Chapter XI: Part 11

I think a great deal can be done in regard to taking care of this matter by the social service work in the hospitals. The good people of Denver have been very kind in every way.

DR. BUTLER: In view of the fact that economy seems to be the order of the day, and to have economy the bird’s-eye view has been pointed out to organizations this morning, I suggest that as a fitting slogan for this body, the words. “Cultivate a bird’s-eye view” be adopted.

GENERAL SAWYER: I don’t know just what authority you gentlemen have in regard to the matter of solicitors, but at White Oaks Farm if interruptions such as these attempted to exist, somebody would get hurt. I would not tolerate the existence of such affairs. There is no reason why you should, and if there is any reason why you shouldn’t, this Board can help you to bring about some regulation or some rule whereby it will be possible for you to protect yourselves and your people against such imposition as this. Be assured that this Board is going to provide it; but I really think that if you will exercise your authority as commanding officers and not allow these people to intrude upon you, you will be able to cure a lot of your difficulties at home.

SURGEON J. M. WHEATE (R), U.S.P.H.S.: A year ago we were swarmed with agents, and I sent out a hospital regulation prohibiting that. It is easy to issue regulations, but hard to put them into effect, so I have made it a rule to make my regulations as few as possible. This, however, I found to be a necessary regulation, and I prohibited agents of all kinds from access to the hospital.

We have a hundred-acre field, which is approachable in a hundred different ways, and there is no way of keeping such agents out of the reservation. I had my Captain of the Watch made a Deputy United States Marshal. I had my head orderly made a constable for the county. They helped me to maintain order outside the reservation.

The matter of compensation has been a big problem with all of us. I recall that about the first time I got “in bad” with my patients was early in the game. I was waited on by a delegation of patients in my office one morning, who asked if I were properly quoted in the morning paper. I had not seen the paper.

A day or two before, a committee of Legion men called at my office (we had most happy relations with the local Legion heads). One of this Committee was the editor of a local paper. Among the general things we discussed was the abuse of compensation. I said I wished we had some law like Canada, whereby all but one-fourth of the compensation could be withheld, as I believed that ten dollars a month was enough for a sick man in the hospital. This was discussed and it sounded reasonable.

The next day, to my surprise, the editor of the local paper printed the story of my recommendation; and the young chap, thinking I suppose to give me the credit for the thought, quoted me freely.

The soldiers appointed a committee to wait on me. They wanted to know if I thought it fair to the United States soldier. They said it was their money and that they proposed to spend it as they saw fit.

Out of this controversy grow consideration by the Legion; and in course of time that Legion Post sent a committee man to Washington, who had a long conference with Mr. Sweet; and indirectly I may be much to be condemned or praised for introducing into the Sweet Bill the measure of withholding compensation. Our committee man who went up there stated that it was a rather new thought to Mr. Sweet and that he waved it aside at first, but that later he showed interest and finally said he was going to rewrite his bill, incorporating that idea.

But it did not go nearly as far as I recommended; that is, the adoption of the Canadian form of withholding all but one-fourth. There is no need to discuss that. Mr. Sweet said it was illegal; that compensation is a wage; but he compromised by saying we could fine the men.

Regarding my drastic order, I might add that I do allow the agents of the banks to come in, and I am proud to say that we do handle much of our trouble by depositing money either for checking accounts or savings. I think that about forty per cent of our men are carrying savings accounts in the local banks.

We have at least 160 N. P. cases in my hospital, although it is officially a T. B. hospital. As you know, the regulation provides that if a man is not capable of handling his money, his compensation check will be sent to the Commanding Officer, who is held responsible for the money. I put the money in the bank, giving to the man, after conferring with the Chief of the N. P. Section, such funds as he may need.

SURGEON M. J. WHITE: Early in 1919, when I first opened Palo Alto, I made recommendation for the amendment of the Act, so that the Compensation of a patient might be held until he had completely recovered, and I see no reason why there is a legal bar to it. I think Congress can say that Compensation is payable when a man has completely recovered and is discharged from the hospital. We cannot undertake to protect the patients from sharks. For instance, we give a man a pass; he goes down town and spends his money. As long as he has money in his pocket, he will spend it. I think it would be legal for Congress to say that Compensation will be payable when the man has reached maximum hospital treatment or when he is properly discharged. Otherwise, if a patient has accumulated, say, $160, he starts a disturbance and you have to give him the money.

CAPTAIN F. W. Wieber, U.S.N.:—I am glad to say that we have had very little trouble with our Veterans’ Bureau patients. We have, however, had trouble occasionally, but I have always been able to attend to these matters myself, for I have a good understanding with a U. S. Attorney, who helps me out.

Regarding money, it would be the best thing if most of the Compensation to the men could be withheld. They may have dependent families, so no uniform rule could guide us in our action. I do not think it should be left to the Commanding Officer, for in the first place, we do not know how much money the men should receive.

With regard to the matter of smuggling into the reservation, I sent a request to the Surgeon General to be allowed to put up a fence but I have never heard from it. I am going to recommend to my successor that he call attention to that matter again. The reservation at Fort Lyon covers 1100 acres, and a portion should be enclosed with a fence. There has been much stealing there, and we have often found the stolen articles in houses around the reservation. The building of a fence would be expensive, but it would counter-balance the loss of government property.

