Eighth SessionFriday, 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’ BUREAUIN CARE OFEX-SOLDIERS OF THE FORMER ALLIED COUNTRIES.
“FOREIGN RELATIONS OF THE U.S. VETERANS’ BUREAUIN CARE OFEX-SOLDIERS OF THE FORMER ALLIED COUNTRIES.
“FOREIGN RELATIONS OF THE U.S. VETERANS’ BUREAU
IN CARE OF
EX-SOLDIERS OF THE FORMER ALLIED COUNTRIES.
Mr. Chairman, Ladies and Gentlemen:
Mr. Chairman, Ladies and Gentlemen:
Mr. Chairman, Ladies and Gentlemen:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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 composedof 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.
Contrast, if you please, with the conditions in our hospitals the patient in private hospital, who is paying from $10 to $50 per day for private nursing, hospital accommodations, etc., and a correspondingly high rate for special professional services, and who in addition to this is losing heavily because of his absence from his personal business. In the latter case there is a much greater incentive for getting well, a greater incentive for requesting that special nurses and other expenses be cut off at the earliest moment it is found that they are no longer needed and for the additional request that they be discharged from the hospital as early as possible after the maximum benefits from hospitalization have been received. In the one case, the private patient is paying freely a large sum of money to get well. In the other case, the patients of our Veterans’ hospitals in many cases are paid liberally for being sick.
In making the above statement, we do not wish to be misunderstood. We all know that we have among our patients in the Veterans’ Hospitals some of the best type of men anywhere to be found; some of the most ambitious; some who are exceedingly anxious to have their health restored and be returned to an earning status in life at the earliest possible moment; but, unfortunately, this does not apply by any manner of means to all the patients whom we are hospitalizing. Out of the disabled arising from an army of nearly five million men, naturally there will bob up representative types of every manner of man in existence. As representatives of Veterans’ Hospitals we owe to our Government as well as to our patient our best efforts to help, not only toward the rehabilitation of every soldier who can be rehabilitated but we are also obligated to help develop this program upon the most economical basis without sacrificing efficiency and the most satisfactory constructive results.”
MR. BURKE: stated that the subjects were now open for discussion, and called on Colonel Patterson for a few words.
COLONEL PATTERSON, of the U.S. Veterans’ Bureau,: stated that it had been a great personal loss to him that he had been unable to attend all of the meetings. He then spoke on the policy of the Veterans’ Bureau with respect to the utilization of contract hospitals and Government institutions. He stated that the Bureau has been for some months endeavoring to take the beneficiaries of the Bureau out of contract institutions and put them into Governmental institutions for several reasons—first, the law says we must utilize to the maximum extent the Government facilities in existence. Another reason is that the majority of contract hospitals are unsatisfactory from the treatment standpoint, if from no other reason, as many of these contract hospitals are purely boarding houses which originated merely for the purpose of making money out of the Government, by taking care of beneficiaries of the Veterans’ Bureau. Of course there are many contract hospitals in which this is not true, but it has been determined that better treatment at least equal cost can be obtained in the Government hospital. Another reason is that the civilian hospital is not particularly interested and does not desire to make the necessary reports. He also mentioned discipline. The contract hospitals do not like to discipline a man because it may lead to the loss of that patient. He stated that every time the Hospital Section of the Medical Division recommends the closing of a contract hospital the Bureau is immediately bombarded by letters from Congressmen, Senators, the American Legion, United Veterans, and other organizations, but the Veterans’ Bureau has been trying to stand firm.
The next subject he took up was the fact that a beneficiary gets more compensation while he is in a hospital. This, however, cannot be changed except by Act of Congress, and the Medical Division has recommended to the Director that the man’s compensation be reduced while he is in the hospital.
He took up next disciplinary regulations. With regard to payment of transportation, he stated that this money could not be deducted from the man’s compensation without Congressional action.
He spoke also on the fact that under the Vocational Rehabilitation Act a man discharged with a disability not connected with the service, who has been denied compensation, can get training even if his disability is the direct result of his own misconduct, and that he is entitled to treatment for any disease contracted while taking training if it interferes with the continuance of his training. The Medical Division recommended some time ago that Section 3 training be discontinued and that no man be given training unless his disability is the result of service or aggravated thereby.
He said he hoped that the gentlemen present would express their opinion as to whether or not meetings similar to this one should be held annually.
