Opening SessionTuesday, January 17, 1922.

At 10:00 A.M. the meeting was called to order by Brigadier-General Charles E. Sawyer.

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

General Sawyer delivered the following address on the subject, “The Present Status of Federal Hospitalization from the Standpoint of the Federal Board.”

“Commanding Officers:

You are here, as your program indicates, by invitation of the Federal Board of Hospitalization. That you may know your host, the following facts are submitted:

The Federal Board of Hospitalization was created by an Executive Order of President Harding. The purpose of the Board is expressed in the Order creating it, which is as follows:

“Circular No. 44.

TREASURY DEPARTMENT,Bureau of the BudgetWASHINGTON

TREASURY DEPARTMENT,

Bureau of the Budget

WASHINGTON

November 1, 1921.

FEDERAL BOARD OF HOSPITALIZATION.

TO THE HEADS OF DEPARTMENTS AND ESTABLISHMENTS:

1. For the purpose of coordinating the separate hospitalization activities of the Medical Department of the Army, the Bureau of Medicine and Surgery of the Navy, the PublicHealth Service, St. Elizabeths’ Hospital, the National Home for Disabled Volunteer Soldiers, the Office of the Commissioner of Indian Affairs, and the United States Veterans’ Bureau, there is hereby organized a Federal Board of Hospitalization.

2. The Board shall be composed of the following officials: An official to be designated by the President, who shall be known as Chief Coordinator and who shall be President of the Board; the Surgeon General of the Army; the Surgeon General of the Navy; the Surgeon General of the Public Health Service; the Superintendent of St. Elizabeths’ Hospital; the President, Board of Managers, National Home for Disabled Volunteer Soldiers; the Commissioner of Indian Affairs; and the Director of the United States Veterans’ Bureau.

3. It shall be the duty of the Board:

(a) To consider all questions relative to the coordination of hospitalization of the departments represented.

(b) To standardize requirements, to expedite the inter-department use of existing Government facilities, to eliminate duplication in the purchase of supplies and the erection of buildings.

(c) To formulate plans designed to knit together in proper coordination the activities of the several departments and establishments, with a view to safeguarding the interests of the Government and to increasing the usefulness and efficiency of the several organizations, and to report to the President thereon.

4. The Chief Coordinator of the Board of Hospitalization shall preside over the Board and be responsible for its efficiency and for developing its activities along practical lines. After a full discussion of any question by the Board, the decision of the Chief Coordinator will be final as to any action to be taken or any policy to be pursued, but any member may appeal from the decisionto his own immediate superior.

By direction of the President:CHARLES G. DAWES,Director of theBureau of the Budget.”

By direction of the President:

CHARLES G. DAWES,Director of theBureau of the Budget.”

CHARLES G. DAWES,

Director of the

Bureau of the Budget.”

From this you will readily see that the extent of the work under the administration of this Board is very far-reaching and is an innovation in Federal Hospitalization activities, for beside being interested in behalf of reasonable economies in administration, the Federal Board of Hospitalization is particularly and especially interested in carrying out the highest ideals of modern hospitalization for the far advanced Veteran.

The President and his administrative family have in mind, as the basic principle of all hospital service, the very best that can be supplied, measured by real end-results.

The Board of Hospitalization represents all of the Departments of the Government directing and controlling the Federal Hospitals of the United States. Each of the Chiefs of these Departments will speak of his particular relation to the subject of Hospitalization as it refers to the World War Veteran, as the program proceeds.

In order that each of you may understand the magnitude of the entire subject of Hospitalization of the World War Veteran, I wish to present the following facts;

Today there are being hospitalized under Government control, in Federal Hospitals, 22,440 World War Veterans, who are distributed among the various Departments as follows:

This does not take into account patients in contract hospitals which now number 9,066. This enumeration demonstrates something of the scope and nature of the work for which the members of the Board of Hospitalization are responsible.

It may interest you to know that there are nowunder construction 7,592 new beds, which will be ready for occupancy within the next few months and that the Government is at present contemplating at least 2,500 more beds under the new Langley Bill, so ultimately the Government will have under its direct administration hospital capacity for a minimum of 32,000 patients, which is estimated to be the peak load.

Heretofore there has been no coordinate plan of operation of these various institutions. Under the Board of Hospitalization all of this has been changed and today, you, whether from the Army, Navy, Public Health Service, National Home for Disabled Volunteer Soldiers or the Department of the Interior are all members of one big professional family, each engaged in the same service, under the same regulations, for the care and treatment of the World War Veteran.

The Hospitals engaged in this service number at present 107, distributed as follows:

These institutions are located in all sections of the United States from the Atlantic to the Pacific and constitute one of the greatest hospitalization propositions within the history of any country.

The personnel engaged represents an Army of almost as many more persons. In other words, Uncle Sam, within himself, is today keeping in operation a hospitalization program incomparable with anything with which former experiences are familiar.

