January 1, 1922.
───────────────────────────────────────────────────────────────────────
Assigned Enrolled Percentage
Dist. Number of Number War Risk to in of Avail.
Institutions of Staff Patients Classes Classes Patients
Enrolled
───────────────────────────────────────────────────────────────────────
1 7 30 1443 652 429 66
2 11 50 2282 926 782 84
3 7 16 819 344 257 75
4 9 61 2538 1228 846 68
5 8 66 3846 2053 1394 68
6 4 18 1185 563 452 80
7 19 49 2309 916 753 82
8 15 52 1631 914 711 78
9 5 12 303 260 239 92
10 11 33 1432 707 521 74
11 2 19 1577 617 341 35
12 15 55 2646 1117 725 65
13 3 9 649 172 138 81
14 1 13 942 442 300 70
───────────────────────────────────────────────────────────────────────
Grand 117 483 23602 10911 7888 72
Total:
ADMIRAL STITT: reminded the men that at the meeting yesterday afternoon a
motion was made to discuss the paper on the “The Social Service Worker”
this morning, and there were about 25 minutes for the discussion of each
of the four subjects—the social service worker, disciplinary
regulations, relation of district managers, and physiotherapy and
occupational therapy in hospitals.
CAPT. BLACKWOOD: said it was his opinion that the social service worker has
done more to aid the Commanding Officer and to follow up the work on the
ex-service man, as well as the service man, than anything else he knew
of that has been introduced into the hospitals. The social service work
in the Navy is all done by the Red Cross, one of the most wonderful
organizations in the United States for doing good.
SURGEON CHRONQUEST emphasized the point that diversion and recreation should
be distinguished from the social service, with which it is so often
linked.
SURGEON LASCHE: stated that at first he was sceptical about the introduction
of people under extraneous control into the hospital, but that he
incorporated the Red Cross into the official organization of the
hospital and made the director a member of the staff. He believed in
keeping a fairly close supervision over the activities until he knew the
individual, and made a rule that the social worker should send a carbon
of every letter written about the patients to the officer in charge. It
was found that at the beginning there was no possible reason for about
30% of the letters written, but only one-half of one percent of the
letters produced harmful results. He said he was inclined to think that
owing to the fact that the Red Cross has the benefit of a nation-wide
organization that for the present it is very much better to utilize
their services than to establish government employees to do the same
work.
COL. BRATTON: said that experience had shown him that the Red Cross is a
great aid in carrying on relation to the outside world. He told of the
situation in Atlanta. When the hospital was established he found it
would be necessary to satisfy the people of Atlanta that the wounded
boys were being properly taken care of, and was fortunate to secure the
services of a first-class man from the Red Cross. The result was that
the people became very interested in the work and sent committees with
food, also provided pictures two or three times a week and all kinds of
entertainment.
SURGEON PAYNE stated that one of the greatest difficulties he had
experienced had been in sidetracking the people who, though kindly
disposed, brought food and all kinds of entertainment which were
injurious to the patients. He said he did not believe in any kind of
athletics in a hospital, unless under the Physiotherapy Department,
neither did he believe in dances in a hospital. He said people would
bring in all kinds of food and the patients would eat it before going to
mess, and then of course would complain of the hospital food furnished.
The greatest benefit from the Red Cross had been the coordination of
those activities.
COL. BRATTON asked that some of the men who served in General Hospital #6
speak on this subject.
SURGEON WILLHITE: stated he had served under Colonel Bratton, and agreed
heartily with all he had said. He stated also that in his work in the
hospital in Philadelphia the Red Cross had done the finest kind of
social service work, coordinating all the agencies that Dr. Payne spoke
of as so detrimental to him, and he believed had been a very great
benefit rather than a hindrance.
Dr. Dedman took up the work of the Red Cross in taking care of relatives
of patients who come to the hospital. Often these people spend all their
money for railroad fare, and have none left when they reach the
hospital, and the hospital has to take care of them. He said he had
arranged that four or five rooms be fixed up for such people as this and
believed some definite authority should be had from the Veterans’ Bureau
to house these people and furnish their meals. He stated that some boys
will ask for things and others will not. He referred to an instance in
which a patient had told a lady that he needed a shirt, and two days
later when she brought him one she gave it to him before the whole ward
and the boy was ridiculed for a long time afterward. He had had trouble
in getting the work done through the social welfare workers in the
hospital, as the public wants the individual glory of handing something
to the boys themselves. The Red Cross has also been a great aid in
investigating home conditions of the patients, especially of tubercular
patients who want to go home to die. Also, in the case of a man who asks
for a long furlough because his mother or sister is dying, the Red Cross
will investigate and get an immediate report, and many times it will be
found that the mother or sister is not sick at all.
