355.U5 
 
 The Sick and Disabled 
 
 Ex- Service Men 
 
 of Illinois 
 
 BY 
 MYRON E. ADAMS 
 
 hXECtXIVE MANACER 
 
 Four SHF.RIUAN ASSOC! \1 ION 
 
 CHICAGO 
 
 INTkODL'CTION BY 
 
 MAJOR GENERAL LEONARD WOOD 
 
 ' ■/ 
 
 Compiled from a census made during the month of 
 
 December of 1920, January and February of 1921, 
 
 for the Henry Blair Keep Post, American Legion. 
 
 Chicago, by John W. Lyden
 
 r:re^o:rrtrpe°.^'^°"*' 
 
 ,suy o( lUinois^U^SS 
 
 1.161- 
 
 -llAl
 
 The Sick and Disabled 
 
 Ex-Service Men 
 
 of Illinois 
 
 BY 
 
 MYRON E. ADAMS 
 
 EXECUTIVE MANAGER 
 
 FORT SHERIDAN ASSOCIATION 
 
 INTRODUCTION BY 
 
 MAJOR GENERAL LEONARD WOOD 
 
 Compiled from a census made during the month 
 
 of December of 1920, January and February of 
 
 1921, for the Henry Blair Keep Post, American 
 
 Legion, Chicago, by John W. Lyden. 
 
 FORT SHERIDAN ASSOCIATION 
 
 21 North La Salle Street 
 
 Chicago
 
 /\> 
 
 
 CONTENTS 
 
 Introduction by 
 MAJOR GENERAL LEONARD WOOD 
 
 Foreword by 
 ABEL DAVIS, CHAIRMAN 
 
 National Hospitalization Committee of American Legion 
 
 Statement by 
 
 A. A. SPRAGUE, Commander 
 
 HENRY BLAIR KEEP POST 
 
 of the American Legion, Chicago, 111. 
 
 THE SICK AND DISABLED EX-SERVICE MEN OF ILLINOIS 
 By JNIyron E. Adams 
 
 ^
 
 C ONTENTS— Continued 
 
 Histoiy of Hospital Care 
 Purpcso and Method of Census 
 
 GENERAL INFORMATION 
 
 A. Wide distribution of patients. 
 
 B. Temporary character of provisions. 
 
 C. Lack of check and centralized information. 
 
 D. Lack of general hospital facilities. 
 
 E. Occasional bad conditions. 
 
 SPECIFIC INFORMATION 
 
 A. Tuberculosis. 
 
 B. Nervous and mental cases. 
 
 C. General medical cases. 
 
 D. AYar Risk Bureau. 
 
 (a) Compensation. 
 
 (b) Insurance. 
 
 E. f nited States Public Health Service. 
 
 F. Federal Board for Vocational Education, 
 
 G. American Legion Co-operation. 
 H. American Red Cross. 
 
 SPECIFIC SUGGESTIONS FOR THE FUTURE 
 
 A. Completion of the Speedwa}" Hospital, 
 
 B. A State Hospital for Mental Cases, 
 
 C. Training Farm for After-Hospital Care of Mental Cases. 
 
 D. Complete Unification, Departmentalization and Decen- 
 
 tralization of Government Bureau, caring for Ex- 
 Service Men. 
 
 E. Clinics ;ind Home Visitation. 
 
 4
 
 INTRODUCTION BY MAJOR GENERAL LEONARD WOOD 
 
 Under a sound conception of citizenship equality of obligation 
 goes hand in hand with equality of privilege. We demand the 
 latter; ice must give the former. The nation has given us every- 
 thing in the way of equality of privilege and, as far as is humanly 
 possible, equality of opportunity, and demands in no uncertain 
 terms equality of obligation, — obligation to serve wherever one 
 can best serve, this to be determined by the Government. 
 
 The Draft system employed by us in the World War embodied 
 the spirit and principal of Universal Obligation for Service, serv- 
 ice somewhere, wherever one could best serve. It was accepted 
 by our people without a murmur, and for the first time in our 
 history in a great war ive did not. resort to the bounty system or 
 to that most degrading practice of purchasing substitutes by those 
 who were umvilling to risk their lives on the battlefield. 
 
 We must keep alive this sentiment of universal obligation and 
 this spirit of service regardless of selfish interests. In order to 
 do so the nation must demonstrate that it appreciates the sacrifices 
 which have been made by the fighting forces and that it intends to 
 take care of all those who have been disabled in service and to 
 restore to the best possible condition those who have been wounded 
 or disabled as a result of service. The dead cannot be called back, 
 but many of the crippled and sick can be restored to usefidness, 
 and the best possible means must be furnished to this end. Shell- 
 shocked and nervous cases must be assembled under the most favor- 
 able conditions in a section of the country which lends itself to out- 
 door activities and to life in the open, under conditions of sunshine 
 and fresh air, which give inspiration and hope. Hospitals for the 
 permanently insane are not suitable for this class of cases. Those 
 who are suffering from tuberculosis, old bone injuries which refuse 
 to heal, from injury to the nerves, in fact, all that long category of 
 chronic cases, where recovery depends so much upon suitable sur- 
 roundings, the right kind of climate, fresh, stimulating air, etc.,* 
 must be given every opportunity for recovery. Almshouses, no 
 matter how well kept, are not suitable places for our wounded 
 veterans, nor are our Old Soldiers' Homes. Fine as the inmates 
 are, they are most of them waiting for the end of life. Our patients 
 are at the beginning of ihe road with life ahead. There should be 
 no farming out of the war cripples and invalids. Investigations 
 have disclosed too many men in utterly unsuitable places. The 
 
 5
 
 surroundings of our hospitals for the sick and crippled of the war 
 must he cheerful, good grounds, reasonable sources of amusement, 
 and an opportiinitg for much outdoor life. Our large divisional 
 hospitals in the Southive^t, West and in other sections of the coun- 
 try are comparatirehj new and can he readily used. The high 
 plateaus of the Southwest, with their dry, hracing air, have demon- 
 strated a thousand times their health-giving qualities. This is the 
 general area in which these classes of cases should he assemhled. 
 
 The soldier invalids should he placed, as far as possible, in 
 special hospitals which would have a spirit of their own, an interest 
 of their own, and everything pertaining to compensation, hospital- 
 ization, educational and vocatio7ial training should he under the 
 charge of some single head, preferably, as I see it, an assistant 
 Secretary of War. These sick men have heen soldiers, and it is 
 under the care of the Army that they should find the most sym- 
 pathy and the keenest interest. 
 
 We cannot do too much for those who have offered everything, 
 even life itself, in our efforts to restore their crippled bodies to use- 
 fulness, to implant again in their souls the fires of hope, to make 
 them feel that the world is still a good place to live in and that 
 there is much that is iisefid and helpful that they can do, and to 
 show them that we have not forgotten their service. In a word, to 
 make them again useftd citizens of the nation, men full of hope and 
 energy, looking ahead io a usefid career, and not despondent vet- 
 erans left in unsuitable hospitals, seeking health in unhealthful 
 places, gradually losing hope, slowly passing beyond the point 
 where help can he extended to them with any hope of success. 
 
 We wa7it to keep alive the spirit of service. It can best he 
 kept alive by prompt and effective recognition and care of those 
 who have served. 
 
 (Signed) LEONARD WOOD 
 
 Fort Sheridan, III., March 34, 1921. 
 
 6
 
 FOREWORD 
 
 BY 
 
 Chairman National Hospitalization 
 Committee of the American Legion 
 
 Your report on the surve^^ of disabled ex-soldiers and hospitals 
 of Illinois is an admirable presentation of facts, conclusions and 
 recommendations for the future. We have rounded the corner. 
 Our time and effort have been concentrated heretofore on indicat- 
 ing the difficulties; your report, based on facts and supported by 
 your survey, points the way to a concrete line of helpfulness by 
 the Government, the American Legion, and the public at large. 
 Truly, the splendid sons of America who still suffer from their 
 contribution to the cause of their country may look hopefully 
 toward the future. 
 
 Sincerely yours, 
 
 ABEL DAVIS 
 Chicago.
 
 A STATEMENT BY THE COMMANDER OF HENRY BLAIR 
 KEEP POST, THE AMERICAN LEGION 
 
 Considerable experience on the National Beneficial Legislative 
 Committee and later on the Hospitalization Committee of the 
 American Legion, conclusivel}^ proved two points to my mind. 
 
 First — That the governmental bureaus themselves were greatly 
 in need of information, accurate and up-to-date, concerning their 
 own wards and patients. 
 
 Second — That the general public, the legislators of the country, 
 and last, but not least, the ex-service people, whether members of 
 the American Legion or not needed exact and accurate information 
 as to the kind of care being given to those still receiving medical 
 and surgical care, the number needing some sort of treatment and 
 not receiving it. This applies particularly to tuberculosis and 
 mental diseases, and primarily what should and could be done by 
 the nation. To get this national action it became apparent that 
 an educational campaign must be carried on. 
 
 With these points in mind I feel that the Legion — and this 
 applies to every post as well as to the National Organization — 
 in order to warrant its existence must have some definite purpose 
 in mind, other than that of having meetings, to hear speeches, or 
 to give entertainments or dances. When I was honored by being 
 made commander of the Henry Blair Keep Post No. 462, a plan 
 was first laid before its executive committee and later before the 
 post, which was unanimously adopted. 
 
 This plan contemplated the taking of a census of every ex- 
 service person in every hospital in the State of Illinois. The 
 major part of the expense for this w^ork was covered by a voluntary 
 assessment of the membership of the Post, and the work has been 
 very carefully, accurately and economically done by J. W. Lyden, 
 who has had considerable. experience in this sort of work. 
 
 The census which was taken was valuable in itself, but the 
 greatest value was in the by-product or information that it gave, 
 definitely proving the need of many reforms and changes. The real 
 good from, this work will be widespread and lasting, is my belief, 
 and to the Post and one whose interest in the post has never flagged, 
 are due not only my thanks for making possible this work, but 
 the thanks of many w^ho have already benefited by the work and 
 the many more who will benefit just as much, even if indirectly. 
 
 The thanks of the wounded ex-service men and women, of 
 every member of the American Legion and of all citizens of the 
 United States interested in paying this debt to their defenders, 
 are due to one man, a man of great experience, of great heart, of 
 great vision, and great name — General Leonard Wood. His coun- 
 sel and assistance in this work, as well as in every effort that has 
 been made in the State of Illinois, have been of the greatest help 
 
 ^"^^ ^^^""^^- A. A. SPRAGUE, 
 
 Commander Henry Blair Keep Post No. 462, Chicago, 111. 
 
 8
 
 THE SICK AND DISABLED EX-SERVICE MEN OF ILLINOIS 
 
 By Myron E. Adams 
 
 We want yon to know the facts about the sick and disabled 
 men of Illinois. They have been gathered carefully and honestly. 
 The truth is bad enough. Exaggerations or the stressing of excep- 
 tions simply prevent the consideration of the real issues. 
 
 The duty of our country to give the best care to sick and 
 disabled ex-service men is not a charity, but a matter of common 
 justice and an essential link in any future policy of National 
 defense. We have bungled our care of these men; we have not 
 kept our promises made to them and to their families. It is true 
 we left it to others — to Government Bureaus, to Welfare Agencies, 
 to kindly friends. 
 
 It was our job — we thought so once. We were grateful; we 
 cheered for them at Chateau Thierry, at St. Mihiel and the 
 Argonne. Each man enriched his personal pride as well as his 
 personal security at the cost of their suffering, but we did not 
 intend to remain their debtors — that was unthinkable ! We would 
 not let Government Bureaus monopolize the thrill and the pride 
 on Armistice Day — why let a few feel the entire responsibility now ? 
 
 Hospitals are needed exclusively for ex-service men, 
 built entirely with their interests at heart. There must 
 be a unification of agencies responsible for their care; 
 it must be made easy for any ex-service man to get 
 quick and fair consideration of his claim. Every known 
 achievement of medical science must be made avail- 
 able to restore the health and strength the nation was 
 compelled to use for its defense. Increasing co-opera- 
 tion must be secured from universities, industries, pro- 
 fessions and citizens generally to reassure the replace- 
 ment of the man disabled in mind or body in a useful 
 self-respecting place in society. Nor should we forget 
 the unspeakable debt we owe to those who have given 
 husband, father, son or brother to their country. 
 
