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 veterans totally 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’ Bureau and 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 treatment of 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.
It was not clearly appreciated that the war program for the care of sick
and disabled could, by no means, be converted into an adequate and
satisfactory system of hospitals for the care of sick and disabled
persons under peace conditions. At all events, no money was appropriated
for purposes of constructing hospital facilities until March 4, 1921.
It is highly significant at the present time to note that the needs
foreshadowed in this public document have, since the date of its
publication, been more or less verified by subsequent experiences.
Making due allowances for discrepancies, which might have been expected,
and for developments, which could not have been readily foreseen, it may
be truthfully said that this document indicated quite clearly and more
or less accurately the hospital needs for the care of sick and disabled
ex-service men and women, if these patients were to receive the
character of medical service which, in the judgment of the best medical
minds, was necessary for their restoration to health and which could not
be satisfactorily given in other than suitably constructed institutions.
Leaving aside these considerations, it was apparent that, when the
Public Health Service was charged with responsibility, it was
immediately necessary to meet the urgent demands suddenly created by the
termination of the war.
The Public Health Service, in the manner indicated above, attempted,
therefore, to formulate and put into execution a temporary program for
the purpose of meeting immediate needs, leaving a permanent program to
be developed in accordance with the appropriations and legislation.
Without going into any more detail, it will suffice to state in very
general terms the work which the Public Health Service has done in this
connection and which it is still doing.
Since the inception of the work, it has created a hospital system of
considerable magnitude, and is now operating some 68 hospitals, with a
total bed capacity of over 21,000, and expects, within the more or less
near future, to open additional hospitals and increase present
facilities by something less than 5,000 additional beds.
This Service now has under its care about 13,500 veterans of the World
War in its hospitals. In addition to this, it is also caring for 3,000
to 4,000 Federal beneficiaries, with whose care and treatment it has
long been charged, making a total of nearly 17,000 hospital patients
under its care at the present time.
In the development of this hospital system, the Public Health Service
has divided its hospitals into three large groups, namely; hospitals for
general medical and surgical cases, for cases of tuberculosis, and for
cases of neuropsychiatry. It has been unable to develop this system of
hospitals with the uniformity desirable under the circumstances, and
has, therefore, found difficulty in meeting the needs of those suffering
from neuropsychiatric and tuberculous disorders. This demand, however,
has of late been far more adequately met, especially with regard to
tuberculosis.
In addition to the development of its hospital system, the Public Health
Service, soon after assuming its responsibilities in this work, created
what was designated as the District Supervisors’ organization. The
United States was divided into fourteen districts and, in some large
center of population in each of these districts, there was established a
district headquarters, with a sub-district organization reaching out
even to the individual counties.
This organisation constituted a decentralizing agency, and, as such,
served a most useful and important function, not only in the work of the
Public Health Service, but also in the work of the War Risk Insurance
Bureau. This entire organization, which had grown enormously, was
transferred to the Bureau of War Risk Insurance in April, 1921, with its
complete personnel. It is now operated by the U. S. Veterans’ Bureau as
its decentralizing agency and is still performing a necessary and
important function in the work of that Bureau.
It was also necessary to create a greatly extended purveying service for
supplying the necessary equipment, etc., to the hospital system which
had been inaugurated. The Purveying Service has grown enormously and, at
the present time, is not only purveying to the hospitals of this
Service, but is also rendering assistance to the U. S. Veterans’ Bureau
in purveying for its offices and its medical facilities.
The creation of an Inspection Service also became a necessity, in order
that the hospitals of this Service might be kept under constant
surveillance, and that all complaints might be carefully investigated.
This Inspection Service has now been reduced somewhat, but still is
functioning satisfactorily and has also rendered a great deal of
assistance to the U. S. Veterans’ Bureau in making certain inspections
for that Bureau.
In addition to these matters, the Public Health Service also began the
creation of a large system of out-patient dispensaries for the care of
veterans of the World War and developed this work considerably. Up to
recently, it had in operation some 58 of these dispensaries, many of
them equipped and staffed for all forms of out-patient diagnosis and
treatment.
The development of this dispensary system was a matter of supreme
importance in furnishing the medical examinations of veterans required
for the purpose of establishing their compensation ratings. This entire
Service, as stated, is about to be turned over to the U. S. Veterans’
Bureau and will, in future, be operated by them.