SURGEON PAYNE: stated that he did not want to be misunderstood, that he did
not mean to take credit away from the Red Cross.
LIEUT. BOONE: stated that the discussions had gone afield, that real social
service work is summed up in four or five heads—securing social
histories and other data for the use of tuberculosis specialists and
psychiatrists, securing reports on home conditions for help of
physicians in deciding whether or not to discharge a patient to his
home, corresponding with home communities to adjust home situations,
thereby making it possible for patients to remain in hospitals, and
arranging through local communities for men who return home to have
proper care and assistance in adjusting themselves to civilian life. He
believed a great deal of this entertainment work should be separated
from social service.
ADMIRAL STITT stated that the question had been considered by the Federal
Board of Hospitalization, and it had been recognized that only the Red
Cross has this tremendous machinery and it was considered that the Red
Cross is the proper agency and organization to take care of that sort of
thing. The Red Cross should coordinate and control these outside
agencies. He announced that the next discussion would be on
“Disciplinary Regulations”.
DR. KLAUTZ took up first that in tubercular institutions the rules must
always be stricter than in the general government hospital. He
emphasized the fact that tuberculosis in a civilian is the same as in an
ex-service man, that the same methods of procedure must be applied in
treatment, and that the patient must recognize the importance of
discipline in the tuberculosis hospital.
SURGEON DEDMAN stated he had taken part in the compilation of General Order
#27, and that he found one flaw in it now. This was the clause about
giving a man his transportation. He believed that a man would soon get
restless and if he could get his transportation home against medical
advice many of these men would get some wonderful home trips. He said
this would make it one of the hardest things on earth to keep sick men
in bed. He said the only way for this to be done would be to deduct the
transportation from the man’s compensation. He stated that General Order
27 had put Commanding Officers where they could sleep at night, that
before there was simply turmoil and strife, like the boy in France whose
wife, every time she wrote to him, nagged him, and he of course was
never anxious to get her letters. Finally he wrote to her “Dear
Maggie—Received your last letter. For God’s sake don’t write me any
more. Let me fight this war in peace!.”
DR.LLOYD: referring to Dr. Dedman’s complaint, stated that in the case of a
man discharged for disciplinary reasons the man would not have the means
to get home, and the community would have to take care of him, that it
was a choice between two evils. In the case of a man who goes home
against medical advice, if his transportation were not paid he would
just do something and get fired for disciplinary reasons. He asked for
some further discussions on the matter of patients being sent back to a
hospital when they ought not to be.
SURGEON MILLER: referring to General Order 27, stated that in his hospital
the patients were willing to pay their own transportation, and would go
whether it was paid or not.
ADMIRAL STITT: asked that those who wished to present resolutions be writing
them.
DR. GUTHRIE: requested that the medical officers who have complaints in
regard to General Order 27 and do not have time to express then write
them out and he would be very glad to have them sent to him.
SURGEON WHITE (Speedway Hospital): asked whether, if a patient stays away
over night A.W.O.L., paragraphs 3 or 4 on Page 3 of General Order 27–A
would apply.
ADMIRAL STITT asked that Dr. Lloyd answer that question.
DR. LLOYD: suggested that if patient stays away less than 24 hours mild
disciplinary action might be applied, if longer than 24 hours he should
be disciplined, that these matters were covered in the paragraphs
referred to.
ADMIRAL STITT: “The next discussions will be on “The Relation of District
Managers to Hospitals.””
DR. WILLIAMS: emphasized the point that when a man comes to the hospital he
should be treated for everything that is wrong with him.
SURGEON BROWNE: wished to report a plan in operation in Boston. Every two
weeks a luncheon conference is held, at which are present the Commanding
Officers of the hospitals, the head of the American Legion in the State,
head of the New England Red Cross, and the Commissioner of State Aid and
Pensions. In this way it was possible to straighten out all difficulties
and there is now practically no friction between these departments.
