(Hospital Circular No. 158. Canceled by General Order No. 27-D) REPORTING DISCIPLINARY DISCHARGES UNDER GENERAL ORDER NO. 27-A

OCTOBER 4, 1923.

Your attention is called to the provisions of General Order No. 27-B, Paragraph II, in relation to transmitting information in regard to patients discharged for disciplinary reasons.

Omissions and inaccuracies in reports forwarded by the field have caused inaccuracies in central office records resulting in confusing reports being sent out to the field. In view of the fact that the information compiled in central office is disseminated to each hospital and district by means of a daily report, which report is the only information available to district managers and medical officers in charge of districts and hospitals of districts other than the one which from the beneficiary has been discharged, it is essential that the statements contained therein be absolutely correct.

To obtain that accuracy special care should be taken when transmitting Medical Division Form 2568 that the name of the patient be correctly spelled, the correct claim number, the latest home address of the patient given, the diagnosis stated, and that the causes for discharge not applying be struck out. In cases of discharge under A and C, the date of discharge given should be the date the patient actually leaves the hospital. Discharges under B (leaving without permission, more than seven days) the date furnished should be the eighth day of absence from the hospital. The name of the hospital from which the patient is discharged is absolutely essential. In cases reported for forfeiture of compensation, the amount of the forfeiture should be stated, together with the length of time said forfeiture shall be effective.

Whenever the disciplinary board recommends both disciplinary discharge and forfeiture of compensation, it shall be so stated on Medical Division Form 2568, and complete findings of the board must be attached. L. B. ROGERS, Medical Director.

(Hospital Circular No. 159. Canceled by Circular No. 232)

MONTHLY REPORTS OF EXPENDABLE X-RAY SUPPLIES AND X-RAY OPERATIONS OCTOBER 21, 1923.

1. Monthly reports of expendable X-ray supplies and X-ray operations will hereafter be made on Supply Division Form 1241, of which a supply has been sent you. 2. Use of Medical Forms 1896 and 1897 and Public Health Service Form 1919-C will be discontinued upon receipt of Supply Division Form 1241. L. B. ROGERS, Medical Director.

(Hospital Circular No. 160. Obsolete) REPORT OF HOSPITAL FACILITIES

OCTOBER 24, 1923.

In order to conveniently provide information necessary to central office it is desired that the medical officer in charge of each service hospital prepare and submit to the director in triplicate a report covering the following points:

In further explanation of the kind of information desired, the following suggestions are offered; for example, under:

(5) State the number of buildings and describe briefly the construction of each, or if there are a large number, the construction of each class; whether permanent or temporary, of wood or brick, number of stories, fire hazard, fire protection, state of repair, purpose for which used, suitability, and any other pertinent information. (In general terms only, and briefly.)

(6) State whether owned or leased; if leased, for how long, annual rental paid, privilege of renewal, etc. (11) Give a very brief statement with regard to source and purity of water supply, whether municipal or private; if from wells, give depth, and state if protected from surface contamination. If municipal, merely state if safe and whether or not water is chlorinated. If of doubtful safety, send separate report, giving details. (14) Give here categorically the number of beds for general medical and surgical cases as follows:

(a) Available beds for white males.
(b) Available beds for white females.

(c) Available beds for colored males.

(d) Available beds for colored females.

This refers to the entire bed capacity, whether beds are occupied or vacant.

(15) Answer same as 14, and add (as of Oct. 1, 1923)—

(e) Number of patients under treatment by artificial pneumothorax.

(f) Number of patients under treatment by heliotherapy:

(1) Natural

(2) Artificial.

(g) Number of patients receiving two hours or more daily therapeutic exercises as occupational therapy. (h) Is sputum certified by medical officers before a positive finding of tubercle bacilli is officially recorded? (16) Answer same as 14.

(17) State briefly the adequacy of your facilities, equipment, and personnel. Can you handle all classes of cases and meet all demands? If not, what class of work can not be done?

(18) State briefly the adequacy of your facilities, equipment, and personnel. Is there a medical officer thoroughly trained in this work who devotes all or a part of his time to laboratory work? What other personnel? Are you prepared to do complement fixation? Blood chemistry? Basal metabolism?

(17 to 30) Names and special qualifications, if any, of physicians who devote their time to this class of work. NOTE. Changes in the personnel in classes above mentioned which may affect your handling of cases should be immediately reported to the bureau in duplicate. Include also statement of services rendered by consultants. Name definitely, so far as possible, the surgical and medical conditions which your station can not handle without additional personnel or equipment.

(33) Describe briefly equipment and give number of personnel on duty.

(34) Answer same as 33.

As any changes may occur effecting the answer to any of the above questions, you are directed to immediately notify the bureau in order that this record may be kept current in the files of your hospital.

IMPORTANT. This report is to be submitted in triplicate on 8 by 101⁄2 inch sheets, unheaded paper, the carbons to be on paper as heavy as can be conveniently used, the object of the director being to combine the reports from various hospitals in loose leaf books for ready reference.

FRANK T. HINES, Director.

