes to change the permanent assignment of any officers assigned to an Army Area installation, he must get the approval of the Army commander. Local commanders determine how medical officers assigned to their installa- tions are utilized. 81 Nor does the Surgeon General have control over Medical Depart- ment expendituresi Excluding the pay of military personnel and the cost of their routine travel (which are budgeted on an Army-wide basis), the Army Medical Department budgets only for approximately 56 percent of the cost of operating their installations and the Surgeon General directly controls only 60 percent of these budgeted funds. In effect, the Surgeon General controls only one-third the total expenditures required for medical services in the Army. Thus, the Surgeon General occupies an essentially supply position in the Army. Although his rank and title and the general public understanding of his position indicate that he controls Army medicine', he does not in fact control either all medical facilities, medical personnel, or medical expenditures. 2) Functions . The routine functions of the Medical Department include physical examinations of applicants for admission to, and members of, the Army, the. pres- ervation of health and prevention of disease among military per- sonnel, care of the sick and wounded, selection and training of Medical Department personnel, inspection of meats and dairy products, provision of medical supplies and equipment, and the conduct of re- search on military medical problems. Broadly, therefore, the mission of the Medical Department is the preparation of medical service to the Army in time of war and the conservation of manpower. In addition, medical care is provided to de-pendents of those in military service whenever facilities are available, and hospital care on a reimburseable 82 basis for beneficiaries of the Veterans Administration and, to a lesser extent, of the Havy and Public Health Service. On June 30, 1948 in the Zone of Interior there were 55 Army hospitals (14 general, 41 station) with a, total "bed capacity of 28,000 beds (19,300 in general hospitals, 8,700 in station hospi- tals), not including the 54 Air Force station hospitals. The general hospitals range in size from 100 to 2,700 beds and the station hospitals between 11 and 800 beds. On July .1, 1948, 16,142 natients (12,542 in general and 3,600 in station hospitals) were hospitalized in Army Medical Department facilities in con- tinental United States. About 70 percent of these patients were active duty Army and Air Force personnel. 3) Personnel Some concept of the variation in the total strength of the Medical Department may be gained from the comparative sizes of the component units, as follows: Strength of the Medical Department July 1, 1941 July 1, 1945 July 1, 1948 Mediepi Corps 1,210 44,924s/ 14,505s/ 4,353 Dental Corps 267 1,385 Veterinary Corps 126 2,040 380 Ku'rse Corps 1,280 54,291 4,317 Sanitary Corps Unknown Medical Administrative Corps Unknown 2,540 ) 19,635 ) 2,620 Dietitians and therapists Unknown 2,740 c/ Enlisted men Unknown 521,282 30,563 Women’s Army Corps - 18,885 i 115,000^' 25,000^/ Civilians Unknown jj\J Excludes those assigned to Veterans Administration, h/ Estimated. c/ The Women’s Medical Specialist Corps numbered 400, 83 The Array Medical Department is now facing an acute shortage of medical and dental officers* Although there were an estimated 4,350 medical officers on duty on September 30, 1948, 2,550 were graduates of the war-time Array Specialist Training Program* Be- cause of resignations and particularly because of the expiration of the period of obligated service of Array Specialist Training Program graduates, the total number of medical officers will be down to an estimated 2,700 by July 1, 1948,-. At the same time the total strength of the Army and Air Force will have increased to 1,335,000 through recruitment and the operation of the Selective Service System, The Army and Air Force would need nearly 6,300 officers on the basis of their standard requirements* Thus there will be a deficit of 3,600 medical officers* Although the Army and Air Force could get along with less than 6,300 medical officers, voluntary methods of recruitment will not supply this impending deficit# Since the close of World War II and the demobilization of civilian physicians from the armed services, the Medical Department of the Army has made a number of efforts to attract additional physicians from civil life# They have employed civilian physicians on a full-time and/or part-time basis; they have put on recruit- ment drives; they have expanded their training program, particularly for interns and residents; they have tried to shift administrative work to non-professional personnel; they have talked about a loan of physicians from medical schools for short terms of duty* and 84 they have set up a career management plan for medical officers •— all in an effort to make service in the Army Medical Department more attractive* Undoubtedly some physicians have been recruited but, broadly speaking, these efforts have failed and the Medical Department now faces increased obligations without any hope of being able to meet them with volunteers* Though not numerically comparable, Pn even more acute shortage will exist in dental offi- cers on July 1, 1949, 4) Costs The appropriation of $69,534,000 in fiscal 1948 for medical and hospital services of the Army, and of $75,126,163 in fiscal year 1949, does not include all items fairly chargeable to the Medical Department* It is estimated that in fiscal 1948 the real expenditure was about $161,000,000 for continental United States alone. 85 The first recognition of aviation medicine dates back to 191?. Prom 1926 to the start of World War II, all medical services were provided to Air Corps personnel by medical officers assigned by the Medical Department of the Army. During World War IX a semi-independent office of the Air Surgeon was created and medical personnel were recruited directly from civilian life ns flight surgeons, for service with Air Force personnel at air bases, training schools and station hospitals. 2a. Air Force Medicpl Department Under the unification act the Medical Department of the Army continues to provide personnel and general hospital care for the Air Force. On June 30, 1945 the total Medical Department strength assigned to the Air Surgeon was 54,457, and by June 30, 1948 it had decreased to 12,818f During the calendar year 1948 Congress authorized a sub- stantial increase in the total Air Force strength which will be re- flected soon in the total Air Force medical -oersonnel. Total Medical Strength of Air Force July 1, 1948 July 1, X945 Medical Corps 4,505 847 Dental Corps 2,598 427 Nurse Corps 3,387 542 Medical Service Corps 1,733 401 Veterinary Corps 261 58 Women’s Medical Specialist Corps 193 23 Enlisted men (Medical Department only) 32,871 8,479 Civilians 8f 909 2,041 86 The responsibility of the Air Surgeon with respect to medical officers assigned to the Air Force and to all Air Force personnel, their dependents, and civilians employed in Air Force installations is comparable to that of the Surgeons General of the Army and Havy, except that the Air Force operates no general hospitals. All per- sonnel requiring general hospital care are transferred to Army general hospitals and returned to the Air Force when medically ready for return to duty. Otherwise, the Air Surgeon is charged with the main- tenance of the mental and physical health of all Air Force personnel, the care of sick and injured, air evacuation, operation of station hospitals and supply activities, and the supervision and direction of training and research programs. Separate divisions have been established for fiscal, medical personnel, medical plans and services, care of flyers, research, professional services, and biometrics. On July 1, 1948 there were 54 Air Force station hospitals, ranging in size from 25 to 600 beds, with 2,583 patients in their operating capacity of 5,650 beds. About 77 percent of these patients were military personnel. The medical research activities of the Air Force are concen- trated at the Aero-Medical laboratory at Wright Field, and the School of Aviation Medicine at Randolph Field. Separate appropriations are not made either to the Air Surgeon or for the health and medical activities of the Air Force. They are included in the estimated expenditures of the Army Medical Department. 87 3, Public Health Service The Public Health Service is one of the eight units of the Federal Security Agency 1/ which has health and medical functions. It is the principal government agency for the promotion of the health of the general popi>- lation as distinguished from other agencies which are primarily con- cerned with special beneficiary groups. The Public Health Service dates from a single hospital “for the relief of sick and disabled seamen” authorised in 1798* The first broad grant of authority to carry on investigations into the diseases of man and the pollution of domestic navigable streams came in 1912, since which time Congress has consistently supported both research, leading ultimately to the establishment of the several research in- stitutes at Bethesda, and investigations and demonstrations in sani- tation, which culminated in the Stream Pollution Control Act in 1948. Since 1930, a very rapid expansion has occurred* General grants-in- aid to states for local public health services were provided by the Social Security Act of 1935, which also increased appropriations for research. The building of the National Institutes of Health in Bethesda began in 1936, and in 1937 the National Cancer Institute was created. A broad-scale attack on finding, treating, and controlling venereal disease was renewed in 1938, followed in 1944 by a comparable initial effort in the field of tuberculosis. l/ Seven other units of Federal Security Agency are presented below (page 123)• 88 During World War II the Service opened an experimental and control center for malaria, it administered an emergency nurse training program, and detailed numerous officers to the Army, Navy, civilian war agencies, and international organizations. Since the close of the war the pace of expansion has increased through new legislation for hospital construction, mental hygiene work, and dis- pensary care for federal employees, all in 1946* In 1948 Congress established research institutes in heart and dental diseases and passed stream pollution legislation* The chief executive officer of the Public Health Service is the Surgeon General appointed from the regular corps of commissioned officers by the President with Senatorial confirmation for four years* The Surgeon General selects his own deputy and six Assistant Surgeons General to servo as chiefs of each of the three (Medical Services, State Services, National Institutes of Health) operating bureaus, chief dental officer, chief sanitary engineer, and chief medical officer of the Coast Guard* ■ The Surgeon General is advised and assisted by a series of advisory councils. In addition to the National Advisory Health Council which is the general advisory group on all health policies of the Service, there are special advisory bodies in cancer, nentaJ. health, hospital construction, heart disease, dental disease, and water pollution control* Most of these groups advise primarily on research activities and grants. They are adviso- ry only. Further, the annual meeting of the Conference of State and Territorial Health Officers and the interim meetings of their committees 89 and subcommittees, provide the Surgeon General with direct contact with the advice and recommendations of the state health officers, mostly on program and grant-in-aid matters. In addition to operating 23 marine hospitals (two of which specialize in tuberculosis) for the general inpatient care of a dozen or more classes of beneficiaries (including principally merchant sea- men, Public Health Service and Coast Guard officers and enlisted men, lepers and narcotic addicts, Coast Guard dependents, and Bureau of Employees1 Compensation cases), outpatient care is provided through clinics in each hospital and at the offices of approximately one hundred designated -physicians in communities where there are no marine hospitals. Freedmen’s Hospital for the general medical care of negro residents in Washington is organizationally within the Public Health Service, although it is the teaching facility of Howard University, a federally aided corporation supervised by the Federal Security Agency. In June 1948 the 23 marine hospitals, two mental hygiene hospi- tals and the Leprosarium had 7,300 patients in 10,240 beds* Ho spitals Capacity . Humber of Beds Operating Patients Remaining TOTAL 26, 9,143 10.240 7.300 Marine general hospitals 21 5,752 6,598 4, 538 Marine tuberculosis hospitals 2 487 537 435 Let) rosarium 1 454 538 404 Mental hygiene hospitals 2 2,450 2,567 1,933 90 During the fiscal year 1948, 444,700 outpatients were treated and an estimated 161,000 physical examinations given. Almost 60 per- cent of the outpatients treated and nearly half of the physical exam- inations were handled in outpatient departments of the hospitals. The mental hygiene work of the Public Health Service consists largely of promotional activities and the supervision of two mental hospitals. The recent National Mental Health Act of 1946 (Public Law 487, 79th Congress) created a special advisory council and authorized a National Institute of Mental Health for research in mental illnesses, training grants to augment the national shortage of specialized mental, health personnel, and grants-in-aid for the encouragement of mental health clinics* Quarantine officers, to prevent the importation of dangerous communicable diseases and vectors, work out of 219 ports. They inspect passengers, crews, cargo and water, air and land transport vehicles arriving in this country. Examinations of prospective immi- grants are conducted at ports abroad and at points of arrival in this country, on behalf of the Immigration and Naturalization Service. The Randolph Federal Employees Health Act of 1946 (Public Law 658, 79th Congress) authorized federal agencies to establish industrial- hygiene type medical services for their employees. Requests to the Service to undertake the actual operation of such clinics (reimburse- able) have reached 17 health units for most of the Washington agencies. The services are limited to treatment of on-the-job illnesses and dental emergencies, pre-employment and other physical and mental examinations, referrals to private physicians and dentists, and limited preventive measures. 91 The Public Health Service details medical, dental and nurse officers to provide direct services to the officers and enlisted men of the Coast Guard, inmates of federal penal and correctional institu- tions, trainees of the Maritime Commission and the Merchant Marine Cadet Corps, the Bureau of Indian Affairs, Foreign Service Division, Bureau of Employees’ Compensation, Office of Vocational Rehabilitation, and Social Security Administration* Most of the health grants-inlaid to states are administered by the Bureau of State Services. In addition to grants-in-aid, services to states include consultations, demonstrations, training, and the compilation and exchange of information* Although the technical con- tent of some programs is formulated in other bureaus (mental hygiene, cancer and stream pollution control), the management of all financial and administrative matters relating to grants is done in a single Bureau. In addition to grants—in—aid for such categorical programs as venereal disease, tuberculosis, hospital facilities, and industrial hygiene, the Service also makes continual studies to improve existing preventive and treatment methods, confers with state and local health officials on more effective organization and use of existing knowledge, lends trained personnel to states, conducts demonstrations, gathers and publishes statistical data, and works in collaboration with public and private groups. The main job of the Atlanta Communicable Disease Center, successor to the malaria control center, is to assist state and local authorities 92 in the intra-state control of insect and animal-home communicable diseases, particularly at present malaria, typhus and hookworm* Supplies, equipment, personnel and technical aid are provided to the states* It also maintains several semi-mobile field stations, a specialized laboratory for plague suppression for field and labora- tory investigations, demonstrations with mobile and other units, DDT spraying and dusting, training of personnel, and preparation of films and posters* Within the last few years two special aid projects have been organized, one for the rehabilitation of health facilities and sen- vices in the Philippine Republic and the other for the development of health and sanitation services in the Territory of Alaska* The former will involve over $5,000,000 in a four-year period and the latter is just beginning with a $1,115,000 appropriation for fiscal 1949, In both causes the aid will be largely in the form of grants for training personnel and for supplies and equipmentand the pro- vision of technical advice and guidance. Over $40 million was distributed to states as grants-in-aid in fiscal 1948, as follows: TOTAL $43,856,805 Venereal disease control 13,953,993 G-eneraJ. health, sendees 11,217,039 Tuberculosis control 6,790,000 Cancer control 2,500,000 Hospital survey 574,140 Hospital projects authorized 5,827,633 Mental health 3,000,000 93 /Another $20 million of grants-in-aid for maternal and child health, for crippled children’s services, and for the terminal phases of the wartime Emergency Maternity and Infants Care program, are ad- ministered hy the Children’s Bureau of the Social Security Administra- tion* An additional $2,171,000 in grants to states, part of which is for health and medical services, is administered hy the Office of Vocational Rehabilitation/, The National Institutes of Health, headquartered in nine buildings in Bethesda, Maryland, but with several field stations elsewhere, are the principal research unit of the public Health Service. The intramural program of the Institutes is primarily in basic and background research in the medical and biological sciences but there is also an extensive program of grants-in-aid to individual scientists and laboratories for research projects and for advanced training. A central division administers all grants and fellowships on advice from 21 advisory councils made up of approximately 250 scientists from universities and private laboratories from all over the country. The National Institutes of Health are in the process of re- organization and enlargement into eight centers along the lines of the National Cancer Institute, xdiich has been the largest single unit since 1937. An Experimental Biology and Medicine Institute was established in 1947 to include work in chemistry, biochemistry, nutrition, pharmacology, and pathology. A Laboratory of Physical Biology In the process of organization will carry on research in 94 high and. low energy radiation, molecular physics, cell metaholism, viruses and large proteins, membrane functions, and high altitude biology., in some of which work there will continue to be collabenac- tion with the Oak Ridge Laboratory of the Atomic Energy Commission* A new Microbiological Institute has been blueprinted to concentrate on the growth and metabolism of microorganisms and to absorb the work of existing laboratories in infectious diseases, including the Rocky Mountain Laboratory at Hamilton, Montana, in tropical diseases, and in biologies control. The present Biologies Control Laboratory is engaged primarily in research and testing incident to the regulation and inspection for safety, purity, and potency of vaccines, serums and other biologies in interstate commerce. The inspection of manu- facturers1 laboratories and the routine testing of specimens of manufactured biologies are essential to licensing of the laboratories by the Federal Security Administrator, Recent legislption authorized separate institutes for research in heart diseases (Public Law 655, 80th Congress), dental diseases (Public La,w 755, 80th Congress) and mental illnesses and a. 500-bed clinical research hospital. In addition to those staff or technical services which serve all the units of the Service, the Office of the Surgeon General includes an assortment of divisions which do not conveniently fit into other bureaus. This has been one of the focal points of the Surgeon General1s Committee on Organization which has been reviewing the internal organization of the entire Service for several months. 95 The chief medical officer of the Coast Guard is nominally attached to this office and it also includes a new Health Emergency Planning Unit (for disaster and emergency planning in cooperation with other federal agencies) and the intramural Research Planning Council. At present separate unite also exist for staff leadership and direction in dentistry, sanitary engineering, nursing, vital statistics, statistical research and -planning, intematicna.1 health relations, and other mere typical staff services as commissioned officers, personnel, "budget and finance, purchase and supply, and management services. The Public Health Service obligated in fiscal 1948 $126.7 • million, of which nearly $43*9 million was distributed to states for public health work and about $15 million allocated to extramural research grants and fellowship training. There were 1,289 (l,043 commissioned) physicians, 202 (199 commissioned) dentists and 1,951 (473 commissioned) nurses employed, including 123 physicians, 49 dentists and 24 nurses on detail to other agencies* 4« Department of Navy Medical activities in the Navy date back to the commissioning of the first American fleet in 1775* A Surgeon General was authorized in 1841 and the Bureau of Medicine and Surgery created in 1842, Between 1898 and 1912 p.n enlisted force, a medical school, a Nurse Corps, and a Dental Corps were established. The Army-Navy Medical Service Corps Act of 1947 (Public Law 337, 80th Congress) gave corps status to hospital specialists, research scientists and other supportive scien- tific personnel. 