sion of this insurance must take place on or before July 2, 1926, although no medical examination is required.

The total number of applications for yearly renewable term insurance number more than 4,500,000 and the amount of insurance represented was more than $40,000,000,000, the average amount applied for being $8,756. The application for insurance carried an authorization for the premium to be deducted from the Army and Navy pay rolls. Therefore, the only way by which the insurance could be discontinued was by the execution of a definite request for cancellation and the acceptance of such request by the bureau. Before the armistice requests for cancellation were negligible. However, in the minds of most of these men, who were young, healthy and free from marital responsibilities, the termination of the war eliminated the need for all protection. As a result of this feeling, and in some instances because of financial difficulties encountered by the men after their discharge, a very large per cent of yearly renewable term insurance was permitted to lapse. It has been estimated that more than 75 per cent of the men who carried insurance while in service never paid a premium after their discharge.

The number of men who have converted their yearly renewable term insurance into a permanent form of insurance is 438,562, the insurance so converted amounting to $1,601,719,180, although this amount is not now in force.

On June 30, 1924, insurance records were maintained for 562,600 veterans carrying $2,984,573,458 of insurance. The number of men carrying yearly renewable term insurance was 209,385, amounting to $1,609,030,534, while those carrying converted insurance numbered 353,215, amounting to $1,375,542,924. This latter amount of insurance is classified by plan of insurance as follows: Ordinary life, $288,370,169.24; 20-payment life, $502,452,246; 30-payment life, $80,181,955.69; 20-year endowment, $304,726,110.48; 30-year endowment, $103,810,986.77; endowment at age 62, $96,001,455.88. In maintaining the foregoing total insurance the average number of premium remittances received monthly during the fiscal year was approximately 325,000, and the amount of insurance premiums received monthly was more than $4,000,000. The total amount of premiums received on account of yearly renewable term insurance to June 30, 1924, was $419,484,960.92. The total income from United States Government life (converted) insurance from premiums and interest on investments as of this date was $141,890,660.79. That part of this fund which is not required for the payment of claims and cash surrenders and loans to policyholders is invested in Government securities, the amount of such investments as of June 30, 1924, being $111,181,891.21. From excess interest earned on these investments dividends are paid to policyholders, which may be received in cash or applied to the purchase of paid-up or extended insurance. The total amount set aside to date for payment of dividends is $8,046,748.69, of which amount $5,879,358.17 has been disbursed as cash dividends.

INSURANCE CLAIMS

All yearly renewable term insurance claims awarded on account of death or disability are paid in monthly installments of $5.75 per

$1,000 of insurance. These installments cover a period of 240 months. United States Government life (converted) insurance may be paid in monthly installments or in a lump sum, at the option of the insured. Under the limited installment plan, payments may be made in as low a number of installments as 36 or as large a number as 240. A continuous installment plan may also be selected, which provides that payments shall be made throughout the lifetime of the beneficiary. Under the latter plan, should the beneficiary die before 240 installments have been made, the remaining installments will be paid to persons entitled thereto, who are within the permitted class of beneficiaries specified in the policy.

The total number of yearly renewable term (contract or automatic) insurance claims filed is 204,170. All but 872 of these claims have been adjudicated, the number allowed being 161,257 and the number disallowed being 42,041.

On June 30, 1924, there were being paid 9,260 term (contract) insurance awards for permanent total disability, the average amount of the policy being $8,666. There have been 14,254 terminations of disability awards, 2,636 because of recovery and 11,618 because of deaths. Of those receiving permanent total insurance awards 3,918 received their disabilities in Europe, while 4,945 received their disabilities in the United States or possessions. Disease was the greatest cause of disability, being the cause in 7,797 cases; 3,833 of the permanent total disability cases on which awards were made resulted from tuberculosis. Term (contract) insurance awards were being paid on June 30, 1924, to beneficiaries of 138,965 deceased veterans, the average policy amounting to $9,052. Forty-six per cent of these awards are being paid for deaths resulting from tuberculosis and other diseases of the respiratory system. Of the total awards to beneficiaries of deceased veterans active on June 30, 1924, 49,135 died in October, 1918, this being the effective date of the largest number of death insurance awards.

The act of Congress which authorized the issuance of yearly renewable term insurance contained a provision that all veterans who were permanently and totally disabled and dependents of veterans who died as a result of service between April 6, 1917, and 120 days after October 15, 1917, or within 120 days after their entry into service up to November 11, 1918, should be awarded insurance payable in monthly installments of $25 each. This form of insurance is known as automatic insurance.