For the benefit of the gentlemen who may succeed at Fort Lyon soon, I might say that when I was ordered to Fort Lyon I was very much grieved; I knew it was in a desert, and everybody who had been there gave such a discouraging report. My sentiment in that matter has changed to such an extent that if the place had remained in the hands of the Navy, I should have liked to have remained there. We are a happy family of about fourteen commissioned officers and we have formed a little community of ourselves, being independent of the outside world to a large extent. We have our power house, ice plant, community house, social meetings, and in fact we are as independent as can be.

During the flood, we were able, for about two weeks to attend to our own things, and after that we were able to help the outsiders. So, to those gentlemen I want to say that they need not be disconsolate upon receiving orders to go to Fort Lyon.

I think it is ideal for the T. B. patients. We have the dry climate, constant sun-shiny days, cool nights, and everything conducive to the proper treatment of T. B. Everything is complete, and the people are greatly benefited by their stay in our vicinity, as can be attested by the fact that many former Navy People, who had been in the institution, are now living there and are as strong as any person in the East.

I might say that the people who have had T. B. and who are doing well out west had better make up their minds to stay our there for fear that change of conditions might bring about activity again in their cases.

Regarding a uniform system of treatment as suggested, I do not believe any strict rules should be set. We can have a sort of general system, but no uniform method as to the hours of rest, food, etc. At Fort Lyon, rest is now being enforced, and every patient gets two rest periods, i. e., from 9 to 11 A.M. and from 1 to 3 P.M. Liberty is allowed only once a week; and overnight, once a month. Those who would be discontented anywhere have left, and those who have stayed feel they have our sympathy and support and are doing well.

GENERAL SAWYER asked for resolutions from the Resolutions Committee.

GENERAL IRELAND: “Your committee has gone over the resolutions that have been presented, and we find all of them in order, with the exception of one submitted by Colonel Bratton with reference to transportation home. We would inform you that there will have to be legislation to carry out that resolution. We have changed the resolution to read as follows:

‘That the Director of the U.S. Veterans’ Bureau be requested to
secure legislation so that the expenses of the patient’s
transportation to his bona fide home, when he has been discharged
for disciplinary reasons, be deducted from his compensation, when
compensation is being given, or may be given thereafter.’

As changed, I recommend that the resolution be adopted by the meeting as read.”

This _Motion_ was seconded, and carried.

CAPTAIN N. J. BLACKWOOD, U. S. N.:—The Committee on Forms has held two meetings at which the general subject of this work was discussed and plans agreed upon. This work is so great that your Committee finds it impossible to report more than progress at present. The whole matter must be gone into carefully and thoroughly in order to avoid mistakes and duplications of the past. The work, to be a success, will require frequent meetings, careful study and cooperation. Therefore, it seems wise that all members of the Committee be officers on duty in Washington, and I recommend that the present chairman, Captain Blackwood, be relieved, and that his place be filled by Captain M. S. Elliott, Commanding Officer of the Naval Hospital; also, that all Commanding Officers here present shall, as soon as possible after returning to their respective commands, take up the subject of forms and paper work regarding Veterans’ Bureau patients, and as soon thereafter as possible submit to the Veterans’ Bureau, Washington, recommendations and suggestions for the elimination, provision and simplification both of the forms themselves and their numbers.

Upon receipt of these letters, your Committee will then take up the whole subject in a more comprehensive way and will, as soon as possible, submit its recommendations for your consideration and approval.

The _MOTION_ was seconded and carried.

Meeting adjourned at 12:30 P. M.

_Eighth Session_ Friday, January 20, 1922.

Honorable Charles H. Burke presiding.

The roll was called by Dr. W. A. White.

MR. BURKE: “We will proceed with the afternoon program. The first subject is “Foreign Relations of the U.S. Veterans’ Bureau in care of ex-soldiers of the former allied countries.” It will be discussed by Dr. F. D. Hester of the Veterans’ Bureau”.

DR. HESTER: read as follows:

“FOREIGN RELATIONS OF THE U.S. VETERANS’ BUREAU

IN CARE OF

EX-SOLDIERS OF THE FORMER ALLIED COUNTRIES.

Mr. Chairman, Ladies and Gentlemen:

As I note that the program upon which I have been placed refers to foreign relations of the U.S. Veterans’ Bureau in care of ex-soldiers of the formed-allied countries, with your permission I will add to that, the care of U.S. ex-service men in foreign countries. The care of U.S. ex-service men in this country has been discussed from every angle, and it would seem proper that we should also refer to his care in foreign countries from a medical standpoint, as well as to the care of the allied ex-service man in this country.

[Sidenote: THE LAW PROVIDING FOR THE CARE OF U.S. EX-SERVICE MEN IN
FOREIGN COUNTRIES]

As act of Congress, Public 104, Sixty-sixth Congress, approved December 24, 1919, provides that the Bureau of War Risk Insurance, now the Veterans’ Bureau, is authorized, to furnish transportation, also medical, surgical, and hospital services to discharged members of the military or naval forces of those Governments which have been associated in war with the United States since April 6, 1917, and come within the provisions of laws of such Governments similar to the War Risk Insurance Act, at such rates and under such regulations as the Director of the Bureau of War Risk Insurance may prescribe, etc.