With this representation of the subject and its magnitude, I wish to remind you that each one of you personally and individually is a part of this great machine; and upon you rests the responsibility of the carrying out of such policies as are adopted by the Central Administration.

In order that there might be perfect coordination and cooperation in all of these hospitals and that all institutions serving the World War Veteran might be operated upon a standardized basis, the Board of Hospitalization recently adopted the following regulation as to personnel:

Making a total of 182 employees to every 200 patients, or almost one attendant and assistant to each patient.

This arrangement provides that all patients will have equal care and attention of such a similar type as to guarantee to all classes of patients the best of professional, nurse and domiciliary attention that can be given, no matter in what Department they are being treated.

All of the Departments constituting the Board of Hospitalization are now meeting in joint sessions, wherein they take up in detail all of the matters pertaining to the welfare of the Veteran Hospitalization subject. Out of this consideration there is developing a much better understanding, a more complete system of operation, better conduct and much better end-results.

One of the objects of this conference is that you the better understand by personal contact with each other and with the different phases of the work, what the business of caring for these veterans in its entirety means. We know of course that you each have your special problems, you each have certain affairs within yourselves that keep your attention very much engaged in the things with which you come personally in contact, but we thought it would give you a better impression of the magnitude and importance of the subject if we were to have you here where those who are responsible for the direction of the affairs of Hospitalization could meet you individually.

We want you to know that we are greatly interested in you and the service you are rendering. We wish you to feel assured that your interests are our interests. We wish to impress upon you that the conduct of the affairs under your administration means the reputation and the historical record of the Government’s treatment of the World War veteran.

We are anxious indeed that you should get from this meeting inspiration for better work and encouragement in the efforts that you are putting forth, new ideas with which to meet the great and everchanging propositions which are before you, closer touch with those who, like yourselves, are interested in the World War defenders. This accomplished and each of us will have benefited and the expense of time and money in your coming here will be justified.

Your contact here should make you bigger and broader men. If you will take out of the great opportunities that are presented in the privileges of this meeting, the effects which may be obtained, we are sure that you will go back to your respective fields of service better satisfied, more capable and certainly more determined than ever to render the best service there is within you under all circumstances and conditions.

It seems pertinent that I should impress upon you at this time that no matter what kind of institutions the Government may possess, how well equipped with apparatus, or how pleasing in location, without your interest, without the scientific care and attention which you can provide, without your determination and your loyal support and action in all of the affairs pertaining to the conduct of these institutions, they will fail.

On the other hand, if you will give them the best within you, if you will keep yourselves professionally and administratively in the vanguard of such affairs, if you will go whole-heartedly, persistently and determinedly forward to the carrying out of the highest ideals your constructive visions can invent, the world War Veteran will realize that in his Government he has the care and appreciation of the best Government under the sun.

Allow me to again admonish you that upon you individually and personally rests much of whatever is to come to the present Administration, either in the form of complaint or of eulogy. To the end that it may be eulogy, let there ever abide with you the assurance that the President of the United States and all of his administrative assistants will be with you heart and soul in everything that promotes the interest of the rehabilitation of the World War Veteran. Remember that you owe to your country and to yourselves that you practice economy, that you deal fairly, that you act squarely with all of the propositions which come to you. Do not forget that you should be loyal to the Departments to which you belong, ever obedient to the orders of your Chiefs; that you be faithful, earnest and sincere, honest, conscientious and ever active in behalf of the highest principles connected with the maintenance of the institution with which you are connected and finally that you be ever able to register and substantiate yourselves as American citizens, full of an American spirit, loyal to country and to flag.

If you will do these things, you will have the everlasting gratitude of the President of the United States, you will be entitled to and will receive the econiums of our dear doughboys and above all you will have the satisfying consciousness of a noble duty truly done.

In order that the business of the conference may be transacted expeditiously and effectively, the following rules will be enforced by the presiding officer of each session:

“I have pleasure at this time in introducing to you Colonel Charles R. Forbes, who will speak to you on the ‘Relation of the Veterans’ Bureau to all Hospitalization Activities’.”

COLONEL FORBES: Addressed the conference as follows:

“Upon the signing of the Armistice on November 11, 1918, there was immediately commenced the demobilisation of the armed military and naval forces of the United States, comprising approximately 4,000,000 men and women. As an aftermath of war service from the result of battle wounds, gassing, injuries and disease it was anticipated that there would be a large number of men and women who would be physically disabled, either temporarily or permanently, partially or totally. While it was known with a reasonable degree of accuracy how many there were who has been discharged from the several services on Surgeons’ Certificate of Disability and the number discharged with disability noted at the time of discharge, it was not possible to foretell the magnitude of that considerablebody of men and women who though discharged from the service apparently in good health would subsequently develop a disability traceable to military service. Even at the present time, more than three years after the Armistice it is not possible to state the exact magnitude of the medical problem confronting the United Veterans’ Bureau, since new claims for compensation because of disability are being filed at the rate of approximately 541 per day. As an index however to the magnitude of this problem, gentlemen, let me tell you that to date have been filed more than 762,000 claims for compensation for disability and death incurred in military or naval service. While this total number of claims have not all been allowed, this number does constitute the present potential load for the United States Veterans’ Bureau.

