were eligible for vocational training. The World War veterans, act of 1924 was occasion for a further audit. The abstract cards used as a basis for the work, resulted in showing 3,915 cases requiring review under this legislation. The bulk of these cases were rated prior to July 1, 1924. One inovation during the year was the establishment of the appeal unit, which was instituted to permit a more careful handling of appeals. The success of this unit is indicated by the fact that it succeeded in reducing appeals to central office by approximately 90 per cent. The claims service itself is maintained, so far as possible, on a 24-hour service. Particularly is this so with claimants in hospital, since it is realized that in these cases the beneficiary has had his means of livlihood stopped, and that the lack of funds proves serious to his dependents, with the consequent lowering of his morale. Therefore, the claims division certifies for payment to the disbursing office awards for increased compensation by reason of hospitalization within 24 hours after receipt of authenticated notice of admission to hospital. BOARD OF APPEALS An endeavor has been made during the past year to bring about a fuller understanding on the part of both beneficiaries and different divisions of the bureau as to the attitude of the board. Some of the beneficiaries have had the impression that the board of appeals operates as a court, endeavoring to place them on the defensive. The policy has been to place the appellant at his ease, treat him with courtesy, and permit him to tell his story in his own language. On the other hand, there has been a tendency on the part of personnel in different divisions to regard decisions of the board which are contrary to action taken by that division as a reflection upon the judgment and efficiency of that group. By calling into consultation on various cases those employees, a fuller understanding throughout the office as to how the board arrives at its decisions has obtained. In each opinion rendered, the presentation of the facts is given, with reasons for the decision. The following is a comparison of the number of cases considered by this board for the fiscal year ending June 30, 1923, as compared with the past fiscal year: 1923 1924 The fiscal year of 1924 afforded the necessary time in which to observe the result of the reduction in the number of subdistrict offices and demonstrated the wisdom of the reduction. Through these consolidations and reductions, the receipt of examination reports and extension of medical relief has been facilitated. Several changes in medical administration have occurred during the past year. Medical inspection was placed directly under the supervision of the district medical officer, with encouraging results as to amount of work performed. The office of chief nurse was abolished, and the entire work of the follow-up activities under the supervision of the district medical officer permitted greater attention to the social side of medical problems presented by the claimants themselves and to elaborate the program of active cooperation with the county Red Cross units and the State and county welfare organizations. Decentralization of the work in medical ratings was started. The first decentralized ratings were made in the New York City office, and, in view of the enormous load encou.tered at that station and the satisfaction with which the ratings have been accomplished there, it is anticipated that the same experience will be encountered with respect to the balance of the district. The elaborate physiotherapy clinic in the New York subdistrict office has been made model in thoroughness, method, and economy of medical administration, with a fully trained specialist in charge. There exists the closest coordination in this clinic with all the other branches of medical work, both for the purpose of diagnosis and for supplementary treatment. Favorable results have obtained during the year in a large number of cases regarded as being more or less persistent chronicity. All physiotherapy aides employed in the district are given an intensive course in this clinic before permanent assignment. In accordance with the policy of closing dental clinics where service could be rendered at less cost on a fee basis, the clinics at Camden, N. J., and New Haven, Conn., were closed during the year and the dental personnel at Newark, N. J., reduced. The economy of operating a clinic in the densely populated area is observed by the fact that a saving was effected in the New York subdistrict office alone of more than $24,000 compared with the cost had the work been done on a fee basis. The installation of the orthopedic shop has been eminently satisfactory from a standpoint of service and economy. All new braces and all repair work on braces and artificial limbs is done when the claimant reports to the shop. The department for supplying prostheses for facial deformities which can not be improved by plastic surgery has been unusually successful. The respiratory diseases situation in the district during the year presented several prominent features-the experiment at the Reco School conducted by the New York County Tuberculosis Association; the evolution of the bureau program at Saranac Lake, N. Y., and the development of its hospital elements. The Reco School is an institution in Long Island City where quiescent and arrested cases of pulmonary tuberculosis cases are being and have been trained for the past three and one-half years under sheltered and controlled conditions. It was an extensive experiment undertaken to determine, first, whether such cases should be under sheltered and controlled conditions or trained under ordinary routine; and, second, to determine whether claimants who have active pulmonary tuberculosis can be trained collectively and as a class to the point of employability. While the complete report of this experiment is not yet available, records to date indicate that it is not feasible to train this type of case collectively to the point of employability, because of the prohibitive cost involved and because of the various physical factors obtaining in each individual case. Saranac Lake, N. Y., with its unique hospital program, was made the subject of an intensive study during the past fiscal year, and on 1 June 20, 1924, instructions were issued to organize there the contract hospital into a hospitalization center directly under the control of the district office, with a staff of United States Veterans' L'ureau physicians and follow-up nurses in attendance. This rearrangement, it is believed, will