COMMISSION ON ORGANIZATION OF THE 
EXECUTIVE BRANCH OF THE GOVERNMENT 
APPENDIX J 
REPORT OF THE 
SUBCOMMITTEE ON MEDICAL RESEARCH 
COMMITTEE ON FEDERAL MEDICAL SERVICES 
Alfred N* Richards, Ph. D. 
0. H. Perry Pepper, M. D. 
A. Raymond Dochez, M. D. Advisor 
November 19l|8 COMMISSION ON ORGANIZATION OF TEE 
EXECUTIVE BRANCH OF TIE GOVERNMENT 
APPENDIX J 
REPORT OF THE 
SUBCOMMITTEE ON MEDICAL RESEARCH 
COMMITTEE ON FEDERAL MEDICAL SERVICES 
Alfred N. Richards, Ph. D. 
0. H» Perry Pepper, M. D. 
A. Raymond Dochez, II* D- Advisor 
November 1948 TABLE OF CONTENTS 
FEDERAL RESEARCH IN THE MILITARY AGENCIES 
Page 
Army 3 
Navy...... 4 
Air Force, 5 
Quartermaster Corps•••.••••.... 6 
Chemical Corps 6 
Committee on Medical Sciences of the 
Research & Development Board., 7 
MEDICAL RESEARCH IN THE NON-MILITARY AGENCIES 
Veterans Administration, 7 
Public Health Service..,,, 8 
Atomic Energy Commission...,.,.,, 9 
Department of Agriculture 
Bureau of Animal Industry 9 
Bureau of Entomology and Plant 
Quarantine ,, 10 
GENERAL CONSIDERATIONS 10 
RECOMMENDATIONS. , 12 REPORT OF THE 
SUBCOMMITTEE ON MEDICAL RESEARCH 
COMMITTEE ON FEDERAL HEDICAL SERVICES 
The question whether medical research, conducted by or through 
the agency of Federal departments, is necessary or desirable can be 
answered categorically in the affirmative. All of the agencies 
which we shall consider have broad responsibilities for the health, 
efficiency and medical care of many people. They are confronted 
with a host of difficult questions which can only be solved by con- 
tinuing medical research, conducted both within the Federal in- 
stallations where knowledge of the existence and nature of the 
problems is most intimate, and in the medical research facilities 
of the universities, medical schools, hospitals and research 
institutes throughout the United States, That research must not 
only be continued but expanded. 
Governmental medical research is being conducted or financed 
by a multiplicity of Federal agencies through programs which have 
recently undergone great expansion and are largely mutually inde- 
pendent, Our task is to study the programs themselves and to 
examine the organizations through which they are conducted with a 
view to the discovery of changes calculated to increase the 
appropriateness of the programs and the effectiveness and economy 
of their conduct. 
Two recommendations of broad import have emerged from this 
study, which, for the sake of clarity, should be stated at the 
outset. 2 
First: The creation of a new department of the Government, 
designated by such a title as Department of Health, Education and 
security, in which, by merger of the administrative responsibilities 
for medical care in the general hospitals of Army, Navy, Veterans 
Administration, and Public Health Service, opportunity will be 
provided for better correlation of the medical research efforts 
within those hospitals; also, through the Division of Education 
and Research of the new organization, correlation with the medical 
research of other Government agencies and with that of the Nation 
as a whole will be facilitated. 
Second: The early creation of a National Science Foundation 
is a vitally important matter if the medical needs of the armed forces 
as well as of the civilian population are to be met. In peace, the 
medical needs of the armed forces comprise only a small fraction of 
the medical needs of our population; in war those needs are tremendously 
expanded and can bo satisfied only by the transformation of a large 
section of civilian medicine into military medicine. The quality of 
military medicine during war depends so essentially upon the pre- 
existing status of civilian medicine that the continuing advance- 
ment of civilian medicine through education and research is a prime 
necessity for national security. That advancement requires the 
impetus and support which the contemplated National Science Foundation 
would give.- 
In what follows, therefore, the assumption is implicit that a 
unified health administration under a new Federal department will be 
created and that a bill establishing the National Science Foundation 3 
will be passed. 
The agencies which are our chief concern are the Army (Medical, 
Quartermaster and Chemical Corps), Navy (Bureau of Medicine and 
Surgery and Office of Naval Research), the Veterans Administration, 
the Public Health Service, the Atomic Energy Commission, and the 
Department of Agriculture< The medical research program of the 
Public Health Service has been greatly expaneded since the end of 
World War II; the reorganization of the medical service of the 
Veterans Administration has introduced a broad program of medical 
research; the Office of Naval Research and the Atomic Energy Com- 
mission, both having large programs of medical research, have come 
into being since 1945. To indicate the present magnitude of the 
Federal effort in medical research, a table of expenditures and 
budgets has been compiled (Table l). 
MEDICAL RESEARCH IN THE MILITARY AGENCIES 
ARMY The Surgeon General's responsibility for medical research is 
discharged by the representatives of his office who constitute the 
Army Medical Research and Development Board (AMRDB), It consists 
of a full-time chairman, the chiefs of six divisions, the air and 
the ground surgeons, and the president of the Army Epidemiological 
Board (AEB.) Under the Surgeon General, the AMRDB has full authority 
for planning, supervising and review of 'research programs in army 
hospitals and installations and for research contracts with non- 
governmental institutions. In the field of infectious diseases, it 
is assisted by the Army Epidemiological Board with its eight special 
commissions made up of outstanding civilian medical investigators. The research programs and projects of the AMRDB are submitted for 
advice and review to the committees of the Division of Medical Sciences 
of the National Research Council which were organized to assist the 
Surgeons General of Army and Navy, and the Chief Medical Director of 
the Veterans Administration, 
The research programs are closely related to military medical 
problems* 
The research budget of the AMRDB is almost equally divided 
between the work of the Army medical installations and that con- 
ducted under contracts in non-governmental institutions. 
NAVY Two organizations are responsible for Navy medical research, 
the Bureau of Medicine and Surgery under the Surgeon General, and 
the Medical Division of the Office of Naval Research (ONR), which 
reports to the Secretary of the Navy and the Chief of Naval Operations. 
The former. Bureau of Medicine and Surgery, conducts the medical 
research programs carried on within the naval facilities, directed 
at the solution of problems, both immediate and long-range, of 
direct importance for naval personnel and operations. The planning 
group consists of the Chief of the Research Division and the heads 
of the six medical branches, with liaison representation from the 
Office of Naval Research, the National Research Council, the Army, and 
the Air Force, It conducts no program of contracts with non-governmental 
institutions but transfers funds to ONR for processing such contracts 
as are deemed necessary to supplement the work of the facilities. 5 
The Office of Naval Research, Medical Division, is responsible 
for the conduct of a large program of contracts with non-governmental 
institutions designed for broad increase in scientific knowledge 
which may bear only indirectly upon problems specific to the Navy, 
It is explicitly charged with the duty of coordinating the programs 
and projects of medical research throughout the Navy. The selection 
of grants is made by the Chief of the Medical Research Division, 
aided by the heads of the eight branches of the Division, by 
specially appointed panels of civilian experts, and by the committees 
of the National Research Council. We are told informally that it 
was designed to effect, ad interim, the medical research purposes 
of the National Science Foundation as envisaged at the time of the 
creation of ONR (August 1, 1946). 
THE AIR FORCE. By agreement, the research problems related to 
the general medical care of Air Force personnel are the respon- 
sibility of the Surgeon General of the Army, Those for which the 
Air Surgeon retains responsibility are related to the selection, 
classification and efficiency, of Air Force personnel and the 
physiological and psychological problems of altitude and combat 
flying. In the planning and review of medical research programs, 
the Air Surgeon has assistance from the Air Force Science Advisory 
Group, the National Advisory Committee on Aeronautics and from the 
National Research Council Committees on Aviation Medicine, Aviation 
Psychology and the Armed Forccs-NRC Vision Committee, 6 
THE QUARTERMASTER CORPS. Medical research under the Quartermaster 
General is almost exclusively directed at the practical problems 
of food, clothing and protective devices and hence is not regarded 
as coming within the scope of this report. 
THE CHEMICAL CORPS. The Chemical Corps conducts medical research 
activities at the Army Chemical Center at Edgcwood Arsenal, Md,, 
and at Camp Detrick at Frederick, Md, 
Medical research at Edgewood is directed at problems of 
chemical warfare and is conducted under throe branches—-toxi- 
cological, clinical research, and bio-analytical. Its concern is 
the hazards to personnel and animals arising from the use of 
chemical agents in warfare; the toxicity of such agents, their mode 
of action and prophylactic and curative measures against them; and 
the physiology, pharmacology and pathology of the action of chemical 
warfare agents. 
The Chief of Medical Research of the Chemical Corps is 
assisted in the planning and supervision of his program by a staff 
of highly qualified scientific consultants, by the Committee on 
Toxicology and the committees and subcommittees of the Chemical- 
Biological Coordination Center of the National Research Cornell, 
The actual research on medical problems of chemical warfare is 
largely conducted in the laboratories at Edgewood, no appropriation 
for a program of contracts with non-governmental institutions having 
been made for the fiscal year 1949. 
Medical research at Camp Detrick is highly classified and will 
not bo discussed in this report. 7 
COMMITTEE ON MEDICAL SCIENCES OF THE RESEARCH AND DEVELOPMENT BOARD 
This Committee, recently established, consists of three civilian 
medical scientists, one of whom is chairman of the Committee, and 
two representatives of each of the three military services. The 
Committee is supplemented by similarly constituted panels, having 
cognizance of specialized areas. It has continuing duties of main- 
taining intimate familiarity with the medical research programs and 
projects of the three services, conducted both within and outside of 
service installations and facilities, of coordination of research 
programs, elimination of undesirable duplications, discovery of gaps 
in the programs and means of filling them, cognizance of research 
programs of the non-military Federal agencies, and of trends in the 
advance of medicine throughout the world. The Committee has been 
in existence for only a few months but gives every promise of in- 
creasing greatly the effectiveness and economy of the entire military 
medical effort. 
MEDICAL RESEARCH IN THE NON-MILITARY AGENCIES 
VETERANS ADMIHISTRATION. The medical research program is planned and 
administered by the Research and Education Service, The plan in- 
augurated and promoted by Hawley and Magnuson, whereby 62 of the 
Veterans Hospitals, through the Deans1 Committees, are associated 
with non-governmental medical centers, is ideally calculated not 
only to provide hospitalized veterans with the highest quality of 
medical care but also to make the best posiblo use of the opportunities 
which those hospitals afford for clinical medical research. The 
chief of the Office of Education and Research is assisted in the planning and review of major programs of research, both within Veterans 
Administration hospitals and through grants, by the Committee on Veterans 
Medical Problems and other Committees of the National Research Council, 
and by specially appointed expert consultants. 
THE PUBLIC HEALTH SERVICE. The provisions of Public Law 410 give to 
the Public Health Service the responsibility for conducting research 
on any and every problem connected with diseases and the physical or 
mental impairments of man. In the fields of cancer, mental health, 
and cardiovascular disease it has specifically defined responsibility 
for actual conduct of research in its own installations and for the 
promotion of research, training, and education in non-governmental 
agencies. 
The Public Health Service conducts an extensive and expanding 
program of grants-in-aid, closely related to its legal responsibilities 
for advancing general medical knowledge as well as that in the three 
fields specified above. In the planning and review of these programs 
the Surgeon General and his staff have the assistance of advisory 
councils appointed by the Surgeon General, and these in turn of study 
sections, 21 in number, made up of investigators and experts drawn 
from widely distributed non-governmental institutions. The system 
is calculated to provide the Surgeon General with the best scientific 
advice available in the United States, 
The responsibilities and the opportunities for research within 
the Public Health Service are soon to be enlarged by the construction 
of hospitals primarily designed for clinical research. Information 9 
is not available concerning the organization planned for the 
effective use of these facilities. 
THE ATOMIC ENERGY COMMISSION. Public Law 5B5 directs the Atomic 
Energy Commission to conduct research and to assist research by 
private or public institutions or persons relating to the utilization 
of fissionable and radioactive materials for medical, biological, 
health or military purposes# Self-conducted research in biology 
and medicine is carried on largely in the Government laboratories 
at Oak Ridge, Brookhaven, and Chicago. The contractual program of 
biological and medical research in non-governmental institutions is 
planned and reviewed by the Washington headquarters staff, most of 
the contracts, however, being conducted through the organization 
of the Office of Naval Research, The research program has guidance 
from an Advisory Committee on Biology and Medicine, consisting of 
seven highly competent authorities drawn from non-governmental 
institutions. The current program includes cancer research both 
in the national laboratories and in private institutions. The 
Commission supports an extensive program of study of atomic casual- 
ties in Japan conducted for it by the National Research Council. 
THE DEPARTMENT OF AGRICULTURE. The Bureau of Animal Industry,, and 
the Bureau of Entomology and Plant Quarantine are the two divisions 
which chiefly relate the Department of Agriculture with other Govern- 
ment agencies concerned with research on problems of human medicine. 
The Bureau of Animal Industry conducts research on animal diseases, a 
number of which arc also diseases of man. Its work is conducted in the laboratories of the Department at Beltsville, Maryland; Ames, 
Iowa; Salina, Utah; Auburn, Alabama; and East Lansing, Michigan, 
It also works in cooperation with the various state experiment 
stations. The ex officio membership of the Chief of the Bureau in 
the National Advisory Health Council of the Public Health Service 
provides cognizance and liaison between the two organizations. 
The Bureau of Entomology and Plant Quarantine has important 
relations with problems of human medicine through its interests in 
insect vectors of disease* It conducts the Orlando Experiment Station 
in which important contributions to the study of epidemic typhus were 
made during the war; also stations in Alaska and Canada for study of 
control of mosquitoes and the black fly* 
GENERAL CONSIDERATIONS 
The following general considerations are basic to an examination 
of the more specific problems with respect to medical research by 
Government agencies, either conducted directly or financed in non- 
governmental institutions, and to underlie the problem of organization* 
1, Wherever there is broad responsibility for medical care 
there is associated responsibility for medical research. Standards 
of medical care are the results of medical research* Advance in those 
standards requires ever-continuing medical research* The responsi- 
bilities assumed by Federal agencies for medical care include, there- 
fore, a comparable heavy responsibility for the support of medical 
research. 
2, Competently trained physicians are a national necessity. 
In war this is especially true since the many fold expansion of the medical corps of the armed services must be accomplished by the 
induction of thousands of civilian physicians. The national security, 
therefore, with respect to the quality of wartime medical service is 
essentially dependent upon the quality of civilian medicine. 
3, The training of physicians is not and should not be a 
Government responsibility. It is part of the educational system of 
the entire country and the diversity of minds of the entire country 
is required for the development of an adequate system of medical 
training. 
U, The competent training of physicians must be closely associated 
with intensive and continuing research. The 78 medical schools of 
this country are centers of medical research, as are also the scientific 
departments of their parent universities. It is in these institutions 
that young minds having research capacities are identified and en- 
couraged, They become a reserve of future investigators whose support, 
training and development is of especial interest to the Government, 
It is an essential obligation of Government to cooperate with these 
centers in which the training of medical investigators is in progress. 
The fullest possible mutual understanding between the Federal agencies 
and non-governmental institutions of the problems and of the capacities 
of each must be developed. 
5, The dearth of competent medical investigators, both within 
and without the Government agencies, is everywhere recognized. The 
present system of support of research in non-governmental insitutions 
by contracts and grants-in-aid from several separate Government agencies 
does not satisfactorily solve the problem of strengthening the training and research capacities of those institutions. Since they are the 
source from which the Government must obtain the investigators needed 
for its research. Government should help the institutions to produce 
them. 
6. The above considerations point directly to the necessity of 
establishing a Federal organization competent and having authority to 
plan and direct a program for the utilization and improvement of non- 
governmental resources for medical research and its development through- 
out the country. And since medical research is nothing more than the 
application of the conceptions, instruments and techniques of mathematics 
and the natural sciences, physics, chemistry, and biology, its true 
development must proceed in those institutions in which these funda- 
mental . disciplines are cultivated. This inter-dependence of medical 
science and the natural sciences is recognized in the plans which 
have been drawn for a National Science Foundation. 
RFC QB5ENDATIOMS 
1, The autonomy which now exists within the military medical 
services with respect to their medical research programs, in so far 
as those are related to the primary functions of the services, should 
not be lessened. The staff of each service is most intimately aware 
of its problems which need solution. Research conducted in service 
installations and facilities should mainly be directed at specific 
questions of practical application. Such research will often suggest 
questions which require fundamental research. Within the limits of 
the facilities and the capacity of the research personnel, research of that nature should be encouraged; its association with applied 
and developmental research gives vitality to the organization. 
The military medical services should limit their programs of 
contracts for basic research in non-governmental institutions to 
problems having clearly identifiable relation to the prime functions 
of the service concerned. The majority of the present ONR contracts, 
which have no more relation to naval than to civilian medicine, should 
be transferred to the National Science Foundation when that is created. 
The question of duplications, overlaps, identification of 
gaps which should be filled may safely be left to the Committee on 
Medical Sciences of the Research and Development Board, 
2. The Public Health Service and the Veterans Administration. It 
is understood that with the creation of a department of Health, Educa- 
tion and Security, the administration of the hospitals of these two 
agencies, under a Director General, will be merged within the Division 
of Medical Care of the new Department, Clinical research should be 
included with medical care and should be encouraged within all of 
the hospitals. Since its character and quality in any hospital will 
depend upon the nature of the clinical material and the interests 
of the members of the staff, there should be a great degree of 
autonomy; at the same time a means of distribution and exchange of 
information among the hospitals must be provided. Duplications in 
this field of clinical research, knowingly undertaken, or not to 
be feared. 
In some hospitals there will be concentrations of patients 
suffering from the same or related disorders. Coordination of the work of two or more hospitals engaged in attack upon one broad 
problem is an obvious desideratum. 
The Grants-in-Aid programs of the combined agencies will 
be administered by the Division of Education and Research of the 
new Department. If past experience is followed, the administrator 
of these programs will require the assistance of non-governmental 
experts in the design of programs, in the choice of institutions 
and individuals whose work is to be supported, and in decisions as 
to amounts of grants. At present the Surgeon General of the Public 
Health Service is assisted in these matters by small Advisory Councils, 
the majority of whose members are non-governmental experts selected 
and appointed by him. Advisory to these councils in the field of 
general medicine and basic medical sciences are Study Sections, 21 
in number, with a total membership of some 250 experts drawn from 
all parts of the country. They are appointed by the Surgeon General, 
receive a substantial per diem and thus have become a part of the 
Public Health Organization, 
The Veterans Administration has recently followed the precedent 
established by the Army, Navy, and Air Force which rely for advice 
concerning research programs, grants or contracts upon medical 
advisory committees of the National Research Council, In addition, 
the Chief Medical Director of the Veterans Administration requested 
that the chairman of the Division of Medical Sciences of the National 
Research Council appoint a Committee on Veterans Medical Problems to 
review and coordinate the recommendations of the medical advisory 
committees and to advise the Veterans Administration on its entire research program. Members of these committees work under the 
terms of President Wilson’s executive order which in 191B 
perpetuated the National Research Council and regard themselves 
as bound by the terms of the congressional charter of the National 
Academy of Sciences, of which the Research Council is the active 
agent. They therefore serve without compensation but with reimburse- 
ment of actual expense incurred. 
It will be the responsibility of the Director General of the 
new Department, in consultation, we assume, with the head of the 
Division of Education and research of the Department, to choose the 
system of expert advisory help best adapted to his needs. Both 
systems described above have proved to be excellent. Our only 
recommendation in this matter is that before deciding upon his 
advisory bodies, the Director General request and consider advice 
from the National Academy of Sciences, 
3. The Clinical Research Center of the Public Health Service. 
Congressional authority has been given to the Public Health Service 
to plan and construct hospitals which shall adjoin the National 
Institute of Health and serve as centers for clinical research on 
cancer, Mental Diseases and Cardiovascular Diseases. *>3,500,000 
has been allocated for the acquisition of a site and the drawing of 
plans, $34,150,000 has been authorized, and of this $25,630,000 
has been appropriated. The foundations arc now being constructed. 
The plans call for 150 bods each for cancer. Mental Disease and 
Cardiovascular Disease, and 50 beds for other diseases. Research facilities arc to occupy about twice as much space as patient care 
facilities. 
If the Department of Health, Education and Security is created, 
the administration of this Clinical Research Center will fall within 
the jurisdiction of the Director of Health, He should know and con- 
sider that many experienced non-governmental medical educators and 
investigators are apprehensive lest the provision of this great 
Center with competent professional and investigative staffs may 
so deplete the personnel of existing non-governmental institutions 
as to be detrimental to the medical economy of the Nation as a whole. 
If, as we believe, the danger is real, the rate at which active 
occupancy and staffing of the Center shall proceed should be so 
adjusted as to avoid it, at the seme time permitting choice of 
personnel of the high quality which the enterprise demands. 
As already stated, it is to bo expected that research programs 
will be developed in Veterans Hospitals in which are concentrated 
patients suffering from the three groups of diseases which are to 
be the chief subjects of study in the Clinical Center, Coordination 
of those programs should be so effected with those of the Center as 
to increase the total scope of t he research and make economies 
possible. 
4. The Atonic Energy Commission. Recognizing that the Atomic 
Energy Commission is not included, among the agencies to be studied 
by this Committee, we venture the following remarks:- The medical 
research policies of the ABC arc still in the formative stage and 
their development should continue without immediate change in present arrangements. The provision of radioactive isotopes makes available 
a unique tool for the investigation of an infinity of problems of 
metabolism of men, animals, plants, and microorganisms. Some of such 
work must be done in the immediate neighborhood of the isotope pro- 
duction machinery, i.e. the national laboratories. The larger part 
will be done in the research laboratories of non-governmental 
institutions throughout the country. Eventually it may be found 
wise to merge the arrangements for the unclassified research now 
promoted by the Atomic Energy Commission with those of the Office of 
Research of a Department of Health, Education and Security and those 
of a National Science Foundation when that shall have been created. 
It is hoped that the biological and medical division of the 
Atomic Energy Commission will sponsor arrangements for the production 
and supply of labelled organic compounds necessary for the study of 
intermediary processes, thus relieving to a degree the necessity for 
laborious, expensive syntheses in laboratories not well equipped to 
conduct them. 
5. A Committee on Medical Sciences, comparable to that of the 
research and Development Board of the Defense Establishment, should 
be created for the continuing study and coordination of medical 
research activities of the non-military Federal agencies. That 
committee should consist of representatives of the Division of 
Education and Research of the Department of Health, Education and 
Security, of the Atomic Energy Commission, and of the Department of 
Agriculture, Representatives of this new Committee on Medical Sciences, 
together with those of the Committee on Medical Sciences of the 
Research and Development Board, should be appointed to form an Inter- 
agency Committee of Medical Sciences with the duty of review and 
coordination of all presently existing Federal programs of medical 
research. 
The duties of the Interagency Committee will relate less to 
the programs of self-conducted research, in which the maximum degree 
of autonomy should obtain, than it will to the programs of contracts 
and grants-in-aid. For in these latter both autonomy and integrated 
cooperation are required if they are to meet individual agency needs 
and at the same time give broad coverage with avoidance of unnecessary 
duplication. The Interagency Committee must preserve the stimulating 
value of independence, at the same time effecting economies incident 
to cooperation. 
When the National Science Foundation shall have been established, 
this Interagency Committee should be linked with the organization of 
the Division of Medical Science of the Foundation. 
6, The influence of the Commission on Organization of the 
Executive Branch of the Government should be exerted in favor of 
the creation of a National Science Foundation. 
The greatest need in relation to medical research both for 
the country as a whole and for the Federal agencies is for more and 
more competent investigators. It can not be overemphasized that the 
selection of talent, the education, training and experience of future 
investigators can be accomplished only in our colleges, universities. medical schools and teaching hospitals. It can not be accomplished 
in the research facilities of the Federal Government, 
From the standpoint of present necessities, the prime service 
which the National Science Foundation would render would be through 
its programs of identification and selection of talent and fellowships 
for training. These programs must be conducted in non-governmental 
institutions, and inasmuch as the natural sciences and engineering 
are integral divisions of the programs, the Foundation can not be 
made to fit within the organization of a Department of Health, Education 
and Security as that Department is now envisaged. 
Of vital, though less immediate urgency, is the program of 
promotion of research by the National Science Foundation, That pro- 
gram, which is nothing less than nation-wide in its scope, must not 
be delegated to the Division of Research of the Department of Health, 
Education and Security because of the essential inter-dependence, 
previously emphasized, of medical research and that in the field of 
the natural sciences. 
7. In one essential respect, the National Science Foundation 
as described in bills presented to the Eightieth Congress will not 
specifically meet certain necessities with which medical schools and 
their parent universities are now confronted. The cost of operating 
a medical school which maintains the standards of education and train- 
ing requisite to the highest quality of medical care, together with 
the facilities for the research basic both to medical education and 
the advance of medical knowledge and skill, is now so great as to 
threaten impoverishment of the university of which it is a part. The budgets of the 7S medical schools of the United States for 
the current year have been reported to total 051,000,000; tuition fees 
will amount to $12,800,000, From outside agencies, including Govern- 
ment, it is estimated that they will receive nearly $20,000,000, The 
income from outside agencies serves to help support teaching and 
research activities necessary to the training of physicians. The 
deficit of more than $18,000,000 is being made up from general 
university funds, gifts, and rapidly diminishing reserves. 
We see no escape from the conclusion that under existing or 
predictable economic circumstances the continuing survival of medical 
education and research requires prompt Federal aid to medical schools. 
