District Manager,
District No. 1,
U. S. Veterans’ Bureau,
101 Milk Street,
Boston, Mass.
Dear Sir:
Referring to General Order No. 26 and to Paragraph No. 2, which reads as
follows:
“All patients now in hospitals in your District, who do not require
further hospital treatment, will be given four days notice to make their
personal arrangements and will then promptly be discharged from
hospital. Each patient discharged under existing Regulations will be
furnished transportation to his bona fide legal residence in the United
States or to the place from which he was hospitalized. Notification of
such discharge will be sent immediately by the Officer in Charge of the
Institution caring for beneficiaries of the U. S. Veterans’ Bureau to
the District Manager of the District in which the institution is
located.”
In complying with these instructions and before authorizing discharge of
patient of the U. S. Veterans’ Bureau from hospital, district Managers
will determine:
1st. Whether the patient is in need of out-patient, dental,
physiotherapy, or other treatment, or convalescent care. If so,
District Managers will make the necessary arrangements to continue
the treatment indicated after discharge of the patient from the
hospital.
2nd. Whether the patient desires vocational training: If so, his
eligibility and feasibility will be determined and arrangements
made for placing him in training promptly upon his discharge from
the hospital.
3rd. Necessary adjustment or readjustment of all matters pertaining to
his compensation will also be completed promptly upon his
discharge from the hospital.
In order to accomplish the above patients of the U. S. Veterans’ Bureau
will not be discharged from hospitals until District Managers have been
notified and the necessary arrangements made by them for the determining
of the above factors upon which the District Managers will approve
discharge and notify the hospital accordingly.
Instructions contained in this communication do not apply to the
Provisions of General Order No. 27, regarding the discharge of patients
for disciplinary reasons.
Very truly yours,
ROBERT U. PATTERSON,
Assistant Director,
U. S. Veterans’ Bureau.
This supplementary letter—perhaps it did not reach you all—was not as
susceptible of misinterpretation as General Order No. 26–A. The needs of
the patients about to be discharged with reference to after-care
out-patient treatment, etc., are not matters which should take long to
determine; feasibility for training is also a matter capable of prompt
determination; eligibility or the right of a patient for training is a
matter that can be handled either before or after a patient’s discharge
has been effected, and the necessary adjustments or re-adjustments of
matters relating to compensation, while necessary of establishment
before discharge from hospital do not require that such patients must
remain in hospital until actually in receipt of compensation. It simply
means that the important steps leading up to this action should be
properly gotten under way, and having done this, the completion of the
compensation status can be as readily carried out after discharge as
before. Notwithstanding the supplementary instructions following General
Order No. 26 still further conflict regarding the application of the two
orders in question in the District offices and in the hospitals was
apparent from reports received in the Central Office, and it was decided
to insert a further explanatory notice in the U. S. Veterans’ Bureau
Field Letter No. 20, of December 24, 1921. This notice was as follows:
Judging from letters that have reached the Bureau, there has been some
confusion with regard to the exact intent expressed in General Orders
Nos. 26 and 26–A.
Rightly interpreted, these orders are in no wise contradictory.
The intent of General Order No. 26–A is fivefold, namely:
(1) To determine the eligibility of claimants for vocational training.
(2) To determine their feasibility for training.
(3) To arrange for training when eligibility and feasibility are
established.
(4) To accomplish everything necessary to adjudicate claims.
(5) Provision for outpatient treatment when required.
“All of these matters ought to be attended to before the patient leaves
the hospital, and with close co-operation and efficient administration,
both in the field and in the Bureau, this can be done, and of course
must be done without keeping the patient in the hospital after his
treatment is completed. Manifestly there is only one way to accomplish
this, and that is, to anticipate the discharge of the patient a
sufficient length of time in advance to provide for these objects.”
“_Feasibility_ of training is to be determined preferably by the Medical
Officer in Charge of the hospital, or his assistant, and means only
that, in his opinion, the patient is physically and mentally fit to
receive vocational training.”
“The other requirements must be met by the Bureau or its field
representatives, but with the co-operation of the hospitals. A
representative will shortly be named at each hospital, who will keep
himself informed of the status of each patient’s claim to the benefits
enumerated and who will follow up all cases in which there may be
delay.”
