Part 2

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.

_HOSPITALS RELEASED FOR CARE OF VETERANS_

By virtue of Act of Congress in March, 1919, every military hospital, including its supplies, no longer required for the proper care of the sick in the military service was to be turned over to the Public Health Service if the latter service so desired. A detailed classified list of hospitals approximating 2,460 beds turned over under this law follows:

General Hospitals at permanent military stations which were transferred to Public Health Service.

Name Bed Date capacity transferred

Fort Bayard, New Mexico 1000 June 15, 1920 Fort McHenry, Maryland 200 June 15, 1920 Whipple Barracks, Arizona 600 Feb. 15, 1920 ———— Total 3600

Hospitals on Leased Properties transferred to Public Health Service.

Name Bed Date capacity transferred

[1]O’Reilly Gen. Hosp., Oteen, N.C. 1300 Oct. 15, 1920 [1]Hoff Gen. Hosp., Staten Island, N.Y. 1468 Oct. 15, 1920 Gen. Hosp. #10, Boston, Mass. 700 July 1, 1919 Gen. Hosp. #12, Biltmore, N.C. 450 Sept, 1, 1919 Gen. Hosp. #13, Dansville, N.Y. 288 April 2, 1919 Gen. Hosp. #15, Corpus Christi, Texas 262 May 31, 1919 Gen. Hosp. #16, New Haven, Conn. 500 Sept. 1, 1919 [2]Gen. Hosp. #17, Markleton, Pa. 187 Mar. 27, 1919 Gen. Hosp. #24, Parkview, Pa. 700 July 30, 1919 Gen. Hosp. #32, Chicago, Ill. 550 May 15, 1919 Gen. Hosp. #34, East Norfolk, Mass. 340 June 24, 1919 Gen. Hosp. #40, St. Louis, Mo. 530 June 12, 1919 Emb. Hosp. #4, (polyclinic) N.Y. 374 Aug. 15, 1919 Norwegian Lutheran and Deaconess Home, Brooklyn, 250 May 15, 1919 N.Y. Post Hosp., Q.M. Terminal, Sewell’s Point, Va. 250 May 27, 1919 Nitrate Plant, Perryville, Md. (approx) 150 Oct. 1, 1919 ———— Total 8299

Camps and Cantonments taken over by Public Health Service.

Name Bed Date capacity transferred

Camp Beauregard, Louisiana 2144 Mar. 18, 1919 Camp Cody, New Mexico 1289 Apr. 14, 1919 Camp Hancock, Georgia 1604 Mar. 27, 1919 Camp Joseph E. Johnston, Florida 816 July 17, 1919 Camp Logan, Texas 1156 Mar. 12, 1919 Camp Sevier, S. Carolina 1396 Apr. 5, 1919 Camp Fremont, California 1156 Mar. 20, 1919 ———— Total 9561 = Total 21,460

Footnote 1:

Indicates buildings constructed by the Army on leased ground.

Footnote 2:

General Hospital No. 17 was closed as an Army hospital on March 27, 1919, the Public Health Service having stated that it did not desire this hospital. Later on, however, this hospital was taken over by the Public Health Service.

Hospitals abandoned by the Medical Department, U. S. Army, and available to the Public Health Service, but not occupied by that Service because they were not located where additional hospitalization was needed.

General Hospitals Capacity Abandoned

GH #1, New York City 1258 Oct. 15, 1919 GH #3, Colonia, New Jersey 1650 Oct. 15, 1919 GH #8, Otisville, N.Y. 1000 Nov. 15, 1919 (tuberculosis) GH #9, Lakewood, New Jersey 986 May 31, 1919 GH #11, Cape May, New Jersey 750 July 20, 1919 GH #18, Waynesville, N. C. 600 June 30, 1919 (tuberculosis) GH #22, Philadelphia, Pa. 450 June 10, 1919 GH #23, Hot Springs, N. C. 600 Mar. 15, 1919 GH #35, West Baden, Ind. 800 June 30, 1919 GH #36, Detroit, Michigan 900 Aug. 10, 1919 GH #38, East View, New York 850 July 15, 1919 GH #39, Long Beach, L. I. 550 May 21, 1919 ————— Total 10394

Base (Camp) Hospitals Capacity Abandoned

BH Camp Wadsworth, S.C. (GH #42) 1000 October 10, 1919 BH Camp Bowie, Texas 1000 Subsequent to Mar. 3, 1919 BH Camp Custer, Michigan 1500 Subsequent to Mar. 3, 1919 BH Camp Gordon, Ga. 1500 Subsequent to Mar. 3, 1919 BH Camp Greene, North Carolina 1000 Subsequent to Mar. 3, 1919 BH Camp McArthur, Texas 1000 Subsequent to Mar. 3, 1919 BH Camp McClellan, Alabama 1000 Subsequent to Mar. 3, 1919 BH Camp Shelby, Mississippi 1000 Subsequent to Mar. 3, 1919 BH Camp Sheridan, Alabama 1000 Subsequent to Mar. 3, 1919 BH Camp Taylor, Kentucky 1500 Subsequent to Mar. 3, 1919 BH Camp Upton, L.I., N.Y. 1500 Subsequent to Mar. 3, 1919 BH Camp Wheeler, Georgia 1000 Subsequent to Mar. 3, 1919 ————— Total 14000