It might be assumed that a further expansion of the grants-in- 
aid and contract programs of the Federal agencies might be increased 
to a level which would provide the necessary help. We believe with 
deep conviction that such a course would be damaging. Despite the 
invaluable aid which these programs have afforded to the medical 
schools during the post-war period, we believe that as a prime method 
of support to medical education and research in medical schools they 
are unsound. Some of the reasons for this statement are as follows: 
Grants-in-aid come as additions to resources without 
helping the fundamental structure of the institutions 
which receive them. They may actually add to- the burden. 
They introduce a foreign and ephemeral element into the 
departments which accept them. They may endanger the 
consciences of the departments and institutions which 
apply for them. 
abundance of Government funds provides the temption of 
asking for more than is needed or justified. They tend to promote volume of work rather than, and 
perhaps at the expense of, quality. 
They tend to result in the delegation of too much of 
the work of a problem to assistants and technicians. 
They may encourage the shaping of .research projects 
to suit what are believed to be the aims of the 
granting agency rather than to the problems of greatest 
value to the science or to the development of the in- 
dividual and his deepest interests. 
Persons employed in research financed by grants-in- 
aid arc apt to be deprived of the opportunity of teaching 
and the good which comes from it. They tend to decrease 
the teaching efficiency in that the conscientious 
responsible investigator feels an obligation which 
leads him to withdraw too much from teaching. 
If the above statements are sound, it follows that reliance 
should not be placed on expansion of the grants program for the 
relief of medical schools and that aid should be given in form and 
amount sufficient to enable a school to encourage the truest develop- 
ment of its personnel without the necessity of adjustment to the 
obligations of grants projects. 
The only alternative seems to us to be a system of block grants. 
These might well be regarded as a partial reimbursement of expense 
incurred in furnishing the country with the personnel of medical care, 
obviously necessary in times of peace —vitally necessary to national 
security in time of war. 
Our recommendation in this connection is that Congress be 
advised to appoint a commission and appropriate funds for a competent 
survey of the financial status of the privately supported, approved 
medical schools of this country, upon the results of which shall be 
based a program of direct Federal grants to those schools. Their purpose shall be the maintenance and increase of facilities and 
staff necessary to provide the best possible training of the maximum 
number of medical students permitted by their facilities to give 
advanced training to exceptional students who show evidence of marked 
investigative capacity. Representatives of the Council on Medical 
Education and Licensure of the American Medical Association should 
be associated with this survey. 
A provision should be devised for prompt Federal assistance to 
certain medical schools which, because of financial stress, are 
confronted with the immediate necessity of reducing their teaching 
strength. 
We recommend that those who conduct the survey referred to 
above examine also the effects which the grants-in-aid assistance 
has had upon the educational and research welfare of the institutions 
which have received it. 
8, The Army Medical Library (formerly the Surgeon General’s 
Library). We recommend that this Library, said to be the largest 
medical library in the world, be transferred from the jurisdiction 
of the Surgeon General of the Army to that of the Department of 
Health, Education and Security, Its present eminence stems from 
the work of John S, Billings while a member of the Staff of the 
Surgeon General in 1864 and 1865. Its present usefulness to the 
Armed Forces is far less than to the Nation as a whole, and indeed 
to the world, less than one-fifth of the usage of its resources 
now being military. Its support, now requiring nearly a million 
dollars a year, is dependent upon military budgets and in comparison with more specific military needs, has low priority. It has become 
a truly national asset in the field of medical education and research 
and could therefore properly be relieved of its military status, A 
new and suitable building for the Army Medical Library is a matter 
of immediate and urgent necessity. 
9* We recommend that the Army Institute of Pathology remain 
in association with the Army Medical Center,  
Basic 
Transfers^ 
Obligations Por 
Agency 
Appro- 
To Other 
Prom Other 
Total 
Self 
Unobligated 
priation 
Agencies 
Agencies 
Available 
Conducted 
Contracts 
Fellowships 
Balance 
Research 
TOTAL 
52.965.130 
3.699.317 
3.602.15^ 
52.867.967 
■25^8^8.7.8 
25.622.600 
1.361.590 
297,899 
Dept. of Army 
M^5,Qi+3 
1+00,037 
167.977 
3.812,983 
2,1+22,950 
1.390.033 
- 
Medical Dept. 
3,100,000 
1100,037 
- 
2.699.963 
1.657.930 
1,01+2,033 
- 
- 
Chemical Corps 
91+5,01+3 
— 
167.977 
1,113,020 
765,020 
51+8,000 
- 
- 
Dept, of Navy 
980.963 
1.593,280 
2,1+00,271 
5,787.95’+ 
1.361,295 
‘*.337.310 
- 
89.31+9 
Bureau of Medicine 
and Surgery 
2,9I+0.91+2 
1,593,280 
- 
1,3^7,662 
1,3^7,662 
- 
- 
- 
Office of Naval 
He search 
2,0^0-OPj. 
- 
2,1+00,271 
1+,1+1+0,292 
13.633 
>+.337.310 
- 
89.3^9 
Dept, of Air Force 
1,to, 200 
5,000 
- 
1,1+56,200 
1.271. >+53 
lSl+jl+7 
- 
- 
Atomic Energy Commis- 
sion 
1,652,500^/ 
- 
12.832,1+55 
8,985,183 
3,370.072 
1+77.200^ 
- 
Veterans Administrar* 
tion 
2,632,1+58 
- 
675.659 
3,308,117 
921,292 
2.178,275 
- 
208,550 
Public Health Service 
2>+,7to783 
1+8,500 
1+8,500 
21*,71*6.783 
9.700,230 
Ii+,i62.i63 
881+.390 
National Institutes 
of Health (including 
National Cancer In- 
23,817,32^ 
stitute) 
- 
1+8,500 
23,865,821+ 
8,819.271 
Ii+,l62,i63 
881+.390 
— 
Other Public Health 
1 
Service 
929 A59 
1+8,500 
- 
880,959 
880,959 
- 
- 
- 
Dept, of Agriculture 
613.728 
_ 
309.7^7 
923.1*75 
923.>+75 
- 
— 
Bureau of Animal 
Industry 
562,275 
- 
- 
562.275 
562.275 
- 
- 
- 
•Bureau of Entomology 
and Plant Quarantine 
51. “*53 
— 
309,71*7 
361,200 
361,200 
— 
— 
— 
a/ Including transfers 
to and from agencies other than those listed. 
b/ Includes $199,57° transferred tc 
\ the Industrial Hygiene Divis-’-'n of Public Health Service for continuation of 
work previously 
done by National Institutes of Health. 
c/ Includes $1,037,080 
transferred 
to National 
Research Council. 
d/ Obligated in fiscal 
*- 
year I9I+8 but actually spent in fiscal year 191+9* 
APPROPRIATIONS AND OBLIGATIONS POE. MEDICAL RESEARCH 
DURING FISCAL YEAR l^g COMMISSION ON ORGANIZATION OF THE 
EXECUTIVE BRANCH OF THE GOVERNMENT 
APPENDIX K 
REPORT OF THE 
SUBCOMMITTEE ON MEDICAL SUPPLE 
COMMITTEE ON FEDERAL MEDICAL SERVICES 
Mr. Herman Hangen 
Mr. C. W. Harris 
H. F. Currie, 00, Staff 
B. C, Fenton, M»D0, Staff 
November 1948 COMMISSION ON ORGANIZATION OF THE 
EXECUTIVE BRANCH OF GOVERNMENT 
APPENDIX K 
REPORT OF THE 
SUBCOMMITTEE ON MEDICAL SUPPLY 
COMMITTEE ON FEDERAL MEDICAL SERVICES 
Mr* Herman Hangen 
Mr* C* W, Harris 
H* F. Currie, M.D* Staff 
B* C* Fenton, M.D*, Staff 
November 1948 TABLE OF CONTENTS 
PART I 
Page 
Summary , 1 
Advantages of Present Organizations apd Procedures5 
Disadvantages of Present Organizations and Procedures........ 5 
Possible Solutions6 
Recommendation*9...................... 7 
PART II 
Present Organization and Functions 
1. General.,,.,,,,.,*,,,,,*,,..., 10 
2, Armed Forces 1,12 
3f Veterans Administration., 24 
4* Public Health Service...........28 
5, Bureau of Federal Supply 29 
6, Facilities., Personnel and Inventory,,,,,,..,;.,,,..,. 30 
7, Cataloging, Specifications, Mass Procurement, 
Stock Control and Inspection,,...,,,.,,,,,,.,,,, 33 
8, Integrating of Military and Civilian Medical 
Supply 35 
PaRT III 
Analysis of the Problem,,. 37 
APPENDIX 
A, Map*................,,,,, ,,,,,,,, 54 
B, Net Depot Space available and Occupied for the 
Storage of Medical Equipment and Supplies by 
the Four Major Federal Medical Agencies as of 
June 30, 1948 , ,, 55 
C, Personnel Engaged in Medical Supply Activities 
by the Major Federal Medical Agencies in the 
United States56 
D, Value of Medical Supply Stocks on Hand and 
Required to. Maintain Authorized Depot Stock 
Levels• 57 
E, Typical Illustration of Minor Variation of Items 
of Medical Supply and Packaging of Same for 
Use by Various Federal Medical Agencies,58 
F, Statistical Information on Federal Medical Supply 
Activities Submitted by Federal Agencies 
Fiscal Year 194B,,,, 64 PART I 
REPORT OF THE 
SUBCOMMITTEE ON MEDICAL SUPPLY 
Summary 
1. Medical supply activities are an important part of medical 
service, but only a part. In determining the best form of organiza- 
tion in the federal government to discharge medical supply functions, 
it must be considered that medical supplies are a tool of the profes- 
sional service. Consequently, the solution presented in this report 
provides for an organization to carry out the medical supply functions 
with certain alternatives depending on decisions which may be made 
concerning the over-all medical and health organization within the 
federal government. 
2* There are two civilian agencies operating major medical 
services - the Public Health Service and tne Veterans Administration, 
The National Military Establishment operates two and a fraction medi- 
cal services. The Navy operates its own; the Army operates its own 
and renders considerable medical service to the Air Force; the Air 
Force operates a partial medical service only, general hospitalization 
functions and medical supply functions being furnished by the Army, 
At the time of writing this report, active study was being carried 
out by the Armed Forces to determine the best type of medical service 
organization within the National Military Establishment, 
3, Brief explanation of the medical supply activities of the 
major medical agencies follows: (Figures are for fiscal year 1948.) 
a. The Public Health Service is responsible for about 2 
five and one-half percent of federal hospital patient days and five 
percent of outpatient treatments. The Public Health Service procures 
about 14j million dollars worth of medical supplies annually, of which 
one-third is procured centrally and two-thirds locally* It operates 
only one depot. In addition to operating hospitals for the care of the 
sick, the Public Health Service is involved in many research and pre- 
ventive medicine projects. The supplies and equipment used in these 
latter activities do not lend themselves to standardization. 
b, The Veterans Administration’s primary medical function 
is care of the sick. Of the total federal hospital patient days* the 
Veterans Administration is responsible for approximately percent, 
but on the other hand, is responsible for only about nine percent of 
outpatient treatments. It procures about 33j million dollars worth 
of medical supplies, 42 percent of which is procured centrally and 
5B percent locally. Four depots are operated. 
c. Navy, The Navy is responsible for about 13j percent of 
federal hospital patient days and 43 percent of outpatient treatments. 
It procures about 12-3/4 million dollars worth of supplies - 94 per- 
cent centrally and 6 percent locally. Cataloging and central procure- 
ment activities are handled by the Armed Forces Medical Procurement 
Agency* The Navy operates two distribution depots and three reserve 
depots in the United States. 
d. Army, The Army is responsible for general hospitaliza- 
tion for Army and the Air Force, Hospitalization in these services 
amounts to about 2lJ percent of federal patient days and 43 percent 
of outpatient treatments. It procures about million dollars worth of supplies - 81 percent centrally and 19 percent locally. Cataloging 
and procurement, activities are handled by the Armed Services Medical 
Procurement Agency. The Army operates five distribution depots and 
two other depots in the United States, It procures for and distributes 
to the Army and the Air Force, 
e. Air Forcef Air Force hospitalization and outpatient 
are included in Army, paragraph 3.d,, above. Cataloging and central 
procurement activities are handled by the Armed Services Medical Pro- 
curement Agency, The Air Force operates no medical depots in the 
United States. 
4. For the last three years the Armed Forces have carried out 
consolidated medical procurement and allied activities in the joint 
Armed Services Medical Procurement Agency (formerly called the Army- 
Navy Medical Procurement Office), This joint Agency performs the 
following functions for the Armed Forces in the field of medical supply: 
Cataloging - a joint catalog is published 
Specification preparation and revision 
Purchase of all centrally procured supplies 
Inspection 
Certain functions in connection with maintenance 
including the operation of joint school for 
training maintenance and repair technicians. 
Developmental engineering on new items 
5. As of the date of this report, the Army and Air Force have 
not decided upon the type of medical service, including supply,, which 
they will have,. At present all the commissioned personnel involved in 4 
Air Force medical activities are detailed from the Array.. The Army 
operates all general hospitalization for itself and the Air Force, 
and procures and distributes all medical supplies. In fiscal year 
1950 the Air Force will budget for the supplies it expects to con- 
sume and will turn this money over to the Army. Whether or not the 
Air Force will have a complete medical service of its own, including 
personnel, general hospitals, and a supply distribution system, has 
not been determined. In any event it seems assured that the Armed 
Services Medical Procurement Agency will continue to discharge its 
present functions for all three of the Armed Forces, 
6. Likewise, as of the date of this report, the type of medi- 
cal service organization which the Armed Forces as a whole will have, 
has not been definitely determined. A recommendation to establish 
a joint medical supply system including distribution as well as pro- 
curement has been made to the Secretary of Defense, 
7. Appendix F presents a statistical summary of functions con- 
cerning medical supply within the federal government. It is difficult 
and dangerous to make comparisons between the various agencies due to 
the many differences in function and methods of reporting. For example, 
Veterans Administration has no separate medical supply system, and, 
consequently, figures on personnel involved in medical supply work, 
space occupied by medical supplies,, etc., are estimates only. As 
another example, the Army procures and handles considerable quantities 
of medical supplies for various foreign aid programs. There are many 
other examples which could be cited to show that comparisons from 
these figures are dangerous. It must be borne in mind that the purpose 5 
of this study is to determine an organizational and functional 
structure for handling medical supply in the federal government 
and not to determine the relative efficiencies and inefficiencies 
of existing agencies. 
8, The four and a fraction major federal medical s ervices 
operate three central procurement offices (Public Health Service, 
Veterans Administration, and the Armed Services Medical Procurement 
Agency). They operate four depot systems (Public Health Service, 
Veterans Administration, Navy and Army) comprising ■ seventeen 
depots in the United States. This results in overlapping and dup- 
lication. 
ADVANTAGES OF PRESENT ORGANIZATIONS AND PROCEDURES 
1, Each major agency using medical supplies, with the exception 
of the Air Force, controls its own supply system and is able to tailor 
it t* its own needs. This makes for clear organizational responsi- 
bility and authority, and quick action to meet varied demandsr 
2. The supply system of each agency, with the exception of 
Veterans Administration, is under professional control and is con- 
sequently responsive to professional needs. 
DISADVANTAGES OF PRESENT ORGANIZATIONS 
AND' PROCEDURES 
1, There is needless duplication and overlapping resulting in 
a wast of money and personnel. 
a. Three separate central procurement offices are maintained 
- four, if the Bureau of Federal Supply is included. All of these 6 
buy essentially the same items without coordination. Each works up 
its own specifications. 
b. Four parallel sets of depot distribution systems exist - 
five, if the Bureau of Federal Supply is included. All of these handle 
essentially the same items. In many instances a hospital of one agency 
is located in the same city as a depot of another agency, yet draws its 
supplies from the depot of its own agency, hundreds of miles away. 
c. There are three systems of cataloging - four, if the 
Bureau of. Federal Supply is included. The Armed Forces have a joint 
catalog. The Veterans Administration and Public Health Service have 
their own catalogs which to a great extent use the numbering and nomen- 
clature of the Armed Forces. The Bureau of Federal Supply has a cata- 
log using a different numbering and nomenclature system. 
d. There is no central control of the stocks of the various 
agencies. In the event of war and the need for rapid mobilization of 
medical supplies for military and civil defense needs, there is no 
central agency which knows the location of stocks or which has the 
power to make them available. Furthermore, the lack of a common system 
of numbering and nomenclature would make it impossible to establish 
rapdily such a central control in time of national emergency. 
e# It is obvious that one supply agency will result in a more 
economical over-all operation. 
POSSIBLE SOLUTIONS 
There are many possible solutions to t he problem. The more 
feasible are briefly mentioned below: 7 
1; That the Commission on Organization of the Executive Branch 
of the Government take no special action on the medical supply pro- 
blem, and let each agency having a medical service have its own 
supply agency. 
2, That one medical supply system be established for civilian 
medical services (Public Health Service, Veterans Administration and 
other minor agencies) and that the Military Establishment work out 
its own solution: maintaining the status quo, splitting into three 
systems, or consolidating into one system. 
3. That two medical supply systems be established* one for 
civilian agencies and one for military. 
4, That one complete medical supply system be established in- 
cluding the functions of procurement, stock control, and depot opera- 
tion. The operation of this system would be either under the control 
of the Military Establishment or a National Health Bureau depending 
upon the organization setup for the administration of federal medical 
care. 
RECOMMENDATION 
Under the act creating the Commission on Organization of the 
Executive Branch of the Government which specifies that duplication 
and overlapping of functions are to be e3.iminated where practical, 
and that services, activities and functions of a similar nature are 
to be consolidated, the subcommittee recommends that alternative No* 4> 
above; be adopted as outlined below: 
1, Inasmuch as it is essential that the Armed Forces have a 8 
complete medical supply system including central procurement and 
distribution functions, the federal medical supply system should be 
assigned to the National Military Establishment and operated as a 
single service on the basis either that there is a merger of their 
medical services, or that the responsibility and authority for opera- 
tion be delegated to one of the three Armed Forces, While this sub- 
committee is cognizant of the present eminently satisfactory operation 
of the Armed Services Medical Procurement Agency on a joint basis in 
the field of procurement, it does not feel that a jointly controlled 
organization could efficiently function in the expanded fields of 
distribution, servicing both military and civilian agencies. 
2, If neither of the solutions in Paragraph 1, above, can be 
worked out because of organizational difficulties, then this subcom- 
mittee recommends that the medical supply agency be operated by the 
Department of Health and Welfare. In this latter event, it would be 
necessary for the Armed Forces to detail personnel to this agency for 
training in depot and other supply operations. This is necessary be- 
cause overseas depots, both in peace and war, would have to be operated 
by the Armed Forces, Furthermore, in time of war the medical supply 
agency could be transferred to the military establishment if that 
seemed necessary. 
3f If alternative No. 4 were adopted, a careful phasing of 
shifts in organization and function would be necessary; first, 
standardization in numbering and nomenclature, standardization of 
forms, accounting systems and administrative procedures; second, the 
merging of all central procurement activities, and the development of 9 
inter-departmental fiscal procedures; and third, the assumption by 
the agency of all stock control and depot activities, 
4* The subcommittee is of the opinion that adoption of alter- 
native No. 4 would result in the following advantages and economies; 
a. A more efficient service to professional groups due 
to concentration of stocks in fewer depots and corresponding decrease 
in nout-of-stockM situations. 
b. The elimination of two of the present three central pro- 
curement offices. 
c. The reduction of the present seventeen depots to about 
four distribution depots, plus an assembly and perhaps a separate depot 
for war reserve stocks. This reduction would be gradual as existing 
stocks were consumed. 
d. The reduction in stocks, 
e. A considerable saving in transportation by the reduction 
in back hauls. 
f. The assurance of fresher stock due to larger volume for 
each depot and more rapid turnover, 
g. The ability to mobilize rapidly all federal stocks in 
time of war or other national emergency and to make them available 
for military and/or civilian needs. PAHT II 
Present Organization and Functions 
1. General* There are at the present time four major federal 
medical services involved in the procurement, storage and distribution 
of medical equipment and supplies. These agencies are the Army 
(including the Air Force), the Navy, the Veterans Administration and 
the Public Health Service. Medical equipment and supplies for the 
Air Forces are presently handled by the Army supply agency. Each 
supply agency of the four major federal medical services maintains 
storage and distribution facilities. The Army and Navy have con- 
solidated certain activities; namely, cataloging, specifications, 
standards, procurement, laboratory, testing, equipment development 
and inspection activities. Each supply agency with the exception 
of the Public Health Service maintains a system of depots through the 
continental United States, and the Armed Forces also have depots over- 
seas. Only one depot is operated by the Public Health Service. The 
Veterans Administration has the greatest medical supply activity, 
with the Army, Navy, and the Public Health Service following in volume. 
Central offices are maintained by all medical supply agencies of the 
four major federal medical services. These offices deal with plans, 
policy, direction and operation of the supply activities of the 
service. 
The medical supply agencies of the four major federal medical 
services, with the exception of the Veterans Administration, are under 
and a part of the office of the respective Surgeons General. In the Veterans Administration medical supply is a part of the general 
supply system, under the Assistant Administrator for Construction, 
Supply and Real Estate, and not under medical control; 
In addition to the medical supply activities of the federal 
medical services referred to above, another federal agency, the 
Bureau of Federal Supply is involved in the procurement of medical 
equipment and supplies on a smaller scale « It is mandatory that 
federal agencies procure certain items through this agency, while in 
other instances the use of the agency is optional. Open contracts are 
lot by this agency through which any federal agency may procure equip- 
ment and supplies against the contract. Several minor federal medical 
services such as Freedmenfs Hospital, the Indian Service, the medical 
services of the Tennessee Valley Authority, etc*, purchase some medi- 
cal equipment and supplies locally and obtain others from the supply 
agencies of the other federal medical services, as well as utilizing 
contracts of the Bureau of Federal Supply. 
The tendency of the suppler agencies of the Veterans Administration 
and the Public Health Service has been to adopt in varying degrees the 
supply system of the Army and the nomenclature and cataloging of the 
Army-Navy Medical Procurement Office* The standards and specifications 
developed by the Army-Navy Medical Procurement Office are utilized by 
these supply agencies insofar as it is practicable; 
/ill supply agencies of the four major federal medical services 
utilize machine records for stock accounting and control; however, the 
various agencies use two systems of machines (IBM and Remington Rand),- 
in which records are not interchangeable,- thus preventing a consolidated rcport of stocks of medical equipment and supplies in the hands of 
the four federal medical services. 
There arc marked variations in the levels of stock hold by the 
four federal medical services* The Army authorizes a 90-day stock 
level at depots and a 60-day level at stations. The Navy authorizes 
180-day levels at depots and officially 90 days at stations. The 
Veterans /administration authorizes 180 days at depots and 90 days at 
stations. The Public Health Service maintains a 120-day level at 
depot (supply station) and a 90-day level at stations. 
The attitude of the supply agencies of the four major federal 
medical services, with reference to local procurement of equipment 
and supplies, varies. This can be explained to some extent by a 
variation in missions of the services. All local procurement is 
within money allowances established for stations, or in special cases 
authority must be obtained from the central office for purchases in 
excess of the allowance. 
2. Armed Forces 
a* Army 
(1) Control Office (Supply Division, Office of the 
Surgeon General). The Supply Division, Office of 
the Surgeon General, Department of the Array, is a staff division of 
that office# The office of the chief of the division is the planning 
and policy making body for operation of the medical supply system of 
the /iimy. The Office of the Surgeon General as one of the Technical 
Services is under the general staff direction of the Director of 
Logistics, General Staff. The central office of the Supply Division is composed of 24 officers and 110 civilian employees* In addition 
to this staff the Army-Navy Procurement Office in Brooklyn, Now York is 
composed of 53 military and 294 civilian personnels Supply planning is 
carried on by the Office of the Chief and liaison maintained with the 
Army-Navy Procurement Office. Specifically the Division is charged 
with; 
(a) Determining medical supplies and equipment 
required for the planned troop strength and medical program of the 
Army. 
(b) Obtaining and storing an adequate supply of 
these items to meet anticipated needs. 
(c) Providing procedures for and supervising the 
distribution of those items through the Army structure, including 
civilian co. ponents, in accordance with the Army medical supply pro- 
gram. 
(d) To plan for the establishment of reserve 
stocks of medical supplies and equipment. 
(c) Establishing and supervising the maintenance 
program for Nodical Department equipment. 
(f) Determining surplus medical supplies and 
equipment and reporting same to disposal agencies. 
(g) Providing procedures for and supervising 
civil affairs supply matters and foreign assistance programs of the 
Surgeon General!s Office. 
(h) Laying plans and providing methods for indus- 
trial mobilization and procurement coordination planning activities. (i) Supervising for the Surgeon General, the 
operation of the Army-Navy Medical Procurencnt Office, insofar as 
the interest of the Medical Department of the Army is concerned. 
(j) Reviewing, consolidating, and defending budget 
estimates pertaining to the Supply Division. 
(3c) Providing procedures for and supervising any 
Medical Department supply matters of the Surgeon General1s Office. 
Other activities of the Division are as follows: 
(a) Depot Branch. This branch is responsible 
for the technical control and direction of operation in medical supply 
depots and medical sections of Army general depots. Liaison is main- 
tained with these depot activities and reports of depot operations 
are received and consolidated. 
(b) Distribution Branch* This branch is further 
subdivided into two sections: 
1 Domestic Section. This section controls 
the issue of medical equipment and supplies to domestic medical stations 
of the Lrmy. Approval action is taken on certain items reserved for 
control by the Office of the Surgeon General, these being chiefly items 
of costly equipment, special apparatus, etc. Questions of issue policy 
are formulated and general direction given to the field relative to 
the domestic issue of supplies. 