CAPT. ELLIOTT: spoke on the contact with the District Manager here in
Washington, that it was very easy to reach him by telephone and obtain
advice which facilitates the discharge and treatment of patients very
much. The relation of the Naval Hospital with the District Manager has
been one of greatest cooperation, that the Veterans’ Bureau had even
gone so far as to lend a typist and stenographer to help in the great
amount of clerical work necessary in making out papers for Veterans’
Bureau patients.
Another man spoke of the multiplicity of paper work necessary in
connection with the new form adopted by the Veterans’ Bureau in place of
1934–B, that it was impossible to manifold this form and it necessitated
just twice as much work as before. He suggested that the Committee on
Forms consider the feasibility of adopting forms that can be manifolded
and thereby make economical saving.
SURGEON YOUNG: stated that in regard to the relation of the District Manager
he would like to know whether the representative of the Veterans’ Bureau
to be in the hospital is to be there as a man directly connected with
the personnel of the District Manager’s office, or whether he is to be
there as a representative of the Veterans’ Bureau itself.
DR. RAWLS gave the information that the educational director would be a
representative of the District Manager, on the staff of the Commanding
Officer of the hospital, who would deal with the District Office in
matters pertaining to the District and to the hospitalization of the
patient. He stated that it might be that in dealing with certain other
phases he would have a direct channel to the Bureau, but this had not
been definitely decided.
GENERAL SAWYER: stated that the subject of hospitalization most now be
viewed as a much broader field than ever before, that after discussing
the subject of an educational department and social service work with
people in contact with it it was decided to be absolutely necessary to
enlarge the personnel of these hospitals so as to take in these various
new things which were coming up for consideration. He emphasized the
fact that the end result is the important thing, but that in
consideration of all of these subjects it should be understood that
these Red Cross representatives and all other employees will be subject
to the Commanding Officer. He said he was satisfied that most of the
complaint made was by individuals who come into the hospital and do not
come in contact with the Commanding Officer. The whole idea of the
social service relation is that these men shall be made more resourceful
and more capable of earning a living for themselves.
COL. EVANS: took up the number of personnel required, and stated that it had
been approved that the average requirements would be—one teacher or one
occupational therapist for each twenty individuals actually engaged, and
one physiotherapy aide for each twenty treatments per day. He stated
that one might not take care of over five patients, but the basis of
estimation was one for twenty, and that the average would be one to
sixteen if the educational director and his clerical help are included.
SURGEON SPRAGUE: spoke on the value of occupational therapy. He told how
after the introduction of occupational therapy in his hospital in New
York boys who had been very troublesome before became deeply interested
in the work and the wards became as quiet as any other wards. He wished
to express himself as most heartily in favor of occupational therapy.
Another discussion on this subject followed. It was stated that there is
no question as to the direct therapeutic value of occupational therapy.
The disciplinary value is its greatest value. Very often, too, there
will be found a boy who has real talent.
SURGEON PAYNE: stated that in his opinion a simpler method of reporting
should be adopted, that the system of bookkeeping is perfectly idiotic
and that nobody knows just what is meant. He said there was a great deal
of sentiment against the Government having any interest in what the man
makes, and that in many cases the men buy their own material. He cited
the case of a man in his hospital who makes all kinds of toys out of tin
cans and has worked up quite a trade. Public sentiment is all on that
man’s side.
COL. BRATTON: with regard to paying transportation for men discharged for
disciplinary reasons, made the following motion, which was carried;
_MOTION_
That the Director of the Veterans’ Bureau be requested to secure
legislation so that the expenses of the patient’s transportation to
his bona fide home, when he has been discharged for disciplinary
reasons, be deducted from his compensation, when compensation is
being given, or may be given thereafter.
DR. KLAUTZ: said it was his opinion that it was better to put a man right on
the train and send him home.
CAPT. BLACKWOOD: “In view of the remarks made at this meeting yesterday in
regard to the nurses, and in view of the fact that Congress is
contemplating the question of pay for the services, I would like to
present this resolution:”
_RESOLUTION_
Be it resolved that it is the sense of this meeting that the pay of
the nurses of all branches of the Government service is far below
what it should be and therefore is a detriment to the entrance to or
continuance in those services of the better type of nurses, and that
it be urged upon Congress by the Federal Board of Hospitalization
that legislation be enacted to remedy this condition.
This resolution was adopted.