By the original War Risk Act and subsequent acts amendatory thereto,—the United States Government recognized its very great obligation to the ex-service men and women who had become disabled through service, and by these Acts provided not only financial aid to the disabled veterans but also all reasonable medical and surgical treatment and care, whether in a hospital, out-patient office, or at home.

The problem of hospitalization itself soon became of paramount importance. It was initially recognized that, in spite of the meagre governmental hospital facilities then available for the care of beneficiaries of the United States Veterans’ Bureau, it was essential for the best administrative control of veteran patients and for the best professional control over their treatment to place the beneficiaries of the United States Veterans’ Bureau under government supervision in government owned or operated institutions. The carrying out of this policy has been proceeding steadily at a rate commensurate with the rate at which additional government hospital beds have been made available. At no time however has it been possible to discontinue the use to a considerable degree of contract civil institutions. Even at the present time the United States Veterans’ Bureau is utilizing approximately 757 civil institutions for the care of approximately 8,924 of its beneficiaries, and has contracts with a total of 1,524 civil institutions for such care. It is however significant to note while in July 1920 more than fifty percent of Veterans’ Bureau patients were in contract hospitals, on January 1, 1922, but 30 percent of patients were in contract hospitals. Furthermore the number of hospitals being utilized at any time had dropped from approximately 1200 to 757.

The curtailment in the use of private facilities was of course the direct result of increased facilities in government operated hospitals. The United States Government had originally stipulated that the hospitalization of veterans of the World War should be provided for the United States Public Health Service through its Marine hospitals and such other hospitals as it had been authorized toacquire. When however it was discovered that the immediate facilities offered by these hospitals were insufficient to meet the demand for hospitalization, the hospital services of the United states Army, the United States Navy and the National Homes for Volunteer Disabled Soldiers were to a certain extent made available to the United States Veterans’ Bureau.

In March, 1919, the United States Public Health Service was operating but 21 small Marine Hospitals. In order to meet the demand made upon it by the then Bureau of War Risk Insurance, additional hospital facilities were rapidly acquired, so that by November, 1919 there were in operation a total of 38 hospitals with a total bed capacity of approximately 7,625. A year later namely on November 1, 1920 there had been made available a total of 52 hospitals representing 13374 hospital beds. At the present time, January, 1922, there are available 65 United States Public Health Service Hospitals representing approximately 18,200 hospital beds. It is true that due to the necessity of securing with the least possible delay adequate hospital beds, it was necessary to make use of certain Army cantonment hospitals of temporary structure. Hospitals of this type are admittedly unsatisfactory, and it is my earnest desire to close such hospitals just as soon as properly located hospitals of permanent construction are available to take their place.

Although prior to July, 1920, there had been a limited use made of the facilities of the Army, Navy and National Soldiers’ Homes in the case of Veterans’ Bureau patients, it was not until that date and in accordance with provisions of the Sundry Civil Act of the 66th Congress that a systematic and more extensive use of these facilities was proposed. It was perceived that with the general reduction in the Army and Navy personnel a number of large and well equipped government hospitals were not being utilized to their full capacity. The utilization of these facilities would have a two fold result, first, the placing of a larger number of patients under direct government medical supervision, and second, a more pronounced curtailment in the use of contract civil facilities.

In June, 1920, under plans agreed upon by the representatives of the then Bureau of War Risk Insurance and of the several government services there were immediately made available 4181 hospital beds, not including those in operation by the United States Public Health Service divided among the services as follows: Navy Department Hospitals, 1760; War Department Hospitals, 1510; National Soldiers’ Homes, 911. Additional plans contemplated increased facilities by all those services. At the present time, January 1922, in accordance with these plans the following number of beds have been made available by these three services: Navy Department, 3396; War Department, 2917; National Soldiers’ Homes, 3317; Total, 9630.

I have briefly outlined the growth to the present time in government hospital facilities available to the United States Veterans’ Bureau. Combining the figures I have enumerated it is seen that the total number of available government hospital beds has increased during a period of a little more than two years and a half from a few thousand beds in 21 Marine hospitals to a total of 28655 beds in 94 government hospitals.

Let me now outline briefly the growth in our hospital population over this period. In September, 1919 there were recorded a total of 6003 patients of the Bureau of War Risk Insurance, which total had increased by January 1920 to 10907, and by July 1920 to 19,489, averaging over this period a monthly increase in hospital patients of approximately 1225. From July 1920 to January 1922 the hospital population increased from 19,489 to 29,263.

These 29,263 patients are hospitalized to the following extent in the several classes of facilities: United States Public Health Service, 13,874; United States Army, 1530; United States Navy 1473; National Soldiers’ Homes, 2637; St. Elizabeth’s Hospital, Interior Department, 825; Contract Civil Hospitals, 8924. By general class of disease, these patients are divided as follows: Tuberculosis, 11,822; Neuro-psychiatric, 8,414; General medical and Surgical, 9027.

