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FRIDAY, JULY 20, 1917.




(See p. 117.)

The CHAIRMAN. Doctor, you are asking $200,000 for the construction, equipment, and furnishing of such semipermanent buildings at St. Elizabeths Hospital as may be required to provide additional accommodations for patients. Why?

Dr. WHITE. To take care of the insane of the military forces. You know that there are going to be a very considerable percentage of insane in the Army.


Dr. WHITE. Well, there is a considerable percentage in the Army in time of peace and there undoubtedly will be more in time of war. The CHAIRMAN. What buildings are you going to erect?

Dr. WHITE. The idea in asking for this $200,000 is this: We know there are going to be a great many insanes to provide for. We do not know, of course, how many of them are going to be sent back to this country. There is no definite policy which has been established by the War Department so that we can figure on anything exactly, but we have got to be prepared for them when they come. This $200,000 is for the purpose of building buildings not now, but for the purpose of putting up semipermanent structures rapidly as the needs develop, so that we will be able to take care of these people as they come in. We have the right to expect at least 1,000 insane for every 500,000 that are added to the Army under ordinary conditions, and we know from what has been experienced in Canada, if we are to expect the same conditions that the Canadians have had, that approximately 20 per cent of the troops that are invalided home are mental and nervous cases. They have brought home something like 40,000 troops. So that we are bound to have a very considerable number of them.

The CHAIRMAN. Forty thousand invalided troops?

Dr. WHITE. Yes; that number has been sent home on their hospital ships, and 20 per cent of those are mental and nervous cases. We also know that the English and French did not make adequate provision beforehand for their insane, and they have had a great deal of trouble with them as a result. If they are not adequately provided for, they are going to be all over the country in general hospitals and not properly taken care of, and that will interfere with the care of the other soldiers, so that they ought to be properly segregated and properly cared for. We have succeeded in getting the Army and Navy people to accede to the plan of adding to their large base hospitals a separate building specially erected for mental cases to be in charge of a psychiatrist. We-when I say we I mean the people who have formed themselves into a committee to help out in this matter-we have succeeded in getting a psychiatrist assigned to every one of the large camps and cantonments for the examination of the enlisted men, so

that, as far as possible, marked defective types will be excluded, so that we will not have to take care of them at the front when they break down there.

The best we can figure, we will probably have several thousand cases to take care of, and in order to provide the accommodations I have asked for this money to build units that can be readily constructed, something after these plans [indicating]. This is practically the plan which the Army has adopted for its units at its base hospitals. I would not want to be held down as to the interior arrangement, because that will have to be changed according to the type of patients we get.

The CHAIRMAN. How many stories will it be?

Dr. WHITE. Just one story-a wooden building.


In addition to that, I am asking you for the land on the river front, so that we can locate the buildings about our present buildings and use that land for farming.

The CHAIRMAN. They have leased that land.

Dr. WHITE. Yes, sir; but the lease expires in December. They could turn it over to us so that we could farm it.


In addition, I am asking for authority to incorporate in the law this language [indicating], which will permit the Secretary of War to send to the public institutions for the insane throughout the United States which are willing to accept them, such patients as go insane in the Army, preferably picking out hospitals in the districts where the patients live. For example, in New York if they had 20 beds at Rochester and there were 20 men from that district they could send them there.

The CHAIRMAN. You want authority granted the Secretary of War to transfer to the various public hospitals for the care of the insane of the country that have facilities for and will receive them, patients of every class entitled to treatment in St. Elizabeths Hospital, and that they be admitted on the order of the Secretary of War? Dr. WHITE. Yes, sir.

The CHAIRMAN. And you want authority granted the Secretary of War to transfer to the nearest available public hospital for the care of the insane any insane patient who is in need of treatment from any military hospital, preference being given to the hospital nearest to the place of the patient's enlistment?

Dr. WHITE. Yes, sir; that is to the hospitals that are willing to accept them, not to force them, of course.

The CHAIRMAN. And you want to take the money appropriated for the support of St. Elizabeths Hospital to pay for those patients at these other institutions. How would you ever be able to know what happened?

Dr. WHITE. If the Secretary of War transfers anybody, why, he has a record of it. This is to be paid for on bills submitted and approved. They will be Federal charges. The purpose of this is to mobilize the beds in the hospitals for the care of the patients that

we can not take care of at St. Elizabeths, unless you want to build tremendously, and even then, I think, it is rather doubtful. This would make the beds in the hospitals throughout the country available, and we would pay for them at the cost of maintenance.

The CHAIRMAN. Is there any authority now for the Secretary of War to transfer insane patients to any hospital?

Dr. WHITE. No; there is only one institution in the United States, and that is St. Elizabeths, that can take a man fram the Army on the order of the Secretary of War, and that puts altogether too much on one institution.


The CHAIRMAN. You estimate that there will probably be about 7,000 insane patients?

Dr. WHITE. I can not tell you. We are going to have a number. At the minimum estimate we are entitled to two thousand per year per million men in the Army. I think that is a moderate estimate.

The CHAIRMAN. Two hundred thousand dollars will provide accommodations for how many?

Dr. WHITE. I think $200,000--it depends somewhat on the cost at the time of erection and where we have to build-will provide accommodations for about 900 beds. Of course I am speaking now of present conditions, and when we start to erect these buildings the price of lumber and labor may have greatly changed.

The CHAIRMAN. All you contemplate is to provide for about 1,000? Dr. WHITE. Yes, sir; that is what I am doing now.

The CHAIRMAN. Will there be facilities there for a larger number? Dr. WHITE. I think, so far as the amount of land is concerned, if you give us the land on the water front, there is ample for indefinite expansion.

