agencies was effected through the offices of the district supervisors of the Public Health Service there was great dissatisfaction on the part of the veterans because of division of control between three separate agencies. There was much complaint regarding delay in obtaining hospital treatment and the insufficiency of hospital accommodations, and the three government bodies concerned with soldiers were subject to much criticism. The charges directed against the Public Health Service were in regard to the placing of patients in private hospitals where they were not given proper care, the utilization by the Public Health Service for hospital purposes of buildings that were subject to a great risk from fire, the lack of beds, and dereliction of duty or improper use of authority by officers o attendants in specific cases. It is not within the province of this monograph to attempt to pass judgment on these topics, but in passing it seems desirable so call attention to certain outstanding facts. Use of private hospitals, the fire risk in government hospitals, and the lack of beds were all incidental to the unparalleled demand for hospital treatment. The construction of fireproof buildings meant considerable delay, and as it was imperative that accommodations be provided at once recourse was necessarily had to the use of such buildings as could quickly be adapted to hospital purposes and to the placing of patients in private institutions. Any other course would have yielded fewer beds, and the criticism resulting from lack of facilities would have been much greater. As regards the criticism of the conduct of hospitals consideration should be taken of the very rapid expansion. The number of hospital days treatment in hospitals operated by the service rose from 415,465 in the fiscal year 1918 to 2,387,884 in the fiscal year 1920, an increase of 475 per cent.; the number of hospital attendants increased from 578 at the end of the fiscal year 1918 to 6471 at the end of the fiscal year 1920, a gain of over 1000 per cent. With such rapid expansion in a technical organization it is not unlikely that the personnel in some instances fell below the standard of earlier years. The division of responsibility between the three organizations concerned with soldier relief was the greatest difficulty in the way of efficient administration and it became evident that steps must be taken to effect unification. Therefore, on April 19, 1921, the Secretary of the Treasury issued an order which transferred to the Bureau of War Risk Insurance all the activities of the Public Health Service affecting the beneficiaries of the Bureau of War Risk Insurance, except the management of hospitals and dispensaries which were operated by the Public Health Service. The effect of this order was to transfer to the Bureau of War Risk Insurance the offices of the district supervisors, the medical examination of claimants, the assignment of beneficiaries of the Bureau of War Risk Insurance to hospitals, and the supervision of private hospitals giving medical treatment to discharged soldiers. The Public Health Service still continued to operate its own hospitals and to supervise private hospitals having contracts for the medical relief of seamen and beneficiaries other than those of the Bureau of War Risk Insurance. The district supervisors were by this order directed to continue all work previously done by them for the Federal Board for Vocational Education.95 As the Federal Board for Vocational Education was not under the supervision of the Secretary of the Treasury, he had no authority to control its activities. His authority as regards this organization was limited to prescribing the subdivision of the Treasury Department that should conduct the work being done by the Department for the board. The unification of facilities for the relief of disabled soldiers had now progressed as far as was possible without legislation. A bill for the establishment of a Veterans' Bureau was introduced in the House of Representatives on May 95 For text of this order see foot-note on page 238. 25, 1921, and was approved by the President on August 9, (Public Act No. 47, 67th Cong). This act created an independent establishment to be known as the Veterans' Bureau, to which were transferred the Bureau of War Risk Insurance and the activities of the Federal Board for Vocational Education dealing with the vocational rehabilitation of disabled soldiers authorized by the act of June 27, 1918. The act also specifically affirmed the transfer to the Veterans' Bureau of the offices of the district supervisors and the supervision of contract hospitals as provided in the order of the Secretary of the Treasury of April 19, 1921. The Director of the Veterans' Bureau is made "responsible for the proper examination, medical care, hospitalization, dispensary, and convalescent care" of discharged soldiers, but the act does not transfer the hospitals of the Public Health Service to the Veterans' Bureau, although the President is authorized to transfer specifically designated hospitals if he deems such action