Z Overseas Section. This section deals with 
the issue of supplies to United States Army Medical Depots located 
in overseas bases or occupation areas. Requisitions from overseas 
medical supply activities are normally received by the port supply agency charged with the supply of tho overseas base or area and 
supply action taken by the port supply agency to edit the requisition 
and forward it to a port filler depot for shipment of the supplies# 
In the event of conflict or question as to the items requisitioned 
by the overseas supply agencies requisitions are forwarded to the 
Overseas Section of the Distribution Branch for further study and 
final decision* 
(c) Requirements and Stock Control Branch* This 
branch, located in Brooklyn, Now York, is responsible for determining 
the medical equipment and supply requirements of the Army and civilian 
components. This agency is further charged with determining the stock 
level of items to be maintained at depots and the maintenance of ade- 
quately balanced stock therein, by initiating procurement, preparing 
delivery schedules and by directing depots to transfer stock as re- 
quired. Further duties are the determining of requirements for mobili- 
zation and the carrying out of an assembly program to meet these re- 
quirements, the determination of excess and surplus stocks, consolida- 
tion of depot stock status reports and the preparation of budget esti- 
mates for medical equipment and supplies. 
(d) Foreign Aid Branch. This branch deals with 
the issue of medical equipment and supplies under control of the Army 
to foreign governments in accordance with approved policies of the 
Department of the Army. These items of equipment and supply are 
requisitioned from depots by this agency and instructions given as to 
packing, narking, shipping, etc, (2) Field Activities 
(a) Depots. The Army has currently in operation 
three Medical Depots and four sections of Army General Depots. Five 
of these depots are used for the storage and distribution of medical 
equipment and supplies; one is utilized as a depot to assemble hospi- 
tals and other assemblies; and one is a bulk storage depot having a 
maintenance and repair shop, an optical shop, and facilities for 
training personnel in repair and maintenance and general medical supply 
activities. The distribution areas and locations of the depots are 
indicated on the attached map, Appendix A The space available for 
storage and other pertinent data is shown on the chart, Appendix B. 
Medical Depots and medical sections of Army General Depots have, 
in addition to the missions indicated above, the mission of maintaining 
stock control in stations within the distribution area. This mission 
is carried out by representatives of the depots visiting the station, 
assisting in establishing stock levels of the items carried, assisting 
in setting up and maintaining required records, and, in general, po- 
licing the medical supply activities at station level. 
(b) Army Areas. Each Army Area Headquarters has 
a Medical Supply Officer who is charged with policing the medical supply 
activities of stations within the Army Area* Since certain supply 
functions are charged to the Army Areas, a report is made to Army Area 
Commanders of activities relative to station supply which are carried 
on by the depot or depots serving the area. 17 
(c) Station Supply Activities«. Each station 
(hospital, dispensary, etc.) has a supply section headed by a Medical 
Supply Officer who is charged with the requisitioning, storage, issue, 
maintenance and repair of equipment and supplies. Levels of supply 
arc established at each station dependent upon the patient load. A 
60-day level of supply is established as the amount to be stocked by 
stations, and dependent upon experience factors, the amount of supplies 
stocked is varied to stay within the 60-day level. Requisitions arc 
submitted by stations to designated distribution depots every 60 days, 
or more frequently whore emergencies arise. Local procurement by 
stations is authorized where items arc required at once to meet emer- 
gencies. Standardized records of stocks arc maintained by stations 
and these records arc audited periodically by representatives of the 
depot, responsible for supply of the station. Mhcro surpluses in 
certain items are found, stations are directed to return these items 
to the depot. No bulk storage of supply over the 60-day level is 
authorized at stations unless the station serves as a sub-depot to 
supply surrounding small stations. 
b. Air Force 
(1) Central Office (Medical Materiel Branch, Office 
of the Air Surgeon). The Medical Materiel Branch 
of the Air Surgeon1s Office, Department of Air, is a part of the 
Medical Plans and Services Division of that office. The branch is 
headed by the Chief and is sub-divided into the Requirements Section, 
the Armed Forces Medical Procurement Section, and the Storage and 
Distribution Section. The Medical I.Sat oriel Branch formalizes medical materiel and supply policies for the Air Force; plans and coordinates 
over-all medical materiel and supply activities# A brief outline of 
organizational functions follows: plans, directs and supervises the 
activities of the branch; will be the Air Force member of the Armed 
Services Medical Procurement Board which is being established this 
month to replace the existing Army-Navy Medical Procurement Agency 
by admitting the fair Force to full participation at the policy level# 
(a) Requirements Section. The Chief of this 
section is a member of the Armed Forces lie die al ISat oriel and Specifi- 
cations Board. The section is responsible for computing quantitative 
and qualitative requirements of all Mr Force medical items. A speci- 
fication unit charged with determining the specifications for medical 
service supply, monitoring and testing of procured materiel for com- 
pliance with specified standards, is a sub-division of this section. 
A development unit, charged with research into and development of 
new medical equipment developing plans and procedures into- the opera- 
tional facilities necessary to determine the strength, durability, 
and application of various items of medical equipment, is also a part 
of this section. 
(b) I-tTTiLcd Forces I.bdical Procurement .Agency 
Section* This section is responsible for 
determining policies for, and directing the procurement of, all items 
of medical equipment and supply required by the fir Force. A purchasing 
unit, responsible for implementation and coordination of plans and poli- 
cies for the soliciting of bids and quotations, awarding of contracts, 
negotiation of purchase, modification of contracts and purchase orders, tcrraination of contracts, disposition of surpluses, sale end recovery 
of salvage stocks, and local procurement, is a part of this section. 
A fiscal unit, responsible for maintenance of records on development 
and research projects, consumption rates, statistics on costs and con- 
tracts status, maintaining liaison with the Budget and Fiscal Branch 
in providing data and factors for budgetary purposes, is also a part 
of this section. A catalog unit, responsible for the preparation and 
publication of medical supply catalogs, for pertinent additions thereto, 
and deletions therefrom on recommendation of the development unit, and 
publication of standard nomenclature lists, is another part of this 
section# 
(c) Storage and Distribution Section* This section 
determines the policies and plans and is responsible for the storage, 
distribution, and technical maintenance of medical supplies and equip- 
ment peculiar to the Air Force, A depot operations unit plans and imple- 
ments policies governing supervision of medical supply storage facilities, 
security and regulations required under public law, and governing storage 
of narcotics, is a part of this section-, A stock control and records 
unit is also a part of this section and is charged with collecting and 
compiling reports of the various medical supply depots, preparing and 
maintaining statistics pertaining to the rate of issue of medical supplies 
from which periodical requirements may be calculated. The table of 
organization and equipment unit of this section is charged with preparing, 
revising and amending tables of organization and equipment and tables of 
allowances for all Air Force medical organizations'; and with initiating 
action for the development of suitable medical equipment for air-borne medical units# A maintenance unit of this section is responsible 
for originating data and technical directives on the repair and upkeep 
of medical equipment and implementing policies governing functions 
of depot maintenance and repair shops. Tito military and one civilian 
employee comprise the medical supply staff of the central office at 
the present time. 
(2) Field Activities 
(a) Depots. One depot, the Wright-Patterson Air 
Force Depot at Dayton, Ohio, maintains a medical section where items 
of Medical Department supply peculiar to the Air Force arc stored and • 
issued. Involved in this operation are two military and twelve civilian 
employees. Small amounts of this type of supply are also stored and 
issued at the larger air bases. For general supply of Medical Depart- 
ment items, stations of the Air Force depend upon the depot system 
operated by the Surgeon General, Department of the Army. 
(b) Station Supply Activities. Station supply 
activities are the same as those of the Army with the exception that 
items of medical supply peculiar to the Air Force are requisitioned 
from the Medical Section of the Air Force Depot at Uright-Patterson 
Air Force Base. 
NOTE; At present all central procurement is handled by the Army-Navy 
Medical Procurement Office; and storage and issue of all medical 
supplies and equipment, with the exception of the storage and issue 
of items peculiar to the Air Force, is carried on by the Supply Division, 
Office of the Surgeon General, Department of the Army. c* Navy 
(l) Control Office (Matoriel Bureau of libdieine 
and Surgery)* The Lledicol Materiel Division is 
a staff division of the Bureau of Medicine and Surgery, Department of 
the Navy. The Division is headed by the Director. The Office of the 
Director is in Brooklyn, New York, with a sub-office in Washington, D.C* 
The Division is charged with establishing basic policies governing Navy 
medical materiel; direction of development and accomplishment of special 
medical materiel programs in support of Naval operating plans; and is 
responsible for the direction and coordination of all elements of the 
Medical Supply System> including the Naval Medical Materiel Office, 
Medical Supply Depots, and such other medical supply facilities as 
may be established under the management or technical control of the 
Bureau of Medicine and Surgery. The Central Office is composed of 
32 military personnel and 60 civilian employees. In addition to this 
staff, the Army-Navy Medical Procurement Office in Brooklyn, New York, 
is composed of 53 military and 294 civilian personnel. Specifically 
the division is charged with: 
(a) Exorcising direct control over the Naval 
Medical Materiel Office. 
(b) Developing basic material policies and specific 
material programs with particular regard to specialized categories of 
material. 
(c} Keeping currently informed of improvements, 
developments, and current trends in the professional and technical 
aspects of the fields of medicine and dentistry, particularly as they 
relate to material requirements.- 
direct control over the Naval (d) Maintaining liaison with Professional, 
Preventive Medicine, Research, Planning, and other divisions of 
the Bureau regarding the development of now items and all other pro- 
fessional and technical material matters. 
(c) Formulating Bureau of Medicine policies rela- 
tive to cataloging, specifications, and the development of standard 
medical materials, and coordinating these policies with the work of 
the Washington office, the Naval Medical Procurement Board, the Army- 
Navy Medical Procurement Office, and other related agencies. 
(f) Determining levels of stock to bo maintained 
by Medical Department activities# 
(g) Prescribe salvage and surplus property dis- 
posal procedures to be employed in the medical supply system. 
(h) In conjunction with the Finance Division, 
proscribing methods of preparation and correlation of data required 
to support budgetary estimates of the medical stores program.. 
(i) Reviewing estimates submitted by field acti- 
vities for materials and services as required, and authorizing pro- 
curement as indicated. 
Other activities of the Division are as follows: 
(a) Depot Management Branch* The Depot Manage- 
ment Officer is in charge of the Branch and is charged with being 
cognizant of the organization and maintenance requirements of the 
Medical Supply Depots; assisting in developing policies and methods 
for the receipt,- inspection, storage, preservation, repair and dis- 
position of stores at the depots; advising the depots generally in such mutters; and making periodic inspections of depots and reporting 
his findings to the Division Director. In addition, he is charged 
with reviewing, studying, and making recommendations concerning the 
organizational structure and the administrative and operating policies 
and procedures of the Material Division and the Naval Medical Materiel 
Office for the purpose of coordinating and integrating their respective 
functions. 
(b) Dental Materiel Branch. The Dental Materiel 
Officer is in charge of the Branch and is charged with assisting and 
giving technical advice to the Division Director in the dental aspects 
of the materiel functions. He is charged with maintaining liaison with 
the Dental Division for the purpose of coordinating the dental materiel 
program with dental personnel and operational programs. 
(c) 'Washington Office* The Washington Office of 
the IIHatoriel Division is charged with performing liaison functions be- 
tween the Ilatericl Division and other divisions of the Bureau; repre- 
senting the Division in necessary personal contacts with other agencies 
in Washington and the surrounding area. The Office is further charged 
with correlating the functions of the Advance Base and Ships Medical 
Materiel Section, the Specifications Section, and the Automotive and 
Medical Material Section, ’which are located in the Washington Office. 
(2) Field Activities 
(q) Depots>' There arc in operation two Naval 
Medical Supply Depots and throe Ibdical Stores Sections of Naval 
Supply Depots in the continental United States* (See map, Appendix A, 
indicating locations and distribution areas). Optical Service Units (Base Type) arc operated overseas but not in the continental limits 
of the United States* The space available for storage of medical 
* ' v ' 
supplies and equipment is indicated on chart, Appendix B. The Naval 
Medical Supply Depots indicated above are responsible for storing and 
distributing medical supplies and equipment to Ships and Shore Stations 
of the Navy. The Medical Stores Sections of Navy Supply Depots serve 
as bulk storage areas for medical supplies and equipment and back up 
the Naval Medical Supply Depot System. 
(b) Naval Districts, The Ibdical Office of the 
Naval District is charged with supervision of medical supply activities 
at station level. Inspections are made to determine the status of 
stocks and to determine that control office directives relative to 
medical suppljr arc being complied with. 
(c) Ships and Shore Station Activities, Ships and 
shore stations requisition nodical supplies and equipment from designated 
depots in accordance with established allowances. Inspection of nodical 
supply activities at station level arc made by representatives of the 
Naval District Medical Officer, Procedures for medical supply activities 
arc established in the central office. Local procurement is authorized 
in accordance with existing directives and within established monetary 
allowances. 
3# Veterans Administration 
a. Central Office. The Central Office Supply Service, which 
is a general organization for all typos of supply required in the opera- 
tion of Veterans Administration facilities, is directly under the Office 
of the Assistant Administrator for Construction, Supply and Real Estate# This office serves to formulate standards, policies and procedures 
for all activities relating to: 
(1) Compilation of supply and equipment requirements, 
processing of same, stock control, propcrtjr records and distribution 
of supplies and equipment. 
(2) Purchase of supplies and equipment, standardization, 
specifications, making and termination of purchase contracts, trans- 
portation of supplies and equipment, acquisition of surplus supplies 
of other federal services and disposal of Veterans Administration sur- 
pluses. 
(3) Storage, preservation, and maintenance of supplies 
and equipment procured. 
(4) Procures all standard items. 
(5) Operates the Veterans Administration supply depots. 
(6) Prepares and publishes the official Veterans Admin- 
istration supply catalog. 
(7) Exercises staff supervision over and provides assist- 
ance to execution of all activities of the Supply Service which arc 
assigned to branch offices. 
b• FieldActivities 
(l) Depots. The Veterans Administration has currently 
in operation four supply depots (see Appendix A for location and dis- 
tribution areas)# Hie space available for storage of medical equipment 
and supplies is indicated in chart, Appendix B. These depots stock all 
classes of supplies and equipment utilized in the Veterans Administration 
facilities, including medical. The supply depots are under the immediate jurisdiction of the Supply Service, Central Office. Depots are headed 
by a manager who is responsible to the Director, Supply Service. Staff 
supervision and technical assistance in connection with activities common 
to supply depots and field stations is rendered by Branch Offices having 
jurisdiction over the area in which the depot is located#- No sectional 
breakdown (such as medical, signal, etc.) is carried out in the Veterans 
-Administration supply depots. 
(2) Branch Office Supply Division. The Supply Division 
at branch level, of which there are thirteen: 
(a) Implements established standards, policies, 
and procedures relating to the Veterans -Administration supply program 
within the Branch Office area# 
(b) Approves the procurement of items not restricted 
to Central Office approval or authorized at field station level. Reviews, 
coordinates, and makes recommendations on requests for items requiring 
Central Office approval. 
(c) Conducts periodic inspection of supply activities 
at field stations located within the Branch area. 
(d) Exercises staff supervision over and provides 
assistance relative to execution of that part of the Veterans Adminis- 
tration supply program assigned to field stations. 
(3) Regional Office Supply Division. The Supply Division 
at regional level (there are 61 regional offices): 
(a) Obtains by requisition or through procurement 
supplies and equipment necessary for the maintenance and operation of 
stations, contact offices, and guidance centers within its territory. • (b) Determines proper stock level of supply. 
(c) Hakes awards and contracts, authorized to 
be made by stations, covering the procurement of supplies. 
(d) Receives, stores and issues, exchanges, 
transfers, and safeguards supplies and equipment. 
(e) Prepares annual and other required inventories 
of all expendable property in stock and all non-expendable property 
in stock or in use* 
(f) Directs the preparation,, issuance and accom- 
plishment of bills of lading. 
(4) Hospital and "Center1’ Supply Divisions; 
(a) Obtain by requisition or through procurement, 
as authorized, supplies and equipment necessary for the maintenance 
and operation of installations. 
(b) Determine proper levels of supply in accordance 
with established policy. 
(c) Make awards and contracts authorized to be made 
by the station covering the purchase of supplies, and processes fiscal 
vouchers. 
(d) Receive, store, and issue supplies and equipment. 
(e) Prepare required inventories of property. 
NOTE: The Chief Medical Director has only advisory functions relative 
to medical supply. These are essentially recommendations as to pro- 
fessional standards, new items desired, review of equipment lists, 
representation on certain committees dealing with supply, professional 
review of performance of medical equipment in the field,, etc. 4* Public Health Service 
a. Central Office* The Office of Purchase and Supply is 
a staff division of the Office of the Surgeon General, Public Health 
Service. This office establishes standards and procedures for the 
procurencnt and delivery of equipment and supplies required by the 
service. It processes some purchasing centrally, but the majority 
of this work is delegated to the stations. The office is also respon- 
sible for property records and disposal of surplus materials. 
b. Field Activities 
(1) Depots. Ono depot (Supply Station) is maintained 
by tho Public Health Service at Perry Point, Maryland, for the storage 
and distribution of medical and certain other supplies and equipment. 
This depot also furnishes supplies and equipment to other federal 
agencies. It is tho policy of the Public Health Service to stock at 
tho depot only items in which there is an appreciable saving by mass 
procurement or where bettor service may bo obtained by such stockago. 
Items arc also stocked where it is desirable to standardize rather 
than allowing stations to procure locally a variety of the same typo 
item. All expenses in connection with the operation of the depot arc 
taken care of by adding a surcharge to the items shipped to stations. 
This includes charges for personal services, material, equipment re- 
quired in handling, transportation, etc. The ono depot serves as a 
distribution depot for the entire United States with the exception of 
some Host Coast stations which arc served by tho Naval Nodical Supply 
Depot in Oakland, California. Tho Navy is reimbursed for tho items 
issued to stations of the Public Health Service, (2) Station Supply Activities* Stations of the Public 
Health Service obtain the bulk of medical equipment and supplies bjr 
local purchase and by the utilization of open-end contracts entered 
into by the Bureau of Federal Supply* It is mandatory that items 
listed in the catalog of the Service be requisitioned from the depot 
unless approval for local purchase is obtained from the central office 
or unless an emergency supply requirement exists. Certain largo sta- 
tions of the Public Health Service, such as the National Institute of 
Health and the Communicable Disease Center, arc authorized vide lati- 
tude in the matter of local procurement because of their specialized 
needs. Station medical supply is policed by representatives of the 
Public Health Service in the various districts throughout the United 
States, who inspect records maintained and the levels of supplies on 
hand. Periodic inspection of station supply activities are also made 
by representatives of the Central Office. Policy as to station supply 
is dictated by the Central Office. 
5Bureau of Federal Supply 
a. Central Office* The Bureau of Federal Supply is an agency 
of tho Treasury Department having its central office in Washington, D.C. 
Tho Bureau is headed by a Director responsible to the Secretary of tho 
Trccsur3r. A stock catalog of items ordinarily carried in depot stocks 
is maintained by this agency. Federal Supply Schedules of the various 
classes of supplies, listing tho contractors holding opon-ond contracts, 
aro also prepared and distributed by this agency. 
Few items of medical equipment and supply aro stocked by the 
depots of the Bureau of Federal Supply; however, a fairly comprehensive listing of those Items is included under desses 51 and 57 of the 
Federal Supply Schedule. The items included on the schedule must 
in some cases he purchased on the contracts of the Bureau; however, 
the purchase of other items is optional. Contracts in all cases call 
for delivery to the using agency. A review of the Federal Suppl3r 
Schedule, invitation, bid and acceptance form indicates that only 
limited utilization was made of the contracts on classes 51 and 57 
during the period July 1, 1946 to July 31, 1947 (those arc the latest 
figures on amounts purchased against existing contracts). 
b. Field Activities. Twelve supply centers arc maintained 
by the Bureau of Federal Supply (sec map, Appendix A). Those centers 
provide geographical coverage for the continental United States. Items 
available in stock may bo requisitioned from these supply centers by 
any federal agency. As previous!:/ stated, feu items of medical equip- 
ment and supply arc stocked by the depots of the Bureau of Federal 
Supply, those stocked being chiefly first aid items, certain chemicals, 
and laborator:’" glassware. According to information obtained, it appears 
that due to limited funds and the constant changing of medical items, 
the Bureau has found it more advantageous to handle this type of suppl}/- 
by open-end contract rather than the acquisition of depot stocks. 
6. Facilities, Personnel and Inventory 
a* Facilities. The facilities currently required by the 
federal agencies involved in medical supply activities are greatly 
in excess of the missions being performed. Not only is an excess 
amount of storage space retained by these agencies, but the number of 
depots is greatly in excess of tkc needs to provide adequate geographical coverage; In many cases facilities of different federal agencies 
involved in medical suppljr activities arc located in the immediate 
vicinity of each other, both performing near or identical functions. 
In some cases facilities are rented; in others the facilities arc 
government-owned- In either ease, the upkeep and operation costs arc 
financed by the federal government. The four major federal agencies 
involved in medical supply operate 17 depots or medical sections of 
General Depots which have varying degrees of medical supply activity# 
Space occupied by medical equipment and supplies in facilities held, 
is indicated on the attached chart, Appendix B. It is plainly in- 
dicated that a costly excess of space is retained which could be 
markedly reduced by discontinuance of some facilities, consolidation 
of stocks, and reduction of inventory. 
In addition to the facilities referred to above, each federal 
agency involved in medical supply activities maintains a central 
office with a medical supply section and in certain cases separate 
procurement offices, inspection activities, etc. 
b. Personnel. Personnel involved in medical supply activi- 
ti os, especially those in the key positions, are considered in a 
scarce category* The technical and professional knowledge of individuals 
in key positions of medical supply is essential to efficient and econom- 
ical operation. There is marked competition for talented individuals 
trained in medical supply, the competition not being limited to federal 
agencies but extending to commercial establishments dealing in medical 
supply. A concentration of the highly trained personnel in the medical 
supply field could effect marked efficiency with resultant economy in the federal government. There is in medical supply as in the pro- 
fessional phase of medicine, a need for specialization* The buyer 
of a medical supply commodity is limited in his knowledge of that 
commodity unless continually trained in improvements which have been 
made. This increased knowledge results invariably in a better product 
received and economy from reduction in waste caused by poor "buys" or 
the purchase of inferior products, which arc unacceptable to the using 
agency. This same principle is equally applicable to all phases of 
medical supply activity. A pooling of the best brains within the field 
of medical supply in federal agencies would result in greatly improved 
efficiency, better service, and marked economies to the federal govern- 
ment. The reduction in depot overhead personnel alone by a consolida- 
tion of depot activities would in itself represent a distinct saving. 
Chart, Appendix C, indicates the personnel currently employed in medical 
supply activities. 
c. Inventory. The inventory of medical equipment and supplies 
currently carried by federal agencies involved in medical supply acti- 
vities appears to be in excess of that required for good business opera- 
tion. The approximate inventory cost of medical equipment and supplies 
in bulk storage in the hands of federal agencies as of 30 Juno 1948 is 
shown in chart, Appendix D. It must be considered, however, that in 
this inventory arc war reserves which rightfully should be maintained. 
There are also many items in excess supply that are carried over from 
the war and that arc gradually being consumed* The levels of supply 
maintained in depots by the federal agencies arc also indicated in 
Appendix D. While it was impracticable to obtain the specific information, it nust be assumed that the various stations (hospitals, dispensaries, 
etc#) have large quantities of nodical equipment and supplies in local 
store rooms which would quite markedly increase the over-all inventory 
valuation# 
Another factor worthy of consideration with regard to stocks of 
medical equipment and supplies in the hands of federal agencies is 
that no uniform system of stock accounting is practiced. This results 
in certain agencies having an excess of certain items and others having 
a shortage, with no easy practicable method for transferring stock 
between agencies. 
7. Cataloging, Specifications, Hass Procurement, Stock Control, 
and Inspoction 
a. Cataloging. At the present time, each federal agency, 
with the exception of the Armed Services, involved in medical supply 
activity has a separate catalog or a section of a catalog devoted to 
medical equipment and supplies. Again attempts have been made to 
standardize to some extent on nomenclature and numbering of items. 
This task, however, is far from being accomplished, and items considered 
as medical supply by some agencies are classified in different groupings 
hy others. (Hospital clothing is an example of this difference in 
cataloging.) It appears that little can bo done toward such goals as 
common stock accounting procedures until all federal agencies reach 
agreement on nomenclature and numbering used in catalogs, and, pre- 
ferably, the adoption of a common medical material catalog for all such 
agenciest b. Specifications. Currently, specifications for items 
of medical equipment and supply arc being developed and prepared by 
a majority of the medical supply systems of the federal agencies,. 
This is in itself an extremely large and costly operation, and the 
time required actually to produce, clear, and release a specification 
of a permanent typo is estimated to be approximately one year. Such 
delay tends to retard the purchase of superior items which have been 
developed, but which cannot be procured without adequate specifications. 
The development of specifications requires specialized technical know- 
ledge whieh is not abundant. The competition for the type of knowledge 
between the federal agencies is keen, and the duplication of this 
function in several agencies docs not allow the concentration of this 
specialized knowledge in any one place. 
A multitude of specifications again places an unnecessary burden 
on industry, with resultant increases in government costs. 
c. Mass Procurement. The -economies of well directed mass 
procurement are well known to private business. The federal government, 
being the largest purchaser of supplies in the country, is in a position 
to demand substantial discounts by concentration of requirements and 
mass purchase. Mass procurement of medical equipment and supplies can 
readily he accomplished once requirements can be computed on a basis 
of a coruon supply language in federal agencies. 
d, Stock Control* Central control of depot stocks is main- 
tained by central offices of federal agencies engaged in medical supply 
activity. Since different machine accounting systems arc used, and 
since no common system of numbering and cataloging of all items has been developed by agencies, except the Armed Services, a consolidated 
report of stock on hand in federal agencies is not possible. 
e. Inspection. The matter of inspecting items of medical 
equipment and supplies procured by or for federal agencies is handled 
in a variety of manners. Some agencies have established more or loss 
elaborate inspection systems, while others have little or no inspection 
facilities or activities. Tho Armed Services Pbdical Procurement Agency 
performs laboratory'examinations■and inspection of material purchased 
by the Veterans Administration. 