“Again reminding all concerned that anticipation is the key-note of the
action desired in these General Orders, the hope is expressed that the
objects outlined may be obtained, as nearly as possible, before the
patient is ready to be discharged.”
Any discussion of the instructions of General Order No. 26 and No. 26–A
must take into consideration the reasons which led to the issuance of
those orders. The officials in the U. S. Veterans’ Bureau had been
convinced for sometime that a high percentage of patients were being
cared for in hospitals, and this applies particularly to contract
hospitals, whose necessity for remaining in hospital was not based upon
sound medical reason, and in many instances upon no real medical
indication at all. A number of factors were responsible for this
situation,—the rapid growth and development of the District offices
required the personnel therein to work at high pressure at all times; it
has been a continuous struggle to keep abreast of the volume of incoming
correspondence, with requests for hospitalization, application for
compensation, claimants crowding the doors, and a thousand and one other
subjects. It has been a struggle on the part of the District personnel
to keep from being swamped by the tremendous and ever increasing daily
load. Hospitalization was authorized and carried out both in contract
and Government institutions in cases of all character for treatment
where the indications for such were great and immediate, or were slight
or nil, for ailments, objective and subjective, imaginary and real, for
physical examination and report, for determination of compensability,
and for information concerning the connection with military service of a
claimants disability. The list grew so rapidly that patients were lost
sight of. Many claimants were hospitalized for examination and
treatment, and overlooked after examination and treatment had been
completed. Contract hospitals particularly, through lack of a proper and
direct connection in channels of communication between such hospitals
and the District offices, were carrying patients over long periods of
time. Patients got into contract hospitals for whom no proper
authorization was ever provided, and the records of whom were never
clearly defined in the District offices. The scattering of patients
anywhere from one to a considerable number in several hundred contract
institutions in each District extended the lines of communication
between the Government and the District Offices until it was practically
impossible to keep the contact clear. The Central Office in Washington
felt that it was time to take stock, and stock-taking at almost any time
is an enlightening process. The Director desired to remove claimants
from contract hospitals; he desired further to utilize as much as
possible the existing Government facilities which have been provided for
this purpose.
Under date of September 1st, about the time of the issuance of General
Order No. 26 there were 9,592 patients in _862_ private hospitals; there
were 18,698 patients in _92_ Government hospitals. Today there are
_8924_ patients in 757 contract hospitals and _20339_ patients in _92_
Government hospitals. From these figures it would appear as though the
clearing out of hospitals, as provided for in General Order No. 26, has
not been productive of results. This, however, must be viewed in the
light of what is actually taking place in the field. About the time of
the issuance of General Order No. 26, or a little before, every District
was putting into the field a Clean-up Squad for practically every state,
the function of which Squad was to make contact with all potential
beneficiaries of the U. S. Veterans’ Bureau for the purpose of
establishing claims, of offering hospitalization for examination, for
emergency treatment, and for other situations. These Clean-up Squads
served to feed a considerably increased number of patients of all types
into hospitals. Anticipating that such period of hospitalization would
be brief, they have used contract hospitals because of this fact, and
because of their location in the near or immediate vicinity of the
patients handled. The turnover has thus been largely increased. The
increase of patients in Government hospitals has risen steadily at the
rate of approximately 600 a month until it has reached the figure of
_20339_ patients, as against _18698_ patients in the early part of
September. There has been a slow but gradual decline of patients
hospitalized in contract institutions, notwithstanding the very material
influx into the hospitals by reason of the Clean-up Squads just spoken
of. It might appear to you who are actually caring for patients in your
institutions that notwithstanding the explanation of the meaning of
General Order No. 26 and 26–A, that the holding of a patient in a
hospital until all of the several matters necessary can be taken care
of, will result in undue delay in discharge. This doubtless would be
true if each hospital were required to assemble data called for and make
the other necessary provisions and forward the reports to the District
office to await return and receive transportation before a patient could
be discharged.