result in better discipline and better medical supervision and in saving a large amount of money for the bureau. While during the year the only veterans' hospital for the treatment of tuberculosis in this district was at New Haven, Conn., there were being constructed during the year two new tuberculosis hospitals at Beacon, N. Y., and Tupper Lake, N. Y. These hospitals were completed shortly after the end of the year and will go far in meeting the demands for hospitalization in this area. The problem of the beneficiary suffering from neuropsychiatric disease was made the subject of an elaborate survey during the year to determine the actual load, which proved to be considerable. In the caring for these conditions the cooperation of the New York State Hospital Commission had been most gratifying, and in numerous instances it has gone to extreme measures to assist the bureau in the placing of psychotic cases. The State hospitals in the three States comprising this district are overcrowded, and the new hospital authorized by the last Congress will go far in meeting the demands in this district for additional facilities. REHABILITATION During the months of February, March, April, and May, 1924, a board of district supervisors of the several general classifications of training visited all the subdistricts in district No. 2, and in cooperation with the subdistrict rehabilitation committees made a thorough survey of all rehabilitation activities including a careful review of the folder of every trainee. After the survey was completed the committee advised with the subdistrict officers relative to the individual program of the various trainees with the view to rehabilitation into employment. Although confining its activities to the New York metropolitan subdistrict, the influence of the cooperation of the Merchants Association has had a helpful and wholesome effect upon the work of the entire district and has even extended beyond its bounds into other districts of the bureau. Composed as it is of representatives of approximately 10,000 leading commercial and manufacuring concerns and various industrial establishments, the Merchants Association of the city of New York appointed committees of its experts in every line who gave freely of their time and counsel, sitting in conference with bureau representatives and beneficiaries several hours each day, several days each week for six months or more, advising, readvising, counselling, and assisting in providing employment opportunities through their extensive connections. The work so generously and efficiently done was performed without expectation of financial remuneration and has been most salutory in its effect upon all concerned. It is probably true that the cooperation of the Merchants Association of New York City will stand out as the most thorough, expert, constructive, and altogether satisfactory assistance rendered the bureau by any business organization in the country. Comparatively few rehabilitated persons are unemployed in the district. It is estimated that the employment load for the next six months will be approximately 2,300. The rehabilitation problem in district No. 2 therefore is rapidly being transformed from one of training into one of employment. Systematic, organized effort is made well in advance to prepare for the efficient discharge of this obligation. Every rehabilitation assistant in the subdistrict offices has been instructed that it is his responsibility to see that men are trained in places where gainful employment is assured and to provide suitable employment for all trainees committed to his care. Every employee of the bureau from the district manager to the messenger boy--not only rehabilitation assistants, but doctors, contact representatives, administrative officers, stenographers, clerks, etc.-considers it his particular business and privilege to seek bona fide compensating opportunities for employment for all persons rehabilitated by the bureau. It is expected that every employee of the bureau in the district will report regularly available employment opportunities for the benefit of those who are completing their training. In this way the employment problem ceases to be a matter of serious concern and melts away in the fine cooperative effort of the personnel in all divisions of the bureau; in turn, the morale of the personnel is strengthened because of enthusiastic interest in a common endeavor and the consciousness of having a vital part in a worth-while achievement. DISTRICT NO. 3 District organization as of June 30, 1924 District States District office District manager 3 Division chiefs Pennsylvania.. (H. J. Crosson, inspector. O. E. Harvey, chairman board of appeals. Philadelphia... L. C. Vannan...W. J. Bott, M. D., medical. S. W. Candee, rehabilitation. (A. L. Johnson, claims. SUBDISTRICTS Offices Scranton, Pa.. Harrisburg, Pa. Philadelphia, Pa. Managers The first year of the Veterans' Bureau in district 3 was one of laborious upbuilding; the second, one of organization; the third, one of regulated output. The successes of the year have been earned profits, made possible by the elaborate structure erected and perfected into operation during the first two years of Veterans' Bureau existence. Quality of work has greatly improved and at reduction in cost. Equipment and personnel have been correlated to yield best results; disabilities have been equitably placed on permanent ratings, successful rehabilitations have brought about in great number and employment provided, and the curative or corrective service of medical examiners supplied with ordered regularity. INSPECTION SERVICE Inspections and investigations pertaining to hospitals and medical subjects have been made by the designed member of the district medical division. Complaints of treatment and care in hospitals, as well as complaints of unsatisfactory surgical operations have been carefully investigated, with submission of suitable reports and recommendations. Inspections of alleged fraud and irregularities, and investigations for which provision has been made by law have been carried out under arrangement with subdistrict offices. A close relationship has been established with the United States Secret Service, the Post Office Inspection Division, the Department of Justice, and State, county and city police forces. Approximately 2,000 cases of all kinds have been investigated during the year. COOPERATION The foremost work of cooperation during the year has been in establishing contact with approximately 3,000 individuals per week. Much misunderstanding of the law under which the Veterans' Bureau |