8. Integration of Ililitary and Civilian ifedlcal Supply 
Organizations 
a. Certain missions common to tho -Armed Forces and not to 
the civilian medical supply agencies must bo considered. Tho military 
forces must continually prepare for and bo ready for a mobilization 
of tho forces as well as carrying out tho mission of providing for the 
care of the sick in peacetime. Certain reserves must be maintained 
by the Armed Forces in the form of bulk stocks and as assemblies which 
will be readily available in the event of mobilization. A trained 
nucleus of medical supply personnel must be maintained upon which may 
be built the medical supply organization required in the event of 
mobilization. 
b. The nodical supply organizations of the civilian agencies 
have but one mission, to supply the medical equipment and supplies re- 
quired to care for the sick regardless of peace or war. The definite possibility exists that in future conflict all nodical agencies nay 
well be called upon to provide nodical care to civilians in the 
United States in the event of attack* This eventuality nay have to 
be net in part from the reserves set up for the Arned Forces, but 
one nodical supply system will assist by its inherent flexibility. PART III 
ANALYSIS OF THE PROBLEM 
1. The functions of a medical supply included the following; 
a, Development of new items, 
b, Standardization of developed or selected items, 
c, Cataloging, 
d, Preparation and revision of specifications, 
er Determination of requirements, (in the case of the 
Armed Forces, this includes the determination of wartime requirements.) 
f, Purchase, 
g, inspection,. 
h, Depot stock control, 
i, Operation of a depot distribution system, (in the case 
of the Armed Forces, this includes overseas distribution), 
j, Station or hospital supply, including stock control,, 
storage and issue, and local procurement, 
k? Maintenance of equipment both in depots and in stations. 
l, Stores accounting, 
m, Disposition of unserviceable and excess property,. 
n, Maintenance of reserve stocks to meet wartime or other 
emergency needs,; 
2, All of the federal medical services revolve around three 
jobs; the prevention of disease, the care of the sick and injured, 
and research into medical problems. The emphasis placed on these 
jobs and the way in which they are done varies with the primary 
mission of the parent federal agency. The Armed Forces orient their efforts toward preparedness for war; the Veterans Administration 
orients its effort toward the care of the sick and evaluation of 
compensible disabilities; the Public Health Service orients 
its work more toward research and public health. In the field 
of medical supply, however, this varied orientation makes relatively 
little difference. By and large the same supplies (drugs, dressings, 
etc.) and the same equipment (surgical and dental instruments, X-ray 
machines, hospital equipment, etc.) are used or can advantageously 
be used by all services. It is true that there arc a few specialized 
items required by one service and not by all. For example, special 
kits may be required for use in airplanes of the Armed Force, and 
special sets of mobile equipment required by field forces of the 
Army or Marines; however, these are the exceptions rather than the 
rule* Even in these instances, standardization and interchangability 
within the Armed Forces is desirable. 
At present considerable coordination is being effected between 
all federal medical services in the fields of development and standar- 
disation/ 
3. Catalogine, specifically the selection and publication of 
item numbers, names and descriptions, is an essential part of any 
supply system. Likewise, in this field, the federal medical services 
have already accomplished a great deal in developing common cata- 
loging. This has been facilitated by the fact that, generally speak- 
ing, medical items can be made common for all the services. For the 
last two years, the Armed Services Medical Procurement Agency has 
published an Army-Navy Catalog of medical materiel (the next issue will be called the Armed Service® Catalog of Medical Materiel) 
and has operated a central catalog registry not only for the Army, 
Navy, and Air Force, but also participated in by the Veterans 
Administration and Public Health Service* The central registry 
controls all item numbers and descriptions. Any of the agencies 
desiring to catalog a new item apply to the registry for a number 
and for an ’•official11 item description. The Veterans Administration 
and Public Health Service each publishes its own catalog, but the 
control now exercised by the registry would facilitate the publi- 
cation of a "Federal Medical Catalog", 
4. The Armed Services Medical Procurement Agency prepares 
and revises specifications for medical items for the Armed Fences, 
The Veterans Administration and Public Health Service each prepares 
its own. Inasmuch as specification work ties in very closely with 
cataloging, the present work of the central catalog registry 
encourages the coordination of specifications between a.ll the agencies 
involved. In each instance, a specific item number is covered by a 
specific specification. 
5, Each of the federal agencies involved computes and deter- 
mines its own requirements for medical supplies. Requirements are 
broken down into two general categories?5 recurrent and programmed. 
Recurrent requirements are those needed for maintenance of supply 
and are in general based on past issue experience. Programmed require- 
ments are those needed for special programs such as the equipping and 
stocking of a new hospital, the development of a special replacement 
or modernization program,. or the initial equipment and supply required for a force to be mobilized. Recurrent requirements lend themselves 
easily to computation by a central agency on a consolidated basis; 
whereas, programmed requirements, which depend on projected plans of 
each using agency, must be evolved unilaterally. Even in this latter 
category, however, the detailed computations and determination of 
requirements can well be handled by a central agency based on plans 
and data furnished by the individual agencies* 
6i During the last three years, the Armed Services Medical 
Procurement Agency has demonstrated the practicability of and the 
economies resulting from a combined purchasing office, 
a. The method of operation is essentially as follows: 
(1) Standard items are divided into two groups: those 
to be purchased only once a year and those to be purchased semi- 
annually (the majority). This latter group is then broken down into 
five subgroups, each subgroup being scheduled for procurement during 
certain months, e, g. Subgroup I, July and January; Subgroup II, 
August and February,* etc. Each service involved submits its require- 
ments for each item on this schedule at the same time, 
(2) Requirements are consolidated and contracts are 
executed,■ Wherever possible, one contract covers the total require- 
ment but cites the funds of the agencies to which the supplies are 
to be delivered, • 
(3) Inspection is mads without regard to whom the 
supplies arc to be delivered. 
Upon delivery, vouchers for payment are certified 
by the central purchasing office and then processed through the fiscal office of the receiving agency for payment. 
b:# No difficulties have been encountered in this pro- 
cedure, Considerable savings in personnel and money have been 
effected. The monetary savings realized by the Armed Services 
Medical Procurement Agency has been estimated at $465,000.00 
annually as against the Army and Navy operating separate offices, 
each performing these functions. 
c. Certain legal difficulties stand in the way of ex- 
panding this to include the Veterans Administration and Public 
Health Service. At the present time the Armed Services effect 
procurement under Public Law 413, 80th Congress. The principal 
feature of this statute is that it allows negotiation of contracts, 
rather than formal advertising, under certain conditions and for 
certain kinds of supplies. The law permits the negotiation of all 
contracts for medicines and medical supplies, although the Armed 
Services take advantage of this provision only in those instances 
whore it is deemed necessary in order to secure the quality required. 
It would be difficult and uneconomical to attempt consolidated pro- 
curement under one law for the Armed Services and another for the 
civilian agencies. Inasmuch as the Armed Services would be reluctant 
to surrender the advantages of Public Law 413, the practical solution 
would be to request Congress to expand the coverage of the law to 
include civilian medical agencies. 
7, At present, each agency having depots operates a central 
depot stock control system. In the Public Health Service, which 
has only one depot, this system of course is very simple and required no consolidation of data* The other three. Veterans administration. 
Navy, and Army, all use the same basic principles but different 
methods and procedures* 
a# Each has a central stock control office which receives 
data periodically from each depot in the form of punched electrical 
accounting machine (Etui) cards. This data is voluminous and de- 
tailed but includes for each item; quantity on hand, due-in, due- 
out, and issue experience. Data relative to procurement is also 
received periodically from the purchasing office* Cards are sorted 
and merged and passed through an electrical accounting machine 
which prepares a consolidated report, usually once a month, thus 
showing on one page for each item, all the information necessary to 
(1) Determine recurrent requirements over-all arid 
by depot* 
(2) Initiate procurement and direct deliveries to 
proper depots and 
(3) Shifts stocks between depots if necessary. 
b* It would be necessary to attain two essentials before 
there could be a merger of the central stock control offices of the 
agencies involved: 
(1) Common or standardized item numbers and item 
nomenclature, 
(2) Common or standardized stock control procedures 
and EAM equipment* At present, Veterans Administration and the 
Army use IBM and Navy uses Remington Rand* 
This is mentioned because if a common medical supply system be established, this standardization would have to be effected before 
any actual consolidation could start. 
8, A total of seventeen principal medical depots are operated 
by the federal medical agencies: seven by Army, five by Navy, four 
l 
by Veterans Administration, and one by Public Health Service,. 
The map (Appendix A) shows locations. It will be noted that existing 
depots are so located that, were they integrated into one system, 
the total number would not be required to secure area coverage. 
As of 1 July 1948* there was approximately 72 percent occupancy of 
tota.1 available storage space. This large amount is due, of course, 
to the extremely large carry-over by the Armed Forces of World War 
II stocks. These stocks are being consumed and within the next few 
years will be reduced to a level representing their maintenance 
requirements plus war reserves. Since 1 July 1948, the Army Medical 
Department has vacated two depots and plan to vacate a third depot 
prior to 1 July 1949. If a consolidated medical supply system were 
established, depots could be eliminated as stocks decreased through 
consumption. Probably four, certainly not loss than three nor more 
than five depots would be required to accomplish the distribution 
mission for all federal medical agencies. As mentioned previously, 
the Armed Services will have a continuing need for war reserve stocks, 
and it would be necessary to maintain the depots for the storage of 
these stocks in the event that the distribution depots did not have 
adequate space to meet this extra demand. Furthermore, the Armed 
Forces have a continuing requirement for an depot where 
items can be assembled into kits and chests and into larger unit 44 
equipments up to and including General Hospitalsp 
The selection of ultimate depots for an integrated medical 
supply service would be based on the criteria of 
a. Proper geographic location for distribution purposes 
b. Availability of suitable buildings,' and 
c. The element of strategic vulnerability. 
It is the opinion of the subcommittee that the present seventeen 
medical depots could be reduced to a total of six in the course of 
five or six years, thus eliminating eleven depots. There would be 
an obvious reduction in personnel, funds, and buildings, attention 
is invited to the following appendices of this report, which concern 
depots and their operation: 
Appendix A is a map showing the location of depots in the 
United States, 
Appendix B shows depot space and occupancy* 
Appendix C shows personnel in various depots* 
Appendix D shows the value of stocks in depots. 
Appendix F shows certain over-all statistical data 
Appendix J is a summary of operating costs,'' 
In connection with these Appendices, it is desired to point out that 
information is based on questionnaire submitted to each using agency. 
In each agency may not have used exactly the same criteria j 
hence these figures are subject to minor revision upon further and 
more exhaustive detailed studies. The following general facts, how- 
ever, stand out clearly. As of 1 November 1948, the various agencies 
in seventeen depots had approximately 5,4 million square feet of net available storage space. Of this approximately 3.9 million square 
feet was occupied - a space occupancy of approximately 72 percent. 
Overall depot stocks amounted to approximately 177 million dollars 
or somewhat over four years supply at present rate of issue. If one 
assumes, for purposes of computation that the extremely liberal 
figure of six months level is required in depot stocks for normal 
operation, this still represents only l/S of the present stocks on 
hand. One-eighth of 3.9 million square feet occupied is approxi- 
mately 400 thousand square feet of stock which would be required for 
this purpose, or converted into net available square feet for 
storage (allowing a figure of 80 percent depot occupancy) 500 thou- 
sand square feet of depot space required to take care of the normal 
issue demand. This of course does not include the stocks required 
by the Armed Services for war reserve purposes or for reserve for 
civil defense. If we allow the extremely liberal figure of one 
million feet of net available storage spa.ee required for this 
purpose, this still adds up to only 1-1/2 million square feet of net 
available depot space required for an integrated supply system. 
The subcommittee realizes that within the next few years, the 
present large stocks will be consumed by the various federal medical 
services, principally the armed Forces, The subcommittee docs not 
take the stand that the integration of the various medical supply 
services into one service having one depot system would necessarily reduce 
.depot space required greatly over that which would be required 
under the present system of each service operating its own depot 
system. The principal saving in the depot system which would be realized through consolidation into one system would be the 
closing of the depots; the elimination of long transportation 
hauls, particularly back hauls and cross hauls; and the ability 
to operate on smaller inventories and at the same time maintain 
adequate stocks in various distribution depots to satisfy demands 
as they arose* 
Aside from the savings and economies which might be effected 
through the consolidation of the various depot systems, there are 
appreciable efficiencies and improved services which can be realized. 
These arc as follows: 
a. Improved service to using installations through being 
able to have in each distribution depot a practically complete 
stockage of all items required through normal distribution needs of 
the various services.. 
b. The ability ot shift stocks, or more preferably to shift 
papers to spots where stocks are located, due to the fact that all 
stocks would bo consolidated and under one control* 
c. The inestimable value of having all federal medical 
supplies under one control and capable of immediate mobilization 
to meet wartime needs,, either of the military or for civil defense 
purposes. This last is probably the most important advantage to be 
gained through such a proposed integrated system. 
The subcommittee has taken cognizance of the fact that the 
Armed Services would of necessity have to operate their own depot 
system or systems in overseas areas, and has not attempted to arrive 
at any recommendation as to how this would be done. The subcommittee does feel that the proposed integrated system of medical depots in 
the United States would fit in without difficulty with any overseas 
supply system which the .Armed Services might determine best suited 
to their needs-. In any event, the proposed system in the United 
States would lay down supplies at the seacoast or at air fields for 
shipment overseas as the Armed .Services might prescribe.. 
9, The problem of station or hospital supply, including stock 
control, storage and issue, and local procurement, is one which 
must be left in the hands of the agencies operating the particular 
stations or hospitals concerned. With the provision that forms, 
particularly requisition forms coming to the depot, be uniform for 
all services. The subcommittee sees no reason why this would 
result in my particularly hardship on any of the seirvices. To 
prevent peaks and valleys in the work load, the- depots would have 
to bo given the authority to set up requisitioning -schedules for 
the various hospitals and stations which they serve. Other than 
this, the stock control at stations and hospitals or the manner in 
which supplies wore stored and issued, and the policies of govern- 
ing local procurement would be of very minor interest only to the 
consolidated supply system. 
10. The maintenance of medical equipment in the United States 
does not present serious problems. In general, medical equipment 
is commercial in nature. Also, in general, manufacturers and 
distributors throughout the United States arc equipped and anxious 
to servo and to maintain equipment of their manufacture. The 
subcommittee is of the opinion that maintenance shops should be operated in depots for such items of equipment as can be repaired 
more cheaply in this manner than by contracting with the manu- 
facturers or dealers. Moreover, there is always a certain amount 
of unserviceable equipment in depot stocks which requires repair. 
All medical services, except Public Health Service presently 
operates maintenance shops in their depots. This policy of depot 
shops should continue; however, the maintenance of equipment at 
station*-hospital level, that is whether it should be repaired locally 
or returned to the depot for repair, should be left largely to the 
individual service for determination. 
11, The fiscal problems involved in stores accounting in a 
consolidated supply system arc of considerable importance. It all 
medical services were consolidated under one head, and if one budget 
were presented to Congress covering all federal medical services, 
there would be no particular fiscal problem. If, however, there 
are, as presumably there will be, several medical services all being 
served -by one consolidated medical supply system, and each of these 
medical services having its own appropriation, a comprehensive fiscal 
arrangement must be made. The subcommittee is of the opinion that 
this can best be handled by the establishment of a revolving fund 
under the operational control of the medical supply agency; the 
establishment of an "Agency” stores account in which would be 
included all of the recurrcnt-issue-demand stocks required by the 
various services. It would probably also bo advisable to include 
all programmed stocks in this general stores account so that they 
would be ”own ed” by the agency rather than being "owned” by the individual services. If this method were adopted, then each service 
could defend its own budget, secure its own appropriation, and pur- 
chase the supplies it required from the consolidated agency. It 
would be necessary, of course, for the various medical services to 
apprise the supply agency periodically of the funds available for 
supplies, and any unusual demands or programmed requirements. If 
this were done, each service could maintain a liaison officer in 
each distribution depot. The liaison officer could not only look 
out for the interests of his service, but also edit requisitions and 
other requests from hospitals, and could "accept” accountability 
for the supplies as soon as they were turned over to a common carrier 
for shipment* In this way, rapid reimbursement to the agency could 
be accomplished. The operating expenses of the agency could be 
financed in any one of several ways: 
a. By securing its own funds from Congress. 
b. By charging each service its pro rata share of the expense. 
c. By "selling" supplies to the services at a mark-up 
sufficient to cover the expenses. 
d. A combination of the above. 
Likewise, the cost of transporting supplies could be borne either by 
the agency or by the using services, as they might be determined, 
12, Unserviceable and excess property would, of course, be 
generated continuously both at the depot level and at the station 
or hospital level. The general policy concerning the disposition of 
this property should be under the supervision of the agency, 
13, .As has been mentioned several times previously, it is essential that the Armed Services maintain reserve stocks and 
supplies to meet the wartime or other emergency needs, particularly, 
those for civil defense. VJere it not for this fact, the consolidated 
supply system could operate strictly on a basis of maintaining 
minimum inventories with which to do the job. It is the opinion 
of the subcommittee that in spite of the fact that at present there 
are large quantities of reserve supplies on hand in depot stocks, 
that insufficient consideration is being given to the over-all general 
long-time policies concerning the establishment and maintenance of 
reserve stocks to meet these requirements. If the mission of the 
responsibility for civil defense needs were given to the military, 
then the whole question of maintaining the reserve stocks will be 
one of almost inclusive interest and responsibility of the Armed 
Forces. If, on the other hand, the civil defense mission of pro- 
viding medical supplies for civil defense needs is turned over to 
a civilian agency, either now existing or to be created, the problem 
of developing requirements for and policies governing the acquisitions 
and maintenance of reserve stocks will be split between the military 
and civilian agency. Obviously the reserve stocks for these two 
emergency needs should not be loft completely divorced, but all 
policies concerning them should be closely coordinated. Again this 
can best be accomplished within the structure of a consolidated 
medical supply service for all federal agencies. Inasmuch as medi- 
cal supplies and equipment are primarily commercial in nature, and 
as such,, are constantly being manufactured to meet ordinary govern- 
ment and civilian peacetime needs does not mean, however, that this 
problem can be neglected nor minimized. On the other hand, it is 5 1 
essential that requirements be determined, and also that pro- 
duction potential be determined, and that reserve stocks of the 
established and maintained are bridging the gap getween require- 
ments and anticipated production in the event of an emergency* 
14* The analysis of the problem indicates that in the field 
of medical supply there is a particularly fertile ground for the 
development of an integrated federal medical supply system. This 
is due primarily to the fact that all of the federal medical 
services utilize essentially the same items in their work. Further- 
more, there has already been a considerable amount of coordination 
and actual integration done in this field, particularly in the 
standardization of items between the various services, cataloging, 
and the preparation of specifications. Within the Armed Forces, 
ther 3 has been an actual consolidation of not only the above, but 
also the functions of purchase and inspection. 
To date, however, no steps have been taken toward consolidating 
the functions of determination of requirements, depot stock control 
or depot distribution. It is'in those fields', particularly in the 
depot operation field, that largest savings in personnel and in costs 
can bo made through the establishment of an integrated federal 
medical supply system. 
This subcommittee does not desire to go on record as predicting 
any actual dollar or personnel savings which can bo made by establish- 
ment of such an agency. The type and general extent of the savings 
are obvious; however, to predict any particular savings would be 
dangerous because the subcommittee realizes that if the concept herein proposed is accepted and legislation is passed to establish 
such a system, it may assume many forms and be subject to many 
compromises. Each of these variances will, of course, affect any 
savings which may be realized* Outline below are the fields in 
which appreciable savings may be anticipated: 
a. PROCUREMENT: 
(1) Reduction in depot inventories of the four 
major Federal Medical Agencies, 
(2) Reduction in cost of multiple purchase actions 
by the four major Federal Medical Agencies, 
(3) More efficient procurement with reduction in 
unnecessary, expensive and poorly controlled local procurement, 
(A) Reduction in personnel and office space required 
for the operation of the present three central procurement agencies. 
b. DEPOT OPERATION: 
(1) Elimination of depot space available but not used, 
(2) Elimination of depot space by reduction of 
inventories and consolidation of activities into fewer depots, 
(3) Reduction in depot personnel and general over- 
head expenses. 
c. OTHERS; 
(1) Reduction in central office overhead, 
(2) Consolidation of inspection activities, 
(3) Standardization of items of supply, 
(4) Publication of one catalog. APPENDIX 
Page 
A. Map 54 
B. Net Depot Space Available and Occupied for the 
Storage of Medical Equipment and Supplies 
by the Four Major Federal Medical Agencies 
as of June 30, 1948 55 
C. Personnel Engaged in Medical Supply Activities 
by the Major Federal Medical Agencies in the 
United States 56 
D. Value of Medical Supply Stocks on Hand and 
Required to Maintain Authorized Depot Stock 
Levels * • • • 57 
E. Typical Illustration of Minor Variation of Items 
of Medical Supply and Packaging of Same for 
Use by Various Federal Medical Agencies 58 
F. Statistical Information on Federal Medical Supply 
Activities Submitted by Federal Agencies 
Fiscal Year 1948 64 
G-. Analysis of Procurement Activities of Federal 
Mbdical Agencies — Fiscal Year 1948 ...*.••** 67 
H. Standardization of Medical Supplies and Equip- 
ment Common to Federal Medical Agencies 68 
I. Levels of Medical Supply Authorized at Depot 
and Station Level in the Four Medical Supply 
Agencies 69 
J. Operating Cost of Medical Supply Depots or 
Medical Supply Activities of General Depots — 
Fiscal Year 1948 # • 70 NAVY 
ABMY 
VJSTEHAHS ADMINXSIHATIOS 
PUBLIC HEALTH SEHVIuE 
MEDICAL DEPOTS IN THE UNITED STATES 
SCALE IN MILES 
This Map is also avaUaMc showing docs. .appendix B 
NET DEPOT SPaCE AND OCCUPIED FOR THE 
STORaGE OF MEDICaL EQUIPMENT SUPPLIES, BT THE FOUR MAJOR 
FEDERAL MEDICAL AGENCIES AS OF JUNE 30, 1948 
Agency Space 
Available 
(Square Feet) 
Space Space 
Occupied Vacant 1 
Percent Percent 
Occupied Vacant 
TOTAL 5.853.692 
Army 3,142,000 
3,946.464 
1,893,320 
2.406.227 
1,747,680 
51.7 V 48,3 
Navy 1,759,133 
1*319,349 
439,783 
74.6. 25.4 
Veterans 
administration 891,000 
677,160 
213,840 
76.0 24.0 
Public Health 
Service 61,559 
56,635 
4,924 
92.0 8.0 
a/ During August 1948 this 
2,614,000 square feet* 
was reduced by releasing depots to 
b/ During August 1948 this 
reason. 
Increased to 62.6 percent due to same 56 
Appendix C 
PERSONNEL ENGAGED IN MEDICuL SUPPLY ACTIVITIES 
BY THE MAJOR FEDERAL MEDICAL AGENCIES IN 
THE UNITED STATES 
Agency 
Central 
Office 
Depots 
Service 
Civilian 
Service ( 
)iviliar 
Total 
111 
716 
m 
1^919 
Army 
24 
110 
52 
962 
Navy 
32 
60 
82 
547 
Veterans Administration 
- 
214 
- 
4H 
Public Health Service 
2 
38 
1 
19 
army-Navy Medical 
Procurement Office 
53 
294 
- 
- 
Total Service 246 
Total Civilian 2,655 Appendix D 
VALUE OF MEDICAL SUPPLY STOCKS ON HAND *ND 
REQUIRED TO MAINTAIN AUTHORIZED DEPOT 
STOCK LEVELS 
Agfcndy 
Value of Stocks 
on Hand 
Value of Stocks 
Required to 
(Depot) 
Maintain Levels 
Total 
1177.123. U0 
£31.425.632 
Army (inc, Air Force) 
91,000,000 &/ 
8,190,000 
Navy 
59,-406,136 
17,000,000 
Veterans Administration 
26,211,116 
5,729,424 
Public Health Service 
506,208 
506,208 
NOTE: Large on hand values for the Armed Forces are explained by 
the fact that they have retained large stocks of World War II items 
of medical supply which are being utilized by these agencies rather 
than selling them at a decided loss. Thus the values of these 
inventories will be gradually reduced. World War II stocks retained 
do not represent balanced stocks but items selected because they do 
not readily deteriorate or become obsolete. It is considered good 
business judgment to retain these stocks;however they could be better 
utilized if available in one medical supply system to all federal 
medical agencies. Further, a portion of the inventory of the Armed 
Services represents what is known as war reserve, this must be main- 
tained. Certain other stocks are retained by the Army for National 
Guard, ROEG, Foreign Aid Programs, etc. 
a/ Includes $9,291,981 of declared surplus owned by War Assets Admin 
istration and $746,437 in Foreign Aid accounts and $2,000,000 held 
for screening against future Foreign Aid programs. Appendix E 
58 
TYPICAL ILLUSTRATION OF IHNOR VARIATION OF ITS IS OF HEDICAL SUPPLY 
AND PACKAGING OF SAME FOR USE BY VARIOUS FEDERAL MEDICAL AGENCIES* 
Federal 
Joint 
Item 
Bureau of 
Public Health 
Army 
Veterans 
Suppiy 
Service 
Navy 
Admini s tration 
Acetyl-Salicylic Acid 
(aspirin) 
1/4 lb. Bottle Crystals 
1 
1/4 lb. Bottle Powder 
1 
1 lb. Canister Granular 
1 
1 lb. Bottle 
1 
1 
1 
1 
.3 gm, (5 gr.) Tab. 
