The question of feasibility of training in these cases is very difficult. In deciding feasibility it will be necessary to keep in mind those same factors which govern a decision that a handicap exists. A claimant who has been insane would not be inducted into training in any vocation where history of psychosis would ordinarily be considered as a ground for a decision that a vocational handicap existed. It would be said in general that this entire group is feasible for training in only those occupations which will not in themselves entail the assumption of great responsibility, or require unusual and unremitting intellectual effort or that would otherwise predispose the recurrence of the mental disorder. L. B. ROGERS, Assistant Director. (Special District Manager Letter, Medical Division, No. 18. Obsolete) MARCH 13, 1923. A definite expression of your opinion as to the advisability of carrying stocks of elastic and silk webbing appliances, heretofore furnished district and subdistrict offices, is desired. A survey of the prosthetic stock sheets which are supposed to be submitted monthly by districts would indicate that the movement of this stock is, in general, sluggish. This raises the question whether the amount saved the Government by the purchase of these supplies in comparatively large amounts is not more than offset by deterioration of the goods ensuing from lack of demand. A second consideration, of course, is the matter of prompt service to beneficiaries needing these types of prosthetic appliances. Here again the question is raised whether the presumed economy of time effected by stocking these goods is not more than offset by the net loss resulting from the enforced holding of the stock. In supplying these goods, the central office is between the horns of the dilemma; for purposes of economy, two sizes are stocked, rather than a wide variety of sizes. This economic arrangement, in turn, defeats the object of the service in that probably in most cases the beneficiary can not be properly fitted, so that the stock remains on hand. While these goods are supposed to be in paraffin packages, so that the rubber is protected from deterioration by dampness, it is still felt that there is a probability of deterioration from other causes, such as dryness, etc. The entire matter of the advisability of supplying these stocks is under consideration and it is desired to consult the experience of the districts in this respect. What, therefore, is your frank impression of the advantages of supplying these stocks of prosthetic goods? Assuming that you can not fit a claimant from the two sizes carried in stock, have you any facilities in your district office for requisite alteration? What has been your experience as to the keeping qualities of these rubber goods? Just what is the actual demand for these goods in your district and subdistrict offices? Do you prefer the keeping of stocks of goods to getting them from outside contract firms? Is your service from such outside contract firms so comparatively satisfactory as to make it no particular advantage to carry stocks of these goods? How much time, on an average, is saved by stocking these goods? So far as your experience goes, could you approximate just what economy is effected by supplying these goods from stock rather than getting them from outside contract firms? How close is your supervision over these stocked goods? What is the condition of the stock that you have on hand at the present time? Just how fast is this stock being depleted? For which of these goods is the demand the more brisk? On which of these items is there little or no demand? Do you feel that these goods should be supplied to the district offices for distribution to the subdistrict offices, or would you consider it advisable to supply subdistrict offices? If you consider it advisable to supply the subdistrict offices, do you think it advisable to stock all of the subdistrict offices, or only the larger? Have you suggestions as to the amount of these goods that should be stocked, as suggested by your experience, assuming that you consider the stocks desirable? It is believed that these questions will put this office in possession of sufficient data upon which to form an opinion as to the general advisability of stocking these elastic and silk webbing appliances. If there is anything further that you could add which would further contribute to an intelligent review of this project by this office, such additional information would be appreciated. Your early attention in this matter is requested. L. B. ROGERS, Assistant Director. (Special District Manager Letter, Medical Division, No. 19. Obsolete) APRIL 6, 1923. The propriety of a liberalization of the bureau's program of home treatment is at present under consideration. A number of resolutions have been received from various organizations in which is agitated the granting of home treatment for tuberculous beneficiaries after a period of hospitalization. A wider extension of home treatment would necessarily involve many important aspects of medical work. It would bear vitally, for instance, on the construction of further hospitals, and, in fact, upon the maintenance of the hospitals now in existence. It would mean a very decided increase in