CONTENTS
| [Opening Session] | Tuesday, January 17, 1922. |
| [Second Session] | Tuesday, January 17, 1922. |
| [Third Session] | Wednesday, January 18, 1922. |
| [Fourth Session] | Wednesday, January 18, 1922. |
| [Fifth Session] | Thursday, January 19, 1922. |
| [Sixth Session] | Thursday, January 19, 1922. |
| [Seventh Session] | Friday, January 20, 1922. |
| [Eighth Session] | Friday, January 20, 1922. |
CONFERENCE OF OFFICERS IN CHARGE OF
GOVERNMENT HOSPITALS SERVING
VETERANS OF THE WORLD WAR
WASHINGTON, D.C.
JANUARY 17–21, 1922, INCLUSIVE
AUDITORIUM DEPARTMENT OF THE INTERIOR
UNDER THE AUSPICES OF THE
U.S. FEDERAL BOARD OF HOSPITALIZATION
| Brig. Gen. Charles E. Sawyer, Chairman. | Chief Coordinator. |
| Col. Chas. R. Forbes, Vice-Chairman. | Director, Veterans’ Bureau. |
| Dr. W. A. White, Secretary. | Supt., St. Elizabeths Hospital. |
| Maj. Gen. Merritte W. Ireland. | Surgeon General, U.S.A. |
| Rear Admiral E. E. Stitt. | Surgeon General, U.S.N. |
| Brig. Gen. H. S. Cumming. | Surgeon General, U.S.P.H.S. |
| General George H. Wood. | President, N.H.D.V.S. |
| Hon. Charles M. Burke. | Commissioner of Indian Affairs. |
PROCEEDINGS OF CONFERENCE OF OFFICERS IN CHARGE OF GOVERNMENT HOSPITALS SERVING VETERANS OF THE WORLD WAR
Opening Session Tuesday, January 17, 1922.
At 10:00 A.M. the meeting was called to order by Brigadier-General Charles E. Sawyer.
The roll was called by Dr. W. A. White.
General Sawyer delivered the following address on the subject, “The Present Status of Federal Hospitalization from the Standpoint of the Federal Board.”
“Commanding Officers:
You are here, as your program indicates, by invitation of the Federal Board of Hospitalization. That you may know your host, the following facts are submitted:
The Federal Board of Hospitalization was created by an Executive Order of President Harding. The purpose of the Board is expressed in the Order creating it, which is as follows:
“Circular No. 44.
TREASURY DEPARTMENT,
Bureau of the Budget
WASHINGTON
November 1, 1921.
FEDERAL BOARD OF HOSPITALIZATION.
TO THE HEADS OF DEPARTMENTS AND ESTABLISHMENTS:
1. For the purpose of coordinating the separate hospitalization activities of the Medical Department of the Army, the Bureau of Medicine and Surgery of the Navy, the Public Health Service, St. Elizabeths’ Hospital, the National Home for Disabled Volunteer Soldiers, the Office of the Commissioner of Indian Affairs, and the United States Veterans’ Bureau, there is hereby organized a Federal Board of Hospitalization.
2. The Board shall be composed of the following officials: An official to be designated by the President, who shall be known as Chief Coordinator and who shall be President of the Board; the Surgeon General of the Army; the Surgeon General of the Navy; the Surgeon General of the Public Health Service; the Superintendent of St. Elizabeths’ Hospital; the President, Board of Managers, National Home for Disabled Volunteer Soldiers; the Commissioner of Indian Affairs; and the Director of the United States Veterans’ Bureau.
3. It shall be the duty of the Board:
(a) To consider all questions relative to the coordination of hospitalization of the departments represented.
(b) To standardize requirements, to expedite the inter-department use of existing Government facilities, to eliminate duplication in the purchase of supplies and the erection of buildings.
(c) To formulate plans designed to knit together in proper coordination the activities of the several departments and establishments, with a view to safeguarding the interests of the Government and to increasing the usefulness and efficiency of the several organizations, and to report to the President thereon.