[Sidenote: AUTHORIZATION FOR SERVICE]

You will note that this provision of the law stipulates at such rates and under such regulations as the Director of the Bureau of War Risk Insurance may prescribe. The regulation that has been issued by the Director of the U.S. Veterans’ Bureau provides that in all cases where application for treatment is made by ex-members of the military or naval forces of the allies, such treatment will be furnished only on the specific authorization of the Director of the U.S. Veterans’ Bureau upon authority obtained from the Government concerned, to incur the expense of treatment in each case. When treatment is so authorized, the same procedure is to be followed as in cases of application made by ex-members of the Canadian forces, which is as follows:

RECIPROCAL AGREEMENT WITH CANADA:

An agreement entered into between the Canadian and this Government upon reciprocal lines provides that when an honorably discharged member of the military or naval forces of the Allies, resident in the United States or its territorial possessions, requires medical or surgical treatment for a disability contracted in, due to, or increased by his military or naval service, he shall apply to the nearest medical representative of the U.S. Veterans’ Bureau. If such representative is not available, information regarding the address of the nearest medical representative of the U.S. Veterans’ Bureau may be secured through any local representative of the American Red Cross, the American Legion, the Y.M.C.A., the Salvation Army, the Knights of Columbus, or other volunteer agency.

METHOD OF PROCEDURE WHEN APPLICATION IS MADE FOR TREATMENT:

When application for treatment is made by an ex-member of the Canadian forces, the medical representative of the U.S. Veterans’ Bureau to whom such application is made will communicate with the District Manager in order to obtain particulars regarding the man’s military or naval status and medical history, and the District Manager will communicate with the Bureau (Assistant Director, Medical Division, Attention Foreign Relations Section), which will obtain from the Government of Canada the necessary information. If additional information is required, the District Manager, if speed be necessary, will request such additional information by telegram. In no case should treatment be undertaken pending receipt of authority from the U.S. Veterans’ Bureau, unless the call be one of emergency, and in all emergency cases the medical officer in the field is authorized to give prompt service.

LETTER OF INSTRUCTIONS:

The articles of agreement with Canada have been supplemented with a letter of instructions that clearly sets forth just how service is to be given by representatives of this Bureau to beneficiaries of the Canadian Government. This letter of instruction is a guide for the representatives of this Bureau in the field as to proper procedure when any doubtful situation should arise, and has been sent to the District Managers in such numbers as to furnish each medical officer with a copy.

It is possible that some of you gentlemen are not in possession of these instructions; should such be the case, a number of copies are at your disposal here, and may be obtained from the stenographers’ table.

NUMBER OF CANADIAN EX-SERVICE MEN CARED FOR BY THIS BUREAU:

It may not be out of order to mention at this time that the U.S. Veterans’ Bureau through its Foreign Relations Section, Medical Division, has cared for over 9,000 Canadian ex-service men. When I say Canadian ex-service men, please know that these are not in reality Canadians, but that 95% of the number are American boys, who, through their valor and enthusiasm, rushed into the breach in the early stages of the conflict, having crossed the Canadian border in 1914, 1915, 1916 and 1917. Their Services having been rendered under the English flag in Canadian organizations, these boys are properly beneficiaries of the Canadian Government, and are being cared for by that Government through the U.S. Veterans’ Bureau, Foreign Relations Section, Medical Division, by cooperation with the Department of Soldiers’ Civil Re-Establishment, which is an organization of the Canadian Government, similar to the U. S. Veterans’ Bureau. The personnel of the Department of Soldiers’ Civil Re-Establishment is something over 6,000, divided into 10 medical units, or districts. The Foreign Relations Section, Medical Division, of the Bureau is constantly in receipt of requests for service from allied ex-service men with whose government this Bureau has no reciprocal agreement. These cases are promptly referred to the representative of that government located in Washington with a view of giving service if the Government under whose flag the man served will authorize the service.

REPORTS TO BE MADE UPON CANADIAN FORMS 346,399 and 76.:

Your attention is particularly called to the necessity of forwarding to the Bureau reports required by the Canadian Government regarding the hospitalization of Canadian ex-service men; and I desire to stress this point, that, when a medical examination is made of a Canadian ex-service man, the report of your findings should be furnished on S. C.R. Form 346 (S.C.R. meaning Soldiers’ Civil Re-Establishment), this Form being similar in requirements to the Bureau Medical Division Form 2545. It is upon the findings in this report mode upon S.C.R. 346 that the Canadian Government gives its approval for hospitalization. S.C.R. Form 399 is a Progress Report, and should be rendered monthly during the man’s stay in hospital, for the reason that until this report is received no pension will be paid to the man or to his dependents. When a Canadian beneficiary is hospitalized his compensation is reduced, but the family allowance, should he have dependents, is increased. $40 is the maximum pension payable to a man while in hospital, $10 of which is paid to him and $30 held in reserve, which is accumulative, and is given to him upon discharge from hospital. The family allowance is increased according to the number of his dependents, and is paid to his family direct. S.C.R. Form. 76 is a discharge report from hospital and should be rendered promptly in triplicate, as all these reports should be. If you are not in possession of these Canadian Forms, 346, 399 and 76, they may be obtained from the District Manager in whose district you are located.