96 The medical department now consists of a Medical, Dental, Medical Service, Nurse, and Hospital Corps (enlisted personnel). Internally, the Bureau, of Medicine and Surgery consists of the Chief, his Deputy, General Inspectors for the Medical Department and the Dental Service, four administrative divisions (Administra- tion, Finance, Medical Statistics, and Publications), and five Assistant Chiefs for research a,nd medical military specialties, per- sonnel and professional operations, dentistry, planning and logistics, and aviation and operational medicine. The functions of the Bureau of Medicine and Surgery consist of the. establishment of physical and mental standards for selection and training of naval personnel, of Navy and Marine Corps personnel, including the care of sick and injured, the procurement, training, administration and assignment of all medical personnel, and the operation of naval hospitals, medical supply depots, laboratories and technical schools. The Chief of the Bureau is a technical ad- visor to the Secretary of the Navy and to the Chief of Naval Operations. The organizational position of the Surgeon General of the Navy is considerably stronger then that of the Surgeon General of the Army because of the difference in fundamental philosophy of the principle of command* The Navy concept of command recognizes command as having four components (military command, technical control, coordination control, and management control), whereas the Army concept is limited to military command alone. Accordingly, the Surgeon General of the Navy exercises direct military command over some medical installations, 97 technical control over all medical activities and medical personnel, and management control over all medical installations. Moreover, except for pay and routine travel, the Surgeon General of the Navy budgets for and controls approximately 80 percent of the medical expenditures of the Navy. The primary duty of the Bureau of Medicine and Surgery is to provide medical services for the officers and enlisted men of the Navy and Marine Corps, In addition medical care is provided to de- pendents of Navy and Marine Corps personnel and to other supernumer- aries, such as Navy civilian employees and Navy contractors and their dependents at overseas stations, fleet reserve and retired personnel, and widows (not including children) of active duty personnel killed in action. The gross total of all these beneficiaries, world-wide on June 30, 1948 was slightly more than one million, including 492,771 active duty personnel. Nearly 735,000, including 268,419 active duty personnel, were in continental United States. On June 30, 1948, the total active duty strength of the Navy and Marine Corps totaled 492,577. The strength of the Medical Depart ment was as follows: Medical Corps 2,497 Dental Corps 956 Medical Service Corps 812 Nurse Corps 1,952 Hospital Corps (enlisted) 15,002 Civilians 8,700 98 The 2,718 medical officers on duty on September 1, 1948 was 485 less than the official Navy requirements, based on 6*5 medical officers per 1,000 active duty personnel in the Navy and Marine Corps (Public Law 381, 80th Congress), Through resignations and the expiration of the period of obligated service of graduates of the V-l2 program the Navy will lose 600 medical officers by July 1, 1949, At the same time the active -duty strength of the Navy and. Marine Corps is expected to increase to 592,000 by July 1, 1949, Thus a deficit, according the standard of 6*5 per 1,000 strength, will be over 1,700 medical officers. Although the Navy efforts have not been as extensive as those of the the Navy has made some efforts in the direction of increasing the attractiveness of the Medical Corps, but the result has been identical, namely voluntary recruitment efforts have failed to enlist an appreciable number* Like the Army, the Navy faces the necessity of drafting physicians to more nearly meet their minimum needs* Although not as great numerically, an even more acute shortage of dental officers exists now and will exist on July 1, 1949* As of July 1, 1948 the Navy was operating 127 hospital facili- ties in the continental United Sta.tes (26 hospitals, 101 dispensaries) with an operating capacity of 24,502 beds* The hospitals ranged in size from 150 to 1,750 beds and the dispensaries from four to 522 beds. In addition, the Navy hag two hospital ships. In addition to the research contracts administered by the Office of Naval Research, medical research is conducted in several installa- tions of the Bureau of Medicine and Surgery, especially the Naval Medical Research Institute at Bethesda, Institute of Tropical Medicine on Guam, the Medical Field Laboratory at Camp Lejeune, and a research unit at Great Lakes, Illinois, specializing in rheumatic fever and streptococcal diseases* Research under the technical control of the Bureau is also in progress at installations under other commands, such as Medical Research Laboratory at Hew London (Bureau of Ships), Experimental Diving Unit at Naval Gun Factory (Bureau of Ships), School of Aviation Medicine at Pensacola, Aero~Medical Laboratory at Philadelphia, and the Physiological Test Section at Patuxent (Bureau of Aeronautics). Research is also supported in Naval hospitals and at training stations* The appropriation of $37,500,000 in fiscal 1948 for medical and hospital services does not include all items fairly chargeable to the Medical Denartment. The Navy estimated that the total cost in fiscal 1948 was $88,384,982 (including $4,440,292 for the Office of Naval Research). 100 III. SUMMARY OF PRESENT HEALTH ACTIVITIES BY AGENCY B. Other Federal Agencies 1# Executive Office of the President ■a. National Security Resources Board b* Interdepartmental Committee on Scientific . Research and Development c. Bureau of the Budget 2, Department of State a*. Office of International Trade Policy b* Office of the Foreign Service c. Institute of Inter-American Affairs 3. National Security Establishment a. Research and Development Board tu Office of Naval Research 4* Department of Justice a» Bureau of Prisons b* Immigration and Naturalization 5* Department of Labor at Bureau of Labor Standards 6. Department of Treasury a* Bureau of Narcotics b, . Coast Guard 7* Department of Commerce a* Civil Aeronautics Administration 8t Department of Agriculture a. Agricultural Research Administration b. .Farmers Home Administration c* Farm Credit Administration d, .Production and Marketing Administration e# Cooperative Extension Service f. .Bureau of Agriculture Economics g* Office of Personnel 9. Department of Interior a* Bureau of Indian Affairs b. Fish and Wildlife Service c. Bureau of Mines d# Bureau of Reclamation 1) Hoover Dam 2) Grand Coulee Dam 10. Federal Security Agency a. Bureau of Employees’ Compensation b. Food and Drug Administration cf* Office of Vocational Rehabilitation d. Howard University and Freedmen’s Hospital e'« Social Security Administration, Children’s Bureau f. St". Elizabeths Hospital g. Office of Education 11. Tennessee Valley Authority 12. Federal Trade Commission 13. Civil Service Commission 14. Atomic Energy Commission 16,. Maritime Commission 16. Federal Works Agency 17. War Assets Administration 18. Selective Service System 19. Post Office Department 2Q. Housing and Home Finance Agency 102 1. Executive Office of the President The National Security Re sources Board, estab- lished by the National Security Act of 1947 (Public Law 253, 80th Congress) is part of the Executive Office of the President* The 3o?rd is composed of a chairman, appointed from civilian life by the President with the consent of the Senate, and representatives of federal agencies as designated by the Presidentf A chairman was named on September 26, 1947, and in Executive Order 9905, the President appointed as members the Secretaries of Treasury, Defense, Interior, Agriculture, Commerce and Labor, to which the Secretary of State was later added (Executive Order 9931). a* National Security Resources Board Medical Division The purpose of the Board is to advise the President on the coordination of military, industrial and civilian mobilization on such broad problems as manpower, natural and industrial resources, relocation of facilities, and implications of mobilization to the civilian economy* Within the Bureau of Human Resources a Medicad- Division has been established and, although its official mission has not been formalized, a small technical staff has been organized to consider resources and mobilization problems in areas of medical man- power, medical supplies, physical health facilities, sanitary ing, and nursing* An advisory committee ha.s recently been appointed* The medical program is still in process of formulation* During fiscal year 1948 the activities of the Board were financed by a transfer of funds from the Army and Navy* Eor fiscal year 1949,, the President’s request for $4.5 million was reduced by Congress to $3 million, of which approximately $60,000 ha,s been allocated to the Medical Division* h. Interdepartmental Committee .on Scientific Research and Development Executive Order 9912, December 24, 3,947, estab- lished the Interdepartmental Committee on Scientific Research and Development as recommended by the President's Scientific Research Board (Steelman Committee), The essential finding of the Board was that the existing agencies for the broad promotion and for the coordination of scientific research in federal agencies were inadequate. The Committee was established to study and to recommend ways and means of improving the effectiveness of federal research and development. It has no operating responsi- bilities. The Committee is composed of representatives of the Departments of Agriculture, Commerce, Interior, Army, Navy, Air Porce, National Military Establishment, and of the following independent agencies: Federal Security Agency, Atomic Energy Commission, Veterans Adminis- tration, National Advisory Committee for Aeronautics, and the Smith- sonian Institution, The chairman of the Committee, designated annually by the President, is authorized to establish subcommittees which may include persons from outside the federal government. Subcommittees, including nongovernmental members, have been created on Scientific Personnel, Selective Service, Budgetary Procedures, and Grants and Contracts, 104 The Committee has held only a few meetings and had no "budget during fiscal 1948, It had only such staff services as the members and subcommittee chairmen contributed on a volunteer basis* c* Bureau of the Budget The Bureau of the Budget was established in 1921 to act as a staff agency to the President and, specifically, to prepare the annual budget for the Executive Branch (with authority to revise, reduce or increase estimates submitted) and to make detailed studies of the departments and agencies to effect economy and improve effi- ciency* Among the major divisions of the Bureau are the Administrative Management Division and the Estimates Division. The Estimates Divi- sion is organized on an agency basis so that the same group of budget examiners hear and pass on the budget requests of the same agencies year after year, thereby becoming quite familiar with the organization, functioning, urogram objectives and needs of the operating agencies. The only unit of the Estimates Division which is organized on a functional basis is the Hospital Branch which has responsibility for both budget review and the coordination of the hospital programs. The Hospital Branch not only reviews estimates but also has a staff for analysis of administrative management problems in medical and hospital services* During the fiscal year 1948 the Hospital Branch had 18 em- ployees, 11 of whom were administrative and budget analysts* The 1948 budget was $109,500* 105 2. Department of State A Health Branch in the Division of Labor, Social and Health Affairs was established in 1945 to provide a mechanism for carrying on United States interests in the international health work formerly handled by the health organization of the League of Nations and to fill the interval until the creation of a new official international health organization. This Branch is essentially the official center of the State Department in health matters and its most important work has been connected with the development of the World Health Organization. The staff of the Health Branch consists of two medical officers, detailed from the Public Health Service, two assistants and a secretary* Its budget is not segrega.ble from other activities of the Division but is very small. b. Office of the Foreign Service Prior to the amendment of the Foreign Service Act in 1946 (Public Law 724) authorizing the Secretary of State to pay for medical and hospital treatment, patient transportation, peri- odic physical examinations, inoculations and vaccinations of Foreign Service officers and employees, the staff of the United States missions abroad were without any authorized system of medical care. a* Office of International Trade Policy During 1947 a Public Health Service officer was detailed to the State Department as Medical Director of the Division of Foreign Service to organize a program of medical and hospital care for personnel of embassies, legations and consulates of the Foreign Service, and for 106 employees of other federal agencies on foreign duty. The first appropriation of $190,000 was made for the fiscal year 1949. c* Institute of Inter-American Affairs The Institute of Interv- Araerican Affairs has had an intricate legislative and corporate history. Created originally under the laws of Delaware in March, 1942, pursuant to authority from Congress, in order to carry out a resolution for the Mimprove- ment of health and sanitary conditions'1, adopted at the Rio Conference in January, 1942, the Institute became a part of the office of the Coordinator of Inter-American Affairs during the war, It was re in- corporated' in August, 1947 (Public,Law 369) for three years unless sooner dissolved by act of Congress, The essential program of the Institute in health and sanitation has been the lending of financial aid and trained and experienced personnel for the planning, construction and operation of such pro- jects as hospitals, health centers, laboratories* nursing schools, water supply systems, malaria control projects and other community sanitation work. Prom its inception through March, 1948* nearly 1,900 special projects or "activities" were inaugurated; more than two-thirds had been completed and 637 were still active* Agreements have been made with all American Republics except Argentina* and work was still in progress in 14 countries in March 1948* Originally, emphasis was placed on work in strategic areas such as those in which critical materials were produced or near where United States military forces were located; later the con— 107 struction of physical plants for hospitalization, malaria control, and sanitary facilities were given priority; more recently the program has concentrated on service projects, including demonstra- tion centers, the control of special diseases and the training of professional and technical personnel. In addition to organizing and conducting local training courses, over 1,100 professional nationals have received grants for study in this country. On June 30, 1948 Field Parties at work on Institute projects included 127 United States citizens, of whom 13 were physicians, 38 were engineers, and 30 were nurses. The Washington office of the Health and Sanitation Division consisted of approximately 20 persons for the review of agreements, control of expenditures, and the re- ceipt and analysis of monthly reports. From the "beginning of the program in March, 1942, through June, 1950, the presently anticipated termination date, it is esti- mated that the Institute will have expended approximately $54,000,000 under bilateral health agreements. The program has been scaled down to an average annual expenditure of approximately $6,000,000 during fiscal years 1947 and 1948. Anticipated expenditures for fiscal year 1949 are $2,990,819, including $94,733 for administrative and travel expenses. At the outset the Institute contributed the greater — even entire — share of the funds for each project but it has been the studied policy to bring about a graduated decrease in the contribu- tions of the United States with a corresponding increase on the part of the other governments* 108 3* National Security Establishment l/ The He search and Development Board is the successor in lav; of the Joint Research and Development Board, created by joint direc- tive of the Secretaries of War and of the Navy in 1946, and of the unliquidated activities of the wartime Office of Scientific Research and Development under the terms of Executive Order 9913, December 26, 1947. Its purpose is to advise the Secretary of Defense on scientific research in relation to national security, including specifically the preparation of an integrated research program, measures for the coordination of research work and programs among the military depart- ments, and recommendations on the relationship of research and devel- opment. Immediately, the several committees are advising the armed forces on the content and method of accomplishing their research program. a* Research and Development Board The Board functions through a limited sec rets,riat and 16 adviso- ry committees, including a Committee on Medical Sciences* The Cor&- mittee on Medical Sciences follows the standard pattern of three civilian members, including the chairman, and two representatives from each of the three military departments. The Public Health Ser- vice, Veterans Administration, and the National Research Council have been invited to designate associate members. The Committee staff 1/ The Medical Departments of the Army, including Air Eorce, and of the Navy are discussed above (page 7?) under Major Federal Agencies. 109 includes a secretariat consisting of three civilians, and one representative from each of the armed services. Funds for the Board were provided from Army and Navy funds during fiscal year 1948; in the fiscal year 1949, out of an appropriation of $1,776,929 for the Board the estimated allocation to the Committee on Medical Sciences will be $75,000, Originally authorized by order of the Secretary in Nay, 1945, the Office of Naval Research was formally established by law in August, 1946 (Public Law 588} in the Office of the Secretary of Navy. The principal executive officer, the Chief of Naval Re- search, is appointed by the President from within the Naval Service. At least one of the 15 members of the civilian Naval Research Ad- visory Committee, appointed by the Secretary, must come from the field of medicine. The operating programs of the Office are directed by three assistant chiefs through nine divisions, one of which is the Division of Hedical Sciences. This Division, in turn, has branches directly supervising its work in biochemistry, microbiology, psychology, human ecology, biophysics, and dentistry. b. Department of Navy Office of Naval Research The Office of Naval Research does not operate or manage any research facilities. Its functions are advisory to all branches of the Navy, including the Bureau of Medicine and Surgery, and it is the central contracting unit for all Naval research with individuals or institutions, principally industrial laboratories and colleges 110 and universities* All proposed research projects in the medical sciences, both by Navy offices seeking to inaugurate studies and by outside scientists seeking support, are submitted to the Division of Medical Sciences for advice and evaluation* The Division evaluates the proposals either through its own staff of about 25 persons, half of whom are professional, or refers them to the Bureau of Medicine and Surgery and/or the Naval Medical Research Institute for comment. Daring fiscal year 1948 the Office of Naval Research spent $2 million of their own funds, mostly in basic science research, and $2*4 million transferred from other agencies. An estimated $2 of the $43.5 million appropriated to the Office of Naval Research for fiscal 1949 will be spent for medical science research. 4* Department of Justice a* Bureau of Prisons At each of the 26 penal and correo- tional institutions, and in the Medical Center at Springfield (Missouri) operated by the Bureau of Prisons, a, complete medical service is provided by personnel detailed by the Public Health Service on a. reinburseable basis* The average prison population was 18,000 in the fiscal year 1948* There were 1,142 beds at the Springfield Medical Center and 1,063 beds in the infirmaries connected with the other institutions* The total prison- ers handled during the year were nearly 34,000. The medical program at each institution is necessarily complete and self-contained because of the impracticability of transferring prisoners to civilian or other federal hospitals* Tile acute nation-wide shortage of psychiatrists has hampered the development of care in these institutions and efforts are being made to get residencies in neuropsychiatry at the Springfield Medical Center approved. At the end of July, 1948, 350 detailed personnel from the Public Health Service were on duty at federal penal and correctional institu- tions, including 53 medical officers, 22 dental officers, 22 nurses and seven psychologists* Congress appropriated Si,497,000 to the Department for medical and hospital services for fiscal 1949 of which $1,356,850 was marked for transfer to the Public Health Service. Estimated obligations for fiscal 1948 were $1,486,645. The Bureau of Immigration, originally established in 1891, wps transferred to the Department of Justice in 1940* The Immigration and Naturalization Service performs no direct medical or health services. Immigrant aliens are given examinations at ports of entry by the Foreign Quarantine Division of the Public Health Service. During the fiscal year 1947, 571,000 aliens were examined. b* Immigration and Naturalization Service Immigration and naturalization patients are hospitalized on a reimburseable basis in the hospitals of the Public Health Service. During fiscal year 1948, 1,714 immigrant aliens were hospitalized. Alien immigrants are also given outpatient care and physical examina- tions at Public Health Service stations. 