the number of follow-up nurses now employed, and it would also mean the employment of more designated examiners in localities where dispensary facilities can not be utilized. The central office desires to give the entire question of home treatment deliberate thought before shaping a policy. In this consideration, it is desired to have the benefit of the district office experience and viewpoint, and it is requested that you take this matter up with the district medical officer, the district relief officer and, the chief of the district tuberculosis section. The following information is particularly desired: 1. Do you approve of home treatment for tuberculous beneficiaries under the conditions specified in regulations United States Veterans' Bureau, 1923, chapter 7, section 7036–b (United States Veterans' Bureau Regulation 20-B)? 2. In your opinion, do those regulations sufficiently meet the needs of the situation? Can the problem of the tuberculous beneficiary, desiring home treatment, continue to be handled satisfactorily under the individual conditions described in the existing regulations? 3. How many tuberculous beneficiaries have you taking home treatment at this time in your district? Of this total number, how many in your opinion actually require follow-up supervision? That is, presumably active cases; and not comparatively static, or arrested cases, that are taking vocational training, or are on a permanent partial rating. 4. Are your subdistrict offices maintaining a card index of tuberculous beneficiaries within your respective territories for better guidance in follow-up nursing work? 5. Do you regard your follow-up nursing of tuberculous beneficiaries as satisfactory at the present time? If not, describe the deficiencies and outline a constructive suggestion as to the creation of a satisfactory nursing follow-up service for your district. 6. In your opinion, how often should these tuberculous beneficiaries be seen by the nurse? 7. Would you advise cooperation with the social service and nursing agencies of welfare organizations in maintaining supervision of tuberculous beneficiaries released from hospitals for home treatment? If so, to what extent could such services be utilized in your subdistrict? 8. Do you consider that it would be advisable or feasible to extend follow-up nursing to include beneficiaries who have been discharged from hospitals for absence without leave, or discharged against medical advice? 9. Do you approve of an extension of home treatment for beneficiaries suffering from types of disability other than tuberculosis? While the central office would desire an expression of opinion on these points at the earliest convenient time, still the reply should be delayed sufficiently long enough to permit of the district office securing opinions from such subdistrict medical officers as it is desired to consult in this connection. It will be recognized by the district manager that this question is a serious one and that before any definite policy is outlined, it will be necessary for the bureau to survey the situation carefully to ascertain the actual need for this step, and to estimate as closely as possible the advantages thereof. L. B. ROGERS, Assistant Director. (Special District Manager Letter, Medical Division, No. 20. Obsolete) APRIL 16, 1923. Reference is made to General District Manager Letter, Medical Division, No. 29 of June 3, 1922, and Special District Manager Letter, Medical Division, No. 16, of February 26, 1923, which letters brought to your attention Forms No. 1896 and No. 1897 to be used in rendering monthly reports on X-ray supplies and X-ray operations at X-ray clinics of the several dispensaries, the report to be prepared at the end of each month and to be transmitted to the central office by the 5th of the succeeding month. It is important that the total amount of X-ray work performed at the clinic, as well as on a contract basis, be included in medical officers' monthly reports of relief, Form 2565, each month, and to be credited to the medical officer in charge of the X-ray clinic or to any contract Röntgenologist concerned. On Form 1897 the names of assistant radiologist and X-ray technicians are to be noted. This method of compilation of the two reports will allow the checking of one against the other. In those dispensaries which have X-ray equipment which is not functioning, a report is necessary each month, giving the reason why the X-ray clinic is not in operation. Reports received to date indicate that instructions relative to this transmittal of monthly reports on X-ray activities are not being followed and, therefore, you are instructed to see that each and every clinic renders its reports promptly each month. L. B. ROGERS, Assistant Director. (Special District Manager Letter, Medical Division, No. 21. Superseded by Circular No. 67) APRIL 17, 1923. 1. Contributions are invited from medical officers on medical, surgical, sanitary, and administrative subjects, or on a medical or surgical case which presents unusual or interesting features. 2. Medical officers will not publish professional papers requiring reference to official records or to experience gained in the discharge of their official duties without the previous approval of the assistant director, medical division. 