Automatic insurance was being paid on June 30, 1924, to 293 claimants whose disability was rated as permanent total, the monthly payment in each case being $25. One hundred and forty-eight of these awards are being paid for psychiatric diseases, 93 for tubertulosis, 10 for blindness, and 12 for amputation. The remaining 30 are paid for various other disabilities which have disabled the veteran to a permanent and total degree. Automatic insurance disability awards have been terminated in 220 cases, 35 being for recovery and 185 on account of deaths, of which 151 resulted from tuberculosis. Automatic insurance is being paid to dependents of 7,855 deceased veterans. Fifty-six per cent of these awards are being paid to beneficiaries of the veterans whose deaths resulted from diseases of the respiratory system or tuberculosis. Of the deceased veterans whose dependents are drawing automatic insur

ance awards, 1,196 died in December, 1917, and 1,189 died in January, 1918. It was during these months that the largest number of deaths not preceded by disability were reported.

The commuted value of all yearly renewable term insurance claims on which payments are now being made is $1,316,337,347.33. This represents the liability of the Government at the time the award was made. By reason of the fact that all yearly renewable term insurance payments are made in 240 monthly installments, interest must be added, which results in the payment of $1,380 for each $1,000 represented in the commuted value. When it is remembered that the premiums received by the Government for term insurance total only $419, 484,960.92 and that term policies must be converted by July 2, 1926, it will be realized that the amount of money in excess of premium receipts which must ultimately be appropriated to cover these payments will approximate one billion dollars.

The number of claims filed for United States Government life insurance on June 30, 1924, was 5,924. Of these, 4,602 have been allowed, the total amount of insurance involved being $19,309,677.25, an average of $4,195.93 for each claim. In 2,447 cases, lump-sum payments were made, which amounted to $10,618,881.03. The number of claims disallowed because no insurance was in force at the time of permanent total disability or death was 1,177. Of the total number of claims filed 1,840 were for permanent total disability and 4,084 were for death. In 264 cases where awards were made because of permanent total disability the claimants have since died, and in 79 cases insurance payments have been discontinued because of the claimant's recovery. Of the total claims filed, only 136 remained unadjudicated on June 30, 1924.

HOSPITALIZATION

Material progress was made during the fiscal year in the hospitalization of bureau beneficiaries in Government facilities, made possible largely through the completion of the majority of projects under the first and second Langley Acts, which together made available some $35,600,000 for hospital construction. Throughout the year the patient load varied from 22,290 patients in September to 24,220 patients, the peak occurring in February of 1924, thus repeating the peak-load experience of previous years. A definite decline in patients was observed in June of 1924, and this decline would have continued in all probability were it not for the passage of the World War veterans act of 1924, which materially liberalized hospitalization. As a direct result of the passage of this act a sharp rise in the patient load was observed which it is estimated will carry the hospital load several thousand cases higher than would have obtained under previous legislation.

At the commencement of the fiscal year there was in all hospitals, both Government and civil, a total of 23,310 patients of this bureau, of which number 16,745, or 72 per cent, were in Government hospitals and 6565, in civil and State hospitals. As of this date 10,440 patients, or 45 per cent, were in hospitals under the direct jurisdiction of the bureau. As of June 30, 1924, the hospital load totaled 22,610, of which number 17,824, or 79 per cent, were in Government hospitals and 4,786, or but 21 per cent, were in civil hospitals. These percentages are interesting, showing as they do that a decided change 17231-24+4

occurred in the distribution of patients between civil and Government hospitals. This reduction in hospitalization in civil hospitals will continue during the next fiscal year directly proportionate to the number of new Government beds to be made available, particularly for insane cases. These latter cases now constitute more than 75 per cent of the load of bureau patients in State and civil hospitals. While at the beginning of the fiscal year but 45 per cent of the total patients were in Veterans' Bureau hospitals, at the close of the fiscal year 53 per cent were so hospitalized. With the exception of the national soldiers' home hospitals, there was very little change throughout the year in the number of patients of this bureau hospitalized in hospitals under the jurisdiction of other Government departments. In the case of soldiers' homes, patients in hospitals decreased by approximately 400, the major portion of this decrease being made up of tuberculosis cases.