Of the total number of 28,655 government hospital beds available, 20,339 are occupied at the present time, leaving a balance of 8,316 unoccupied hospital beds.

As previously stated, it is the policy of this Bureau wherever practicable, to remove beneficiaries of the Bureau from contract institutions and place them in hospitals operated by the governmental medical services. If it were possible at the present time to fill every vacant government bed by patients in contract hospitals we would still be obliged to continue 608 cases in contract institutions.

An analysis of the vacant government beds shows that they fall under the following category:

An analysis of the patients in contract hospitals shows they are classified as follows:

A review of these two sets of figures shows that although there are apparently ample facilities for the care of general medical and surgical cases, there is a real and serious shortage of government beds for the care of tuberculosis and neuro-psychiatric cases.

In considering the use of government hospital beds at present reported vacant, it is of course entirely impracticable to attempt to accomplish the complete filling up of all government hospitals. As you all realize, this is due to a number of reasons, chief of which are (1) the administrative necessity at all hospitals of maintaining a surplus of beds amounting to from ten to fifteen percent of capacity to allow flexibility in case of epidemic or sudden emergency; and to permit unhampered the routine admission and discharge of patients, (2) the location of vacant beds away from the points of greatest demand, and (3) the fact that the vacant beds available are not of the type required at points where the Bureau needs them.

From an analysis of this whole situation it is believed that we have sufficient beds available for the care of general cases with the exception of two or three areas of the country, such as Memphis, Tennessee, and in the metropolitan district of New York. Some provision must be made to care for cases of a general nature because facilities at these points are totally inadequate. In New York, the existing facilities must be given up by June 1922.

However, the number of general medical and surgical cases requiring treatment will steadily diminish and contract hospitals in many instances would ultimately be able to care for their needs. On the other hand, the Bureau must make provision for the care of tuberculosis and neuro-psychiatric cases for many years to come.

The general medical and surgical cases are a type which justify the use of contract institutions more than the other classes referred to, by reason of the comparatively short length of time that treatment is indicated: emergency conditions which require immediate hospitalization where the patient may be; and the disinclination on the part of claimants to be far from home, especially when a surgical procedure is indicated.

The hospital program of the Veterans’ Bureau is meant to provide approximately 20,500 permanent beds for the treatment of tuberculosis and mental cases. It is estimated that between the present time and the end of 1923 the Veterans’ Bureau will lose the use of approximately 5,400 beds because the hospitals will have to be abandoned by reason of expiration of lease, temporary nature of the structure, or for other cogent reason.

The hospitals being constructed out of the Langley Bill (Act of 4 March 1921) and appropriations for the Public Health Servicemade either by the Secretary of the Treasury or the United States Veterans’ Bureau which will become available during the two years ending with the calendar year of 1923, will only provide 7,198 beds, while during the same period of the time the Bureau will lose 5,397 beds for the reasons already indicated. The ultimate loss of beds by reason of expiration of lease, temporary nature of the structure, etc., will be approximately 4,875 greater than the beds which will be provided as result of construction now going on under existing appropriations.

From careful studies that have been made, it is evident the Bureau will require additional hospital facilities at the following points:

It has recently become apparent that the neuro-psychiatric hospital at Marion, Indiana, operated by the National Home for Volunteer Disabled Soldiers, can only care for nervous and mild mental cases, and is not prepared to handle definitely insane. Development in the future may make it necessary, therefore, to ask for further provision for insane at that or some other point in the country east of the Mississippi River.

Estimating that we will have approximately 2,000 or 2,500 cases in contract institutions for many years, the Bureau is endeavoring to provide for a maximum load of about 32,000 cases, the peak probably being reached in 1922. It is estimated that the general medical and surgical cases will diminish rapidly, but that permanent beds for the treatment of approximately 13,000 tuberculosis, and 9,500 neuro-psychiatric cases must be available.

Gentlemen, I have attempted briefly to outline the growth and the magnitude of our hospitalization program, and have told you roughly what the expectation and needs of the United States Veterans’ Bureau in regard to hospitalization facilities are. It is allsummed up in our earnest endeavor of the United States Government to provide every ex-soldier, sailor, marine or nurse who becomes a beneficiary is the United States Veterans’ Bureau with the best medical treatment available under the best conditions possible. But in spite of our needs for additional governmental hospital facilities, I want to assure you all that to my best knowledge there is not a single veteran of the World War, eligible for treatment and who has applied for hospital treatment, for whom hospital facilities have not been found or who has not been offered hospitalization.”

GENERAL SAWYER:

“Allow me to suggest just one thing. You will notice that on the program there is a time for general discussion of all these subjects, and I wish you would make pencil notes of the things that appeal to you as being of importance enough to be called up during the discussion. We are here really to get out of this all we can, and we want you to feel free to call for any further consideration of these subjects when we get to that hour of discussion.