Bot. 100 
1 
1 
1 
.3 gm. (5 gr.) Tab. 
Bot. 1000 
1 
1 
1 
1 
.3 gm. (5 gr.) Tab. 
Bot. 5000 
1 
1 
.3 gm. (5 gr.) Tab.(pink) 
Bot. 1000 
1 
Alcohol, Ethyl U.S.F. 
1 qt. 
1 
l/2 gal. 
1 
1 gal. 
1 
5 gal. 
1 
1 
1 
1 
54 gal. 
1 
1 
]_ 
1 
Amphetamine Sulfate 
.01 gm. (l/6 gr.) 
Bot. 100 
1 
1 
1 
1 
.01 gnu (1/6 gr.) 
Bot. 1000 
1 
,01 gm. (1/6 gr.) 
Bot. 1500 
1 
1 
.005 gm. (l/l2 gr.) 
Plcg. 6. 
1 
.005 gm. (l/l2 gr.) 
Bot. 100 
1 
Atropine Sulph 
.0004 gm. (1/150 gr.) 
II. T. Tube 20 
1 
1 
1 
1 
.0004 gm. (1/150 gr.) 
II.T. Bot. 100 
1 
1 
.0004 gm. (1/150 gr.) 
T.T. Bot. 100 
1 
1 
.0006 gm. (1/100 gr.) 
H. T. Tube 20 
1 
1 
.0006 gm. (1/100 gr.) 
H.T. Bot. 100 
1 
,0012 gm. (l/50 gr.) 
H,T. Tube 20 
1 
1/8 ounce Bot. (pdr.) 
1 
1 
1 
1 ounce Bot. (pdr.) 
1  
Federal 
Point 
Item 
Bureau of 
Public Health 
Army 
Veterans 
Supply 
Service 
Navy 
Administration 
Bismuth-Sub-Salicylate 
Bot. 30 cc USP 
1 
Bot. 60 cc USP 
1 
1 
1 
Bot. 480 cc USP 
1 
X 
Cascara Sagrada 
.12 gm. (2 gr.) Tab. 
Bot. 100 
1 
.12 gm. (2 gr.) Tab. 
Bot. 500 
1 
.12 gm. (2 gr.) Tab, 
Bot, 1000 
1 
.32 gm. (5 gr.) Tab. 
JL 
Bot. 100 
1 
.32 gm, (5 gr.) Tab. 
Bot. 500 
1 
.32 gm. (5 gr.) Tab. 
Bot. 1000 
1 
1 
"1 
.25 gm. (4 gr.) Tab. 
X 
Bot. 100 
i 
Compound Tabs. 1000 
1 
Fluid Extract Arom. Pt. 
1 
1 
Fluid Extract Arom. Gal 
* 
1 
X 
Fluid Extract Pt, 
X 
Fluid Extract Gal. 
X 
1 
Glyceryl-Trinitrite 
(Nitroglycerine) 
.0005 gm. (l/lOO gr.) 
Tube 20 
.0005 gm. (1/100 gr.) 
1 
Bot. 100 
1 
1 
.0005 gm. (1/100 gr.) 
X 
Bot, 500 
1 
.0006 gm. (1/100 gr.) 
Bot. 1000 
1 
.0004 gm. (1/150 gr.) 
Tube 20 
.0004 gm, (1/150 gr.) 
X 
1 
Bot. 100 
1  
Federal 
Joint 
Item 
Bureau of 
Public Health 
Army 
Veterans 
Supply 
Service 
Navy 
Admin i s t rat ion 
Ifegnesium Sulphate 
1 ounce Bot.. A,C,S. 
1 
1 lb, Bot. A.C.S, 
1 
1 lb. Can USP 
1 
2 1/2 lb. Can USP 
1 
1 
4 lb. Can USP 
1 
5 lb. Can USP 
1 
25 lb. Drum USP 
1 
50 lb. Drum USP 
1 
1 
125 lb. Drum USP 
1 
Petrolatum USP 
Light 1 Pt. Bot, 
1 
1 
1 Q,t. Bot, 
1 
1 G-al. Can 
1 
1 
5 Gal. Drum 
1 
Heavy 1 Q,t. Can 
1 
1 
1 Gal. Can 
1 
1 
1 
5 Gal. Drum 
1 
54 Gal. Drum 
1 
Potassium Permanganate 
1 Lb, Bot, USP 
1 
1 
1 
5 Lb. Bot, USP 
1 
1 
,324 gm. (5 gr,) Tab, 
Bot. 100 NP 
1 
1 
1 
1 
,324 gm* (5 gr,) Tab. 
Bot. 1000 NP 
1 
1 
,05 gm. (1 gr.) Tab, 
Bot. 100 nf 
1 
*06 gm. (1 gr.) Tab. 
Bot. 1000 m 
1 
*12 gm, (2 gr.) Tab, 
Bot. 100 NP 
1 
.12 gm. (2 gr.) Tab. 
Bot. 1000 NP 
1 
.2 gm. (3 gr.) Tab. 
Bot. 100 NP  
Federal 
X * 
Joint 
Item 
Bureau of 
Public Health 
Army 
Veterans 
Suppiy 
Service 
Navy 
Administration 
Quinine Sulphate USP 
.12 gm. (2 gr. 
} Tab. 
Hot. 100 
1 
.12 gm. (2 gr. 
) Tab. 
Bot. 1000 
1 
1 
.2 gm. (3 gr.) 
Tab. 
. Bot. 100 
1 
•2 gm. (3 gr.) 
Tab. 
Bot, 1000 
1 
1 
.324 gm. (5 gr 
.) Tab. 
, Bot. 100 
1 
.324 gm. (5 gr 
.) Tab. 
Bot, 1000 
1 
1 
i 
1 ounce Bot* Powder 
1 
1 
1 
Riboflavin 
.001 gm. (1/60 
gr.) 
Bot. 25 
1 
.001 gm. (l/60 
gr.) 
Bot. 100 
1 
1 
1 
.001 gm. (1/50 
gr.) 
Bot. 500 
1 
.001 gm. (1/60 
gr.) 
Bot. 1000 
1 
.005 gm. (l/l2 
gr.) 
Bot. 25 
1 
.005 gm. (1/12 
gr.) 
Bot. 100 
1 
.005 gm. (1/12 
gr.) 
Bot. 500 
1 
.005 gm. (1/12 
gr.) 
Bot. 1000 
1 
1 
Scopolamine Hydrobromide 
.0003 gm. (1/200 gr.) 
Thbe 20 
1 
.0004 gm. (1/.150 gr.) 
Tube 20 
1 
1 
.0006 gm. (1/100 gr.) 
Tube 20 
1 
1 
1 
1 
l/8 ounce Bottle 
1 
1 
1  62 
Federal 
Joint 
Item 
Bureau of 
Public Health 
Army 
Veterans 
Supply 
Service 
Navy 
Administration 
rhiamine Chloride 
.001 gra. (1/60 gr.) 
Bot. 100 
1 
.001 gm. (1/60 gr.) 
Bot. 500 
1 
.001 gm.' (l/50 gr.) 
Bot. 1000 
1 
.003 gm. (l/20 gr.) 
Bot. 100 
1 
.003 gm. (1/20 gr.) 
Bot, 1000 
1 
.005 gm. (1/12 gr.) 
Bot, 50 
1 
.005 gm. (1/12 gr.) 
Bot. 100 
1 
.005 gm. (l/l2 gr.) 
Bo t .i 250 
1 
.005 gm. l/j.2 gr.) 
Bor. 500 
1 
1 
.005 gin- (i/l2 gr/) 
Bot.. 1000 
1 
1 
.01 gm- (1/6 gr.) 
Bot, 100 
1 
,01 gm. (1/6 gr.) 
Bot. 1000 
1 
.032 gm, (l/2 gr.) 
Bot. 1000 
.05 gm, (3/4 gr.) 
JL 
Bot. 100 
1 
.1 gm. (1 1/2 gr.) 
Bot. 100 
1 
.1 gm. (1 1/2 gr.) 
Bot. 1000 
1 63 
Federal 
Joint 
Bureau of Public Health 
Army 
Veterans 
Item Supnly Service 
Thyroid 
Navy 
Administration 
l/2 ounce Powder Bottle 
1 
1/2 lb. Powder Bottle 
.015 gm. (l/4 gr.) 
Coated Tab. Bot. 100 1 
.015 gm. {1/4 gr.} 
1 
Tab. Bot. 500 
.015 gm. (l/4 gr.) 
Coated Tab. Bot. 1000 1 1 
.032 gm. (1/2 gr.) Tab. 
1 
Bot. 100 1 1 
.032 gm. (1/2 gr.} Tab. 
1 
1 
Bot. 500 
.032 gm. (l/2 gr.) Tab. 
1 
Bot. 1000 
.032 gm. (l/2 gr.) 
Coated Tab. Bot. 1000 1 
.06 gm. (1 gr.) Tab. 
1 
Bot. 100 1 1 
.06 gm. (1 gr.) Coated 
Tab. Bot. 100 1 
.06 gm. (l gr.) Coated 
Tab. Bot. 1000 1 1. 
.12 gm. (2 gr.) Tab. 
Bot. 100 1 
.12 gm, (2 gr.) Coated 
Tab. Bot. 100 1 
.12 gm, (2 gr.) Coated 
Tab. Bot. 1000 1 
.2 gm. (3 gr.) Coated 
Tab. Bot. 100 1 
.2 gm. (3 gr.) Coated 
Tab. Bot 1000 1 
1 
1 
* These items were picked at random; they were not 
therefore be considered typical. 
selected 
and can  
Army 
(including 
Mr Porce) 
Davy 
Public 
Health 
Service 
Veterans 
Admini s- 
tration 
1. 
Inpatient days during past 12 months 
10.537.830 
fi.5s9.s15 
2.83U,913 
29,2^3,5^2 
2. 
Outpatient treatments during past 12 months 
12,014,000 
12,073.53s 
1.399,319 
2,U9S,230 
3. 
Humber of standard items in catalog 
6,788 
6,125 
1.531 
6.926 
4. 
Dollar value of procurement of standard 
items during past 12 months 
17,623,1101 
10,269,OSS 
976,600 
12,829 ,4o4 
5. 
Dollar value of procurement of nonstandard 
items during past 12 months 
2,701,16s 
387.266.93 
13,582.676 
20,732,^9^ 
6. 
(a) Humber of jointly standardized items 
5.3S7 
5,305 
1,250 
3,887 
(h) Percent of total standard items 
79p 
S2-9$ 
18fo 
56$ 
7. 
Humber of Medical Supply Depots in 
9 §/ 
United States 
5 
1 
4 
S. 
Gross space for Medical Supply in Depot 
5,iS3,ooo5/ 
System 
2,966,703 
66,764 
950,600 
9. 
(a) Net space available for Medical 
3,1^2,000-^ 
Supply in Depot System 
1,759,133 
61.559 
891,000 
(h) Percent occupied 
51.7^/ 
7’4.6fi 
76£ 
10. 
Tonnage of Medical Supplies on hand 
105,750 
!+7J0S 
HA 
42,4oo 
n. 
Dollar value per ton 
S56.46 
1.350 
HA 
619 
12. 
Total dollar value of Medical Supplies 
f / 
and equipment on hand 
91,000,000*^ 
59,906,136.83 
506,20S 
26,211;116;09 
13. 
Uhat is authorized stock level, expressed 
in months: (a) Depot 
3 
6 
4 
6 
(b) Station 
2k 
6 
3 
4 
APPENDIX F 
STATISTICAL INFORMATION ON FEDERAL MEDICAL SUPPLY ACTIVITIES 
SUBI-IITTBD BY FEDERAL AGENCIES 
FISCAL YEAR 19^g  
Army 
(including 
Air Force) 
Davy 
Public 
Health 
Service 
Veterans 
Admini s- 
tration 
ik. 
Dollar value in Medical Supplies and 
Equipment necessary to maintain 
authorized stock level: (a) Depot 
8,190,000 
17,000,000 
506,208 
5,729. 
(h) Station 
6,825,000 
6,800,000 
HA 
Uo.000,000 
15. 
Dollar value of issues during past 
12 months 
1S,8SM53 
10,701,552.72 
1.525.*126 
12,110,818 
16. 
Humber of optical, maintenance and repair 
shops above hospital level 
2 
9 
None 
1+ 
17. 
Cost of operation of depots during past 
12 months 
3.770,951 
2.56U.7S9 
’9^*821 
1,329,000 
is. 
Dollar value of supplies under procurement 
13.607.9ss 
9.153.693.21 
7.^53.051 
19. 
Dollar value of central procurement for 
past 12 months 
16 026 
11.965,996.86 
■5.101.393 
1^.098,792 
20. 
Dollar value of local procurement for 
past 12 months 
j.sia.sp 
765,506 
9,l(-5l,8S3 
19,^63,106 
21. 
Total procurement, central and local 
20,32^.569 
12,722,502.86 
1^.553.192 
33.561.s9s 
22. 
Percent central procurement 
Sip 
94$ 
35'P 
k2<fo 
23. 
Percent local procurement 
19$ 
Sc/> 
6 5$ 
5P 
2k. 
Medical Supply personnel in depots 
(a) Service 
(b) Civilian 
52 
962 
82 
5^7 
1 
19 
Ull 
25. 
Medical Supply personnel in Central Office 
(a) Service 
(b) Civilian 
110 2/ 
82SJ. 
602.I 
2 
33 
21k 
26. 
Total Medical Supply Personnel 
(a) Service 
(b) Civilian 
76 
1072 
Ilk 
607 
3 
57 
625 
APFBI-1DIX ff (continued) a/ Reduced to 7 in August 19^4-S- 
b/ Reduced to 4,303>000 square feet in August 19^+S, 
c/ Reduced to 2,6l4,000 in August 19^S. 
d/ Increased to 62.6 percent in August 19US. 
oj These figures do not include personnel in the Armed Services 
Medical Procurement Agency v/hich are; 
Service 53 
Civilian 294 
fj Includes $9,291 of declared surplus owned hy War Assets 
Administration; $746,437 in Foreign Aid accounts and $2,000,000 
hold for screening against future Foreign Aid programs. 
FOOTNOTES TO APPSWDIX _F appendix G 
iJNALYSIS OF PROCUREMENT ACTIVITIES OF 
FEDERAL IvEDICiJL AGENCIES 
FISCAL YEAR 19AB 
(Millions of Dollars) 
Army and 
.air Forge 
Navy- 
Public 
Health 
Service 
Veterans 
Adminis- 
tration 
Total 
All .agencies 
Central Procurement 
jLocal Procurement 
Procurement of Standard Items 
Procurement of Nonstandard Items Appendix H 
68 
STANDARDIZATION OF MEDICAL SUPPLIES aND EQUIPMENT 
COMMON TO FEDERAL MEDICAL AGENCIES 
Approximate 
Normal 
For All 
Agencies 
Jointly Standardized Technical 
Medical Items of Equipment an:' 
Supply 
U.S.Army 
& Air Force 
U.S, 
Navy 
Public 
Health 
Service 
Veterans 
Adminis- 
tration 
Average 
For Four 
Agencies Appendix I 
LEVELS OF MEDICAL SUPPLY AUTHORIZED AT DEPOT 
AND STATION LEVEL IN THE FOUR MAJOR 
MEDICAL SUPPLY AGENCIES 
Army 
(incl. Air 
Force) 
Navy 
Veterans 
Adminis- 
tration 
Public 
Health 
Service 
Depot 
Station 70 
Appendix J 
OPERATING COSTS OF MEDICO, SUPPLY DEPOTS OR MEDICAL 
SUPPLY ACTIVITIES OF GENERAL DEPOTS 
FISCAL YEAR 19AB 
Supply Agency 
Annual Cost 
•«if .Operation 
Total 
$7,759,570 
urmy 
3,770,951 
Navy 
2,564,792 
Veterans Administration 
1,329 >000 3/ 
Public Health Service 
94,821 
a/ Estimated because 
for medical supply in 
depots* 
of no definite breakdown of operating cost 
Veterans Administration general supply COMMISSION ON ORGANIZATION OF THE 
EXECUTIVE BRANCH OF THE GOVERNMENT 
APPENDIX L 
ACTUARIAL PROJECTIONS 
COMMITTEE ON FEDERAL MEDICAL SERVICES 
Prepared by Edward A. Lew, 
Assistant Actuary of the 
Metropolitan Life Insurance 
Company, Advisor to the 
Committee 
November 194-8 COMISSION ON ORGANIZATION OF THE 
EXECUTIVE BRANCH OF THE GOVERNMENT 
APPENDIX .L 
ACTUARIAL PROJECTIONS 
COMMITTEE ON FEDERAL MEDICAL SERVICES 
Prepared by Edward A* Lew,. 
Assistant Actuary of the 
Metropolitan Life Insurance 
Company, Advisor to the 
Committee 
November 1948 TABLE OF CONTENTS 
Page 
PART A. ESTIMATES OF THE FUTURE DEMAND FOR 
HOSPITALIZATION BY VETERANS 1 
PART B, TARGETS FOR PREVENTIVE MEDICINE 
AND RESEARCH 39 
PART C. HOSPITAL-MEDICAL INSURANCE FOR 
DEPENDENTS OF THE PERSONNEL OF 
, THE ARMED FCECES iiND OF FEDERAL 
EMPLOYEES 5A 1 
PART A 
ESTIMATES OF THE FUTURE DEMAND FOR HOSPITALIZATION BY VETERANS 
Basis of estimates 
As a basis for estimating the future demand for hospitalization 
by veterans, studies were made of the three main elements determin- 
ing it, namely; the future veteran population, the anticipated rates 
of admission to hospitals, and the probable average durations of 
hospitalization, 
(l) Future veteran population — Forecasts of the veteran 
population from 1955 through 1980 were made separately for each of 
the following sic categories:- veterans of World War II with and 
without service-connected disabilities, veterans of service prior 
to World War II with and without service-connected disabilities, 
and new veterans created by maintaining armed forces at 1,500,000 
men with and without service-connected disabilities. 
The following assumptions were involved in these forecasts; 
(a) Veterans with service-connected disabilities were con- 
sidered to include only those who at one time or another 
qualify for a service-connected disability pension award. 
(b) The maintenance of armed forces at 1,500,000 men, recruited 
as at present, was considered to produce an annual incre- 
ment of 400,000 new veterans, beginning in 1950. On the 
basis of actual post-war experience in the armed forces, 
it was assumed that some 17,500 out of each 400,000 new 
veterans would have service-connected disabilities. 2 
(c) It was assumed that future mortality among veterans with- 
out service-connected disabilities would follow the medium 
mortality assumptions developed by P, K. Whelpton in his 
monograph "Forecasts of the Population of the United 
States, 1945-1975." A study of the actual mortality 
experienced by veterans with service-connected dis- 
abilities in recent years indicated that the same 
mortality assumptions wrere also appropriate for all 
veterans with service-connected neuropsychiatric and 
general medical and surgical conditions, and for veterans 
of service prior to World War II with service-connected 
tuberculosis. Higher mortality rates, reflecting actual 
experience, were used for new veterans and veterans of 
World War II with service-connected tuberculosis. 
The initial veteran populations and their age distributions 
are shown in Table 8. The survival rates assumed in making the 
forecasts are indicated in Table 9*- 
(2) Anticipated rates of admission to hospitals — In order 
to determine what rates of admission to hospital might reasonably 
be anticipated in the future, a study was made of the Veterans 
Administration experience during 1947 with age specific admissions 
for (i) tuberculosis, (ii) neuropsychiatric conditions and (iii) 
general medical and surgical conditions, separately for veterans 
with service-connected disabilities and for veterans without service- 
connected disabilities-. The variations in the rates of admission 3 
to Veterans Administration hospitals in the past were also noted. 
Attention is called to the following characteristics of the 
admission rates derived from this study:- 
(a) The admissions were adjusted to include not only the 
cases admitted to Veterans Administration hospitals 
but also those admitted to non-Veterans Administration 
hospitals ivhen paid for by the Veterans Administration. 
(b) The admission records distinguished primarily between 
veterans with service-connected disabilities and veterans 
without service-connected disabilities. Included among 
the admissions of veterans with service-connected dis- 
abilities were cases where a veteran with a service- 
connected disability was admitted for treatment of a 
disability that was not service-connected. The pro- 
portion of these cases was quite small for veterans 
with service-connected tuberculosis or neuropsychiatric 
conditions, but was fairly large (of the order of 23 
percent) for veterans with service-connected general 
medical or surgical conditions. For use in forecasting 
future admissions, the admission rates derived from this 
study were appropriately adjusted so as to produce (i) 
admission rates for service-connected disabilities and 
(ii) admission rates for non-sorvice-connected dis- 
abilities, including in the latter admissions of veterans 
with service-connected disabilities admitted for treat- 
ment of disabilities that were not service-connected. 4 
(c) The fact that Veterans Administration hospitals have been 
practically filled to capacity in recent years was un- 
doubtedly a restraining factor on veterans! demand for 
hospitalization during this period. The admission rates 
derived from this study reflect, therefore, a curved 
demand for hospitalization, at least for non-service- 
connected general medical and surgical conditions* 
The adjusted rates of admission to hospitals used as basis for 
forecasting future admissions are shown in Tables10 and 10a. 
(3) Probable average durations of hospitalization — The most 
pertinent data for judging the effect on the patient load of future 
durations of hospitalization consisted of the ratios of patients re- 
maining in hospital to admissions for tuberculosis, neuropsychiatric, 
and general medical and surgical patients, among (i) veterans of 
service prior to World War II and (ii) veterans of World War II, The 
ratios of patients remaining in hospital to admissions among veterans 
of World War II were considered to indicate the gradual growth of the 
patient population before the maximum durations of hospitalization are 
attained. The corresponding ratios among veterans of service prior 
to World War II were assumed to reflect the situation after the maximum 
durations of hospitalization have been attained. 
Table 11 shows the ratios of patients remaining in hospital to 
admissions, derived from recent experience of the Veterans Administra- 
tion. Table 12 shows the graduated ratios used in calculating the 
numbers of beds required to meet future veteran demand for hospital- 
ization. 5 
Estimates presented in tables and charts 
Table 1 presents the veteran population at quinquennial inter- 
vals from 1955 to 1980, It shows separately the surviving veterans 
of World War II, the surviving veterans of service prior to World 
War II, and the surviving new veterans created by maintaining armed 
forces at 1,500,000 men. It should be borne in mind that the veterans 
with service-connected disabilities include only those who at one time 
or another qualify for a service-connected disability pension award. 
Tables 2} 3, and 4 present the numbers of anticipated hos- 
pital admissions at quinquennial intervals from 1955 to 1980, Table 
2 shows the anticipated admissions of veterans with service-connected 
disabilities; it should be noted that the admissions include only cases 
where the veteran was admitted for treatment of a service-connected 
disability. Table 3 shows the anticipated admissions of veterans with- 
out service-connected disabilities; it should be noted that the ad- 
missions for non-service-connected general medical and surgical con- 
ditions include a moderate proportion of cases where the veteran had 
a service-connected disability but was admitted for treatment of a 
general medical or surgical condition that was not service-connected. 
Table 4 shows the anticipated admissions for all veterans combined. 
It should further be borne in mind that those anticipatedhospital 
admissions assume a continuation of the recent conditions affecting 
demand for hospitalization of non-service-connected disabilities, that 
is a continuation of some curb on the demand for the hospitalization 
of non-service connected disabilities such as_was recently effective 
on account of the filling of Veterans Administration hospitals to 6 
capacity. It should also be noted that a large proportion of the 
veteran population has in recent years preferred to seek hospital- 
ization in private hospitals, partly, because of the availability of 
Blue Cross and other hospitalization insurance plans. 
Tables 5, 6,. and 7 set forth the numbers of beds required to 
meet future veteran demand for hospitalization at quinquennial inter- 
vals from 1955 to 1980. It should be noted that the numbers of beds 
required for veterans with service-connected disabilities include only 
the beds required for cases admitted for treatment of service-connected 
disabilities; the number of beds required for veterans with non-service 
connected general medical and surgical conditions include a moderate 
proportion of beds required for cases where the veteran had a service- 
connected disability but was admitted for treatment of a general medi- 
cal or surgical condition that was not service-connected* 
In considering the figures shown in Tables 3* 4, 6, and 7 for 
new veterans,, it should be borne in mind that the estimates assume 
that such new veterans without service-connected disabilities will 
eventually be given equal rights to hospitalization. 
The trends in the numbers of beds required for the major cate- 
gories of veterans are shown graphically in Charts A, B, C, D, E and 
F appended. 
What do the estimates show 
The salient points brought out in Tables 1, 2, 3, h, 5, 6, 
and 7 are summarized below; 
(l) Numbers of Future Veterans (Table 1) 
(a) The total veteran population with service-connected 7 
disabilities is estimated to remain at a figure over 
2,000,009 for many years to come — provided armed 
forces are maintained at about 1,500,000 men. Armed 
forces of this magnitude will produce sufficient new 
veterans with service-connected disabilities to offset 
in large degree the decrease in numbers of veterans 
with service-connected disabilities whose service was 
earned in World War II or earlier. In I960 the new 
veterans will comprise seven percent of the total 
veteran population with service-connected disabilities 
and in 19B0 about 25 percent. 
(b) The total veteran population without service-connected 
disabilities will increase slowly over the years — 
provided armed forces are maintained at about 1,500,000 
men. The number of new veterans without service-connected 
disabilities produced by armed forces of this magnitude 
will more than offset the decrease in the numbers of 
veterans without service-connected disabilities whose 
service was earned in World War II or earlier. In I960 
the now veterans will account for about 20 percent of the 
veteran population without service-connected disabilities 
but in 1930 they will comprise more than half of all such 
veterans. (c) If armed forces are maintained at about 1,500,000 
men, the total veteran population will keep on 
increasing — from about 20,000,000 at the present 
time to nearly 23,000,000 in I960 and almost 
24,500,000 in 1980. 
