November 17, 1921.
Assistant Director, Medical Division,
The Director, U. S. Veterans’ Bureau.
Physical Reconstruction Section.
1. Modern hospital treatment requires that Physical Reconstruction be
established as a part of the hospital program. It is our duty under the
Sweet Bill to render this service to the beneficiaries of the Bureau
while in hospitals and in dispensaries. Such service includes.
(a) Occupational therapy and Pre-Vocational Training.
(b) Physiotherapy, which comprehends directed physical exercise,
Mechanotherapy, Massage, Electrotherapy, Hydrotherapy, etc.
(c) Follow-Up Nursing.
_OCCUPATIONAL THERAPY AND PRE-VOCATIONAL TRAINING_
In order to carry out the work in hospitals of Occupational
Therapy and pre-vocational training it is necessary to have
(a) Personnel.
(b) Equipment.
(c) Expendable material.
(d) Suitable space for work.
(a) It is estimated that it will require 50 additional trade and
industrial teachers, 50 additional commercial or academic
teachers, and 100 occupational aides, making a total of 200,
salaries ranging from $1600 to $2400.
(b) As the new hospitals opened will be receiving men from
smaller hospitals, the equipment that has been used in the small
hospitals may be transferred to the larger ones. It is not
possible to make an accurate estimate as to what additional
material may be needed, as we do not know how much of this can
be secured from other branches of the Government, but in
hospitals numbering less than 200 patients the amount to be
expended for equipment would be relatively small. In the new
hospitals, however, numbering over 200 patients, where
pre-vocational training is desired, a reasonable equipment would
have to be furnished.
(c) As to expendable materials for Occupational Therapy the past
experience has shown that it will amount to $2.00 per month per
man actually at work, and possibly 25 per cent of the entire
hospital population will be doing some work of this character.
I would recommend the approval of the plan in operation in the
Public Health Hospitals for disposing of salable materials made
in Occupational Therapy or trade work, which is that the patient
may make two articles, giving one to the Government to be sold,
and the other retained by himself. The price for which the
articles to be sold should be established by a Board of
Appraisal, appointed by the Medical Officer in Charge, or
Superintendent, the proceeds to be used as a revolving fund for
purchasing supplies for this work, if it is legal—if not, the
proceeds to revert to the Treasury of the United States.
_PHYSIOTHERAPY_
The personnel for this work has been previously authorized to
the extent of 100 physiotherapy aides and 10 Medical Officers in
Physiotherapy. It will be necessary, of course, to have suitable
equipment. This will be recommended by the District Managers and
approved by the Medical Division before a requisition is filled.
There is a small expense for expendable material in
Physiotherapy, which will not amount to more than 50¢ per month
per man for treatments.
_FOLLOW-UP NURSING_
The plan for Follow-Up Nursing has been approved and 300 nurses
have been authorized. These are practically all assigned, and we
are requesting authority for an additional 50 as they may be
needed.
_NATIONAL SOLDIERS’ HOMES_
It is the desire of the Board of Governors of the National
Soldiers’ Homes that the personnel and equipment for the
reconstruction work, including Occupational Therapy,
pre-vocational training, and Physio-Therapy, be furnished by
this Bureau.
_NAVY_
It is desired that the personnel, equipment, and material for
reconstruction service, covering all phases of the work, be
furnished to the Naval Hospitals and detailed there to work
under the direction of the Medical Officer in command.
_ARMY_
It is the desire of the Army Hospitals serving the Veterans’
Bureau patients that they be permitted to operate the entire
reconstruction program for these men, and to submit monthly
statements prorating to the Bureau its proportional part of the
expense incurred in serving the patients, the entire personnel,
supplies, and equipment for these hospitals to be furnished by
the Army, and compensated on the pro rata basis.
_CONTRACT HOSPITALS STATE AND COUNTY INSTITUTIONS_
The Bureau has been furnishing all personnel and equipment for
the work in these hospitals, and this work should be established
in the hospitals where there are 50 or more War Risk patients,
and continued in the smaller hospitals where it is now
established until the number available for this work is reduced
to 20. In all contract hospitals where contracts are to be made
in the future suitable supplies should be required of the
hospital for this work as a part of the minimum standard for
hospital requirements.
_PUBLIC HEALTH HOSPITALS_
Formerly the Public Health Service furnished all personnel and
equipment utilized in Physiotherapy. The personnel utilized in
Occupational Therapy was also furnished by the Public Health
Service but the workers engaged in Pre-Vocational Training were
furnished by the Federal Board.
In view of the consolidation of all three agencies for the care
of the World War Veterans in the U. S. Veterans’ Bureau, the
following relation is recommended between the Public Health
Service and the U. S. Veterans’ Bureau. Physiotherapy Aides, and
Reconstruction Aides used in Occupational Therapy, will be
furnished by the Public Health Service and will be paid by them
from appropriations made from time to time by this Bureau. The
workers and teachers utilized in Pre-Vocational Training in
Public Health Hospitals will be furnished and paid by the U. S.
Veterans’ Bureau. The Aides will work directly under the medical
officers in direct contact with the patient under the general
supervision of the Medical Officer in Charge of the hospital.
The teachers and workers in Pre-Vocational Training will operate
directly under the Educational Director of the hospital, who in
turn will be directly responsible to the Commanding Officer or
Medical Officer in Charge of the Hospital.
_SUPPLIES_
Supplies and equipment for the work in Physiotherapy and
Occupational Therapy and Pre-Vocational Training will be
furnished by the Public Health Service or upon request of the
Public Health Service by the U. S. Veterans’ Bureau.
_SUITABLE SPACE FOR WORK_
It is necessary, in order to carry on the work in Occupational
Therapy and pre-vocational training to have well lighted space,
properly ventilated and heated, suitable situated, and
approximately, ten per cent of the bed space in a hospital.
This, however, does not have to be in a ward, but may be
provided in a separate building.
3. The general outline of the policy is that to serve the men in
Occupational Therapy and pro-vocational training it will require one
teacher for every 20 men at work, or for every 40 men in a hospital,
exclusive of the administrative force, as it is estimated that only 50
per cent will be available for this work. Experience has taught us that,
where there are 50 beds there will be 20 or more men available for this
work, and that in such small groups trade work should not be undertaken,
but in hospitals of 200 beds or more the work should be organized on the
following lines—Occupational Therapy for ward work and pre-vocational
training, to include academic, commercial, agricultural and trade work,
as the survey of the hospital indicates and as the Medical Officer in
charge may approve.
4. In organizing the work in new hospitals a survey of the needs and
facilities shall be made to the Medical Division for approval before the
work is established. When the hospital population has been so reduced in
any unit that it is deemed impracticable by the Medical Division to
continue this work, it may be closed at their direction.
5. It will be necessary to have specially qualified and experienced
individuals in Central Office to be detailed to the Inspection Section
from the Reconstruction Section to make inspections of the work in the
hospitals, and approval for travel authorization and expenses incurred
by this personnel is requested.
Robt. U. Patterson,
Assistant Director,
Medical Division.
Approved: _C. R. Forbes_
Director.