With regard to the attitude of the Veterans’ Bureau towards the various Services, he stated that when allegations are made all the Veterans’ Bureau can do is to send them to the Head of the Service, asking him to take the usual steps to find out whether or not those things are true. On the other hand, if there is a charge a man is mistreated, the Veterans’ Bureau must investigate it. It is a very peculiar situation for one Department to investigate something conducted in another Department.
Regarding complaints, he cited one case. A letter was received from an insane man in the west Roxbury Hospital, who signed the letter “All the patients in the hospital”, and complained about everything in the institution. A letter was immediately received from a Congressman, then another, and one from a Senator. The institution had been inspected only ten days previous and the Veterans’ Bureau was sure the allegations were not true, but sent out another man to investigate the matter. Later the Bureau received copies of similar letters which the insane man had sent to President Harding, King George and the Prince of Wales. He mentioned this as an illustration of what the Veterans’ Bureau has to put up with.
Speaking about coordination and cooperation, he mentioned the fact that the Public Health Service is represented in the Veterans’ Bureau by Dr. Guthrie, Dr. Lloyd and Dr. Long, the Navy by Commander Garrison and Commander Boone, and the Army by Colonel Brooke and Colonel Hutton. In this way the Bureau benefits by the advice of these men, and friction between the Departments is avoided.
Another thing he took up was the situation in Arizona. Attempts have recently been made to get the Bureau to put hospitals in two towns, Phoenix and Tucson, both of which he stated were so hot that everybody would have to get out in the summer. There are 431 vacant beds at Prescott, within 400 miles, and in a few months 422 more will be available. Transportation has been offered these men to these hospitals but many have refused to go. He believed that the Veterans’ Bureau could do more than this, but wanted an expression of opinion on the subject.
MR. BURKE: asked for further discussions on the questions raised by Colonel Patterson.
DR. KLAUTZ: stated that he would like to ask Col. Patterson whether the question of furloughs has been taken up in connection with disciplinary regulations.
COLONEL PATTERSON: informed him that length or frequency of furloughs had not been determined, but permission to be absent will be obtained from District Managers under policies issued by the Central Office from time to time. He asked for an expression of opinion on this subject.
DR. KLAUTZ: stated in regard to the situation in Arizona that probably all the hospitals available there were situated in an altitude of 5000 ft.
COL. PATTERSON: informed him that Camp Kearny is lower than this. He stated that the policy of the Veterans’ Bureau in regard to tuberculosis has the backing of the National Tuberculosis Association, and that the men asking for hospitalization had been offered transportation to Kearny or Prescott.
DR. KLAUTZ: offered the suggestion that somewhere in the mountains North of Tucson there might be places which were not too high and would be good all the year round.
COL. PATTERSON: reported that there are already at Prescott 131 vacant beds and within four months will be 432 additional. Why should we go to additional expense when we have these other hospitals?
DR. LONG: took up the subject of the speeding up of patients in hospitals, which is necessary for two reasons—first, in the interest of the man himself, and, second, in the interest of economy. The average man was about 25 years of age when he entered the service, and it should be taken into consideration that his character had not been formed, and that keeping him in a hospital tends to destroy still further his initiative, so the sooner a man gets out of the hospital the better it will be for him. As for economy, it costs about $240 a month to keep a man in a hospital. He stated that dispensaries are now being established in the district and sub-offices, where treatment can be obtained, thus a man should be discharged as soon as he has reached the maximum improvement. He cited the case of Palo Alto, where arrangements had been made with Dr. Wheate that when a man had reached the maximum hospital improvement such further treatment as was needed should be obtained in the out-patient office. In about six weeks the total number of patients was reduced from 540 to 417.
DR. ELLIOTT: took up the question of furloughs, stating that at the Naval Hospital in Washington at Christmas time many Veterans’ Bureau patients asked for leave, and pursuant to advice from the District Manager they were given the same amount of leave that the other Naval patients received, from 5 to 10 days.
DR. DEDMAN: spoke on economy. He said he understood a certain rate per diem was to be established for the care of patients, and wanted to call attention to several things in this connection. First, the environment. Some hospitals have central heating plants; others have stoves. He said that his hospital was an old cantonment hospital, with a unit heating system which required the employment of about 45 stokers.
Another thing, some hospitals Are a great distance from markets; also, prices may be higher. All those things make quite a difference in the average cost of the care of a patient per day.