 Here's the way they did it "over there": 
 
 His commanding officer wrote, ' ' He carried his platoon through 
 to the objective, and then ordered the men to 'dig in' and to get 
 under cover. While they were doing this he noticed several 
 wounded men lying in the open, exposed to machine gun fine and 
 snipers' bullets. He called for volunteers to go with him to bring 
 in the wounded, and with two non-commissioned officers he went 
 out and carried back three of the wounded. He started on the 
 second trip, but just as he passed a stone wall several rifles opened 
 fire on the party and Lieutenant Hoyer, who was in advance, fell 
 forward on his face — dead."
 
 That Avas llic i)ii('e incii willingly ])ai(l 1o take care of their 
 wounded comrades overseas. Under the white crosses on the liill- 
 sides of France lliere rests today a l)rav(' Company of men wlio 
 gave their lives that their wounded comrades might come back 
 home and get a fighting ehauee toward a normal life again. 
 
 In 1919, when the tighting men were returning from overseas 
 and parading before their welcoming friends, these men, with 
 limbs torn by enemies' bullets, or with minds and bodies disturbed 
 by shell-shock or disease, were returned to great Army hospitals 
 hastily erected for temporary occupancy. They passed from the 
 seaboard to the inland hospitals, in the main, unnoticed. Many 
 of them were too wrecked and wretched to care, but all were glad 
 to get back home. 
 
 Most of the Illinois men were brought directly to Fort 
 Sheridan. Here a great series of wooden buildings was erected, 
 the stone barracks were renovated, and an immense hospital plant 
 was completed. This hospital and the hotel at 47th and Drexel 
 Boulevard housed the sick and disabled ex-service men for a period 
 of a year and one-half. 
 
 The first returning disabled and sick ex-service men came at 
 a time when there was a great deal of honest appreciation and 
 genuine consideration for these men. War w^ork agencies Avere still 
 active; Red Cross canteen -workers met the passing trains; Red 
 Cross recreational buildings Avere erected near the hospitals; Y. 
 W. C. A. and Y, M. C. A. buildings w-ere opened. Libraries, indoor 
 and outdoor recreation, and vocational education were furnished 
 to supplement the Avork of the Army Medical Service. Community 
 hospitality was furnished by the War Camp Community Service 
 and other organizations. 
 
 Early in 1920 it was evident that these arrangements were 
 temporary; efforts w^ere being made to discharge as many men as 
 possible; medical officers were resigning from the Service. The 
 care became more lax, and the men. in the hospitals began to show 
 the strain of their long hospitalization. 
 
 It was in October that the care of these men was transferred 
 from the Army Medical Corps to the Public Health Service. On 
 short notice the military hospitals Avere closed and dismantled — 
 in some cases actually torn down. The Public Health Service was 
 called upon to secure hospitalization and to afford medical care 
 and physical examination, not only for the men who were trans- 
 ferred from the Army hospitals, but for all claimants of the War 
 Risk Bureau, for all applicants for Vocational Training, and in 
 addition, for several classes of Government officials, including Post 
 Office employees and Merchant Seamen. 
 
 They had only one small hospital in Chicago. In a brief period 
 they had to build up their medical personnel, their central and 
 sub-offices, and in addition, secure sufficient hospital facilities to 
 care for these men. It was necessary to lease the hotel at 47th 
 
 10
 
 and Drexel, whicli had been used as a military hospital; also, to 
 make arrangements for the care of these men in public and private 
 hospitals throughout the State, as there were no central hospitals 
 available. This wide distribution of patients to public and private 
 institutions was in the nature of a temporary- expedient, and in the 
 eases of Tubercular and Neuro-psj'chiatric cases, failed to meet 
 squarely the needs of ex-service men, and often subjected them 
 to conditions which were unfair and unsatisfactory. 
 
 Earl}^ in May, 1920, a National Committee on the Hospitaliza- 
 tion and Care of Sick and Disabled Ex-Service Men, with General 
 Abel Davis as Chairman, was appointed by the National Comman- 
 der of The American Legion. This Committee surveyed the entire 
 National field, and found that there were three great problems: 
 the lack of speedy and efficient co-operation between the Bureaus of 
 Public Health, War Risk Bureau, and the Bureau of Vocational 
 Education; the lack of proper public hospital facilities available 
 for this purpose; the lack of both means and methods of properly 
 caring for tubercular and mental cases. 
 
 THE ILLINOIS CENSUS 
 
 While engaged in the work of consolidating these Bureaus and 
 securing better service for the tubercular and mental cases, the 
 Committee realized the need of a more careful census of men 
 actually in hospitals, in order that the facts might be secured. 
 Through the co-operation and support of the Henry Blair Keep 
 Post, A. A. Sprague, Commander, and Dr. George de Tarnowsky, 
 Chairman of the Medical Committee, a census of the disabled and 
 sick ex-service men in the State was made by John W. Lyden, for- 
 merly Assistant Director of the Service Department of the Amer- 
 ican Legion of Illinois. 
 
 Day after daj', for two mouths, Lyden Avent through all the 
 hospitals of Illinois, starting at Chicago and going south as far 
 as the Ohio River. He talked with each man individually, listened 
 to their stories, heard their complaints, consulted with nurses, 
 physicians, welfare workers, local representatives of the American 
 Legion, always keeping in mind that the main purpose was to 
 be personally helpful to these men, as well as to improve their 
 general conditions, and those of the men who came after them. 
 
 The Census disclosed that there were approximately 1,200 ex- 
 service men in hospitals of Illinois. This number varies monthly 
 and the average will run from 1,200 to 1,600. 250 were in Tuber- 
 culosis hospitals, 400 in Mental hospitals and 550 in General Medi- 
 cal and Surgical hospitals. 
 
 The General Medical and Surgical cases were in 3 U. S. P. H. 
 Service hospitals and in 23 private and public contract hospitals. 
 The Tuberculosis cases were in 12 hospitals and the Mental cases 
 were in 1 Public Health Service hospital and in 10 private and 
 public contract hospitals. 
 
 11
 
 The ini'orniatioii was secured on this form card: 
 
 1 2 3 4 5 
 
 HOSI'ITAL 19: 
 
 Sur Name Given Name 
 
 Claim No Serial No Age 
 
 Home Address 
 
 Street City or Town State 
 
 Married No. of Dependents Condition of Dependents 
 
 Nearest Kin 
 
 Name Street City or Town State 
 
 Date of Enlistment Rank Org Date of Dis 
 
 Diagnosis 
 
 Date and Source of Admission 
 
 Approximate Date of Discharge .'.. 
 
 Compensation — Date Filed Amount Awarded 
 
 Occupation Where By Whom 
 
 Resume Former Occupation? : 
 
 Best Friend 
 
 Name Street City or Town State 
 
 Insurance ^ 
 
 Remarks 
 
 As soon as the information was -secured it was copied on 4 
 duplicate cards and sent immediately to American Legion Head- 
 quarters, to the War Risk Bureau, the Board of Vocational Train- 
 ing and the U. S. Public Health Service. In this \xay there was a 
 .check up by these departments and delayed action was remedied 
 as soon as possible. 
 
 The census showed that 50% of the men wdio w-ere in Mental 
 Hospitals were overseas men. 10% were from the Navy and 40% 
 from noncombatant units. A larger percentage of overseas men 
 were found among the Tubercular and a somewhat larger per- 
 centage among the surgical cases. There were 720 men unmarried 
 and 315 with families, among which the majority had other de- 
 pendents. 
 
 GENERAL INFORMATION 
 
 The disabled and sick ex-service men of Illinois are widely 
 distributed. There were nine hospitals used in Chicago, and fifty- 
 one hospitals in the State outside Chicago, at the time of the 
 census. The largest hospital in Chicago, at Drexel and 47th Street, 
 houses from 250 to 500 patients, while many of the smaller hos- 
 pitals throughout the State have only one or two. 
 
 The impression of the temporary character of all arrangements 
 is evident througliout the entire State. It is purely an emergency 
 situation. The hospitals make arrangements under pressure. In 
 the majority of cases they will w'elcome the centralized care of 
 these men in Government institutions. They recognize a respon- 
 sibility, which arises from the fact that ex-service men have special 
 claims on the Government for a type of care Avhich they are often 
 not equipped 1o ])rovide. The Government is very slow in pay- 
 ments for hospilal care, and very exacting on detailed financial 
 i-eports. The slightest mistake often holds up entire payments 
 for long periods. The patients are constantly being changed from 
 
 12
 
 hospital to hospital. They also realize that the complaints of some 
 bed-weary, despondent ex-service man may cast a cloud of sus- 
 picion over their hospital record. All these facts, and many others, 
 conspire to make the majority of public and private hospitals 
 anxious to have the care of these men centralized where construc- 
 tive plans can be made and special work developed to meet the 
 special needs. 
 
 There is an evident lack of centralized information. The 
 Public Health Service does not keep accurate reports of the men 
 in hospitals at any one time, and there is no system of supervision 
 by which the Governmental agencies are kept in personal touch 
 with the patients. This results frequently in overcrowding and 
 bad conditions. For example, the census of St. Paul's Hospital, 
 a private contract hospital at 828 W. 35th Place, Avas made on 
 December 30th. It had a 20-bed capacity. There were five ex- 
 service men there, and two weeks later twenty -five more ex-service 
 men were sent there. It became over-crowded and dirty, and a 
 public scandal resulted. The men were all removed. A similar 
 complaint was made in another case, and overcrowding stopped. 
 The tremendous pressure of men needing hospital care, and the 
 lack of hospital facilities, makes this situation inevitable without a 
 constant check up on the men actually in hospitals, and a personal 
 supervision by the Public Health Service. 
 
 Every Hospital in which an ex-service man was placed by the 
 Public Health Service was visited during the months of December, 
 January and February. The medical care, personal attention and 
 consideration and general treatment given to ex-service men was 
 good. The real difficulties lay along the line of more adequate 
 hospital facilities, the special care needed for all mental and tuber- 
 cular diseases, and the proper functioning of the War Risk Bureau 
 and the Public Health Service. 
 
 TUBERCULOSIS 
 
 The Tubercular Patient 
 
 The medical care of the tubercular ex-service man is an 
 enormous outstanding problem. There is a vast difference 
 between his situation and that of the general medical patient. 
 He bears no outward sign of his contribution to his country's 
 service. Mechanical and surgical skill have combined to help 
 the man who has lost leg or arm or other physical parts, to a 
 place of real usefulness. Often he has health, strength, ambi- 
 tion and resolution to overcome his handicap, and to assist in his 
 speedy restoration. 
 
 The tubercular soldier has had a different lot. Some have 
 been held back through the war period from active participation 
 in the Service because of the development of the disease under 
 earlier hardships ; others have developed it in the active Service, 
 and while outwardly untouched, have been inwardly marked for 
 periods of tedious and lonely isolation in quiet hospitals, and no 
 prospect of speedy return to normal work-a-day life. 
 
 13
 
 There are three features of the problem in Illinois: The 
 first is the large number of tubercular men not in hospitals. No 
 accurate estimate has been or could be made, but it is several 
 times the number in hospitals. There are various reasons. Incip- 
 ient cases often are cared for at home, sometimes under medical 
 supervision, but frequently without any attention or care. Some, 
 through sheer ignorance or carelessness, delay seeking medical 
 care, or, having sought it, ignore the only treatment which could 
 assure them a return to health and strength. Others resent the 
 idea of going to a hospital, fearing the period of loneliness, and 
 eagerly seek some excuse in the nature of the hospitalization which 
 they can offer for not going. Among many ex-service men, in 
 addition, there has long been noticed a certain natural nervous 
 dissatisfied attitude toAvard the quietness and passivitj^ of the hos- 
 pital treatment required, which causes them to break away from 
 restraints and to hazard their physical future at whatever cost. 
 This situation cannotibe ignored. It has already, and will increas- 
 ingly, contribute a vast army of men to the incapacitated citizens 
 of America. 
 