(2) Numbers of Anticipated Hospital Admissions (Tables 2, 
3, and 4). 
(a) The admissions for all service-connected disabilities 
may be expected to decrease gradually. The admis- 
sions for tuberculosis are likely to decrease to 
about one-third their present level by 1970, The 
admissions for mental conditions are anticipated 
to remain at somewhat above their present level 
for many years to come. The admissions for general 
medical and surgical conditions are expected to 
decrease slightly over the years. However, the 
admissions for chronic diseases included in this 
category will probably increase with the passage 
of time. As a result, the aggregate number of 
✓ 
admissions for service-connected tuberculosis, 
mental conditions, and other chronic conditions 
may stabilize at about 35,000 cases a year. 
(b) New veterans will not be an important factor in 
the admissions for service-connected disabilities 
in the near future. 9 
(c) The admissions for all nonservice-connected cases may 
be anticipated to increase substantially over the years, 
if armed forces are maintained at about 1,500,000 men. 
Even the admissions of veterans of World War II and 
earlier service are likely by 1980 to increase by over 
a third.. Total admissions for tuberculosis are likely 
to double by 1980; those for mental conditions are 
anticipated to increase by ?0 percent, while those for 
general medical and surgical conditions may nearly 
double by 1980., The aggregate number of admissions for 
nonservice-connected tuberculosis, mental conditions, 
and other chronic diseases may also nearly double by 
1980* 
(d) New veterans will not be a very Important factor in the 
admissions for nonservice-connected disabilities in the 
near future* 
(3) Number of Beds Required (Tables 5, 6, and 7). 
(a) The number of beds needed for service-connected dis- 
abilities is estimated to increase from about 35,000 at 
present to some 96,000 by 1980. The patient load due to 
service-connected tuberculosis cases may be expected to 
decline by 1980 to less than a third of the present 
6,000 figure. The load due to service-connected 
general medical and surgical conditions is likely to 
stabilize at a figure not much above the present level 
of 5,000. Thus, the entire increase in the service- 
connected patient load by 1980 can be attributed to the 10 
anticipated almost fourfold increase in mental cases (from about 
24,000 at present to nearly 90,000 in 1980)* The service-con- 
nected mental cases are expected to average about six years1 stay 
in hospital; this is an important factor in the accumulation of 
such patients in hospital. 
(b) Qf the service-connected patient load in I960* new veterans will 
comprise only about 5 percent; in 1980 about 13 percent of the 
service-connected patient load will be due to new veterans. 
(c) The number of beds needed for non-service-connected disabilities 
is estimated to increase from 68*000 at present to some 210,000 
by 1980* The patient load due to non-service-connected tuber- 
culosis cases may be expected to rise from 7,000 at present to 
17,000 by 1980; included in the latter figure will be 4,700 new 
veterans. The load due to non-service-connected mental cases is 
anticipated to increase from 32,000 at present to over 110,000; 
included in the latter figure will be 23,000 new veterans. The 
non-service-connected mental cases are expected to average about 
two years in hospital; this is one of the reasons for the 
accumulation of such patients in hospital. The load due to non- 
service-connected general medical and surgical cases is antici- 
pated to increase from 30,000 at present to over 82,000 by 1980; 
included in the latter figure will be 21,000 new veterans. 
(d) Of the non-service-connected patient load in I960, new veterans 
will comprise only about 8 percent; in I960 about 23 percent of 
the nori-service-connected -patient load will be due to new veterans. 11 
(e) It is estimated that from 15 percent to 35 percent of the 
non-service-connected general medical and surgical patients 
could be regarded as chronic cases; the lower percentage 
would apply to World War II veterans at the present time 
while the higher percentage would now apply to World War I 
veterans and to World War II veterans twenty years hence. 
(f) The total number of beds required for veterans with tuberculosis 
(whether service-connected or not) is expected to rise from 
about 13,000 at present to nearly 19,000 in 1980, of which 
5,600 would be for new veterans. 
(g) The total number of beds required for veterans with mental 
conditions (whether service-connected or not) is anticipated 
to increase from 55,000 at present to about 200,000 in 1980, 
of which nearly 35,000 would be for new veterans. 
(h) The total number of beds required for veterans with general 
medical and surgical conditions (whether service-connected 
or not) is expected to increase from 35,000 at present to 
nearly 88,000 in 1980, of which 22,000 would be for new 
veterans. 
(i) The aggregate number of beds required for all veterans 
with service-connected disabilities and for veterans 
with non-service-connected tuberculosis, mental and 
other chronic diseases are shown on the following 
page. 12 
Service- 
Connected 
Cases 
Non-service tuberculosis, 
mental and other chronic 
disease cases 
Total service-connected cases 
and chronic non-service- 
connected cases 
1955 
49,000 
71,000 
120,000 
I960 
62,000 
90,000 
152,000 
1965 
75,000 
110,000 
185,000 
1970 
87,000 
128,000 
215,000 
1975 
98,000 
149,000 
247,000 
1980 
96,000 
154,000 
250,000 
Developments affecting reliability of forecasts 
The reliability of any forecasts depends in large measure on the 
reasonableness of the underlying assumptions as to future experience. 
The estimates here presented will portray the future patient load 
accurately only to the extent that the indicated assumptions as to the 
numbers of future veterans, as to the rates of admission to hospitals, 
and as to the average durations of hospitalization are actually realized 
in the future. 
Some of the developments that could materially alter the magni- 
tude of the future patient load are discussed below. 
(l) Changes in the numbers of new veterans 
The forecasts of the numbers of new veterans assume not 
only the maintenance of armed forces at 1,500,000 men 
but also continued resort to the draft, an average period 
of enlistment of about three years and approximately 20 
percent reenlisting at the end of each three-year term of 
enlistment. These circumstances will, after the first 
two or three years, produce an annual increment of about 
400,000 new veterans. If the strength of the armed forces 
were increased or decreased but the present method of 13 
recruiting retained, the numbers of new veterans would be pro- 
portionately affected. However, if service in the armed forces 
became more of a career service, a higher proportion ®f men 
would probably reenlist and relatively fewer new veterans would 
be created. 
The numbers of new veterans, of hospital admission among 
them, and of the patient load they produce are all shown 
separately in the appended tables. It is, therefore, possible 
to determine readily what the admissions and the patient load 
would be for larger or smaller numbers of new veterans. For 
instance, the hospital admissions and patient load resulting 
from another war of the magnitude of World War II could be 
approximated from the corresponding figures for World War II 
veterans. 
(2) Variations in admission rates to hospital 
The 'admission rates to hospital used in the estimates 
here presented are based on actual,Veterans Administration 
experience during 1947. They reflect the characteristic ago 
specific incidence of tuberculosis, mental disease, and general 
medical and surgical conditions among the major categories of 
veterans, modified by the limited availability of beds for non- 
service-connected general medical and surgical conditions. 
It is extremely important to boar in mind that the filling of 
Veterans Administration hospitals to capacity has had the effect 
of curbing veterans * demand for hospitalization of non-servicc- 
connected general medical and surgical conditions and that the - 14 
admission rates based on recent expedience -reflect such a 1 
restraint on demand. If this restraint were removed, admission 
rates for non-service-connected general medical and surgical 
conditions would undoubtedly increase appreciably. The use 
of admission rates based on recent experience assumes that 
in the future hospital facilities will be built up so as to 
lag somewhat behind veterans * demand for hospitalization. 
Current surveys of the hospital admissions in several 
localities indicate that a substantial proportion of the 
veteran population now turns to private hospitals for hos- 
pitalization, partly because of the widespread availability 
of Blue Cross and other hospitalization insurance plans. 
There is evidence that even as far back as 1935-36 over 30 
percent of all veterans sought hospitalization in private 
hospitals at their own expense. It should be noted, however, 
that private hospitals have provided hospitalization predom- 
inantly for acute medical and surgical conditions. 
It is probable that a large proportion of the veterans 
who now pay for their own hospitalization in private hos- 
pitals would turn to the Veterans Administration in event of 
another prolonged depression. In 1932 the admissions to 
Veterans Administration hospitals were about 40 percent higher 
and the patient load about 20 percent higher than might have 
otherwise been expected. The tuberculosis patient load was not 
affected, but mental patients increased about 20 percent and 
the general medical and surgical patient load increased over 15 
80 percent. It is possible that in event of another prolonged 
depression the increase in mental patients and in the general medi- 
cal and surgical -oatient load may be even greater, if only because 
of more acute awareness of mental disorders and of the •presently 
higher proportion of older men subject to unemployment and to 
disabling diseases. 
(3) Changes in average durations of hospitalization 
The average durations of hospitalization implicit in the ratios 
of patients remaining in hospital to admissions used in making the 
estimates of future patient load were as follows! 
Ivne of Case 
Average Hosnital Stay 
Tuberculosis 
219 days 
Kentpi Cases 
Service-Connected 
6 years 
Non-Service-Connected 
2 years 
General Medical and Surgical 
40 days 
The ratios of patients remaining in hospital to admissions 
shown in Table 12 reflect the gradual accumulation of patients in 
the case of new veterans and veterans of World War II; 
Generally speaking, the number of beds required would be 
decreased about in proportion to any reduction in average duration 
of hospitalization. Barring the discovery of a strikingly effective 
new treatment for tuberculosis, there does not seem to be much pros- 
pect of any reduction in the average duration of hospitalization of 
tuberculosis cases, since, as it is, too many tuberculous veterans 
leave hospital against medical advice. AlsOj there appears to be 
little likelihood of any marked reduction in the average duration 
of hospitalization of general medical and surgical cases, since an 16 
increasing proportion of the longer duration chronic patients is to 
"be anticipated among them, and this will tend to offset any gains 
from shorter hospitalization of other general medical and surgical 
cases* The hest chance for reducing the number of beds required 
would appear to lie in measures designed to shorten the rather long 
duration of hospitalization of mental cases. 
Another development that might be considered is the possibility 
of a transfer of some mental aud other chronic cases from hospitals 
to special old age and nursing homes. In 1975 over 20 percent of 
the mental patients will be 65 years of age or older. Any such trans- 
fer could, of course, materially reduce the hospital patient load. 
Principal Conclusions 
The principal conclusions to be drawn from the figures presented 
and the considerations outlined above are as follows: 
1* The service-connected patient load which stands at present 
at 35,000 is likely to increase to some 50,000 in 1955 and to nearly 
100,000 in 1975. About 10,000 beds may be required in 1975 for new 
veterans with service-connected disabilities. 
2, Over 80 percent of the beds required for service-connected 
cases in 1955 and over 90 percent in 1975 will be needed for mental 
patients. 
3. The non-service-connected patient losad will depend largely 
on the hospital facilities which the Veterans Administration has 
available. Assuming that such facilities are increased gradually so 
as to lag somewhat behind veterans’ demand for hospitalization (as 
has been the case in recent years), then the number of non-service- 
connected cases in hospital may be expected to rise from 68,000 at 17 
the present time to about 100,000 in 1955 end to nearly 200,000 in 
1975.' About 5,000 beds may be required in 1955 and over 35,000 beds 
in 1975 for new veterans with non-servlce-connected disabilities* 
4.' If the hospitalization of non-service-connected a ases were 
restricted to tuberculosis, mental and other chronic cases, then 
the number of beds required for this purpose might be expected to 
increase from 45,000 at the present time to over 70,000 in 1955 and 
to nearly 150,000 in 1975. The number of beds required for non-service- 
connected chronic cases among new veterans will be relatively small. 
5. About 50 percent of all the beds required for non-service- 
connected cases (or about 70 percent of the beds required for non- 
service-connected chronic cases) will be needed for mental patients. 
6. In the event of a prolonged business depression, the 
veteran patient load might temporarily increase by as much as 20 
percent or more over the normal trend. Mental patients would prob- 
ably increase in about the same proportion, but the largest increase 
would be in general medical and surgical cases. 
7, Because of the preponderance of mental cases in the 
veteran patient load and Because of the relatively long average 
duration of hospitalization of such cases (about 6 years for service- 
connected cases and about 2 years for non-service-connected cases) 
the best chance for reducing the veteran Patient load would seem to 
lie in keeping down the admission rates and shortening the average 
stay in hospital of mental cases* 8* The magnitude of the anticipated veteran patient load and 
the serious problems that it raises indicate that there was no ade- 
quate appraisal made of the resources necessary to implement the 
commitments made to veterans in the past. A careful evaluation of 
the personnel, facilities, and funds needed to carry out any long- 
range program of medical services should he a prerequisite to the 
adoption of any such program* 19 
TABLE 1 
ESTIMATE OF THE NUMBERS OF FUTURE VETERANS 
Veterans 
with Service-Connected Disabilities* 
Service Prior 
New 
World War II 
to World War II 
Veterans** 
Total 
1955 
2,185,000 
334,000 . 
104,000 
2,623,000 
1960 
2,127,000 
281,000 
189,000 
2,597,000 
1965 
2,052,000 
219,000 
274,000 
2,545,000 
1970 
1,949,000 
154,000 
357,000 
2,460,000 
1975 
1,804,000 
94,000 
438,000 
2,336,000 
1980 
1,603,000 
49,000 
519,000 
2,171,000 
Veterans without Service-Connected Disabilities 
Service Prior 
New 
World War II 
to World War II 
Veterans** 
Total 
1955 
13,402,000 
3,590,000 
2,283,000 
19,275,000 
I960 
13,089,000 
3,044,000 
4,166,000 
20,299,000 
1965 
12,675,000 
2,418,000 
6,028,000 
21,121,000 
1970 
12,104,000 
1,749,000 
7,866,000 
21,719,000 
1975 
11,296,000 
1,121,000 
9,667,000 
22,084,000 
1980 
10,183,000 
627,000 
11,423,000 
22,233,000 
All Veterans 
Service Prior 
New 
World War II 
to World War II 
Veterans** 
Total 
1955 
15,587,000 
3,924,000 
2,387,000 
21,898,000 
I960 
15,216,000 
3,325,000 
4,355,000 
22,896,000 
1965 
14,727,000 
2,637,000 
6,302,000 
23,666,000 
1970 
14,053,000 
1,903,000 
8,223,000 
24>179,000 
1975 
13,100,000 
1,215,000 
10,105,000 
24,420,000 
1980 
11,786,000 
676,000 
11,942,000 
24,404,000 
* This 
i category includes only veterans who at one time or 
another 
qualify for a disability pension award 
for a service-connected 
disability 
** Assumes that Armed 
Forces continue at a 
strength of 1,500,000, re- 
cruited as at present. TABLE 2 
ESTHETE OF THE FUTURE VETLRaN ADMISSIONS TO HOSPITAL 
Veterans with Service-Connected Disabilities* 
Service Prior 
New 
World War II 
to World War II 
Veterans** 
Total 
Tuberculosis 
1955 
4,700 
1,600 
1,000 
7,300 
I960 
2,900 
1,800 
1,200 
5,900 
1965 
1,800 
1,900 
1,300 
5,000 
1970 
1,000 
1,600 
1,300 
3,900 
1975 
600 
1,100 
1,300 
3,000 
19B0 
600 
. 600 
1,500 
2,700 
Neuropsychiatric 
1955 
14,100 
1,900 
1,000 
17,000 
I960 
13,800 
1,800 
1,800 
17,400 
1965 
13,400 
1,700 
2,500 
17,600 
1970 
13,000 
1,500 
3,200 
17,700 
1975 
12,600 
1,200 
4,000 
17,800 
1980 
12,200 
800 
4,700 
17,700 
General Medical 
and Snrgical 
1955 
49,800 
7,000 
2,500 
59,300 
I960 
46,600 
6,600 
4,300 
57,500 
1965 
43.900 
6,200 
5,900 
56,000 
1970 
41,500 
5,400 
7,500 
54,400 
1975 
39,400 
4,000 
8,900 
52,300 
1980 
37,800 
2,400 
10,300 
50,500 
Total 
1955 
68,600 
10,500 
4,500 
83,600 
I960 
63,300 
10,200 
7,300 
80,800 
1965 
59*100 
9,800 
9,700 
78,600 
1990 
55/>00 
8.500 
12,000 
76;000 
1975 
52,600 
6,300 
145200 
73,100 
1980 
50,600 
3,600 
16,500 
70900 
* This category includes only veterans who at 
one time or another 
qualify for a 
disability 
pension award for a 
service-connected 
disability. 
** Assumes that armed Forces 
continue at a strength of 1,500, 
,000 re- 
cruited as at 
present. TABLE 3 
ESTIMATE OF THE FUTURE VETERAN ADMISSIONS TO HOSPITAL 
Veterans without Service-Connected Disabilities* 
World War 
Service Prior 
II to World War II 
New 
Veterans'5™' 
Total 
Tuberculosis 
1955 
8,300 
6,500 
1,000 
15,800 
I960 
10,100 
6,300 
1,900 
18,300 
1965 
12,600 
5,500 
2,900 
21,000 
1970 
15,500 
4,300 
4,100 
23,900 
1975 
17,900 
3,000 
5,700 
26,600 
1980 
18,900 
1,800 
7,900 
28,600 
Neuropsychiatric 
1955 
34,600 
13,500 
4,900 
53,000 
1960 
35,500 
13,200 
9,400 
58,100 
1965 
36,100 
12,500 
14,200 
62,800 
1970 
36,900 
10,900 
19,100 
66,900 
1975 
37,700 
8,500 
24,100 
70,300 
1980 
38,200 
5,800 
29,200 
73,200 
General Medical 
and Surgical 
1955 
270,400 
177,800 
41,200 
489,400 
I960 
286,400 
188,200 
76,200 
550,800 
1965 
309,800 
172,100 
112,700 
594,600 
1970 
350,200 
145,600 
150,500 
646,300 
1975 
410,500 
109,400 
189,700 
709,600 
1980 
488,100 
68,700 
233,000 
789,800 
Total 
1955 
313,300 
197,800 
47,100 
558,200 
I960 
332,000 
207,700 
87,500 
627m200 
1965 
358,500 
190,100 
129,800 
678,400 
1970 
402,600 
160,800 
173,700 
737J 00 
1975 
466,100 
120,900 
219,500 
80b,500 
1980 
545,200 
76,300 
270,100 
891,600 
* The category of veterans 
with service-connected disabilities includes 
only veterans 
! who at one 
time or another qualify for a disability 
pension award for a service-connected disability. 
** Assumes that 
Armed Forces continue at a strength of 1,500, 
000, 
recruited as 
at present. TABLE 4 
ESTIMATE OF THE FUTURE VETERAN ADMISSIONS TO HOSPITAL 
All Veterans 
World War II 
Service Prior 
to World War II 
New 
Veterans*"* 
Total 
Tuberculosis 
1955 
13,000 
8,100 
2,000 
23,100 
I960 
13,000 
8,100 
3,100 
24,200 
1965 
14,400 
7,400 
4,200 
26,000 
1970 
16,500 
5,900 
5,400 
27,800 
1975 
18,500 
4,100 
7,000 
29,600 
1980 
19,500 
2,400 
9,400 
31,300 
Neuropsychiatric 
1955 
48,700 
15,400 
5,900 
70,000 
I960 
49,300 
15,000 
11,200 
75,500 
1965 
49,500 
14,200 
16,700 
80,400 
1970 
49,900 
12,400 
22,300 
84,600 
1975 
50,300 
9,700 
28,100 
88,100 
1980 
50,400 
6,600 
33,900 
90,900 
General Medical 
and Surgical 
1955 
320,200 
184,800 
43,700 
548,700 
1960 
333,000 
194,800 
80,500 
608,300 
1965 
353,700 
178,300 
118,600 
650,600 
1970 
391-700 
151,000 
158,000 
700,700 
1975 
449,900 
113,400 
198,600 
761,900 
1980 
525,900 
71,100 
243,300 
840,300 
Total 
1955 
381,900 
208,300 
51,600 
641,800 
I960 
395,300 
217,900 
94,800 
708,000 
1965 
417,600 
199,900 
139,500 
75?,000 
1970 
458,100 
169,300 
185,700 
813,100 
1975 
518,700 
127,200 
233,700 
879,600 
1980 
595,800 
80,100 
286,600 
962,500 
** Assumes that 
recruited as 
.armed Forces 
at present. 
continue at a strength of 1,500, 
000, TABLE 5 
ESTIMATE OF THE NUMBERS OF BEDS REQUIRED TO MEET 
FUTURE VETERAN DEMAND FOR*HOSPITALIZATION 
Veterans 
with Service-Connected Disabilities 
World War II 
Service Prior 
to World War II 
New 
Veterans*'5 
Total 
Tuberculosis 
1955 
2,800 
900 
600 
4,300 
I960 
1,800 
1,100 
700 
3,600 
1965 
1,100 
1,100 
700 
2,900 
1970 
600 
1,000 
800 
2,400 
1975 
400 
700 
800 
1,900 
1980 
400 
400 
900 
1,700 
Neuropsychiatric 
1955 
28,200 
11,100 
900 
40,200 
I960 
41,400 
10,600 
2,100 
54,100 
1965 
53,700 
9,900 
3,800 
67,400 
1970 
65,000 
8,900 
5,800 
79,700 
1975 
75,500 
7,100 
8,300 
90,900 
1980 
73,000 
4,800 
11,200 
89,000 
General Medical 
and Surgical 
1955 
3,700 
800 
200 
4,700 
I960 
3,700 
700 
300 
4,700 
1965 
4,000 
700 
400 
5,100 
1970 
4,200 
600 
600 
5,400 
1975 
4,300 
400 
800 
5,500 
1980 
4,200 
300 
900 
5,400 
Total 
1955 
34,700 
12,800 
1,700 
49,200 
I960 
46,900 
12,400 
3,100 
62,400 
1965 
58,800 
11,700 
4,900 
75,400 
1970 
69,800 
10,500 
7,200 
87.500 
1975 
80,200 
8,200 
9,900 
98,300 
1980 
77,600 
5,500 
13,000 
96,100 
* This category includes only veterans who at one 
time or another 
qualify for a 
disability pension award for a service-connected 
disability. 
** Assumes that 
Armed Forces continue at a strength of 1,500, 
000, 
recruited as 
at present. 24 
TABLE 6 
ESTIMATE OF THE MULLERS OF BEDS REQUIRED TO MEET 
FUTURE VETERAN DEMAND FOR HOSPITALIZATION 
Veterans without Service-Connected Disabilities* 
World War II 
Service Prior 
to World War II 
New 
Veterans** 
Total 
Tuberculosis 
1955 
5,000 
3,900 
600 
9,500 
I960 
6,000 
3,800 
1,100 
10,900 
1965 
7,500 
3,300 
1,700 
12,500 
1970 
9,300 
2,600 
2,400 
14,300 
1975 
10,700 
1,800 
3,400 
15,900 
1980 
11,300 
1,100 
4,700 
17,100 
Neuropsychiatric 
1955 
22,500 
26,900 
1,500 
50,900 
I960 
35,500 
26,500 
3,800 
65,800 
1965 
48,800 
25,000 
7,100 
80,900 
1970 
60,800 
21,900 
11,500 
94,200 
1975 
75,300 
17,000 
16,800 
109,100 
1980 
76,500 
11,600 
23,300 
111,400 
General Medical 
and Surgical 
1955 
20,300 
19,600 
2,700 
42,600 
I960 
22,900 
20,700 
5,300 
48,900 
1965 
27,900 
18,900 
8,500 
55,300 
1970 
35,000 
16,000 
12,000 
63,000 
1975 
45,200 
12,000 
16,100 
73,300 
1980 
53,700 
7,600 
21,000 
82,300 
Total 
1955 
47,800 
50,400 
4,800 
103,000 
I960 
64,400 
51,000 
10,200 
125,600 
1965 
84,200 
47,200 
17,300 
148,700 
1970 
105,100 
40,500 
25,900 
171,500 
1975 
131,200 
30,800 
36,300 
198,300 
1980 
141,500 
20,300 
49,000 
210,800 
* The category of veterans with 
service-connected disabilities 
includes 
only veterans 
who at one time 
or another qualify 
for a disability 
pension award 
for a service-connected disability, 
» 
** Assumes that - 
Armed Forces continue at a strength of 1,500,000 recruited 
as at present 
• 25 
TABLE 7 
ESTIMATE OF THE NUMBERS OF BEDS REQUIRED TO MEET 
FUTURE VETERAN DELIAND FOR HOSPITALIZATION 
All Veterans 
World War II 
Service Prior 
to World War II 
New 
Veterans*"* 
Total 
Tuberculosis 
1955 
7,800 
4,800 
1,200 
13,800 
1960 
7,800 
4,900 
1,800 
14,500 
1965 
8,600 
4,400 
2,400 
15,400 
1970 
9,900 
3,600 
3,200 
16,700 
1975 
11,100 
2,500 
4,200 
17,800 
1980 
11,700 
1,500 
5,600 
18,800 
Neuropsychiatric 
1955 
50,700 
38,000 
2,400 
91,100 
I960 
76,900 
37,100 
5,900 
119,900 
1965 
102,500 
34,900 
10,900 
148,300 
1970 
125,800 
30,800 
17,300 
173,900 
1975 
150,800 
24,100 
25,100 
200,000 
1980 
149,500 
16,400 
34,500 
200,400 
General Medical 
and Surgical 
1955 
24,000 
20,400 
2,900 
47,300 
I960 
26,600 
21,400 
5,600 
53,600 
1965 
31,900 
19,600 
8,900 
60,400 
1970 
39,200 
16,600 
12,600 
68,400 
1975 
49,500 
12,400 
16,900 
78,800 
1980 
57,900 
7,900 
21,900 
87,700 
Total 
1955 
82,500 
63,200 
6,500 
152,200 
1960 
111,300 
63,400 
13,300 
188,000 
1965 
143,000 
58,900 
22,200 
224,100 
1970 
174,900 
51,000 
33,100 
259,000 
1975 
211,400 
39,000 
46,200 
296,600 
1980 
219,100 
25,800 
62,000 
306,900 
** Assumes that 
recruited as 
Armed Forces 
at present. 
continue at a strength of 1,500 
o 
o 
o 
N# 26 
TABLE 8 
POPULATION USED IN ESTIMATING THE NUMBERS 
OF FUTURE VETERANS 
Veterans of World War II and Prior Service 
Number as of 
June 30, 1947 
Veterans of 
World War II 
Veterans of Service 
Prior to World War II 
All Veterans 
16,051,000 
4,684,000 
with 
without 
with 
without 
Service 
Service 
Service 
Service 
Connected 
Connected 
Connected 
Connected 
Disability* Disability 
Disability* 
Disability 
TYPE OF DISABILITY 
Total 
2,260,000 
13,791,000 
400,000 
4.284,000 
Tuberculosis 
41,000 
58,000 
Neurops ychiat ric 
581,000 
78,000 
General Medical 
and Surgical 
1,638,000 
264,000 
AGE DISTRIBUTION AS 
OF JUNE 30, 
1947*** 
Total 
2,260,000 
13,791,000 
400,000 
4,284.000 
15 - 19 
3,744 
463,339 
20 - 24 
493,016 
4,214,742 
226 
831 
25 - 29 
781,873 
4,253,326 
5,686 
30,942 
30 - 34 
493,593 
2,479,052 
6,831 
130,318 
35 - 39 
305,943 
1,332,864 
6,063 
164,634 
40-44 
133,232 
664,502 
6,585 
169,237 
45 - 49 
35,479 
295,171 
46,431 
508,067 
50 ~ 54 
10,588 
61,640 
183,429 
1,907,881 
55 - 59 
1,959 
15,696 
107,288 
980,715 
60 - 64 
480 
5,765 
27,554 
191,523 
65 - 69 
93 
4,903 
6,537 
87,879 
70 - 74 
- 
- 
2,0?1 
79,437 
75 - 79 
- 
869 
24,694 
80 - 84 
- 
- 
315 
6,296 
85 - 89 
- 
- 
. 94 
1,261 
90 - 94 
— 
- 
19 
263 
95 - 99 
- 
- 
2 
22 27 
TABLE 8 (Continued) 
POPULATION USED IN ESTIMATING THE NUMBERS OF 
FUTURE VETERANS 
New Veterans 
-X-* 
Number of Entrants on June 30, 
1950 and Annually thereafter 
Total 
400,000 
with 
Service 
Connected 
Disability* 
without 
Service 
Connected 
Disability 
TYPE OF DISABILITY 
Total 
Tuberculosis 
Neuropsychiatric 
General Medical and 
Surgical 
17,492 
875 
6,122 
10,495 
382,508 
AGE 
Totali 
15 - 19 
20 - 24 
25 - 29 
30 - 34 
35 - 39 
40 - 44 
17 f492 
15,109 
2,210 
147 
26 
382,508 
338,631 
40,989 
2,474 
405 
9 
* 
•** 
The category of veterans with service-connected disabilities in- 
cludes only veterans who at one time or another qualify for a ser- 
vice-connected disability pension award. 