I have pleasure in introducing Major Merritte W. Ireland, who will address you upon the subject of ‘The Army’s Relation to the hospitalization of the World War Veteran’.”

GENERAL IRELAND:

The treatment provided in our military hospitals for World War soldiers may be summarized in instructions approved by the Secretary of War, which were about as follows: That no member of the military service disabled in line of duty even though not expected to return to duty, would be discharged from the service until he had attained complete recovery or as complete recovery as could be expected he would attain when the nature of his disability was considered. It was laid down, further, that physical reconstruction consisted in the completest form of medical and surgical treatment carried to the point where maximum functional restoration, mental and physical, had been secured. To secure this result the use of work, mental and manual, was required during the convalescent period. This therapeutic measure, in addition to aiding greatly in shortening the convalescent period, retains or arouses mental activities, prevents the state of mind acquired by chronic hospital patients, and enables the patient to be returned to service or to civil life with the fullest realization that he can work in his handicapped state and with habits of industry much encouraged, if not newly formed. Early in 1918, the Secretary of War also authorized the Medical Department to proceed with the scheme for reconstruction of officers and enlisted men of the Army alone without consideration of the other bureaus of the government involved. This reconstruction it was clearly understood would end at the point where the medical reconstruction ceased and the future reconstruction of such cases was to be completed by other agencies of the Government after the individuals had been discharged from the Army.

Patients then were cared for in military hospitals up to the point of maximum functional restoration, both mental and physical. In the case of patients who were ultimately to be discharged from military service, arrangements were made whereby the Federal Board for Vocational Training might have access to these men as soon as it was known that they were to be discharged and the educational officers of the Medical Department were directed to cooperate with the representatives of the Federal Board to the fullest possible extent, in order that the patients concerned might have all the advantages assured them by the Federal Government.

It was recognized that in order to make this program successful for the attainment of the maximum physical and mental condition through complete medical and surgical treatment, it would require the establishment of a policy of extended publicity. This embraced the necessity to educate the public to the need of this physical reconstruction for the disabled men before their return to civil life; to educate the family of the soldier with regard to the need of continued treatment that they might be satisfied to have them remain in hospital, and finally, to educate the soldier himself by placing in his hands at the earliest possible moment after his disability had been incurred the necessary literature which would inform him of his status as a soldier and of the privileges, which were to be his as a disabled man, from the Medical Department of the Army, the Federal Board for Vocational Education, the Bureau of War Risk Insurance, and also to place in his hands such literature as would inform him of facts concerning various trades from which he might choose a vocation, together with all the information in regard to the need for men in the various industries of the country.

As above outlined this policy of treatment was carried out. At the approved time for the discharge of the patients from the military service, they at once became beneficiaries of the Bureau of War Risk Insurance and subject to further physical reconstruction or education, if such were necessary, under the direction of the Federal Board, Public Health Service or the Bureau of War Risk Insurance.

Such facilities as were in our hospitals and were not required for the care of the sick of the active list of our army were placed at the disposal of the discharged veterans of the World War. This was done mainly in two ways: first, by turning over to the Public Health Service which was charged with the medical work of the Federal Board, many complete hospitals and second, by caring for many of the veterans in our own hospitals after their proper discharge from the service.

By virtue of Act of Congress in March, 1919, every militaryhospital, including its supplies, no longer required for the proper care of the sick in the military service was to be turned over to the Public Health Service if the latter service so desired. A detailed classified list of hospitals approximating 2,460 beds turned over under this law follows:

1. Indicates buildings constructed by the Army on leased ground.

2. General Hospital No. 17 was closed as an Army hospital on March 27, 1919, the Public Health Service having stated that it did not desire this hospital. Later on, however, this hospital was taken over by the Public Health Service.

Hospitals abandoned by the Medical Department, U. S. Army, and available to the Public Health Service, but not occupied by that Service because they were not located where additional hospitalization was needed.

In addition to the foregoing the following permanent military posts have been recently acquired by the Public Health Service from the Army:

“Now, with reference to assistance rendered within our own hospitals, in an interview with the Director of the War Risk Insurance in 1919, I heard the former Secretary of War say that he considered it an obligation on the Army to assist in caring for the discharged World War veterans and that any vacant bed in Army hospitals was always available for the treatment of these men. To carry out this policy, the Bureau of War Risk and later the Veterans’ Bureau was from time to time advised by the Medical Department of the number of available beds in our hospitals in which we could accept for treatment veterans of theWorld War. The number of beds thus offered has varied slightly from time to time, but has always been on the increase, particularly since last July. Last May 1450 beds were available to the Veterans’ Bureau; in October 1752 beds were available, and by November 24th 2200 beds were available. The following brief table gives the exact status on January 5, 1922:

Within a few days we expect to open up several hundred beds at Fitzsimmons General Hospital for veterans suffering from tuberculosis. This last large increase has been made possible by funds transferred by the Veterans’ Bureau to the War Department for the specific purpose of enlarging this hospital. When the construction and alteration made possible by these funds has been completed (and the completion is expected almost daily) 700 additional beds for the tuberculosis will have been provided in permanent structures for a little over $1000 per bed.

