to date there have been 38 such mergers. Four other consolidations have been authorized and will be effected upon completion of construction now in progress. It is expected that eventually all regional offices will have been consolidated with other field facilities. In addition, consolidation has been effected in the supply activities at five stations, in finance activities at two, and in medical activities at one. It is estimated that a saving of approximately 10 percent in operating costs is obtained in combining regional offices with hospitals or homes, and in total this recurring annual saving is of considerable amount. These savings are reflected largely in such items as salaries, miscellaneous medical fee services, supplies, telephone service, rentals, and miscellaneous contract services. The Administration is able to give equal or better service at combined facilities, with a minimum of administrative expense, because of the more extensive activities which are immediately available to the veteran, especially in connection with his physical examination.

MEDICAL TREATMENT AND DOMICILIARY CARE

HOSPITALIZATION

Remaining under treatment. At the expiration of this fiscal year the total hospital load of the Veterans' Administration was 54,117 as compared with 50,899 on June 30, 1938, an increase of 3,218, or approximately 6.32 percent during this period. This increase was distributed by types as follows: Tuberculosis, 71; neuropsychiatric, 1,930; and general medical and surgical, 1,217. At the close of this year 77.54 percent of the veterans under hospitalization were receiving treatment for disabilities not of service origin, as compared with 76.32 percent on June 30, 1938.

The total patient load at the expiration of this year was composed of 53.861 United States veterans, classified by service as follows: World War, 48,527; Spanish-American War, 2,715; Civil War, 48; all other wars, expeditions, and occupations, 85; and Regular Establishment, 2,486. There were 12,097 United States veterans under treatment for diseases or injuries determined to be of service origin, of whom 10,443 had service in the World War; 20 in the Spanish-American War; 1,633 in the Regular Establishment during peacetime; and 1 in other wars, occupations, or expeditions.

In addition to United States veterans there were under treatment 37 veterans of countries allied with the United States in the World War; 106 employees of the Civilian Conservation Corps and Works Progress Administration; and 113 miscellaneous beneficiaries. Included in the 53,861 United States veterans are 376 female and 5,244 colored beneficiaries.

Of the patients in hospitals at the close of this year 9.20 percent were under treatment for tuberculosis, 57.68 percent for neuropsychiatric diseases, and 33.12 percent for general medical and surgical conditions. This represents a marked change in the character of the patient load since June 30, 1923, when 41 percent of the patients were classed as tubercular, 39 percent as neuropsychiatric, and 20 percent as general. Of the 53,861 United States veterans under treatment at the end of this year, 50,131 were in facilities controlled by the Veterans' Administration, 2,749 in other Government hospitals, and 981 in State or

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civil institutions. Over 64 percent of the United States veterans in all hospitals are receiving treatment in facilities located in the State of their reported home addresses.

Admissions. Since March 3, 1919, when the acquisition of Government hospital facilities was first authorized for the treatment of veterans of the World War, there have been 2,028,865 admissions of United States veterans to hospitals, of which 165,576 were made during this year, an increase of more than 8 percent over 1938. The admissions for 1939 were the highest of any fiscal year to date.

Since June 7, 1924, when hospitalization was first authorized for the veterans of all wars without regard to the origin of their disabilities, 1,206,966, or about 75 percent of all admissions, have been for the treatment of disabilities not connected with service. Over 92 percent of the admissions this year were on account of non-serviceconnected disabilities.

Of the United States veterans admitted to hospitals during this year 90 percent had service in the World War and 6.8 percent in the Spanish-American War. In addition to United States veterans there were 2,661 admissions of other patients, including 199 allied veterans, 1,675 employees of the Civilian Conservation Corps and Works Progress Administration, and 787 miscellaneous beneficiaries.

An analysis of the types of hospital admissions during this year shows that 67,762 or 40.9 percent of the total, were first admissions; 92,136, or 55.7 percent, readmissions; and 5,678, or 3.4 percent, admissions by transfer from other facilities.

During this year 11,268 admissions were authorized for the observation and treatment of pulmonary tuberculosis; 9,372 for psychotic or mental diseases; 13,240 for other neurological disorders, and 131,696 for general medical and surgical conditions.

There were 1,005 female and 15,804 colored veterans admitted to hospitals during this year.

Of the 165,576 admissions of United States veterans during this year, 140,018, or 84.6 percent, were made to facilities controlled by the Veterans' Administration; 23,232, or 14 percent to other Government hospitals; and 2,326, or 1.4 percent to civil or State hospitals.

Turn-over. During the fiscal year 1939 the patient turn-over in all types of Veterans' Administration hospitals was approximately once every 4 months. Based upon the experience of this year, hospitals devoted principally to the treatment of neuropsychiatric diseases have a complete patient turn-over once every 2% years. The relatively low turn-over rate experienced for this type of case is due to the long and continuous hospital treatment usually required and a low mortality rate. During this fiscal year the turn-over rate for hospitals utilized primarily for the treatment of tuberculosis was about once every 4% months. The turn-over rate for this year in hospitals treating a majority of general medical and surgical patients was approximately once every 14 months.