Modified by General Order No. 68-D)

(Hospital Circular No. 161.
WASTE AND SALVAGED MATERIAL FOR USE IN OCCUPATIONAL THERAPY

NOVEMBER 20, 1923.

1. As a matter of economy it is desired to conserve new supplies for occupational therapy, and in their stead to utilize waste and salvaged material whenever practicable. In furtherance of this plan the medical officer in charge will instruct other departments at the station to cooperate with the occupational director by turning over such waste and salvaged material as can be advantageously used for occupational therapy. 2. The following list gives suggestions of material which can be used and of articles which can be made thereform:

Scrap lumber, wooden boxes, packing cases, sal- Book ends, checker boards, door stops, flower boxes, furnivaged furniture.

ture repairs, lamp bases, rug frames, shelves, shuttles, spindles, tool handles, toys, utility boxes, window wedges. Containers for nails, paint, etc.; toys, vases. Feed for chickens, rabbits, and pigs.

Back stops for tennis and baseball, window guards.

hot Tray base covers, glass for framed pictures.

Transparent inserts in card cases. pocket books, etc.

3. At some stations it has been possible to obtain from other Government agencies waste material, such as copper from confiscated stills, which could be utilized for occupational therapy. At one station the chief aide reports worn-out bath robes are laundered, dyed by the patients, and woven into rugs which are not unlike the expensive chenille rugs made commercially. Willow which can be cut and prepared for making willow baskets and furniture may be found near some stations, or can be grown on the hospital grounds.

4. Occupational therapy is a therapeutic measure. At many of the stations occupational therapy may be so prescribed and guided as to meet the therapeutic indications and at the same time to produce articles useful to the station. The construction of cabinets, shelves, chicken houses, runways, and other station utilities, and the repair of furniture and buildings are in many cases practical forms of occupational therapy.

(Hospital Circular No. 162)

L. B. ROGERS, Medical Director.

TRANSMISSION OF PATHOLOGICAL SPECIMENS TO BE IN COMPLIANCE WITH POSTAL LAWS AND REGULATIONS

NOVEMBER 22, 1923.

In order that the transmission of pathological specimens mailed from your station may be expedited and that the method of such transmission is in compliance with Postal Laws and Regulations, the following extract from the Postal Bulletin, dated November 16, 1923, is quoted for your information and guidance:

The attention of postmasters is called to paragraph 6, section 473, of the Postal Laws and Regulations, which reads as follows:

Upon the outside of every package of diseased tissues admitted to the mails shall be written or printed the words "Specimen for bacteriological examination. This package to be pouched with letter mail."

It is requested that all dispatching clerks be instructed to hereafter dispatch specimens for bacteriological examination with letter mail, in order that their handling and delivery may be expedited. Strict compliance with this regulation is imperative for the proper safeguarding of the public health. L. B. ROGERS, Medical Director.

(Hospital Circular No. 163)

DIVISION OF NEUROPSYCHIATRIC FACILITIES ON WEEKLY CENSUS REPORT, FORM NO. 2601

NOVEMBER 30, 1923.

1. In order that current statistical reports prepared in the Bureau may be utilized to the fullest extent possible in connection with questions of administration, it is necessary to procure from veterans' hospitals through the medium of Form No. 2601, Weekly Census Report, certain additional data as regards the use of neuropsychiatric facilities.

2. In the present report all types of neuropsychiatric beds are listed under one classification, namely, neuropsychiatric. It is now requested that hereafter in submitting this weekly report this class be divided between the true psychoses (definitely insane) and all other neuropsychiatric conditions (not insane), under which captions the number of beds occupied, the number of unoccupied beds, and the total number of available beds will be furnished.

3. You are further requested to report under "Remarks" the number of psychiatric beds maintained for observation cases only, both occupied and unoccupied.

4. The need for this additional information is apparent when it is considered that the neuropsychiatric group is so large and includes so many distinctly different conditions involving particularly the matter of mental competency that previous reports give an inadequate picture of the existing situation to any one attempting to determine the extent and general type of neuropsychiatric facilities.

5. It will be necessary to utilize the present form for this purpose until such time as a revised edition can be printed. 6. Your personal attention is invited to this matter to the end that accurate reports may be received, commencing immediately following the receipt of these instructions.

L. R. ROGERS, Medical Director.

(Hospital Circular No. 164. Canceled by General Order No. 370) COMPOSITION OF TELEGRAMS TO THE DIRECTOR OF MEDICAL SERVICES, DEPARTMENT OF SOLDIERS' CIVIL REESTABLISHMENT, OTTAWA, CANADA, IN REGARD TO ADMISSIONS AND DISCHARGES TO AND FROM HOSPITALS OF ALLIED EX-SERVICE MEN

DECEMBER 14, 1923.

1. A letter from the director of medical services, department soldiers' civil reestablishment, Ottawa, Canada, indicates that medical officers in charge of United States veterans' hospitals in reporting admissions to and dis charges from hospitals of allied ex-service men in many instances include unnecessary and frequently omit im portant information.

2. In order that correct information may be given, and as a matter of economy, it is requested that medical officers in charge of United States veterans' hospitals when forwarding telegrams covering admissions to and discharges from hospitals, or in reporting a death case, give the following information only: (1) Given and