 The following report supports this conclusion. These ex- 
 service men, who were under treatment at the Municipal Tubercu- 
 losis Sanitarium of Chicago, were discharged during the months 
 of January and February', 1921. There were forty-two men in 
 this hospital on January 1st, forty-one men on February 1st — 
 six were admitted during the month of February. 
 
 A- 
 C- 
 H- 
 J- 
 R- 
 11- 
 S- 
 B- 
 B- 
 C- 
 D- 
 0- 
 R- 
 S- 
 
 s- 
 s- 
 s- 
 
 V- 
 W- 
 W- 
 
 NAME 
 
 — W- 
 
 — J- 
 
 — R- 
 
 — C- 
 
 — A- 
 
 — F- 
 E- 
 A- 
 C- 
 V- 
 
 J- 
 
 A- 
 L- 
 A- 
 T- 
 R- 
 T- 
 J- 
 S- 
 B- 
 
 DATE OF DISCHARGE 
 
 January 15, 1921 
 January 2, 1921 
 January 30, 1921 
 January 30, 1921 
 January 26, 1921 
 January 27, 1921 
 January 27, 1921 
 February 22, 1921 
 February 1, 1921 
 February 2, 1921 
 February 10, 1921 
 February 7, 1921 
 February 24, 1921 
 February 27, 1921 
 February 23, 1921 
 February 2, 1921 
 February 1,1921 
 February 14, 1921 
 Fel)i-uary 7, 1921 
 February 24, 1921 
 
 14 
 
 REASON 
 
 Own Request 
 
 Died 
 
 Died 
 
 Discipline 
 
 Own Request 
 
 Discipline 
 
 Truant 
 
 Died 
 
 Transfer 
 
 Died 
 
 Truant 
 
 'Order of U.S.IMI.S. 
 
 Own Request 
 
 Transfer 
 
 Died 
 
 Non T.B. 
 
 Transfer 
 
 Transfer 
 
 Discipline 
 
 Discipline
 
 The second is hospitalization. Tliere are no Public Healtli 
 or Military Tuberculosis Hospitals in this District. Some men 
 have been sent to New Mexico, Arizona, Colorado, and during; 
 the last six months, to the new Public Health Hospital in Johnson 
 City, Tennessee. 
 
 At the time of the census, tuberculosis patients in Illinois 
 were located at the following hospitals: 
 
 Municipal and County Institutions 
 
 Chicago Municipal T.B. Sanitorium, Chicago 39 
 
 Cook County Sanitarium, Oak Forest 80 
 
 Fairview-McLean County Sanitarium, Normal 13 
 
 La Salle County Sanitarium, Ottawa 4 
 
 Peoria Municipal T.B. Sanitarium, Peoria 4 
 
 Adams County T.B. Sanitarium, Quincj'' 1 
 
 Rock Island Municipal Sanitarinm, Rock Island 2 
 
 143 
 Contract Hospitals 
 
 Chicago Fresh Air Hospital, Chicago 14 
 
 Edwards T.B. Sanitarium, Naperville 7 
 
 Ottawa T.B. Colony, Ottawa 12 
 
 Palmer Sanitarium, Springfield 28 
 
 Chicago Municipal Sanitarium, Winfield 5 
 
 66 
 
 There has been a great deal of dissension about tuberculosis 
 hospitals, particularly the one at Oak Forest. The facts are as 
 follows : When the Public Health Service took over the medical 
 care of ex-service men they had no tuberculosis hospital in the 
 District. The number of applicants for hospitalization increased 
 very fast. They filled every available bed in private and public 
 hospitals in Michigan, Wisconsin and Illinois, and still there 
 were very many serious cases left over. The only available hos- 
 pital was at Oak Forest, the County Poor Farm. Here they sent 
 a group of men who at first were housed with the other patients. 
 Complaints were made ; they were separated and put in cottages 
 and in separate wards ; a Red Cross worker was sent there for 
 recreational work ; and while complaints about the food continued, 
 it was much improved, and a special representative of the U. S. 
 Public Health Service was sent there to look after their interests. 
 The situation, due to publicity, has prevented many tubercular 
 ex-service men from seeking hospital care. This has been one 
 of the worst reactions. In addition, the men there feel that when 
 anything goes wrong, the fact that they are at a County institu- 
 tion is a blow at their self-respect, and they know that they are 
 
 15
 
 entitled to the best of care l)y tlie Government in a Government 
 liospit^il, and not in a County institution. This applies not only 
 to Oak Forest, but to all County and Municipal institutions 
 throughout the State. 
 
 There is no question of the intense need of a local tubercu- 
 losis hospital for ex-service men. Such a hospital, conducted along 
 the best lines, -would help to care for many men who will not go 
 to the hospitals named. It would bring the entire group under 
 responsible care and constant inspection, and would create a 
 psychological condition of satisfaction and self-respect among 
 the ex-service men, which would help materially in effecting a 
 cure. 
 
 The third is training. "The training of the tubercular 
 patient," according to Dr. H. A. Pattison, of the National Tuber- 
 culosis Association, "is exceptional, in that it eliminates strong 
 physical exertion, continuous effort or preparation for indoor 
 occupations or outdoor occupations, with physical hazards. The 
 chief function of the training is to keep the man's mind occupied 
 in useful directions so that his cure may proceed more rapidly. 
 The fact that he realizes that if he is ever to live as a self- 
 respecting, self-supporting member of society, he must readapt 
 himself to occupations in most cases entirely foreign to those in 
 learning which he has spent his formative years, often over- 
 whelms him and it is only as he feels the possibility of entering into 
 a, new vocation that his mind reacts happily to treatment given, 
 and the training contributes directly to his recovery, as well as 
 to his future ability to take his place in society." 
 
 The situation of those Avho are not in hospitals, the wide 
 distribution of the men in public and contract hospitals, and the 
 type of training which the Government can and will give them, 
 all point to the urgency of centralizing this work where it can 
 be conducted along lines which are somewhat commensurate with 
 the importance of the problem. 
 
 Out of the 209 tubercular patients interviewed, thirteen were 
 from t^he United States Navy, 118 were from overseas organiza- 
 tions, and 72 were from non-combatant or organizations which 
 did not get overseas. Among this latter number there were a 
 large number of patients whose tubercular condition was due to 
 the terrible effects of the "Flu," which left so many of them 
 weak and handicapped in the Winter of 1918. 
 
 At the time of writing this report the number of cases ask- 
 ing for compensation because of tuberculosis is increasing faster 
 than for any other physical cause. It is estimated that there are 
 now a minimum of 1,000 who would profit from hospital care if 
 the proper Government facilities were available. Tuberculosis 
 patients should have immediate action on all compensation claims, 
 as the failure to receive attention aggravates tlieir trouble and 
 prevents a state of mind which will assist in their cure. 
 
 16
 
 MENTAL AND NERVOUS DISEASES 
 
 "Mental and nervous diseases," Dr. II. Doii<ilas Singer, Di- 
 rector of the Illinois Psvcliopatliic Institute, states, "differ from 
 other diseases by reason of the fact that they affect the machinery 
 which controls and regiilates the action of t^lie body as a whole. 
 Damage to the nervous system disabled the connected part of the 
 body — it i^ractically cuts off that part. The diseased mind is 
 dift"erent. The man can use his body, but not direct it. His 
 physical strength becomes dangerous to himself and others. 
 Without outward sign or inward warning, he may jeopardize 
 the standing his Service has given him, by irresponsible acts. The 
 man who has been deprived of his mind has made the greatest 
 sacrifice of all; he has been changed from a defender of his 
 country to a possible menace to society. 
 
 "To earn a living an^ to occupy a position which will bring 
 satisfaction and happiness, a man must conform to the rules 
 which society establishes as a safeguard for the welfare of all. 
 The ability to choose a course of action which will bring this 
 result depends upon the quality of brain which the man possesses 
 and the training he has received. The quality of brain depends 
 largely upon the character of his inheritance, but often upon 
 changes produced by injury or disease. A brain that is poor in 
 quality from birth is said to be defective, and persons with such 
 brains are classed as mental defectives. The severest form of 
 deficiency is called feeble-mindedness. 
 
 "Persons with minds of poor quality will conduct themselves 
 without conflict with social regulations only when conditions are 
 relatively simple. When the responsibilities are too complex or 
 the difficulties too great, thej" behave irrationally." 
 
 The Selective Draft eliminated over 72,000 men for this 
 reason. Some, however, were accepted, and in many more cases 
 the defect was so subtle that it was not capable of recognition. 
 
 The "Call to the Colors" completely overturned many people 
 who had settled down to a sphere of life which presented only 
 such conditions as they were able to face. It brought those people 
 face to face with new conditions ; many broke down under this 
 strain, and some later. Some succeeded in adjusting themselves 
 to Armj^ life, only to find when they left the Service aud were 
 once more placed upon their own responsibility, that thej- had 
 lost the powers and habits which had previously been satisfactory. 
 
 Dr. T. W. Salmon, Director of the National Society of Mental 
 Hygiene, in answer to a question before the Congressional Com- 
 mittee, gave an excellent illustration of this fact, when he testified : 
 "In that connection, one illustration may be of some value. J 
 have heard it said sneeringly by those who do not believe in all 
 this fuss about ex-solcfiers, that they know of a feeble-minded 
 man who was taken and passed and drafted into the Army, and 
 who is now getting compensation. That was given as one of the 
 most glaa-ing instances of improper payment. 
 
 17
 
 "Let us see if this is necessarily so. I know a feeble-minded 
 boy wlio was drafted into the Army, and wlio is iiot gettinj? 
 compensation. He used to stay around a livery stal)le. lie was 
 an illej^'itimate child; no one knew who his father was. His 
 mother was a i)rostitute who had left town. He slept on the 
 liay in tlie stable and picked up a quarter or half-dollar here 
 and there workino: around the livery stable and holding horses. 
 That boy had found a level for himself upon which he could 
 adjust himself even with his feeble mind. It was pretty low 
 level, but he was not a charge upon anyone. 
 
 "The Draft came and took him. His mental condition 
 escaped detection until he had been six month's in a training 
 camp; and then he was discharged and sent off with only rail- 
 road fare, and nobody to supervise his activities. Since that 
 time he has been alcoholic and arrested many times-. Before that 
 he had never been a.rrested. He has had his whole Avorld and 
 all his standards of living dislocated. I think that where a boy 
 like that had been taken right out of the surroundings in which 
 he had made a place for himself, even in a livery stable, the 
 Government ought to do something for him. We took this feeble- 
 minded boy, who had found his own level where he was, just 
 as we ha,ve found our own levels, and dislocated his entire 
 universe. I do not think that anybody ought to give him $100 
 or $80 a month, but I think the Government should re-establish 
 him on the footing that he had before the War, or a little better. 
 Tliey cannot make a mechanic out of him ; they cannot give him 
 an education through the Vocational Board, but the}' caji give 
 him slight compensation, enough to make up for his defect, and 
 that boy can be put back where he was before the "War. That 
 represents the very bottom of this list of mental disorders due 
 to the War, which is represented at the top by a man with a 
 piece of shrapnel in his brain. I do not think we can afford to 
 draw the line and say to that boy, 'You are responsible for your 
 own brain, and if you got drafted into the Army a'ou ought to 
 have known better.' We took these men as they were, and I 
 think we took the responsibility for any injury Ave did to them." 
 
 In many cases, the hardships and privations, exposure, 
 wounds, gas, excitement, fear of failure in duty and the con- 
 demnation of their felloAvs, gave rise to actual disease and damage 
 in the brain, Avith a consequent loAvering in the quality of the 
 brain Avith Avhich the men entered the service. If thci'o had been 
 even the slightest trace of disease at the time of eidistment, the 
 conditions of service Avould have magnified and developed it. 
 
 It^ Avill thus be seen that the strenuous conditions of Avar 
 serA'ice liaA'e operated to giA'C rise to mental disorders in many 
 different Avays, and that these defects have been produced in 
 well-formed as Avell in poorly developed brains. 
 