In carrying out all of this work, the Public Health Service has, of
necessity, been obliged to assemble a large personnel. The personnel at
the present time is somewhat less than it has been previously, by reason
of the transfer of certain activities to the U. S. Veterans’ Bureau,
but, with the anticipated opening of many new hospitals and the increase
of its facilities, this personnel must, of necessity, slowly increase.
At the present time, the Public Health Service has in this work about
1,700 medical officers, not including attending specialists. Of these,
about 950 are officers of the Reserve Corps. A Dental Corps has been
created and numbers, at the present time, about 180 dental officers. A
corps of female nurses has been assembled and numbers, at the present
time, about 1,800. A Reconstruction Service has been formed and numbers,
at the present time, about 580 reconstruction aides. A Dietetic Service
has been organized and numbers about 165 trained dietitians. These
figures will give some idea of the large personnel necessary in the
performance of this work.
It is difficult to draw distinctions between the various classes of
personnel, but it may perhaps be said in general terms, at the present
time, that the most difficult qualified personnel to secure is the
medical officer. The Public Health Service was peculiarly fortunate in
assembling a large Reserve Corps. At the close of the war, many medical
men who had been in the military forces were demobilized. Finding
themselves somewhat adrift, and having broken completely old
associations, they were inclined, if opportunity offered, to continue in
the Government service. A special appeal was made to these men by the
Public Health Service and inducements were offered to them to accept
service in the care of disabled discharged veterans. As a result, the
Public Health Service was able to assemble a much larger number of
reserve officers than could have been done under any other
circumstances.
It has been a matter of great difficulty to maintain among these
officers the necessary morale, by reason of the difficult circumstances
and conditions under which they are employed. Having only a limited and
somewhat uncertain tenure of office, with many uncertainties as to their
future, it is worthy of note that they, nevertheless, have, given to the
Government a service which could not easily have been secured from any
other source. They have shown a fine spirit in the performance of this
duty, and, as much as any set of men assembled under such conditions and
circumstances, have delivered a service the quality of which is
comparatively high. The retention of their services seems to me a matter
of importance.
From the inception of this work up to date (Jan. 16, 1922), there have
been cared for in hospital by this Service about 245,000 veterans, who
have been furnished a total of about 12,831,000 hospital relief days.
Also, about 1,945,000 outpatient treatments have been given and a total
of over 1,427,000 medical examinations have been made. Many special
services of various kinds have been rendered. For example; about 175,000
patients have been given dental treatment. Several thousand patients are
being given occupational therapy and several thousand patients given
physiotherapy every week. Prosthetic appliances of various kinds have
been furnished to thousands of patients.
The important matter of medical social service in its hospitals has not
been neglected by the Public Health Service. In cooperation with the
American Red Cross, there has been organized an efficient medical social
service, which has administered to the needs of the discharged disabled
soldiers and sailors. These activities of the American Red Cross have
been supplanted by many other agencies, including the American Legion,
Knights of Columbus, Jewish Welfare Society, and others. All of these
agencies have rendered valuable assistance in the prosecution of this
important phase of the work.
The Public Health Service accepted a share in the responsibility for the
care of discharged and disabled ex-service men, with a full
comprehension of the privilege which had been conferred. It has taken a
pride in attempting to give to disabled ex-service men the very best
service possible. While its ideals have not always been realized, it
has, nevertheless, I believe, always treated the ex-service man with
consideration and given him good professional service. It is my endeavor
that the character of this service shall continue to improve, and I
believe that it does improve constantly. No effort will be spared to
render the very best service possible under the circumstances and
conditions imposed.
Just what the future will hold for the Public Health Service in this
work, it is now impossible to say. It appears, however, that the Public
Health Service for sometime to come will be one of the designated
agencies for furnishing hospital care and treatment to beneficiaries of
the U. S. Veterans’ Bureau. This responsibility of supplying hospital
facilities, with all that is implied, will be as adequately met as
possible. The Public Health Service at the present time is operating a
number of hospitals which, from many standpoints, are not suitable to
the purpose to which they have been put. To attempt to operate hospitals
in unsuitable buildings, unsuitably located, subjects the Public Health
Service to unmerited criticism, but, since these facilities are needed
for a time, it will be necessary to continue such places in operation.
It is not possible, under such circumstances, to render the highest type
of service, but every effort will be made to render the best service
possible.