4. The Chief Coordinator of the Board of Hospitalization shall preside over the Board and be responsible for its efficiency and for developing its activities along practical lines. After a full discussion of any question by the Board, the decision of the Chief Coordinator will be final as to any action to be taken or any policy to be pursued, but any member may appeal from the decision to his own immediate superior.
By direction of the President:
CHARLES G. DAWES,
Director of the
Bureau of the Budget.”
From this you will readily see that the extent of the work under the administration of this Board is very far-reaching and is an innovation in Federal Hospitalization activities, for beside being interested in behalf of reasonable economies in administration, the Federal Board of Hospitalization is particularly and especially interested in carrying out the highest ideals of modern hospitalization for the far advanced Veteran.
The President and his administrative family have in mind, as the basic principle of all hospital service, the very best that can be supplied, measured by real end-results.
The Board of Hospitalization represents all of the Departments of the Government directing and controlling the Federal Hospitals of the United States. Each of the Chiefs of these Departments will speak of his particular relation to the subject of Hospitalization as it refers to the World War Veteran, as the program proceeds.
In order that each of you may understand the magnitude of the entire subject of Hospitalization of the World War Veteran, I wish to present the following facts;
Today there are being hospitalized under Government control, in Federal Hospitals, 22,440 World War Veterans, who are distributed among the various Departments as follows:
| U.S. Public Health Service | 16,373 |
| U.S. Army Hospitals | 1,681 |
| U.S. Navy Hospitals | 1,059 |
| Soldiers Home Hospitals | 2,500 |
| Dept. of the Interior Hospitals | 827 |
| A total of | 22,440 |
This does not take into account patients in contract hospitals which now number 9,066. This enumeration demonstrates something of the scope and nature of the work for which the members of the Board of Hospitalization are responsible.
It may interest you to know that there are now under construction 7,592 new beds, which will be ready for occupancy within the next few months and that the Government is at present contemplating at least 2,500 more beds under the new Langley Bill, so ultimately the Government will have under its direct administration hospital capacity for a minimum of 32,000 patients, which is estimated to be the peak load.
Heretofore there has been no coordinate plan of operation of these various institutions. Under the Board of Hospitalization all of this has been changed and today, you, whether from the Army, Navy, Public Health Service, National Home for Disabled Volunteer Soldiers or the Department of the Interior are all members of one big professional family, each engaged in the same service, under the same regulations, for the care and treatment of the World War Veteran.
The Hospitals engaged in this service number at present 107, distributed as follows:
| 77 | Hospitals controlled and operated by the Public Health Service, |
| 6 | Hospitals controlled and operated by the War Department, |
| 14 | Hospitals controlled and operated by the Navy Department, |
| 9 | Hospitals controlled and operated by the Soldiers Homes, |
| 1 | Hospitals controlled and operated by the Interior Department. |
These institutions are located in all sections of the United States from the Atlantic to the Pacific and constitute one of the greatest hospitalization propositions within the history of any country.
The personnel engaged represents an Army of almost as many more persons. In other words, Uncle Sam, within himself, is today keeping in operation a hospitalization program incomparable with anything with which former experiences are familiar.
With this representation of the subject and its magnitude, I wish to remind you that each one of you personally and individually is a part of this great machine; and upon you rests the responsibility of the carrying out of such policies as are adopted by the Central Administration.
In order that there might be perfect coordination and cooperation in all of these hospitals and that all institutions serving the World War Veteran might be operated upon a standardized basis, the Board of Hospitalization recently adopted the following regulation as to personnel:
| Doctors, | 1 | to every | 20 patients |
| Nurses, | 1 | to every | 10 patients |
| Occupational Therapists, | 1 | to every | 50 patients |
| Social Workers, | 1 | to every | 50 patients |
| Vocational and Prevocational trainers and assistants | 14 | to every | hospital of 200 patients |
| Other hospital employees. | 130 | ||
Making a total of 182 employees to every 200 patients, or almost one attendant and assistant to each patient.
