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Health Service Hospital the discharged soldier must be a beneficiary of the Bureau of War Risk Insurance or its successor, the Veterans' Bureau, the hospital treatment being given in addition to the compensation provided by law. Persons entitled to compensation from the Bureau of War Risk Insurance and, therefore, entitled to treatment in Public Health Service Hospitals were those embraced in the following classes who were rated as having a disability of at least ten per cent. according to the schedule of disability ratings adopted by the bureau.

(a) Any soldier, sailor, marine and Army nurse discharged after April 6, 1917, who is suffering from injury or disease contracted in line of duty and not the result of his own willful misconduct. However, a person is ineligible to compensation if he received a dismissal or dishonorable or bad conduct discharge from the service, if he was discharged or dismissed from the military or naval forces as an enemy alien, a conscientious objector, a deserter or by reason of being guilty of mutiny, treason, spying, or any offense involving moral turpitude or willful and persistent misconduct.

(b) Any person who, after induction by a local draft board, but before being accepted and enrolled for active service, became disabled as the result of disease contracted or injury suffered in the line of duty, and not the result of his own willful misconduct involving moral turpitude, or a result of the aggravation in line of duty and not because of his own willful misconduct involving moral turpitude of an existing disease or injury.

Persons who had a claim pending before the Bureau of War Risk Insurance were given treatment while their claims were being adjudicated, provided they did not fall within the class of persons who are denied compensation as outlined above. The beneficiaries of the bureau who were not taking vocational training were treated only for conditions definitely connected with their military service or for conditions having an untoward effect upon the cure or amelioration of conditions

definitely connected with their military service. Discharged soldiers receiving vocational training were entitled to treatment for any disease which might interfere with their training regardless of whether the disease had any relation to military service.

In the medical treatment of discharged soldiers, the service acted for the Bureau of War Risk Insurance up to August 9, 1921, under authority of the Secretary of the Treasury, who had supervision over both the organizations. The activities of the Public Health Service in connection with the work of the Bureau of War Risk Insurance included not only hospital and dispensary treatment but also the medical examination of claimants in order to determine their degree of disability, and until the latter part of the fiscal year 1920, the medical review of claims in the office of the Director of the Bureau of War Risk Insurance.83

Vocational rehabilitation of disabled soldiers was to be provided by the Bureau of War Risk Insurance under the provisions of section 304 of the act of October 6, 1917, but that bureau did not develop this work, and the act of June 27, 1918 (40 Stat. L., 617-620), transferred this activity to the Federal Board for Vocational Education, an independent establishment not under the control of any executive department. When this work was first undertaken by the board, physicians were generally employed on part time, and were paid as a rule on the basis of individual examinations. At this time. the board depended largely on transcripts of medical examinations from the files of the War and Navy Departments and the Bureau of War Risk Insurance. Under the act of June 27, 1918, a disabled soldier was entitled to vocational training only after he had been awarded compensation by the Bureau of War Risk Insurance. On July 11, 1919, an act was passed (41 Stat. L., 158-159) making the board the sole judge of need for vocational education. As this change made many reexaminations necessary the medical staff had to be increased. 83 Secretary of the Treasury, Annual Report, 1920, p. 208.

On account of the limited number of salaries at $2500 and above available for the use of the board, it was difficult to secure good doctors on full time. In order to supply medical personnel the Public Health Service assigned medical officers to the main office of the board in order to direct the medical work, and arranged for the physical examinations to be made at the stations of the Public Health Service.84

On August 28, 1919, medical officers in charge of Public Health Service hospitals and stations were directed to make physical examination of disabled soldiers when requested by the Federal Board for Vocational Education, 85 and on September 30, 1919, they were instructed to give hospital service to disabled soldiers undergoing a course for vocational education, when requested by the district officers of the Federal Board for Vocational Education.86 The work done for the Federal Board has been small compared with that carried on for the Bureau of War Risk Insurance.

Unfortunately no general hospitalization program had been worked out by Congress or the executive officers of the government, and the Public Health Service soon found that the demand for hospital treatment far exceeded the capacity of its hospitals.