In the issuance of General Order No. 26–A and the supplementary
instructions it was contemplated in the Bureau here in Washington that a
representative of the District Manager would be necessary in each
hospital, at least, in those of considerable size, and some distance
away from the District office, in order that direct liaison between the
District Manager and the hospital in question might be maintained, it
being the business of this representative to see that matters of
after-treatment, convalescent care, feasibility for training, and
necessary adjustments of compensation matters will be properly taken
care of prior to the time that it is actually necessary to discharge the
patient. This representative will keep contact with the appropriate
District office and handle transportation for returning a claimant home
or to point of hospitalization. Anticipation on the part of the medical
officers actually taking care of claimants in hospitals, of the needs of
each patient in respect to these necessary details would enable the
District Manager’s representative located in the hospital to carry out
the proper adjustments of these important matters and the patient made
ready for discharge at the proper time without delay. To make effective
the services of the Government hospitals in the functions which they are
carrying out, a thorough understanding of the problems involved is very
necessary and a sympathetic understanding of each other’s problems, as
between the District Managers and Hospitals together with a spirit of
co-operation and fair play is essential to the desired results, if not
an absolute prerequisite to the success of the undertaking.
Many features of our work are, I recognize, trying and a thousand and
one annoyances are a part of each day’s work. Keeping before us at all
times the meaning of the work involved is a great aid to the elimination
of misunderstanding, and personal conferences serve to smooth out and
adjust overlapping of authority. One ex-service man maimed or injured,
replaced into his particular niche of our social fabric should make us
feel appreciative of what our work means, and the knowledge that we are
rebuilding men who have suffered in the service of our country, should
fortify us very strongly against the annoyances and trials which must
sink into insignificance when compared with the work done. I know that
you all realize this and that your every effort and energy is bent to
the accomplishment of the purpose for which we are all working together;
that we are making headway in the proper direction is beyond question;
that we are helping to rebuild the disabled is becoming more apparent as
our work goes along, and we all, I know, are not only proud that we are
having a part in this work, but feel privileged that our services are
helping to bring about these ends.”
Upon the conclusion of Dr. Guthrie’s paper, the subject-matter of the
several papers read during the morning session was thrown open to
discussion, the presiding officer remarking in this connection that full
opportunity would be given to all to freely express themselves. With
reference to the matter of the issuance of so-called conflicting orders,
which had been referred to, he stated that the administration of the
Veterans’ Bureau is regulated by certain laws upon which these orders
were based, and that when such laws are changed, it of course becomes
necessary to revoke certain orders in force at the time. He added that
the matter of hospitalization, thrown suddenly upon the Public Health
Service and the U. S. Veterans’ Bureau is a tremendous undertaking and
that those who carry on this work are entitled to the sympathy of all
good people.
COL. BRATTON: wished to place himself on record as saying that there is
nobody who is in greater sympathy with the wounded soldier, whom he
would like to see receive all that a grateful Government can give, but
that due to the very liberality of the Sweet Bill, cases have crept in
whereby compensation is being received for disabilities in no way
connected with the service. He stated that the Sweet Bill does not
clearly define what the line of duty shall be and that he is amazed at
the number of cases that are being carried along and hospitalized; that
he is of the opinion that the gentlemen in Congress do not realize how
liberal this act is and that men would receive compensation for diseases
which existed prior to their coming into service. He offered the
following motion amending section 300 of the Sweet Bill, to be
incorporated in a resolution to Congress as coming from this body, which
resolution was adopted:
Motion:
RESOLVED, that in considering the question of line of duty, it
should be understood that an officer of the Army or Navy, or an
enlisted man of the Army or Navy, who has been accepted on his first
physical examination after arrival at a military station as fit for
service shall be considered to have contracted in line of duty any
subsequent determined physical disability, unless such disability
shall be shown to be the result of the patient’s own carelessness,
misconduct, or vicious habits at any time, or to have been
contracted while absent from duty without permission, or unless the
history of the case shows unmistakably that the disability existed
prior to entrance into the service.
DR. G. H. YOUNG: stated that it has frequently been a shock to his
sensibilities to see the manner in which compensation has been awarded
to certain ex-service men who are not in any sense deserving; that
assuming John Doe had a disability when he came into the service, it is
now going on four years since his discharge and if such disability was
exaggerated in service he should be compensated just as if he had been
wounded in action; that the question comes up as to how it can be
determined as to whether the exaggeration of his disability arose say
during six weeks, six months or eighteen months of his military service
or in the period of nearly four years which has since elapsed? That he
is of opinion that this applies especially to the in-patienthiatric
cases.