EX-MEMBERS OF THE MILITARY AND NAVAL FORCES OF THE UNITED KINGDOM:

At this time the Veterans’ Bureau has completed agreements whereby service is being given to British ex-service men, which includes ex-members of the military and naval forces of the United Kingdom of Great Britain and Ireland, New Zealand and South Africa, as well as those of Canada.

RUSSIAN ALLIED EX-SERVICE MEN:

In addition to the above named may be included the Russian allied ex-service men, an agreement having been entered into with the Russian Ambassador now located in Washington, whose official status has not changed since his appointment as a representative of the late Czar. When medical, surgical, or hospital treatment is requested for a Russian ex-service man, it must be approved in advance by the Russian Ambassador, who certifies that any expense incident to this service will be reimbursed by the Russian Ambassador.

CZECHOSLOVAKIAN EX-SERVICE MEN:

Through an agreement with the Czechoslovakian Minister, this service is also furnished to the Czechoslovakian allied ex-service men upon request from the Minister of that country, accompanied by a statement that any expense incident to service will be reimbursed by his Government.

RECIPROCAL AGREEMENT WITH THE BRITISH GOVERNMENT:

An agreement is pending at this time with the British Government to provide service for all U.S. ex-service men who may be permanently or temporarily domiciled in the United Kingdom.

CO-OPERATION OF THE STATE DEPARTMENT IN GIVING SERVICE TO U.S. EX-SERVICE MEN IN FOREIGN COUNTRIES.:

All medical, surgical, or hospital service that may be required for U.S. ex-service men now in foreign countries is provided for by this Bureau through co-operation with representatives abroad of the Department of State, this Bureau authorizing such service upon receipt of information that the man is in need of such service, and upon the establishment of his identity and the fact that the disability for which treatment is requested was due to or aggravated by his U.S. military service. Any expense incident to this service is provided for by this Bureau and is paid for through the State Department by transfer of appropriation. This procedure has been found very satisfactory, for the reason that it expedites the service to the man and simplifies the accounting problem by the prompt payment of any expense that may have been incurred.

MEDICAL EXAMINATIONS IN FOREIGN COUNTRIES MADE BY PHYSICIANS DESIGNATED BY U.S. CONSUL:

For the past six months a ruling has been in effect that where a Bureau beneficiary in a foreign country was ordered for examination, he must appear before a physician designated by the U.S. Consul only, and that unless a report was received within three months from the date of the letter directing him to appear, or to furnish satisfactory evidence to the Bureau as to the cause of his inability to report, his compensation, if he received such, would be held in suspense pending the report of his medical examination. The result of this procedure in securing an examination by competent physicians has been that more satisfactory reports are received.

CHECKS SENT TO BENEFICIARIES IN FOREIGN COUNTRIES:

The records of the Bureau for the month of December show that at this time there were 5,977 beneficiaries of the Bureau to whom checks were sent, totalling in value $489,714. These beneficiaries are resident in foreign countries located in all parts of the earth, as is shown by the tabulated statement submitted.

SOME CASES OF INTEREST:

In order that you may have a slight conception of the far-reaching effect of the strong arm of this Government in giving aid to its ex-service men wherever located, which means that they are scattered all over the earth, I believe that it will serve my purpose if I cite a few cases that may prove of interest to you. I shall with-hold the names of these men and refer to them by numbers only.

CASE NO. 1:

In this case a member of Congress came to the Veterans’ Bureau and stated that he had been excursioned around from department to department in his effort to obtain assistance in coming to the rescue of a boy who had been discharged from the U.S. military service against medical advice, suffering from melancholia, and who was sent to his home at the earnest request of his parents, as it was believed that his return to normalcy would be more quickly effected in the environment of his home and under parental care, than in a hospital. The Congressman went on to relate that after remaining home for about four months, the boy was one day reported missing. Diligent inquiry and searching parties failed to locate him, and a river nearby suggested the possibility of an accident or suicide. We will drop the curtain on this distressing situation, for we know by the law of the universal heart of the suffering that must have followed in that afflicted home.

LOCATED IN SYDNEY, AUSTRALIA:

After a lapse of fourteen months a letter was received from Sydney, Australia, addressed to a small town in a Southern State, signed by the Christian name of the writer, Henry, we will call him. The letter was a rambling, disconnected communication, addressed to no one, not even to the Postmaster, but simply to the town. The Postmaster, being the self-appointed recipient of the Communication, incidentally mentioned it to the father of the missing boy. The father did not associate the letter in any way with his lost son, but that evening upon returning home, he told his wife of the letter which the Postmaster had mentioned. I can almost see in your faces now that you have read the sequel to my story, that the mother’s love quickly put the question: “Did you see that letter?” and when the father said, “No”, the mother insisted that the letter must be from her lost boy. A visit to the Postmaster was made immediately, the letter was produced and identified by the mother as having been written by her boy. The letter was then two months old. The Congressman had come to see what could be done as to locating the boy in far away Australia.