112 5* * Department of Labor The Safety Standards branch of the Bureau of Labor Standards gives technical advice and assistance on request to trade associations, labor organizations and trade unions on safety codes and problems, publishes training and safety bulletins, and pamphlets on chemical hazards. Its functions arc wholly advisory; it has no operating responsibilities. In fiscal year 1948 its estimated obligations were $53,220 of the Division’s estimated $342,900. The staff is composed of seven permanent employees. a* Bureau of Labor Stpndards 6* Department of Treasury Bureau of Narcotics The Bureau of Narcotics was established in 1930,. It conducts investigations for the detection and prevention of violations of the laws relating to narcotic drugs and. marihuana* determines, in cooperation with the Public Health Service, the quantities of crude opium and coca leaves to be imported for medical and other legiti- mate uses; issues permits to import the crude drugs and to eucport the drugs and derivative preparations; cooperates with the Depart- ment of State in international obligations concerning the drug traf- fic, particularly the Narcotic Limitation Convention of 1931; cooper- ates with state and local enforcement agencies in suppressing abuses of narcotics and marihuana* During the fiscal year 1948 the Bureau obligated approximately $1,430,OCX) through a total staff numbering 292, of which 225 are assigned to the Bureau’s 16 field stations in the United States and Hawaii* 113 h* Coast Guard The Coast Guard is a unit of the Treasury Department during peacetime hut is inte- grated into the Navy during war. The -total Coast Guard strength approximates 20,000 men, including 2.,600 officers, and a small Hos- pital Corps of about 200, All medical and hospital services are either arranged for or furnished hy the Public Health Service.. Coast Guard personnel receive medical and dental treatment and hospitalization at the marine hospi- tals and outpatient facilities of the Public Health Service and through contract hospitals and designated physicians. Coast Guard dependents are eligible for medical care on the same basis as Navy personnel. During the fiscal year 1948, 7,070 Coast Guard personnel were hospi- talized; 36,329 received outpatient treatments and 12,663 were given physical examinations; 2,133 dependents were hospitalized and 15,788 dependents received outpatient care. Medical and hospital care for Coast Guard personnel and depend- ents are not accounted for separately by the Public Health Service. The Coast Guard estimated its obligations for medical and hospital services at about $600,426 during fiscal year 1948. 7. Department of Commerce The Medical Division of the ■Civil Aeronautics Administration Office of Aviation Safety supervises physical examinations required of all civilian pilots. The examination of student and private pilots may he made hy any qualified physician, and any except commercial pilots may he examined hy some 2,500 designated private physicians. Examinations for commercial pilots may he made only hy the 150 physicians who have had training as flight 114 surgeons who have been designated by the Administrator. For the fiscal year 1948, about $195,000 was spent by the Medical Division by a staff of two physicians and three physiologists in the central office and a regional medical officer in each of the nine regions. 8. Department of Agriculture None of the constituent units of the Department of Agriculture has any responsibility for direct medical or hospital services, but several units are engaged in either research or regulatory activities which relate to health and for which an estimated $16.5 million was expended in fiscal 1948, Within the Bureau of Human Nutrition and Home Economics the Ecod and Nutrition Division conducts research concerned with the composition and nutritive value of foods, the nutritional and food requirements of man, improved methods of food preparation, and the economy and nutritional adequacy of family diets. The Family Econo- mics Divisions work includes efforts to improve standards of hygienic living within the home* a. Agricultural He search Administration The Bureau of Animal Industry is concerned with the treatment and prevention of animal diseases, many of which directly affect the health man. The Bureau administers federal animal quarantine and inspection acts which involve regulatory inspections of all meat in- tended for interstate shipment, control of biologies intended for treatment animal diseases, examination of all livestock entering 115 the country, inspection and testing of animals intended for export, and the inspection and disinfection of a.ninal hy*-ptcdufcts* There has been an outstanding record of discoveries in the transmission of diseases "by insects, effect of “bovine tuberculosis on man, including design of tuberculin tests, livestock diseases transmittable to man, such as trichinosis and other parasitic diseases, and such milk-borne diseases as undulant fever. Because the research-work of the Bureau is primarily pointed toward improvement of the health of livestock, it is not possible to segregate the portion of its expenditures which are even indirectly related to the public health. The annuel expenditures for the Meat Inspection Service have more than doubled since 1940 and in fiscal year 1948 reached $11 million, about $5 million of which was received from nonfederal sources*• Since 1942 the Bureau of Agricultural and Industrial Chemistry has carried on research in chemistry, physics, and biology in relation to agricultural products and in efforts to find new uses for them. Its work in relation to health is incidental but has included signi- ficant discoveries in the increased production of penicillin, a new antibiotic tomatin, the development of subtilin and rutin, and the production of vitamins from agricultural products* The Office of Experiment Stations, established in 1887, admin- isters federal grants and research contracts for agricultural research* During fiscal 1948 more than 45 research projects in nutrition and in rural health were in progress from an appropriation of $194,000 for research projects in the general field of health* 116 Two major divisions of the Bureai of Dairy Industry* namely the Division of Nutrition and Physiology and the Dairy Products Re- search Laboratories Division, conduct chemical, bacteriological, nutri- tional and technological investigations in the production and handling of milk, dairy products, and the manufacture of renovated butter. The Bureau of Entomology and Plant Quarantine, conducts research on insects which are vectors of human diseases and insect pests and plant diseases that threaten food production. The control of insects which carry malaria, dengue, typhus, filaria, plague, Rocky Mountain Spotted Never, and various intestinal diseases are fundamental to health protection. Promising antibiotic agents have recently been found by the Division of Bee Culture in cooperative work with the Public Health Service. Nor fiscal year 1948 $68,800 was appropriated for health and related activities. The Bureau of Plant Industry, Soils and Agricultural Engineering* is engaged in research which touches health only, through its work on methods for the improvement of crop and soil management to supply a higher quality of feeds and vegetable oils* and on the culti- vation of medicinal plants* condiments and insecticides* b. Farmers Home Administration The primary function of the Farmers Home Adminis- tration is the extension credit to low-income farmers. Loans may be used for the cost of medical care and helping the family to meet its needs in general health* sanitation* and health education, and until recently this agency provided a. number of health services in- cident to making and servicing loans* 117 c. Farm Credit Administration The health activities of the Farm Credit Adminis- tration are incidental to the assembling of information of specialized rural health cooperatives and other health programs in which farm cooperatives participate. In this capacity it collects and makes analyses of costs, benefits, and general effectiveness of prepaid medical service or medical insurance plans as used by rural coopera- tives. The Production and Marketing Administration includes four branches which provide services related to health: the Dairy Branch and the Poultry Branch develop standards and inspect foods for whole- someness and the Livestock Branch has regulatory powers over the manufacture of insecticides, fungicides, rodenticides and disin- fectants; and the Pood Distribution Programs Branch administers a school lunch -program under which grants made to states for food and equipment purchases must be matched dollar for dollar, (During the fiscal year 1948, $87,2 million was spent for the school lunch pro- gram, for grants to the states, and for direct operations*) d* Production and Marketing Administration The Cooperative Extension Service is the primary educational and promotional unit of the Department and it is the distributing agent for all technical knowledge developed in the Department, Its prin- ciple educational efforts with respect to health are pointed toward food and nutrition, home and environmental sanitation, rural health services, and livestock disease control*' e. Cooperative Extension Service The work of the Bureau of Agricultural Economics is al- most entirely concerned with the compilation,, study and reporting of agricultural statistics** In relation to health,, data are gathered on farm accidents ahd their economic significance in relation to production, the distribution of physicians, dentists,, and related health personnel in rural communities, available medical services,, the incidence of disease and death rates in rural areas*- fV Bureau of Agricultural Economics g#- Office of Personnel A Division of Employee Health has recently been organized in the Office of Personnel to provide pre-employment physical examina- tions* emergency treatments for on-the-job illnesses,., nreventive services* and referral to other health agencies and to private prac- titioners of Department employees in need of health care. 9. Department of Interior pi Bureau of Indian Affairs The Bureau of Indian Affairs exorcises a trusteeship in Behalf of, and provides nearly all public services including health and medica.1 services to* an estimated 400,000 Indians in continental United States and S3,000 Indians, Eskimos and Aleuts in Alaska* The Division operates 58 hospitals and sanitoria, ranging from 10 to 335 beds* in United States and eight in Alaska* Eight additional domestic hospitals give only 1 or outpatient service. The bed capacity of the continental hospitals is 3,864, of which 1,066 are tuberculosis beds* The present policy is to move toward closing the federal hospitals 119 "by increasing contracts with community hospitals and private physicians* Contracts are presently in effect with about 80 public and private hospitals* Infirmaries are operated at a number of Indian boarding schools* There is an almost universal lack of sanitary facilities, and an extremely high prevalence of venereal tuberculosis and trachoma* The principal supervisory medical positions in the Washington and the four field offices are filled by officers detailed by the Public Health Service but the great majority of the hospital staff are .re- cruited through the civil service* The medical program at present has 2,200 employees, of vrhich 110 are full-time and 85 part-time physicians, 13 are full-time and five part-time dentists, and about 500 nurses* There is a chronic shortage of all professional personnel* Pop health and medical services the Bureau expended $9,038,179 in fiscal year 1948; estimated obligations for 1949 are $12,118,426* b. Fish and Wildlife Service The primary function of the Fish and Wildlife Service is the conservation of land and water mammals, fish, shellfish and birds, but it also carries on incidental health activities in such areas ns stream and lake pollution, fish biology, and wildlife and fishery re- search. Although the Service has regulatory control over the issuance of permits for the importation of foreign wildlife, the regulations governing importation of disease-bearing birds and animals are formu- lated by the Public Health Service. 120 Research includes studies in the nutritive value offish and fishery products, vitamins,, the toxic properties of fish and shell- fish, and the sewage pollution of shellfish areas*- The Service, incident to its work with the Alaska, fisheries and the Pribilof Islands fur seal and fox herds, provides medical care to the inhabitants of the Islands (who are virtual wards of the govern- ment) and for the Serviced own permanent employees there,. The offi- cers and crews of the vessels of the Service are entitled to complete medical, surgical and dental treatment and hospitalization at Public Health Service hospitals* During the fiscal year 1948 the Pish and Wildlife Service ob- ligated $28,739 for medical care on the Pribilof Islands*. One eight- bed hospital is maintained and two doctors, °ne dentist,, and one nurse are employed*. c*. Bureau of Mines In the health and safety field the activities of the Bureau of Mines are primarily preventive in character in that emphasis is placed on acci- dent prevention* Research includes studies on dusts,, toxic and ex- plosive gases,., and the development of respiratory protective devices*. One of six operating divisions of the Bureau, the Division of Health and Safety has separate organizational units on safety and on coal mine inspection located in Washington,, and one on health with headquarters in Pittsburgh*, 121 Daring fiscal 1947 nearly 30,000 persons were given training in first aid and nine rescue and over 2,000 miners were given mine safety and accident prevention courses# During the fiscal year 1948 the Bureau reported obligations of $511,873 for medical hospital and related activities#- d. Bureau of Reclamation The health and medical activities of the Bureau of Reclamation con- sist only of the operation of two hospitals, at Hoover Dan and at Grand Coulee Dam. l) Hoover Dam A small hospital at Hoover Dam in Bmilder City, Nevada was "built "by the contractor during the construction of the Dam in the thirties* Upon completion of the Dam, the hospital was used "by the National Park Service as a, recreation center until it was taken over hy the Bureau, reconverted and reopened as a hos-oital in March, .1944, .to serve the wartime influx of population. The Public Health Service continues to direct the operation of the hospital and is reimbursed by the Bureau of Reclamation#, All medical care is rendered by private practitioners in the community,, but the Service assigns a commissioned nurse officer and recruits personnel for about 30 other nositicns,. including seven nurses#. The hospital has 23 beds and six bassinets; the patient load during fiscal 1948 averaged 13♦4,. 122 Patients are charged for hospitalization at fixed rates, hut patient fees make up only about 45 percent of the operating costs* . During fiscal 1948 a deficit of $65,405 was hilled to the Bureau hy the Public Health Service* ‘The costs of operating the hospital are considered part of the costs of operating the power plants so that the gross funds accruing to the Bureau from the sale of power to the nine power allottees include the costs of the hospital* . 2) Grand Coulee Dam At the Grand Coulee Dam there is a small hospital, ,the Coulee Dam Community Hospital, which is operated hy a private physician under contract with the Bureau of Reclamation# A temporary frame building with 20 to 25 beds, the hospital was built by the contractor for the construction workers and was intended to be operated only for the duration of the contract* Patient fees, fixed by the Bureau of Reclamation, are $1*00, less than comparable hospital fees charged in Spokane, the nearest big city. The Bureau pays an annual sum of $36,000 out of appropri- ated funds toward the expenses of the hospital and the physician—, contractor defrays other expenses* During the fiscal year 1948, t<~tal operating costs were $99,312,. 123 10« Federal Security Agency^/ The principal medical responsi- bilities of the Bureau of Employees’ Compensation flow from the act (Public Law 267, 64th Congress) under which all civil employees of the government are entitled to medical care for injuries sustained in the performance of duty. The care is furnished by fed- eral medical officers and hospitals where practicable but the Bureau is authorized to engage nonfederal services. a. Bureau of Employees' Compensation The Bureau has no medical corps of its own in the field and it does not maintain any hospitals. All the professional personnel of the Bureau are officers of the Public Health Service on detail and the hospitals and dispensaries of that Service are available without charge to the Bureau, as are those of the Bureau of Indian Affairs. Army and Navy hospitals are generally used only for the treatment of civilian employees of those departments; Veterans Administration hospitals are normally used only for emergency cases. The Army, Navy and Veterans Administration are reimbursed by the Bureau. More than 2,000,000 employees are covered by the terms of the Compensation Act. In fiscal year 1948 there were 79,010 nonfatal and 1,018 fatal injuries. The majority were among Army, Navy and Post Office Department employees. Public Health Service statistics show that during fiscal year 1948 they furnished 145,468 hospital l/ Other than Public Health Service which is presented above (page 87) as one of the four major health agencies. 124 days, 186,015 outpatient treatments, and 20,165 examinations to Bureau 'beneficiaries* During the fiscal year 1948 the Bureau obligated armroximat e ly $2,900,000 for medical and hospital services and supplies of which $1,800,000 was paid to nonfederal physicians and hospitals and about $950,000 reimbursed to other federal agencies. An estimated $1,700,000 represents the value of services delivered by the Public Health Health Service, Phis item is included in the budget of the Public Health Service, The Pood pnd Drug Administration, a unit of the Department of Agriculture until 1940, is charged with the enforcement of the Pood, Drug and Cosmetic Act, Tea Importation Act, Import Milk Act, Caustic Poison Act and Pilled Milk Act. Through 16 field testing laboratories, each manned "by a staff of chemists and inspectors, factories are inspected for sanitary conditions, raw materials and controls over compounding, processing,' packaging and labeling commodities intended for inter- state shipment. The more fully equipped Washington laboratory per- forms the more difficult analyses and assays and conducts research to establish improved methods of testing and evaluation for enforce- ment purposes. ITew drugs may only be offered for sale after their evaluation and acceptance by the Administration on the basis of their safety for use and sufficiency of manufacturers* controls., Because ccal-tar colars, insulin, penicillin, and streptomycin do not lend themselves to the usual methods of enforcement, samples of each t). Food and Frag Administration 125 manufactured lot are tested for -purity and potency by the Food and Drug Administration before approval for distribution.. The obligations of the Administration for fiscal year 1948 were about $4,815,700.