3. Any reports or articles of this kind, intended for publication, should be forwarded in duplicate to the assistant director, medical division, attention chief consultant. When case reports are made, one copy of the clinical record should be forwarded therewith. The author of a paper after its approval may have it published in the journal of his choice, unless it is desired that central office endeavor to secure its publication. L. B. ROGERS, Assistant Director. 1 (Special District Manager Letter, Medical Division, No. 22) MAY 31, 1923. (Special District Manager Letter, Medical Division, No. 23. Canceled by General Order No. 370) TRANSPORTATION FOR ALLIED EX-SERVICE MEN JUNE 11, 1923. The department of soldiers' civil reestablishment, Ottawa, Canada, has requested this bureau to embody certain amendments in instructions now in force and furnished all district offices. For your information it is proper to state that where the word "department" appears, it means the department of soldiers' civil reestablishment, Ottawa, Canada. It is also proper to state that "Canadian forces includes ex-members of the naval and military forces of the United Kingdom of Great Britain and Ireland and ex-members of the Australian, New Zealand, and South African forces, and whenever the term "discharged" is used with reference to discharge from military or naval service in respect to the Canadian forces, it shall include "retired" officers as well as discharged enlisted men. Inquiry has been made by a district office as to whether, on presentation of documentary or other evidence of military service, an ex-member of the Imperial or Canadian forces is entitled to transportation, lodging, and meal requests without authority from the department, through central office. The department's reply is as follows: (1) When the bureau is requested by the department to examine an ex-member of the Canadian or Imperial forces for pension purposes, transportation from his home to the place of examination, also transportation for the return journey, either prior to or on completion of examination, may be issued by the bureau, together with any necessary lodging and meal requests. (2) When the bureau is requested by the department to furnish treatment or hospitalization to an ex-member of the Canadian or Imperial forces, transportation from his home to the place of treatment, also transportation for the return journey, either prior to or on completion of treatment, may be issued by the bureau, together with any necessary lodging, and meal requests. (3) In any case not covered by the above instructions, transportation, lodging and meal requests will not be issued without specific authority from the department, which may be obtained by telegram where necessary through central office. Medical examinations of Canadian and British ex-service men should be made when such men present themselves voluntarily for examination, and their identity as ex-service men having been established, it is believed that they are suffering from service-connected disabilities, but no transportation or subsistence should be furnished or paid in connection with such examinations until authorized by central office, and an examination is not in order if necessary to be made by any other than a salaried medical officer of the bureau until proper authority is received for such examination from the bureau. It is in order to state that the district offices have a supply of instructions governing the treatment of discharged members of the military and naval forces of those governments which have been associated in war with the United States since April 6, 1917. These instructions were issued under date of September 6, 1921, and furnished to the district offices in such numbers as were indicated by the district managers for the requirements of their offices. Should it be found necessary to furnish additional copies, such are available upon request from the district manager. It is desired to again emphasize the fact that notices of admissions to and discharges from hospitals and of deaths of Canadian and Imperial ex-service men should be expedited by wire. L. B. ROGERS, Assistant Director. (Special District Manager Letter, Medical Division, No. 24. Canceled by General Order No. 370) INSERTION OF DENTURES FOR ALLIED EX-SERVICE MEN JUNE 28, 1923. The department soldiers' civil reestablishment, Ottawa, Canada, has requested this bureau to advise all district managers that in cases of allied ex-service men (Canadian, British, Australian, South African, and New Zealand) where dental services have been authorized by central office for beneficiaries of the Canadian Government as outlined, that full upper and lower dentures are not to be inserted until a period of approximately six months have elapsed since the date of extractions, except in cases where the medical advisers indicate that it is imperative for the health of the patient that dentures be supplied to provide facilities for mastication. When a case falls within the excepted class you are directed to have the medical adviser indicate the necessity for immediate restoration, in order that a report may be forwarded to the department of soldiers' civil reestablishment, Ottawa, Canada. L. B. ROGERS, Medical