necessary. The Director of the Veterans' Bureau is authorized to utilize the facilities of the Public Health Service and other specified government agencies, and these agencies are authorized and directed to furnish such hospital services and supplies as the director may deem necessary; if the hospital facilities of the Government are not sufficient for medical care and treatment the director is authorized to improve or extend existing hospitals, acquire additional hospitals, or to contract with state, municipal, or private hospitals. It should be noted that this act does not set up a separate hospital organization in the Veterans' Bureau, but gives the director of that organization authority to take this action if he deems such a course necessary. The Director of the Veterans' Bureau is made primarily responsible for the medical treatment of beneficiaries and to accomplish this purpose he is authorized to use the facilities of the Public Health Service or any other government organizations. The Public Health Service became in effect a contracting agency for giving hospital treatment. The detailed hospital management still re mained for a time under the Public Health Service, but the Director of the Veteran's Bureau is directed to maintain an inspection service, which is authorized to examine all facilities and services utilized for medical relief. The President was authorized to transfer to the Veterans' Bureau specifically designated hospitals under the control of the Public Health Service, and by the executive order of April 29, 1922, there were transferred to the Veterans' Bureau the annexes to the Marine Hospitals at Mobile (No. 13) and New Orleans (No. 14) and all Veterans' Hospitals.96 The noncommissioned personnel was transferred to the Veterans' Bureau, but the commissioned personnel of the Public Health Service on duty in the hospitals was detailed for similar duty under the Veterans' Bureau. By this order the Public Health Service was relieved of all responsibility for the treatment of veterans of the War with Germany, and the nature of the hospital work reverted approximately to the condition in the early part of 1917 although greater in extent. Revision of Salaries of Commissioned Officers, 1922. On June 10, 1922, there was approved an act (Public No. 235, 67th Congress) which established a new basis for fixing the salaries of the commissioned officers of the Public Health Service, Army, Navy, Marine Corps, Coast Guard, and Coast and Geodetic Survey. By this act the pay is fixed by rank and length of service, while the allowances for subsistence and quarters are determined by the rank, length of service, and whether or not the officers have dependents. Details regarding the pay and allowances of the several grades are given on page 169. 96 Prior to January 17, 1922, the hospitals which had been opened after 1918 had been known as Public Health Service Hospitals, while the older hospitals were known as Marine Hospitals. On January 17, 1922 the hospitals at Sewall's Point, Virginia, Ellis Island, New York, Carville, Louisiana, and 67 Hudson Street New York, which had been known as Public Health Service Hospitals were designated Marine Hospitals, all the other hospitals were designated Veterans' Hospitals. A complete list of the hospitals is given on page 254-257; the executive order of April 29, 1922, is given in full on page 244. CHAPTER II ACTIVITIES Medical Treatment. Medical treatment for merchant seamen was the purpose for which the Marine Hospital Service was created in 1798, and this continued to be its only function for over three-quarters of a century. Gradually the service enlarged its activities in the field of quarantine, medical inspection of immigrants, sanitation, hygiene, and general investigations relating to the public health, until by 1918 the hospital work, measured by personnel and expenditures, was a relatively minor activity of the service. By 1920 the medical and hospital treatment of patients of the Bureau of War Risk Insurance had become the major activity of the organization in terms of persons employed and money expended. In the spring of 1922, the treatment of discharged soldiers was transferred to the Veterans' Bureau, and the hospital work was materially reduced although it still has an important place in the activities of the service. Beneficiaries. Hospital treatment and out-patient relief are given to the classes of persons listed below. If hospital treatment for any class of patients is specifically authorized by law the date of the act and the references to the statute are given. If not specifically authorized by law, reference is made to the earliest regulations authorizing treatment. It will be noted that treatment for seamen on several classes of government vessels is not provided for specifically by statute, these patients presumably being treated under the general authority of Section 6 of the Act of March 3, 1875 (18 Stat. L., 486), which is as follows: That sick and disabled seamen of foreign vessels and of vessels not subject to hospital dues may be cared for by the |