This arrangement provides that all patients will have equal care and attention of such a similar type as to guarantee to all classes of patients the best of professional, nurse and domiciliary attention that can be given, no matter in what Department they are being treated.
All of the Departments constituting the Board of Hospitalization are now meeting in joint sessions, wherein they take up in detail all of the matters pertaining to the welfare of the Veteran Hospitalization subject. Out of this consideration there is developing a much better understanding, a more complete system of operation, better conduct and much better end-results.
One of the objects of this conference is that you the better understand by personal contact with each other and with the different phases of the work, what the business of caring for these veterans in its entirety means. We know of course that you each have your special problems, you each have certain affairs within yourselves that keep your attention very much engaged in the things with which you come personally in contact, but we thought it would give you a better impression of the magnitude and importance of the subject if we were to have you here where those who are responsible for the direction of the affairs of Hospitalization could meet you individually.
We want you to know that we are greatly interested in you and the service you are rendering. We wish you to feel assured that your interests are our interests. We wish to impress upon you that the conduct of the affairs under your administration means the reputation and the historical record of the Government’s treatment of the World War veteran.
We are anxious indeed that you should get from this meeting inspiration for better work and encouragement in the efforts that you are putting forth, new ideas with which to meet the great and everchanging propositions which are before you, closer touch with those who, like yourselves, are interested in the World War defenders. This accomplished and each of us will have benefited and the expense of time and money in your coming here will be justified.
Your contact here should make you bigger and broader men. If you will take out of the great opportunities that are presented in the privileges of this meeting, the effects which may be obtained, we are sure that you will go back to your respective fields of service better satisfied, more capable and certainly more determined than ever to render the best service there is within you under all circumstances and conditions.
It seems pertinent that I should impress upon you at this time that no matter what kind of institutions the Government may possess, how well equipped with apparatus, or how pleasing in location, without your interest, without the scientific care and attention which you can provide, without your determination and your loyal support and action in all of the affairs pertaining to the conduct of these institutions, they will fail.
On the other hand, if you will give them the best within you, if you will keep yourselves professionally and administratively in the vanguard of such affairs, if you will go whole-heartedly, persistently and determinedly forward to the carrying out of the highest ideals your constructive visions can invent, the world War Veteran will realize that in his Government he has the care and appreciation of the best Government under the sun.
Allow me to again admonish you that upon you individually and personally rests much of whatever is to come to the present Administration, either in the form of complaint or of eulogy. To the end that it may be eulogy, let there ever abide with you the assurance that the President of the United States and all of his administrative assistants will be with you heart and soul in everything that promotes the interest of the rehabilitation of the World War Veteran. Remember that you owe to your country and to yourselves that you practice economy, that you deal fairly, that you act squarely with all of the propositions which come to you. Do not forget that you should be loyal to the Departments to which you belong, ever obedient to the orders of your Chiefs; that you be faithful, earnest and sincere, honest, conscientious and ever active in behalf of the highest principles connected with the maintenance of the institution with which you are connected and finally that you be ever able to register and substantiate yourselves as American citizens, full of an American spirit, loyal to country and to flag.
If you will do these things, you will have the everlasting gratitude of the President of the United States, you will be entitled to and will receive the econiums of our dear doughboys and above all you will have the satisfying consciousness of a noble duty truly done.
In order that the business of the conference may be transacted expeditiously and effectively, the following rules will be enforced by the presiding officer of each session:
1. Those having addresses upon specified subjects are expected to present a typewritten copy to the Secretary that it may be kept for reference in the Office of the Board of Hospitalization. 2. All addresses will be limited to 15 minutes. All special subjects will be limited in presentation to ten minutes. General discussions will be limited to five minutes. 3. Each session will begin promptly on time. 4. Roll call of the attendants will be taken at the beginning of each meeting. 5. Reports of all proceedings of sufficient importance will be recorded by the expert stenographers in attendance. 6. This is a business affair and should be so considered by all present. We are here to develop plans. We are here to receive suggestions and get in line for the execution of orders which will lead to the development of the highest order of hospital care and treatment. With these suggestions we will proceed to the carrying out of the program.”