- The staff of approximately 925,, two-thirds of whom are stationed in the field, includes bacteriologists, chemists, biologists, pharmacologists, veterinarians, micro analysts, physicians, and inspectors. The Office of Vocation?1! Reha~ bilitation formulates standards, gives technical assistance, certifies funds for grants-in~aid to the states for vocational rehabilitation for persons handicapped by a permanent mental or physical disability caused by accident, disease or congenital defect. The states actually operate all programs. States are reimbursed for expenditures made in accordance with approved plans, as follows; all cost for war disabled civilians and the costs of administration and guidance and placement; 50 per~ cent of the cost of other services including medical examinations, surgical and therapeutic treatment, hospitalization (not to exceed 90 days), prosthetic appliances, vocational training and maintenance. Examinations to determine eligibility are available at no cost to the disabled, and medical treatment is provided without cost where economic need is established. To be eligible for these services, the person must be of employable age, his disability must be an occupational handicap, and rehabilitation services must render him more employable. c. Office of Vocational Hehabilitation 126 Hiring the fiscal year 1948 state rehabilitation agencies purchased medical examinations for 93,076 clients and psychiatric examinations for 2,098, and furnished prosthetic appliances to 16,967* Medical, psychiatric, surgical, dental and other treat- ments were purchased for 14,668 clients, hospitalization and related care weie provided to 10,050, and physical and occupational therapy was furnished to 1,124.. An index of the increasing demands for such services locally is seen in the fact that medical and related treat- ments were purchased for 36 percent more clients in fiscal year 1948 than in fiscal 1947, hospitalization increased 30 percent, and physi- cal and occupational therapy increased 92 percent* Appropriations for grants to the states in fiscal 1948 for all vocational rehabilitation activities totaled $18 million, of which $2.2 million was spent for medical examinations, treatments, hospi- talization and prosthetic appliances* The total staff numbers 115 of which 68 are professional per~ sonnel, including; four medical officers on detail from the Public Health Service* In 1867, Howard University or- ganized a Medical Department primarily for negroes* Now the School of Medicine includes separate colleges of medicine, dentistry, and pharmacy* The professional and educational services and educational services at Preedmenrs Hospital are under the direction of the College of Medicine of Howard Univei>- sity, although the hospital is administered by the Public Health d. Howard University ?reedmen!s Hospital 127 Service*-. The hospital has 400 beds, an approved school of nursing,, and a 150~bed tuberculosis annexe The total expenditures for fiscal 1948 were $2,?ei,872. The Childrens Bureau was created in 1912 to make investigations and reports on problems of child welfare, parti- cularly infant mortality, birth rates, and accidents and diseases of children*.. The Bureau provides to states expert consultant services on child health and development,, administers federal grants-in-aid to states for maternal and child health and for crippled children's services, conducts research and makes reports on medical problems and on standards of maternal and child care. During the late war the Bureau also administered funds for the emergency care of wives and babies of men in the four lowest pay grades in the armed forces, in- cluding aviation cadets*. This program was terminated in the spring of 1948*. e. Social Security Administration Childrens Bureau In 1948, 60 of the approximately 200 employees in the Washington office of the Childrens Bureau were engaged in the medical services programs. There were ten field offices of the Bureau (prior to the creation of Federal Security Agency regional offices on July 1,. 1948)., In fiscpl 1948, $21 million vras obligated by the Childrenrs Bureau. Bor the fiscal year 1949 Congress has appropriated $11,000,000 for grants-in-aid to states for maternal and child health services and $7,500,000 for crinplcd children's services... Each of these appro- priations is divided; one-half is distributed to the states on a 50-50 128 matching basis and the other half (unmatched) is distributed on the basis of need* Approximately $244,757 was appropriated for adminis- trative expenses related to the medical services programs for fiscal year 1949, f, St* Elizabeths Hospital Since its founding in 1855 for the ’’most humane and enlightened curative treatment of the insane of the Army and Havy of the United States and of the District of Columbia”, St* Elizabeths Hospital has also received patients from among beneficiaries of the Public Health Service, Indians under the Bureau of Indian Affairs, persons charged with federal crimes, expatriated American citizens from Canada, the mentally ill from the Canal Zone and the Virgin Islands, and members of the. armed forces admitted prior to July 16, 1946. Approximately 80 percent of all patients are residents of the District of Columbia, The Hospital is now an independent bureau in the Federal Security Agency, has 7,000 beds in sixty-odd buildings permitting the classification of patients. There is a training school for nurses and facilities for the training of medical stu- dents, dietitians, and social workers, and postgraduate courses for physicians and nurses in psychiatry. In the fiscal year 1948 the total obligations were approximately $8,510,516 for a total personnel complement of 2,438, including 80 physicians and 266 nurses. g. Office of Education The Office of Education collects statistical and other data on the instruction and administration of schools and colleges, advises and consults with school authorities, administers grants~in-aid for 129 education, and conducts research in educational practices. Incident tc these primarily educational activities, the Office naturally touches on health subjects and methods of promoting health education, including the encouragement of physical examinations for teachers and school children, assistence through grants in the training of school health workers and of teachers and practical nurses, and the conduct of health education conferences on school health programs. The activities related to health are sc small and so incidental to the other work of the Office of Education that it is impractical to try to allocate any specific percentage of the budget or staff to health. 11 • Tennessee Valley Authority The Tennessee Valley Authority was created by Congress in 1933 as in independent federal corporation. The need for a health and medical services program for employees, arising out of the temporary concentration of large groups in hazardous construction work, often in isolated or remote areas, was recognized in the first year. The first medical program, started at Norris Dam, has become a Division of Health and Safety. Under a Director of Health, the Division includes four service units for (l) employees' health,, including medical services, safety, and industrial hygiene;- (2) malaria, control; (3) public health engi- neering; and (4) corperation and administrative services, including nursing, health education and information.. 130 Although the emphasis is on prevention, the program includes medical services for employees injured on the joh and facilities for the care of employees and their families* Medical and safety services provided to employees include pre-employment examinations, periodic health examinations, and the maintenance of health records for each employee, immunization of employees against communicable diseases, emergency care for any service-connected illness or injury through first aid stations, field medical units, and base area-medical centers established at construction sites, health guidance for the employees and their families in finding medical services, and programs in safety and health education* In cooperation with state and local governments and other federal agencies, the Tennessee Valley Authority conducts research in such problems as malaria control, stream pollution, and environmental sani- tation and supports public health education in the states by financial aid and technical assistance. During fiscal 1948 the Tennessee Valley Authority expended $542,607 for all health activities* Approximately half this total went for public health and preventive medicine work, including $16,393 as grants to states# 12* federal Trade Commission Insofar as their activities touch medical matters, the Commission is active in preventing improper statements in the advertising of foods, drugs and cosmetics in interstate commerce. Its Bureau of Medical Opinions provides medical advice and scientific information 131 for the preparation of formal complaints and on the acceptance of stipulations, assista the legal staff in preparation for hearings and in obtaining expert testimony from scientific witnesses* The Director of the Bureau is the Commission's liaison officer with the Food and Drug Administration, Bureau of Standards, Public Health Service, Bureau of Animal Industry, and other agencies* The esti- mated obligations of the Bureau in fiscal year 1948 were $35,100 of the Commission*s estimated $2,900,000* The authorized professional staff consisted of four, including the director, a chemist, and a physician; there is one vacancy* 13. Civil Service Commission The Medical Division has no important responsibilities for the provision of direct medical services; its work is almost entirely advisory and consultative to the other divisions of the Civil Service Commission and to personnel officers of the government agencies on such problems as physical standards for federal employment, criteria for retirement on grounds of disability, and formulation and adminis- tration of standards professional positions in medicine, nursing and allied fields* The Division1s 1948 workload consisted largely of approximately 22,000 medical actions in connection with disability retirement, and in passing on the physical qualifications of 33,000 individual cases referred by the agencies or appealed agency decisions. Only an estimated 15 percent of the 1948 workload was in providing first aid and emergency medical service to the Commission*s employees in Washington* 132 The staff rf the Medical Division consists of 42 employees in Washington (10 physicians, three nurses, five other professional) and medical director in each of the Commission*s 14 regional offices# The Washington office budget of the Medical Division for the fiscal year 1948 was $165,649, ■ 14, -Atomic Energy Commission The Atomic Bnergy Act (Public Law 585, 79 Congress) -provides expressly for the improvement of the public welfare through the maximum utilization of atomic energy. While the functions of the Commission relate primarily to the development of atomic energy for milltpry ond industrial purposes, the research and disease control work of the Division of Biology and Medicine holds great -promise and has a direct bearing on health and medical care. There are four programs in the Division of Biology and Medicine, (l) Medical and biological research is conducted on a large scale at the Commission1s own installations, particularly at the national laboratories at Clinton (Oak Ridge), Brookhaven (Long Island) and Argonne (Chicago), (2) 175 fellowships in biology, medicine and health physics have been established* • They are administered by the National Research Council, • (s) Sup-port is given to selected projects at nongovernmental institutions, five of which a.re administered directly by the Commission and 60 others by the Office of Naval Re- search for the Commission, ■ (4) A broad cancer research program in- cludes the distribution of radioisotomes for cancer research* support of cancer research at civilian institutions, establishment of cancer 133 research facilities at the Connission!s laboratories, pnd support of the optional Research Council Committee on Atomic Casualties. For the fiscal year 1949 the Commission budgeted $24.3 million for health and medical activities in comparison with $15.1 million for the preceding year. During 1948 more than half ($8.9 million) vias for direct research activities in the laboratories, about one-quarter ($3.4 million) for contracts with private labora- tories, nearly S2 million for medical care in the hospitals and clinics which serve the laboratory communities, and $0.5 million for fellowship training. The remainder ($0.4 million) was for administrative costs.' 15.' Maritime Commission Since 1938 the Maritime Commission has operated five training facilities and supervised five state maritime academies for the training of both licensed and. unlicensed personnel. Detailed officers from the Public Health Service supervise the medical services in the training program on a reimhurseahle basis. The detailed personnel include seven medical officers, six dental officers, and one nurse officer. There are also two pant-time civil service physicians. About 50 hospital corpsmen of the Maritime Service are also employed in the medical program. About 3,000 trainees are eligible for medical services. There a.re small hospitals or infirmary facilities at each of the centers to a total of 143 beds,, but 60 beds in three centers are not open. Daring fiscal year 1948, almost 7,000 inpatient days were furnished, pnd about 90,000 outpatient treatments.. 134 The Commission estimates that during fiscal year 1948 the total cost of medical and health activities was $269,350, including the pay of hospital the costs of health units and the cost of the hospital corps training course.. In fiscal year 1949,. the Public Health Service will purchase for the Commission through its regular supnly system on a reimburseable basis. 16* Federal Works Agency Two of the units of the Federal Works Agency, the Public Buildings Adminis- tration and the Bureau of Community Facilities, are engaged in the construction and/or planning of health facilities. The Public Buildings Administration plans, supervises construc- tion, and keeps in repair (not including routine maintenance) all hospitals and buildings of the Public Health Service. During the fiscal year $1,157,523 was obligated for construction and repair of hospital and medical research facilities of which almost $1 million was transferred from the Public Health Service for construction of new research facilities and new buildina-s at St. Elizabeths, Infirma- ries in connection with penal institutions and residency halls have also been constructed.. The Public Works Administration constructed and maintains two residency halls for 400 girls working for the federal government.- There is an infirmary of 40 beds which provides outpatient care and inpatient nursing care to prevent the spread of contagious diseases and to provide convalescent facilities. . The Public Health Service has detailed 17 nurses to the infirmary; there are no physicians, dentists or other medical nersonnelr 135 The infirmary is staffed by nurses detailed from the Public Health Service and is operated on a reimburseable cost basis, (estit- illated at $65,000 for fiscal 1949)During the first half of 1948 about 4,000 visits were made to the outpatient service* the average daily infirmary census was 24, and the average length of stay 4.68 days* Two programs of the Bureau of Community Facilities <— wartime hospital construction and child care centers and advance planning of local public health works -—. were terminated in 1946 and 1947, respec- tively. The Public Health Service will determine the need and prepare comprehensive programs for the prevention and abatement of water pollution; the Federal Works Agency will plan and supervise the con- struction of treatment works to control the discharge of sewage into interstate waters. The Federal Works Administrator is authorized to make loans to states, municipalities, and interstate agencies for the construction of approved projects up to one-third of' the estimated cost but more than $250,000, whichever is smaller# Loan funds will be appropriated to the Federal Security Agency and transferred to the Federal Works Agency for approved projects upon request.* The Federal Works Administrator is also authorized to make grants up to one-third of the estimated cost of planning approved projects or $20,000, whichever is smaller#1 No funds for grants or loans were appropriated for the fiscal year 1949.* The same act authorized the appropriation of funds to the Federal Works Agency for the construction and equipment of facilities 136 at Cincinnati, Ohio, for the use of the Public Health Service in connection with the research and study of water pollution and the training of personnel. $200,000 wa.s appropriated. 17* War Assets Administration The War Assets Administration was established to administer domestic surplus property, including hospitals, drugs and medical supplies. Both of these programs are near completion and the agency is in liquidation, effective February 28, 1949. New declarations of surplus property to the War Assets Administration ended June 30, 1948, since which time surplus property has been disposed of by the owning agencies. Up to September 30, 1948, about 15 general hospitals had been sold or transferred and one (a Havy hospital in Washington) remained. Most of the hospitals have been transferred to state governments for educational or hospital use at a 100 percent public benefit allowance with a reversion clause to insure continued use for the purpose for which they were transferred. Public benefit allowances may be made to state, local and municipal governments and to nonprofit tax-exeirpt institutions when substantial benefit will accrue to the health of the nation from the proposed use, whether for research or bedside care. Except by an act of Congress* a hospital may not be transferred to an agency of the federal government (other than the owning agency) without reimbursement at fair value. The disposal of all drugs and medical supplies was handled by regional offices and customer service centers. Instructions from 137 the central office related principally to compliance with narcotics and food and drugs laws. Adequate records on the sale of all. surplus goods, including drugs, medicines, laboratory equipment, and surgical and scientific supplies, are not available. Careful record keeping and good accounting procedures have been sacrificed in an effort to channel the huge surpluses into the market as promptly as possible. Considerable quantities of medical and scientific supplies and equipment were disposed of prior to that date by the predecessor War Assets Corporation. As of June 30, 1948, the declared value of all drugs and medical supplies on hand was $13,787,000. This was about 10 percent of all drugs and medical supplies for which the War Assets Adminis- tration has been responsible. The declared value of all medical supplies disposed of between July 1, 1946 and June 30, 1948 was about $122 million. About 80 percent was sold and the rest transferred or donated. 18. Selective Service System The Selective Service Act (Public Law 759, 80th Congress) prescribed that inductees meet specified standards of physical and mental fitness, as set forth in Amy Regulations (AR 40-115), This Regulation con- tains a list of physical defects, any one of which will cause a local board of medical advisors to automatically disqualify a registrant. All registrants who are found eligible for service by local boards are given final physical examinations by Army medical personnel at present• 138 Based on World War II experience, the Selective Service System will not become pn important medical agency in terms of expenditures for medical and hospital care, hut it will gather significant statistics on the existence of disqualifying physical defects in the selectees. 19. Post Office Department There is no formally established health and safety program for the employees of the Department, although at approximately 50 of the larger installations full-time physicians and/or nurses maintain dispensaries for the use of employees. For example, there are full- time physicians in the central post office in Dos Angeles, Portland, Chicago, Minneapolis, St. Paul, Hew York, and Washington, some of whom are designated as superintendents or assistant superintendents of mails. The recently appointed (1946) safety director, although technically attached to the personnel office for departmental em- ployees in Washington only, has been acting as advisor to the Assistant Postmasters General in charge, of field activities. His office has up to now concentrated on accident prevention work but its activities and staff are being expanded and postal employees will also be affected by the government-wide Federal Employee Health Act of 1946. 