Director. (Special District Manager Letter, Medical Division, No. 25. Canceled by General Order No. 370) EMERGENCY TREATMENT TO FORMER MEMBERS OF THE IMPERIAL FORCES JULY 17, 1923. With regard to the granting of emergency treatment to article 9 claimants, being those former members of the imperial forces who may require such treatment in the United States, the department of soldiers' civil reestablishment requests that the certificate (as to treatment being urgently necessary and the disability, in respect of which it is required, being undoubtedly attributable to or still aggravated by service in the World War) be signed by a whole-time medical officer of the United States Veterans' Bureau or by a whole-time medical officer of the department of soldiers' civil reestablishment. In compliance with the foregoing request, it is directed that in cases where it is impossible to have the above-mentioned certificate signed by a whole-time medical officer of the United States Veterans' Bureau, the case will be referred to the central office, where the necessary action will be taken to obtain from the Canadian Government authority to render the treatment. L. B. ROGERS, Medical Director. (Special District Manager Letter, Medical Division, No. 26. Obsolete) AUTHORITY TO PURCHASE ILETIN (INSULIN) DURING PERIOD ENDING DECEMBER 31, 1923 OCTOBER 23, 1923. Contract has been made with Eli Lilly & Co., 224 McCarty Street, Indianapolis, Ind., for furnishing iletin as follows: Package H-10, 50 units, 1 ampule, $1.50 per package; package H-20, 100 units, 1 ampule, $2.50 per package. F. o. b. Indianapolis. You are therefore authorized to place orders direct with Eli Lilly & Co., for this product during the contract period, which expires December 31, 1923. Vouchers in payment of this character of supplies should be duly certified and presented to the special disbursing agent in the district for payment. A. J. MCINTYRE, Acting Medical Director. (Special District Manager Letter, Medical Division, No. 26-A. Superseded by Circular No. 22) DECEMBER 6, 1923. Special District Manager Letter, dated October 23, 1923, Medical Division, No. 26, relative to authority to purchase iletin (insulin) during period ending December 31, 1923, is amended to read: Package U-10, $0.95 per package; package U-20, $1.65 per package. Postpaid. You are therefore authorized to place orders direct with Eli Lilly & Co. for this product during the period ending December 31, 1923. Vouchers in payment of this character of supplies should be duly certified and presented to the special disbursing agent in the district for payment. L. B. ROGERS, Medical Director. (Special District Manager Letter, Medical Division, No. 27. Canceled by General Order No. 370) SUBMISSION OF MEDICAL REPORTS UPON FINAL DISCHARGE FROM REST CAMPS OR CONVALESCENT HOMES OF ALLIED EX-SERVICE MEN JANUARY 28, 1924. The department of soldiers' civil reestablishment, Ottawa, Canada, has invited attention to the fact that in a few cases of Canadian ex-service men receiving treatment in hospitals under the bureau they have been transferred to certain rest camps and convalescent homes for variable periods prior to final discharge. It is further shown that in some of these cases difficulty has been encountered in obtaining a medical report on the S. C. R. (Canadian Form) 76, covering discharge from treatment, due to the fact that no physician is assigned to the rest camp or convalescent home. The accomplishment of the above indicated form is necessary for the department, as in a majority of cases a reassessment of the pension award to the Canadian ex-service man is made on the basis of the report. When the beneficiary is discharged from a rest camp or convalesecnt home and there is no medical officer of this bureau on service at such places, arrangements shall be made to have an examination of the man by one of this bureau's medical officers and a report furnished on S. C. R. 76 showing the present physical condition at date of final discharge from the rest camp or convalescent home. Transportation to the nearest suitable center where the report can be completed will, in these circumstances, be supplied. An acknowledgment of this instruction is desired, addressed to the insular and foreign service subdivision, medical division, central office. A. J. MCINTYRE, Acting Medical Director. (Special District Manager Letter, Medical Division, No. 28. Canceled by Circular No. 220) ALLOWANCES FOR MEALS AND LOSS OF TIME FOR EX-MEMBERS OF THE NEWFOUNDLAND FORCES JUNE 3, 1924. The board of pension commissioners for Newfoundland, St. John's, Newfoundland, has requested this bureau to instruct all district offices to furnish transportation only to ex-members of the Newfoundland forces reporting for medical examinations authorized by central office. No allowances will be paid by the bureau for meals or loss of time. Ex-members of the Newfoundland forces are required by the board of pension commissioners for Newfoundland to make claim direct to that board at St. John's, Newfoundland, for such allowances, and not through the district offices of this bureau. An acknowledgment of this instruction is requested for the attention of the insular and foreign service, central office. E. O. CROSSMAN, Medical Director. |