“I have pleasure at this time in introducing to you Colonel Charles R. Forbes, who will speak to you on the ‘Relation of the Veterans’ Bureau to all Hospitalization Activities’.”
COLONEL FORBES: Addressed the conference as follows:
“Upon the signing of the Armistice on November 11, 1918, there was immediately commenced the demobilisation of the armed military and naval forces of the United States, comprising approximately 4,000,000 men and women. As an aftermath of war service from the result of battle wounds, gassing, injuries and disease it was anticipated that there would be a large number of men and women who would be physically disabled, either temporarily or permanently, partially or totally. While it was known with a reasonable degree of accuracy how many there were who has been discharged from the several services on Surgeons’ Certificate of Disability and the number discharged with disability noted at the time of discharge, it was not possible to foretell the magnitude of that considerable body of men and women who though discharged from the service apparently in good health would subsequently develop a disability traceable to military service. Even at the present time, more than three years after the Armistice it is not possible to state the exact magnitude of the medical problem confronting the United Veterans’ Bureau, since new claims for compensation because of disability are being filed at the rate of approximately 541 per day. As an index however to the magnitude of this problem, gentlemen, let me tell you that to date have been filed more than 762,000 claims for compensation for disability and death incurred in military or naval service. While this total number of claims have not all been allowed, this number does constitute the present potential load for the United States Veterans’ Bureau.
By the original War Risk Act and subsequent acts amendatory thereto,—the United States Government recognized its very great obligation to the ex-service men and women who had become disabled through service, and by these Acts provided not only financial aid to the disabled veterans but also all reasonable medical and surgical treatment and care, whether in a hospital, out-patient office, or at home.
The problem of hospitalization itself soon became of paramount importance. It was initially recognized that, in spite of the meagre governmental hospital facilities then available for the care of beneficiaries of the United States Veterans’ Bureau, it was essential for the best administrative control of veteran patients and for the best professional control over their treatment to place the beneficiaries of the United States Veterans’ Bureau under government supervision in government owned or operated institutions. The carrying out of this policy has been proceeding steadily at a rate commensurate with the rate at which additional government hospital beds have been made available. At no time however has it been possible to discontinue the use to a considerable degree of contract civil institutions. Even at the present time the United States Veterans’ Bureau is utilizing approximately 757 civil institutions for the care of approximately 8,924 of its beneficiaries, and has contracts with a total of 1,524 civil institutions for such care. It is however significant to note while in July 1920 more than fifty percent of Veterans’ Bureau patients were in contract hospitals, on January 1, 1922, but 30 percent of patients were in contract hospitals. Furthermore the number of hospitals being utilized at any time had dropped from approximately 1200 to 757.
The curtailment in the use of private facilities was of course the direct result of increased facilities in government operated hospitals. The United States Government had originally stipulated that the hospitalization of veterans of the World War should be provided for the United States Public Health Service through its Marine hospitals and such other hospitals as it had been authorized to acquire. When however it was discovered that the immediate facilities offered by these hospitals were insufficient to meet the demand for hospitalization, the hospital services of the United states Army, the United States Navy and the National Homes for Volunteer Disabled Soldiers were to a certain extent made available to the United States Veterans’ Bureau.