20. Housing and Home Finance Agency The Housing; and Home Finance Agency, created hy Executive Order 9070 hy a consolidation of 17 or more agencies with housing functions, now 139 includes the Federal Housing Administration and Public Housing Administration, each of which has minor projects related to health. The Federal Housing Administration, established by the National Housing Act (Public Law 479, 73 Congress) develops a model uniform plumbing code, conducts investigations on the design of individual sewage disposal systems, and consults with Public Housing Adminis- tration on sanitary engineering aspects of the Veterans Emergency Housing programs. Its standards of health, safety and sanitation are the basis of eligibility for credit aid to private residential construction through mortgage insurance. ■ The Federal Housing Admin- istration spent an estimated $116,000 in fiscal year 1948 for these health functions. The primary function of Public Housing Administration is to provide capital loans and annual subsidies to local housing authori- ties for low rent houses and slum clearance projects. The health functions consist of the supervision of a limited health program in publicly constructed houses and in converted war workers’ homes and of insistence upon proper sanitary facilities; the expenditures are not segregable from other work. Appendix I STATISTICAL DATA ON FEDERAL HOSPITALS, HOSPITAL BEDS, AND PATIENTS 141 Appendix I 1. DISCUSSION OF TERMS, An attempt has been made to collect and assemble in this summary certain data concerning hospitals operated by the federal government within the United States, (Dispensaries of the Coast Guard and of the Maritime Service have been excluded). It proved to be difficult in some cases to ob- tain comparable data on bed capacity and patient loads, not only for each hospital system but even for different hospitals within the same hospital system. In large measure, this was because the various federal agencies have never arrived at common definitions of what is meant by "patient” or "bed" and because even within a single system various hospitals are under different administrative controls. For the Departments of the Army and Air Force, information shown on total hospital capacity is based on a survey made by the Office of the Surgeon General during 1945 and represents the latest information available. Inasmuch as many of the station hospitals and even some of the general hospitals are of nonpermanent construction, or have been expanded by use of adjacent barrack space, release of this extra space can have substantially altered the figures assembled at the time of survey. Because of the dissimilarity of data, no attempt has been made to combine all of the available data into a total federal 142 picture except in the summary in Table 12. Data on the trends in "beds'1 and in "patients" from 1935 to 194B are shown only for individual hospitalizing agencies in Tables 1 through 4 and Charts 1 through 7. The information on the number of patients receiving care was obtained for each agency as of June 30, 194S and in certain instances is not necessarily a typical count of the number of patients given care in the bed capacities shown for the same dates. In the hospitals of the National Military Establishment there have been in the past marked seasonal variations in patient loads, producing high utilization during the winter and many vacant beds in the summer. In the facilities of the Veterans Administration and the Public Health Service this is not true to the same ex- tent, patient loads being more constant throughout all the seasons. There are two principal ways in which the number of patients in a federal hospital is counted — Jbeds occupied" or "patients remaining." The count of "patients remaining" is a more inclusive one, comprehending not only patients who are actually in hospital — i.e., occupying beds — but also patients retained on the rolls of the hospital but away from the institution on convalescent furlough or some other type of leave. The count of "beds occupied" includes only those patients actually occupying beds in a hospital at any given time. In the case of the Public Health Service hospitals, the only available count is one of patients remaining, and there 143 are, according to the Service, only about two or three percent away on leave at any tine. The Veterans Administration data on patients are of the 'beds occupied’type and there are in the range of 10 percent to 15 percent of all patients on leave at any one time (mostly neuropsychiatric patients). In the case of the military hospitals, counts of both types are usually available. Tables 5 through 11 which deal with the beneficiary status of patients in each of the principal federal hospital systems, carry specific footnotes defining the type of patient count and expressing the relationship between the two types of counts wherever such data are available. In addition to the tables and charts which show the trends of patients and beds in the federal hospital systems. Tables 5 through 11 and Charts B through 12 contain data which break down the total patient population of each major federal hospital system into its various beneficiary groups. Thus in Table 5* the patients in Army and Air Force hospitals are first subdivided by type of hospital and further to show those patients who have a prime eligibility for military medical care and those who — as super- numeraries — have at best a contingent eligibility for care in military hospitals. Continental United States Army . Hospitals General Hospitals^/ Army & Air Forced , Station Hospitals-^/ Overseas All June 30 Oper- Oper- Oper- Oper- Beds of Each ating Beds ating Beds ating Beds ating Year Beds Occupied Beds Occupied Beds Occupied Beds Occupied 1935 10.S65 6,931 **,532 3,077 6,283 3.85** 1,675 1,022 1936 11,990 7.922 U,339 3,333 7.651 **.53** l,6UU 1,0S6 1937 U.S75 M92 3,559 7,183 1,730 963 193S 11,951 7,SS2 3.326 7,259 **.556 1.653 1,02^- 1939 12,370 3,171 5,136 3,796 7.23** **.375 1.656 99S 19U0 16.379 9,309 6.337 3.9*1*1 10,^92 5.365 2,5^2 i,3**3 19U1 75.056 3S.5S2 7.709 5.519 67,3** 7 33.063 2,779 2,^69 19U2 116,971 73.235 16,219 12.365 100,752 60,920 HA HA 19^3 276,237 5^,828 ,0^2 221,U09 S0,S71 71.225 , 9^-2 I9UU 303.67^ 137.673 117,Op 56,291 126,631 81,337 285.350 135,567 19^5 3**3.1*U 250,395 226,973 172.2SS ll6,l6S 78,607 165,360 19^6 91,713 57,509 57,521 39,723 3*1,132 17.786 36, 3**7 16,961 19^7 45,6l6 2^, 27,613 17,215 is,003 7.325 . 2^,9Uo 11.732 19HS 33.626 IS,725 19,262 12,5^2 iU,36U 6,183 17,7^0 s,3io a/ Including convalescent hospitals. b/ Including regional hospitals cj The following data are available which show beds and patients separately for Army and Air Force station hospitals for 1945, and Station Hospitals of Army Air Force 0 K"> 0) of Each Year Operating Beds Beds Occupied Operating Beds Beds Occupied 19**5 HA. HA 32,522 19^6 25,257 13. ip 3.375 **,639 1947 12,003 *1.921 6,000 2,U0U 19^S 3,71*1 3,600 5.650 2,583 Table 1 - HOSPITAL BEDS MD P ATI MTS — HBPASEMEEITS OP TEH ARMT MD AIR PORCH 1935 - 13^8 Chart 1 HOSPITAL BEDS MD PATIENTS — DEPARTMENTS OF THE ARI.IT AND AIR FORCE CONTINENTAL UNITED STATES 1937 - 1948 STATION AND GENIAL HOSPITALS Number Operating Beds i i Beds Occupied ! ' June 30 Chart 2 HOSPITAL BEDS AND PATIENTS — DEPARTMENTS OE HIE ARMT AND AIR FORCE CONTINENTAL UNITED STATES 1937 - 1948 GENERAL HOSPITALS Operating Beds Beds Occupied STATION HOSPITALS Operating Beds Beds Occupied June 30 June 30 of Each Year Continental United States Overseas Total . in U. S. Hospitals Total Dispensaries Overseas Hospitals Dig- 'S; Ships pensaries Beds Patients Remaining Capacity Patients Remaining Operating Beds Patients Patients Remaining Remaining Patients Patients Remaining Remaining 1935 HA HA 5,5^0^/ 2,491 HA HA HA 493 HA 1936 HA HA HA 2,812 HA HA HA 537 HA 1937 HA HA 4,635a/ 3.116 HA HA HA 53s HA 193s HA HA HA 3.342 HA HA HA U31 HA 1939 HA HA 3,830 HA HA HA 366 HA I9U0 HA HA 5.634 4,333 HA HA HA 753 HA I9U1 HA HA 8,437 6,759 HA HA HA 933 HA 19^2 HA HA 22,775 12,210 HA HA HA 1.300 HA 1943 HA HA 38,786 35.SSI HA HA HA 5,773 HA I9UU 75.954 70,223 Us,550 56.548 27.U0U 14,275 11.398 11,273 125 1945 99.682 105,091 72.391 90,s6i 27,291 lU,230 20,275 19,608 667 19^6 57,883 37,022 UU,295 34,477 13.588 2,545 1,975 1,675 300 19^7 39.70S 16,192 31,622 lU,9io 8,086 1.282 2.159 1.497 662 19US 3U.6U2 13.958 27.965 12,800 6,677 1,158 1.72s 1,199 529 a/ Operating teds Table 2 — HOSPITAL BEDS AND PATIENTS — DEPARTMENT OE THE NAVY 1935 - ishE Chart 5 HOSPITAL BEDS AND PATIENTS — DEPARTMENT OF THE NAVY CONTINENTAL UNITED STATES 1937 - 1948 DISPENSARIES Capacity Patients Remaining Data Not Available HOSPITALS c Patients Remaining Capacity On June 30, 1944 and 1945 the number of Patients exceeded capacity and were accomodated in expanded capacity Capacity Patients Remaining i June 30 Table 3 HOSPITAL. BEDS AND PATIENTS IN PUBLIC HEALTH SERVICE MARINE AND CENTAL HYGIENE HOSPITALS 1935 - 1948 June 30 of each ve^r All Hospitals General Hospitals Tuberculosis . Beds Patients Remaining Capac- ity Patients Remaining Capac- ity . Patients Remaining 1935 5,396 4,100 4,701 3,550 270 192 1936 7,020 5,617 5,319 4,293 270 189 1937 7,204 5,894 5,480 4,393 270 161 1938 7.196 5,856 5,472 4,358 270 178 1939 7,498 6,111 5,472 4,238 237 183 1940 8,302 6,574 5,611 4,472 237 163 1941 8,728 6,474 6,037 4,532 237 157 1942 9,096 7,217 5,888 4,811 237 195 1943 9,289 7,575 5,903 5,088 237 173 1944 9,262 8,058 5,939 5,415 237 184 1945 9,357 8,426 5,939 5,687 322 203 1946 9,887 7,342 6,387 4,692 412 337 1947 9,205 7,756 5,752 4,805 487 438 1948 9,260 7,300 5,752 4,538 487 425 150 Table 3 (continued) HOSPITAL EPS AND PATENTS IN PUBLIC HEALTH SERVICE MARINE AMP MENTAL HYGIENE HOSPITALS 1935 - 1948 •June 30 of each year Mental Hygiene Penrosarium Operating Beds Patient s Remaining Capac- ity Patients Remaining 1935 - - 425 358 1936 1,000 751 431 374 1937 1,000 975 454 365 1938 1,000 971 454 349 1939 1,335 1,325 454 365 1940 2,000 1,567 454 372 1941 2,000 1,412 454 373 1942 2,517 1,824 454 387 1943 2,695 1,941 454 373 1944 2,632 2,075 454 384 1945 2,642 2,160 454 376 1946 2,634 1,941 454 372 1947 2,512 2,127 454 386 1948 2,567 1,933 454 404 Chart 4 HOSPITAL BEDS AND PATIENTS IN PUBLIC HEALTH SERVICE MARINE AND MENTAL HYGIENE HOSPITALS 1937 - 1948 BEDS / PATIENTS REMAINING1 June 30 152 Chart 5 HOSPITAL BEDS AND PATIENTS IN PUBLIC HEALTH SERVICE . IE JUNE AHD LENTIL HYGIENE HOSPITALS 1937 - 1948 GENERAL HOSPITALS Capacity Patients Remaining June 30 LENTIL HYGIENE HOSPITALS Operating Beds Patients Remaining June 30 153 Chart 5 (Continued)' HOSPITAL BEDS AND PATIENTS IN PUBLIC HEALTH SERVICE MARINS AND IIENTAL HYGIENE HOSPITALS 1937 - 1948 TUBERCULOSIS HOSPITALS Capacity Patients Remaining June 3Q LEPROSARIUM Capacity Patients. Remaining June 30 154 Ta.ble 4 HOSPITAL BEDS ADD PAT IDIOTS - VETERANS ADMINISTRATION 1935 - 1948 June 30 of Number of Operating Beds each year Hospitals Beds Occupied ALL HOSPITALS 1935 81 43,955 39,401 1936 81 44,846 38,539 1937 81 47,406 43,234 1938 82 51,460 47,255 1939 85 54,280 50,033 1940 87 58,834 , 52,671 1941 92 . 61,405 54,616 1942 93 • 60,666 53,206 1943 93 61,717 54,184 1944 94 70,598 60,389 1945 97 77,727 66,051 1946 109 87,379 , 76,405 1947 123 101,273 91,224 1948 125 102,219 91,290 GENERAL MEDICAL AND SURGICAL HOSPITALS 1935 42 17,406 14,435 1936 42 16,851 12,753 1937 43 .18,013 15,383 1938 42 18,614 16,401 1939 45 19,846 16,959 1940 46 ’21,432 18,007 1941 50 22,772 19,020 1942 50 20,988 15,846 1943 51 21,504 15,598 1944 51 . 24,072 17,272 1945 51 35,360 19,682 1946 62 31,691 26,285 1947 72 43,764 38,279 1948 74 43,758 37,230 155 Tpble 4 (continued) HOSPITAL BSPS AND PATIENTS - “TETEEANS ADMINISTRATIOH 1935 - 1948 June 30 of Humber of Operating Beds each year Hospitals Beds Occupied TUBERCULOSIS HOSPITALS 1935 13 5,979 4,699 1936 13 5,904 4,173 1937 12 5,372 4,290 1938 12 5,112 4,334 1939 12 5,274 4,478 1940 12 5,286 4,400 1941 12 5,286 4,298 1942 13 5,672 4,746 1943 13 5,184 4,341 1944 13 6,350 5,234 1945 14 6,431 5,401 1946 14 6,577 5,610 1947 18 7,782 6,595 1948 18 7,825 6,919 heuropsychiatric HOSPITALS 1935 26 20,570 20,267 1936 26 22,091 21,613 1937 26 24,021 23,561 1938 28 27,734 26,520 1939 28 29,160 28,596 1940 29 32,116 30,264 1941 30 33,347 31,298 1942 30 34,006 32,614 1943 29 35,029 34,245 1944 30 40,176 37,883 1945 32 45,936 40,968 1946 33 49,111 44,510 1947 33 49,727 46,350 1948 33 50,636 47,141 Ta.T?le 4 (concluded) DOMICILIARY BEDS ABB PATIENTS ~ VETEHANS ABM IN I ST BAT I Oil 1935 - 1948 June 30 of ©Derating each year Beds Beds Occunied 1935 17,853 9,323 1936 15,929 7,574 1937 13,555 11,038 1938 16,272 14,106 1939 16,736 15,426 1940 18,476 16,320 1941 18,688 13,978 1942 17,951 11,506 1943 15,050 8,997 1944 13,344 8,647 1945 13,366 8,779 1946 14,868 11,320 1947 16,101 13,458 1948 16,174 14,275 a/ Including 16 domiciliary patients employed at Veterans Administration hospitals, Chart 6 HOSPITAL BEDS AND PATIENTS VETERANS ADMmSTRATION 1937 - 1948 Thousand Operating Beds ALL VA HOSPITALS Beds Occupied June 30 Chart 7 158 HOSPIT/X BEDS END PATIENTS VETERANS ADI.HNISTRATION 1937-1948 Thousand GMS HOSPIT/XS NP HOSPIT/XS Operating Beds Onp-ratin/a’ Bods Beds Occupied Bods Occupied DOMICILES TB HOSPITALS Operating Beds ;Beds Occupied Beds pcoupled a/ Primarily dependents b/ than 0,1 ' c/ In addition, 2,158 patients were absent fran the hospitals on leave (convalescent furlough) — 1,861 from General. Hospitals, 202 from Army Station Hospitals, and 95 from Air Force Station Hospitals Status Total Patients in Hospital General Hospitals Station Hosi itals Number Percent of Total Total Army Air Force 1. All Patients 18,725 c/ 100.0 12,542 o/ 6,183 c/ 3,600 c/ 2,583 c/ 2. Active Duty Army and Air Force Personnel 13,243 70.7 8,521 4,722 2,725 1,997 3. Supe mumerarie s Total 5,482 29.3 4,021 1,461 m 586 ;v Veterans 2,460 13.1 2,377 23 65 18 Other Civilians a/ 2,969 15.9 1,624 1,345 792 553 Other U.S.Armed Forces 45 0.2 12 33 18 15 Allied Soldiers 8 y 8 - - - Table 5 — BENEFICIARY STATUS OF IA TIEN TS IK ARMY AND AIR FORCE HOSPITALS IN THE UNITED STATES June 30, 194S Chart 8 BENEFICIARY STATUS OF PATIENTS IN ARMY AND AIR FORCE HOSPITALS IN THE UNITED STATES June 30, 1948 number of patients Active-Duty Army and Air Force Personnel Supernumeraries Exclusive of Veterans Veterans PERCENT OF AIL PATIENTS Active-Duty Army and Air Force Personnel Supernumeraries Exclusive of Veterans Veterans Table 6 BENEFICIARY STATUS OF PATIENTS REMAINING IN NAVAL HOSPITALS AND DISPENSARIES IN THE U. S. June 30, 194& Beneficiary Status Total Naval Percent Hospitals Dispensaries Number of Total Total Patients 13%958 100*0 12.800 a/ 1,158 Active Duty Navy and Marine Corps Personnel 8*632 61.8 . 7% 587 1*045 Supernumeraries Total 38.2 5.213 m Veterans NA 3,518 NA Retired Personnel NA 570 NA Army and Air Force NA 23 NA Coast Guard NA 12 NA . Employees Compensation NA 39 NA Dependents NA 989 NA . All other NA 62 NA NA -— not available a/ Including 177 patients on sick leave or furlough Chart 9 BENEFICIARY STATUS OF PATIENTS REMAINING El NAVAL HOSPITALS AND DISPENSARIES IN THE UNITED STATES JINS 30, 1948 NUMBER OF PATIENTS Active-Duty Navy and Marine Corps Personnel Veterans in Naval Hospitals Other Super- numeraries PERCENT OF ELL PATIENTS Active-Duty Navy and Marine Corps Personnel Veterans in Naval Hospitals Other Super- numeraries 163 Table 7 benifigiary status of patients remaining in PUBLIC HEALTH SERVICE June 30, 194B All Hospitals Type of Number Percent Beneficiary of Total Marine Hospitals Mental Hygiene Hospitals All Patients 2*120 100.0 1*112 x*211 Non-reimbursable Patients Total , 1*221 71.9 1*222 1.252 American Merchant Seamen, 2,847 39.0 2,643 204 Narcotic Addicts 1,008 13.8 1,008 Hansen’s Disease Patients (Lepers) ... 405 5.5 405 Employees Compensation Csmmission ...... ., 315 4.3 315 Coast Guard Personnel ... 305 4.2 291 14 Seamen - Army Engineer and Transportation Corps, 156 2.1 156 ,, Public Health Service Personnel 88 1.2 73 15 Maritime Service Enrollees 15 0.2 15 Seamen - Other Government vessels 12 0.2 12 Coast and Geodetic Survey Personnel ............... 6 0.1 6 Special Study Patients .. 56 0.7 45 nfe/ Dependents of Army Personnel 16 0.2 16 Dependents of Navy and Marine Corps Personnel .... 5 0..1 5 Newborn , 11 0f,2 11 - Emergency Patients ...... 6 oa 6 - 164 Table 7 (Continued) BENEFICIARY STATUS OF PATIENTS REMAINING IN PUBLIC HEALTH SERVICE HOSPITALS June 30, 194B Type of ] Beneficiary All Hospitals dumber Percent of Total Marine Hospitals Mental Hygiene Hospitals Reimbursable Patients Total 2,049 28.1 1.368 681 Veterans ,. 1,316 18.0 1,075 241 Navy & Marine Corp Personnel , ,. 361 4.9 5 356 Foreign Seamen .......... 153 2,1 153 - Immigration and Natural- ization Service Patients, 39 0.5 38 1 Army Personnel 53 0.7 10 43 St. Elizabeths Hospital Patients 39c/ 0.5 ., 39S/ Farmer WPA and CCC Employees 7 0.1 7 -f- Dependents of Coast Guard Personnel 63 0.9 63 ri|. Coast & Geodetic Survey Personnel 2 »/ 2 Public Health Service Commissioned Officers ... 11 0.2 , 11 _ Bureau of Prisons Patient 1./ s/ 1 , - Civilian Evacuee ........ e/ zi/ - Civilian Casualty ....... ifF y ii/ - Other 1 */ 1 a/ Including patients on leave or fulough; from the Marine Hospitals and from the Mental Hygiene Hospitals, b/ Reported as Special Study and Emergency Patients, c/ Including 28 Indians,. d/ Medical Relief Section patients.. e/ Less than 0,1, 165 Chart 10 BENEFICIARY STATUS OF PATIENTS REMAINING IN PUBLIC HEALTH SERVICE HOSPITALS June 30, 1948 Number of Patients Percent of All Patients American Merchant Seamen** Veterans Narcotic Addicts Other Non-reim- hursable Government Military Personnel Lepers Dependents All Others Including Seamen - Army Engineer Transportation Corps and Seamen of other government vessels. Table 8 166 BENEFICIARY STATUS OP PATIENTS IN ST. ELIZABETHS HOSPITAL June 30, 1948 Type of Beneficiary Number Percent of Total -All Patients 6,345 a/ 100.0 Non-Reimbursable Pat i ent s 1,107 17.4 .Army 325 5.1 District of Columbia Prisoners 245 3.9 Navy 159 2.5 Virgin Islands Residents 76 1.2 Public Health Service 50 0.9 United States Prisoners 61 1.0 Military Prisoners 46 0.7 U.S. Citizens Resident in Canada 46 0.7 Marine Corps 28 0.4 Coast Guard 18 0.3 Canal Zone 14 0.2 Bureau of National Homes 9 0.1 U.S. Soldiers Home, (Retired .Army), Washington, D. C. 8 0.1 Interned -Aliens 6 0.1 Foreign Service 2 i/ Immigration and Naturalization 2 V Bureau of Employees Compensation 2 Jb/ District of Columbia Non-resident 1 i/ Re imbur sable Pat i ent s 5,238 82.6 District of Columbia Residents 4,950 78.0 Veterans administration 212 3.3 Indian Service 54 0.9 U.S. Soldiers Home (Regular Army Non-retired) 20 0.3 Civil Works .Administration 1 y y In addition there wore 317 patients on leave from the hospital V Less than 0AL 167 Table 9 BEHE51CIART STATUS OF VETERANS ADMINISTRATION PATIENTS IN STEPANS ADMINISTRATION AND NON-VETERANS ADMINISTRATION HOSPITALS June 30, 1948 Beneficiary Tot al Legal Status Service Non-Service Connected Connected Status Number Percent of Total Number Percent of Total All Patients 103.576^/ 100 wm*m Veterans • Total 103.263 . 99*7 34.872 6.^391 §6.2 Civil War 3 i/ — 3 , — Spanish Ameri- can War 2,765 . 2.7 72 .. • 2,693 . 97.4 World War I 46,567 . 45.0 . 10,249 .36,318 ' . 78,0 World War II 50,804 49.0 22,472 ,28,332 ■, 55.8 Other Wars 112 0.1 : 2 110 . 98.2 Regular Estab- li aliment 2,779 . 2,7 2,028 751 . 27,0 Retired officers and enlisted men 233 ■ 0.2 49 184 . 79.0 Non-Veterans Total 313 0.3 — —• — Allied Soldiers 31 5/ — — —. Employees Compen- sation Commission 136 0.1 __ „ Navy & Marine Corps 9 — -T- .... — Army & Air Force 21 i/ — — -r- Other 116 0.1 &/ On June 30, 1948 there were an additional 13,512 Veterans Adminis- tration patients on leave or furlough from Veterans Administration and Fon-Veterans Administration hospitals. b/ Less than 0.1 percent. s/ Includes 935 cases under observation. 168 Table 10 BENEFICIARY STaTUS OF PATIENTS IN VA HOSPITALS June 30, 1948 Number of Patients Beneficiary Total Legal Status Status Number Percent of Service Non-service Connected Total Connected Number Percent of non-service connected All Patients 91,290 a/ 100.0 - - - Veterans Total ■2Qj.2ai 99.7 30.283 60.700 66*2.. Civil War 3 - 3 T Spanish American War 2,546 2.8 • 50 2,496 98.0 World War I 42,776 46.9 9,506 33,270 77.8 World War II 42,615 46.7 • 18,694 23,921 56.1 Other Wars 107 0.1 1 106 99.1, Regular Establish- ment 2,703 3.0- 1,983 720 26,6. Retired Officers and Enlisted men 1 233 0.2- 49 184 79.0. Non-Veterans Total 307 0.3- - - - .. Allied Soldiers 25 T - — — Employees Compen- sation Commission 136 0.1 - - - . Navy and Marine Corps 9 y. - - Army and Air Force 21 y - - - Other 116 0.1 - - - %/ On June 30, 1948 there were an additional 13,358 VA patients on leave or furlough from the VA hospitals. b/ Less than 0.1 169 Table 11 BEH53PICIAH3T STATUS 0? VETSBANS ADMINISTRATION PATIENTS IN NON-VETERANS ADMINISTRATION HOSPITALS June SO, 1948 Total Leaal Status Service Hon-Service Connected Connected Beneficiary Status Humber Percent of Total Humber Percent of Total All Patients 12.286&/ 100.0 Veterans Total 12.280 100.0 4.589 .6.91 62.6 Civil War — — — — i— Spanish Amer- ican War 219 1.8 22 197 90.0 World War I 3,791 30.8 743 3,048 80*4 World War II 8,189 66.6 3,778 4,411 53.9 Other Wars 5 b/ 1 4 80*0 Regular Estab- lishment 76 0.8 45 31 40*8 Retired officers and enlisted men — -r- — Won-Veterans Total 6 b/ — — — Allied Soldiers 6 b/ &/ On June 30, 1948 there were an additional 154 Veterans Administra- tion patients on leave or furlough from Non-Veterans Administration hospitals* b/ Less than 0.1 percent. Chart 11 BENEFICIARY STATUS OF VETERANS ADMINISTRATION PATIENTS IN VETERANS ADMINISTRATION AND NON -VETERANS ADMINISTRATION HOSPITALS June 30, 1948 Period of Service NUMBER OF PATIENTS Veterans — World War II Veterans World War I Regular Establish. Retired Offi cers and Enlisted Hen and Non- Veterans Veterans of Other Wars Period of Service PERCENT OF ALL PATIENTS Veterans — World War II Ve te rans — World War I Regular Establish* Retired Offa cers and Enlisted Her and Non- Veterans Veterans of Other Wars Chart 12 LEGAL STATUS OF VETERANS ADMINISTRATION PATIENTS IN VETERANS AND NON-VETERANS ADMINISTRATION HOSPITALS June 30, 1948 THOUSANDS OE PATIENTS PERCENT OE .ALL PATIENTS Veterans Witt Service- Connected Disabilities Veterans With Nonservice- Connected Disabilities NP Nonservicel Connected Disabilities am Nonservice- Connected Disabilities TB Nonservice- Connected Disabilities Agency Humber of Humber of Beds — Humber of Patients By Type of Care Hospitals Capacity Operating Total TB HP GMS GRAHD TOTAL HA 200.556 155,SS2 13,945 63.096 78,841 HATIOHAL MILITARY ESTABLISHMMT Total m HA 58,128 52.6S5 1*231 2,867 28.619 Department of the Army- Total 55 54,465 27,976 l6,l42 ny !.9°9. 151+2/ 13,514,, 3,440^ Station Hospitals 4i 30,237 8,714 3,600 General Hospitals i4 24,228 19,262 12,5^2 713 1.755 10,074 Department of the Air Force / , Station Hospitals 54 15,954 5,650 2,5^3 2s7 96^ 2,485^/ Department of the Havy Total 128 HA 2^,502 13.952 476 862 12,620 Hospitals 27 27.965 17.825 12,800 476 862 11,462 , Dispensaries 101 HA 6,677 1.158 - - 1,15s27 VETSHAHS ADMI HISTHATI OH Hospitals - Total 125 110,577 102,21£ il.290 10,821 52,6iq 27,S50 TB Hospitals IS 8.975 7,825 67^9 T7I5T 73S HP Hospitals 33 53.005 50,636 47,l4i 263 45,145 1,733 QMS Hospitals 74 48,597 43.758 37.230 4,4l4 7,433 25.383 Domiciles 12 i6,4g4 16,174 14,259 - - 14,259^ Table 12 SUMMARY OP BEDS AND PATIENTS IN FEDERAL HOSPITALS IN THE UNITED STATES, BY AOSNcW Juno 30, I9I+S Agency Number of Number of Beds —,—.—. Number of Patients By Typo of Care Hospitals Capacity Operating Total TB HP CMS JUSTICE DEPARTMENT (Bureau of Prisons) Total 26 itl2L 1,216 5!+ 121 1,039 Medical Center Center 998 998 663 123^ US 62/ 117% Camp 1 ikk 117 - - Prison Dispensaries Total 25 1,612 1,063 i+36 — — Penitentiaries 6 791 5^2 2^3 — — 2U3 Reformatorios 5 299 2*K) 77 — — 77 Correctional Institutions 9 iso 229 100 — — 100 Comps k 133 6 — - - 6 Federal Detention Headquarters 1 9 9 10 - •- 10 FEDERAL SECURITY AGENCY Total 2S i6,6Ui U.738 1^,022 251 7,*+S7 5-587 Public Health Service — Total 26 9.1^3 10,2^0 7,300 S27 1,1^2 5,331 Marino General Hospitals 21 5.752 6,59s '*,533 217 3.916 Marine TB Hospitals 2 kzj 537 3 Leprosarium 1 53s Uo^ — _ *>K, 1,008-' Mental Hygiene Hospitals 2 2.