DR. KLAUTZ: offered the following resolution, which was also adopted:
_RESOLUTION_
That a standard procedure be adopted for the treatment, medical
supervision and control of tuberculous patients in all Government
hospitals for ex-service men, including uniformity in matters of
furlough, application of occupational therapy and pre-vocational
training, as far as it may be possible, without sacrificing
individualization of treatment.
The meeting adjourned at 12:25 P. M.
_Sixth Session_ Thursday, January 19, 1922.
Present: Members of the Federal Board of Hospitalization and about one
hundred Conferees.
GENERAL SAWYER: In arranging the program of this afternoon, we wish you to
consider it as open for discussion for bringing to the attention of the
Conference any subject which you may have in mind.
We have divided the work in this way. In order that we might have some
leading thought from which to start and upon which to base our
discussions, I would remind you that in the n.p, and tubercular case,
the Government has its greatest liability.
I would remind you also that particularly in the n.p. case the medical
man has his greatest responsibility.
We have learned by comparison month by month since taking over this work
that the general medical case has already become a quite rapidly
decreasing case in numbers. We find, however, that the mental case and
the tubercular subject are both increasing in number. We realize that in
the general medical case ultimately we must get to a place where we
shall have finished largely with that character of case.
But with the n.p. case we know that so long as we have a remnant of the
World War Army in existence, we have these neuro-psychiatric cases under
our observation.
I would like to charge you, while I have this opportunity, with this
particular responsibility on your part, and I would like to tell you how
I think you can do greater justice to the soldier and how you can
certainly help your Government best in considering this subject.
For myself, after a very close personal contact of ten years in the
specialty of treating mental and nervous diseases, I am satisfied that
in 99% of all of these cases,—perhaps that is a little strong,—I should
say in 90 per cent of these cases you will find, where the case is
genuine, that you have some physical cause at the bottom of the mental
trouble.
Therefore I wish to suggest that in the consideration of this case, that
you never allow one of them to pass you excepting you give him the most
careful examination; that you go over him in the most thorough way; that
you look into his case, so far as his history is concerned, taking into
consideration the decade in which he is living; go over it with every
laboratory refinement of diagnostic assistance that you can possibly
give and see if you cannot find somewhere some physical trouble that is
behind the mental symptoms.
For myself, I am convinced that there is no case, excepting those that
have gone on to the degenerate class of diseases, which usually appear
after fifty, but has some physical derangement the overcoming of which
may help very materially in the curing of the case.
So I would like to emphasize this thought: that you have not exhausted
the service that you can render, you have not relieved yourselves of the
responsibility, you have not acted as loyal doctors of modern times
should have acted, excepting that you take the greatest care in the
preliminary examination of these patients.
And then I would like to emphasize also that your preliminary
examination, by comparison with frequently recurring examinations, so
long as they are under your observation, will help you very materially.
I wish you to know that I am impressed with this idea. This is what I
believe:
That many of these cases that come to you will be better off outside of
institutions than in them, and I want you all, all of you, to help us to
try and correct this impression that is now existing, that the
Government does not give this class of cases proper attention.
If the Government is not giving them proper attention, it is not because
of their disposition to do so, but it is because they have not had time
enough to develop resources by which they can handle these cases well.
I would feel that I have not performed my function here as a doctor if I
did not say to you to be thus careful in your diagnosis and then help to
work out a plan whereby, if this subject cannot be made well, he can at
least be made more self-dependent. Use all of your influence to help to
cite where these men can find niches into which they can go and make it
possible through the influence you can bring to bear upon the people who
are associated and connected with them that they are better when they
really are established in their homes. There is no case in the world
that is more unfairly treated than the neuro-psychiatric case. We all
know that by many experiences and observations. So let us give
particular and special attention to this subject.
They say to us we have no specialists in this line. I am not so sure but
we are better off for that. This is what I do believe: that every man
who has broad experience of a general practice of medicine is competent
and capable of quickly developing himself to conduct these cases along
carefully.
You have no greater field, men, either for yourselves, for the patient,
or for your Government, than in this field.
Now as to the tubercular case. The error we find in the matter of the
tubercular case is this: We find a great many cases are diagnosed
tubercular when really they are not,—a very bad impression, as you can
imagine, to give to any subject. So let us be very sure, let us leave no
influence, or power, or activity unused that will help us to define the
exact attitude of these cases.