In March, 1919, the United States Public Health Service was operating but 21 small Marine Hospitals. In order to meet the demand made upon it by the then Bureau of War Risk Insurance, additional hospital facilities were rapidly acquired, so that by November, 1919 there were in operation a total of 38 hospitals with a total bed capacity of approximately 7,625. A year later namely on November 1, 1920 there had been made available a total of 52 hospitals representing 13374 hospital beds. At the present time, January, 1922, there are available 65 United States Public Health Service Hospitals representing approximately 18,200 hospital beds. It is true that due to the necessity of securing with the least possible delay adequate hospital beds, it was necessary to make use of certain Army cantonment hospitals of temporary structure. Hospitals of this type are admittedly unsatisfactory, and it is my earnest desire to close such hospitals just as soon as properly located hospitals of permanent construction are available to take their place.
Although prior to July, 1920, there had been a limited use made of the facilities of the Army, Navy and National Soldiers’ Homes in the case of Veterans’ Bureau patients, it was not until that date and in accordance with provisions of the Sundry Civil Act of the 66th Congress that a systematic and more extensive use of these facilities was proposed. It was perceived that with the general reduction in the Army and Navy personnel a number of large and well equipped government hospitals were not being utilized to their full capacity. The utilization of these facilities would have a two fold result, first, the placing of a larger number of patients under direct government medical supervision, and second, a more pronounced curtailment in the use of contract civil facilities.
In June, 1920, under plans agreed upon by the representatives of the then Bureau of War Risk Insurance and of the several government services there were immediately made available 4181 hospital beds, not including those in operation by the United States Public Health Service divided among the services as follows: Navy Department Hospitals, 1760; War Department Hospitals, 1510; National Soldiers’ Homes, 911. Additional plans contemplated increased facilities by all those services. At the present time, January 1922, in accordance with these plans the following number of beds have been made available by these three services: Navy Department, 3396; War Department, 2917; National Soldiers’ Homes, 3317; Total, 9630.
I have briefly outlined the growth to the present time in government hospital facilities available to the United States Veterans’ Bureau. Combining the figures I have enumerated it is seen that the total number of available government hospital beds has increased during a period of a little more than two years and a half from a few thousand beds in 21 Marine hospitals to a total of 28655 beds in 94 government hospitals.
Let me now outline briefly the growth in our hospital population over this period. In September, 1919 there were recorded a total of 6003 patients of the Bureau of War Risk Insurance, which total had increased by January 1920 to 10907, and by July 1920 to 19,489, averaging over this period a monthly increase in hospital patients of approximately 1225. From July 1920 to January 1922 the hospital population increased from 19,489 to 29,263.
These 29,263 patients are hospitalized to the following extent in the several classes of facilities: United States Public Health Service, 13,874; United States Army, 1530; United States Navy 1473; National Soldiers’ Homes, 2637; St. Elizabeth’s Hospital, Interior Department, 825; Contract Civil Hospitals, 8924. By general class of disease, these patients are divided as follows: Tuberculosis, 11,822; Neuro-psychiatric, 8,414; General medical and Surgical, 9027.
Of the total number of 28,655 government hospital beds available, 20,339 are occupied at the present time, leaving a balance of 8,316 unoccupied hospital beds.
As previously stated, it is the policy of this Bureau wherever practicable, to remove beneficiaries of the Bureau from contract institutions and place them in hospitals operated by the governmental medical services. If it were possible at the present time to fill every vacant government bed by patients in contract hospitals we would still be obliged to continue 608 cases in contract institutions.
An analysis of the vacant government beds shows that they fall under the following category:
| For tuberculosis | 2,292 |
| For neuro-psychiatric | 748 |
| For general medical & surgical | 5,276 |
| Total | 8,316 |
An analysis of the patients in contract hospitals shows they are classified as follows:
| Tuberculosis | 2,930 |
| Neuro-psychiatric | 4,004 |
| General medical & Surgical | 1,990 |
| Total | 8,924 |
A review of these two sets of figures shows that although there are apparently ample facilities for the care of general medical and surgical cases, there is a real and serious shortage of government beds for the care of tuberculosis and neuro-psychiatric cases.