Assumes that Armed Forces continue at a strength of 1,500,000, 
recruited as at present. 
Actual estimates of the numbers of future veterans were based on 
individual age distributions. 28 
TABLE 9 
PROJECTED 5-YEAR SURVIVAL RATES'* USED IN ESTIMATING 
THE NUMBERS OF FUTURE VETERANS** 
Age at 
Beginning 
1945- 
1950- 
1955- 
I960- 
1965- 
1970- 
1975- 
of Period 
1950 
1955 
I960 
1965 
1970 
1975 
1980 
15 - 19 
991.2 
992,3 
993.1 
993.6 
994.2 
994.5 
994.8 
20 - 24 
988.2 
989.7 
990.7 
991,6 
992.3 
992.9 
993.5. 
25 - 29 
986.1 
987.7 
989.0 
990.0 
990.8 
991.4 
992.0 
30 - 34 
981,8 
983.8 
985.4 
986.6 
987.6 
988.4 
989.2 
35 - 39 
974.6 
977.3 
979.5 
981.0 
982,4 
983.4 
984.4 
40 - 44 
963.4 
968.0 
971.7 
974.2 
975.8 
977.0 
978.2 
45 - 49 
944.3 
949,2 
953.8 
957.4 
960,0 
961.6 
963.2 
50 - 54 
917.0 
921.7 
927.0 
931.6 
934.8 
936,8 
938.8 
55 - 59 
879.4 
882.0 
885.5 
889.4 
893.2 
896.3 
899.4 
60 - 64 
829.6 
832.5 
835,4 
838.1 
840.0 
841.4 
842.8 
65 - 69 
758.0 
758,7 
759.4 
759.9 
760.3 
760.8 
761.3 
70 - 74 
661.7 
661.7 
661,8 
661.9 
661.9 
662.0 
662.1 
75 - 79 
529.0 
529.0 
529.0 
529,0 
529.0 
529.0 
529.0 
80 - 84 
386.8 
386.8 
386.8 
386,8 
386.8 
386.8 
386.8 
85 - 89 
254.1 
254.1 
254.1 
254.1 
254.1 
254.1 
254.1 
90 - 94 
123,6 
123.6 
123.6 
123.6 
123.6 
123.6 
123.6 
* From P. 
K. Whelpton’s "Forecasts 
1 of the 
Population of the 
United 
States 
1945-1975 
l! - medium mortality assumptions 
- 90$ of Native 
White Male Rate 4- 10$ of Non-White Male 
rate. The rates : 
for the 
period 1975-1980 
were obtained by extrapolation. 
** Survival rates for individual ages were 
obtained by interpolation 
and were applied to the individual age distributions of veterans 
without 
, service- 
connected 
disabilities to obtain 
the future number 
of veterans without service-connected disabilities, A study of the 
actual mortality experienced by veterans 
with service-connected 
disabilities in 
recent years indicated that these 
1 survival rates 
could also be used for all veterans with 
. service- 
•connected neuro- 
psychiatric and general medical 
and surgical disabilities 
and for 
veterans of service prior 
to World War II with service-connected 
tuberculosis. Lower survival rates, reflecting the actual mortal- 
ity experience, 
were used 
for World War 
II and New Veterans with 
service 
s-connected tuberculosis. 29 
TABLE XO 
ASSUMED RATES OF V. A. ADMISSIONS 
TO V. A. AND NON-V. A. HOSPITALS 
Attained Ages 
Admission Rates that are Applicable to Veterans with 
Service-Connected Disabilities 
General Medical 
Tuberculosis* 
Neuropsychiatric 
and Surgical 
15 - 19 
.100 
.150 
.200 
20 - 24 
• 090 
.030 
.045 
25 - 29 
.080 
.025 
.036 
30 - 34 
.070 
.025 
♦033 
35 - 39 
.065 
.025 
.031 
40 - 44 
.060 
.025 
.030 
45 - 49 
.042 
.025 
.029 
50 - 54 
.023 
.025 
.028 
55 - 59 
.024 
.026 
.029 
60 - 64 
•027 
.028 
.031 
65 - 69 
.050 
.032 
.035 
70 - 74 
.065 
.040 
.045 
75 - 79 
.080 
.055 
.060 
BO - 84 
,100 
.080 
.080 
85 - 89 
.120 
.120 
.110 
90 - 94 
.150 
.200 
.150 
95 & over 
.200 
.350 
.200 
* These rates 
are applicable to veterans of service prior to World 
War II. Corresponding rates 
for veterans of World War II and 
new veterans 
are shown in Table 10a. 
Admission Rates 
that are Applicable 
s to Veterans 
without Service-Connected Disabilities 
Attained Ages 
General Medical 
Tuberculosis 
Neuropsychiatric 
and Surgical 
15 - 19 
,00020 
,0016 
,018 
20 - 24 
.00040 
.0020 
.018 
25 - 29 
,00045 
.0023 
.018 
30 - 34 
.00050 
,0025 
.019 
35 - 39 
,00055 
.0026 
.020 
40-44 
.00070 
.0027 
.021 
45 - 49 
.00105 
.0028 
.022 
50 - 54 
,00140 
.0030 
.026 
55 - 59 
,00170 
,0033 
.035 
60 - 64 
,00200 
.0038 
,060 
65 ~ 69 
.00225 
.0046 
.070 
70 - 74 
,00250 
.0058 
.080 
75 - 79 
.00275 
.0075 
.100 
80 - 84 
,00300 
.0100 
.125 
85 - 89 
,00350 
.0150 
.150 
90 - 94 
.00400 
,0250 
.200 
95 & over 
.,00500 
.0500 
c500 30 
TABLE 10a 
ASSUMED RATES OF V. A. ADMISSIONS 
TO V. A. AND NON-V. A. HOSPITALS 
Attained 
Admission Rates Applicable 
New Veterans with Service- 
to World War II and 
-Connected Tuberculosis 
Ages 
1950 
1955 
1960 
1965 
1970 
1975 
1980 
15 - 19 
.500 
.400 
.310 
.230 
.160 
.100 
.100 
20 - 24 
.320 
.250 
.190 
.150 
.120 
.090 
.090 
25 - 29 
.190 
.150 
.120 
.100 
.090 
.080 
.080 
30 - 34 
.185 
,140 
.110 
.090 
.080 
.070 
.070 
35 - 39 
,200 
.140 
,100 
.080 
.070 
.065 
.065 
40 - 44 
,230 
.150 
.100 
.075 
.065 
.060 
.060 
45 - 49 
.270 
.180 
.110 
.060 
.045 
.042 
.042 
50 - 54 
.310 
.210 
.120 
.060 
.030 
.023 
.023 
55 - 59 
.350 
.250 
.150 
,080 
.040 
.024 
.024 
60 - 64 
.400 
.300 
,200 
.100 
.050 
.027 
.027 
65 - 69 
.450 
.350 
.250 
.150 
.075 
.050 
.050 
70 - 74 
.500 
.400 
.300 
.200 
.100 
.065 
.065 
75 - 79 
• 440 
.340 
♦240 
.140 
.080 
,080 
BO - 84 
.380 
.280 
.180 
,100 
.100 
85 - 89 
.320 
*220 
.120 
.120 
90 - 94 
.260 
.150 
.150 
95 & over 
f 200 
.200 31 
TABLE 11 
RECENT EXPERIENCE WITH RESPECT TO 
RATIOS OF PATIENTS 'REMAINING TO ADMISSIONS 
Admissions of 
VA Patients 
Ratio - % 
Patients Re- 
VA 
Patients in 
Remaining 
maining to 
Fiscal Year 1948 
on 6/30/48 
Admissions 
Tuberculosis 
Veterans of World War II 
Service-Connected 
8,487 
5,402 
63.1% 
Nonservice-Connected 
6,625 
3,473 
52.4 
All Veterans 
15,112 
8,875 
58.7 
Veterans of Service Prior 
t-o World War II 
Service Connected 
1,662 
756 
45.5 
Nons ervice-C onnected 
5,779 
3,414 
59.1 
All Veterans 
7,^41 
4,170 
56.0 
Neuropsychiatric 
Veterans of World War II 
Service-Connected 
15,641 
12,704 
81.2 
Nonservice-Connected 
31,531 
9,629 
30.5 
All Veterans 
47,172 
22,333 
'47.3 
Veterans of Service Prior 
to World War II 
Service-Connected 
1,824 
10,774 
590.7 
Ncnservice-Connected 
11,958 
21,683 
181.3 
All Veterans 
13,782 
32,457 
235,5 
General Medical and Surgical 
Veterans of World War II 
Service-Connected 
58,170 
4,366 
7.5 
Nonservice-Connected 
258,168 
14,598 
5.7 
All Veterans 
316,338 
18,964 
6.0 
Veterans of Service Prior 
to World War II 
Service-Connected 
8,046 
870 
10.8 
Nonservice-Connected 
141,513 
14,659 
10.4 
All Veterans 
149,559 
15,529 
10.4 32 
TABLE 12 
ASSUMED RATIOS OF PATIENTS REMAINING TO ADMISSIONS 
Service-Connect ed 
Nonservi c e-Conne ct ed 
Service 
Service 
World 
Prior to 
New 
World 
Prior to 
New 
Year 
War II 
World War II Veterans 
War II 
World War II Veterans 
TUBERCULOSIS 
1955 
.60 
.60 
,60 
.60 
.60 
.60 
I960 
.60 
.60 
.60 
.60 
.60 
.60 
1965 
,60 
.60 
, 60 
.60 
.60 
.60 
1970 
.60 
.60 
.60 
.60 
.60 
.60 
1973 
.60 
.60 
.60 
.60 
.60 
.60 
19B0 
.60 
, 60 
,60 
.60 
.60 
.60 
NSUROPSYCHIAT RIC 
1933 
2.00 
6.00 
.90 
.65 
2.00 
.30 
I960 
3.00 
6.00 
1.20 
1.00 
2.00 
.40 
1965 
4,00 
6.00 
1.30 
1.33 
2.00 
.30 
1970 
3.00 
6.00 
1.80 
1.65 
2.00 
.60 
1973 
6.00 
6.00 
2.10 
2.00 
2.00 
.70 
1980 
6.00 
6.00 
2.40 
2.00 
2.00 
.80 
GENERAL MEDICAL and SURGICAL 
1933 
.073 
.11 
.065 
,073 
,11 
.065 
I960 
,08 
.11 
.07 
.08 
.11 
.07 
1965 
.09 
.11 
.073 
.09 
.11 
.073 
1970 
.10 
.11 
.08 
.10 
.11 
.08 
1973 
.11 
.11 
.085 
.11 
.11 
.085 
1980 
.11 
.11 
.09 
.11 
.11 
.09 Chart A 
ESTIMATE OF THE NUMBER OF 
BEDS REQUIRED TO MEET FUTURE VETERANS 
DEMAND FOR HOSPITALIZATION 
Veterans with Service-Connected Disabilities 
(in thousands) 
i All Veterans 
Veterans of World War II 
Veterans of Service Prior to World War II 
New Veterans Chart B 
ESTIMATE OF THE NUMBER OF BEDS 
REQUIRED TO MEET FUTURE VETERANS 
DEMAND FOR HOSPITALIZATION 
Veterans Without Service-Connected Disabilities 
in thousands 
All Veterans 
Veterans of World 
War II 
Veterans of Service Prior to World War II 
New Veterans 35 
Chart C 
ESTIMATE OF THE NUMBER OF BEDS 
REQUIRED TO MEET FUTURE VETERANS DEMAND 
FOR HOSPITALIZATION 
All Veterans 
(in t housands) 
All Veterans 
/ i 
''Veterans of World War II 
Veterans of Service Prior to World War II 
Mew Veterans 36 
Chart D 
ESTIMATE OF THE NUMBER OF BEDS 
REQUIRED TO MEET FUTURE VETERANS DEMAND 
FOR HOSPITALIZATION! 
Veterans With Service-Connected Disabilities 
[in thousands) 
{Total 
■fleur©psychiatric 
General Medical and Surgical 
Tuberculosis 
Year 37 
Chart E 
ESTIMATE OF THE NUMBER OF BEDS 
REQUIRED TO MEET FUTURE VETERANS DEMAND ■ 
FOR HOSPITALIZATION 
Veterans Without Service-Connected Disabilities 
[in thousands] 
Total 
'Neuropsychiatric 
General Medical and Surgical 
Tuberculosis 
Y 0 ar Chart F 
ESTIMATE OF THE NUMBER OF BEDS 
REQUIRED TO MEET FUTURE VETERANS DEMAND 
FOR HOSPITALIZATION 
All Veterans 
in thousands 
Total 
Ncuropsychiatric 
General Medical and Surgical 
Tuberculosis P..RT B 
39 
TARGETS FOR. PREVENTIVE MEDICINE ADD RESEARCH 
When public funds are spent on preventive medicine and research 
programs, such programs may reasonably be expected to bear a close 
relationship to those causes of death and disability in which the 
public has the greatest stake. Attention might, therefore, first 
be given to the more important causes of death and disability during 
the working years of life, since any increase in the working years 
of life adds to the country*s labor force and a gradual addition to 
the labor force can be regarded as advancing the country’s economy* 
This study deals with the man years that might be added to 
the working years of life through the hypothetical elimination of or 
reduction in the major causes of mortality and disability during the 
working years of life. It sheds light on the directions in which 
preventive medicine and research could be apnlied to secure tangible 
benefits for the country’s economy* However, the advisability of 
particular projects designed to eliminate or reduce mortality or 
disability from specified causes must also be Judged by the uroba- 
bility of their success in achieving these objectives* 
Effect of eliminating or reducing the major causes of mortality. 
The effect on the working years of life of eliminating or re- 
ducing deaths from fifteen major causes is indicated in Tables 1, 2, 
and 3 attached. 
The figures in the first line of Table 1 show the average 
working life, that is, the expectation of life to age 65. for white males and white females at ages 20,. 25, 35, 45,. and 55,. assuming 
continuation of the mortality experience that prevailed in the general 
population in 1945. The remaining figures in Table 1 show the in- 
creased length of the average working life that would result from the 
hypothetical elimination of all deaths from ea.ch of the specified 
causes during the working years of life. 
Table 2 indicates the years of life that would be added to the 
average working life at various ages through the hypothetical elimina*- 
tion of all deaths from the specified causes. It brings out the 
relative importance of various causes of death in so far as their effect 
on shortening the years of working life is concerned. Judged by this 
criterion, 
(a) among white males in the working years of life 
(1) Accidents are the second most important cause of 
death being outranked only by heart diseasef 
(2) Cancer ranks third as a cause of death hut tubercu- 
losis is of almost equal importance. 
(3) Pneumonia and influenza and suicide are approximately 
as important as nephritis and intracranial lesions. 
(b) among white females in the working years of life 
(1) Cancer outranks heart disease as the most important 
cause of death. 
(2) Tuberculosis ranks third and is closely followed by 
intracranial lesions. 
(3) Accidents and nephritis are of about the same importance. 41 
In other words, deaths from the more important conditions that 
are subject to some control, such as tuberculosis, accidents, pneumonia 
and influenza, and suicide, are seen to be of about the same importance 
in the working years of life as deaths from the major degenerative 
diseases, such as heart disease, intracranial lesions, and nephritis, 
over which medical science has thus far established relatively little 
control* Cancer among females may be regarded as at least partly 
controllable* 
The years of life that would be added to the average working 
life at various ages under the assumption that mortality from each 
of the specified causes was reduced by some hypothetical percentage 
would be approximately proportional to the figures shown in Table 2 
for complete elimination of that cause of death* 
Table 3 considers the total years of life likely to be lived 
from age 20 to age 65 by all white males and all white females who 
were alive in 1945, assuming continuation of the mortality experience 
that prevailed in 1945* It then shows the additional years of working 
life that would result from the elimination of deaths from each of 
the fifteen specified causes* It brings out that the hypothetical 
elimination of the major causes of death in the working years of 
life would under present conditions result in relatively small addi- 
tions to the total years of working life. This is because survival 
rates under present conditions are already quite high,, as may be seen 
from the fact that approximately two out of every three white males 
and three out of every four white females alive at present would sur- 
vive to age 65 if current mortality continued* There are, therefore, definite limits on the increase in the working years of life which 
could he realized from further reductions in mortality rates. 
The years of life that would he added to the total years of 
life likely to he lived from age 20 to age 65 hy all white males and 
all white females, who were alive in 1945, under the assumption that 
mortality from each of the specified causes was reduced hy some hypo*- 
thetical percentage would he approximately proportional to the figures 
shown in Table 3 for complete elimination of that cause of death. 
It is essential to hear in mind that not all deaths which might 
he prevented during the working years of life would result in a clear- 
cut gain in the labor force. While the prevention of deaths from 
accidents and acute diseases which leave no disabilities does result 
in a definite addition to the labor force, the saving of lives who 
are left permanently disabled not only does not add to the labor 
force hut usually imposes an extra drain on the community1s economy. 
Since deaths from some of the major causes are frequently preceded 
hy long periods of disability, the termination of such disabilities 
by death could he regarded as beneficial to the community’s economy, 
deaths of unemployable individuals, individuals who are frequently 
unemployed, and individuals in overcrowded fields of employment also 
would not diminish the effective labor force* 
Effect of eliminating or reducing the major causes of disability. 
The effect on the working years of life of eliminating or re- 
ducing the major causes of disability is indicated in Tables 4 and 5. 
Specifically, Tables 4 and 5 show the years of working life lost 43 
in 1945 on account of the more important causes of death and disability 
by white males and by white females respectively. Only the deaths 
and disabilities which occurred during the working years of life are 
considered. - 
The working years of life lost on account of the major causes 
of disability in 1945 were as follows; 
Working Yesrs 
of Life Lost 
White 
White 
Cause of Disability 
Males 
Females 
Diseases of the nervous system 
Hesnira.tory diseases other than 
332,000 
285,000 
tuberculosis 
230,000 
218,000 
Cardiovascular renal conditions 
190,000 
154,000 
Orthopedic conditions 
138,000 
70,000 
Accidents 
129,000 
103,000 
Diseases of digestive system 
120,000 
151,000 
Tuberculosis 
Arthritis, neuritis, and allied 
94,000 
44,000 
conditions 
93,000 
95,000 
It should be noted that the working years of life lost on 
account of disability include only the time lost on account of dis- 
abling illnesses and do not take account of non-disabling illnesses 
during the working years of life, 
It can be demonstrated from the data in Tables 4 and 5 that 
the years of working life lost in 1945 by white males on account of 
all disabilities were equal to about half the years of working life 
lost on account of deaths due to the fifteen most important causes 
of death at these ages. Similarly, the yes.rs of working life lost 
in 1945 by white females on account of disability were almost as great as the years of working life lost on account of deaths due to 
the fifteen most important causes of death at these ages. To the 
extent that deaths among the permanently disabled and the unemployable 
are not a loss to the community, the relative seriousness of disa~ 
bility is greater than indicated by the data in Tables 4 and 5. 
The years of working life that would be gained under the 
assumption that disability from each of the specified causes was 
reduced by some hypothetical percentage would be approximately pro- 
portional to the figures shown in Tables 4 and 5 for complete 
elimination of that cause of disability. TABLE 1 
EFFECT OF ELIIHNATING LORE IliPORTANT CAUSES OF DEATH 
ON THE AVERAGE LENGTH OF WORKING LIFE* 
White Males 
Expectation, of 
Additional 
Life , 
at Age 
20 
25 
35 
•; . . , 
45 
55 
Average Length of 
Working Life* 
39.85 
35.63 
26.59 
17.63 
9.02 
Average Length 
of Working 
Life Which .Might 
Bo Expected If 
All Deaths from Each of the Following. Causes Wero 
Eliminated 
Heart Diseases 
41.05 
36.80 
27.70 
18.51 
9.42 
Intracranial 
40.03 
35.81 
26.76 
17.77 
9.10 
Diseases 
Cancer 
40.30 
36.06 
26.98 
17.94 
9.17 
Accidents 
40 • 66 
36.26 
26.97 
17.82 
9.08 
Tuberculosis 
40.29 
35.99 
26.84 
17.76 
9.06 
Nephritis 
40.04 
35.80 
26.74 
17.73 
9.07 
Pneumonia and 
40.02 
35.78 
26.71 
17.70 
9.05 
Influonza 
Suicide 
40.02 
35.78 
26.69 
17.68 
9.04 
Diabetes 
39.91 
35.69 
26.64 
17.56 
9.04 
Syphilis 
39.91 
35*69 
26.65 
17.57 
9,04 
Ulcers of Stomach 
39.92 
55.70 
26.65 
17.66 
9.03 
and Duodenum 
Hernia and Intcs- 
39.88 
35.66 
26.62 
17.64 
9.03 
tinal Obstruction 
Appendicitis 
39.89 
35.66 
26.62 
17*64 
9.03 
Biliary Calculi, etc. 39.86 
35.64 
26.61 
17.64 
9.02 
Cirrhosis of the 
39.92 
35.70 
26 • 66 
17.67 
9.04 
Liver 
* Expectation of life to age 
65 based on 1945 mortality rates 
in general population table i 
(Continued) 
EFFECT OF ELIMINATING- IDEE IMPORTANT CAUSES OF DEATH 
ON THE AVERAGE LENGTH OF EARNING LIFE* 
White Females 
Expectation of 
Additional 
Life a 
t Age 
20 
25 
35 
45 
55 
Average Length of 
Working Life* 
42.02 
37.26 
27.80 
18.51 
9.40 
Average Length of Working Life Which Might Be Expected if 
/J.1 Deaths from Each of the Following Causes Wore Eliminated 
Heart Diseases 
42.57 
37.79 
28.28 
18.89 
9.59 
Intracranial 
Diseases 
42.21 
37.45 
27.99 
18.57 
9.47 
Cancer 
42.S7 
37.90 
28.39 
18.94 
9.56 
Accidents 
42.20 
37.40 
27.89 
18.56 
9.42 
Tuberculosis 
42.27 
37.45 
27.90 
18.55 
9.41 
Nephritis 
42.17 
37.40 
27.93 
18.60 
9.43 
Pneumonia and 
Influenza 
42.11 
37.35 
27.86 
18.55 
9.41 
Suicide 
42*09 
37.32 
27.84 
18.53 
9.40 
Diabetes 
42.11 
37.35 
27.89 
18.58 
9.44 
Syphilis 
42.04 
37.28 
27.82 
18.52 
9.40 
Ulcers of Stomach 
and Duodenum 
42.03 
37.27 
27.81 
18.52 
9.40 
Hernia and Intes- 
tinal Obstruction 
42.06 
37.30 
27.83 
18.53 
9.40 
Appendicitis 
42.04 
37.28 
27.82 
18.52 
9,40 
Biliary Calculi, etc. 12.05 
37.29 
27.83 
18.53 
9.40 
Cirrhosis of the 
Liver 
42.06 
37.30 
27.84 
18.53 
9.40 
* Expectation of life to age 
in general population 
65 based on 1945 mortality rates 47 
TABLE 2 
EFFECT OF ELIIIINATING IDEE IMPORTANT CAUSES OF DEATH 
YEARS ADDED TO AVERAGE LENGTH OF WORKING LIFE* 
White Holes 
-Ago 
20 
25 
35 
45 
55 
Average Length of 
Working Life* 
39.85 
35.63 
26.59 
17.63 
9.02 
Years of Life Added to Average Length of Working Life 
if All Deaths from Each 
of the 
Following Causes Wore Eliminated 
Heart Diseases 
1.20 
1.17 
1.11 
.88 
. *x0 
Intracranial 
.18 
.18 
.17 
.14 
.08 
Diseases 
Cancer 
.45 
.43 
.39 
.31 
i!5 
Accidents 
.81 
.63 
.38 
.19 
.06 
Tuberculosis 
A A 
.36 
.25 
.13 
,04 
Nephritis 
.19 
.17 
.15 
.10 
.05 
Pneumonia and 
.17 
,15 
.12 
.07 
,03 
Influenza 
Suicide 
.17 
.15 
.10 
.05 
.02 
Diabetes 
.06 
.06 
.05 
.03 
.02 
Syphilis 
.06 
,06 
.06 
.04 
,02 
Ulcers of Stomach 
.07 
,07 
.06 
.03 
.01 
and Duodenum 
Hernia arc. Lit os- 
.03 
,03 
.03 
.01 
.01 
t.:nal obstruction 
Appendreit rs 
.04 
.03 
.03 
.01 
.01 
Biliary Calculi, etc* 
.01 
,01 
.02 
.01 
.00 
Cirrhosis of the 
.07 
.07 
.07 
.04 
.02 
Liver 
* Expectation of life to ago 
in general population 
65 based 
on 1945 
mortality rates TABLE 2 
(Continued) 
EFFECT OF ELBYNATIKG MORE IMPORTANT CAUSES OF DEATH 
YEARS ADDED TO AVERAGE LENGTH OF WORKING LIFE* 
White Females 
Age 
20 
25 
35 
45 
55 
Average Length of 
Working Life* 42 
.02 
37.26 
27.80 
18.51 
9.40 
Years of Life Added 
to Average Length of 
Working Life 
if All Deaths from Each of 
the Following Causes Were S: 
liminated 
Heart Diseases 
.55 
.53 
.48 
.38 
.19 
Intracranial 
.19 
.19 
.19 
*16 
.07 
Diseases 
Cancer 
.65 
.64 
.59 
.43 
.16 
Accidents 
.18 
.14 
.09 
.05 
.02 
Tuberculosis 
.25 
♦ 20 
.10 
.04 
*01 
Nephritis 
.15 
.14 
.13 
.09 
.03 
Pneumonia and 
.09 
.09 
.06 
.04 
.01 
Influenza 
Suicide 
.07 
.06 
.04 
.02 
.00 
Diabetes 
.09 
.09 
.09 
.07 
.04 
Syphilis 
.02 
.02 
.02 
.01 
.00 
Ulcers of Stomach 
.01 
.01 
.01 
.01 
.00 
and Duodenum 
Hernia and Int e s- 
.04 
.04 
.03 
.02 
.00 
tinal Obstruction 
Appendicitis 
.02 
.02 
.02 
.01 
.00 
Biliary Calculi, etc. 