Discharges. During this fiscal year 221,509 patients were under hospitalization, of whom 218,621 were United States veterans. The total number of patients treated represents an increase of approximately 10 percent over 1938. Of the United States veterans treated 164,760 were discharged after an average of 72.4 in-patient days. Patients who remained until the completion of treatment numbered 132,919, or 80.67 percent of the total discharges. The incomplete

cases totaled 31,841 and include 8,169 cases in which further treatment or care was required in another facility or out-patient clinic, 7,909 cases in which the patient was transferred to domiciliary care in the same facility, 14,148 cases in which the patient was discharged for personal reasons, i. e., against medical advice, leaving without permission, etc.; and 356 cases not entitled to hospitalization under the laws now in effect. Approximately 78 percent of the United States veterans discharged during this year had been under treatment for general diseases or conditions; 15 percent for neuropsychiatric diseases; and 7 percent for pulmonary tuberculosis. In 75 percent of the completed and 59 percent of the incomplete cases, recovery or some improvement was effected.

Deaths in hospitals during this year totaled 10,880, or 6.60 percent of the discharges as compared with 10,117, or 6.75 percent in 1938. 'Of the total deaths, 7,365 or 67.69 percent occurred among patients under treatment for general conditions; 1,947, or 17.90 percent, for pulmonary tuberculosis; and 1,568, or 14.41 percent for neuropsychiatric diseases. Considering the total discharged after treatment for each type of disability during this year, 17.40 percent of the pulmonary tuberculosis cases resulted in death, 5.70 percent of the general, and 6.44 percent of the neuropsychiatric. Of the 7,365 deaths among general patients, approximately 37 percent were caused by diseases of the circulatory system, including organic heart disease, and approximately 34 percent by malignant tumors and diseases of the digestive system. During the year 133,539 World War veterans were discharged after treatment for diseases or conditions not connected with service and 10,226 for disabilities of service origin. There were 8,206 cases in which the veteran was admitted for examination or observation, and 75 cases classed as emergency. The remaining 12,714 discharges of United States veterans were classified by service as follows: SpanishAmerican War, 90 service-connected and 7,246 non-service-connected; Regular Establishment, 2,014 service-connected and 2,967 nonservice-connected; Civil War, 179 non-service-connected; and miscellaneous occupations, rebellions, etc., 2 service-connected and 216 non-service-connected. In addition to United States veterans there were 2,632 discharges of other patients, 202 of which were veterans of countries allied with the United States in the World War, 1,689 for employees of the Civilian Conservation Corps and Works Progress Administration, and 741 for miscellaneous beneficiaries.

Included in the total of 164,760 discharges of United States veterans during this year are 7,909 cases classified as intrafacility transfers, i. e., cases in which the veteran was transferred from hospital treatment to domiciliary care within the same facility.

DOMICILIARY CARE

Remaining. On June 30, 1939, the veteran population reported as present in domiciliary status in facilities under the control and jurisdiction of the Veterans' Administration totaled 15,426, as compared with 14,254 on June 30, 1938, an increase of 1,172 during this fiscal period. The number present in domiciliary status on June 30, 1939, was divided as to color and sex as follows: White males, 13,708; white females, 66; and colored males, 1,652.

The percentage distribution of the membership, by wars, as of June 30, 1939, was as follows: Civil, 0.01; Spanish-American, 4.95; World,

91.13; other wars, expeditions, and occupations, 0.12; and peacetime service in the Regular Establishment, 3.79.

The approximate average age of the veterans of each of the major wars who were present in domiciliary status at the close of this fiscal year was as follows: Civil, 94; Spanish-American, 64; and World, 46. Of the veterans remaining under domiciliary care at the end of this year, 10,644 were disabled by general medical and surgical conditions, 4,461 by neuropsychiatric diseases, and 321 by tuberculosis.

Over three-fourths of the domiciled veterans on June 30, 1939, were under care in facilities located in California, Kansas, Ohio, Tennessee, Virginia, and Wisconsin.

In conformity with the act of August 27, 1888 (U. S. C., title 24, sec. 134), the Federal Government is required to reimburse State or Territorial homes for disabled volunteer soldiers at the rate of $120 per year for each person domiciled therein who is eligible for similar care in facilities controlled by the Veterans' Administration. During this year an average of 5,978 such persons were cared for in these homes, thereby creating an obligation of over $717,000 on the part of the Federal Government. Public, No. 250, Seventy-sixth Congress, August 1, 1939, increases the amount of Federal aid to State or Territorial homes from $120 per annum to $240 per annum.