Port Hospitals Capacity Abandoned

EH #1, (St. Marys) Hoboken, N.J. 500 Oct. 31, 1919 DH #3, (Greenhut Bldg.) New York 3100 July 15, 1919 City DH #5, (Grand Central Palace) 2700 June 30, 1919 N.Y.C. BH Camp Merritt, New Jersey 2000 Dec. 15, 1919 BH Camp Mills, L.I. N.Y. 2000 Sept. 18, 1919 BH Camp Stuart, Newport News, Va. 2000 Sept. 10, 1919 —————— Total 12300

Total 36694

In addition to the foregoing the following permanent military posts have been recently acquired by the Public Health Service from the Army:

Post Size of Post

Boise Barracks, Idaho 4 troops cavalry Ft. W.H. Harrison, Montana 4 companies infantry and hdqrs. 1892 Ft. Walla Walla, Washington 4 troops cavalry and hdqrs. 1859 Ft. McKenzie, Sheridan, Wyom. 8 companies infantry & hdqrs. 1898 Ft. Logan H. Roots, Arkansas 4 companies infantry 1892

_VETERANS’ BUREAU CASES TREATED IN MILITARY HOSPITALS_

“Now, with reference to assistance rendered within our own hospitals, in an interview with the Director of the War Risk Insurance in 1919, I heard the former Secretary of War say that he considered it an obligation on the Army to assist in caring for the discharged World War veterans and that any vacant bed in Army hospitals was always available for the treatment of these men. To carry out this policy, the Bureau of War Risk and later the Veterans’ Bureau was from time to time advised by the Medical Department of the number of available beds in our hospitals in which we could accept for treatment veterans of the World War. The number of beds thus offered has varied slightly from time to time, but has always been on the increase, particularly since last July. Last May 1450 beds were available to the Veterans’ Bureau; in October 1752 beds were available, and by November 24th 2200 beds were available. The following brief table gives the exact status on January 5, 1922:

Hospital │Beds as │ Patients in Hospital │ Total │ Vacant │ signed │ │ Cases │ Beds │ to │ │ Under │ B.V.B. │ B.V.B. │ │treatment.│ │ (1) │ │ │ ───────────────┼────────┼────────┬────────┬────────┼──────────┼──────── │ │ T. B. │ Neu-P. │ G.M. & │ │ │ │ (2) │ (3 │ S. │ │ │ │ │ │ (4) │ │ ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── Army & Navy │ 150│ 0│ 2│ 85│ 87│ 72 ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── Beaumont │ 200│ 43│ 5│ 18│ 66│ 134 ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── Fitzsimmons │ 600│ 787│ 0│ 74│ 861│ 338 ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── Letterman │ 250│ 7│ 7│ 58│ 72│ 237 ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── Ft. Sam Houston│ 300│ 139│ 11│ 63│ 213│ 87 ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── Walter Reed │ 750│ 26│ 24│ 334│ 384│ 366 ───────────────┼────────┼────────┼────────┼────────┼──────────┼──────── TOTAL │ 2250│ 1002│ 49│ 632│ 1683│ 1234 ───────────────┴────────┴────────┴────────┴────────┴──────────┴────────

Within a few days we expect to open up several hundred beds at Fitzsimmons General Hospital for veterans suffering from tuberculosis. This last large increase has been made possible by funds transferred by the Veterans’ Bureau to the War Department for the specific purpose of enlarging this hospital. When the construction and alteration made possible by these funds has been completed (and the completion is expected almost daily) 700 additional beds for the tuberculosis will have been provided in permanent structures for a little over $1000 per bed.

In addition to the buildings turned over to the Public Health, which have already been enumerated, the Medical Department has turned over to that Service supplies approximating a value of $12,336,000.00. It has been a source of gratification to the Medical Department, and I am sure to the War Department, that the Army was in a position to assist in rendering aid to the American soldier disabled in the World War.

The total number of all cases treated in our general hospitals during the last year was approximately 30,000; of these 10,000 were local cases and 20,000 were general cases, and of the latter 15,700 were our own and 4300 pertained to the Veterans’ Bureau.

A brief summary of the Veterans’ Bureau cases treated in our hospitals may be of interest. Of the 4,300 cases treated during the year (October 1, 1920, to October 1, 1921) 180, or about 4% were suffering from either nervous or mental conditions; 2195 or about 51% with tuberculosis; 770, or about 18% with diseases or injuries of the osseous system; 75, or nearly 2% with heart or vascular diseases, and the remaining 25% was made up of all other conditions combined.

In addition to this work, much assistance has been rendered in making physical examinations for that Bureau to determine the right to compensation or the necessity for hospitalization. Over 2,000 of these examinations were made during the year, many of which necessitated admission to hospital for varying periods to permit a thorough survey in order that correct diagnosis or physical condition might be established.”