In considering the use of government hospital beds at present reported vacant, it is of course entirely impracticable to attempt to accomplish the complete filling up of all government hospitals. As you all realize, this is due to a number of reasons, chief of which are (1) the administrative necessity at all hospitals of maintaining a surplus of beds amounting to from ten to fifteen percent of capacity to allow flexibility in case of epidemic or sudden emergency; and to permit unhampered the routine admission and discharge of patients, (2) the location of vacant beds away from the points of greatest demand, and (3) the fact that the vacant beds available are not of the type required at points where the Bureau needs them.
From an analysis of this whole situation it is believed that we have sufficient beds available for the care of general cases with the exception of two or three areas of the country, such as Memphis, Tennessee, and in the metropolitan district of New York. Some provision must be made to care for cases of a general nature because facilities at these points are totally inadequate. In New York, the existing facilities must be given up by June 1922.
However, the number of general medical and surgical cases requiring treatment will steadily diminish and contract hospitals in many instances would ultimately be able to care for their needs. On the other hand, the Bureau must make provision for the care of tuberculosis and neuro-psychiatric cases for many years to come.
The general medical and surgical cases are a type which justify the use of contract institutions more than the other classes referred to, by reason of the comparatively short length of time that treatment is indicated: emergency conditions which require immediate hospitalization where the patient may be; and the disinclination on the part of claimants to be far from home, especially when a surgical procedure is indicated.
The hospital program of the Veterans’ Bureau is meant to provide approximately 20,500 permanent beds for the treatment of tuberculosis and mental cases. It is estimated that between the present time and the end of 1923 the Veterans’ Bureau will lose the use of approximately 5,400 beds because the hospitals will have to be abandoned by reason of expiration of lease, temporary nature of the structure, or for other cogent reason.
The hospitals being constructed out of the Langley Bill (Act of 4 March 1921) and appropriations for the Public Health Service made either by the Secretary of the Treasury or the United States Veterans’ Bureau which will become available during the two years ending with the calendar year of 1923, will only provide 7,198 beds, while during the same period of the time the Bureau will lose 5,397 beds for the reasons already indicated. The ultimate loss of beds by reason of expiration of lease, temporary nature of the structure, etc., will be approximately 4,875 greater than the beds which will be provided as result of construction now going on under existing appropriations.
From careful studies that have been made, it is evident the Bureau will require additional hospital facilities at the following points:
| 500 | beds for tuberculosis patients in the State of California; |
| 500 | beds for insane in California; |
| 200 | beds in Chicago to enable the Edward Hynes Jr. Hospital to be converted into a hospital for mental cases; |
| 150 | beds for general medical and surgical cases in the vicinity of Memphis; |
| 600 | beds for general medical and surgical cases in the metropolitan area of New York; |
| 250 | beds for general medical and surgical cases at the Walter Reed Hospital |
| _____ | |
| 2,200 |
It has recently become apparent that the neuro-psychiatric hospital at Marion, Indiana, operated by the National Home for Volunteer Disabled Soldiers, can only care for nervous and mild mental cases, and is not prepared to handle definitely insane. Development in the future may make it necessary, therefore, to ask for further provision for insane at that or some other point in the country east of the Mississippi River.
Estimating that we will have approximately 2,000 or 2,500 cases in contract institutions for many years, the Bureau is endeavoring to provide for a maximum load of about 32,000 cases, the peak probably being reached in 1922. It is estimated that the general medical and surgical cases will diminish rapidly, but that permanent beds for the treatment of approximately 13,000 tuberculosis, and 9,500 neuro-psychiatric cases must be available.