DR. COBB: suggested that general discussion of the other subjects be taken
up and that this very important matter be brought up later.
DR. BREW: referred to the case of a man in hospital with a fracture of the
thumb, which was operated upon with the result that it functioned
properly and the man was not handicapped in the least. After the
operation, which resulted in his total rehabilitation the man was
awarded vocational training and drew $80 a month. He referred to the
case of another man who had been in every hospital he could reach,
obtaining transportation from the Red Cross when he could not otherwise
obtain it; this man was inducted into service at Jefferson Barracks and
had a military service of 28 days, of which 28 days he was in hospital
14 days, and his disability was amoebic dysentery, which he could not
have incurred at Jefferson Barracks; this man was in hospital for 18
months and has been drawing $130 a month for training, which he has been
taking for two years. Dr. Brew also referred to the case of a negro, who
had syphilis before he went into the service; that he is as well as the
average man of his type and is receiving a compensation of $110 a month;
that this man has benefited by his military service because he has had a
line of treatment that he would not have received in civil life.
DR. WHITE: (Speedway Hospital) thought that the matter of allowing the space
of six feet between beds should be adjusted, as this space will greatly
reduce the hospital capacity. He also referred to the matter of rations
for absentees and stated a man may be away a matter of seven days
without leave and asked whether or not the hospital shall charge for
that patient’s rations, as the dietary service must prepare for him
whether he is there or not, and there is always the possibility of his
return the next day; that it also happens that a patient on leave may
return two days before he is expected. He thought that if meals are
prepared they ought to be paid for.
Dr. White also referred to losses of clothing which take place and
thought it was unfortunate that individual lockers were not supplied for
use of patients, as if they were supplied they could be rented to
patients at a nominal cost, thereby relieving the institution of the
custody of the clothing.
The large amount of paper work was also mentioned by Dr. White. He
stated that he understands that when a patient is sent to a hospital he
receives a compensation of $80 a month automatically, in which case he
cannot see the necessity for making additional physical examinations.
With reference to the matter of admissions, transfer and discharges, Dr.
White expressed the opinion that officers should require a patient to
state whether or not he is receiving compensation; that in the matter of
transfers as well as admissions, officers should be required to state in
writing, specifically and distinctly, the reason why they desire cases
transferred. He mentioned one instance wherein it was stated that a
patient had a gunshot wound of the left thigh, and he simply had a scar
to show for it. He thought that officers should be required to state in
writing the hospitalization needed. Dr. White also referred to cases
where it is desired to discharge a man from a hospital for certain
offenses, stating that if this is done, compensation of course would be
stopped and the man will not feel kindly toward the particular hospital
which discharges him. He was of opinion that in such cases a hospital
should be required to terminate its own cases and not dump them off on
other institutions and stated that at the Speedway Hospital there is no
hesitation about reporting such cases as they are found, and if officers
who transfer patients would give specific reasons as to why patients
need hospital treatment, there will not be so many men coming into
hospitals who do not require treatment anywhere.
In regard to G. O. 26, Dr. White inquired as to who is to decide the
feasibility and eligibility of patients who are ready to be discharged,
stating that he had been waiting for a representative of the Veterans’
Bureau to be sent to his hospital empowered and authorized to make
awards of compensation, as if medical officers are expected to do it,
their number will have to be increased; that a man should be sent from
the Veterans’ Bureau to attend to matters relating to training and who
could say definitely to a patient that he can have such and such
training, as it is absolutely necessary to have such a man and if he is
provided it will prevent a large number of complaints.
DR. GUTHRIE: stated that he would like to have some discussion as to whether
the representative referred to by Dr. White should be a medical officer
or a layman; that Dr. White stated that he had expected the arrival of
such a representative for some time, and as the doctor is a
young-looking man, he thought that if he lived long enough he will see
this representative get there.