Although the distance between the yearning mother and her lost boy was over 12,000 miles, I do not think I am exaggerating when I state that within thirty minutes after learning the facts a cablegram was under the water, requesting that the Consul General at Sydney cause a thorough search to be made in the hospitals and other institutions in the city with a view of finding the boy whose personal description was furnished, and to hospitalize if necessary and cable results. Within two days a reply was received, stating that the boy had been found and placed in a hospital. He has subsequently been returned to the United States, where he is now being cared for as a beneficiary of this Bureau, and I am glad to say that he is progressing satisfactorily. Is it strange that the Congressman and the Bureau should have the gratitude of these parents?

CASE NO. 2.:

A medical officer of the U.S. Army while traveling in Northern Africa stopped over night at a hotel in Algiers and there learned of the presence and illness of a U.S. Ex-service man. This young officer was out of funds and in need of hospitalization. The attention of the Surgeon General of the Army was called to the case, who in turn advised the Veterans’ Bureau of the man’s distress. The State Department was called by telephone and requested to cable the U.S. Consul at Algiers, directing him to give immediate service to this American boy and report action taken, with the result that the boy was promptly cared for and sent by first available transportation to Marseilles, France, where he was hospitalized.

CASE NO. 3.:

This case is that of a navy man whose disappearance was a mystery to his family. The first information as to his location was obtained through the U.S. Veterans’ Bureau, Medical Division, as the result of a telegram received from the Director Medical Services, Department of Soldiers’ Civil Re-Establishment, Ottawa, Canada, which stated that a man had been arrested there as a vagrant; that he was apparently a mental case, and had been in the U.S. Navy. His name was furnished and his identity established through the Bureau of Medicine and Surgery of the Navy. He was promptly hospitalized by the Bureau through the co-operation of the Canadian officials and returned to this country with an attendant, where he is under treatment at St. Elizabeth’s Hospital.

PURPOSE OF THE BUREAU’S ENDEAVORS:

I might go on to cite many such cases, but my time allotted is insufficient. My purpose is simply to inform you that it is the wish of the Director and his associates in the Veterans’ Bureau that it and its co-operating agencies may give to each case a human touch, reflecting personal interest and I can think of no better maxim for our guidance than the title of Charles Reade’s book, “Put Yourself In His Place,”—and give service as you would have it given unto you.”

MR. BURKE: stated that in the absence of Major Fraser his subject would be taken up by Mr. Milliken.

MR. J. B. MILLIKEN, of the U. S. Veterans’ Bureau, discussed the subject “Relation of U. S. Veterans’ Bureau to other existing bureaus in caring for its beneficiaries”, as follows:

“Ladies, Mr. Chairman, and Gentlemen: The subject of my twenty minutes talk to you might more appropriately be termed the relation of the U. S. Veterans’ Bureau to all the Executive Departments of the Government, for indeed, there is not a Department of this government with which the U. S. Veterans’ Bureau does not have a vital and immediate contact.

Probably there are three Executive Departments of the Government with which the Bureau has more contact than with the other Executive Departments—that of the Treasury Department, the War Department, and the Navy Department. Inasmuch as the U. S. Public Health Service is a part of the Treasury Department our contact with this Department of the government is immediate and vital, and is of more immediate importance than our contact with the other Executive Departments.

As is appreciated, no hospitals are operated directly by the U. S. Veterans’ Bureau, and all hospitals with the exception of contract hospitals are operated by the other independent establishments of the government, the Public Health Service of course having the lion’s share in providing facilities, and prior to the Act of August 9, 1921 creating the U. S. Veterans’ Bureau, the U. S. Public Health Service had charge of the various fourteen district offices where was stationed at each district office a Supervisor.

The Secretary of the Treasury’s order of April 19, 1921 transferred the functions of the District Supervisor’s Office to the then Bureau of War Risk Insurance, and the Act of August 9, 1921 transferred by law the activities of these offices to the U. S. Veterans’ Bureau, but left unhampered the jurisdiction and authority of the U. S. Public Health Service concerning matters of hospitalization.

Without the work of the facilities afforded by the U. S. Public Health Service it would indeed be impossible for the U. S. Veterans’ Bureau to function and discharge its obligations relative to the hospitalization, medical care, and treatment of disabled ex-service men and women. Co-ordination of their work has led to the fullest cooperation on the part of every agency, to the end that the disabled ex-service man is receiving the best treatment which a grateful government can provide. You have, of course, before you all the data and information relative to the extent of the work carried on by the U. S. Public Health Service as it relates to the beneficiaries of the U. S. Veterans’ Bureau.