With regard to General Order 27, he called attention to the clause which gives the Medical Officer in charge the privilege of giving the man his transportation back to his home, and mentioned the case of a man who come to the hospital from Oteen, where he had been discharged for disciplinary reasons. The hospital could not admit him, but authority was obtained from the Veterans’ Bureau to admit him for examination, and, if active, to hospitalize. The man was examined and found to be inactive. He then complained to the American Legion because they did not hospitalize him, and he had no way to get home. However, in this particular case, transportation was later received from the Veterans’ Bureau. General Order 27–A now gives the Medical Officer authority to pay transportation.
He then asked whether a man who had been discharged for disciplinary reasons and was very sick should be hospitalized.
COL. PATTERSON: informed him that General Order 27 has ample authority for emergency cases.
CAPT. BLACKWOOD: expressed his appreciation of the opportunity to attend the conference, and of the great value it had been.
He mentioned the fact that the word “discipline” carries with a feeling of dread. Discipline is purely and simply obedience, and when you have obedience you have discipline. Orders should be issued in such away that no antagonism will be created. He gave an example: In the Naval Hospital the patients are all supposed to stand at attention, if able, when the Commanding Officer comes thru the wards. The Veterans’ Bureau patients objected most seriously to this, so an order was issued that they should sit down, and now you couldn’t make them sit down.
He stated that with regard to the question of absence of a patient over leave for seven days, under G.O. 27 a man can now stay away six days without any action other than minor punishments, which he said is absolutely ridiculous. He thought some other form of punishment, should be devised, as reduction of compensation would not affect many of the patients who are not receiving compensation, and believed the Commanding Officer should be allowed to assign these minor punishments. He did not believe the patient should be discharged, as in that case he would only go to another hospital.
Another thing he suggested, with reference to medical records, was that a skeleton record, at least, of the history of a man’s treatment, his examination and diagnosis, should be made to follow him around from place to place. This would save a great deal of work and give the hospital a line on what has been done for the man in the past.He said patients had been hospitalized anywhere from one to thirty-five times prior to coming to his hospital, and it was impossible to get a history of their previous hospitalization.
HON. CHARLES H. BURKE: I happen to be, as some of you may know, at the head of the Bureau of Indian Affairs.
In listening to the discussion this morning by Mr. Madden and by General Dawes, I have had brought to my notice that there are some things in connection with hospitalization that compare in some respects with some of the things I have to come in contact with in connection with the administration of the affairs of the Indians.
Mr. Madden referred to the politicians and the harm they may do by criticism and comment and so forth. I don’t think he meant when he said politicians, the men who may participate in politics. I think he had in mind these demagogues and agitators and sources of propaganda that are doing more harm in the Government service,—I know it is true of the Indian Bureau,—than anything else or everything else all put together; and I think something of that applies to the hospitalization question. Agitators, I call them. Some of them are perhaps interested in the Indians and in their purposes, supersensitive, possibly. Others have selfish motives that they desire to serve; others are just ordinary trouble makers.
So, in the Indian Service, one of the things that we are handicapped by is this aggregation that I have just described, that are criticizing and finding fault with practically everything that is being done. One of the things that they contend for more than anything else is that the Federal Government, in supervising and administering the affairs of the Indians should, before they put into operation any policy for their uplift and their advancement, have the consent of the Indians. What an absurd proposition! When you contemplate sending your boy to some educational institution, are you going to permit him to dictate and say to you what you shall do, or, when he selects a certain institution and tries it for a few weeks, say that he does not like it and is going to try some other institution? How far would a father get with a son if he permitted him to dictate and dominate the situation?
So it seems to me that this question of hospitalization and caring for the ex-service man is very largely a medical question and it ought to be administered with a view to what will be most productive in rehabilitating and restoring these men to full health; and so it occurred to me that before this meeting adjourns, and because possibly the impression may have been given this morning that the principal question was one of economy, that we should, just for a moment, consider this other question of what can be done and what should be done for the best interests of these ex-service men.It will require regulations; it will require legislation.
If you have not been repaid in the other sessions of this Conference until this forenoon, I think every one of you who has come from some distance will feel that he has been fully compensated in listening to the discussion by General Dawes and Mr. Madden with reference to what the Government, under our present Chief Executive, is endeavoring to accomplish in the matter of administering Government. And so we have this hospitalization proposition and all of the Departments having to deal with that subject. We have this Federal Board of Hospitalization made up of representatives or the heads of these different departments.