GEN. SAWYER: mentioned that the Board of Hospitalization has an
understanding with the various Departments and the Veterans’ Bureau that
these things are to be settled by the Vocational Director, who, it is
understood, is to become as quickly as possible a part of the hospital
personnel; that he was of the opinion that the Board of Hospitalization
came to the conclusion that it was not material whether the vocational
representative was a layman or a medical man, but that he personally was
of the opinion that upon the judgment of a medical man a great deal
depends for the answer that is finally given; that he would like to
encourage Dr. White with the thought that the Hospitalization Board has
this matter very definitely in mind in order that the man needed may be
provided.
COL. EVANS: stated that the matter just referred to was a part of the
program had been approved and was now awaiting the signature of the
Director; that the individual designated as Vocational Director in a
hospital will be responsible for contacting the men with regard to their
compensation and their preparation for vocational training; that he will
confer with the medical officers and of course should be directed by
them, but he is responsible for the work.
DR. GUTHRIE: was of the opinion that the location of these men in the
hospitals in connection with the work referred to is most valuable.
DR. DEDMAN: Stated that General Order No. 26 has been a wonderful help. In
connection with the matter of discharged he thought that four days would
be enough, because a man’s discharge can be anticipated and arrangements
made for his vocational training, provided a representative from the
Veterans’ Bureau is furnished. He stated that everyone has the same
ideals as to the restoration to health of these ex-service men but that
this matter cannot function properly and we cannot attain the maximum
for these men unless we do work together in harmony and peace in
hospitals; that when these representatives come, it should be distinctly
understood that they are members of the official family and staff of the
hospital; that these representatives should not be medical men as a
medical board can determine the means and advisability of training, but
that they should be well versed in the subject in order that they may be
competent to judge as to what is best for a certain man to take up.
Dr. Dedman added that difficulty had been experienced in getting men to
leave the hospital. He mentioned the case of a boy who had been admitted
to the hospital with active tuberculosis, who was eventually rated as an
arrested case and told that he had received the maximum benefit, that
this boy did not want to leave the hospital and made a protest to his
Congressman.
DR. COOK: stated that he was going through his hospital one day and met a
big husky and asked him where he worked; that he replied he did not work
but was a patient; that this incident set him to thinking and he got his
discharge board working with the result that he reduced the number of
patients from 910 to 500; that in connection with existing requirements
to the effect that no patient would be discharged from a hospital
without going through a contact man, he was fortunate in having a man
assigned to him from the Veterans’ Bureau and every case of discharge
goes through his hands; that under this arrangement he has no difficulty
in discharging patients.
DR. EVANS: informed the Conference that there was on the Director’s desk a
ruling stating that personnel from the Veterans’ Bureau will be under
the commanding officers on hospitals.
DR. YOUNG: referred to G.O. 26, authorizing discharges from hospitals and
mentioned experiences where difficulty had arisen in this connection due
to the lack of adequate means being provided to enforce such order. He
mentioned cases that had come up where men who had received the maximum
benefit, would state that they were not going to be discharged; that
these cases would generally occur on the eve of a holiday, or on
Saturday night and the men would go into a ward and get into bed. He
believed that in such cases the hospital authorities should be given
some means of enforcing this order by the Veterans’ Bureau, as aid can
not be had from the local police who will not enter upon a Government
reservation; that another way would be through swearing out a warrant,
but as these cases generally occurred on Saturday and a warrant could
not be sworn out until the following Monday, a man is thereby enabled to
stay four days longer.
DR. CHRISTIAN: stated that in his experience the police had not refused to
go upon the reservation and that he has had one of his staff sworn in as
a deputy sheriff; also, that upon the date named in the discharge order
the man affected is not officially in the hospital and is not rated as
present for the purpose of being fed.
Concerning transfers, Dr. Christian mentioned that authority for
transfers has changed a number of times and was of opinion that it would
be advantageous if stations like his could be given blanket authority to
transfer mental cases when they are not prepared to take care of them,
as it would relieve the medical officers of great anxiety and would save
the family of the man a great deal of torture; that this could be
accomplished in a few hours by telephoning to the nearest mental
hospital and receiving an answer in a short time as to whether or not a
bed was available, all of which would expedite the transfer of the
patient; that it is now taking too long to get transfers.