With the construction which is now going on, under appropriations which
have been made available by Congress, it is anticipated that, in the
more or less near future, it may be possible for the Public Health
Service to close some of its unsuitable plants and open others of a far
more satisfactory character. This will relieve the present situation a
great deal and will do much to obviate the criticism which has been made
against the National Government because it has not supplied suitable
hospital facilities for the care of men who have given so much to their
country.
In conclusion, it seems appropriate to say that the Public Health
Service, in all of this work, has realized fully the necessity for the
most complete and cordial cooperation with other governmental agencies
engaged in it. It has been a firm policy of the Public Health Service to
stimulate an attitude of cooperation on the part of all of its
employees. It is a matter of peculiar satisfaction at this time to say
that the Public Health Service feels that, in the present Director of
the Veterans’ Bureau, it is receiving from him a most cordial support in
this policy of cooperation and the relationships which exist between
these two Bureaus daily grow better, as they must if the work is to be
properly accomplished.
It is also to be noted in this connection that the recent creation of
the Federal Board of Hospitalization has added to the administrative
machinery a piece of co-operating mechanism, which will, undoubtedly, do
much to stabilize and coordinate, as well as standardize, many necessary
things, which, up to this time, have been carried on more or less
independently. A governing body of this character, which can lay down
broad policies, influencing all of the official agencies engaged in this
work, must of necessity be in a position to subserve a very useful
purpose. The sympathetic consideration and support of this body should
have a fine moral effect.”
GENERAL SAWYER: “Representing General Wood we have Colonel Mattison.”
COLONEL MATTISON read the following article prepared by General Wood:
relative to the N.H.D.V.S. and its Relation to the World War Veteran:
“Of all the various agencies utilized by the Federal Government in
caring for disabled men of the World War, the National Home for D.V.S.
is probably the oldest in this line of work, dating back over fifty
years in its care for disabled soldiers. Immediately after the close of
the Civil War, the necessity for some organization of the government to
care for the many thousand disabled soldiers of that war became
apparent, and in 1866, by act of Congress, the National Home for
Disabled Volunteer Soldiers came into existence with a Board of Managers
selected by Congress to carry out the purposes of this Act. Prior to
this, several of the States, civic and benevolent organizations had
taken up the work locally in many parts of the country, but the creation
of a National Board superseded the local work and for quite a number of
years prior to the time that State homes were established by various
States the burden of caring for disabled veterans of the Civil War fell
on the National Military Home.
The first Home established was located at Dayton, Ohio and was known as
the Central Branch, but as the necessities of the question developed,
other branch Homes were established by Congress until at present there
are ten different institutions under the control of the Board of
Managers, scattered from Maine to California. But as the Civil War was
practically a war between sections of the country, all the Homes, with
the exception of the one at Johnson City, Tennessee, are located either
in the North or on the extreme Northern border of the South. For example
the Home at Hampton, Virginia.
Membership in the Home was originally confined to disabled soldiers of
the Civil War, but gradually as the need developed, this privilege was
extended to soldiers of the Mexican War of 1846, the Indian campaigns,
the Spanish American War, and the Philippine service, so that by the
year 1917 when the World War occurred, practically all disabled soldiers
who had served in any of the wars of the Republic, were eligible to
membership in the Home. The high tide of membership in the Home was in
1906 when over twenty one thousand disabled soldiers were members of the
various Branches. After the peak of the load had been reached there was
quite a decided downward curve in membership owing to the advancing
years and heavy death rate among the soldiers of the Civil War, so that
by 1917 the membership had decreased to about thirteen thousand men, and
there were in the various branch Homes many thousand vacant beds, both
in barracks and in hospitals.
In this connection, attention is called to the fact that the Home
functioned in a two fold capacity. It furnished hospital service to the
man who actually needed such attention and it also furnished domiciliary
service to men who were disabled and prevented from taking care of
themselves in the active competition of life but who were not actually
patients. This latter service is called our domiciliary service and is a
service that probably will increase very materially in its scope with
the passage of time, as men who have served in the World War, owing to
disability will find themselves unable to meet the active competition of
the world outside and will therefore need this domiciliary service in a
very acute way.