 "In a general way," said Dr. Singer, "avc may subdiA'ide 
 mental disorders into tAvo groups. First, those Avliich represent 
 more or less difficulty in making adjustments. These are coni- 
 
 18
 
 monly called psycho-neuroses (many of them were labeled shell- 
 shock), of which there are several different varieties, such as 
 hysteria, neurasthenia, and other forms of neuroses. The second 
 group are often called psychoses, or more commonly, insanity. 
 They differ from the first in that they are evidences of actual 
 damage to the brain. The most frequent varieties are called 
 dementia praecox, manic-depressive insanity, and general 
 paralysis. To be included within tliis last group, though not 
 necessarily insane in the ordinary sense, is a group of conditions 
 known as epilepsy. Here the fit is the most characteristic symp- 
 tom, but often it is associated with brain disease, which alters 
 the ability of the individual to choose his course of action 
 satisf a.ctorily. ' ' 
 
 The prevalence of insanity in civilian life, without the abrupt 
 changes incident to war service is well illustrated by the fact 
 that the State hospitals of Illinois now contain approximately 
 20,000 such persons. With regard to psycho-neuroses, we have 
 no exact figures, but they are conceded to be one of the most 
 potent causes of chronic suffering, dependency and economic 
 inefSciency. 
 
 It must also be recognized that the full effect of the damage 
 received in Army service to the nervous and mental system will 
 not be evident for some years to come. Such diseases develop 
 s1ow1a(», and often obscurely. Unfortunately there is also attached 
 to them an unjust stigma on the part of society, which makes 
 it difficult to secure their recognition until events force the issue. 
 The earlier eyidences of failure in adjustment are often con- 
 cealed or overlooked, and yet to afford the best chance for 
 successful treatment, it is essential that this be started at the 
 earliest possible moment. There is, therefore, urgent need that 
 the Nation should provide agencies, free from every appearance 
 of charity or condemnation, for the early recognition and treat- 
 ment of ex-service men. 
 
 The following summary of hospitals and the nature of 
 diseases was secured in a census of January and February, 1921. 
 The number is constantly increasing, and does not include those 
 sent to Waukesha, Wis., Marion, Ind., or other hospitals outside 
 the 'State. 
 
 Kankakee State Hospital, Kankakee, 111. 
 
 NAME OP DISEASE NUMBER OF PATIENTS 
 
 Mental Deficiency, 2 
 
 General Paralysis, 1 
 
 Manic Depressive 1 
 
 Other Psychosis, 1 
 
 Dementia Praecox, 31 
 
 36 
 Lincoln State Colony and School, Lincoln, 111. 
 
 Mental Deficiency, 1 
 
 19
 
 Peoria State Hospital, Peoria, 111. 
 
 
 XAMi; (IF DISEASE 
 
 NUMBER OP PATIENTS 
 
 Other Psychosis, 
 
 1 
 
 Mental Deficiency, 
 
 5 
 
 Epilepsy, 
 
 1 
 
 Dementia Praecox, 
 
 12 
 
 
 19 
 
 Watertown State Hospital, E. Moline, 111. 
 
 
 General Paralysis, 
 
 1 
 
 Dementia Praecox, 
 
 6 
 
 7 
 
 Wilgus Hospital, Rockford, 111. 
 
 Manic-Depressive Psychosis, 
 
 2 
 
 Dementia Praecox, 
 
 1 
 3 
 
 Chicago State Hospital, Dunning, 111. 
 
 Dementia Praecox, 
 
 60 
 
 General Paralysis, 
 
 7 
 
 Mental Defective, 
 
 1 
 
 Other Psychosis, 
 
 1 
 
 
 69 
 
 Jacksonville State Institution, Jacksonville, 
 
 111. 
 
 Dementia Praecox, 
 
 39 
 
 General Paralysis, 
 
 1 
 
 Manic-Depressive Psychoses, 
 
 4 
 
 Psycho-Neurosis, 
 
 1 
 
 Mental Deficiency, 
 
 1 
 
 Other Psychosis, 
 
 1 
 
 Epileptics, 
 
 1 
 
 
 48 
 
 Elgin State Hospital, Elgin, 111. 
 
 
 Dementia Praecox, 
 
 87 
 
 Mental Defective, 
 
 3 
 
 General Paralysis, 
 
 1 
 
 Epilepsy, 
 
 1 
 
 
 92 
 
 Anna State Hospital, Anna, 111. 
 
 
 Dementia, Praecox, 
 
 6 
 
 Manic Depressive Insanity, 
 
 1 
 
 7 
 Marine Hospital No. 5 (Observation Hospital), Chicago, 111. 
 
 Epilepsy, 11 
 
 Dementia Praecox, 1 
 
 General Paresis, 1 
 
 Psycho-Neurosis, 2^ 
 
 38 
 
 20
 
 Treatment Required — The ex-service niau should be able to easily 
 consult physicians trained to recognize the beginnings of such 
 disorders. These experts must be supplementary to and must not 
 replace the general physician and surgeon. Some specialists are 
 working on the development of this clinical service at the present 
 time. 
 
 Its importance arises from the fact that the patient com- 
 plains of pains and discomforts, really of nervous or mental 
 origin, which are apparently connected with some other part of 
 the body. When these are detected at an early stage a careful 
 study of the patient is made. The difficulties which the patient 
 is meeting or failing to meet will often disclose the actual trouble 
 and will reveal conditions which can be remedied by advice as 
 to how thev mav be adjusted by a proper change in the mode 
 of life. 
 
 Sometimes the situation is too complex or there are evidences 
 of actual disease. Removal to a hospital especially equipped 
 with every means known to science may be necessary. Here the 
 most careful study should be made to determine whether any 
 disease exists, and if so its nature. Appropriate remedies should 
 then be given, if such are known, to arrest it if still active or to 
 remove or minimize its consequences. Unfortunately, our knoAvl- 
 edge of the nature and treatment of many of these diseases is 
 extremely limited. But there can never be a worthier cause nor 
 a better opportunity for developing new knowledge by investi- 
 gation than is here presented. 
 
 The next step consists of training in ways of living which 
 will secure satisfaction for the patient without bringing him into 
 conflict with social regulations. Such training includes not only 
 the vocation but also means of recreation and pleasure which 
 are helpful as well as harmless. 
 
 There still remains the further problem of finding a sphere 
 of life where the man can successfully adjust and compete Avith 
 others, after the limits of mental capacitj^ have been determined. 
 This may take prolonged study and educational effort. It requires 
 an exceptionally well organized employment bureau and recrea- 
 tional facilities. 
 
 Another feature of the utmost importance in the program 
 concerns the employment of social workers or community nurses 
 specially trained for mental work. They can assist in establish- 
 ing the first contact with patients, in the investigation of the 
 home, work and play conditions under which the patient has 
 failed, in the alleviation of suffering or distress among those 
 dependent upon the patient, which is often a factor in the break- 
 down and finally in supervising and assisting the patient in his 
 rehabilitation in society. 
 
 Treatment Given — The United States Public Health Service, 
 through the District Supervisor, is now establishing, at strategic 
 points throughout the state, hospitalization units which will serve 
 as consultation centers and for the treatment of such cases as 
 
 21
 
 do not need hospitalization or have been returned from liospitals. 
 This Bureau has also set aside the Marine Hospital in Chicago 
 as a place for the special study and diagnosis of mental and 
 nervous disorders. When the alterations are completed this hos- 
 pital will be well equipped for the purpose. The principal dif- 
 ficulty is the securing of trained personnel, both medical and 
 nursing. 
 
 In the state hospitals to which most of the insane are sent 
 for hospitalization, the general principle of treatment is that laid 
 down above. But these hospitals are all large and greatly over- 
 crowded. 
 
 Dr. C. F. Read, Superintendent of the Chicago State Hospital 
 for the Insane, appeared before the Appropriation Committee of 
 the Senate and House to ask aid from that body in constructing 
 additional buildings. He states : "That beds are so close together 
 that the patients could hardly get out on the side of their cots." 
 
 At the time of writing there 200 more patients in Elgin than 
 there were beds. The patients slept on mattresses on the floor. 
 
 The medical, nursing, occupational and recreational staffs 
 are entirely too small to give the individual study and active 
 treatment, which are essential for the best results. Some of these 
 deficiencies have been partly remedied by assistance from the 
 Federal Board for Vocational Training and the American Red 
 Cross, but the space available in buildings is inadequate. 
 
 Dr. T. "W. Salmon testified before the Congressional Com- 
 mittee : — ' ' I am not a lawyer and I am not an administrator, but 
 I am a doctor, and for twenty years I have devoted mj'self to 
 the care of people suffering with mental disease. I have studied 
 the care of the insane in many States, but I do not know today 
 any group of 5,000 men suffering from insanit.y Avho are so 
 ])oorly cared for as the ex-soldiers of the United States Army. 
 I do not mean by that, that all are equally badly cared for, but 
 I know of no group of that; size that are allowed to remain in 
 unsuitable places week after week and month after month be 
 cause there is a divided authority on the part of those who are 
 responsible for them. So, gentlemen, all I have to say, my only 
 reason for coming here as a doctor, is to say that from the 
 simplest dictates of humanity it is necessary to set up here in 
 Washington and in the fourteen districts of the United States a 
 real unified agency that can reach into these men's houses, take 
 tliem out, and put them into Government hospitals established, 
 built, and maintained solely for their benefit; not constructed to 
 care for dying, demented old people, but to care for young men 
 in full vigor, who-, nevertheless, are suffering from this disease. 
 Only in this way can be averted the dementia that will even- 
 tually overcome all these men. 
 
 "Unless something is done Avithin tlie present year to im- 
 prove conditions under which insane ex-service men arc receiv- 
 ing treatment, hundreds who noAv stand a fair chance of being 
 cured, will be doomed to permanent insanity, 
 
 22
 
 "In spite of the fact that on December 16, 1920, 5,500 ex- 
 service men were in neuro-psj'cliiatric hospitals, tlie Government 
 has not spent a. dollar for the constrnetion of a sinyle hospital 
 for the insane up-to-date. Only one-third of these men are in 
 hospitals owned by the Government. One of them is a converted 
 reform school in Koxbury, Mass. Another is a naval hospital 
 in Philadelphia, Avliich was built just after the Civil War. An- 
 other is a hotel at Augusta, Ga,., which has been used by a girls' 
 seminary, and then has been turned over to the Government and 
 a few thousand dollars spent for partitions. Yet those are 
 regarded as special hospitals for the treatment of this special 
 form of disease." 
 
 Dr. Singer, the Director of the Illinois Psychopathic Insti- 
 tute, advises : — ' ' In the hospitalization of ex-service men, the 
 need of temporary hospitals should be considered, such as the 
 Marine Hospital for diagnostic purposes, and local clinics for 
 observation in connection with the hospitalization units of the 
 United States Public Health Service. But the most important 
 question is the hospitalization for treatment of a more pro- 
 longed kind. 
 
 "(a) Psycho-neuroses should be hospitalized only 
 for a short time or not at all. The great thing here is the 
 development of morale and confidence and the avoidance 
 of anj'thing which would tend to confirm a feeling of 
 invalidism. 
 
 "(b) Psychoses (or insanity), demands hospitals 
 specially planned with reception service for intensive 
 study, hospital wards for bodily illness, specially 
 equipped pavilions for disturbed and excited patients, 
 educational facilities and means for recreation, con- 
 valescent departments. 
 
 "These hospitals should belong to the Government 
 and be limited to ex-service men. These should set 
 national standards for constructive treatment and no 
 such case should be considered as merely custodial. 
 Large personnel necessary to permit individualization. 
 Illinois' quota at the peak of the load would amount to 
 between six hundred and a thousand cases. 
 
 • "(c) Epilepsy needs special grouping. There are 
 about twenty-five cases of epilepsy now in hospitals of 
 Illinois, and it is estimated that there are five hundred 
 outside in the state. They are a special problem. The 
 nature of their trouble prevents them from being re- 
 liable in employment. The only solution seems to be 
 to find a special friend or relative who will assure the 
 epileptic continued employment, in spite of his affliction, 
 and then give tlie man such training as Avill make him 
 valuable as an employee. Compensation should be 
 awarded on a temporary total basis, which would assist 
 the men in being cared for in their homes." 
 