We know, as was related here yesterday, that many of the so-called cases
of shell shock are really due to other causes. This is my own
observation of those cases, we had a number immediately after the war,
at the Institution with which I am connected, and we found a most
invariably these men were the subject of the toxemias of fatigue, and by
relieving the toxemic conditions, whether it be uremic infection, or
what not, these cases soon got well and their mental symptoms soon
subsided. So be sure that you be perfectly fair with these men, and you
are never fair with them until you have exhausted every resource in
discovering whether or not, as the basis of their mental or nervous
disturbance, there may not be some physical condition.
The meeting is now in charge of Dr. White.
DR. WHITE: I hope there will be free discussion of this matter. There are a
good many men who have had charge of neuro-psychiatric hospitals, and I
hope you will feel free to get up and briefly set forth such vital
problems as you may have in mind. In order that we may cover as many
problems as possible, I will, with your permission, let you know when
the five minutes is up, so we can cover the ground as fully as possible.
DR. KOLB: In relation to the examinations made of these neuro-psychiatric
cases which were sent to us, I want to outline the procedure we use at
Waukesha in arriving at correct diagnosis and methods of treatment. The
patient is given to one special doctor. This doctor is supposed to make
the first preliminary examination, which included a complete physical,
neurological and psychiatric examination, and do all the work in
connection with these patients while in hospital. In making this
examination we have on our staff a number of very competent attending
specialists in order that we can obviate the mistake General Sawyer has
mentioned of assuming that these men are simply neurotics and passing
over important physical conditions. By this method we have caught a
number of cases which have been passed over as cases of neurasthenia.
For instance, I have in mind a case diagnosed neurasthenia which was
treated six months ago, which was a case of brain tumor.
After we have made the first preliminary examination the man is
carefully observed in hospital, not only by his own officer but by the
clinical director, and notes are made from time to time. Examinations
are also made by the dentist, x-ray examinations and various laboratory
examinations, including serological and base metabolism. In the end,
after all the data is assembled and written up, he is brought to the
staff and there his case is thoroughly discussed by all the members of
the staff; a diagnosis is arrived at, methods of treatment discussed and
afterwards put into effect.
Now as to the organic conditions with which our neurotics suffer. It is
true a large proportion of them do have organic disorders in connection
with their neuroses. We find that most of them do have functional
disorders originating purely in their mind, or because of some
constitutional nervous defect and that the real fundamental condition
from which they are suffering is not an organic condition but is nervous
or mental and must be approached along lines of psycho-therapy.
Now I will not go into the subject of psycho-therapy. We pay special
attention to mental questions but we do not neglect the physical by any
means. Every physical disorder which is found is corrected, if
correction is possible. We have complete physio-therapy and occupational
therapy and all other facilities for treating nervous cases. We are
careful never to stress too much on the physical treatment we give these
patients, because by so doing we suggest to them conditions they really
do not have and by that means prolong their functional disorders.
Regarding occupational therapy. We all know that this is a very
important method of treatment. It should always, as Colonel Evans said,
be directed treatment and should not be given in a hap-hazard way. All
of our occupational therapy treatment has been given a definite
prescription. For eighteen months we have had a bright young medical
officer interested in this subject, whom we have made reconstruction
officer and who observes the effect of treatment and changes the
prescriptions of the other physicians when he finds the treatment given
does not have the desired effect.
With reference to reconstruction aides, every week our reconstruction
officer gives them a talk on some phase either of occupational therapy
or physio-therapy or of mental disorders. We cover any subject in which
the neuro-psychiatrist should be interested. This officer has devised a
system of observation which the aides are supposed to make on patients
and which they do make on each patient who takes occupational therapy
and which is looked over by our reconstruction officer and the officer
in special charge of the case. We are getting up data and statistics
which we think will be of interest to the general profession when it is
finally published,
DR. TREADWAY: I think that the Public Health Service has had a very grave
and serious problem affecting the N.P. Veterans of the World War. We
have included in that term, besides the mental and nervous cases, the
neuro-surgical cases as well.
There are a number of problems which still confront us, and one of these
is the question of personnel. I am sorry that Dr. Kolb did not say
something about the training school he had started in connection with
his hospital. We sent some young officers over to learn technique and
methods of handling the psycho-neurotics. We have also sent some
officers to the Public Health Service clinic at the Psychopathic
Institute in Boston and we hope that some of our other hospitals will
start a similar school. The question of personnel is an exceedingly
grave one. A great many young men want to become surgeons.