At the beginning of the fiscal year 42 per cent of all patients were suffering from tuberculosis, 40 per cent from neuropsychiatric conditions and 18 per cent from general medical and surgical conditions, whereas at the close of the fiscal year tuberculosis cases were 39 per cent of the total load, the neuropsychiatric diseases 44 per cent and the general medical and surgical conditions 17 per cent. Numerically, there was observed a reduction in both the tuberculosis general medical and surgical conditions, and with an increase for neuropsychiatric conditions. In considering the distribution of these cases, it is significant to note that, whereas, on July 1, 1923, but 60 per cent of the neuropsychiatric cases were in Government hospitals and 39 per cent in United States veterans' hospitals, on June 30, 1924, 72 per cent were in Government hospitals and 52 per cent in United States veterans' hospitals, and that the per cent of general cases in Government hospitals increased from 86 to 93 per cent. With reference to neuropsychiatric cases in hospitals, the numerical increase of these patients in United States veterans' hospitals throughout the year amounted to 1,524 patients, which was primarily due to the transfer of these patients from State institutions to the new hospital facilities of the bureau.

HOSPITAL FACILITIES

To meet the hospital load there was available as of the beginning of the fiscal year in United States veterans' hospitals a total of 15,625 Government beds, of which number 7,378 were established in tuberculosis hospitals, 4,076 in neuropsychiatric hospitals and 4,171 in general hospitals. While at the expiration of the fiscal year the actual number of available beds has not materially changed, being increased to only 15,798, the distribution and character of these beds was greatly affected. With reference to type of bed, at the close of the year, 6,511 were established in tuberculosis hospitals, 5,141 in neuropsychiatric hospitals and 4,146 in general hospitals. The reduction in available beds in United States veterans' tuberculosis hospitals from 7,378 to 6,511 was a result of continuous decrease in utilization or unsatisfactory service of certain facilities. This reduction was in part offset by the increase in capacity of certain other hospitals to that originally provided for the projects, and to the conversion of a general hospital to a tuberculosis hospital. The increase in beds at neuropsychiatric hospitals from 4,076 to 5,141 was due largely

to the opening of a new hospital constructed under the second Langley Act. There resulted a decrease of only 25 beds in general hospitals throughout the year. Four Veterans' Bureau general hospitals were closed during the year at Chicago, Ill., Arrowhead Springs, Calif., Fort McHenry, Md., and Chillicothe, Ohio, while a new hospital at Dwight, Ill., was opened and the hospital at Tacoma, Wash., was converted from a tuberculosis to a general hospital. In all during the year five hospitals with an aggregate capacity of 1,704 beds were opened, and during the same period five hospitals with an aggregate capacity of 820 beds were closed, two of the latter hospitals being leased hospitals.

In considering the hospital beds reported available in United States veterans' hospitals established for tuberculosis or neuropsychiatric diseases, or general conditions, it is to be borne in mind that with each of these classes of hospitals, more especially general hospitals, there are set aside certain beds for cases other than those for which the hospital is principally used. Where it is reported that there are 5,141 beds in hospitals established for neuropsychiatric diseases, included in this number are some 200 beds for tuberculous and some 50 beds for general conditions. These beds are set up to meet unusual conditions, such as the use of certain temporary buildings at Palo Alto, Calif., for tuberculosis cases pending the completion of new tuberculosis hospitals for that area, or the use of a certain ward at Chillicothe, Ohio, to meet the demand for general hospitalization among the trainees at the vocational school at Chillicothe, Ohio. Similarly, among the 6,500 beds in hospitals established for the treatment of tuberculosis, there are some 300 beds for neuropsychiatric conditions and 75 beds for general conditions, the former largely made up of beds for negroes suffering from tuberculosis, and the latter to meet the demand for general hospital facilities at Helena, Mont., where the operation of a general hospital on its own account is not warranted. With reference to general hospitals, of the approximately 4,000 beds in general hospitals, more than 600 beds are available for neuropsychiatric cases and more than 700 beds for cases of tuberculosis. This situation in general hospitals is due to the fact that frequently, prior to permanent hospitalization, a bureau beneficiary is admitted to a general hospital for observation and diagnosis and, to provide such service, it is necessary that certain wards in general hospitals be available to all types of cases.

In addition to those facilities made available by hospital under the direct jurisdiction of the bureau, there are 9,200 beds made available through other governmental agencies, including the War Department, the Navy Department, the National Homes for Disabled Volunteer Soldiers, the Public Health Service, and St. Elizabeths Hospital, Washington, D. C. In all, 39 Government hospitals under the jurisdiction of departments other than the United States Veterans Bureau were receiving patients from this bureau at the end of the fiscal year, representing in available beds 3,500 for tuberculosis cases, 2,200 for neuropsychiatric cases, and 3,500 for general cases. Thus, in all Government hospitals, including veterans' hospitals, there was available as of June 30, 1924, a total of 25,010 beds.