The CHAIRMAN. I am not certain that Congress is in a position to give you that land on the water front for permanent buildings for the insane. Do you want to cultivate it?

Dr. WHITE. Yes, sir; because it would be cheaper to put the buildings on the land on the hill and use the water-front land for the farm. The CHAIRMAN. You want to use that land for the farm?

Dr. WHITE. Yes, sir. If we were to put the buildings down there, it would cost materially more.

The CHAIRMAN. I thought that you meant to put the buildings down there?

Dr. WHITE. You asked me how much I could expand. If we do away with the farm entirely and use the water-front land, we could expand thousands, but if we did that we would have to build a separate heating plant and go into the thing on a large scale. If we put these buildings on the hill, we will have to use land that is now farmed. It would be better to put them there, because they would be built more cheaply and could be easily connected with the existing lighting and heating system, and then simply transfer the farming operations down on the water front.

The CHAIRMAN. I thought that the War Department had agreed to give you that land?

Dr. WHITE. They never made any agreement. The thing has been left in the air each time. The only agreement they made was that

when the lease expired they would consider the matter. I think it would be a calamity after the lease expires in December to rent the land to some farmer to raise corn on for $600 a year, when it could be of so much benefit to the Government at this time. Here is a little suggestion of where we would build the buildings. If we should go beyond these structures [indicating], we would have to use land that is now farmed.

The CHAIRMAN. Where is this other land?

Dr. WHITE. On the river front. The river front, that is the filled-in flats, do not show on this picture. Last year, just closed, we had the largest admission rate ever had in the history of the hospital, including the Spanish War, 897 admissions, 75 a month. We have 3,250 patients, and we are full. If you are going to increase the military force by approximately a million

The CHAIRMAN (interposing). Not increase the force by a million, but increase the number to a million, an increase of about 650,000. Dr. WHITE. Yes, sir. That is the beginning. We are the only institution that can take care of the insane from the Army at the present time.


(See p. 114.)

The CHAIRMAN. Does this include the cost of the buildings and furnishing and equipping them?

Dr. WHITE. We were in hopes that we could provide the ordinary furnishings, such as the beds. It includes all the plumbing, fixtures, and all that sort of thing. I do not know whether we can do that or not; it depends on what the cost is when we put the buildings up. Those things are not very expensive, and as it stands now they could be built for this price, including the equipment, but whether it can be done at the end of six months or not, I do not know. I do not want to build these structures until they are necessary. My idea is not to go ahead, except, perhaps, one at a time, and try to keep pace with what is expected of us.

Here indicating] is a canvass of the situation in the public hospitals of the United States. Practically 1,200 beds would be immediately available for the insane, provided that law passes. A great Inany States can increase their capacity materially. Most of these beds are in institutions already crowded, and they are simply saying that they can take them and will crowd them in.

Authority is granted to the Secretary of War to transfer to the various public hospitals for the care of the insane of the country that have facilities for and will receive them, patients of every class entitled to treatment in said St. Elizabeths Hospital and that are admitted on an order of the Secretary of War. The Secretary of War is authorized to transfer to the nearest available public hospital for the care of the insane any insane patient who is in need of treatment from any military hospital, preference being given to the hospital nearest to the place of patient's enlistment.

The superintendent of said public hospital shall possess the right to retain the aforementioned class of patients in his hospital in the same manner and to the same extent as now possessed by the superintendent of St. Elizabeths Hospital.

The superintendent of St. Elizabeths Hospital, with the approval of the Secretary of the Interior, shall transfer to the various public hospitals, out of the various appropriations made by the Congress of the United States for the support and treatment of the patients in St. Elizabeths Hospital, a sum sufficient to pay for the support and treament of patients sent to the public hospitals

as above, based upon the per capita cost as per statements on file in the office of the Secretary of the Interior, said payment not to exceed at any time the exact cost of support and treatment of these patients.


The Secretary of War is authorized to grant a revocable permit to the hospital for the use of such portions of land as are at present not under lease, and such other portions thereof where lease may expire, of that portion of land lying along Anacostia Flats which has been reclaimed by the engineers of the War Department and is valuable for farming property adjacent to the hospital.

TUESDAY, JULY 17, 1917.




The CHAIRMAN. For manufacture of adhesive postage stamps, special-delivery stamps, books of stamps, and for coiling of stamps, $60.000.

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Mr. FITCH. We can reduce that to $22,000.

The CHAIRMAN. Is that an actual deficit?

Mr. FITCH. It is the actual deficit in round numbers. It is a trifle under that,


The CHAIRMAN. For manufacture of stamped envelopes and newspaper wrappers, $225,000.

Mr. FITCH. You can reduce that to $220,000.

The CHAIRMAN. How does this arise?

Mr. FITCH. From two causes. The cost prices were increased during the year.

The CHAIRMAN. Were you not operating under a contract?

Mr. FITCH. Yes; but the contract prices were changed. The paper was changed and the contract prices were changed during the year. We were operating under a four-year contract, but the contractor was up against the proposition of getting material because paper had increased very largely in price and he was about to fail. The department, acting upon the decision of the comptroller and under a provision of the contract, changed the paper and increased the prices for the envelopes paid the contractor.

The CHAIRMAN. That was after Congress refused to permit them to modify the contract?

Mr. FITCH. No, sir; it was before that.

Mr. BARROWS. The case was brought to the attention of Senator Bankhead and Mr. Moon at the time. This was before the bill was introduced modifying the contract. This was decided upon before that.

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