 23
 
 Dr. Salmon empliasizes this conclusion: — "Certain important 
 factors are on tlie side of these ex-soldiers. They are young and, 
 for the most part, in excellent bodily condition. Thoy have what 
 is denied most of the insane — an opportunity to leave hospitals 
 partially well and yet, with monetary aid, to live happy, con- 
 tentfed and moderately useful lives. Their social rehabilitation is 
 not, fortunately, dependent upon a 100 per cent economic re- 
 habilitation for, whatever the Government has failed to do, it is 
 ready to compensate and to train vocationally those men who 
 have had their earning capacity impaired bj^ mental illness and 
 thus enable them to compete, if not on equal terms, upon fairly 
 satLsfactory terms, Avith their fellow-men." 
 
 There was never, in the whole history of mental medicine, 
 such an opportunity as this for showing what can be accom- 
 plished by re-education in the justly dreaded mental disease that 
 constitutes the chief problem in the care of mentally disabled 
 ex-service men. 
 
 Beginning with occupational tlierapy carried on by nurses 
 and occupation aides in the wards and even at the bedsides in 
 these hospitals, vocational education can .be employed at the 
 earliest possible moment when resumption of activity and in- 
 terest justifies it. This training can be directed by those expert 
 in abnormal psychology and carried on under the Federal Board 
 for Vocational Education, by teachers who even now can be 
 trained for the very dilificult and special work which they will 
 have to do in behalf of mental patients. 
 
 Through a system of psychia,tric social service and Govern- 
 ment dispensaries, it will be possible to contijiue skilled super- 
 vision and direction of these men for months or years after they 
 have left the shelter of neuro-psychiatric hospitals. It is believed 
 by those most familiar with the proTjlem that not less than half 
 the ex-soldiers suffering from this especially malignant type of 
 mental disease can be economically and socially restored under 
 such' unusually favorable conditions. 
 
 All these things depend, however, first, upon quick and 
 favorable action by the Appropriations Committee of Congress; 
 second, upon the establishment within the Public Health Service 
 of an efficient neuro-psychiatric service, headed by men of long 
 experience in dealing with the intricate problems that fall to the 
 neuro-psychiatrist and, third, upon co-operation between hos- 
 pitals, psychiatric social service workers and committee agencies 
 to ensure the after-care and community supervision that form 
 such an essential part of dealing successfully with the lifetime 
 problem presented by most forms of mental diseases." 
 
 24
 
 SOME SIGNIFICANT MENTAL CASES FROM THE FILES OF 
 THE CHICAGO RED CROSS 
 
 Case 1. March 18, 1921. 
 
 Mr. X enlisted in the United States Army August 5, 1915 and 
 M-as discharged July 26, 1919, S. C. D. 4th Ind. H. C. D., Chicago, 
 Illinois, July 18, 1919. Served overseas and was gassed. Was 
 cited by General Pershing and by the French Government. 
 
 He enlisted in the Navy, October 2, 1919, at Chicago and was 
 discharged December 6, 1919, as an "undesirable." Subsequently 
 enlisted in the Marine Corps and was discharged June 10, 1920, 
 "by reason of physical disability." 
 
 Mr. X has been under hospitalization on several different 
 occasions and in various hospitals including Hospital No. 34, East 
 Norfolk, Fort Sheridan General Hospital No. 28, United States 
 Navy Hospital, Mare Island, California, State Hospital, Stokholm, 
 California, United States Public Health Service Hospital No. 30, 
 Chicago Psychopathic Hospital and finally Chicago State Hos- 
 pital, Dunning, Illinois. He was committed to Dunning from 
 Psychopathic Hospital, September 30, 1920. Diagnosis: Manic 
 reaction. 
 
 A report from Chicago State Hospital, November 8, states 
 that X was suffering from Catatonic Excitement. Was very rest- 
 less and noisy. While under observation did not eat well and on 
 account of his constant excitement, exhausted himself. Mr. X had 
 been reared by an aunt, and she removed him from Dunning about 
 November 1, 1920, because of the prejudices she held against 
 Dunning. Mr. X was to be transferred to the Elgin State Hospital, 
 but his aunt would not listen to this as she maintains that all 
 State Hospitals are alike, and that he would receive no better 
 treatment at Elgin than elsewhere. . She is therefore keeping him 
 at home with her, where the conditions are most abominable. Her 
 own mental condition seems to be none too sound. She is very 
 irritable and easily excited and quite filthy minded. She main- 
 tains a rooming house, which in the past has had a questionable 
 reputation and the room in which Mr. X is kept is dirty, poorly 
 lighted and ventilated, and in addition this room serves as a bed- 
 room for Miss herself and one of her men roomers, an ignorant 
 type of person, whom she states she is employing to assist her in 
 caring for Mr. X. Patient is usually strapped to his bed on 
 account of his excited state. Miss keeps him constantly in a 
 sort of harness w^hich prevents him from doing any undue violence, 
 but even with this contrivance she keeps very close watch of him. 
 
 Indeed the conditions here are such as would unbalance the 
 mental state of a healthy person if he were compelled to submit 
 to them very long, but these conditions cannot be remedied because 
 of the horror Miss has for the State Institution on account of 
 her opinion of X 's treatment there and because there is no Govern- 
 ment Hospital to care for this discharged soldier and give him 
 the care he is so greatly in need of. 
 
 25
 
 Case 2. j^^^^^l^ 17^ 1921. 
 
 ]Mr. Klaiik, in June 1018, at the a^'o of 23 years, entered the 
 World War Serviee. He h^ft a very good position where lie Avas 
 in partnership with his brother. While at eanip, during the early 
 days of his training, lie received a severe head injury and after 
 several months at the Camp Hospital, he was discharged on a 
 Certificate of Disability, because of mental trouble. 
 
 For two years, Mr. Blank has lived at home and has been 
 supported by his family. He has been unable to perform any kind 
 of work. He is not able to travel without an escort and his presence 
 at his brother's firm causes commotion and a decrease in business. 
 
 Mr. Blank has rational times and is perfectly aware of his 
 disability. The entire family feel keeiil.y his affliction and are 
 reticent regarding his ])ehavior. We finally persuaded the family, 
 in September of 1920, to file claim for compensation for Mr. Blank 
 and lately an award of compensation of $16.00 per month was made. 
 The boy is gradually becoming worse. On several occasions he has 
 attempted suicide, liut the family still struggle along. They are 
 unwilling to institutionalize him, seeing the only means to do so 
 thru court action and a State Institution. They feel keenly the 
 stigma of "County" procedure. The family would be willing to 
 have him enter an institution, if the entire matter could be con- 
 trolled by the Government. 
 
 Case 3. ^^^^.^,1^ ^7^ 2921. 
 
 On September 20, 1918, the mother of John D. asked our 
 a.ssistance in securing an unpaid allotment made to her bj^ her 
 son. When questioned as to the Avhereabouts of her son, it was 
 learned that he was suffering from mental trouble and under 
 close surveillance of the family. Although he had received a 
 disabilit}' discharge, the mother refused to file a compensation claim 
 because she feared this step would mean hospitalization in a State 
 Institution. 
 
 In November, 1919, over a year from the date of his discharge, 
 John escaped from the home and appeared at the army recruiting 
 station. His strange actions there caused the army officers to take 
 him directly to a Public Health Service Hospital. W^hile at the 
 latter place his claim for compensation Avas sent thru, the mother 
 being willing because he was at that time in a government hospital. 
 Later he was committed to a State Institution. 
 
 For over a year this young man was without proper medical 
 attention because the government had no institution for discharged 
 soldiers suffering with mental trouble. 
 
 General Medical and Surgical Care 
 
 Medical and Surgical care of sick and disabled ex-service 
 men covers the entire field of medicine. During the war the 
 medical service of the country was mobilized to this end. After 
 the Armistice, many leading ])hysicians reniaiiied for reeonsti-uc- 
 
 26
 
 tioii work. The local Public Health Service still has as their 
 consultants, leaders of medicine from this district. The splendid 
 work of these consulting specialists, Avho have unsparingly 
 devoted their time and service in many difficult cases, deserves 
 high praise. They did not work for compensation as the fees 
 were small, but took the attitude that nothing was too good for 
 the disabled ex-service man. These specialists — the best in their 
 profession, deserve much better appreciation than can be given 
 them in the narrow field of this report. 
 
 The general medical and surgical care of ex-service men has 
 been uniformh" good. It covers a very wide field, including all those 
 who are patients of the AVar Risk Bureau and there have been few 
 complaints. 
 
 The turn-over in this field is \evy great — the number, for 
 instance, in the 47th Street Hospital, Public Health Service No. 
 30, is approximately 500. They are received and discharged so 
 rapidlj^ that it is estimated that the average stay is about four 
 weeks. Other hospitals Avith a smaller number of beds are used 
 for more chronic cases. 
 
 The following hospitals were used throughout the state for 
 hospital care : 
 
 General Medical Cases 
 
 U.S.P.H. Service Hospital No. 30, Chicago, 232 
 U.S.P.H. Service Hospital No. 53, Dwight, 100 
 
 Contract Hospitals 
 
 BrokaAV Hospital, Bloomington, 1 
 
 St. Mary's Hospital, Cairo, 10 
 
 St. Mary's Hospital, Centralia, 2 
 
 St. Paul's Hospital, Chicago, 5 
 
 Auburn Park Hospital, Chicago, 35 
 
 Bremerman Hospital, Chicago, 35 
 
 Jackson Park Hospital, Chicago, 27 
 
 St. Elizabeth's Hospital, Danville, 4 
 Decatur Mason Countj^ Hospital, Decatur, 1 
 
 St. Mary's Hospital, Decatur, 1 
 
 St. Mary's Hospital, E. St. Louis, 14 
 
 Sherman Hospital, Elgin, 14 
 
 Galesburg's Cottage Hospital, Galesburg, 1 
 
 Holmes Hospital, Macomb, 14 
 
 Wallbright Hospital, Metropolis, 2 
 Methodist Hospital of Central Illinois, Peoria, 9 
 
 St. Francis Hospital, Peoria, 1 
 
 St. Mary's Hospital, Quincj', 4 
 
 Robinson Hospital, Robinson, 3 
 
 Springfield Hospital, Springfield, 7 
 
 St. Anthony's Hospital, Rock Island, 6 
 
 St. Mary's Hospital, Streator, 2 
 
 St. John's Hospital, Springfield, 3 
 
 27
 
 Every patient in these hospitals was visited by Mr. Lyden in 
 the course of his census. The number in tlie hospitals varies. New 
 hospitals are added and the patients withdrawn for others each 
 month. The U.S.P.H. Service Hospital No. 30 on Drexel Blvd., 
 at the time of writing has over 500 patients, and the hospital at 
 Dwight is making arrangements to care for more than 250. 
 
 "I enjoyed talking with all the men," said Mr. Lyden. ''The 
 medical and surgical cases are always more contented than the 
 others. They see a speedy prospect of recovery. The men down 
 state, particularly, wanted to be in a home hospital. They told 
 me that the food, the medical treatment and the general con- 
 ditions were good. All of these hospitals are old established hos- 
 pitals and are known to the boys and their relatives." 
 
 One young ex-service man in Metropolis expressed the attitude 
 of the men tOAvard this group of hospitals when asked if he wanted 
 to be transferred to Chicago. "This is our hospital. It is our 
 town and we Avant to be near our folks. Visits from them would 
 be out of the question if we Avere transferred very far from here. 
 I Avant to staj' here." 
 
 The policy of using local hospitals for medical care AA'hen that 
 care can be guaranteed and inspected has many advantages, both 
 in sentiment, in service and economy. 
 
 The Public Health Service treats as medical and surgical cases, 
 all claimants of the War Kisk Insurance AA^ho have been gi\^en ten 
 per cent or more disabilitA', or claimants AA'ho, because of physical 
 trouble, caused by or aggravated by army service, are Avaiting for 
 the decision of the War Risk Bureau. 
 