The relation of this Bureau to the War and Navy Departments is fundamental, for the reason that before any person can be accorded the benefits provided for under the act creating the U. S. Veterans’ Bureau, a record must be obtained from the War or Navy Department showing the military or naval record of the person seeking benefits either for compensation, insurance, vocational training, or medical care and treatment. Something over 900,000 requests have been made to date on the War and Navy Departments requesting a transcript of the military or naval record of the person while in the active service and there has been no diminution in the number of reports requested daily, in that our average number of requests each day is about 1,000. The matter of furnishing adequately the transcript of record of an ex-service man or woman, showing whether or not they received any medical treatment while in the active service is indeed a most difficult problem. It must be remembered cases are now arising where a given individual has been discharged from the military or naval service for a period of approximately three years, and that in all probability they did not receive medical care or treatment while in the service, but their health has become impaired subsequent to their discharge from the service. Quite true they might have had some slight attack of influenza while in the service or some other disability, but did not report for medical care and treatment.

The most of these individuals believe that the War or the Navy Department should have had a record of such indisposition on their part, and that, in turn, it is up to the U. S. Veterans’ Bureau to secure such a record upon which to predicate the service origin of a given disability. Certainly not in the history of this government has the military and naval establishments been called upon to complete and compile the records of statistics and facts comparable to that resulting from the late war, and while there have been many mistakes made both on the part of the U. S. Veterans’ Bureau in requesting the information and on the part of the War and Navy Departments in submitting information, the great bulk of work has been performed in a most satisfactory manner, and great benefits have been accorded to those applying for the same under the beneficent laws passed by our Congress.

On January 1st, 1922 there had been filed with the U. S. Veterans’ Bureau 81400 claims for compensation. In each and every claim filed it was necessary to request the War or Navy Department for the military or naval record of the person applying for compensation benefits, and in many instances it was necessary to make duplicate requests because of inadequate identification given or of additional evidence which the claimant submitted which would make it possible for the War or Navy Department to make a more exhaustive search of their records. To show the promptness with which reports have been received from the War and Navy Departments for no claim is either allowed or disallowed without a report from the War or Navy Department—out of the 814,000 claims filed, 51% have been allowed, 41% have been disallowed, and 8% are pending awaiting information either from the War or Navy Departments or from the claimant himself.

Also to December 15th, 1921, 486,884 former service men had requested vocational training. It was necessary for the Rehabilitation Division of the Federal Board for Vocational Education, (now a part of the U. S. Veterans’ Bureau), to request the military or naval record from the War or Navy Department, and out of that number 299,000 had been declared eligible for training; 135,000 had been declared ineligible for training; and 51,000 cases were pending to determine their rights to vocational training. These figures also represent a tremendous work required of the War and Navy Departments in that the records of each man must be obtained before final disposition was made of the case.

When viewed from the stupendous task, the results accomplished are indeed commendable.

The great assistance of the War and Navy Departments should also not be overlooked when it is remembered that at the date of the signing of the Armistice there were approximately $40,000,000,000 worth of insurance in force which had been written through the service of the War and Navy Departments in providing insurance officers to make contact with every man who was a member of the military or naval forces.

The War and navy Departments have always been of tremendous assistance in the matter of hospitalization of ex-service men and women. On December 1st, there were 1,410 beds occupied in Army Hospitals, and 2,032 beds occupied in Naval Hospitals. Certainly then from this resumé of facts the contact with the War and Navy Departments is most vital.

The contact of the U. S. Veterans’ Bureau with the Post Office Department is apparent. It need only be mentioned that to date the U.S. Veterans’ Bureau, representing the consolidated agencies since their organization have received approximately 90,000,000 incoming pieces of mail, and have dispatched approximately 105,000,000 pieces of mail, and the daily average receipt of incoming mail in the Bureau, even under decentralization, is approximately 41,000 pieces of mail per day and the outgoing pieces of mail from the Central Office of the Veterans’ Bureau is approximately 58,000 pieces of mail per day.

The Veterans’ Bureau as you have been informed relative to the care of ex-service men of foreign allied countries and of American soldiers residing in allied countries has a vital contact with the State Department in addressing their communications to the various foreign countries and in the utilization of the various U. S. Consuls.

The Department of Justice has charge of all suits filed against the U. S. Veterans’ Bureau where suit is brought on an insurance contract. The department of Justice also handles all prosecutions where irregularities are found under the act creating the U. S. Veterans’ Bureau.

Under the Interior Department you know of the use made of the St. Elizabeth’s Hospital and of hospitals under the jurisdiction of the Commissioners of Indian Affairs.

The contact is also quite vital with the Department of the Interior in obtaining various information from the Pension Bureau as a person may be filing an application for compensation and also an application for a pension.

The Department of Agriculture has been of very great assistance to the Bureau in rendering advice relative to the training of disabled ex-service men with a vocational handicap who desire to take up agricultural pursuits, and at the present time the Department of Agriculture is rendering most valuable service in mapping out agricultural courses for the first Vocational School of the Government located at Chillicothe, Ohio.

Many disabled ex-service men taking vocational training have been assisted by the Department of Commerce in mapping out their careers for work incident to that of the Department of Commerce.

The Department of Labor has been of very great assistance in aiding the Bureau to find employment objectives for disabled ex-service men undergoing training or who have been rehabilitated by the U. S. Veterans’ Bureau.

This will give you a general view of the relation of the U. S. Veterans’ Bureau to the Executive Departments of the government. The U. S. Veterans’ Bureau naturally must have a close contact with the Congress. Congress continually calls upon the Bureau for data and information which can only be obtained from the other Executive Departments of the government but which immediately relate to the work of the U. S. Veterans’ Bureau.