They are not interested in mental or nervous cases. They want to go into
general medicine. Last year we sent two officers to the Southern
University and to the Northern and Western universities to meet the
graduating classes and the internes, and from that we have been
recruiting some younger men who are manifesting considerable interest.
We hope to get additional personnel by interesting the young graduate.
Another problem is the question of creating, in connection with General
hospitals, wards where patients of this sort may receive at the
beginning of their treatment, their preliminary examination, where they
may be evacuated home with compensation or without compensation, or
evacuated to a prolonged treatment hospital for further care.
It has sometimes been difficult to get enough men, trained personnel, to
man these wards.
We have believed all along that the proper method of treating the
pyscho-neurotic, so-called, is in out-patient clinic and we have
attempted to develop out-patient clinics with the old dispensaries
maintained by the Public Health Service; but the question of personnel
again entered into it, and we were unable to develop as many
out-patients clinics as we should like. We think, however, that the
mild, mental case, as General Sawyer has said, is far better off in the
outside world than he is in an institution. If such cases go to a
hospital, it tends to have their symptoms crystallized and they believe
they are sicker than they really are. In other words, they seek out some
minor physical disability as a peg on which to hang what they think is a
grave disorder.
The question of compensation for these cases is an important one which
must be worked out. The man who believes he is seriously ill when he has
but a minor defect, if he has compensation and has a weak will, will not
make a strenuous effort to get back on his feet. The question of maximum
compensation for these cases many times interferes with rehabilitation.
We believe that this is a new method of handling mental patients and it
may serve as a copy to other States to prevent this enormous building
program which every State has had to go through and which has not met
the needs of the insane.
Compensation for epileptics and their examination is a very important
question and has been a serious problem to us.
We find among neuroses not infrequently mild convulsions. We don’t know
a great deal about these convulsions; some are epileptic and some are
not. The true epileptic, however, has great difficulty in making a go in
the outside world. The number of convulsions per month is not an
indication of his disability, entirely, because the passage of the
Employees Compensation Act in the several States, has interfered with
the employment of men with an epileptic past.
It is as hard for the man who has a seizure once a month to get a
position as the one with four, so the question of treating epileptics is
one largely of social service and compensation.
The hospitalization of epileptics has not been a success in the hands of
the Public Health Service. One of the Western States that built a large
colony for epileptics some years ago has now turned it into an
institution for feeble-minded.
The question of vocational training is also a big problem in connection
with this type of disability. A man, for example, whom I saw a few weeks
ago, had been a jewelry polisher in Boston. Before the war he had to get
up every morning early and go to his work. He gave most of his earnings
to his family. He was suddenly taken out of that situation by the draft
and put into a situation where it was simple for him. All he had to do
was to get up and move around when some one told him to. He was
furnished with his clothing; he was furnished with his food. When he got
over on the other side he painted a rosy picture about how things were
at home. When he got back home it was not like what he imagined it was.
He had to get up and go back to his old job. It was hard for him to make
the effort. He quit his job. He goes to the Vocational people (he had a
seventh-grade education). He wants to become a civil-engineer. Obviously
he cannot. He tries another occupation, etc. Now the attempt of that man
to better his condition is a laudable one, but very often that desire to
get away from a difficult situation is a part of his mental disorder. He
must be made to understand and meet that problem frankly and not be
seeking round-about paths without very much continuity of purpose.
Vocational training in connection with epileptics has not been very
successful. Dr. Ellison who has had charge of a hospital for epileptics
can give us some valuable information on the problems of the epileptics.
I think that Dr. Wilbur, who has had charge of a large station at
Chicago, can give us some valuable information about preliminary
examinations, the social service aspect of these cases, the need of
social service and the handling of the psychoneurotic in out-patient
clinics. Dr. Wilbur and Dr. Chronquest can tell us about the problem
affecting the insane. Mr. Chairman, I suggest that you call on them.
Dr. ELLISON: I want to say the program as outlined in the afternoon
session is one of vital interest to me, because I have been in charge of
one of the most problematic Government Institutions in the country, that
is, an epileptic hospital in East Norfolk. The administrative program in
hospital of this kind, taking into consideration the application of
general orders, hospital regulations and internal regulations as within
the hospital, is entirely different from any other class of hospital
under Federal control.