In addition to the buildings turned over to the Public Health, which have already been enumerated, the Medical Department has turned over to that Service supplies approximating a value of $12,336,000.00. It has been a source of gratification to the Medical Department, and I am sure to the War Department, that the Army was in a position to assist in rendering aid to the American soldier disabled in the World War.

The total number of all cases treated in our general hospitals during the last year was approximately 30,000; of these 10,000 were local cases and 20,000 were general cases, and of the latter 15,700 were our own and 4300 pertained to the Veterans’ Bureau.

A brief summary of the Veterans’ Bureau cases treated in our hospitals may be of interest. Of the 4,300 cases treated during the year (October 1, 1920, to October 1, 1921) 180, or about 4% were suffering from either nervous or mental conditions; 2195 or about 51% with tuberculosis; 770, or about 18% with diseases or injuries of the osseous system; 75, or nearly 2% with heart or vascular diseases, and the remaining 25% was made up of all other conditions combined.

In addition to this work, much assistance has been rendered in making physical examinations for that Bureau to determine the right to compensation or the necessity for hospitalization. Over 2,000 of these examinations were made during the year, many of which necessitated admission to hospital for varying periods to permit a thorough survey in order that correct diagnosis or physical condition might be established.”

GENERAL SAWYER: “I am sure it must be gratifying to you to obtain a more intimate knowledge of the conduct of these affairs. I have pleasure in introducing to you Rear Admiral Edward R. Stitt, Surgeon General of the United States Navy, who will inform you as to ‘The Navy’s Part in the Hospitalization of the World War Veterans’.”

ADMIRAL STITT:

“The Medical Department of the Navy has been able to work with the Veterans’ Bureau along the following lines:

First: the turning over to the Public Health Service for the care of the Veterans of the World War of the Naval hospitals at Philadelphia, Pa., Cape May, N.J., Gulfport, Miss., and New Orleans, La. and quite recently to the Veterans’ Bureau itself of the hospital at Fort Lyon, Colo. used for tuberculosis patients. These institutions were completely equipped when transferred, so that no additional expense was involved. The hospital for tuberculous patients at Fort Lyon has been operated by naval personnel since November first, but this institution will be taken over by the Public Health Service on March 1st. With the great reduction in naval personnel and the discharge from the service of large numbers of the tuberculous, the needs of the Navy did not seem to justify the maintenance by the Navy of so large a hospital, there being at present 735 beds with possibilities of expansion. Upon his return from a recent inspection the Surgeon General of the Public Health Service expressed to me his admiration for the institution. We should not have been able to turn over this hospital had it not been for the generous offer of the Surgeon General of the Army to take care of the naval tuberculous at the Fitzsimmons General Hospital at Denver. The bed capacity of these five hospitals totaled 2229.

Second: The caring for the veteran patients in the same hospitals in which the sick of the Navy are being treated. In assigning accommodations to the patients of the Veterans’ Bureau there aremany problem which complicate this matter. Manifestly it is necessary for the Navy to be prepared to receive the patients from its own personnel, and when it is considered that the fleet may at one time be in the port of New York and sending its sick to the New York Hospital during such time and then sail away for another port to then transfer its sick to another hospital the difficulties are apparent. If we could divide the ships between different ports and their sick between different hospitals the matter would be easy of adjustment.

Again we have only a limited number of beds in our three hospitals on the Pacific Coast and at the present time a large fleet is based on this station so that we are unable to offer accommodations in those hospitals to the Veterans’ Bureau and at the same time make adequate provision for the naval sick.

As a general rule we are only able to provide hospital facilities for general medical and surgical cases, but much of our work is in studying cases of suspected tuberculosis and where a positive diagnosis is made the determination of the extent of the process.

At Great Lakes, Ill. owing to the urgent needs of this section of the country, we have agreed to care for approximately 300 neuropsychiatric patients, this in addition to 300 beds for general patients. In order to obtain medical personnel trained in the supervision of such cases it was necessary to withdraw our psychiatric specialists from various stations where their services were needed, but it was felt that this was a greater need. To provide for additional men trained in this specialty we now have a number of young medical officers under training at St. Elizabeths Hospital.

The Navy is not only indebted to Doctor White for this service but it owes him obligations for his many years of instruction to the classes at our Naval Medical School. At the present time there are under consideration plans for the establishment under Doctor White of a school for the training of psychiatric personnel for other services caring for veterans, taking advantage of the abundant clinical material at St. Elizabeths.

At our hospital at Chelsea, Mass., we have been able to offer 539 beds to the Veterans’ Bureau and from the letters I receive, as well as from a personal inspection, I can attest the care that is there being given our veterans.