Inasmuch as you Gentlemen are essentially interested in hospital administration, I should like to speak briefly on the question of hospital records, and what data the Bureau is required to have when it is called before Congress relative to Appropriations. As you know, Congress makes one appropriation to the U. S. Veterans’ Bureau for Medical and Hospitals Services. Sums from this appropriation are in turn allotted to the U.S. Public Health Service, the War and the Navy Departments, the Interior Department, and the National Homes for Disabled Volunteer’ Soldiers. When the U. S. Veterans’ Bureau is called before Congress for every appropriation it must show specifically how the money has been allotted, for what purposes it has been allotted, and the result accomplished.

It has become imperative for the U. S. Veterans’ Bureau to have available comprehensive records concerning all hospitals in which there are being treated its beneficiaries. It is not sufficient that these records be only those concerning the admission and discharge of patients and the physical examination report in each instance, but equally fundamental data concerning the results of treatment, periodical turn-over of patients, the hospitals’ administration, and of equal importance, but from a different angle, the cost of operation with the resulting per diem cost per patient.

A considerable part of the records on patients, their flow in and out of hospitals and similar data are available or can be made available, the value of these data so derived, of course, will be proportionate to the accuracy or thoroughness with which the records of admission and discharge are prepared and transmitted. The report of admission and discharge of patients and the report of physical examination are at present the only reports common to all Government Hospitals. The necessity for the prompt rendering of accurate admission and discharge reports and physical examination reports in all instances is apparent. Such reports are of very great importance to the U. S. Veterans’ Bureau, for upon them is determined the medical rating of the hospitalized beneficiaries and any delay or omission in the rendering of records of this character reflects upon the administration of the U. S. Veterans’ Bureau.

In regard to the individual hospital operation costs, until very recently the U. S. Veterans’ Bureau has been operating in the dark on unit costs. It is demanded that the U. S. Veterans’ Bureau have complete knowledge of the cost of operating all government hospitals, not merely as a gross item, but classified by purpose of expenditure and by department of hospital for which spent. The reason for this point is made two-fold—First, that the Bureau before it can allot money to the several services for hospital expense, must be in a position to know for what purpose the money should be disbursed; and second, because the Congress of the United States is holding the Bureau accountable for all moneys appropriated to it and unless this Bureau can tell Congress in detail this money has been spent, or is to be disbursed, our hospitalization program will be jeopardized until such information can be secured.

The per diem rates for hospitals of the several services vary materially so far as our estimates are concerned. The degree to which such a variation in rates is only an apparent variation due to the different bases upon which they are calculated is not at present ascertainable, but it should be. Not only should this Bureau know what it costs for its own patients at any one institution, but it should know the per diem cost over a given period for all the patients hospitalized there. The cost to this Bureau affects not only our appropriation; the cost to the service operating the hospital, including this Bureau’s share, but it affects the U. S. Treasury. If the cost of maintenance of certain hospitals is excessive, it would be poor business not to evacuate that hospital, if other conditions made it practicable, or if impracticable to attempt to reduce its operating cost.

Recently the U. S. Public Health Service inaugurated a system of cost accounting by individual hospitals. With the perfection of this procedure the U. S. Veterans’ Bureau will be in a position to talk intelligently about operating costs with these hospitals whether by departments of hospitals, purposes of disbursement, such as salaries, repairs, etc., or by unit costs.

The U. S. Veterans’ Bureau looks forward to the time when similar data are available and regularly submitted by the War Department, the Navy Department and the National Homes for Volunteer Disabled Soldiers, not merely as reimbursements due certain appropriations, but by actual disbursements of detailed purpose of not only for this Bureau’s share, but for total operations.

The U. S. Veterans’ Bureau also maintains contact with the various miscellaneous Departments and institutions of the government. Time will not permit of going into any details or of mentioning these contacts.

The U. S. Veterans’ Bureau when viewed from its huge task of running an insurance company with over three and one-half billions of insurance in force, of making payments on 149,000 insurance claims each month, making payment on 204,000 compensation claims each month, with approximately 29,000 ex-service men and women undergoing hospitalization, and having caused to be made over 1,000,000 medical examinations and responsible for 104,000 disabled ex-service men undergoing vocational training, representing a task which calls for the closest cooperation and assistance from every department of the government and only by having the closest cooperation possible will the government, through the U. S. Veterans’ Bureau, be able to discharge its obligations to the host of disabled ex-service men and women of this country.

The Bureau has always enjoyed the fullest cooperation from the various departments of the government and knows that the same cooperation will be extended with unstinted measure in the future, to the end that every pledge will be redeemed concerning the care and treatment of the defenders of this Republic, and to the end that this administration will go down in history as an administration that did not forget its sick and wounded soldiers, and brought peace and contentment to every fireside where assistance on the part of the government was requested and was due.”

COLONEL JAMES A. MATTISON, N. H. D. V. S, gave the following discussion of “Economy of Administration in U. S. Veterans’ Hospitals”:

“The subject is so broad that we can only consider certain phases of it within the time allotted for this paper. We all recognize that there are certain fundamental essentials which must of necessity be provided in every hospital regardless of the number of patients cared for. This necessarily means that overhead expenses of an institution hospitalizing small numbers of patients will be out of proportion to those of a hospital caring for a large number.