^50 2.567 1,9 33 - 925 St, Elizabeths 1 7,000 7,000 6,3^5 - 6,3^5 Frecdmons 1 1+9S hqs 3S2 126 — 256 Table 12 (Continued) SUMMARY OR BEDS AND PATIENTS III FEDERAL HOSPITALS IN THE UNITED STATES, BY AGENCY^/ June 30, 19^8 Agency Number of Hospitals Number of Sods Total Number of By Patients Type of Care Capacity Operating TB HP GMS INTERIOR DEPARTMENT Total §1 m Mli s.M7 920 — MSI Indian Service Total 66 NA 3.S6M- 2,lK& 920 — 1 ,l+su United States Total 56 NA 3.W 2,0^9 716 - 1,333 GMS Hospitals 5U NA 2,9>a 1,667 331* rr 1,333 T3 Hospitals k NA 503 362 362 — — Alaska Native Service Total 6 NA U20 355 20k —■ 151 GMS Hospitals 7 NA 270 22k 73 - 151 T3 Hospitals 1 NA 150 131 131 — — Eish. and Wildlife Service l 6 6 3 — — 3 1T£ - Hot available. a/ Excluding dispensaries of the Coast Guard (U) and Maritime Commission, h/ Hospitalized narcotic addicts., c/ Estimated, d/ Domiciliary patients. Excluding domiciliary patients (l6) not in domiciles. oj All patients in dispenaries have heen considered Gi-IS although there may he a few T3 or HP at any one time. Table 12 (Concluded) SUMMARY OP BEDS AHD PATIENTS IH EEDEHAL HOSPITALS IH THE UHITSD STATESr BY AGENCY^/ June 30, I9U8 PAT 1 ENTS BY BENEFICIARY STATUS6 AREA, TYPE NUMBER OF BEDS NUMBER PATIENTS BY TYPE OF STATE AGENCY OF OF DISABIL 1 TY Pr i me Contingent Beneficiaries AND HOSPITAL HOS- Capac- Ope r- PATIENTS Bene- P1TA La ity at i ng TB NP GMSd fi c i ari es Total Dependents Vete rans Ot h e rs NEW ENGLAND MASSACHUSETTS Mu rphy . . Army G 540 540 31 1 — — 31 1 234 77 (c) — 77 Westover Field A i r Force S 392 125 43 — — 43 41 2 (c) — 2 Chelsea Navy G 914 700 470 15 31 424 324 146 37 86 23 Boston Naval Recruiting Station ... Navy D N. A. 25 — — — — — — — — Squanturn Navy Air Station Navy D N. A. 12 4 — — 4 4 — — — — Boston PHS G 37 2 364 255 32 — 223 192 63 8 45 10 Vineyard Haven PHS *G 24 39 1 1 — — 1 1 1 I — — — — Rut 1 and He i ghts VA TB 637 524 478 47 1 — 7 205 273 - — 269 4 Bedford VA NP 1,875 1,840 1,844 — 1,844 — 977 867 — 867 — No rt hampton VA NP 1, 105 1, 105 1,085 — 1,084 1 577 508 — 507 1 Framingham VA G 1,000 1,000 826 65 370 391 26 1 565 — 564 1 West Roxbury VA G 382 382 317 6 53 258 62 255 — 255 — CONNECTICUT Newington VA G 387 352 220 21 12 187 43 177 — f77 — New London Submarine Base Navy D N. A. 164 23 — — 23 21 2 (c) — 2 RHODE ISLAND Newport Navy G 725 725 49 1 7 39 445 296 195 17 167 1 1 Charleston Naval Air Aux. Station . Navy D N. A. 16 5 — — 5 o — — — — Newport Naval Training Center ...... Navy D N.A. 20 — — — — — — — — — Quonset Point Naval Air Station ... Navy D N. A. 170 41 — — 41 41 — — — — NEW HAMPSHIRE Portsmouth Navy G 380 150 66 — — 66 17 49 15 30 4 Portsmouth Naval Disciplinary Barr, Navy D N.A. 56 3 — — 3 3 — — — — Grenier Air Base Ai r Force S 141 25 3 — — 3 3 — — — -- MAINE Port 1 and PHS G 72 72 51 — — 51 21 30 3 20 7 Togus VA NP 924 9 15 706 15 512 18 1 233 475 — 47 3 2 Dow Ai r Base Ai r Force S 166 50 15 — — i5 13 2 (c) — 2 VERMONT White River Junction VA G 250 250 212 6 23 183 53 179 — 179 — MIDDLE ATLANTIC NEW YORK St Albans Navy G 2, 1 12 1,400 987 251 37 699 612 375 35 226 1 14 Brooklyn Navy Recruiting Station .. Navy D N.A. 37 8 — — 8 8 — — — — See footnotes at end of table. TABLE 13 BEDS, TYPE OF PATIENT AND PATIENTS BY BENEFICIARY STATUS IN FEDERAL HOSPITALS IN THE UNITED STATES ON JUNE 30, 1948 AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PATIENTS PAT It ENTS BY TYPE OF PAT 1 ENTS BY BENEFICIARY STATUS** AGENCY OF DISABILITY rontinoent Beneficiaries HOS- Capac- ity Oper- ating PITALa TB NP GMSd fi c i ari es Total Dependents Veterans Others MIDDLE ATLANTIC—Cont. HEW YORK—Cont. New York Navy Air Station Navy D N. A. 25 1 — — 1 1 — — — — Scotia Navy Supply Depot Navy . D N. A. 13 1 — — 1 1 — — — Ft. Totten Army e 75 100 48 — — 48 27 21 (c) — 21 Mitchel1 Ai r Base Air Fo rc e s 633 250 87 — — 87 71 16 (c) — 16 Stewart Air Base Ai r Force s 94 25 7 — — 7 7 — — — — Fort Hami 1 ton Army s 312 100 36 — — 36 1 35 (C) — 35 Fort Jay Arrn> s 229 350 1 64 — — 164 1 42 22 (C) — 22 U. S. Military Academy Army s 192 262 62 — — 62 36 26 (c) — 26 Buffalo PHS G 75 76 44 -- — 44 23 21 — 20 1 Neponsit Beach PHS TB 250 300 257 257 — 233 24 3 6 15 Ellis 1s 1 and PHS G 455 454 300 62 139 99 247 53 1 — 52 Staten Island PHS G 869 1,050 7 45 42 29 67 4 683 62 13 — 49 Puerto Rico PHS G 48 87 68 — — 68 32 36 -- 34 2 Batavia VA G 294 294 263 2 44 217 82 18 i — 179 2 Bath VA G 466 466 359 4 76 279 57 302 — 302 — Bronx VA G 1, 670 1,543 1.397 1 12 206 1,07 9 251 1. 1 46 — 1, 141 5 Brook lyn-Manhattan Beach VA G 400 350 304 1 1 15 188 36 268 — 268 — Saratoga Springs VA G 50 50 43 — — 43 12 31 — 31 — Staten Island VA G 1,500 1, 125 1,005 248 250 507 378 627 — 622 5 Puerto Rico VA G 20 0 200 191 — 9 182 16 175 — 175 — Castle Point VA TB 619 619 57 1 555 — 16 203 368 — 362 6 Sunmount VA TB 564 564 490 470 — 20 230 260 — 256 4 Canandaigua VA NP 1,742 1,742 1,638 — 1.637 1 774 864 — 8 64 — Northport PENNSYLVANIA VA NP 2.7 14 2,7 14 2,608 — 2, 598 10 1,739 869 — 866 3 Ph i1ade1ph i a Navy G 1.420 1 200 878 (3 57 808 229 649 42 560 47 Meehanicsburg Navy Supply Depot ... Navy D N. A. 50 — — -- — — — __ — r~ Willow Grove Navy Air Station Navy D N. A. 50 2 — -- 2 2 — — — — Olmsted Ai r Base Ai r Force S 47 25 5 — — 5 5 — — — — Carlisle Barracks Army S 97 100 27 — — 27 20 7 (c) — 7 New Cumber! and Army S 100 1 00 24 — — 24 10 14 (c) — 14 Valley Forge Army G 2,082 2. 082 1, 433 — 215 1.218 1, 215 218 (C) 141 77 Pi ttsbu rgh PHS G 73 79 57 — -- 57 12 45 — 39 6 Asp i nwal1 VA G 943 943 869 4 77 788 155 7 14 — 7 14 — Butler VA G 1,000 964 835 500 12 323 297 538 — 533 5 Coatesv i11e VA NP 2, 1 19 2, 1 19 2,054 — 2,052 2 1,084 970 — 969 1 Lebanon VA NP 477 285 246 — 6 240 45 20 1 — 201 — NEW JERSEY Earle Ammunition D D N. A. 46 Atlantic City Navy Air Station .... Navy N.A. 75 — — — — — — — — ~ AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PATIENTS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS5 AGENCY OF DISABILITY Prime Bene- f i c i ari es HOS- Capac- ity Oper- at ing P1T A La TB NP GMSd Total Depenaents Veterans Ottie rs MIDDLE ATLANTIC—Cont. MEW JERSEY—Cont. Lakehurst Navy Air Station Navy D N. A. 44 2 — 2 2 — — — — Camp Ki Imer Army S 1,4-19 800 156 — — 156 136 20 (c) — 20 Fort Monmouth Army S 818 300 133 — — 133 104 29 (°) — 19 TiIton Army G 2,359 1,500 936 — 66 870 713 223 179 44 Lyons VA NP 2,557 2,399 2.373 — 2.273 100 806 1,567 — 1,566 1 SOUTH ATLANTIC MARYLAND Annapo i i s Navy G 333 200 62 62 42 20 15 5 Bethesda Navy G 1 ,418 1,350 1,017 9 152 856 476 54! 120 34! 80 Indian Head Naval Powder Factory .. Navy D N . A. 18 1 — — 1 1 — — - Patuxent Navy Air Station Navy D N. A. 293 45 — — 45 25 20 (<*) 2D Bainbridge Navy School Navy D N, A. 40 1 — — 1 1 — — — — Aberdeen Prov. Ground Army S 690 150 74 — — 74 41 35 (C) — 33 Army Chemical Center Army 5 187 50 7 — — 7 6 i (c) — 1 Camp Detrick Army S 60 25 — — — — — — — Fort Meade Army S 697 250 94 — — 94 73 2 i (c) — 21 Fort Howard VA 6 483 443 402 55 27 320 48 354 — 354 — Perry Point VA NP 1,910 1,910 1,802 90 1,641 71 757 1,045 — 1,044 1 Baltimore PHS G 500 551 334 — — 334 279 55 10 35 10 DELAWARE Wi 1 m i ngton VA G 150 150 133 153 23 1 10 , 1 10 DISTRICT OF COLUMBIA Anacostia Navy Air Station Navy D N. A. 10 1 — — 1 1 — — — — Washington Recruiting Station ..... Navy 0 N. A. 28 1 — — 1 1 — — — — Anacostia Research Lab Navy D N. A. 6 — — — — — — — — — Walter Reed Army G 2, 100 2. 100 1,422 — 357 1,065 1, 125 297 26 271 Andrews Air Base Ai r Force S 112 50 17 — 17 17 — — — Bolling Air Base Ai r Force S 233 175 73 — — 73 27 46 ( o) — 46 Mt. Alto VA G 335 317 273 2 IB 253 40 233 — 232 1 VIRGINIA Portsmouth Navy G 1,203 1, 100 7 10 8 62 640 519 191 97 70 24 Quant ico Navy G 261 150 101 — 2 99 82 ! 9 19 — — Alexandria Ord. Pi ant Navy D N. A. 21 1 — — 1 1 — — — —; Dahlgren Naval Proving Ground Navy D N. A. 14 — — — — — — — — — Quantico Marine Corps Air Station . Navy 0 N. A. 40 1 — — I i — — — — Quantico Marine Corps School Navy D N, A. 66 — — — — — — — — — Chinco Tenque Aux. Air Station .... Navy D N. A. 52 14 — — 14 9 5 (c) — 5 Little Creek Phib. Base ........... Navy D N. A. 80 14 — — J 4 14 — — — — AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PATIENTS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS*5 AGENCY OF DISABI L ITY Prime Bene- f i c i ari es HOS- Capac- ity Oper- ating P1TA La TB NP GMSd Total Dependents Vete rans Others SOUTH ATLANTIC—Cent. VIRGINIA—Cent. Oceana Aux. Air Station Navy D N. A. 25 3 3 3 Yorktown Mine Depot Navy D N. A. 103 5 — — 5 5 — — — — Yorktown Mine Warfare School Navy D N. A. 10 — — — — — — — — — Norfolk Marine Corps Supply Depot . Navy D N. A. 1 — — — — — — — — — Norfolk Navy Air Station Navy D N. A. 1 18 25 — — 25 25 — — — — Norfolk Naval Re-training Com Navy D N. A. 20 10 — — 10 10 — — — Norfolk Naval Station Navy D N. A. 297 61 ■ — — 61 61 — — — — Lang ley Air Base Air Force S 366 100 46 — — 46 33 13 (c) ■ — 13 Fort Eustice Army S 522 100 61 — — 61 54 7 (C) — 7 Camp Lee Army s 1,207 300 101 — — 101 85 16 (C) — 16 Fort Monroe Army s 149 100 53 — — 53 18 35 (C) — 35 Fort Be 1 vo i r Army s 893 350 186 — — 186 152 34 (c) 10 24 Fort Myer Army s 1 19 160 80 — — 80 55 25 (°) — 25 Norfolk % PHS G 360 417 275 5 — 270 216 59 12 27 20 Kecoughtan VA G 604 561 410 57 1 14 239 46 364 — 363 I Richmond VA G 1,000 1 ,000 795 191 106 498 258 537 — 529 8 Roanoke VA NP 2,000 2,000 1,836 — 1,713 123 497 1,339 — 1,338 i WEST VIRGINIA Huntington VA G 290 240 225 2 17 206 35 190 — 190 — Mart i nsbu rg 'VA G 1 ,0Q0 700 598 219 120 259 147 45 1 — 45 1 — NORTH CAROLINA Camp Lejeune Navy G I, 178 300 187 — 6 181 163 24 20 — 4 Camp Lejeune Navy D N. A. 53 8 — — 8 8 — — — . — Cherry Point-Marine Corps Air Sta. Navy D N. A. 219 31 — — 31 16 15 (C) — 15 Fort Bragg Army S 2, 261 625 381 — — 381 309 72 (C) 12 60 Fayettev i11e VA G 460 258 230 5 47 178 57 173 — 172 1 Oteen .VA TB 996 996 890 854 — 36 438 452 — 429 23 Swannanoa VA TB 1,000 504 357 214 1 142 197 160 — 156 4 Cherokee Ind. Serv. G N. A. 28 21 — — 21 N. A. N. A. N. A. N. A. N.A, SOUTH CAROLINA Charleston Navy G 672 450 292 3 29 260 155 137 13 i 20 4 Parris Island Navy 6 300 150 129 — — 129 1 15 1.4 10 — 4 Charleston Ammunition Depot Navy D N. A. 4 — — — — — — — — — Parris Island Navy D N. A. 104 54 — — 54 54 — — — —- Greenville Air Base Air Fo rce S 328 100 41 — — 41 30 1 1 (c) — I 1 Shaw Ai r Base A i r Fo rce S 144 75 49 — — 49 42 7 (C) — 7 Fort Jackson Army S 2,396 500 37 1 — — 371 344 27 (C) — 27 Columbia VA G 700 700 607 77 63 467 71 536 — 536 — AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PAT-1 ENTS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS** AGENCY OF DlSABILITY Prime Bene- ■ f 1 c 1 aries HOS- Capac- ity Opcr- at i ng PITALa TB NP GMS^ Total Dependents Veterans Others SOUTH ATLANTIC—Cont. GEORGIA0 Atlanta Air Station ...- Navy D N. A. 25 1 1 — — I I 1 1 — — / — — Glynco Air Field Navy D N. A. 28 — — — — — — — — — Oliver Army G 1,500 1 ,500 953 — 66 887 706 247 (c) 158 89 Rob ins Air Base Ai r Force S 388 25 6 — — 6 4 2 (c) — 2 Turner Air Base Ai r Force S 1 19 50 30 — — 30 29 1 (c) — 1 Fo rt Benn 1 ng Army S 2,072 600 288 — — 288 177 I I 1 (O) 45 68 Fort McPherson Army S 701 200 45 — — 45 23 22 (c) — 22 Savannah PHS G 180 101 138 4 — 134 76 62 2 57 3 Chamb lee VA G 750 572 480 14 59 407 97 583 — 374 9 Augusta VA NP 1,383 1,336 1,222 31 1, 137 54 641 581 — 581 — Atlanta VA TB 225 225 209 178 16 15 74 135 — 1 135 — FLORIDA Jacksonv i11e Navy G 949 550 316 1 12 303 171 145 41 87 17 Key West Navy G 275 150 137 1 2 134 86 51 27 18 6 Pensacola Navy G 536 350 233 — 6 227 124 109 48 60 1 Green Cove Springs Navy D N. A. 44 17 — — 17 17 — — — Jacksonville Air Station Navy D N. A. I 12 19 — — 19 19 — — — — Key West Air Station Navy D N. A. 46 5 — — 5 5 — — — — Key West Open. Dev. Center Navy D N. A. 4 2 — — 2 2 -— —, — — Miami Air Station Navy D N. A. 15 — — — — — — — — — Panama City Mine Depot Navy D N. A. 6 2 — — 2 2 — — — — Pensacola Air Station Navy D N. A. 50 5 — — 5 5 — — — — Pensacola Air Training Base Navy D N. A. 58 10 — — 10 10 — — — — Eg~Hn Ai r Base Ai r Force S 317 150 60 — — 60 46 14 (c) — 14 MacDiII Air Base Ai r Force S 476 150 1 1 1 — — 1 1 1 76 35 (c) — 35 Orlando Air Base Ai r Force S 752 50 16 — — 16 5 1 1 (°) — I I TJfndal 1 Air Base A i r Fo rce S 290 50 28 — — 28 16 12 (c) — 12 Bay P i nes VA G 440 440 396 5 88 303 54 342 — 341 1 Lake City VA G 378 - 308 258 19 35 204 36 222 — 221 1 Coral Gab 1 es VA G 390 350 371 45 31 295 59 312 — 282 30 EAST-NORTH CENTRAL omo Columbus Air Station Navy D N. A. 20 8 — — 8 8 — — — Lockbourne Air Base Ai r Force S 165 75 44 — — 44 39 5 (c) — 5 Wright-Patterson Air Base ......... Ai r Force S 457 200 75 — — 75 62 13 (c) — 13 Cleveland PHS G 250 292 254 20 — 214 86 14-8 2 141 5 C1 eve 1 and VA G 1,000 1,000 825 159 666 157 668 ' — 666 2 Dayton VA G 1,004 1,004 917 230 12 I 566 1 18 799 — 793 6 AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PAT 1 ENTS PAT 1 ENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS* AGENCY OF D1SABIL ITY Pri me Bene- f i c i ari es . . . _ . _. HOS- Capac- ity Ope r- at ing P1TA La TB NP GMSd Total Dependents Veterans Others EAST-NORTH CENTRAL—Cont. OHIO—Cont. B recksv i 1 ! e VA TB 265 264 250 249 — 1 125 125 — 124 1 Chilli cothe VA NP 2,262 2,262 2, 156 — 2, 148 8 823 11»353 — 1,332 I INDIANA Crane Ammunition Depot Navy D N. A. 100 1 — — ! 1 — — — — Indianapolis 0rd. Plant Navy D N. A. 6 — — — — — — — — — 1nd i anapo1 i s . VA G 34-9 345 304 26 45 235 47 257 — 257 — Fort Harrison VA G 500 400 319 35 33 25! 42 277 — 271 6 Marion ILLINOIS VA NP 1,924 1,924 1,847 — 1,834 13 764 1,083 — 1,082 1 G neat Lakes Navy G 1,381 1, 100 846 1 1 46 789 74! 105 51 45 9 G1env i ew Navy D N. A. 75 1 — — 1 1 — — — — Great Lakes Training Center Navy D N. A. 416 133 — — 133 153 — — — — Chanute Ai r Base Ai r Force S 617 250 72 — — 72 61 1 1 (*) — 1 1 Scott Air Base Ai r Force s 780 250 1 10 — — 1 10 92 18 (*) — 18 Fort Sheridan Army s "342 100 63 — — 63 55 28 (c) — 28 Chicago PHS 6 250 293 183 14 — 169 1 10 73 2 7 1 — Dwight VA 6 286 21 1 158 — 19 159 14 144 — 144 — H i nes VA G 3,235 3, 200 2,451 330 71 1 1,410 363 2,088 — 2,076 12 Marion VA G 202 176 145 1 12 132 9 136 — 136 — Danv i 1 Ie VA NP 2,050 2,029 1,846 — 1,816 50 658 1, 188 — 1, 188 — Downey VA NP 2,947 2,340 2, 109 40 2,027 42 1,0 10 1 ,099 — 1,098 1 MICHIGAN Grosse Isle Air Station Navy D N. A. 105 4 — — 4 4 — — — SeIfridge Ai r Base Ai r Force S 166 50 14 — — 14 14 — — — — Percy Jones Army G 3,300 1,700 1 ,007 — 240 767 806 201 (°) 144 57 Det ro i t PHS G 250 267 226 23 — 203 102 124 2 121 1 Dearborn VA G 1,117 712 706 24 99 583 108 598 — 596 2 Fort Custer VA NP 2,218 2, 156 2,004 — 1,981 23 697 1,307 — 1,306 1 WISCONSIN USDS, Milwaukee Army S 56 50 19 — — 19 12 7 (c) — 7 Wood VA G 1,453 1,453 1,327 356 269 702 252 1,075 — 1,070 5 Tomah VA NP 1, 172 831 769 — 766 3 254 515 — 514 1 Waukesha VA TB 256 240 208 205 — 3 134 74 — 71 3 Hayward Ind. Serv. G N.A. 45 18 — — 18 N.A. N.A. N.A. N.A, N.A, EAST-SOUTH CENTRAL KENTUCKY Camp Campbell Army S 1,604 500 33 — — 33 . 24 9 (c> — 9 Fort Knox Army S 1,532 600 294 — — 294 246 48 (c) — 48 AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PATIENTS PAT 1 ENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS6 AGENCY OF DISABIL ITY Prime Bene- f i c i ari es HOS- Capac- ity Ope r- at ing PITA La TB NP GMSd Total Dependents Vete rans Ot he rs EAST-SOUTH CENTRAL— Cont. KENTUCKY—Cont. Lou i sv i11e VA G 1,000 1,000 744 56 79 629 80 664 — 642 22 Ft. Thomas VA G 300 300 85 — 24 61 29 56 — 56 — Lex i ngton VA NP 1,230 1, 130 1,058 — 1,04 1 6 \ig 469 589 — 589 ■ — Outwood VA TB 376 318 282 27 5 — 9 108 174 — 174 — Lexington PHS NP 1,450 1,517 1,049 — 197 852 968 81 — — 81 TENNESSEE Memphis Navy G 697 250 21 1 — 3 208 173 38 25 — 13 Memphis Air Tech. Tr. Center Navy D N. A. 40 14 — — 14 14 — — — — Memphis Air Station Navy D N. A. 10 1 — — 1 1 — — — — Memph is PHS G 130 168 108 31 — 77 104 4 1 — 3 Memphis (Kennedy) VA G 1,750 1,416 1,111 48 125 938 299 8 1 2 — 798 14 Mountain Home VA G 609 51 1 426 24 43 359 43 383 — 383 — Nashv i 1 1 e VA G 600 550 419 70 30 319 62 357 — 356 1 Memphis VA TB 300 284 270 263 — 7 109 161 — 161 — Murfreesboro VA NP 1,307 1,043 985 — 978 7 463 522 — 522 — ALABAMA Brook)ay Air Base Air Fo re e S 138 50 12 — — 12 10 2 (c) — 2 Craig Ai r Base A i r Force S 198 25 1 1 — — 1 1 1 1 — — — — MaxweII Air Base Air Fo rce S 569 175 74 — — 74 28 46 (<=) — 46 Huntsv i11e Arsenal Army S 36 25 12 — — 12 7 5 (C) — 5 Mobile PHS G 175 195 129 6 3 120 85 44 2 39 3 Montgomery VA G 300 300 268 12 14 242 67 20! — 201 — Tuskegee VA NP 2, 208 2,208 2, 106 42 1,723 341 565 1,541 — 1,535 6 Tuscaloosa VA ' NP 1,020 921 812 5 698 109 261 551 — 551 — MISSISSIPPI Kess1er Air Base Ai r Force S 936 300 1 19 — — 1 19 84 35 (c) — 35 Biloxi VA G 238 238 199 1 30 168 19 180 — 180 — Jackson VA G 650 362 290 40 16 234 28 262 — 259 3 Gulfport VA NP 1,098 1,098 1,058 — 1,052 6 458 600 — 600 — Choctaw Ind. Serv. G N. A. 35 9 — — 9 N. A. N. A. N. A. N. A. N. A. WEST-NORTH CENTRAL MINNESOTA Minneapolis Air Station Navy D N. A. 21 3 — — 3 3 — — — — Mi nneapo Ms VA G 1,050 1,018 996 179 173 644 125 87 1 — 864 7 St. Cl oud ,. . VA NP 1,528 1 ,437 1,349 — 1,347 2 706 643 — 643 — Pipestone Ind. Serv. G N. A. 36 3 — — 3 N. A. N. A. N. A. N. A. N. A. Red Lake Ind. Serv. G N. A. 23 15 — — 15 N. A. N, A. N. A. N. A. N. A. Cass Lake Ind. Serv. G N, A. 32 12 — — 1 2 N. A. N. A. N. A. N. A. N. A. TYPE NUMBER OF BEDS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS* AREA, AGENCY OF NUMBER DISABILITY Prime Bene- f ic iar ies STATE HOS- Capac- ity Oper- at ing OF AND HOSPITAL P1TA La PATIENTS TB NP GMSrf Tot a 1 Dependents Vete rans Ot he rs WEST-NORTH CENTRAL—Cont. MINNESOTA—Cont. Fon-d u-1 ac 1 nd. Serv. G N.A. 18 14 — — 14 N.A. N.A. N.A. N.A. N.A. White Earth 1nd. Serv. G N.A. 22 1 0 — — 10 N.A. N.A. N.A. N.A. N.A. IOWA Des Moines VA G 506 506 430 12 34 384 52 378 — 376 2 Knoxv iIIe VA NP 1,940 1,905 1 ,738 35 1,703 — 731 1 ,007 — 1 ,007 — MISSOURI St. Louis Air Station Navy D N.A. 50 3 — — 3 3 — — — — Ki rkwood ... - PHS G 144 162 75 8 — 67 43 32 — 32 — Jefferson Barracks VA G 707 707 637 1 8 1 15 504 1 17 520 — 520 — Springfield VA TB 500 444 395 340 — 55 129 266 — 252 4 Excelsior Springs VA TB 252 226 208 196 — 12 1 00 I 08 — I 05 5 NORTH DAKOTA Fargo VA G 400 227 157 2 26 129 23 134 — 154 — Ft. Bert ho Id Ind. Serv. G N.A. 18 7 — — 7 N.A. N.A. N.A. N.A. N.A. Standing Rock 1nd. Se rv . G N.A. 47 23 — — 23 N.A. N.A. N.A. N.A. N.A. Ft. Totten Ind. Serv. G N.A. 31 13 — — 15 N.A. N.A. N.A. N.A. N.A. T u rt 1 e Mt Ind. Se rv. G N..A. 42 23 — — 23 N.A. N.A. N.A. N.A. N.A. SOUTH DAKOTA Weave r A i r Base A i r Force S 162 75 49 — — 49 31 18 (c) — ) 8 Black Hills Ord. Depot Army S 38 16 4 — — 4 — 4 (c) — 4 Fort Meade VA MP 720 720 645 — 637 8 228 417 — 415 2 Hot Springs VA G 270 270 226 65 22 141 28 198 — 196 2 Cheyenne R iver Ind. Se rv. G N.A. 40 14 — — 14 N.A. N.A. N.A. N.A. N.A. Pine R idge Ind. Se rv. G N.A. 51 27 — — 27 N.A. N.A. N.A. N.A. N.A. Rose Bud Ind. Se rv. G N.A. 48 30 — — 30 N.A. N.A. N.A. N.A. N.A. Yankton Ind. Se rv. G N.A. 25 15 — — 15 N.A, N.A. N.A. N.A. N.A. S isseton Ind, Serv. G N.A. 32 20 — — 20 N.A. N.A. N.A. N.A. N.A. Sioux Sanitorium Ind. Se rv. TB N.A. 123 128 128 — — N.A. N.A. N.A. N.A. N.A. NEBRASKA Hastings Ammunition Depot Navy D N.A. 58 4 — — 4 4 — — — — Kearney Air Base A i r Force S 21 1 50 21 — — 21 17 4 (c) — 4 Offutt Air Base A i r Force S 139 75 31 — — 31 21 1 0 (c) — i 0 Sioux Ord. Depot - Army S 38 1 1 — — — — — — — — — Lincoln VA G 306 306 273 2 37 234 38 235 — 235 — W i nnebago - KANSAS Ind. Serv. G N.A. 54 16 — — 16 N.A. N.A. N.A. N.A. N.A. Olathe A i r Stat ion Navy D N.A. 28 7 — — 7 7 — . — — Smoky Hill Air Base A i r Force S 240 1 00 52 — — 52 26 26 (c) — 26 Fort Leavenworth Army S 265 150 84 — — 84 42 42 (c) — 42 AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PATIENTS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS6 AGENCY OF DISABILITY Prime Bene- ficiaries HOS- Capac- ity a PITALa mg TB NP GMSrf Total Dependents Veterans Others WEST-NORTH CENTRAL—Cont. KANSAS Fort Riley Army S 1,036 175 105 — — 105 82 23 — 23 Topeka VA NP 1,400 1 ,400 1,044 1 847 196 330 7 14 — 7 14 — Wadsworth VA G 1,082 1,020 1,000 49 355 596 175 825 — 822 3 Wichita ■ VA G 256 256 213 1 30 182 15 198 — 198 — WEST-SOUTH CENTRAL ARKANSAS Army and Navy Army G 516 410 319 — — 319 79 240 (<=) 152 88 N. Little Rock VA ND 2,095 2,095 1,810 4 1,742 64 753 1,057 — 1,057 — Fayettev i11e VA G 302 243 172 — 10 162 12 160 — 160 — OKLAHOMA Mail ester Ammunition Depot Navy D N. A. 19 — — — — — — — — — Ti nker Ai r Base Ai r Force S 166 25 9 — — 9 9 — — — — Fort Sill Army S 1, 192 200 72 — — 72 42 30 (c) — 30 Muskogee VA G 386 386 283 13 52 218 56 227 — 227 — Ok 1ahoma City VA G 220 220 196 6 14 176 45 151 — 151 — Claremore Ind. Serv. G N. A. 80 35 — — 35 N. A. N. A. N. A. N. A. N. A. Ta1i k i ma . Ind. Serv. 6 N. A. 237 154 59 95 N. A. N. A. N. A. N. A. N. A. Ta 1 ague 'Ind. Serv. G N. A. 72 23 — — 23 N. A. N. A. N. A. N. A. N. A. Shawnee Sanitorium Ind. Serv. TB N. A. 150 78 78 — — N. A. N. A. N. A. N. A. N. A. Pawnee & Ponca Ind. Serv. G N. A. 50 16 — 16 N. A. N. A. N. A. N..A. N. A. Kiowa Ind. Serv. G N. A. 150 51 — — 51 N. A. N. A. N. A. N, A. N. A. Clinton Ind. Serv. G N. A. 27 1 1 — — 1 1 N. A. N. A. N. A. N. A. N „ A. LOUISIANA New Orleans Air Station Navy D N. A. 25 2 — - 2 2 — — — — New Orleans Naval Station Navy D N. A. 120 28 — — 28 28 — — — — Barksdale Air Base Ai r Force S 25 1 100 47 — — 47 35 12 rc; 2 10 New Orleans Port of Embarkation ... Army S 961 75 40 — — 40 37 3 (c) — 3 New Orleans PHS G 500 572 365 38 44 283 189 176 4 160 12 Carville Leprosarium PHS L 454 538 404 — — 404 404 — — — — A1exand ri a VA G 662 522 480 263 — 217 127 353 — 353 — New Orleans VA G 670 579 477 34 64 379 95 382 — 380 2 , TEXAS Corpus Chri st i Navy G 691 250 17 1 1 9 161 69 102 9 90 3 Houston Navy G 1,000 600 432 3 32 397 121 31 1 9 295 7 Corpus Christ! Air Station Navy D N. A. 73 16 — — 16 16 — — — — Dallas Air Stat ion Navy D N. A. 32 4 — — 4 4 — — — — Orange Naval Station Navy D N. A, 29 7 — — 7 6 I ( c) — 1 TYPE NUMBER OF BEDS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS4* AREA, OF NUMBER DISABILITY Prime Bene- f ic iar ies STATE AGENCY HOS- Capac- ity Oper- at ing OF AND HOSPITAL P1TA La PATIENTS TB NP GMSd Total Dependents Vete rans Ot he rs WEST-SOUTH CENTRAL—Cont. TEXAS—Cont. Bergstrom Air Base A i r Force S 156 25 23 — — 23 25 — — — — CarsweII Air Base A i r Force s 165 1 00 56 — — 56 37 19 (e) — 19 Goodfellow Air Base A i r Force s 91 50 16 — — 16 16 — — — — Lackland Air Base Air Force s 878 600 401 — — 401 576 26 (c) — 26 Perri n Air Base A i r Force s 122 50 15 — — 15 15 — — — — Randolph Air Base A i r Force s 375 1 00 48 — — 46 45 3 (C) — 5 Camp Hood Army s 2,207 150 54 — — 54 33 21 (c) — 21 Red River Arsenal Army s 1 09 25 1 — — 1 1 — — — — Beaumont Army G 2,046 700 400 — 35 565 208 192 (C) 125 69 Brooke Army G 1 ,900 1 ,900 1,412 — 211 1 ,201 799 613 (C) 388 225 Fort Worth PHS NP 1 ,000 1,050 804 — 72 e* 156* 284 600 — 241 359 Galveston PHS G 1 60 202 176 12 2 173 150 46 — 44 2 Leg ion VA TB 695 348 341 309 — 52 176 165 — 162 5 Waco VA NP 2,214 2,003 I ,944 — 1 ,918 26 730 1,214 — 1 ,214 — Amarillo VA G 1 87 187 130 1 1 1 1 18 18 1 12 — 1 I 1 1 Dallas . VA G 366 365 327 5 44 280 58 289 — 288 1 McKinney VA G 1,000 671 483 1 18 20 345 143 540 — 331 9 Temple VA G 1,000 719 687 1 06 240 541 150 537 — 534 5 ROCKY MOUNTAIN MONTANA s 506 258 50 193 I 7 17 125 17 27 Fort Harrison VA G 145 .