 BUREAU OF WAR RISK INSURANCE 
 
 The Bureau of War Risk Insurance Avhich Avas created in 19J.4 
 and Avhose Avork Avas enlarged and extended by legislation en- 
 acted in 1916 and 1917, had the responsibility of organizing four 
 distinct projects — Marine and Seamen's insurance, allotments of 
 pay and family alloAvances, Military and Naval insurance, and 
 the payment of compensation on account of death and disability 
 incurred in the Militarj^ or NaA^al service during the present Avar. 
 Under the act defining the present functions, CA'ery sick or dis- 
 abled man entitled to treatment, compensation or training is 
 technically a Avard of this Bureau, although his actual treatment 
 or training is carried on by other agencies. 
 
 Tliere are tAvo functions Avhich are of A^tal importance — one, 
 tiie payment of compensation — the other, the providing of insur- 
 ance for dependents. 
 
 Compensation — The exact situation Avith reference to compensa- 
 tion is shown in the analysis of the census. It shoAvs claims 
 ])ending, claims that need adjusting and claims satisfactorily 
 adjusted. It Avas impossible to get the information from the 
 mental hospitals. In every case, as soon as Mr. Lyden Avas 
 informed that compensation AA'as not adjusted, the facts Avere 
 
 28
 
 sent directly to Mr. E. V. Dickson, the Local Representative of 
 the War Risk Bureau and to the Service Department of the 
 American Legion. Mr, Dickson states — "that 584 cases had been 
 sent him as a result of the census which he did not have in his 
 files." A sta.tement of the situation follows: 
 
 COMPENSATION 
 
 General Medical Cases 
 
 CLAIMS UNAD- 
 
 AD- 
 
 HOSPITALS 
 
 St. Mary's, 
 
 Brokaw, 
 
 Auburn Park, 
 
 U.S.P.H.S. No. 30, 
 
 St. Paul's, 
 
 St. Mary's, 
 
 St. Elizabeth's, 
 
 U.S.P.H. No. 53, 
 
 Decatur, Mason Co. 
 
 St. Mary's, 
 
 Sherman, 
 
 St. Mary's, 
 
 Holmes, 
 
 Wallbright, 
 
 Methodist of Central 111. 
 
 St. Francis, 
 
 Rockford, 
 
 St. Anthony's, 
 
 Springfield, 
 
 St. John's, 
 
 Jackson Park, 
 
 Cook County T.B., * 
 
 Municipal T.B. San., 
 
 Fairview McLean, 
 
 LOCATION PENDING JUSTED JUSTED 
 
 Cairo, 3 
 
 Bloomington, — 
 
 Chicago, 
 
 Chicago, 
 
 Chicago, 
 
 Centralia, 
 
 Danville, 
 
 Dwight, 
 
 Decatur, 
 
 Elgin, 
 
 E. St. Louis, 
 
 Macomb, 
 
 Metropolis, 
 
 Peoria, 
 
 Peoria, 
 
 Rockford, 
 
 Rock Island, 
 
 Springfield, 
 
 Springfield, 
 
 Chicago, 
 
 Oak Forest, 
 
 Chica.go, 
 
 Chicago, 
 
 19 
 125 
 
 2 
 
 3 
 
 3 
 
 21 
 
 1 
 9 
 11 
 6 
 1 
 4 
 1 
 2 
 
 7 
 
 2 
 
 15 
 
 47 
 
 26 
 
 7 
 
 1 
 70 
 3 
 1 
 1 
 19 
 
 1 
 3 
 
 5 
 1 
 
 9 
 
 12 
 
 1 
 
 1 
 
 2 
 1 
 5 
 34 
 1 
 
 52 
 
 Tubercular Cases 
 
 CLAIMS UNAD- 
 
 4 
 
 25 
 
 12 
 
 5 
 
 AD- 
 
 HOSPITALS 
 
 Edward 's Sanitarium, 
 La Salle County, 
 Ottawa T.B. Colony, 
 Peoria Municipal Sanitarium, 
 Palmer T.B. Sanitarium, 
 Rock Island M.T.B., 
 Adams County, 
 Chicago Fresh Air, 
 
 LOCATION PENDING JUSTED JUSTED 
 
 Naperville, 
 
 Ottawa, 
 
 Ottawa, 
 
 Peoria, 
 
 Springfield, 
 
 Rock Island, 
 
 Quincy, 
 
 Chicago, 
 
 Chicago Winfield Sanitarium, Winfield, 
 
 3 
 
 4 
 6 
 
 15 
 
 In many of these claims, particularly in the Mental Hospitals, 
 great difficulty in securing proper compensation has been due 
 
 29
 
 to tlie iiatiu'c of the disease and the establishment of its definite 
 connection with the service. A plan has been worked out in Illi- 
 nois, by Mr. Hartman, A.ssistant Director of the Service Depart- 
 ment, whereby the clerks of county courts co-operate with the 
 American Legion in filing the necessary papers and securing the 
 proper aiifidavits. 
 
 The principal reasons for delay in adju.sting claims of men 
 in hospitals are : 
 
 1. Rapid turnover prevents agency handling claims 
 from obtaining action from Washington before the man 
 leaves the hospital. 
 
 2. lusufificient evidence to connect the man's dis- 
 ability M'ith his service. 
 
 3. Lack of workers by agencies handling claims. 
 
 4. Lack of co-operation between agencies handling 
 claims. 
 
 The normal method of filling an original claim for com- 
 pensation is for the applicant to first fill out two forms, an appli- 
 cation for compensation and a sta,tement regarding his occupation, 
 which, together with a certified cop,y of his discharge, is taken to 
 the nearest Public Health Service physician, where an examina- 
 tion, together with the three papers above mentioned, is then for- 
 warded through the U. S. Public Health Service to the Bureau of 
 War Risk Insurance. 
 
 Decentralization of tlie Bureau of War Risk Insurance will 
 be of great benefit, according to Mr. Dickson, to men in hospitals, 
 for the foUoAving reasons : 
 
 1. It will be possible to establish personal contact 
 betAveen the awarding office and the claimant, something 
 W'hich is practically impossible under the present system. 
 
 2. Expedited action can be given to practically 
 every case owing to the fact that there will be propor- 
 tionately a very much smaller volume of business being 
 
 ^handled than in one office in Washington. 
 
 3. In the event of an award not being satisfactory 
 to the claimant, it will be an easy matter for the 
 claimant to either Avrite or call at the awarding office 
 and either have a satisfactory adjustment made or be 
 furnished with the information as to what would be 
 required to complete his case. 
 
 4. A great deal of the dissatisfaction with the pres- 
 ent sj^stem of handling awards is due to the long lapse 
 of time — first, in having an award made and — second, in 
 the event of any trouble, of having adjustment made. 
 Practically all of this will be done aAvay with with the 
 decentralization of tlie Bureau, as check being made 
 out in the regional offices will insure prompt action upon 
 not only the original award but also upon readjustment. 
 
 30
 
 Insurance — The insurance situation as far as sick and disabled 
 men in Illinois hospitals are concerned, is most unsatisfactory 
 as the following facts show: 
 
 HOSPITAL NO INSURANCE INSURANCE IN FORCE 
 
 Auburn Park Hospital, Chicago, 32 3 
 
 U.S.P.H.S. Hospital No. 30, Chicago, 197 38 
 
 Cook Co. T.B. Sanitarium, Chicago, 64 16 
 
 These men had every reason to keep up insurance, but lacked 
 resources. Many of them allowed their insurance to lapse because 
 they did not have the money. Many of them did not have the 
 monej^ because they were incapacitated for work and had not 
 received adequate compensation. The premium often ran as high 
 as $7.00 per month, while at best they were only receiving from 
 $8.00 to $30.00 from the Government, and frequently nothing. 
 
 Before the Government finally got around to paying adequate 
 compensation, the insurance had lapsed, and when the sick and 
 disabled ex-service men tried to restore their insurance, as healthy, 
 uninjured men were being solicited to do, they found an iron-clad 
 ruling that no man could restore his insurance unless he was physi- 
 eally fit. In other words, the Government got the sick and disabled 
 ''coming and going." When they could retain insurance secured 
 in service to protect dependents, they couldn't because the Govern- 
 ment had neglected to pay them compensation, but when they could 
 pay, they were not allowed to because the Government had decided 
 to play safe. 
 
 The matter was taken up with R. G. Cholmeley-Jones, Director, 
 as a result of the census. He stated on February 24th, "that the 
 suggestion of a ruling on this matter possessed great worth, and 
 that he had given careful study relative to the promulgation of a 
 regulation concerning the reinstatement of lapsed insurance where 
 an insured was unable to reinstate his insurance because of the 
 aggravation of a war disability. You may rest assured that this 
 matter will receive affirmative action in the course of the next few 
 days. ' ' If this can be corrected it will clear up an unfair situation 
 both for the insured' and for those who are dependent upon them. 
 Mr. Cholmeley-Jones has since resigned and up to the time of 
 writing this report no such action has been taken. 
 
 When, the Regional Offices of the Bureau of War Bisk Insur- 
 ance are vested with full authority to settle claims, adjust awards 
 and issue checks to those men justly entitled to them, 95 per cent 
 of the present complaints directed at present against this hureau 
 will be cleared 'up immediately and all claims of merit will receive 
 immediate action. Congress can give the Bureau this power to 
 decentralize. The responsible local head must have the power to 
 act. 
 
 31
 
 THE UNITED STATES PUBLIC HEALTH SERVICE 
 
 Tlie Public Health Sen-vice is an ancient institution of tlic 
 Treasury J)cpai'tnient, where it has been located from the date of 
 its creation. It had its origin in tiie old Marine Hospital Service, 
 which was authorized by an Act of Congress in 1798. In 1902 its 
 name was changed to the Public Health and Marine Hospital 
 Service and by the Act approved August 14, 1912, it became known 
 as the Public Health Service. 
 
 During its life of 122 years, the service has grown from a 
 small institution, designed to furnish medical care to the sick and 
 disabled seamen of the American Merchant Marine, to a great 
 national health agency, operating the maritime quarantine stations, 
 protecting the country against foreign epidemics, preventing the 
 interstate spread of disease, co-operating with state and local health 
 authorities in the control of sickness. 
 
 The care of patients of the Bureau of War Risk Insurance 
 was delegated to the United States Public Health Service under 
 Public Act No. 326, which provided for the furnishing of hospital 
 and sanitarium facilities by the Secretary of the Treasury appro- 
 priating a sum of money for each purpose and turning over to 
 the Secretary certain Army Base Hospitals. This so increased the 
 already existing functions of the Hospital Division of the Public 
 Health Service that early in May, 1919, it was decided to decen- 
 tralize into fourteen districts. This decentralization w'as begun the 
 latter part of May and early in June, 1919, and the functions of 
 the district offices grew with tremendous rapidity. 
 
 The Eighth District is the second largest of these Districts, 
 and comprises the states of Illinois, Wisconsin and Michigan and 
 has Headquarters located in Chicago. Dr. W. C. Witte is the 
 District Supervisor. 
 
 The main functions of the district office can be divided into 
 five factors; namely: 
 
 1. The procuring of examinations and furnishing of 
 reports of the same to the Bureau of War Risk Insurance 
 and the Federal Board for Vocational Education. In this 
 connection it might be added that these reports are fur- 
 nished to both these bureaus simultaneously. 
 
 2. The providing of relief to compensable claimants 
 of the Bureau of War Risk Insurance and Trainees of 
 the Federal Board. 
 
 3. Tiie keeping of records. 
 
 4. The preparation and certification of vouchers to 
 cover payment for services rendei-ed. 
 
 5. The supervision of property and personnel. 
 
 32
 
 To carry on the administrative details of this organization, 
 there are on duty at Headqnarters of the Eighth District, 260 non- 
 medical personnel, including three nnrses and one dental me- 
 chanic, 45 medical officers, 8 of whom are assigned for special 
 duty with the Federal Board. The district field work is handled 
 by means of officers and specially designated physicians and at- 
 tending specialists, located at the various points of the District, it 
 being desired to have a representative in every county. There are 
 at present on duty in the Eighth District, 126 Acting Assistant 
 Surgeons (officers), 147 Designated Physicians and 87 Attending 
 Specialists. 
 