In the middle of March, 1918, the Director of the Bureau of War Risk Insurance requested the Public Health Service to give hospital service to discharged soldiers as far as possible.87 At that time there were in all the Marine Hospitals 1704 beds, of which 1171 were occupied, leaving 533 available for patients of the Bureau of War Risk Insurance.88 In July the Public Health Service was requested to provide accomodations for 14,000 tuberculosis soldiers. On September

84 Federal Board for Vocational Education, Annual Report, 1920, p. 281.

85 Bureau Circular Letter, 179.

86 Ibid., 188.

87 Hearings before Committee on Public Buildings and Grounds, House of Representatives on . . . H. R. 13,026, 1918, p. 28. 88 House Hearings on Sundry Civil Bill for 1919, p. 154.

II, 1918, a committee of medical officers of the Army, Navy, and Public Health Service reported that in addition to the 14,000 men suffering from tuberculosis already discharged 20,000 men would be rejected during 1918 and 1919 at the military camps after induction into the service. As the men accepted by the draft boards but afterwards rejected at the training camps became beneficiaries of the Bureau of War Risk Insurance, it was necessary to provide hospital facilities for these men. It was estimated that three-fourths of these men, or 26,000, would apply for sanitarium treatment, and that the average length of treatment would be six months. This would require 13,000 beds. The War and Navy Departments had made no provision for treatment of patients other than those of the active forces, and the Public Health Service had available a total of 1704 beds to take care of 13,000 cases.8 On September 20, 1918, the Secretary of the Treasury transmitted to the Speaker of the House of Representatives a draft of a bill appropriating $10,500,000 for providing additional hospital and sanitarium facilities.

89

Hearings on the proposed measure (House bill 13,026) were held before the House Committee on Public Buildings and Grounds, but the act was not approved until March 3, 1919 (40 Stat. L., 1302-1305). This act transferred to the Public Health Service a number of army hospitals, and authorized the transfer of other hospital property which might be vacated by the army. The Secretary of War was authorized to transfer hospital equipment, medical supplies, and motor driven vehicles, and the President was given power to transfer to the Treasury Department land and buildings which were under the control of other departments, but which were not needed by them. A number of specific hospital projects were authorized and the Secretary of the Treasury was empowered to contract with existing hospitals for the use of all or part of their equipment. The act carried an appropriation of $8,840,000 for hospital projects, $210,000 for furniture and equipment, 89 65 Cong., 2 Sess., H. Doc. 1294. P. 4.

and $785,333 for operation and maintenance during the remainder of the fiscal year 1919. The regular annual appropriation for the maintenance of hospitals during the fiscal year 1920 was $4,845,000; several deficiency acts for the same year made additional appropriations of $15,166,187.14. The act of March 3, 1919, was the first law which recognized the Public Health Service as the instrumentality for furnishing medical relief to the beneficiaries of the Bureau of War Risk Insurance, as up to this time this work had been assigned to the service at the direction of the Secretary of the Treasury. The sundry civil appropriation act for the fiscal year 1920, approved July 19, 1919, further confirmed this by appropriating to the Public Health Service the money necessary for the medical and surgical treatment of discharged soldiers and by providing that no appropriations made to the Bureau of War Risk Insurance should be used to reimburse "any expenses incurred by any government owned hospital or hospital under contract with the Public Health Service for examination, care, or treatment of beneficiaries of the Bureau of War Risk Insurance (40 Stat. L., 173). This left the Bureau of the War Risk Insurance free to contract with non-government owned hospitals not already under contract with the Public Health Service, but it seemed inadvisable to divide the hospital work, and all discharged soldiers in private hospitals were placed there under the supervision of the Public Health Service.

The result of the legislation of March 3, 1919, was that the hospital work in the next three months expanded more than ever before in the history of the service.90 Between April and June 30, 1919, the service opened ten new hospitals with a capacity of 5693 beds. In March, 1918, the bed capacity of the old Marine Hospitals was 1704, and it probably increased very little until the new hospitals were taken over. During the fiscal year 1919 reserve officers to the number of 222 were assigned to active duty, and the number of acting assistant surgeons increased from 383 to 701, most

90 Surg. Gen., Annual Report, 1919, p. 219.

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