Now what I want to ask you gentlemen, and I am talking to you now as experts, as men who are in the field in charge of hospitals, in a position to see this Question from every angle,—what can you do now that will help the situation. This is what I want to bring to your attention: that is, that each and every one of you, through your proper officers, communicate freely and from time to time what you believe ought to be done to strengthen and improve this service; and then, these suggestions coming from every part of the country and all of those different institutions and services will be concentrated and ultimately have consideration by the Federal Board of Hospitalization, and a regulation will be prepared where needed and necessary legislation will be suggested to Congress in the interest of better caring for and administering these different hospitals throughout the United States.
My opinion, gentlemen, is this: that when a man goes into a hospital he is presumed to be ill and should be governed by such regulations and by such control as will best enable him to recover from his disability at the earliest practicable time; and if he ought to have considerable money and if he ought to be permitted to go his way, let him go; but if, on the contrary, he should be required to live within certain reasonable discipline as to his personal conduct, if he should be limited in the amount of money that he should have to spend as he desires he should be limited by you, who are expert and who have no possible thing in mind except the welfare of these men.
Now don’t get the impression that you can get all the legislation that you think perhaps you ought to have. I am not going to speak of the Congress as constituted now, because a person in the administrative side of the Government and in a bureau is not supposed to talk about the Congress and so I am not going to say anything about the present Congress; but up to about six years ago and for a period of many years, I happen to know that there were men in Congress that don’t measure up to what my friend, Mr. Madden, said a member of Congress ought to be.There used to be members of Congress who kept their ears very close to the ground listening constantly for any criticism, for any comment on any part of the Government service, perhaps through a magazine or newspaper; and they rose on the floor in their might to denounce some policy or administrative action on the part of the Government simply because they lacked the courage of their convictions.
Mr. Madden does not come within that class of members of Congress. He is a man who has always been known to have the courage of his convictions. Perhaps the entire body is now made up of that type of members, but such was not the case up to 1915.
These agitators that I have spoken of, these demagogues, have learned what you can do with a scared member of Congress, and we used to say that the thing that emphasized most a scared Congressman was two. We don’t have them I think any more.
My friends, let us hope that Congress is so constituted at the present time, and we will assume that it is, that it will courageously and fearlessly and without any regard as to what the results may be to themselves, rise up and respond to what you gentlemen, through the heads of these various Departments and the Federal Board of Hospitalization may indicate and will enact into law such legislation, and if there are any in the Congress who may have any fears about the results if they do so act, I would say to them they have less to fear by keeping courageous and standing for what is right, regardless of the comment at the time, or the criticism that may come from certain sources.
Gentlemen, I thank you for the privilege of these few words and I hope that all of you and each of you will be generous and diligent in communicating, whenever you have any suggestions to make with reference to bettering this service, in order that they may have the consideration of these co-ordinating Departments that were so ably described this morning by General Dawes. I thank you.
GEN. SAWYER: General Ireland, have you anything to say?
GEN. IRELAND: I don’t believe I have. I think it is time well spent and I trust that there will be further meetings of this kind.
ADMIRAL STITT: I can only repeat what General Ireland has said. I have learned a great deal from this Conference and feel sure that everyone agrees that we should have a similar Conference, possibly every year.
GENERAL CUMMING: I have nothing to say except to express what I know is the appreciation of everybody here to you as Chairman of the Board for having inaugurated such a Conference, and, secondly, I think we owe something to Colonel Forbes as an agent for having brought us all together.
COL. MATTISON, N.H.D.V.S.: I can voice the sentiments just expressed.I expected this meeting to be exceedingly valuable and it is vastly more so than I had ever anticipated. I am very glad indeed to have had this opportunity.
DR. WHITE: I want to express my personal appreciation for having had the opportunity of coming into personal contact with all of you men who are engaged in this work. I have long felt that one of the very great values of a congregation of this sort is that resulting from personal contact with men who are doing the same work.
I have listened to all of the discussions. I don’t know what I have learned, but I feel, as I go back to my desk, that during the coming year I will, in my various decisions, hark back to something that has been said here that will help me solve the questions of the day. The real things that one learns on occasions of this sort it is almost impossible to formulate in one’s mind at the moment but they are always brought up and proven valuable day by day. Thank you very much, gentlemen, for the privilege of meeting you and I am going to ask you to come out to St. Elizabeths and visit with us.