 It is possible with this organization to provide service to claim- 
 ants promptly and, if necessary, in their own community. It is 
 the express desire of the Director of the Bureau of War Risk In- 
 surance that beds in Government owned and operated hospitals 
 be utilized to the fullest extent. However, because of the scarcity 
 of such beds it has been necessary to make arrangements with 
 private hospitals for the care of these patients by means of con- 
 tracts. In the Eighth District there are 213 such institutions 
 being used. In this connection, it might be noted that the Service 
 anticipated this urgent need for beds, and submitted to Congress 
 an estimate calling for the building of sufficient hospitals to provide 
 for the increasing number of cases needing care. However, this 
 was not granted and it became necessary to lease certain buildings 
 and reconstruct them for their use. In the Eighth District there 
 are approximately 2600 cases in hospitals, more than half of which 
 are in contract hospitals. 
 
 One of the serious problems of the Public Health Service is 
 the salary restrictions placed by Congress upon it. It is almost 
 impossible for them to secure an adequate, permanent medical and 
 surgical personnel at the salaries now authorized. In a report 
 from the Surgeon-General, it was stated that ''there were more 
 resignations from the Public Health Service during the last year 
 than there were appointments." The chief reason for this is that 
 the majority of their physicians, particularly those who have a 
 background of real experience, cannot afford to work for the 
 Government in this department at the salaries which Congress 
 has authorized. Many of those who do remain are compelled to 
 do so at a great personal sacrifice. 
 
 While it is important that the Oovernment should huild and 
 maintain proper hospitals for sick and disahled ex-service men, 
 it is equally important that the department responsible for their 
 medical and surgical care shoidd he in a position to employ and 
 adequately pay the best men wlio can be secured for special 
 service. 
 
 33
 
 FEDERAL BOARD FOR VOCATIONAL EDUCATION 
 
 TIr' Fedi'i-al lioarcl for Vocational Ecliu-alioii is a govenimeiii 
 agency organized to retrain or re-edncate ex-service men who have 
 become disal)lcd thru their military or naval service. It is the 
 Board's duty to take a disabled man and to give him the sort of 
 training that Avill make it possible for him to be independent in 
 spite of his disability. The Board is required to plan the man's 
 training so that after the work is completed its employment de- 
 partment can secure for him a position that will make a good 
 living for himself and family, a preservation of his self-respect and 
 financial independence for the rest of his life. 
 
 "There are approximate!}^ 4000 disabled ex-service men," 
 Mr. Charles W. Sylvester, Divisional Vocational Officer, reports, 
 "taking training under the Board of Vocational Education in the 
 State of Illinois. ' ' 3000 are in Chicago. The majority are in edu- 
 cational institutions, some are in factories, offices, business houses, 
 railroads, but because of the wide distribution of the hospitals, 
 the training work is only done in hospitals which have more than 
 25 ex-service men as patients. Preliminary fundamental training, 
 such as English, Mathematics, Typewriting, etc. is chietly given 
 during this period. It is used largely as a period to discover along 
 what lines vocational education should be given. 
 
 In the State of Illinois, such schools as the University of 
 Illinois, Chicago Universit}', Northwestern University, Kent Col- 
 lege of Law, Armour Institute, Academy of Commercial Art — the 
 various high grade musical schools, Lewis Institute and the AVash- 
 burne School are among those with whom the Board has con- 
 tracted to furnish training. 
 
 The men receive from $100 to $170 per month while they are 
 taking the worjc, the exact amount depending upon the number 
 of dependents each man has. After they have finished their courses 
 of training, employment is secured by the Federal Board and 
 followed up until such a time as the Board realizes they have 
 successfully completed their training and are rehabilitated to the 
 point where they need no further assistance. 
 
 All types of training are given the men, this ranging from 
 shoemaking thru the other various different lines of work, up to 
 and including such courses as law, medicine and pedagogy. The 
 various disabilities that the men have range from systematic dis- 
 eases, such as tuberculosis, heart trouble, etc. to those suffering 
 with loss of limbs, sight or hearing. Each case presents an indi- 
 vidual problem and no two of them are alike. It is difficult to 
 say when the peak of this load will be reached in this District 
 and in this State, but it probably will not come for at least two 
 
 34
 
 or three years. This is due to the fact that a great many men 
 remain in the hospitals and that a great many men are discon- 
 tinued during their courses due to their physical inabilitj^ to 
 continue their work. 
 
 At the present time, there are at least several hundred men 
 in the State of Illinois who have been approved for the full benefits 
 of the Act but whose physical condition will not permit their 
 entrance into training. There are also as many as 2000 men in 
 the State of Illinois wjio have been approved for training under 
 Section 2 of the Act and who have not accepted same, probably 
 due to an ignorance of what is being done. The number of men 
 who are being made eligible for training is increasing day by day, 
 and if some of the Legislation which is now before Congress is 
 enacted the number of men eligible for training in the State of 
 Illinois will at least be trebled. It is believed that the present 
 facilities at the disposal of the Federal Board in this District offer 
 to the men in this District the greatest and most generous oppor- 
 tunity that any country has ever offered to its disabled men. 
 
 During 1920 the Federal Board in the 8th District came in 
 contact with several hundred men who had been discharged from 
 hospitals and sanitoriums as cured from tuberculosis, but who, 
 on account of their weakened physical condition, could not enter 
 the regular vocational training classes. There was an immediate 
 need for training under medical supervision and in such quantity 
 as the particular man could take with safety. 
 
 After searching the district for a suitable location, a school at 
 Nauvoo, Illinois, on the bluffs of the Mississippi River, which would 
 accommodate 150 of these men at a time, was selected. 
 
 A comprehensive plan for the rehabilitation of tuberculous 
 ex-service men has been worked out bj^ R. H. Harpster, Educational 
 Director and Dr. John W. Turner. It is founded on sound eco- 
 nomic and pedagogical principles and on a thorough knowledge 
 of tuberculosis, the mode of development, the manner and rate of 
 its healing during convalescence and the psychology and physio- 
 logy of the inactive cases. 
 
 The thought in the present work being done by the Rehabili- 
 tation Division of this Board bring us back to the period just 
 following the Civil War when thousands of men who were dis- 
 abled, were eventually granted compensation or a pension, as it 
 then was called, and allowed to go on their way thru life. 
 
 A man ma}^ be able to exist with a sufficient amount of money 
 to live on from the Government or from his family, but in this 
 condition he is not independent and is not an asset to the com- 
 
 35
 
 miuiity. If our Pension Bureau records were available, we would 
 find that tens of thousands of men who were partially disabled by 
 reason of their Civil War duties, have been, ever since that time, 
 doing nothing but receiving their monthly check from the Govern- 
 ment. If they had been given a course of training which w^ould 
 have given them an opportunity to work in spite of and with their 
 disabilities, they would not have w^anted to continue to draw this 
 compensation and would have been a distinct asset to the com- 
 munity in which they lived. 
 
 The Government at the present time does not propose to 
 alloAv these men to drift into a life which will make them de- 
 pendent upon the monthly mail from Washington for their exist- 
 ence. It is a proven fact that even the men with the most serious 
 disabilities can learn something in which they can support them- 
 selves and their families and not ask for Government pension, 
 charity or community assistance. They will become independent 
 of all of this which is so distasteful to Americans, and educate 
 themselves into some niche of life wherein they will be as valuable 
 to the community as are their more able bodied neighbors, and 
 where thej^ do not need continually to ask for assistance. 
 
 The policy of the Government in this respect is so markedlj^ 
 changed from that folloAving the Civil War that it is worth notice 
 and comment. What has caused the change is doubtful, but it 
 probably can be attributed to the general progress of education in 
 this country. 
 
 The success of Rehabilitation work thus far, has indicated to 
 thinking people hoAv unnecessary it is to allow those crippled by 
 industry to live their present mode of existence. The chances are 
 very good that out of the work now being accomplished in soldier 
 rehabilitation, results will come which Avill revolutionize this un- 
 fortunate phase of social conditions today. 
 
 The Bureau, thru Mr. Charles W. Sylvester, District Vocational 
 Officer and his assistant, Mr. H. J. Betty, are arranging in con- 
 nection with Major General Leonard Wood and the Fort Sheridan 
 Association, a summer vacation at Fort Sheridan for more than 
 5000 of its students during the summer of 1921. This is but one 
 of the many indications of the progressive, humane policies of 
 this Board. 
 
 The results secured l)y this Board are due to the fact that 
 responsihilifif has heen definitehj reqlonalizcd and treatment has 
 been liberalized and red tape has heen cut. The responsible local 
 head can act. No case qoes to Washington for decision except on 
 an appeal. The needs of ex-service men come first. 
 
 36
 
 THE SERVICE DEPARTMENT 
 
 American Legion of Illinois 
 
 The Service Department of the American Legion commenced 
 its functions in the latter part of March 1920. At that time, 
 Milton J. Foreman, Commander of the American Legion of Illinois, 
 realized that the governmental agencies charged with the care of 
 ex-service men, were not functioning, and that it would be neces- 
 sary to establish an agency in which the ex-service men would 
 have confidence as a liaison between the Government and these 
 men, because the burden of proof lies upon the claimant and he 
 was receiving little assistance from the Government. This was 
 due to the fact that the three governmental agencies, namely the 
 Bureau of "War Risk Insurance, the Federal Board for Vocational 
 Education and the United States Public Health Service were not 
 efficientl}^ co-operating. It was found that something had to be 
 done to connect up these three agencies with the ex-service men 
 in order that they would be given a square deal. 
 
 The work was organized by A. H. Ogle who was the first direc- 
 tor. In the first month of the work of the Service Department 
 about five hundred cases were handled. This number gradually 
 increased up to October 1920, when about twelve hundred cases, 
 and a total of six thousand for the first six months, had been ac- 
 cepted for settlement. These cases ranged from claims for back 
 pay on up to hospitalization and collection of death claims. 
 
 During the month of June 1920, the American Legion, De- 
 partment of Illinois, conducted a whirlwind campaign regarding 
 the benefits of War Risk Insurance and was instrumental, with 
 the assistance of the local representative of the Bureau of War 
 Risk Insurance, in having reinstated over thirteen million dollars 
 worth of War Risk Insurance. At this time J. W. Lyden was 
 Assistant Director of the Service Department and John A. Hart- 
 man was in charge of the insurance campaign. 
 
 In October 1920, William R. McCauley assumed his duties as 
 State Commander, Wm. Q. Setliffe was appointed Director and 
 John A. Hartman, Assistant Director of the Service Department 
 at the Chicago office. Steps were immediately taken to secure 
 proper co-operation with the different Bureaus. They were in a 
 great measure successful. Co-operation was secured with the U.S. 
 P.H.S. Hospital No. 30, through Dr. Wilcox G. Thorne, the Fed- 
 eral Board for Vocational Education, Mr. Charles W. Sjdvester, 
 Director, through Mr. H. J. Betty, liaison officer, and with the U.S. 
 P.H. Service, through Dr. Witte. An account of the present work 
 of the Service Department is given below: 
 
 37
 
 Considerable difficulty was experienced regarding the care and 
 protection of the men who were insane or mentally unbalanced. 
 These men passed through the psychopathic court and were farmed 
 out to different insane asjdums Avithout any effort being made to 
 connect their disability with their military service. This has 
 caused considerable confusion and added a great expense to the 
 various counties and the result has been that there were main- 
 many insane men who are ex-service men who have never had their 
 compensation claims taken up and little has been done to protect 
 their interests. 
 
 The Service Department arranged a plan Avhoreby all of the 
 county clerks in the one hundred and two counties in Illinois will 
 notify the American Legion Commander in their towns whenever 
 an ex-service man comes up for trial as to his sanity. Forms 526, 
 539 and 545 are then made out for the man by the American 
 Legion Commander and forwarded to the District Supervisor of 
 the United States Public Health Service. Under this plan the 
 man immediately becomes a ward of the government, at least for 
 observation purposes and until such time as his claim is estab- 
 lished with the Bureau of War Risk Insurance. 
 