The very fact that you attempt to apply certain regulations in a
hospital of this kind where the morale is naturally at a low ebb, due to
the mental phases under which these men are suffering, sometimes results
in disaster and the breaking down of the morale you have in the
hospital.
I would like to go on record in stating it is my belief that voluntary
hospitalization of the epileptic is anything but desirable.
From the standpoint of rehabilitation of the epileptic, I must take into
consideration the particular type of epileptic we have in the hospital.
As Dr. Treadway stated, the majority of these man have not reached
probably the school grade of seven years. There has been an attempt on
the part of the rehabilitation department to make lawyers, doctors,
diplomats out of these epileptics. It is absurd and cannot be done.
These men are social and economic lepers, so far as their rehabilitation
is concerned. The communities do not want them. Their families do not
want them and the responsibility for their care rests upon the
Government. Then what is to be the solution of the disposition of these
men? I can see but probably two solutions to the question. Voluntary
hospitalisation is out of the question. I believe that that part of the
Bureau concerned with the compensation of these men, from an economical
standpoint, must take into consideration the question of the grouping of
these epileptics. There is a class which can live at home. There is
another class, not definitely formidable, which does need custodial
care. Then there is the psychiatric epileptic who needs psychopathic
institutional care. In arriving at the disposition of these men you must
take into consideration those three groups.
Then there is another group, there is a mixed group of epileptics. In
many instances we have noted, after a long period of observation, that a
man may react to some situation, starting out in a hysterical seizure
and wind up in a definite epileptic attack. That has been true in quite
a number of cases and I should like to urge upon the Bureau District
officers and those concerned, this one thing:
In referring cases to East Norfolk, I think a very careful examination
should be made of these men to determine as nearly as possible that they
are epileptics.
At East Norfolk there is a situation existing which I have endeavored to
correct; that is hospitalizing psycho-neurotics,—neuropsychiatry cases
which are not definitely epileptic, which are made worse by contact with
the epileptic patient. These men are being made worse every day. Some of
them simulate very closely the epileptic; many have learned to bite
their tongues as the epileptic does. They should not be hospitalized;
about 25% of the cases are not epileptic. I think that should be taken
into consideration and a careful survey made of these patients before
they are transferred to East Norfolk.
As to these cases, very much the same program is carried out as Dr.
Kolb’s. Complete preliminary physical and neurological examinations are
made and patients are placed under observation of one man, who observes
them and makes notes from time to time. As for the treatment of these
men, there is little to be done in a way. I think it resolves itself
into occupation mostly. I think the occupational measure as applied to
the epileptic is the only solution. I think they should be kept busy
every moment, for many reasons. They are naturally fault finding and if
they have something to do it will lessen the time they have to think of
these things. It will promote interest in their surroundings. It will
lessen the liability of deterioration but as the thing now stands that
cannot be done, under the present method of hospitalization. The
solution covering that is, I believe, for the Government to formulate,
properly taking into consideration these districts, and build an
epileptic colony, under proper supervision, and I believe from an
economic standpoint, it could be made almost self-supporting.
In regard to the medical treatment, we have been instituting at East
Norfolk a very careful treatment,—careful observation—to determine the
real value of luminol in the treatment of epilepsy and we have found
that it has been beneficial in many ways; that it lessens the severity
of the shock, prolongs the intervals between shocks and in many
instances effects complete cessation; the patient becomes more alert,
more active, more interested in his surroundings. This treatment must be
continued day after day. If there is a cessation, or lack of it, or a
failure or inability on our part to obtain luminol, these men
immediately react to the lack of it. I should say we have had at least
four deaths at East Norfolk due absolutely to the lack of luminol.
DR. WILBUR: At Chicago we developed a diagnostic clinic at the Marine
Hospital and had two departments: in-patient and out-patient
departments. We had a capacity for in-patients of about 150. The
out-patient department was unlimited and developed to approximately 160
to 175 patients at one time. The in-patient department is divided into
five groups for the investigation of cases;
1. Cases which would be immediately transferred to some other hospital
as soon as arrangements could be made;
2. Certain disorders taken up under direction of an officer particularly
interested in such disorders and investigated as fully as possible;
3. Hyper-thyroidism, following operations, where the pulse is still
high. When such cases were sent to us, an attempt was made to stabilize
the patient and bring him down to a nearly normal basis so that he could
go out and take Federal Board training.