— 22 1 18 117 1 Blackfeet Ind. Serv. G N. A. 45 21 — — 21 N.A. N.A. N.A. N.A. N.A, Crow 1 nd . Se rv. G N. A. 56 18 — — 18 N.A. N.A. N.A. N.A. N.A. Fort Belknap Ind. Se rv. G N.A. 47 10 — — 40 N.A. N.A. N.A. N.A. N.A. Fort Pec k Ind. Se rv, G N. A. 25 12 — — 12 N.A. N.A. N.A. N.A. N.A, IDAHO Pocatello Ord. Plant Navy D N.A. 12 1 — — 1 1 — — — Boise VA G 263 263 (71 1 4 ♦ 66 26 145 — 145 WYOMING Fort F.E. Warren Air Base A i r Force S 306 125 90 — — 90 71 19 (c) — 19 Sheridan VA NP 777 777 698 — 673 25 260 418 — 418 — Cheyenne VA 6 201 201 128 — 21 107 17 1 1 1 — 1 1 1 — Wind River 1 nd . Se rv . G N.A. 50 14 — — 14 N.A. N.A. N.A. N.A. N.A. COLORADO Denver Air Station Navy D N.A. — 1 — 1 1 — — — — Lowry Air Base A i r. Force S 291 250 87 r— — 87 84 3 (c) — 3 Camp Carson Army S 1 ,548 100 21 — 21 8 13 (c) — 13 AREA, STATE AND HOSPITAL AGENCY — TYPE OF HOS- PITAL3 NUMBER, OF BEDS NUMBER OF PATIENTS PATIENTS BY TYPE OF DISABILITY PATIENTS BY BENEFIC 1 ARY STATUS4 Pr i me Bene- f ic iar ies Contingent Beneficiaries Capac- ity Oper- at i ng TB NP GMSd Tot a 1 De pendents Vete rans Ot he rs RXKY MOUNTAIN—Cont. COLORADO—Cont. F itzs i mons A rmy G 5,417 2,695 1 ,884 713 1 88 983 1 , 091 793 (C) 608 1 35 Fort Lyon VA NP 918 918 876 — 873 3 355 521 — 52 1 — Fort Logan VA . G 300 289 283 44 8 231 64 219 219 — Arango 1nd. Se rv. G N. A. 21 8 — — 8 N. A. N.A. N.A. N.A. N.A. NEW MEXICO Ho 1 1 Oman A i r Base Air Force S 209 25 16 — — 16 16 — — — — Wa 1 ke r Air Base . Air F o rc e s 215 50 28 — — 28 24 4 (c) — 4 Fort Stanton PHS TB 237 237 1 68 165 — 3 163 5 — 1 4 Fort Bayard VA TB 223 223 193 1 42 2 49 41 152 — 151 I Albuquerque VA G 294 294 280 100 19 161 85 195 — 1 95 — Crown Point 1nd. Se rv . 6 N. A. 65 20 — — 20 N. A . N.A. N.A. N.A. N.A. Shiprock 1 nd. Se rv . G N. A. 43 22 — — 22 N. A. N.A. N.A. N.A. N.A. Mesca 1 e ro . 1 nd . Serv. G N. A. 32 1 0 — — 1 0 N. A. N.A. N.A. N.A. N.A. Albuquerque 1 nd . Se rv . G N. A. 60 40 — — 40 N. A. N.A. N.A. N.A. N.A. A Ibuque rque 1 nd . Serv. TB N. A. 1 00 93 93 — — N. A. N.A. N.A. N.A. N.A. Zun i 1nd. Se rv . G N. A. 42 24 — — 24 N. A. N.A. N.A. N.A. N.A. Santa Fe Ind. Serv. G N. A . 52 26 — — 26 N. A. N.A. N.A. N.A. N.A. ARIZONA Davis-Monthan Air Base Air Force S 409 75 38 — — 38 27 1 1 (c) — 1 1 Willi ams A i r Base A i r Force S 240 50 26 — — 26 25 1 (c) — 1 Navajo Ord. Depot Army s 46, 25 1 0 — — 1 0 1 9 (c) — 9 Tucson VA TB 414 41 1 367 242 5 120 141 226 — 223 3 Whipple VA TB 391 387 263 142 7 1 14 62 201 — 1 99 2 Phoenix VA G 1 44 1 44 1 15 — 1 1 14 24 91 — 91 Co 1 orado River Ind. Se rv. G N. A. 42 1 0 — 1 0 N. A. N.A. N.A. N.A. N.A. Ft. Apache Ind. Se rv. G N. A. 48 21 — — 21 N.A. N.A. N.A. N.A. N.A. Hopi Ind. Se rv. G N. A. 38 25 — — 25 N. A. N.A. N.A. N.A. N.A. Navajo Medical Center Ind. Se rv. G N. A. 250 250 1 00 — 150 N.A. N.A. N.A. N.A. N.A. Tubabty ' - . .. . Ind. Se rv. G N..A. 28 25 — — 25 N.A. N.A. N.A. N.A. N.A. W i ns 1 ow Ind. Serv. G N. A . 50 30 — — 30 N.A. N.A. N.A. N.A. N.A. Pima Ind. Serv. G N. A. 40 15 — — 15 N.A. N.A. N.A. N.A. N.A. San Carlos Ind. Se rv. G N. A. 45 16 — — 16 N.A. N.A. N.A. N.A. N.A. Phoenix General Ind. Serv. G N. A. 64 56 — — 56 N.A. N.A. N.A. N.A. N.A. Phoenix Sanitorium Ind. Serv. TB N. A. 130 83 83 — — N.A. N.A. N.A. N.A. N.A. San Xavier Sanitorium Ind. Serv. G N. A. 46 18 — — 18 N.A. N.A. N.A. N.A. N.A. UTAH Clearfield Supply Depot Navy D N. A. 72 I — — 1 1 — — — — Hill Air Base A i r Force S 128 50 19 — — 19 9 1 0 (c) — 1 0 Sa 11 Lake City VA G 204 204 138 — 2 136 12 126 — 125 1 Unitah Ind. Serv. G N. A. 24 7 — — 7 N.A. N.A. N.A. N.A. N.A. AREA, STATE AND HOSPITAL TYPE NUMBER OF BEDS NUMBER OF PATIENTS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS6 AGENCY OF DISABIL ITY Prime Bene- ficiaries . . . HOS- Capac- ity Ope r- at i ng uiiyciu P1TA La TB NP GMSd Total Dependents Vete nans Ot he rs ROCKY MOUNTAIN—Cont. NEVADA Hawthorne Ammunition Depot Navy D N. A. 36 1 — — 1 1 — — — — Reno VA G 166 125 101 2 9 90 7 94 — 94 — W. Shoeshone Ind. Serv. G N. A. 20 7 — — 7 N. A. N. A. N. A. N. A. N. A. Walker River Ind. Serv. G N. A. 36 21 — — 21 N. A. N. A. N. A. N. A. N. A. PACIFIC COAST CALIFORNIA El Centro Air Station Navy D N. A. 10 — — — — — — — — — E! Toro Marine Corps Air Sta Navy D N. A. 140 28 — — 28 14 14 Cc) 14 Inyokern Ord. Test. Sta Navy D N. A. 84 22 — — 22 7 15 (C) — i 5 Long Beach Recruiting Sta Navy D N. A. 48 7 — — 7 7 — — — — Los Alamitos Air Sta Navy D N. A. 35 — — — — — — — — — Miramar Aux. Air Sta Navy D N. A. 29 2 — — 2 2 — — — — Camn Pendleton Navy D N. A. 65 23 — — 23 23 — — — — Point Mugu Air Missile Dev. Center Navy D N. A. 1 1 5 — — 5 5 — — — — Ft. Hueneme Train, h Dist. Cent. .. Navy D N, A. 350 10 — — 10 7 3 (C) — 3 San Diego Marine Corps Recr. Dep. . Navy D N, A. 94 16 — — 16 16 — — — — San Diego Air Station Navy D N. A. 159 26 — — 26 9 17 (e) — 17 San Diego Flight Sonar School Navy D N. A. 23 3 — — 3 3 — — — — San Diego Phib. Tr. Base Navy D N. A. 106 7 — — 7 7 — — — — San Diego Naval Station Navy D N. A. 41 15 — — 15 15 — — — — San Diego Training Center Navy D N. A. 522 186 — — 186 186 — — — — San Ysidro Aux. Air Sta Navy D N. A. 33 3 — — 3 3 — — — — Santa Ana Air Station Navy D N. A. 35 — — — — — — — — — Alameda Air Station Navy D N. A. 48 16 — — 16 16 — — — — Moffett Field Navy D N. A. 66 4 — — 4 4 • — — — Monterey Aux. Air Sta. & Naval Tr. S. Navy D N. A. 26 6 — — 6 6 — — — — Oakland Air Station Navy D N. A. 9 2 — — 2 2 — — — — Pt. Chicago Naval Magazine Navy D N. A. 85 — — — — — — — — — Oakland Supply Center Navy D N. A. 6 1 — — 1 1 — — — — San Francisco Naval Ship Yard Navy D N. A. 12 1 — — 1 1 — — — — Stockton Supply Annex Navy D N. A. 9 4 — — 4 4 — — — — Tiburon Naval Net Depot Navy D N. A. 9 — — — — — — — — — Treasure Island Naval Station Navy D N. A. 147 20 — — 20 20 — — — — Corona Navy G 2,246 650 412 151 — 261 188 224 — 176 48 Long Beach Navy G 1,791 ' 1,250 1,036 — 49 987 553 483 92 320 7 1 San Di ego Navy G 1 ,981 1,550 1,273 — 125 1, 148 874 399 1 18 185 98 Oceanside Navy G 1,228 250 200 — 1 199 183 17 14 — 3 Mare Island Navy G 873 700 408 2 107 299 202 206 23 16! 22 TYPE NUMBER OF BEDS NUMBER OF PAT I ENTS PATIENTS BY TYPE OF PATIENTS BY BENEFICIARY STATUS6 AREA, AGENCY ’ OF D1SABI L ITY Pr ime Bene- f ic iaries STATE HOS- Capac- Oper- at ing AND HOSPITAL P 1TA L1 TB NP GMSd T ota 1 De pendents Veterans Others PACIFIC COAST— Cont. CALIFORNIA • Oakland Navy G 2,779 1,750 1,192 — 32 1,160 666 526 82 397 47 Cast 1 e Air Base A i r Force S 1 16 75 1 8 — — 1 8 12 6 (c) — 6 Fa I rf ie Id-Su isun Air Base A i r Force S 166 125 30 — — 30 27 3 (c) ' 3 Ham i It on Air Base A i r Force S 358 200 73 — — 75 43 30 (c) - 30 March Air Base A i r Force s 479 1 00 60 — — 60 34 26 (o) 26 Mather A i r Base A i r Force s 21 1 50 42 — — 42 13 29 (C) — 29 Mu roc A i r Base A i r Force s 233 25 9 — — 9 7 2 (C) — 2 Fort Ord A rmy s 1 ,434 400 21 1 — — 21 1 181 30 (C) — 30 Camp Stoneman Army s 826 300 87 — — 87 70 1 7 (c) — 17 Camp Cook Army s 1,304 40 28 — — 28 2! 7 (c) — 7 Sierra Ord. Depot Army s 57 25 9 — — 9 — 9 (C) . — 9 Letterman Army G 2,185 2,185 .1,189 — 273 91 6 857 332 (C) 1 05 227 McCornach Army G 550 550 377 — — 377 178 1 99 (C) 99 1 00 San Franc isco PHS G 485 550 368 73 — 295 301 67 1 50 I 0 Livermore VA TB 458 458 429 414 — 15 i 65 264 — 261 3 San Fernando VA TB 383 369 340 332 — 8 200 140 — 132 8 Palo Alto . VA NP 1,473 1,473 1 ,447 — 1,432 15 747 7 00 — 687' 13 Los Ange1 GMS 1,448 1,409 1 ,204 24 40 1,140 99 1,105 — 1,101 4 Los Ange 1 VA NP 2, 149 1 ,979 1,931 — 1 ,921 10 672 1 ,259 — 1 ,257 2 Oak 1 and VA G 800 489 429 63 33 333 78 351 — 349 San Francisco . . VA G 396 374 318 — 13 305 72 246 — •246 — Van Nuys VA G 1,499 1 ,447 1 ,263 284 277 7 02 528 935 — 930 5 Fort Yuma 1 nd . Serv. G N. A. 28 7 — — 7 N.A. N.A. N.A. N.A. N.A. Hoopa Va1 ley 1 nd . Serv. G N. A. 29 22 — — 22 N.A. N.A. N.A. N.A. N.A. OREGON Tongue Pt. Naval Station Navy D N. A. 80 1 1 — — 1 1 4 7 — — 7 Roseburg VA NP 670 670 594 — 584 10 228 366 — 366 — Port 1 and Warm Springs VA 1 nd. Serv. G G 510 N. A. 509 23 404 8 404 8 39 N.A. 365 N.A. — 363 2 WASHINGTON Key port Naval Torpedo Station Navy D N. A. 8 — — — — — — — — — Seattle Air Station Navy D N. A. 1 1 0 18 — — 18 4 14 — — — Seattle Naval Station Navy D N. A. 40 4 — — 4 4 — — — — Whidbey Island Air Station Navy D N.A. 87 41 — — 41 41 — — — -- Bremerton Navy G 622 550 329 — 23 3 06 229 1 00 37 41 22 McChord Air Base Air Force S 213 75 30 — — 30 30 — — — — Spokane Air Base A i r Force S 1 16 125 64 — — 64 42 22 (c) I 6 6 Fort Lawton Army S 617 300 96 — — 96 83 13 ( c) — 13 Fort Worden Army S 68 25 1 4 — — 14 14 — — — — AREA, STATE AND HOSPITAL AGENCY TYPE OF HOS- P1 TA La NUMBER OF BEDS NUMBER OF PAT 1 ENTS PATIENTS BY DISABI L TYPE OF ITY PAT 1 ENTS BY BENEFICIARY STATUS6 Pr i me Bene- f ic iaries Contingent Beneficiaries Capac- ity Oper- at i ng TB NP GMSd Tota 1 De pendents Vete rans Ot he rs PACIFIC COAST—Cont. WASHINGTON—Cont. Mad i gan Seatt le Wat la Walla American Lake Vancouver - Tac oma Colville A rmy PHS VA VA VA 1 nd . Se rv. 1 nd. Serv. G G TB NP G G G 1 ,658 400 421 1,028 500 N.A. N.A. 1 ,300 517 421 951 500 335 36 851 596 378 830 440 303 21 46 295 133 175 1 04 10 828 1 7 747 350 73 2 290 128 21 483 257 145 362 101 N.A. N.A, 368 1 59 233 468 339 N.A. N.A. (c) 4 254 229 468 336 1 14 2 4 3 N.A.--Not Available. aType of Hospital: G- - genera 1 ; S - ‘■s ta t ion; D-- dispensary; TB-- tuberculosis; NP-- neur opsychiatrie. “Patients are considered as prime or contingent beneficiaries a ccord ing to their has ic e1i gibi lities for care by the agency which is hospitalizing them. Thus, any veteran in a non-VA hospital is considered as a contingent beneficiary. Prime beneficiaries in VA hospitals include only those veterans receiv- ing treatment for service-connected disabilities. Prime beneficiaries in Army, Navy and Air Force hospitals include only active duty military personne1. Prime beneficiaries in PHS hospitals include merchant seamen and PHS and Coast Guard PersonneI. cNumber of dependents in Army and Air Force station hospitals and in Navy dispensaries not ava ilable separately- - included in "others » For the purposes of this table it has been, assumed that all patients in Army and Air Force station hospitals and in Nary dispensaries are GNS patients . In the foregoing summary table an attempt has beenimade to estimate the distribution of these patients by type of disability. eDublin general hospital excluded--being in the process of transfer from the Navy to the VA on June 30 1948. These are operated as parts of one VA hospital (Sawtelle). &Narcotic addicts in GMS column, all other patients, most of whom are NP, in NP column • NEW HOSPITAL CONSTRUCTION PROGRAM OP VETERANS ADMINISTRATION A, Hospitals For Which Principal Construction Contracts Have Been Awarded Number of Beds Cost^/ Name and State Total Estimate By Type of Care^ TB NP GMS Square Peet Per Bed Total (In Thou- sands) Per Bed Per Square Poot Date of Con- tract Award Esti- mated Date of Completion GENERAL MEDICAL and SURGICAL HOSPITALS * Miles City, Montana 100 mm 100 1.693 $ 5.101 $51,013 $30.14 Sept 1948 NA Manchester, N, H# 150 - - 150 1.325 4,949 32,991 2I+.97 June 1948 Mar. 1950 Grand Junction, Colo. 152 - 6 i46 1,056 ■3,886 25.565 24.23 Jan. 1947 Oct. 1948 Minot, N. D, 162 — i4 148 1,045 4.215 26,020 24.85 Jan. 1947 July 1949 Altoona, Pa. Erie, , Beckley, W. Va.^/ 200 M 2k 176 1.173 6.256 31,281 27.31 Mar. 1948 Nov. 1949 200 2k 176 1.13s 6.383 31,915 28.04 Apr. 1948 Jan. 1950 200 - 2k 176 1,102 6.19s 30,988 28.17 Feb. 1948 Peb. I95O Clarksburg, W. Va. 200 ~ 2k 176 1.195 6.365 31,827 26.57 Mar. 1948 Mar. 1950 Saginaw, Mich, 200 - 2k 176 1,016 4,882 24,403 23.99 Apr. 1948 Apr. 1950 Pt* Wayne, Ind. 200 - 2k 176 1,057 6,012 30,05s 28.4l Peb. 1948 Oct. 1949 Grand Island, Nehr. 200 - 2k 176 1,182 6,o46 30.228 25.5S Dec. 1947 Dec. 1949 Poplar Bluff, Mo. 200 - 2k 176 1.175 5.829 29,146 24.85 Dec. 1947 Aug. 1949 Marlin, Texas 200 - 2k 176 960 4,964 24,818 25.S3 June 1948 May 1950 Spokane, Wash, 200 — 2k 176 908 4,642 23.209 25.5S Mar. 1948 Apr. I95O Iron Mt., Mich, 250 • 2k 226 972 6.979 27,917 28.66 Peb. 1948 Oct. 1949 Big Spring, Texas 250 - 2k 226 1,026 6,552 26,206 25.58 Jan. ig4s Aug. 1949 Fresno, Calif. 250 2k 226 1,060 6.597 26,386 25.58 Aug. 1947 Mar. 1949 Sioux Palls, S. D, 282 6 276 742 “+.303 15,206 20.54 Nov, 1946 Nov. 1948 Wilmington, Seattle, Wash 300 —1 18 282 1.172 8,569 28,562 24.35 Peb. 1948 Mar. 1950 300 100 200 893 7.247 24,156 27.06 Oct. 1948 NA Providence, R. I. 399 9 390 807 5.671 14,214 17.59 Sept 1946 Completed Shreveport, La. 450 - 160 290 i.o46 11.194 24,876 23.74 Nov. 1947 Oct. 1949 Wilkes Barre, Pa. 475 160 315 931 13,202 27,793 29.89 Mar. 1948 Mar. 1950 Omaha, Nehr. 500 _ 160 34c 840 11,559 23.119 27.55 Dec. 1947 Mar. 1950 Little Rock, Ark, Denver, Colo.^ 500 - 160 3U0 S5I4 11,981 23,961 28.04 Peb. 1948 Mar. 1950 500 - 160 3I+0 716 9.72S 19 M5 27.18 Sept 1948 NA Brooklyn, N. T 1,000 — 280 720 757 19.3S7 19,327 25.5S AO£. 1947 Aug. 1949 Newark, N, J. 1,000 280 720 800 20,241 20,241 25.34 Apr. 1948 Nov. 1950 Albany, N. Y, 1.005 — 280 725 75S 19,592 19,1+95 25.70 Mar. 1948 June 1950 Buffalo, N, Y. 1,005 280 725 760 IS, 7*9 18,696 24.60 Dec, 1Q47 Nov. 1949 NEW HOSPITAL CONSTHJCTIOK PROGRAM OP VETERANS ADMINISTRATION A, (Continued) Hospitals For Which Principal Construction Contracts Have Been Awarded Number of Beds Cost^ Name and State Total Estimate By Type Square Total of Careii/ Feet (In Per Per Square Date of Con- Esti- mated. TB HP CMS Per Thou- Bed Bed sand^ Foot tract Award Date of Completion NBDEOPSYCHIATRIC HOSPITALS Peekskill, N, Y. 1.965 - 1,965 - NA $12,682 NA Jan. 19^7 Nov. I9U9 NA H y y y - Not Available These hospitals are being built to replace existing hospitals. All others are additions to the capacity of the Veterans Administration system. Obtained from records of the Federal Board of Hospitalization. All other data obtained from Construction, Supply, and Real Estate Service of Veterans Administration Includes cost for construction, contingencies, fixed equipment, site landscaping, and technical services, Capaci ty of Brooklyn hospital authorized at 1,000 beds. Changes during construction will reduce this to 9S1 beds. 191 NEW HOSPITAL CONSTRUCTION PROGRAM OF VETERANS ADMINISTRATION B, Hospitals In Various Stages of Planning^/s/ Number of Beds Hospital Total Estimated By Type of Care-/ TB NP GMS GENERAL MEDICAL and SURGICAL HOSPITALS Tallahassee, Florida 100 _ 100 Thwnasville, Georgia 100 — 100 Harrisburg, Pennsylvania 200 — 24 176 Greenville, South Carolina 200 - 24 176 Grand Rapids, Michigan 200 - 24 176 Duluth, Minnesota 200 - 24 176 Mound Bayou, Mississippi 200 - 24 176 Tupelo, Mississippi . Klamath Falls, Oregon-2/ Phoenix, Arizona-2/ 200 -■ 24 176 200 - 24 176 200 - 24 176 San Diego,’ California 200 — 24 176 Decatur, Illinois Bonham, Texas 250 . ** 2v 226 , 350S/ 350^/ - - Charlotte, North Carolina 500 _ 160 340 Durham, North Carolina 500 - 160 340 Birmingham, Alabama 500 -• 160 340 Chattanooga, Tennessee 500 - 160 340 Ann Krbor, Michigan , Indianapolis, Indiana!/ 500 - 160 340 500 - 160 340 Ifcwa City, Iowa Dallas, / New Orleans, Louisiana-/ 500 - 160 340 500 - 160 340 500 — 160 340 Chicago, Illinois^/ 600 _ ' 600 Kansas City, Missouri 745 250 160 335 Cincinnati, Ohio . Louisville, Kentucky—/ 750 — 200 550 750 - 200 550 Washington, D. cjy 750 - 200 550 Atlanta, Georgia!/ 750 — 200 550 West Haven, Connecticut 900 400 160 340 192 NEW HOSPITAL CONSTRUCTION PROGRAM OF VETERANS ADMINISTRATION B, (Continued) Hospitals In Various Stages of Planning^/£/ Hospital Total Number of Beds Estimated By Type TB NP of GMS GENERAL MEDICAL and SURGICAL HOSPITALS (Continued) St, Louis, Missouri / Boston, Massachusetts-/ Syracuse, New York Philadelphia, Pennsylvania Cleveland, Ohic£/ Chicago, Illinois Oklahoma City, New York City, N. New York City AreaE/ Pittsburgh, Pennsylvania 8 888888888 o ooooooooo 2 SO 280 280 280 280 280 280 280 280 v> fO OfOWWMPiUWN) O OOOOOOOOO NEUROPSYCHIATRIC HOSPITALS El Paso, Texas 500 500 Salt Lake City, Utah 500 500 Norman, Oklahoma 750 650 100 Salisbury, North Carolina 921 781 140 Boston, Massachusetts 1,000 860 140 Gainesville, Florida 1,000 860 140 North Carolina Area 1,000 860 140 Memphis, Tennessee 1,000 860 140 Toledo, Ohio 1,000 860 140 Topeka, Kansas 1,000 860 140 Houston, Texas 1,000 860 140 Los California 1,000 860 140 San Francisco, California 1,000 860 140 Pittsburgh, Pennsylvania 1,250 1,110 140 Cleveland, Ohio 1,250 1,110 140 193 NEW HOSPITAL CONSTRUCTION PROGRaM OF VETERANS ADMINISTRATION B, (Concluded) Hospitals In Various Stages of Planning^^/ Number of Beds Hospital Total Estimated By Type of CareR/ TB NP GMS TUBERCULOSIS HOSPITALS Americas, Georgia 250 250 Baltimore, Maryland 300 300 Detroit, Michigan 500 Madison, Wisconsin 500 500 500 s/ i/ f/ tJ Hospitals for which bids have been advertised, those for which plans and specifications are ready to advertise, those so far advanced that material changes are impractical, and those still being designed. These hospitals are designed as replacements for existing tempo- rary hospitals. All others will be net additions to Veterans Administration capacity. Projected costs of these hospitals are excluded on request. Obtained from records of the Federal Board of Hospitalization, all other data obtained from Construction, Supply, and Real Estate Service of Veterans Administration, Includes 50-bed GMS hospital and 300-bed domicile. Tumor clinic. Site undetermined. 194 c. SUMMARY OF VETERANS ADMINISTRATION NEW HOSPITAL CONSTRUCTION PROGRAM AS OF October 11, 19A8 Construction Status and Number Number of Beds Estimated Cost f/ Typo of of Hos- Estimate by Type of Care a/ ( in ) Hospital pitals Total TB NP CMS Domiciliary (thousands) 1. HOSPITALS UNDER CONTRACT# Total 31 12,995 - 4,350 8,645 fp282,240 IB c/ HP c/ 1 1,965 QMS b/d/g/ 30 11,030 - 1,965 - 2,385 8,645 24,921 257,319 2. HOSPITALS IN PLANNING STAGE Total 58 38,266 2,200 17,711 18,055 788,212 TB c/ NP c/ ■ QMS b/h/ 4 1,550 15 14,171 39 22,545 1,550 - - 12,391 1,780 650 5,32016,275 300 34,237 287,188 c/ 466,787 3. HOSPITALS COMPLETED NP c/ 2 1,649 - - 1,437 212 7,750 4, TOTAL FOR NEW HOSPITALS Total 91 52,910 2,200 23,498 26,912 300 1,078,202 TB NP QMS 4 1,550 18 17,735 69 33,575 1,550 - 15>793 1,992 6$0 7,705 24,920 300 34,237 319,859 724,106 a/ b/ c/ d/ e/ £/ From records of Federal Board of Hospitalization, From report of Construction Supply and Real Estate Division of Veterans Administration, dated October 11, 194-8, Frcn report of Construction Supply and Real Estdte Division of Veterans Administration, - dated September 24, 1948* Manhattan Beach,N,Y, hospital included at authorized bed capacity of 1,000 although changes during construction have reduced capacity to 981 beds. Only cost included for Topeka is authorization of $127,000 for ac- quisition of land. Estimates for projects not under contract are based on cost levels of March 1, 1948 while estimates for projects under contract are based on contract awards. Footnotes (continued) gj Six of the 30 QMS hospitals under contract are being built as replacements* These six hospitals have 2,500 beds (606 NP and 1,894- GMS) and will cost an estimated $57,512,000, y Twelve of the 39 QMS hospitals in planning will be built as re- placements, These 12 hospitals will have 8,150 beds (2,24-8 NP and 5j902 GMS) and will cost an estimated $162,155,000, OBLIGATIONS OF FEDERAL AGENCIES FOR MEDICAL, HOSPITAL, AND RELATED SERVICES To obtain information on the costs of federal medical, hospital, and related services, the budget offices i/of the appropriate agencies were requested to supply information to the “Medical Services Committee with a breakdown of their actual obligations during fiscal year 1940, 1947 and 1948 and an estimate for fiscal year 1949 in six functional areas; inpatient care, outpatient care, research and development, education and training; projects relating to public health, and general administration. The following definitions were used in assembling the data: M1ATIEKT CARE. Costs directly related to provision of inpatient care in own and contract facilities, including hospital construction and maintenance, excluding hospital costs pertaining to research, education, and other nonpationt care functions. OUTPATIBM1 CARS. Costs of outpatient service in hospitals and out- patient clinics (dispensaries, relief stations, etc.) and contract facilities. RESEARCH. Costs of formal research programs and laboratories; includes the work of organizational units particularly devoted to the development of new knowledge, basic or applied, in medical, biologic and related fields of science. The term does not include such research as is per- formed as an incidental part of program operations. 