He also stated that he appreciated the importance of the Inspector’s
Department, which is of wonderful benefit to the commanding officers.
With reference to G.O. 26, he thought that the length of time prescribed
is too long, as with the generality of patients who have received the
maximum amount of treatment, it does not make a great deal of difference
as to how much notice they have as to when they are going to be
discharged, as the necessary arrangements can be made in a very short
time without any inconvenience; that there is, however, a certain class
of cases which very often takes advantage of the four days’ notice; that
it has been his experience that when four days’ notice is given it
apparently has no effect on the first day, on the second day the patient
will begin to develop symptoms, on the third day the symptoms are very
much increased and on the 4th day you get a letter from the patient’s
Congressman.
DR. LASCHE: was of the opinion that all the authority needed is given by
G.O. 27 of the Veterans’ Bureau, which gives the medical officer in
charge considerable authority to enforce discipline; that the average
patient, however, chafes under the word “discipline”; that the gentlemen
from the Army and Navy have referred to the advantages of discipline. He
stated that he was on a discharge board for soldiers after they came
home from Europe and frequently heard them say: “Well, by Jove, we are
away from this —— discipline now;” that with all due respect to
discipline that is necessary in Army and Navy organizations, he does not
believe that the same degree of discipline is necessary after these men
become beneficiaries of the Veterans’ Bureau; that in a year’s time he
has only had to apply the provisions of G.O. 27 on one patient who was
A.W.O.L. three times for the period of twenty-four hours or more within
thirty days; that he finally discharged this man, who, however,
subsequently applied for readmission and was successful in obtaining it
within two weeks and all the patients at the institution know that this
man got back after he was discharged.
With reference to the question of Dr. Guthrie as to whether a layman
would serve successfully, Dr. Lasche was of opinion that the layman is
the only desirable person, as the medical man’s function is exclusively
to determine the vocational disability and after this is determined all
the other matters should be left to a layman, as they are more or less
in the nature of an investigation and a layman who is properly selected
would be much better able to run down and ferret out such matters; that
it is important, however, to select a man for this particular function
who has shown an adaptability for research along these lines, and, some
of the men who have been in charge of vocational centers do not possess
the requisite qualifications to decide as to visibility or eligibility
in the matter of vocational training.
DR. T. R. PAYNE: thought that the hospital brand had been placed on a great
many men in cases where it should not have been; that once you get a man
in a hospital he is going to repeat as long as he can. He referred to a
class of so-called gas bronchitis patients and stated that it is well
known that during the war all a man had to do was to say he had been
gassed and receive a wound stripe, and this same man is now coming in to
our hospitals; that the office of The Adjutant General of the Army has
no record of such men being gassed; that he has no chest pathology. He
thought that these men should never have gotten into the hospitals and
should have been handled outside more by psychology than by doctors and
hoped that the dispensaries are going to keep these men out of
hospitals; that there is no doubt in his mind that a great many
neurasthenics should never have gotten into general hospitals; that the
great trouble is the compensation given those men places a premium upon
their hospitalization; that men are in hospital who have been discharged
as having received their maximum hospitalization; that these men have
been taken out of vocational training; that they would rather go back
into hospital and get $80 a month and three meals a day and be
entertained several times a week; that more care must be taken by
doctors regarding the men they send in to hospitals.
GENERAL IRELAND: stated that it has been found that there is no after effect
from gases and that Lieut. Col. Gilchrist, M.C., U.S.A., representing
the Medical Department of the Army in the office of the Chief, Chemical
Warfare Service, has data relative to this subject, which can probably
be obtained by writing him.
DR. LLOYD: offered the following resolution, which, however, was not
adopted:
“That it is the sense of this body that the Federal Board of
Hospitalization recommend to the Director of the Veterans’ Bureau and to
the Surgeon General of the Public Health Service the designation of an
officer of each service to receive special suggestions and
recommendations from the field, criticisms also of instructions
contained in field orders, circular letters and similar communications;
these designated officers to constitute a board for the consideration of
these recommendations, with the view of recommending to the Director the
adoption of such as are believed to be of value.”
