master of arts in the normal department; 14, the degree of bachelor of arts, and 12, the degree of bachelor of science. RECEIPTS AND EXPENDITURES The total receipts, including balance on hand July 1, 1939, were $199,631.70. Expenses were $196,331.04. A reserve of $507.32 was returned to the treasury, leaving a balance of $2,793.34. Dr. T. Edward Jones, Director in Chief A MOMENTOUS event occurred in the history of Freedmen's Hospital during the fiscal year just closed. By virtue of the authority contained in section II (e) of Reorganization Plan IV made effective June 30, 1940, by Public Resolution No. 75, Seventy-Sixth Congress, approved June 4, 1940, the following order was promulgated by the Administrator of the Federal Security Agency for the guidance of all concerned: 1. Freedmen's Hospital and its functions shall be administered under the direction and supervision of the Federal Security Administrator through the Surgeon General of the Public Health Service. Subject to the provisions of Agency Orders No. 5 and No. 6, the service facilities of the Public Health Service shall be made available to and utilized by Freedmen's Hospital. The Cooperative Agreement for the Management and Operation of Freedmen's Hospital, executed October 27, 1939, by the Secretary of the Interior, the President, and the Acting Secretary of the Howard University shall remain in full force and effect. The reorganization plan thus transferred Freedmen's Hospital from the United States Department of the Interior which had exercised supervision for more than 70 years. The growth and expansion of Freedmen's Hospital during that period of time can be depicted as follows: Its establishment as a Bureau for the relief of freed men and refugees dates back to an act of Congress dated March 3, 1865. During the years 1868-69 the Freedmen's Hospital permanent quarters were built; a brick building 54 by 100 feet and three frame wards. 24 by 120 feet were constructed. The ground surrounding them covered a space of nearly 4 acres. The third and fourth stories of the brick building were occupied by the medical department of Howard University, and the rest of the building along with the frame wards were used for hospital purposes. The hospital is now comprised of nine buildings situated within a square bounded by two city blocks on either side. Provision is made for both indigent and pay patients without regard to legal residence. PROFESSIONAL ADVANCEMENT The visiting (attending) staff has grown from approximately 10 in 1869 to 85 during the fiscal year ending June 30, 1940. There is also a professional staff of 17 internes, 8 assistant residents, and 4 residents. The members of this staff are the immediate aides to the visiting staff. TRAINING SCHOOL FOR NURSES Freedmen's Hospital Nurse Training School, established in 1894, gives young women theoretical and practical instruction in trained nursing. Upon graduation they are eligible for membership in graduate nurse associations, and for State boards examination. The Training School for Nurses graduates annually approximately 12 percent of all colored nurses graduating from schools within the United States. The present director of nurses of Freedmen's Hospital is a product of its school. HOWARD UNIVERSITY RELATIONSHIP Freedmen's Hospital is the training center for the students of Howard University School of Medicine. This school graduates annually upward of 40 percent of all Negro medical graduates in the United States. Both institutions are rated class A by the American College of Surgeons. The close affiliation of Howard University School of Medicine with Freedmen's Hospital, which has existed since the founding of the school in 1867, was further strengthened by the Cooperative Agreement for the Management and Operation of Freedmen's Hospital executed October 27, 1939, by the Secretary of the Interior and the President, and the acting secretary of the Howard University. This agreement definitely outlines the functions of each, and enhances the value of these two institutions as an efficient training center for the medical profession. ACTIVITIES AND ACHIEVEMENTS FOR THE One of the most outstanding achievements is the addition of a tuberculosis unit building of 150-bed capacity. This unit is the result of an allotment of $700,000 by the Public Works Administration, for its construction and equipment. Its available occupancy January 1, 1941, will do much toward the establishment of an adequate number of beds for tuberculous patients. ACCOUNTING SYSTEM Approving a request from the director in chief of Freedmen's Hospital, the Secretary of the Interior invited the General Accounting Office to make a comprehensive survey of the accounting needs and requirements of Freedmen's Hospital. The purpose of this survey was to develop and install a standardized accounting system and procedures for the purpose of furnishing accurate and essential data to the Congress, the Bureau of the Budget, the Department of the Interior, and the administrative officers of Freedmen's Hospital. As a result of the survey, a standardized system of general ledger and allotment ledger control accounts was installed. The sum of the benefits derived from the installation of this system are as follows: 1. Increased collections of moneys due the hospital from pay patients. 2. Coordination between the various pay units of the hospital and the collection department. 3. Establishment of uniform standards to be used in determining patients' ability to pay for services. 4. Administrative approval for the reduction or cancellation of erroneous pay patients' accounts. 5. Uniform and consistent issuance of formal receipts. 6. Prompt recording and depositing of payment by patients. 7. Periodic billings to all hospital debtors. 8. Development of new income by claims for service rendered in incident and compensation cases against insurance companies. 9. Improved control over stores and equipment. 10. Improved and uniform purchasing procedures. 11. Establishment of accurate accountability for retirement funds. The procedures encompassed within the system installed have resulted in a substantial reduction of hospital expenditures. Subsequent to the original request and at the informal suggestion of the Bureau of the Budget, in order to facilitate the preparation of statements of expenditure required by the Bureau of the Budget, the Department of the Interior, and Freedmen's hospital, it was decided to develop a standard cost distribution system for Government hospitals and utilize the experience gained at Freedmen's Hospital for this purpose. This was accomplished through the departmentalization of the various units of the hospital together with a classification by objects of expenditure by departments. This standard system of cost distribution provides accurate data for the preparation of operating statements and administrative reports, a careful study of which by the administrative officials tends toward a more economical and efficient operation of the hospital, as well as providing the Bureau of the Budget with adequate information for comparison with operating costs of other Government hospitals looking to the ultimate development of true and factual standards of efficient administration and professional service. FILING SYSTEM A comprehensive filing system has been completed by a corps of District of Columbia W. P. A. workers. Work on the project started July 5, 1938. As many as 43 qualified typists, clerical workers, and other white-collar workers were engaged at peak employment. In setting up the case record files, the W. P. A. workers transcribed several thousand such records to assure their future existence. Index cards briefly recording other case histories, dating from 1881, also were made a part of the records. Other accomplishments include the arrangement, classification, codification, and filing of 10,000 emergency patients' cards, as well as the rearrangement in chronological sequence of the hospital census sheets dated July 1907 to the present. On September 8, 1938, a unit history system for in-patients was installed, thus bringing together in one folder all hospital admissions regardless of the number of times a patient is admitted. A similar system was installed at the same time for the out-patient records, however, existing personnel and space have not been adequate to combine the two systems so that there would be actually one unit system which includes both in-patient and out-patient records. A lack of sufficient personnel is at this time a distinct handicap to the efficiency and completeness of this system. GROWTH EXCEEDS PHYSICAL CAPACITY AND PERSONNEL The continued rapid growth of activities has overtaxed the physical capacity of the hospital as well as its personnel and equipment. The attendance upon our out-clinics was: |