Admissions. During this year there were 29,337 admissions for domiciliary care, as compared with 28,585 admissions for the fiscal year 1938, an increase of 752, or 2.6 percent.

An analysis of the types of admissions shows that 4,563, or 15.55 percent, were first admissions; 21,513, or 73.33 percent, readmissions; and 3,261, or 11.12 percent, admissions by transfer from other facilities.

Of the veterans admitted to domiciliary care during this year 26,418, or approximately 90 percent, had service in the World War, and 1,652, or approximately 6 percent, in the Spanish-American War. There were 110 female and 2,266 colored veterans admitted for domiciliary care during the year.

Approximately 91 percent of the admissions this year were for non-service-connected disabilities.

Of the veterans admitted during this year 72 percent were disabled by general medical and surgical conditions, 26 percent by neuropsychiatric diseases, and 2 percent by tuberculosis.

Discharges. During this year 27,847 veterans were discharged after an average of 5 months' domiciliary care. These discharges were classified as follows: 13,220 routine; 8,415 transfers within the same or to other facilities; 61 deaths; 443 ineligible for further care; and 5.708 without formal discharge, including disciplinary reasons. Approximately 70 percent of the discharges were for veterans with general medical conditions. The principal causes of death among domiciled veterans were diseases of the arteries, organic diseases of the heart, and embolism and thrombosis, which collectively were responsible for approximately 66 percent of the deaths.

Of the total veterans discharged 24,923 were World War veterans, and of these 22,328 were disabled for non-service-connected disabilities. The other discharges were classified as to service as follows: Spanish-American War, 1,738; Regular Establishment, 1,147; Civil

War, 5; and all other wars, occupations, and expeditions, 34. Included in the total of 27,847 discharges during this year were 7,056 cases classified as intrafacility transfers, i. e., cases in which the veteran was transferred from domiciliary care to hospital treatment within the same facility.

HOSPITAL AND DOMICILIARY FACILITIES

On June 30, 1939, the Veterans' Administration was operating hospital facilities at 84 locations in 45 States and the District of Columbia. These facilities had a capacity of 54,779 beds, an increase of 2,788 in the number reported on June 30, 1938.

Additional hospital beds were acquired during this year through new construction, alterations, or readjustment of space at Alexandria, La.; Bath, N. Y.; Bay Pines, Fla.; Camp Custer, Mich.; Chillicothe, Ohio; Danville, Ill.; Dearborn, Mich.; Fargo, N. Dak.; Hot Springs, S. Dak.; Lake City, Fla.; Legion, Tex.; Lincoln, Nebr.; Livermore, Calif.; Los Angeles, Calif.; Lyons, N. J.; Marion, Ind.; Newington, Conn.; Northampton, Mass.; North Little Rock, Ark.; Portland, Oreg.; Reno, Nev.; Roanoke, Va.; San Fernando, Calif.; Tuscaloosa, Ala.; and White River Junction, Vt.

At the expiration of this year the Veterans' Administration was utilizing 2,748 beds in other Government hospitals, distributed by branch of service as follows: Army, 1,100; Navy, 1,063; Public Health Service, 499; and Interior Department, 86.

On June 30, 1939, there were 16,345 beds set aside for domiciliary care in facilities under the jurisdiction of the Veterans' Administration as compared with 16,798 on June 30, 1938, a decrease of 453. Additional domiciliary beds were acquired at Bay Pines, Fla.; Boise, Idaho; Hot Springs, S. Dak.; Kecoughtan, Va.; and Mountain Home, Tenn. The reductions in capacities at Bath, N. Y.; Dayton, Ohio; and Los Angeles, Calif., due to the evacuation of unsatisfactory space are temporary, pending certain replacements.

The total number of beds in facilities controlled by the Veterans' Administration on June 30, 1939, was 71,124 as compared with 68,789 on June 30, 1938, an increase of 2,335.

During the period beginning with the act of March 3, 1919 (Public, No. 326, 65th Cong.), and ending with the act of March 16, 1939 (Public, No. 8, 76th Cong.), the Congress has specifically authorized and appropriated the sum of $157,909,267 for new hospital, domiciliary, and out-patient dispensary facilities. In addition, since 1923 there has been expended from regular fiscal funds the sum of $24,702,533 for permanent improvements and extensions to facilities. Subsequent to the consolidation of veterans' activities in 1930 there has also been expended from the general post fund established by the former National Home for Disabled Volunteer Soldiers, the sum of $1,123,116, for improvements. Further, the Veterans' Administration has been allotted for improvements and new construction, the sum of $3,041,650 from the National Recovery Act of 1933, and the sum of $13,268,200 from the Public Works Administration Appropriation Act for 1938. In all, a total of $200,044,766 has been made available for construction purposes during the past 20 years.