The Navy is particularly proud of its good food and I think our hospitals lead the Navy in this important service, which not only makes for contentment but aids convalescence. We have just agreed to receive the patients from the Polyclinic Hospital of New York and expect in a short time to be caring for approximately 350 patients in the naval hospital located in Brooklyn. We are very proud of the physio-therapy installation at this hospital, which has been pronounced by experts as one of the most complete equipments in the country.

In our hospital in Washington we are offering 250 beds. In this institution we are peculiarly well equipped for the diagnosis and treatment of obscure cases by reason of its association with the laboratories of the Naval Medical School. These naval hospitals are geographically so situated that large numbers of patients can be treated near their homes. Although most of our hospitals in our island possessions are small yet we can take care of a limited number of veterans who might be in such localities.

The mental environment at these hospitals is admirable from a standpoint of cheerfulness, amusement and when indicated occupational recreation, our rule has been so far as possible to treat veterans and sailors alike. To the Red Cross we owe much of the measures for contentment among the patients, although we also owe obligations to the morale division of the Navy Department for assistance along the lines of recreational and educational opportunities, especially as regards well conducted libraries. The number of beds now available in our hospitals approximates 2900. Adding the 2229 beds transferred to the Public Health Service makes approximately 5172.

THIRDIn the transfer to other agencies caring for veterans of hospital supplies and equipment. As noted previously we have turned over not only the beds of five hospitals but in addition surgical, X-Ray, laboratory and other facilities as well as store rooms full of varied supplies. In addition we have from time to time given various medical and surgical supplies. I may state that we are now turning over to the Public Health Service $1,375.00 worth of stock from our Supply Depot and stand ready to transfer another million dollars worth of medical stores when called for.

FOURTHOn board ship and at our various stations medical officers have examined claimants by the thousands, assisted them in making their applications and aided them with advice.

In the Bureau of Medicine and Surgery one of our most important activities is in supplying data to the Veterans’ Bureau for use in the adjudication of claims for compensation. The reports at present are more comprehensive than formerly made, and include in addition to the name, rank or rate and claim number, the date and place of birth, enlistment, discharge or release to inactive duty, together with a detailed medical history. The maximum number of reports sent out by the Bureau has been 250 in a day with an average daily completion of about 100 cases. At present we are up to date in answering claims. Notwithstanding the reduction of the clerical force in some divisions to the point of extinction of the activity in the effort to make the furnishing of records to the Veterans’ Bureau our first consideration we should have been far behind in furnishing records had it not been for the hearty and willing cooperation of the Veterans’ Bureau in assigning clerks from their ownforces to assist in this most important and imperative work.

Where by reason of law or otherwise we have been unable adequately to provide for the veterans either in personnel or material Colonel Forbes has ever stood by to give us hearty cooperation and assistance. I am also indebted to General Sawyer, the Chief Coordinator of the Hospitalization Board for encouragement and advice whenever asked of him.

In reciting the activities of the Navy in providing hospital care for veterans, I trust it has become apparent that I have the honor to represent an organization, equipped to aid the Veterans’ Bureau in fulfilling the pledges of our government to its veterans, disabled in the Great War, and manned by a personnel actuated in all ranks by an earnest desire to contribute in the discharge of our obligations.”

GENERAL SAWYER: “I do not know exactly what impression you get from this information that is given out here by the heads of these great departments, but to me it seems that here is a spirit, a whole-souled determination to put everything at the command of the Government at your service to help you, that we may help the World War Veteran to the best that can be given. The recitation of these things by this Admiral and this Major General shows how much really comes through a closer affiliation,—how much we get that is worth the while from a better understanding; and that is what we really believe we have in this new Board of Hospitalization.

We have with us this morning the man who has been personally responsible for the largest number of these patients; in fact, he is responsible for more of these patients than all of the rest of the departments together; and if you do not know him, I should like to introduce to you a man whom I have found, by close contact and personal observation during the months I have been in Washington, to be a man who is giving everything within him to make of the Public Health Service of the United States of America the best Public Health Service in the world and to give to the World War veteran the best hospitalisation service that can be rendered.

I have pleasure in introducing to you Surgeon General Hugh S. Cumming, of the United States Public Health Service, who will speak on the subject of “The Service Rendered World War Veterans by the Public Health Service.”

GENERAL CUMMING:

In presenting even a brief outline of the services which have been rendered, and are being rendered, to disabled veterans of the World War by the Public Health Service, it is necessary, for a proper comprehension of the subject, to state, at least in general terms, the genesis of the relationships which the Public Health Service has sustained, and now sustains, to this very important responsibility.

The Congress, before the close of the war, had given consideration to a comprehensive plan for the care of disabled veteranstotally unlike the previously existing pension systems, and had passed legislation putting into effect this program.

In doing so, use was made of existing agencies rather than the creation of new ones. Among these existing agencies was the U. S. Public Health Service. This Service, on March 3, 1919, was given authority to furnish medical care and treatment to veterans, acting in this capacity as an agency of the War Risk Insurance Bureau. The Director of that Bureau was charged with the real responsibility, but was permitted, under the legislation, to make use of the Public Health Service in discharging his responsibility with regard to medical care and treatment.

