ing that these trainees stand among the highest in their classes in scholarship, in attendance, and proper pursuit of objective sought. The entire work of this subdivision appears to stand out from other classes of bureau activities as having special and distinctive character, in that it constantly presents complex and varied problems requiring a specially trained type of personnel adapted for the work. The subdivision maintains personal contact and most cordial relations with the various embassies and legations in Washington, and might well be called a clearing house for the difficulties and problems of the ex-service men who are extraterritorial. The Minister of the Department of Soldiers' Civil Reestablishment and other high officials of the Canadian Government have visited Washington to hold personal conferences regarding our reciprocal agreement. Much mutual benefit has resulted from these visits, as well as from corresponding visits by bureau officials to Canada.

The personnel of this subdivision on the whole have always been sympathetic and cooperative in the performance of their duty in extending service in proper directions. The work from its inception has gradually been on a growing basis, but the personnel taking care of the service has been so organized that it has been found possible to handle the increased work without enlarging the force.

The following is a detailed statement regarding the total volume of work cared for by the insular and foreign subdivision during the fiscal year 1924:

Number now in training in foreign countries and insular possessions

There are 52 men eligible for training who have not accepted training or whose training arrangements have not been completed; 101 cases are deferred for physical reasons; 787 cases are in the status of lapsed eligibility, due to time limitation; 235 men have been rehabilitated under section 2, and 9 men have completed section 3 training.

Employment data is being obtained in cases of men rehabilitated in foreign countries and in the insular possessions. The data is complete

for Porto Rico. Out of 74 men rehabilitated, 60 of the number are employed along the lines of their objective. The majority of these men pursued an agricultural course for one year at the College of Agriculture and Mechanic Arts, Mayaguez, where they specialized in poultry, hog, and cattle raising, beekeeping, gardening, and dairying. Men have been rehabilitated along the following objectives: International law, veterinary surgery, teacher of foreign languages, consular service, accountancy, private secretary, artist, journalist, physician, sugar technologist, agriculturist, interior decorator, and landscape gardener. Investigations

The dental subdivision has administrative jurisdiction over all dental activities in hospital and out-patient clinics, as well as treatment furnished beneficiaries through the medium of designated dentists. It also originates all necessary orders and regulations governing the activities necessary in determining eligibility for and furnishing of dental treatment.

Dental treatment and prosthesis are being authorized to claimants of this bureau under the following classifications:

Class 1. Service connected compensable dental disabilities, such as gunshot wounds or other trauma or disease so extensive in scope that it is difficult, if at all possible, to make a satisfactory or perma

nent restoration.

Class 2. Service connected noncompensable dental disabilities, such as caries, pyorrhea, Vincent's stomatitis, etc.

Class 3. Adjunct dental treatment given as an aid in the cure or relief of a service connected general physical disability.

Class 4. Intercurrent dental treatment furnished to trainees for the relief of such oral conditions as manifestly prevent or interfere with the course of training which has been prescribed.

Nearly five years have elapsed since the majority of claimants were discharged from military service in the World War, and during that period practically all claimants having a dental disability rating under class 2 and class 4 have been taken care of. Because of the decline in the number of cases requiring dental treatment under these two classes, authorizations for dental treatment at the present time are for cases under classes 1 and 3, i. e., compensable cases and those requiring adjunct dental treatment.

In that dental authorizations are so largely confined to classes 1 and 3, and that such treatment is usually given in connection with hospitalization, it has been found unnecessary and unprofitable to maintain certain out-patient clinics, which have consequently been discontinued, with corresponding saving in operating expenses. During the fiscal year the number of out-patient dental clinics has been reduced from 84 to 46, the number of dentists from 182 to 87, and the number of oral hygienists from 7 to 4. Hospital clinics have been reduced from 46 to 44, and the personnel reduced by 10 dentists. In some localities where both out-patient clinics and hospital clinics were in operation the functions of the two clinics were combined, thus reducing rental costs, with a concomitant reduction in the expense of operating two separate establishments.

The natural decrease in dental authorizations has made possible a betterment of dental service rendered by the bureau, so that at the present time dental teatment and prosthesis of a high quality are being furnished beneficiaries.

The use of designated dental examiners upon a fee basis has been largely discontinued, except at localities remote from bureau clinics, although yearly reappointments of designated dental examiners are made so that emergency cases may be cared for, and that reference of claimants may be made when the transportation expense, etc., of bringing a claimant to a bureau clinic is in excess of what such treatment would cost upon a fee basis.

The scope of adjunct dental treatment and the conditions under which such treatment may be given has been broadened, through the approval by the director of new procedure. Much thought has been given to the standardization of dental treatment and prosthesis and to the insuring of uniformity of procedure in authorizations for such treatment.

Under recent legislation, it is to be expected that there will be an increase of authorizations for dental treatment of claimants while hospitalized. This treatment, however, can be given at a minimum of expense, in that hospital dental clinics are properly equipped and staffed to care for all claimants who may be hospitalized.

PROSTHETICS

Through standardization of prices, renovation of used appliances, curtailment of long-distance travel for purposes of inspection and fitting of appliances, the reduction in volume of service, especially to trainees completing their courses, the prosthetics section was able to effect a saving of $72,839.17 for the fiscal year.

The close supervision of the furnishing of prosthetic devices through the district offices was continued by the central office. A checking-up system was maintained whereby duplicate requests for appliances for the same claimant through different field offices could be discovered, unfair prices controlled, the supplying of devices as adjunct measures for associated disabilities properly supervised, and statistical data assembled.

When, after proper inspection and fitting, a prosthetic device was supplied to a claimant, a receipt card was secured from him, indicating his satisfaction with the apparatus, and these cards were kept on file, together with all other information relative to the compensation status of the individual claimant.

The present policy is to supply a claimant with a new artificial limb only after two or three years' usage of a formerly supplied limb. In the event of breakage or maladjustment of apparatus, the necessary repairs are made in the orthopedic shops maintained by the bureau in several districts. The workmanship on the orthopedic and prosthetic appliances made or renovated in these shops is of high grade, done as it is by employees who have had previous long practical experience with manufacturing firms. It has often been found possible to supply a fabricated article more quickly through the shops than to purchase it from an outside contracting firm, and promptness of service is essential in dealing with those particularly deserving claimants who have lost limbs in the service of their country. The price of appliances made in the bureau's shops, including all overhead expenses such as rental, supplies, labor, depreciation, etc., compares favorably with the contract price for the same goods supplied by manufacturing houses.

The appended report shows the approximate saving made by the orthopedic shops from October 1, 1923, to the end of the fiscal year:

District No. 9 includes only the period from Feb. 1, 1924, to June 30, 1924, as the orthopedic shop was closed until Feb. 1, 1924.

A total of 10,684 fewer claimants have been furnished prosthetic supplies during the past year as compared with the fiscal year ending June 30, 1923. This was due largely to the fact that completion of courses of vocational training released the bureau from the need of supplying glasses for reading or vision to many trainees who had previously been so supplied. The cost of glasses furnished trainees during the past year was $17,751.20, against a total cost of $40,790.27 for the preceding fiscal year. A total of 1,677 claimants, apart from