Gentlemen, I have attempted briefly to outline the growth and the magnitude of our hospitalization program, and have told you roughly what the expectation and needs of the United States Veterans’ Bureau in regard to hospitalization facilities are. It is all summed up in our earnest endeavor of the United States Government to provide every ex-soldier, sailor, marine or nurse who becomes a beneficiary is the United States Veterans’ Bureau with the best medical treatment available under the best conditions possible. But in spite of our needs for additional governmental hospital facilities, I want to assure you all that to my best knowledge there is not a single veteran of the World War, eligible for treatment and who has applied for hospital treatment, for whom hospital facilities have not been found or who has not been offered hospitalization.”
GENERAL SAWYER:
“Allow me to suggest just one thing. You will notice that on the program there is a time for general discussion of all these subjects, and I wish you would make pencil notes of the things that appeal to you as being of importance enough to be called up during the discussion. We are here really to get out of this all we can, and we want you to feel free to call for any further consideration of these subjects when we get to that hour of discussion.
I have pleasure in introducing Major Merritte W. Ireland, who will address you upon the subject of ‘The Army’s Relation to the hospitalization of the World War Veteran’.”
GENERAL IRELAND:
The treatment provided in our military hospitals for World War soldiers may be summarized in instructions approved by the Secretary of War, which were about as follows: That no member of the military service disabled in line of duty even though not expected to return to duty, would be discharged from the service until he had attained complete recovery or as complete recovery as could be expected he would attain when the nature of his disability was considered. It was laid down, further, that physical reconstruction consisted in the completest form of medical and surgical treatment carried to the point where maximum functional restoration, mental and physical, had been secured. To secure this result the use of work, mental and manual, was required during the convalescent period. This therapeutic measure, in addition to aiding greatly in shortening the convalescent period, retains or arouses mental activities, prevents the state of mind acquired by chronic hospital patients, and enables the patient to be returned to service or to civil life with the fullest realization that he can work in his handicapped state and with habits of industry much encouraged, if not newly formed. Early in 1918, the Secretary of War also authorized the Medical Department to proceed with the scheme for reconstruction of officers and enlisted men of the Army alone without consideration of the other bureaus of the government involved. This reconstruction it was clearly understood would end at the point where the medical reconstruction ceased and the future reconstruction of such cases was to be completed by other agencies of the Government after the individuals had been discharged from the Army.
Patients then were cared for in military hospitals up to the point of maximum functional restoration, both mental and physical. In the case of patients who were ultimately to be discharged from military service, arrangements were made whereby the Federal Board for Vocational Training might have access to these men as soon as it was known that they were to be discharged and the educational officers of the Medical Department were directed to cooperate with the representatives of the Federal Board to the fullest possible extent, in order that the patients concerned might have all the advantages assured them by the Federal Government.
It was recognized that in order to make this program successful for the attainment of the maximum physical and mental condition through complete medical and surgical treatment, it would require the establishment of a policy of extended publicity. This embraced the necessity to educate the public to the need of this physical reconstruction for the disabled men before their return to civil life; to educate the family of the soldier with regard to the need of continued treatment that they might be satisfied to have them remain in hospital, and finally, to educate the soldier himself by placing in his hands at the earliest possible moment after his disability had been incurred the necessary literature which would inform him of his status as a soldier and of the privileges, which were to be his as a disabled man, from the Medical Department of the Army, the Federal Board for Vocational Education, the Bureau of War Risk Insurance, and also to place in his hands such literature as would inform him of facts concerning various trades from which he might choose a vocation, together with all the information in regard to the need for men in the various industries of the country.
As above outlined this policy of treatment was carried out. At the approved time for the discharge of the patients from the military service, they at once became beneficiaries of the Bureau of War Risk Insurance and subject to further physical reconstruction or education, if such were necessary, under the direction of the Federal Board, Public Health Service or the Bureau of War Risk Insurance.
Such facilities as were in our hospitals and were not required for the care of the sick of the active list of our army were placed at the disposal of the discharged veterans of the World War. This was done mainly in two ways: first, by turning over to the Public Health Service which was charged with the medical work of the Federal Board, many complete hospitals and second, by caring for many of the veterans in our own hospitals after their proper discharge from the service.