.03 
.03 
.03 
.02 
.00 
Cirrhosis of the 
.04 
.04 
.04 
.02 
.00 
Liver 
* Expectation of life to 
age 
65 based 
on 1945 mortality rates 
in general population  
White Kales 
White Eemales 
Percent of 
Percent of 
Expected Total 
Expected Total 
Working Years 
Working Years 
Humber of Years 
of Life 
Humber of Years 
of Life 
Total Working Years of Life Likely 
1,6)47,000,000 
to be Lived by 19*45 Population 
—* 
1,720,000,000 
Working Years of Life Added "by Elimination of Deaths from Each Cause 
Heart Diseases 
58,000,000 
3.5 
26,000,000 
1.5 
Accidents 
33,500,000 
2.0 
8,000,000 
0.5 
Cancer 
21,500,000 
1.3 
30,500,000 
1.8 
Tuberculosis 
17.000,000 
1.0 
9,000,000 
0.5 
Intracranial Lesions 
9,000,000 
0.6 
9,500,000 
0.6 
Hephrltis 
8,500,000 
0.5 
7,000,000 
0.5 
Pneumonia and Influenza 
7,500,000 
0.5 
*4,500,000 
0.3 
Suicide 
7,000,000 
o.*4 
2,500,000 
0.2 
Cirrhosis of the Liver 
3,500,000 
0.2 
1,800,000 
0.1 
Diabetes 
3,000,000 
0.2 
*4,500,000 
. 0.3 
Syphilis 
3,000,000 
0.2 
1,000,000 
0.1 
Ulcer of Stomach and Duodenum 
3,000,000 
0.2 
500,000 
0.0 
Appendicitis 
2,000,000 
0.1 
1,000,000 
0.1 
Hernia and Intestinal Obstruction 
1,500,000 
0.1 
1,500,000 
0.1 
Biliary Calculi and Allied Diseases 
500,000 
0.0 
1,500,000 
0.1 
* Years lived to age 65 from 20 or 
attained age if older, assuming 19*45 mortality rates 
in 
general population 
TABLE 3 
W0RKI1TG- mRS OP LIPS ADDED BY 
ELIMINATION OF DEATHS FROM SPECIFIED CAUSES DEATHS 
DISABILITIES 
Working Years of Life Lost 
Cause of Death Dae to Death* 
Working Years of Life Los‘ 
Cause of Disability Duo to Disability** 
Heart Diseases 
9S3.000 
Heart Diseases 
118,000 
Intracranial Lesions 
1^8,000 
Cerebral Hemmorhage 
11,000 
llephritis 
151,000 
nephritis 
18,000 
Arteriosclerosis 
35,000 
Other Circulatory Diseases 
8,000 
Arthritis (Including Acute 
Rheumatic Lever) 
81,000 
ITcuritis and Lumbago 
12,000 
Accidents 
733,000 
Accidents - Other than 
shown below 
129,000 
Blindness - Total 
26,000 
Orthopedic Impairments 
138,000 
Cancer 
363.000 
Cancer 
*+3,000 
Tuberculosis - All forms 
332,000 
Tuberculosis - All forms 
9*1,000 
Pneumonia and Influenza 
1*11,000 
Respiratory Diseases (l) 
230,000 
Suicide 
133,000 
Diseases of nervous System 
332,000 
Cirrhosis of Liver, 
- 
Diseases of Liver and Cadi 
Biliary Calculi, etc. 
73»000 
Bladder 
13,000 
TABLE k 
vomim YE AES OF LIFE* LOST 017 ACCOUNT OF DEATHS A3ID DISABILITIES 
LEIGH OCCURHSD IE I9U5 BETWEEN AGES 20 AND 65 
WHITE MALES DEATHS 
DISA3ILITI3S 
Working Years of Life Lost 
Cause of Death Dae to Death* 
Cause of Disability 
Working Years of Life Lost 
Due to Disability** 
Ulcer of Stomach and 
Duodenum 57*000 
Appendicitis 32*000 
Ulcer of Stomach and 
Duodenum 
Appendicitis 
Other Diseases of 
Digestive System 
32.000 
£0,000 
55.000 
Syphilis 53,000 
Syphilis 
3,000 
Diabetes 51,000 
Diabetes 
1*1,000 
Hernia and Intestinal 
Obstruction 25,000 
Hernia and Intestinal 
Obstruction 
Other Causes 
29,000 
1^.000 
All Causes 
1,60*1,000 
* Years that would have been lived by those who died in 19*+5 between ages 20 and 65 from ago at death 
to age 65, assuming mortality rates in general population. 
** Years of disability lost in 19*+5 by those disabled between ages 20 and 65; estimated on the basis of 
(a) National Health Survey data, adjusted for illnesses of less than seven days duration and under 
enumeration* and (b) special studies with respect to respiratory diseases, mental conditions, 
tuberculosis, cancer and blindness, 
(l)Respiratory diseases include pneumonia, influenza, grippe, bronchitis, colds, sinusitis, asthma, hay 
fever, tonsilitis, tonsillectomy and other respiratory diseases. 
TABLE U 
(Continued) 
WORKING YEARS OE LIFE* LOST OH ACCOUNT OF DEATHS AND DISABILITIES 
WHICH OCCURRED IN 19I+5 BETWEEN AGES 20 AND 65 
white males DEATHS 
DISABILITIES 
Working Years of Life Lost 
Working Years of Life Lost 
Cause of Death Dae to Death* 
Cause of Disability Duo to Disability** 
Heart Diseases 
448,ooo 
Heart Diseases 
81,000 
Intracranial Lesions 
152,000 
Cerebral Hemorrhage 
6,000 
Nephritis 
12S,000 
Nephritis 
22,000 
Art erio sclero si s 
1*1,000 
Other Circulatory Diseases 
4,000 
Arthritis (Including Acute 
Rheumatic Never) 
80,000 
Neuritis and Lumbago 
15,000 
Accidents 
159,000 
Accidents - Other than 
shown below 
103,000 
Blindness - Total 
24,000 
Orthopedic Impairments 
70,000 
Cancer 
541,000 
Cancer 
66,000 
Tuberculosis - All forms 
243,000 
Tuberculosis - All forms 
44,000 
Bneumonia and Influenza 
86,000 
Respiratory Diseases (l) 
218,000 
Suicide 
66,000 
Diseases of Nervous System 
285,000 
Cirrhosis of Liver, 
Diseases of Liver and Gall 
Biliary Calculi, etc. 
64,000 
Bladder 
44,000 
TABLE 5 
W03KING YEANS OP LIPS* LOST Oil ACCOUNT OF DEATHS AND DISABILITIES 
WHICH OCCUBHBD IN BETWEEN AGES 20 AND 65 
WHI ES PSKAL3S DEATHS 
DISABILITIES 
Working Years of Life 
Cause of Death Due to Death* 
Lost 
Working Years of Life Lost 
Cause of Disability Due to Disability** 
Ulcer of Stomach and 
Duodenum 9»000 
Appendicitis 23,000 
Ulcer of Stomach and 
Duodenum 
Appendicitis 
Other Diseases of 
Digestive System 
8,000 
36,000 
63,000 
Syphilis 22,000 
Syphilis 
2,000 
Diabetes j6,000 
Diabetes 
28,000 
Hernia and Intestinal 
Obstruction 35*000 
Hernia and Intestinal 
Obstruction 
Other Causes (2) 
6,000 
37^,000 
All Causes 1 
,620,000 
* Years that would have been lived by those who died in I9H5 between ages 20 and 65 from age at death to 
age 65, assuming mortality rates in general population, 
** Years of disability lost in by those disabled between ages 20 and 65; estimated on the basis of 
(a) Rational Health Survey data, adjusted for illnesses of less than seven days duration and under 
enumeration, and (b) special studies with respect to respiratory diseases, mental conditions, 
tuberculosis, cancer and blindness*. 
(1) Respiratory diseases include pneumonia, influenza, grippe, bronchitis, colds, sinusitis, asthma, hay 
fever, tonsilitis, tonsillectomy and other respiratory diseases, 
(2) The other causes figure for females includes 119,000 years lost due to disability from live births 
and 95,000 years lost due to disability from other female diseases. 
TABLE 5 
(Continued) 
WORKING- YEARS OR LIRE* LOST ON ACCOU1TT OE DEATHS AND DISABILITIES 
WHICH OCCURRED IN 19U5 BETWEEN AGES 20 AND 65 
WHITS FSm3S PART C 
HOSPITAL-IEDICAL INSURANCE FOR EQEPENDEOTS OF THE 
PERSONNEL OF THE ARIEL FORCES AND OF FEDERAL El PLOFEES 
Summary 
!• It appears feasible to provide some standard form of hospital- 
medical insurance for the wives and dependent children of the per- 
sonnel of the armed forces, the Coast Guard, Coast and Geodetic 
Survey, and commissioned officers of the Public Health Service in 
most localities in the United States. 
2# Such insurance does not appear practicable for dependents of 
federal employees other than those mentioned above, since in their 
case hospital-medical care has usually been made available in emer- 
gencies only or under circumstances where adequate medical care 
could not otherwise be obtained# Furthermore, in these cases, a 
substantial part of the cost incurred by the federal government 
for the care of dependents has been paid by the individuals respon- 
sible for the dependents# 
3# A typical form of hospital-medical insurance covering the wives 
and dependent children of enlisted personnel of the armed forces and 
of the relatively low paid federal employees mentioned under 1 above 
WDuld provide the following benefits: 
(a) Full cost of hospitalization for 21 days and half the cost 
of hospitalization for 180 days following, 
(b) Full cost of surgery, including that involved in maternity 
cases, 55 
(c) Full cost of medical care in hospital for a limited 
number of visits, such as two visits per day the first throe days 
of hospitalization, one visit per day for the 18 days following, 
and one visit every two days thereafter. 
(d) Full cost of medical care obtained at home or at physi- 
cian’s office, with a limitation on the number of visits per illness 
and with specified allowances for specialists’ fees. 
In most cases the individual would have free choice of hospitals and 
physicians. In the case of officer personnel and the higher paid 
federal employees mentioned under 1 above, this type of insurance 
would provide the same hospitalization benefits, but would allow 
only the scheduled amounts for surgery, the scheduled fees for 
doctors’ visits to hospital, or for home and office visits, and the 
scheduled foes for specialists. The excess, if any, of the amount 
charged by a surgeon, doctor, or specialist over the scheduled foe 
would have to be paid by the individual responsible for the dependent. 
4* . This type of insurance could not, of course, be provided in those 
localities where physicians and hospital facilities arc not available 
to render the services indicated* Thus, it could not be provided 
outside of the United States. The insurance where available would 
carry certain limitations; it would not cover dependent parents or 
other collateral dependents, would not cover chronic diseases, would 
not as a rule provide for an unlimited number of homo or office 
visits and would allow only reasonable amounts as fees for surgery, 
visits, or consultations. 5* The number of wives and dependent children of the personnel of 
the armed forces, Coast Guard, Coast and Geodetic Survey, and 
commissioned officers of the Public Health Service who reside in 
the United States is estimated at 1,050,000. In recent years such 
dependents have added from 5,000 to 6,000 patients to the hospital 
load of the armed forces and the Public Health Service-. To provide 
hospital-modi cal coverage for them along the lines outlined under 3 
above would cost about $35,000,000 a year (or approximately $2,900,000 
monthly). This may bo somewhat more than it now costs the government 
to provide medical care for them. 
Present situation with regard to the medical care of dependents 
of the personnel of the armed forces and of federal employees 
Table 1 appended summarizes the principal facts regarding de- 
pendents of the personnel of the armed forces and of federal employees 
currently eligible for medical care from the federal government. 
The only major problem presented is that of dependents of the 
personnel of the armed forces, the Coast Guard, the Coast and Geodetic 
Survey, and commissioned personnel of the Public Health Service. These 
dependents have long been given both inpatient and outpatient service, 
at a nominal charge for hospitalization (such as from $1*30 to $1.75 
per day). They currently number about 1,400*000* of whom Some 250,000 
are collateral dependents, that is, dependents other than wives or 
children. Of the wives and dependent children, perhaps as many as 
100,000 arc currently located outside the continental United States. 
The dependents of employees of the Veterans /administration have 
been given hospitalization care in emergencies only, and medical and 57 
hospital care onljr when residing at installations where such service 
is difficult to obtain; they have been charged $9*75 per day for 
hospitalization and $2 per outpatient visit# The dependents of em- 
ployees of the Indian Service and of federal agencies remote from 
adequate medical service are relatively few in number and have been 
charged for hospitalization on the basis of actual average costs* 
Since private medical facilities are not available in many of the 
localities involved and since the number of such patients is rela- 
tively small, there is little reason to seek alternate arrangements 
for their medical care* 
Available hospital-medical care coverage. 
It appears feasible to provide hospital, surgical, medical care 
in hospital, and homo and office medical care along the standard lines 
developed by Blue Cross and Blue Shield plans for wives and dependent 
children of personnel of the armed forces, the Coast Guard, the Coast 
and Geodetic Survey, and commissioned personnel of the Public Health 
Service. Some precedent for such coverage exists in the arrangements 
which a number of Blue Cross and Blue Shield plans made to continue 
the family coverage for families of men who entered the armed forces 
during the war. The premiums charged in such cases were usually 
calculated by deducting from the family premium the premium for a 
single individual# Even though experience showed that this premium 
basis was not adequate, it is believed that somewhat higher premium 
rates would bo actuarially sound# The types of benefits which could be provided under a standard 
form of hospital-medical insurance arc set forth in Table 2*. The' 
principal types of benefits provided are hospital service, 
(A), hospital and surgical service, (B), hospital, surgical, and 
medical service in hospital, (c), and hospitalsurgical, medical 
care in hospital, and medical care at homo or office service, (D). 
For the wives and dependent children of enlisted personnel (and 
for the dependents of the relatively low paid federal employees) it 
would probably be possible to obtain for the premiums charged all of 
surgery provided under B, all of the medical care in hospital provided 
under C, and all of the homo and office medical care provided under D.,, 
In the case of officer personnel (and the more highly paid federal 
employees), only the scheduled amounts allowed for surgery, the 
scheduled foes per home or office visit, and the scheduled specialists* 
fees would be paid under the insurance plan and the individual respon- 
sible for the dependents v/ould have to bear the charges in excess of 
the scheduled amounts. This docs not appear unreasonable in view of 
the fact that nominal subsistence charges have been made for hospitali- 
zation services provided by the federal government and that under the 
hospital-medical care insurance provided the individual would as a 
rule have the right to choose the surgeon or physician for his depend- 
ent s •. 
It should be noted that the insurance plans made available by 
the Blue Cross, Blue Shield, and other private insurance agencies carry 
certain limitations in coverage. Such limitations appear necessary to 59 
assure the financial soundness of the plans. Limitations on the 
number of visits per illness have been found desirable to discourage 
unnecessary calls on physicians. Limitations on the amount of foes 
allowed are needed to bring the cost of the insurance down to a 
reasonable level. In fact, it may be said that insurance plans are 
practicable only where the cost of the services to bo rendered can 
be predicted with some degree of accuracy and this requires limita- 
tions in coverage to forestall unreasonable demands for services as 
well as predetermined service costs. 
It is doubtful whether hospital medical coverage along the above 
lines could be obtained for dependent parents, or other collateral 
dependents-. It has been estimated that almost 20 percent of all /army 
personnel have such collateral dependents. 
Cost of hospital-medical care for wives and dependent children 
of the personnel of the armed forces, Coast Guard, Coast and 
Geodetic Survey, and commissioned personnel of the Public 
Health Service 
From the experience of certain Blue Cross and Blue Shield plans 
with dependents of men in the armed forces, it is believed that the 
coverage outlined in the first three columns of Table 2 could be 
obtained at the premium rates shown in column 4 of Table 2. Those 
premium rates might vary somewhat in different localities, but the 
average rate should be close to that shown in column 4 of Table 2,. 
On this basis, the aggregate premium for some 1,050,000 wives 
and dependent children of the personnel of the armed forces, Coast 
Guard, Coast and Geodetic Survey, and commissioned personnel of the Public Health Service would anount to about $2,900,000 monthly or 
nearly $35,000,000 annually. 
While this nay not be very nuch more than the cost currently 
incurred by the government for the care of these dependents on a 
/ 
pro rata basis, it -would be substantially in excess of the differ- 
ential cost incurred by the government when government hospital 
facilities arc not fully utilized# Dependents of the 
Personnel of 
Definition of Dependent 
Estimated 
Number 
Eligible 
Number Recently 
Receiving Care 
Type of Care 
Provided 
Conditions 
Charges 
1. 
Army and 
Air Force 
Wives 
Dependent husbands 
Dependent children 
Other families residing 
in home not legally de- 
pendent upon an individual 
not in military service 
About 
900,000 
About 
3,000 
Inpatient and 
outpatient 
service 
When suitable facilities for 
hospitalization are available 
Charge for subsistence 
only, based on ration rate 
plus 25 percent. In 19*48 
between $1.30 and $1.50 per 
patient day 
2. 
Navy 
Active 
Retired 
Fleet Reserve 
Lawful wife 
Unmarried dependent children 
under 23 
Dependent mother or father 
Widows - but not dependent 
children of widows 
About 
About 
1,000 
Inpatient and 
outpatient 
service 
Limited to acute medical and 
surgical conditions, exclusive 
of nervous, mental, or conta- 
gious diseases. Also excludes 
domiciliary care 
Charge fixed by President. 
Now $1-75 per patient day. 
3- 
Coast Guard 
Same as Navy except that 
widows are not covered 
33.80*4- 
2,20*4 
Inpatient and 
outpatient 
service 
PHS Medical Relief Stations, 
hospitalized if suitable 
accommodations available 
*1.75 Per day for hospitali- 
zation. Outpatient treatment 
free 
k. 
Coast and Geodetic 
Survey 
Same as Navy except that 
widows are not covered 
S63 
78 
Inpatient and 
outpatient 
service 
PHS Medical Relief Stations, 
hospitalized if suitable 
accomodations available 
$1.75 Per day for hospitali- 
zation. Outpatient treatment 
free 
5- 
Commissioned 
Public Health 
Service Personnel 
Same as Navy except that 
widows are not covered 
3.969 
515 
Inpati-ent and 
outpatient 
service 
PHS Medical Relief Stations, 
hospitalized if suitable 
accomodations available 
$1.75 per day for hospitali- 
zation, Outpatient treatment 
free 
6. 
Veterans 
Administration 
Members of employee's 
family 
Hospitalization 
and outpatient 
treatment 
Hospitalization in emergency 
or when residing at installa- 
tion and unable to obtain 
treatment elsewhere 
$9.75 per day for hospitali- 
zation. $2.00 per outpatient 
treatment 
7. 
Indian Services 
t 
Dependent members of 
employee's family 
Hospitalization 
only 
Charged at average cost per 
patient per day 
s. 
Federal Agencies 
remote from ade- 
qiate facilities: 
Atomic Energy 
Commission, TVA, 
Hoover Dam 
Dependents of employees 
Hospitalization 
and medical care 
Hate fixed on basis of cost 
TABLE 1 
Medical Services Provided for Dependents of Federal Employees 62 
Table 2 
HOSPITAL MEDICAL SERVICES CUSTOMARILY 
PROVIDED AND PREMIUM RATES THEREFOR 
Typo of 
Coverage 
Services or Costs Services or Cost 
Allowed Not Included 
Monthly 
Pfeniun Rato 
A. Hospital 
Servi cc 
Full cost of 21 days 
hospitalization in 
semi-private room 
followed by 
50% of the cost of 180 
days of hospitalization 
in soni- private room 
§1#50 for wife 
only 
§2#00 for wife 
and 
children 
50% of cost of 
ho sp i t al i z at io n 
after 21 days 
Hospitalization includes 
bed and board, general 
nursing, drugs, X-ray 
c nans, lab,, exons, 
physical therapy, oxygen 
sera, ope rat ing ro on, 
anesthesia by hospital 
cnployccs• 
Diagnostic procedures 
and certain expensive 
therapies (X-ray, 
radium, etc.) 
> 
Maternity care included 
B. Hospital 
and dur- 
gicel _ 
Scr'/ic c 
Hospital service os pro- 
vided under A 
Surgical service allows fees 
from §50 to §225 according 
to typo of operation and in- 
cludes surgery necessary in 
maternity cases 
§2#20 for wife 
only 
§3,50 for wife 
and 
Children 
For lower income groups 
likely that full cost of 
surgery would be covered 
above foes. For higher 
groups the difference 
between foes actually 
charged and foes al- 
lowed under plan would 
have to bo borne by 
individuals responsible 
for dependents. 
it is 
all 
by 
income 
Cost of surgery 
in excess of 
scheduled fees Table 2 (cent inued) 
63 
Typo pf 
Coverage 
Service or Costs Services or Cost 
.Allowed Not Included 
Monthly 
Premium Pate 
0. Hospital and 
Medical Sor- 
vice, Medical 
Caro in 
Hospital and medical service 
as- provided under B above 
06 per day for doctors* visits 
first throe days of hospital- 
$2*50 for wife 
only 
$4#00 for wife 
and 
Hospital 
ization 
children 
03 per day for doctors* visits 
for 18 days following 
OlO per week for doctors* visits 
thereafter 
OlO allowance for one bedside 
consultation by specialist 
Bor lower income groups, it is 
likely that full cost of 
doctors* visits would be 
covered by above fees 
For higher income groups Cost of medical 
the difference between care in hospital 
foes actually charged in excess of 
and foes allowed under scheduled foes 
plan would have to be 
borne by individuals 
responsible for 
dependents 
D. Hospital and 
Modi col Ser- 
vice. Medical 
Care in 
Hospital and nodical service and 
medical care in hospital os 
provided under C above 
$2 per office visit 
$4*10 for wife 
only 
$6.50 for wife 
and 
Hospital, $3 per home visit 
Homo and Office with a limit of 20 visits 
children 
Modical Care 
per illness (including 
maternity care) 
50$ of amounts scheduled for 
specialists* foes 
For lower income g roups, it is 
likely that full cost of 
doctors* visits would bo 
covered by above fees 
For higher income groups the Cost of home 
difference between fees and office visits 
actually charged and and specialists’ 
fees allowed under plan fees in excess 
would have to be borne of scheduled fees 
by individuals respon- 
sible for dependents