Peace having come unexpectedly and demobilisation following shortly thereafter, the problem of the care for the disabled veteran became at once very pressing. The Public Health Service had under its control only a few hospitals, with a total bed capacity of about 1,500. The Director of the War Risk Insurance Bureau looked to the Public Health Service to supply him with the necessary medical services, and the Public Health Service, therefore, found itself faced with the task of supplying, in a short space of time, an extensive system of medical relief.

It undertook this problem and, under the legislation, sought to meet the responsibility in several ways. By the transfer to its jurisdiction of facilities used by the Army and Navy during the war, by the purchase of such facilities as were available and within the moderate appropriation, by the leasing of fairly suitable places and their conversion to hospital purposes, and by making contracts with civilian hospitals all over the United States for the care of veterans, this Service was able to furnish facilities with rapidity. These facilities were by no means always desirable, but at least it may be said that the Public Health Service was enabled to keep pace with the demand and to supply to all veterans who applied some form of hospital care and treatment.

The administrative organization, which had been formed under the law, for the care of veterans, included three bureaus, namely; the Bureau of War Risk Insurance, the Federal Board for Vocational Education, and the Public Health Service. This organisation, while it was the best that could be formed under the circumstances, left a good deal to be desired, and was the cause of much criticism and no little dissatisfaction.

Matters became so urgent finally that, under the President’s direction, certain changes were made, and later, by act of Congress, even more radical changes were made, all with the ultimate tendency of concentrating in one organisation the entire responsibility for all matters affecting veterans of the World War. This culminated in the passage of legislation creating the U. S. Veterans’ Bureauand charging that Bureau with the full responsibility for all matters affecting veterans. (Aug. 19, 1921.)

In the legislation creating this Bureau, however, the Director of the Newly created Bureau was authorized, in giving hospital care and treatment to his beneficiaries, to make use of certain official agencies, and among these the Public Health Service, which at that time was carrying most of the medical work for veterans, and in fact this Service is still supplying by far the largest number of hospital beds for their care.

Under this new legislation, adjustments were made as rapidly as possible, and are still going on, with the result that the present situation of the Public Health Service in this responsibility is fairly clearly defined for the first time since it has undertaken this work.

The U. S. Veterans’ Bureau has now taken over, or will shortly take over, from the Public Health Service all of the responsibility and all of the work involved, with the exception of the operation of hospitals. The work taken over by the U. S. Veterans’ Bureau includes the entire responsibility for the operation of all outpatient departments for the care of veterans. Thus the Public Health Service is now left simply as a hospitalizing agency for the use of the Director of the Veterans’ Bureau.

The Public Health Service, therefore, stands in the same relationship to this work as other official agencies, namely; the National Homes for Volunteer Soldiers, the Army, the Navy, and St. Elizabeth’s Hospital of the Interior Department. That is to say; it operates independently a system of hospitals for the use of the Director of the Veterans’ Bureau in the care of his beneficiaries. It has no responsibility with regard to meeting the demands for hospital facilities and it has no responsibility with regard to the distribution of patients to those hospitals. Its responsibility is limited simply to the operation of such hospitals as the Director desires, and, to the admission of such patients as he may desire to send to the same.

When the Public Health Service was suddenly charged with the large and important responsibility for supplying medical care and treatment to veterans of the World War, it proceeded at once to organize, on a commensurate scale, to meet a problem the character of which was unknown and the magnitude of which could only be surmised.

The first and greatest problem faced by the Public Health Service was, of course, to determine as soon as possible the character and the magnitude of this problem. In conjunction with the War Risk Insurance Bureau, there was compiled and finally published a public document (481 of the 66th Congress, December 5, 1919). In this document, this entire problem was analyzed, and certain very definite conclusions were stated as to the need for medical and surgical facilities for the proper care and treatmentof discharged disabled veterans.

It is unnecessary at this time to attempt any analysis of this document, but it is worthy of some comment. It indicated that within two years from the date of its publication there would be needed for patients of the War Risk Insurance Bureau 7,200 beds for general medical and surgical cases, 12,400 beds for tuberculous cases, and 11,060 for neuropsychiatry cases, making a total of 30,660 beds.

Recommendations in this document were made for the expenditure of a large sum of money for necessary construction, and a draft of a bill was offered which would appropriate the money for this purpose. The bill contemplated that this money should be expended in annual installments, extending over a period ending June 30, 1923. This document also indicated that the peak of the load, at least for neuropsychiatric and tuberculous disorders, would not be reached for some years.

The conclusions reached in this document were the subjects of a good deal of criticism. It was rather generally felt that the facilities which had been provided during the war for the medical care and treatment of soldiers and sailors could be made use of very readily and very satisfactorily in the care of discharged disabled soldiers and sailors at the termination of the war.

Back to Index Next