DR. CHRISTIAN: offered the following amendment to Dr. Lloyd’s resolution:
“That these officers be detailed to the Veterans’ Bureau for a limited
period, say six months; that they be field officers.”
DR. JOHNSON: moved that the resolution of Dr. Lloyd be laid on the table
indefinitely, which resolution was adopted.
DR. LLOYD: suggested that it would be well to have one man of each service
who could be advised as to what is the matter with certain general
orders and know that such matters will not be pigeon-holed but will
receive action.
COL. BRATTON: was of the opinion that all suggestions relating to
improvement of service should go through the chief of the service. He
stated that no difficulty was experienced in this connection in the Army
and that it seemed to him that the chief of a bureau should know what
was going on.
GEN. IRELAND: stated that contemplated changes affecting the hospitalization
of patients of the Veterans’ Bureau in the Army are always referred to
his office for review before they are issued.
DR. BLISS: thought that there should be a representative of the Veterans’
Bureau in all Government hospitals where there are Veterans’ Bureau
patients, which representative would not have anything to do with the
internal administration of the hospital.
DR. WILLIAMS: with reference to the matter of bed space in hospitals offered
a resolution to the effect that the question of floor space and distance
between beds be reconsidered by the Veterans’ Bureau, with a view to the
revision of the present requirements; that unnecessary bed space is
being provided and it should be cut down; that he believes the allowance
of six feet is necessary in respiratory cases and in infectious cases,
but that in the ordinary general ward he believed that a little less
space would be quite sufficient, as the larger requirement will cut down
the hospital capacity very materially. This resolution was duly
seconded.
DR. BARLOW: With reference to space allowed per patient, thought that there
should be a difference in accordance with the classes of patients; that
he has charge of a hospital for mental cases, and it would be necessary
to arrange for 100 square feet; these men are not suffering from
physical disabilities. He stated that the State Hospitals cannot provide
even fifty square feet of floor space and that it was absolutely
necessary for the Veterans’ Bureau to take out of the State hospitals
every insane patient they have.
DR. BLACKWOOD: concerning the allowance of six feet between beds, asked if
this was not intended to mean six feet between bed centers.
The following motion was adopted:
“That the Federal Board ask the Veterans’ Bureau to reconsider the
question of bed space.”
A motion was offered, which failed of adoption, to the effect that the
Director of the Veterans’ Bureau set aside a certain amount for the
reimbursement of unavoidable losses of property of ex-service men in
hospitals.
DR. KRULISH: was of the opinion that if the foregoing resolution was
adopted, that more trouble would be experienced than before.
It was further brought out that such a motion would carry no weight;
that it was thought the service had this question up once before and the
Comptroller’s office advised that no money arrangements could be made
and it was not believed that the Veterans’ Bureau could make allowance
for losses of clothing.
It was also stated in this connection that in some institutions steel
lockers had been provided, a small deposit being required, which was
given back when the key was returned, under which arrangement very
little clothing was lost.
DR. HETERICK: stated that his institution is equipped with steel lockers and
a small deposit required, which is returned when the patient is
discharged; that the patient is told that due preparation has been made
for taking care of his clothing and it is in his custody; that the
installation of these lockers has reduced the theft of personal property
to a minimum; that some times, however, lockers will be broken into.
The meeting adjourned at 12:30 p.m.
_Fourth Session_ Wednesday, January 18, 1922.
Present: Members of the Federal Board of Hospitalization; also, about
one hundred conferees.
GEN. CUMMING, presiding, called the meeting to order.
DR. WHITE called the roll, and read the following announcement:
“It is requested that, at the first available opportunity, the
following officers confer with Dr. Maddox, “C” Building, Room 1–319,
concerning urgent construction work going on at their stations:
Dr. W. H. Allen, of Boise, Idaho.
Dr. W. C. Billings, of Ellis Island, N.Y.
Dr. R. L. Allen, of Arrowhead Springs, Cal.
Dr. A. P. Chronquest, of West Roxbury, Mass.
Dr. E. R. Marshall, of Detroit, Mich.”
GEN. CUMMING: “This afternoon we are going to consider administrative
policies. The first paper will be “Professional Service,” by Dr.
Lavinder,”