COL. PATTERSON: I have already occupied a great deal of time and so I can only voice the sentiments expressed by the previous gentlemen. I know those of us in the Bureau have learned a great deal and I hope that it will be possible to let us have the benefit of a similar Conference next year. We in the Bureau will be in a much better condition to profit by your suggestions than we are this year and we will know better where we stand than we do at present. Most of us are rather new to the job and are in a very receptive mood.
In passing I would like to tell Captain Blackwood that the new order, G.O. 27, covers most of the things he brought up. Some of the other suggestions as to the way patients got into hospitals I fear will take some time to rectify. We are in the hands of our agents in the field. Many of them are not up to the standard. We hope to rectify that. As far as the hospital question is concerned, I think you understand that the Medical Bureau is with you and I hope you will take to heart what Commissioner Burke has said and give us in writing the benefit of your opinions and send them in through your chiefs. I hope you will give that your attention and let us have the benefit of your advice. We want constructive criticism and we need your help.
GENERAL SAWYER: How many of the Commanders present are accompanied by their wives. Those that are, please stand. (Six stood up) I want to say furthermore that the reception at the White House is at 8:30; entrance by the North Portico. I feel sure that I can predict for you a very pleasant evening.
In summarizing, just in a few words, I would like to give you something of an idea of the impressions that have come to me and I believe that you will agree that they are fair and that you should accept the same impression for yourself.
First, it has been a great delight to me, personally, to meet you Commanders of these various hospitals. I have a very much better idea of the kind of men that are caring for these institutions and wish to say to you that I am more than pleased with the capacity and the efficiency that you demonstrate. Your contact here with each other has helped you very greatly. To me the whole hospital question is visualized in a much broader way. I thought I had a fair conception of what this proposition meant, but I must say I have enlarged my horizon very materially. As for myself I have received an inspiration such as I have never had before to make of this hospitalization subject a matter for consideration and of engagement of a much higher type. With the idea of its immensity, with a better understanding of many of the details and requirements and difficulties, I myself go forth to the undertakings I have before me as the Chief Coordinator of this Board with much more determination than ever before, with an ambition that has never quite possessed me before, so I feel that I myself have been very greatly benefited.
There are some things you will take back with you out of this crowded program. As the days come and go you will have the experience of referring to this Conference as having given you new light and as having given you an assistance you hardly record today.
It is my own wish that we may be able to put in the hands of each of you quite extensive minutes of all of these proceedings. If I can bring that about in the course of a reasonable length of time, you shall be possessed of such a record.
I wish to thank the speakers for conforming so regularly to the suggestion as to time limit. I wish to thank you for the care with which you have prepared your papers and presented them. I wish to thank those of you who have participated in the discussions. I want to express my appreciation of those of you who have listened so intently and apparently with such interest.
I would be unfair to the occasion if I did not express my gratitude for the assistance that has been given us by the nurses in their association with us here.
One thing I would have you do. You are but single representatives of the institutions from which you come.
It would be somewhat selfish if you were to go home and bottle up within yourselves the experiences that you have had here and the observations you have made. Now, fellows, let me tell you what to do: Go back to your various fields. Call in your associates and your assistants, take up your whole administrative family and try to inject into them a little of the enthusiasm, a little of the spirit, a little of the determination; give to them some of the ideas you take away from here.
I want you to go while you are still under the influence of the inspiration of the occasion, and I want to urge that each of you, as soon as you get home, take up with your administrative family the various things that have been discussed here, and try to instill in them the same renewedearnestness and enthusiasm that you possess this evening, and convey to them for us, this Board of Hospitalization and the great President of this United States of America, Warren G. Harding, the assurance that he appreciates every effort that you are putting forth.
Coming from a doctor’s family, he realizes more fully than you can possibly guess the difficulties that are confronting you every day; and be assured that when you act upon your best judgment that you will find him standing by whatever you may have regarded as necessary to the bringing about of the end-results in this war veteran’s case.
Let me emphasize once more that the concern that the Administration has is not how you may entertain them while they are in the hospital, is not how easy and sympathetic you may be with them, but it is how you engender in them a spirit of determination to get back into the world again as productive citizens. That is your job.
In closing, let me say that at the suggestion of Colonel Patterson and the Veterans’ Bureau which we are serving, that we are hoping that somehow before another year shall have passed around that we will have a real place to which we may invite you to participate in the most interesting program that could possibly be produced. Fellows, I thank you for your presence.
COMMANDER BOONE: I am sorry we are not able to raise our glasses to a toast to the Chief Coordinator and the members of the Federal Board of Hospitalization. The least we can do is to stand for a rising vote of appreciation.