1/ Data wore obtained directly from all agencies with exception of Children’s Bureau, Food and Drug Administration, Federal Trade Commission, Federal ’Tories Agency, Housing and Home Finance Agency, Bureau of Labor Standards and Bureau of Narcotics — for which obligations were obtained from information submitted to the Brookings Institute. PROJECTS RELATING TO PUBLIC HEALTH. Costs related to programs for the prevention of disease, control of community infections and environmental sanitation, industrial hygiene, health education, and other functions related to the conservation and promotion of personal and public health, EDUCATION and TRAINING. All costs related to education and training of direct and ancillary medical personnel, including costs of directly operated programs, tuition, and other costs for training obtained on a contract basis. GENERAL ADMINISTRATION. ' Costs of operating Washington and field super- visory headquarters (i.e., central offices in Washington, branch offices, area and district headquarters, and district offices). Excludes super- visory costs at field stations which should be charged to the main functions of the station concerned. Certain of these data, some of which — particularly those of the Departments of Army, Air Force, and Navy — have necessarily been estimated in part. Appropriate footnotes have been included on the basic table. OBLIGATIONS OF FEDERAL AGENCIES FOR MEDICAL. HOSPITAL AND RELATED SERVICES CONTINENTAL UNITED STATES, FISCAL YEARS 1940, 1947, 1948 AND 1949 ACTUAL OBLIGATIONS ESTIMATED OBLIGATIONS Fiscal Year 1940 Fiscal Year 1947 Fiscal Year 1948 Fiscal Year 1949 FUNCTIONS AND AGENCIES Amount Percent of Total For Funct i on Amount 1 Percent of Total For Funct ion Amount Percent of Total For Funct i o/i Amount Percent of Total For funct ion ALL FUNCTIONS A11 Agenc i es $200,691,737 100.0 $1,077,307,184 100.0 $1,246,315,746 100.0 $1,923,385, 304 100.0 Agricu 11,636,607 5.-8 17,348,907 1.6 16,528,243 1.3 17,205,950 0.9 Army (Including Air Force)3 13,949,354 7.0 194,803,620 18. 1 161,409,391 13.0 165,553,469 8.6 Atomic Energy Commission — — 6,249,000 0.6 15,119,455 1.2 24,339,037 1.3 Bureau of Budget 14,000 » 90,950 * 109,500 ♦ 126,400 * Civil Service Commission 1,800 * 1 1,29 1 * 13,421 * 15,701 * Federal Security Agency Total '54,585, 124 • 27.1 175,736,630 16. 1 184,265,060 14.8 344,408,310 17.9 Children's Bureau 8,641,193 4.3 29,867,195 2.8 20,869,965 1.7 20,098,115 1.0 Employees' Compensation Commission ... 5,321, 100 2.6 2, 375, 309 0.2 2,892,287 0.2 3, 1 15,000 0.2 Food and Drug Administration 2,572,466 1.3 4,620,05 3 0.4 4,8 15,700 0.4 5 * 135, 1 16 0.3 Freedmen's Hospital 498,244 0. 2 1,468,768 0. 1 2,296,760 0.2 2, 39-3,454 0. 1 Howard University 219,875 0. 1 443,470 ♦ . 485,112 ♦ 796,767 ♦ Office of Vocational Rehabilitation .. 2,047,387 1.0 14, 188,933 1.3 17,701,123 1.4 18,000,000 0.9 Public- Health Service 31, 125,953 15.5 1 12,536,443 10.4 126,691,597 10.2 285,038,840 14.8 St. Elizabeth's Hospital 4, 158,906 2. 1 8,236,459 0.8 8,510,516 0.7 9,831,018 0.5 Federal Trade Commission 22,640 * 29,754 * 35,100 * 38,930 * Federal Works Agency 3,013,584 1.5 588,636 0. 1 290,134 * 4,497,219 0.2 Housing and Home Finance Agency — — 100,489 * 116,000 * 20,000 * 1nte rior Total ... 6, 250,842 3. 1 8,900,834 0.8 9,676,833 0.8 12,808,580 0.7 Bureau of Mines and Others 248,576 0. 1 434,065 * 511,873 * 524, 1 19 * Fish and Wildlife Service 11,243 * 16, 278 * 28,739 * 29,000 * Bureau of Indian Affairs 5,97 1,.023 3.0 8,364,355 0.8 9,038,179 0.7 12, 1 18,426 0.6 Bureau of Reclamation Just ice — — 86,136 * 98,042 * 137,035 * Total 1, 157,658 0.6 1,634,878 0.2 1,607, 296 0. 1 1,785,171 0. 1 Immigration and Naturalization Service 53,556 * 116,952 * 1 20,65 1 * 109,700 * Bureau of Prisons 1 , 104, 102 0.6 1,517,926 0. 1 1,486,645 0. 1 1,675,471 0. 1 Labor: Bureau of Labor Standards 290,485 0. 1 295,916 * 249,486 * 276,429 * Maritime Commission — — 334 , 204 * 269 , 350 * 268,190 * Navy 11,291,206 5.6 99, 305,827 9.2 88,384,982 7. 1 104,831,748 5.5 State: Institute of 1 nter-Ame r ican Af fa i rs — — 5,730,501 0.5 5,922,173 0.5 2,990,8 19 0.2 Tennessee Valley Authority 306,279 0.2 611,308 0. 1 542,607 * 562, 162 * T reasu ry Total 1,485,000 0.7 2,086,516 0. 2 2,030,426 0.2 2,147,501 0. 1 Bureau of Narcotics 1,306,700 0.6 1,440,000 0. 1 1,430,000 0. 1 1,450,000 0, 1 Coast Guard 178,300 0. 1 646,516 0. 1 600,426 ♦ 697,501 * Veterans Administration 1 IN-PATIENT CARE (Total) 96,707,158 48.2 565,447,923 52.5 759,748,289 61.0 1,241,509,688 64. 5 Al 1 Agencies , 121.582.904 100. 0 697,378,490 100.0 859,013,279 100.0 1,508,675,849 100.0 Agriculture — — — —, — — — — Army (Including Air Force)3 10,224,877 8,4 142,644,898 20.5 132,552,691 15.4 137,509,878 9. 1 Atomic Energy Commission — 1,071,000 0.2 1,887,000 0.2 1,546,037 0. 1 Bureau of Budget — — — — — — — Civil Service Commission — — — — — Federal Security Agency Total 20,383,283 16.6 40,886,842 5.8 49,077,793 5.7 189,865,297 12.6 Child ren's Bureau — — — — — — — — Employees' Compensation Commission0... 5,172,813 4.2 2,274,710 0.3 2,784,780 0.3 3,000,000 0.2 Food and Drug Administration — — — — — — — Freedmen's Hospital 498,244 0.4 1,468,768 0.2 2,296,760 0.3 2,393,454 0.2 Howard University — — — — — — — Office of Vocational Rehabilitation .. — — 898,366 0. 1 1,3 1 1,226 0.2 1,637,982 0. 1 Public Health Service 10,754,719 8.8 28,458,949 4. 1 34,658,066 4.0 173,557,774 1 1.5 St. Elizabeth's Hospital Federal Trade Commission 3,957,507 3.2 7,786,049 1. 1 8,026.961 0.9 9, 276,087 0.6 Federal Works Agency 3,01 3,584 2.5 544,000 0. 1 257,041 * 4,404,955 0.3 Housing and Home Finance Agency 1 nteri or — — — — — — — — Total 4,465,508 3.7 7,380, 917 1. 1 8,270,781 1.0 1 1, 144,513 0.7 Bureau of Mines and Others 248,576 0.2 434,065 0. 1 511,873 0. 1 524,119 * Fish and Wildlife Service 1 1,243 ♦ 16,278 * 28,739 * 29,000 * Bureau of Indian Affairs6 4,205,689 3.5 6,844,438 1 .0 7,632, 127 0.9 10,480,394 0.7 Bureau of Reclamation Just ice — — 86,136 * 198,042 * III,000 * Total 490,862 0.4 646,991 0. 1 638,672 0. 1 693,257 * Immigration and Naturalization Service 43,575 « 89,402 * 95,325 * 83,600 ♦ Bureau of Prisons 447,287 0.4 557,589 0. 1 543,347 0. 1 609,657 * Labor: Bureau of Labor Standards — — — — •— — Maritime Commission — — 110,410 * 109,895 * 209,441 * Navy 7,812,712 6.4 66, 122,070 9.5 49,668,174 5.8 67,411,825 4.5 State: 1 nst itute of 1 nter-Ameri can Affairs — — — — — — Tennessee Valley Authority 93,043 0. 1 18,9 14 * 10,97 1 * 14,472 * Treasu ry Total — — — — — — Bureau of Narcotics — — — — — — Coast Guard — — — — — — Veterans Administration 75,099,035 61.8 437,952,448 62.7 616,540,261 71.8 1 ,095,876,174 72.6 ACTUAL OBLIGATIONS ESTIMATED 0BL 1 GAT IONS FUNCTIONS AND AGENCIES Fiscal Year 1940 Fiscal Year 1947 Fiscal Year 1948 Fiscal Year 1949 Amount Percent of Total For Funct i on Amount Pe rcent of Total For Funct i on Amount Percent of Total For Funct i on Amount Percent of Total For Funct i on 1. INPATIENT CARE: a. Within Own Facilities A 11 Agenc i es $ 102,619,495 100.0 $584, 157,361 100.0 $583,127,088 100.0 $654,187,821 100.0 Agriculture — — — — — — — Army (Including Air Force)3 10,071,434 9.8 141,975,898 24.3 131., 833, 581 22.6 136,766,404 20.9 Atomic Energy Commission — — 1,07 1,000 0.2 1 ,887,000 0.3 1.546,037 0.2 Bureau of Budget — — — — — — — — Civil Service Commission — — — — — — — — Federal Security Agency Total 14,8 19,383 14.4 37,055,962 6.4 40,173,366 6.9 38,301,380 5.9 Child ren's Bu reau — — — — — — — — Employees' Compensation Commission0 .. — — — — — — — — Food and Drug Administration — — — — — — — — Freedmen's Hospital 498,244 0.5 1,468,768 0.3 2,296,760 0.4 2,393,454 0.4 Howard University — — — — — — — — Office of Vocational Rehabilitation .. — — — — — — — — Public Health Service 10,363,632 10. 1 27,801,145 4.8 29,849,645 5. 1 26,631,839 4. 1 St. Elizabeth's Hospital 3,957,507 3.8 7,786,049 1.3 8,026,961 1.4 9, 276,087 1.4 Federal Trade Commission — — — — — — — — Federal Works Agency — — 40 1,728 0. 1 70,000 * 65,000 * Housing and Home Finance Agency — — — — — — — — 1nte r i o r Total 3,825,45 2 3.7 6, 1 1-5,645 1.0 6,669,763 1. 1 7,177,945 1 . I Bureau of Mines and Others 39,736 * 63,982 * 74,973 * 76,119 * Fish and Wildlife Service 11,243 ♦ 16,278 * 28,739 * 29,000 * Bureau of Indian Affairs** 5,774,473 3.7 6,035,383 1.0 6,566,051 1. 1 7,072,826 1 . 1 Bureau of Reclamation — — — — — — — — Just ice Total 318, 305- 0. 3 462,394 0. 1 451,775 0. 1 514,786 0. 1 Immigration and Naturalization Service — — — — — — — — Bureau of Prisons 318,305 0.3 462,394 0. 1 451,775 0. 1 514,786 0. 1 Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — 1 10,410 * 109,895 * 209,441 * Navy 7,5 15, 118 7.3 55,88 1, 174 9.6 48,499,822 8.3 51,215,812 7.8 State: Institute of 1 nter-Ameri can Affairs — — — — ~ — — — Tennessee Valley Authority 93,043 0. 1 18,914 * 10,97 1 * — — Treasury Total — — — — — — —- — Bureau of Narcotics — — — — — — •v — Coast Guard — — — — — — — — Veterans Administration * 65,976,760 64.3 34 1,064,238 58.3 355,420,915 60.7 418,391,0 16 64.0 b. Outside Own Facilities (Total) A1 I Agenc i es $13,151,405 100.0 $35,066,429 100.0 $46,379,263 100.0 $70,666,684 100.0 Agriculture — — — — — — — — Army (Including Air Force)3 153,443 1.2 669,000 1 .9 7 19, 1 10 1.6 743,474 1 . 1 Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — — — — — Civil Service Commission — — — — — — — — Federal Security Agency Total 5,563,900 42.3 3,830,880 11.0 4,794,320 10.3 5,573,297 7.9 Child ren's Bureau — — — — — — — — Employees' Compensation Commission0 .. 5,172,813 39.3 2,274,710 6.5 2,784,780 6.0 3,000,000 4.2 Food and Drug Administration — — — — — — — — Freedmen's Hospital — — — — — — — — Howard University — — — — — — — — Office of Vocational Rehabi litation .. — — 898,366 2.6 1,3 11,226 2.8 1,637,982 2.3 Public Health Service 391,087 3.0 657,804 1.9 698,314 1.5 935,315 1.3 St. Elizabeth's Hospital — ~ — — — — — — Federal Trade Commission — — — — — — — — Federal Works Agency Housing and Home Finance Agency — — — — — — — — 1nterior Total 208,840 1.6 1,144,228 3.3 1,253,463 2.6 1,493,859 2. 1 Bureau of Mines and Others 208,840 1.6 370,083 1. 1 436,900 0.9 448,000 0.6 Fish and Wildlife Service — — — — — — — — Bureau of Indian Affairs** N. A. N. A. 688,00 9 2.0 718,521 1.5 934,859 1.3 Bureau of Reclamation — — 86,136 0.2 98,042 0.2 111,000 0.2 Just ice Total 172,557 1.3 184,597 0.5 186,897 0.4 178,471 0.2 Immigration and Naturalization Service 43,575 0.3 89,402 0.2 95,325 0.2 83,600 0. 1 Bureau of Prisons 128,982 1.0 95,195 0.3 91,572 0.2 94,871 0- 1 Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — — — — — — — Navy 9,094 0. 1 316,123 0.9 1.168,352 2.5 1, 196,013 1.7 State: 1 nst itute of 1 nter-Amer ican Affairs — — — — — — — -— Tennessee Valley Authority — — — — — — — — T reasury Total — — — — — — — — Bureau of Narcotics — — — — — — — — Coast Guard — — — — — — — — Veterans Administration 7,043,571 53.5 28,921,601 82.4 38,257,421 82.5 61,481,570 87.0 ACTUAL OBLIGATIONS ESTIMATED OBLIGATIONS Fiscal Year 1940 Fiscal Year 1947 Fiscal Year 1948 Fiscal Year 1949 FUNCTIONS AND AGENCIES Amount Percent of Total For Funct ion Amount Percent of Total For Funct i on Amount Percent of Total For Funct ion Amount Percent of Total Fo r Funct ion 1. INPATIENT CARE. b. Outside Own Facilities: 1. In Federal Hospitafs: AI 1 Agenc i es $4,852,536 100.0 $ 18,833, 184 100.0 $29,026,780 100.0 $34,646,355 100.0 Ag ricu Iture . — — — — — — — — Army (Including Air Force)* 102,333 2. 1 157,349 0.8 169,110 0.6 280,010 0.8 Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — — — — — Civil Service Commission — — — — — — — — Federal Security Agency Total 733,084 15. 1 976,732 5.2 1,238,487 4.3 1,545,022 4.5 Child ren's Bu reau — — — — — — — — Employees' Compensation Commission0 .. 633,21\d 13.0 763, 9 19^ 4. 1 957,962d 3.3 1, I50,000rf 3.3 Food and Drug Administration — — — — — — — Freedmen's Hospital — — — — — — — — Howard University — — — — — — — — Office of Vocational Rehabilitation .. — — — — — — — Public Health Service 99,873 2. 1 212,813 1 . 1 280,525 1.0 395,022 r. i St. Elizabeth's Hospital — — — — — — — — Federal Trade Commission — — — — — — — — Federal Works Agency — — — — — — — — Housing and Home Finance Agency — — — — — — — — 1 nteri or Total — — 107,100 0.6 1 10,880 0.4 110,000 0.3 Bureau of Mines and Others — — — " — — — — Fish and Wildlife Service — — — — — — Bureau of Indian Affairs6 N. A. N. A. 107,100 0.6 110,880 0.4 1 10,000 0.3 Bureau of Reclamation — — — — — — — — J ust i ce Total 40,793 0.8 77,524 0.4 89,372 0.3 77,500 0.2 Immigration and Naturalization Service AO,193 0.8 77,524 0.4 89,372 0.3 77,500 0.2 Bureau of Prisons — — — — — — — — Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — — — — — — — Navy — — 208,687 1. 1 1,044,996 3.6 998,418 2.9 State: 1 nst itute of 1 nter-American Affairs — — — — — — — — Tennessee Valley Authority — — — — — — — — T reasu ry Total — — — — — — — — Bureau of Narcotics — — — — — — — — Coast Guard (*) re; re; re; re; re; re; re; Veterans Administration 3,976,326 81.9 17,305,792 9 1.9 26,373,935 90.8 31,635,405 91.3 2. In Hon-Federal Hospitals: All Agencies $8,298,869 100.0 $ 16,233,245 100.0 $ 17,352,483 100.0 $36,020,329 100.0 Agriculture — — — — — — — — Army (Including Air Force)* 51, 1 10 0.6 511,651 3.2 550,000 3.2 463,464 1.3 Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — — — — — Civil Service Commission — — — — — — — — Federal Security Agency Total 4,830,816 58.2 2,854,148 17.5 3,555,833 20.5 4,028,275 11.2 Child ren's Bu reau — — — — — — — Employees' Compensation Commission0 .. 4,539,602 54.7 1,510,791 9.3 1,826,818 10.5 1,850,000 5. 1 Food and Drug Administration — — — — — — — — Freedmen's Hospital — — — — — — — — Howard University — — — — — — — — Office of Vocational Rehabilitation .. — — 898,366 5.5 1,311,226 7.6 1,637,982 4.5 Public Health Service 291,214 3.5 444,991 2.7 417,789 2.4 540,293 1.5 St. Elizabeth's Hospital — — — — — — — — Federal Trade Commission — — — — — — — — Federal Works Agency — — — — — — Housing and Home Finance Agency — — — — — — — — 1nte r i o r Total 208,840 2.5 1,037, 128 6.4 1,142,583 6.6 1,383,859 3.8 Bureau of Mines and Others 208,840 2.5 370,083 2. 3 436,900 2.5 448,000 1. 2 Fish and Wildlife Service — — — — — — — — Bureau of Indian Affairs6 N. A. N. A. 580,909 3.6 607,641 3.5 824,859 2.3 Bureau of Reclamation — 86,156 0.5 98,042 0.6 1 1 1,000 0.3 J ust i ce Total 131,764 1.6 107,073 0.7 97,525 0.6 100,971 0.3 Immigration and Naturalization Service 2,782 11,878 0. 1 5,953 * 6, 100 * Bureau of Prisons 128,982 1.6 95, 195 0.6 91,572 0.5 94,871 0.3 Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — — — . — — — Navy 9,094 0. 1 107,436 0.7 123,356 0.7 197,595 0.5 State: 1 nst i t ute of 1 nter-Ameri can Affairs — — — — — —- — — Tennessee Valley Authority Treasu ry — — — — — — — Total — — — — — — — — Bureau of Narcotics — — — — — — — — Coast Guard .. — — — — . — - — — — Veterans Administration 3,067,245 37.0 1 1,615,809 71.5 1 1,883, 186 68.4 29,846,165 82.9 ACTUAL OBLIGATIONS • ESTIMATED* OBLIGATIONS Fiscal Year 1940 Fiscal Year 1947 Fiscal Year 1948 Fiscal Year 1949 FUNCTIONS AND AGENCIES Amount Pe rcent of Total For Funct i on Amount Pe rcent of Total Fo r Funct i on Amount Pe rcent of Total For Funct i on Amount Pe rcent of Total For Funct i on 1. INPATIENT CARE c. Construction (Bed and Non Bed Producing Projects) All Agencies $5,812,004 100.0 $78,154,700 100.0 $229,506,928 100.0 $783,821,344 100.0 Agriculture — — — — — — — — Army (Including Air Force)3 N. A. N. A. N. A. N. A. N. A. N. A. N. A. N. A. Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — — — — Civil Service Commission — — — — — — — — Federal Security Agency Total — — — — 4, 1 10, 107 1.8 145,990,620 18.6 Ch i1d ren1s Bu reau — — — — — — — — Employees' Compensation Commission ... — — — — — — — — Food and Drug Administration — — — — — — — — Freedmen's Hospital — — — — — — — — Howard University — — — — — — — Office of Vocational Rehabilitation .. — — — — — — — — Public Health Service — — — — 4,110,107 1.8 145,990,620 18.6 St. Elizabeth's Hospital — — — — — — — — Federal Trade Commission'1 — — — — — — — — Federal Works Agency 3,013,584 51.8 142,272 0.2 1 87,04 1 0. 1 4,339,955 0.6 Housing and Home Finance Agency ; — — — — — — — 1 nterior Total 431,216 7.4 121,046 0.2 347,555 0.2 2,472,709 0.3 Bureau of Mines and Others — — — — — — — — Fish and Wildlife Service V — — — — — — — Bureau of Indian Affairs 431,216 7.4 12 1,046 0.2 347,555 0.2 2,472,709 0.3 Bureau of Reclamation — — — — — — — — Justice Total Immigration and Naturalization Service — — — — — — — Bureau of Prisons — — — — — — — — Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — — — — — — Navy 288,500 5.0 9,924,773 12.7 — — 15,000,000 1 .9 State: 1 nst itute of 1 nter-American Affairs — — — — — — — — Tennessee Valley Authority — — — — — — 14,472 * Treasury Total Bureau of Narcotics — — — — — — — — Coast Guard — — — — — — — — Veterans Administration 2,078,704 35.8 67,966,609 86.9 224,862,225 97.9 616,003,588 78.6 II. OUTPATIENT CARE (Total) A 1 1 Agenc i es 12,278,356 100.0 174.646.255 100.0 172,801,578 100.0 175,979,174 ‘ 100.0 Agriculture 60 * 1,868,197 1 . 1 417,321 0.2 46,100 ST Army (Including Air Force)3 2,650,377 21 .6 37, 178,0 13 21.3 20,489,900 1 1.9 22,114,559 12.6 Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — __ — — — Civil Service Commission 1,800 * 1 1,29 1 * 13,421 * 15,701 * Federal Security Agency Total 1,054,138 8.6 4,638,218 2.7 5,244,620 3. 1 4,304,966 2.4 Child ren's Bu reau — — — — — — — Employees' Compensation Commission ... (c) re; rc; rc; rc; rc; rc; rc; Food and Drug Administration — — — — — — — * Freedmen's Hospital — — — — — — — — Howard University — — — — — — — — Office of Vocational Rehabilitation .. . 132,525 1.1 872,499 0.5 1,299,208 0.8 1,522,922 0.9 Public Health Service 921,613 7.5 3,765,719 2.2 3,945,412 2.3 2,782,044 1.6 St. Elizabeth's Hospital — — — — — — — — Federal Trade Commission — — — — — — — — Federal Works Agency — — — — 12,311 * 17,264 * Housing and Home Finance Agency — — — — — — — — 1 nte r I o r Total — — — — — — 26,035 * Bureau of Mines and Others — — — — — — — — Fish and Wildlife Service — — — — — — — — Bureau of Indian Affairs (b) (b) (b) (b) (b) (b) (b) (b) Bureau of Reclamation — — — — — — 26,035 * J ust i ce Total 645,192 5.2 949,527 0.5 925,995 0.5 1,045,772 0.6 Immigration and Naturalization Service 2,781 * 18,878 * 16,654 * 16,200 * Bureau of Prisons 642,411 5.2 930,649 0.5 909,34! 0.5 1,029,572 0.6 Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — 151,590 0. 1 137,438 0. I — — Navy 2,483,783 20.2 23,358,760 13.3 24,249,790 14.0 24,514,268 • 13.9 State: 1 nst itute of 1 nter-Ameri can Affairs — — — — — — — — Tennessee Valley Authority 140,298 1. 1 274,388 0.2 229,233 0. 1 243,423 0. 1 T reasury Total 175,000 1.4 622,016 0.4 600,426 , 0.3 672,501 0.4 Bureau of Narcotics — — — — — — — — Coast Guard 175,000 1.4 622,016 0.4 600,426 0.3 672,501 0.4 Veterans Administration 5,127,708 41.8 105,594,255 60.4 1-20,481,123 69.7 122,978,585 69.9 ACTUAL OBLIGATIONS ESTIMATED OBi 1 GAT IONS Fiscal Year 1940 Fiscal Year 1947 Fiscal Year 1948 Fiscal Year 1949 FUNCTIONS AND AGENCIES Amount Pe rcent of Total For Funct i on Amount Pe rcent of Total For Funct i on Amount Percent of Total For Funct i on Amount Percent of Total For Funct i on II. OUTPATIENT CARE a. Within Own Faci1ities: A1 1 Agencies . — $11,445,620 100.0 $106,554,969 100.0 $102,383,147 100.0 $1 10,724,544 100.0 Agriculture 60 18,197 * 55,521 0. 1 46,100 • Army (Including Air Force )a 2,650,377 23.2 37,178,013 34.9 20,489,900 20.0 22, 1 14,559 20.0 Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — — — — — Civil Service Commission , 1,800 * 11,291 * 13,421 ♦ 15,701 ♦ Federal Security Agency Total 921,613 8. 1 3,765,719 3.5 3,945,412 3.9 2,744,094 2.5 ChI Idren's Bureau . — — — — — — — — Employees' Compensation Commission ... — — — — — — — — Food and Drug Administration — — — — — — — — Freedmen's Hospital — — — — — — — — Howard University — — — — — — Office of Vocational Rehabilitation .. — — — — — — — — Public Health Service 921,613 8. 1 3,765,719 3.5 3,945,412 3.9 2,744,094 2.5 St. Elizabeth's Hospital . — — — — — — — -- Federal Trade Commission — — — — — — — — Federal Works Agency — — — — 12,31 1 ♦ 17,264 ♦ Housing and Home Finance Agency — — — — — — — — 1 nter ior T ot a 1 — — — — — — — — Bureau of Mines and Others — — — — — — — — Fish and Wildlife Service • Bureau of Indian Affairs (b) (b) (b) (b) (b) (b) (b) (b) Bureau of Reclamation — — — — — — — — Just ice Total 642,41 1 5.6 940,349 0.9 919,258 0.9 1,039,072 0.9 Immigration and Naturalization Service — — 9,700 * 9,917 * 9,500 ♦ Bureau of Prisons 642,411 5.6 930,649 0.9 909,341 0.9 1,029,572 0.9 Labor: Bureau of Labor Standards — — — — — — — — Maritime Commission — — 15.1,590 0. 1 137,438 0. 1 — — Navy 2,472,182 21.6 23,303,017 21.9 24,203,015 23.6 24,469,818 22.1 State: 1 nst it ute of 1 nter-Amer ican Affairs — — — — — — — — Tennessee Valley Authority 140,298 1 .2 274,388 0.3 229,233 0.2 243,423 0.2 T reas ury Total 175.,000 1 .5 622,016 0.6 600,426 0.6 672,501 0.6 Bureau of Narcotics — — — — — — — — Coast Guard 175,000 1 .5 622,016 0.6 600,426 0.6 672,501 0.6 Veterans Administration 4,441,879 38.8 40,290,389 37.8 5.1,777,212 50.6 59,362,012 53.6 b. Outside Own Facilities: A 1 1 Agenc ies $832,736 100.0 $68,091,286 100.0 $70,418,431 100.0 $65,254,630 100.0 Ag r i c u 11 u re — — 1,850,000 2.7 361,800 0.5 — — Army (Including Air Force)3 — — — — — — — — Atomic Energy Commission — — — — — — — — Bureau of Budget — — — — — — — — Civil Service Commission — — — — — — — — Federal Security Agency Total 132,525 15.9 872,499 1 .3 1 ,299,208 1.8 1,560,872 2.4 Chi Idren's Bureau — — — — — — — — Employees' Compensation Commission ... r