The general business management, the purchasing of supplies and equipment, the conservation and dispensing of the same, the elimination of waste, etc,. will be considered only casually for the purpose of emphasizing the importance of adhering as closely to strict business methods as is done in the case of every successful business man, whether he be a hospital executive, a merchant, or a man in any other line of business.

In this connection, it might be said that a mistake which is made in many government institutions, and one which is not made by the most successful business men, is to attempt to start on economy at a place where one can least afford to economize, that is in the pay and allowances of the personnel immediately responsible for the management of the institution, the responsible heads of departments, etc. In other words, we are not always willing to pay for brains, a price commensurate with the business responsibility involved. Again when we have been fortunate enough to secure the right man the right place, we do not always recognize his value by paying him a price commensurate with the value of his work. Furthermore, when we have made the mistake of getting the wrong man, who in reality is receiving a greater compensation than his services are worth, and one who, in reality, is a very expensive employee, we oftentimes make the mistake of not recognizing inefficiency and promptly correcting it,

In case there is any decided handicap along the lines of inefficiency in the responsible personnel in the administrative, utility, service or professional departments, it should be promptly corrected, as it is to those in such petitions to whom we constantly look to be on the alert in recognizing the short comings of all subordinate personnel.

In visiting our own or other hospitals we promptly recognize the presence or absence of evidence of the proper vigilance or efficiency in every department. In case of a tour of inspection of one of these institutions there should be found spurting steam valves, leaking water faucets, extravagant use of electric lights, overheated buildings, garbage and swill tanks running over with waste food supplies, evidence of lack of organization and co-operation on the part of the personnel, professional or otherwise, we should immediately recognize the fact that there was inefficiency existing in the personnel of such an institution, and as a result of this, a decided lack of economical and efficient administration. Finding such conditions in other departments, we should expect to find unsatisfactory conditions when the patient population was reached. We should expect to find histories poorly written or not written at all, patients waiting over-time for special examinations or special treatments, lack of accurate laboratory and X-ray records, etc. The matter of such inefficiency and consequent poor administration on the part of the personnel in any institution would naturally lead to great dissatisfaction on the part of the patients of such an institution and to the greatest lack of economy on the part of the administration, of the hospital.

In connection with the professional department proper, again the attainment of the most satisfactory results from the standpoint, both of economy and efficiency, is dependent upon the capacity and co-operation of the responsible personnel. There has been much discussion in regard to the number of professional personnel doctors, nurses, attendants, etc., and on this subject there has been apparently wide differences of opinion. However, these differences have been based upon differences of viewpoints of what the actual conditions to be met were.

A definite agreement has been reached in regard to the required personnel, nurses, doctors, attendants, social service, workers, etc., to each two hundred patients in a hospital caring for all acute patients, whether they be major surgical, acute active neuro-psychiatric, active tuberculosis, or other type of acute condition requiring active, constructive treatment.

As a matter of fact, however, we all know that in none of our Veterans’ Hospitals, especially the larger ones of 500 to 1000 or more beds, are all the patients or even a majority of them represented by this type of patients, on the contrary we have a large group of convalescent patients who require professionally very much less attention from the standpoint of active constructive treatment, dietetic attention, etc., and hence require vastly less personnel, and the expense of their maintenance in the hospital will be very greatly reduced from that of the acute type. Again, we have another group which represents the semi-domiciliary type, many of whom require very slight constructive treatment, and yet they belong to a type of patients who are capable of being finally rehabilitated and restored to an earning status in life. This group requires still less care than the former, and naturally less personnel and proportionately less per capita cost to the institution caring for them. Lastly, we pass to a purely domiciliary group who are to a large measure permanently disabled and are, therefore, many of them, to be permanent charges oh the Veterans’ Hospitals. The great majority of the latter group will require little or no special treatment, but will require only general care and maintenance. In this group we are dealing with a type who will represent the minimum per capita cost.

As time goes on we shall realize, especially in our larger hospitals, that the above condition will exist to a larger and larger measure and the necessity of a very close checking system and a very careful classification of the patients along the lines indicated above will be a matter of the very highest importance.

This does not mean that as long as special treatment along any line is needed that each patient will not have such expert examinations, care and treatment as his condition calls for. Quite the contrary, the most careful and competent examinations should be directed by hospital units composed of the most competent staff of men including surgical; medical; ear, nose and throat; X-ray., etc., at such intervals as the condition of the patient calls for. It will be by this system alone that we are to keep a check on the progress toward recovery of each individual patient and prevent an undue accumulation of a domiciliary group. By proper cooperation of such a group with the rehabilitation section, many men may be selected as suitable persons for rehabilitation in the vocational schools. The importance of this we all realize as there is a certain percentage of patients who will be quite content with their state as long as they are receiving complete maintenance and a liberal compensation of from $80 to $150 per month and no cares and no responsibilities to assume in life. That is we should be constantly on the alert to prevent making permanent residents or charges of any man who can be restored to an earning status in life.