By the Act of October 6, 1917, eligibility in the Soldiers’ Home was
given to men who had served in the World War, on exactly the same terms
and conditions as it had been given to the veterans of the other wars,
and therefore today the disabled soldiers of the World War stand in
exactly the same position in their rights to care and treatment in the
National Home as does the soldiers of the Civil, or Spanish American
Wars. But few men of the World War had taken advantage of this privilege
prior to the year 1920 when the Sundry Civil Bill for the F. Y. 1921
gave authority to the Director of the Bureau of War Risk Insurance, now
the Director of the U. S. Veterans’ Bureau, to make allotments to the
Board of Managers of the National Military Home for alterations and
improvements of existing facilities to meet the demand of
hospitalization from the Bureau of War Risk Insurance. Such changes were
thought necessary as a large amount of space available was barrack space
which while satisfactory for domiciliary service, was not satisfactory
for hospital service.
Acting in accordance with the desires of Congress, as shown in this
bill, the Board of Managers at once entered upon an energetic campaign
of construction to prepare their plants for this work. Conferences were
held with the Director of the Bureau of War Risk Insurance, and the
statement made by him that the greatest need of the Bureau of War Risk
Insurance at that time was for tuberculosis and neuro-psychiatric beds.
To meet this need, and to grant to the fullest the wish of segregation
on the part of the World War men, two branch Homes were set aside and
their domiciliary and hospital population moved to other branch Homes,
and acting under the advice of the most competent experts, the Board
could find, the branch at Johnson City, Tennessee was changed into a
tuberculosis sanatorium, and the branch at Marion, Indiana was changed
into a neuro-psychiatric sanatorium.
In addition to the complete change of two branch Homes, numerous and
extensive improvements and alterations were made at a majority of the
other Homes so that the fullest cooperation might be given to the Bureau
of War Risk Insurance in its great work, and today outside of the Home
at Hampton, Virginia, and the one at Danville, Illinois, which have been
practically set aside for the older class of veterans, adequate
facilities have been prepared for the hospitalisation of such soldiers
of the World War as may be assigned to them for hospitalization.
But in this connection especial attention must be called to one very
peculiar and unique feature of the service furnished by the National
Military Home, and that is the fact that under the law, the Home must
care for the victims of peace as well as the victims of war and
furthermore, that the gates of any branch Home are open to any disabled
soldier of the World War and that for admission, it is not necessary
that the disabled soldier be sent there by the U. S. Veterans’ Bureau or
any other organization. If he presents himself with his honorable
discharge and the medical examination shows disability, under the law
the Home must take care of him as long as such disability exists, this
whether the disability be one of war or one of peace. To give a concrete
example, if a World War soldier presents himself at any branch Home with
a leg or arm amputated, under the law, the Home must take care of him
whether he lost the limb in the Argonne or in a saw mill, and this
feature is one that I think should be carefully considered because it
leads up to the question spoken of above, of domiciliary care. Now a man
with a leg gone is naturally crippled in the battle of life and cannot
compete on equal terms in almost all professions or trades, but still
when the operation is completed and the wound healed, he does not
require hospital treatment but comes under the domiciliary class, and I
cannot help but feel that there are probably many hundred of cases along
this line of disability which if transferred from the active hospitals
of other branches of the service to the National Military Home for
domiciliary care, will lighten the load very materially of hospitals
where active curative work is being done, and increase the number of
beds available for active hospital work, and at the same time give the
domiciliary case the best of care and attention.
This brief summary of the relation of the National Military Home to
disabled soldiers of the World War, leads one to the inevitable
conclusion that the work of the Home in caring for these disabled
soldiers is one that will increase from year to year and if the results
of the Civil War can be relied upon, the peak in caring for these men
will not be reached for twenty years, possibly thirty would be a more
correct estimate of the time. In other words while it is probable that
the hospital peak will be reached by 1923 or 1924, and then fall off,
the domiciliary load is one that will grow from year to year and become
more and more important as time goes by.
In conclusion, speaking for the National Military Home, I wish to state
that the relations existing between the former head of the Bureau of War
Risk Insurance, Col. R. G. Cholmeley-Jones, and the present Director of
the U. S. Veterans’ Bureau, Col. C. R, Forbes, have in every way been
most pleasant and cooperative and every request made by the Home for
allotments and assistance in this work has been most generously and
promptly met.”
GENERAL SAWYER: “I have pleasure in introducing Dr. A. White, Secretary of
the Board of Hospitalization, who will address you on the subject of
“the Neuro-Psychiatric Case and How to Meet its Requirements”.”