 In Februar}', as the result of a conference between Department 
 Commander, Wm. R. McCauley, Dr. Witte and Mr. Hartman, an 
 agreement was entered into whereby a liaison officer has been 
 appointed by the United States Public Health Service, and all 
 differences of opinion and questions arising regarding hospitaliza- 
 tion are referred to this office, which settles them, if possible, and 
 if not they are referred to higher authority. 
 
 The Department Commander dedicated the Legion to one 
 duty for the year 1920-21, namely, that of service. That this idea 
 has been practical is proved by the fact that the number of claims 
 handled by Chicago office of the Service Department has jumped 
 from some thirteen hundred eases in October to ten thousand and 
 six during the month of February. 
 
 A Legal Department is maintained in this office and questions 
 regarding the appointment of conservators, administrators, etc. 
 are taken care of. 
 
 During the latter part of the year 1920, the Legion has been 
 instrumental in closing two contract hospitals, namely Sunnybrook 
 Farm and St. Paul's Hospital. A number of Public Health Service 
 examiners have been removed l)ecanse of their failure to understand 
 the point of view of the ex-service men. 
 
 In a conference between Assistant Surgeon-General Lavinder 
 and Commander William R. McCauley, Adjutant Wm. Q. Setliffe 
 
 38
 
 and John Hartman, Dr. Lavinder agreed to cancel the contract of 
 Cook County Tuberculosis Sanitarium at Oak Forest, just as soon 
 as hospital space for the ex-service men who are now patients at 
 that hospital can be secured elsewhere. 
 
 For about six weeks during November and December, this 
 Service Department maintained an employment bureau for ex- 
 service men and was instrumental in placing about two hundred 
 and fifty men in employment. During the same time about four 
 hundred dollars was expended for meal tickets, lodging and emer- 
 gency assistance for these men. This employment bureau was dis- 
 continued because of the desire of the American Legion to co- 
 operate with the Central Employment Bureau, which is under the 
 control of the Illinois Free Employment Bureau. We have re- 
 ceived uniform satisfaction from this Bureau. 
 
 The State of Illinois has been divided into districts. These 
 districts are under the supervision of the different County Central 
 Committees, who have the hospital within the district assigned to 
 them and who are responsible for the proper inspection and 
 reports. These inspections are made weekly and include a gen- 
 eral report on conditions found. Particular attention is paid to 
 the quarters, food, medical treatment and general surroundings. 
 A report is made to this office and if any complaints are regis- 
 tered they are immediately taken up through this office with the 
 district supervisor of the U.S.P.H.S. with a view to remedying 
 conditions without any delay. 
 
 In addition to this work, the Legion Posts in the towns in 
 which hospitals are located, have been furnished with a supply of 
 forms (as used in the hospital census) which are filled out for 
 each patient admitted. All necessary information is secured and 
 these forms are forwarded to Chicago to this office. If the man's 
 claim is already in our file or a hospital card has already been 
 filled out, the additional information is placed on the card. If 
 there is no card in our file, they immediately take it up with the 
 Bureau of War Risk Insurance and endeavor to secure an adjust- 
 ment and prompt action. 
 
 In addition to the above, the post or several posts in the 
 vicinity of each hospital visit it at intervals and mingle with the 
 patients and assist them in every way possible. Entertainment is 
 provided and whenever possible patients are taken for automobile 
 rides, etc. The entire policy is to see, not how much you can give 
 the man, but how much you can do for him. The hospitals in the 
 Chicago district are very well taken care of for the reason that 
 there are so many more posts than hospitals. Various entertain- 
 ments are provided and on an average of three posts visit each 
 institution weekl3^ 
 
 39
 
 Over the entire Illinois District, instead of going to the hos- 
 pitals Avitli fruit or what might be termed useless articles, a spirit 
 of eo-opcralion has heon establislicd and information is secured 
 from this office prior to the visit as to just -what the men need or 
 desire. It has been noted that posts visiting hospitals have over- 
 looked the fact that tooth brushes, tooth paste, shaving brushes 
 and soap, and razors are needed in a great many instances. This 
 has been corrected. It has also been noticed that Avell meaning 
 persons have sometimes visited hospitals with fruit, candy, etc., 
 and handed them out to the patients without regard to special 
 treatment certain patients were receiving. In this w^ay patients on 
 a diet have been furnished with articles of food forbidden by the 
 doctor. This has been remedied by asking the committees visiting 
 hospitals to consult with the hospital authorities in order to prevent 
 upsetting the patient's diet. 
 
 The condition of dependents of ex-service men has also been 
 investigated and their needs taken care of by the various posts. 
 
 Heretofore individual posts in the different communities have 
 visited hospitals on their own initiative and although conditions 
 needing attention were remedied, the office had no knowledge of 
 what w^as done and in many instances this resulted in duplication 
 of effort and neglect- of some hospitals. Under the present pro- 
 gram, all of the hospitals are visited regularly through instructions 
 from these headquarters and in this way there is no danger of one 
 hospital receiving four visits and other hospitals not receiving any. 
 
 It is noticed that within the past four months, posts have 
 become interested in Dunning, Elgin, Jacksonville and Kankakee 
 asylums and these hospitals or asylums are visited regularh' and 
 articles of comfort provided. This was not true in the past be- 
 cause of the fact that the average individual knew nothing of 
 conditions surrounding insane ex-service men. 
 
 During the Christmas Holiday's every hospital in the state of 
 Illinois where ex-service men were receiving treatment, was visited 
 and a Christmas program provided. This program consisted of a 
 Christmas tree, presents to the individual and a general spirit of 
 comradeship. Some of this work w^as done by the local posts and 
 in some instances by headquarters, with the assistance of local 
 posts. At Elgin the local post of the American Legion furnished 
 a Christmas dinner for all of the ex-service men in the Elgin State 
 Hospital and all who could possibly do so visited the hospital and 
 sat down at this Christmas dinner. In the afternoon an entertain- 
 ment program was furnished, wdiich was well attended by both the 
 patients and the members of the post with their friends. This is 
 typical of the visits paid to the hospitals in the state on that day. 
 
 A spirit of co-operation has been established in the different 
 hospitals and this plan has resulted in the ex-service men being 
 treated with better understanding of their condition than hereto- 
 fore. 
 
 40
 
 THE BED CROSS 
 
 The record of the Red Cross in military hospitals is well 
 understood. Under present conditions they are still doing a work 
 of outstanding importance. The Central Divisional Offices take 
 charge of the work in hospitals actualH^ controlled by the U. S. 
 Public Health Service. The Chicago Chapter and other chapters 
 throughout the State undertake it in contract hospitals. 
 
 The Central Division is responsible for Red Cross activities in 
 U. S. Marine Hospital No. 5, 4141 Clarendon Ave., where they 
 have three full time and one part time worker with Miss Estelle 
 Schulte as chief of the department; U.S.P.H.S. Hospital No. 30, 
 47th & Drexel Blvd., where they have thirteen full time workers 
 and one part time worker with Mr. Maurice R. Reddy as chief ; 
 and U.S.P.H.S. Hospital No. 53, Dwight, 111., where they have 
 three workers with Miss Alice J. Barker as chief. 
 
 The work of these departments is as follows: 
 
 Shortly after a patient is admitted to the hospital, he is inter- 
 viewed by a Red Cross worker, who takes up with him the subjects 
 of compensation, insurance, and Federal Board training, with a 
 view to assisting him in adjusting any claims that may be pending, 
 and at the same time, learning of any possible difficult}^ the man 
 may be having, in which the Red Cross might be of assistance to 
 him or his family. 
 
 During the man's stay in the hospital, many minor services 
 are rendered him by the Red Cross. In cases where compensation 
 has not been received, or all his compensation is needed for his 
 family, loans or grants, as the situation requires, are made by the 
 Red Cross. These loans or grants are often necessary' because of 
 needed clothing, transportation home, and other miscellaneous ex- 
 penditures. 
 
 When a diagnosis of tuberculosis is made, the Red Cross 
 Avorker immediately gets in touch with the man's local Home 
 Service, asking that every effort be made to have the rest of the 
 family examined for T. B. and proper hygiene and nourishment 
 to any of the familj^ who might be a suspicious case. They believe 
 preventive work in tuberculosis is a dut3^ 
 
 In the case of severe illness of an out-of-town patient in the 
 hospital, it is the duty of the Red Cross to keep the family in- 
 formed as to the man's condition. 
 
 In the case of death, all possible assistance is given any rela- 
 tives who may be visiting the hospital at the time, and the man's 
 Local Home Service is communicated with, in order that any 
 possible needed assistance in arranging the details of the funeral 
 may be given. Also it is customary for the Red Cross to send to 
 the man's Local Home Service any information thej- may have 
 regarding the status of his compensation and insurance ; and if no 
 relatives were present, information regarding the details sur- 
 rounding the patient's last hours that could possibly, be of any 
 comfort to the family. 
 
 41
 
 In these letters, there is a definite request for the Red Cross 
 worker to call at the home and render any assistance to the family. 
 
 On the discharge of patients from the hospitals, a letter is 
 sent to the man's Local Home Service describing the nature of his 
 trouble, his present condition, the doctor's advice for proper after- 
 care including points regarding recreation, diet and hygiene, the 
 date and place of his next examination, what has been accomplished 
 on adjusting the patient's compensation, insurance, or vocational 
 training while he has been in the hospital, together with a definite 
 request for a reply, whether or not it has been possible to arrange 
 for the doctor's directions to be carried out. The types of cases 
 the Red Cross is especially anxious to do such follow-up work on, 
 are mental eases, tuberculosis, heart, nephritis, diabetes, gastro- 
 intestinal condition, and orthopedic troubles, including major am- 
 putations. 
 
 In each of these hospitals, the Red Cross has a full time re- 
 creational worker, who arranges for entertainment for the patient 
 personnel. They work in co-operation with, and direct, any volun- 
 teer entertainment offered by organizations or individuals. The 
 recreational workers make an effort to develop a plan of recreation 
 for ward patients who are able to go out on pass. 
 
 From February first, 1921, the Chicago Chapter of the Amer- 
 ican Red Cross undertook to furnish social service to the men in 
 contact hospitals within its territory, and a staff of five workers is 
 now looking after their needs. 
 
 When a maii enters the hospital, if he has not proper clothing, 
 he is at once given two suits of pajamas, a bathrobe, a pair of slip- 
 pers, and in the tuberculosis hospitals a thermometer is given also. 
 Immediate inquiry is made into the state of his government claims, 
 and the necessary steps are taken to hasten compensation if it is 
 not being received. Moiiey for personal needs is furnished those 
 Avho have none. Games, reading matter and cigarettes are pro- 
 vided. 
 
 If the patient is from another cit.y and is worried about his 
 family, these w'orkers communicate with the Red Cross in his home 
 town and establish means of communications which usiuilly relieves 
 his anxiety at once. 
 
 In February, 350 men were under care in contract hospitals. 
 Of these 1,8G were given cash relief or new clothing, and 298 were 
 given many forms of service, such as writing letters, adjusting 
 personal affairs, and attending to necessary business matters for 
 them. 
 
 These workers also distribute gifts of fruit, candy and deli- 
 cacies. 
 
 The Chapter has also established a follow-up service for men 
 discharged from the hospitals into the out-patient group. The Red 
 Cross undertakes to see that the man returns for treatment at the 
 required times and that the physician's instructions are carried 
 out in the Jiome. The proper diet is provided, and the housewife 
 instructed in its preparaliou if necessar}'. 
 
 42
 
 CONCLUSIONS 
 
 Specific Suggestioxs for the Future. 
 
 A — Completion of the Speedway Hospital 
 
 The most important question is the proper hospitalization of 
 tubercular and neuro-psychiatric cases. The Government has had 
 this hospital under construction for the last three years. It is 
 located some eight miles west of the Chicago Loop. The buildings 
 are practically completed, at a cost of more than $5,000,000. It 
 should be available for patients during the mid-summer of 1921. 
 A great deal remains to be done to make the Speedway a proper 
 place for ex-service men. There are 320 acres of open land without 
 trees, natural shrubbery or recreational facilities. Immediate ef- 
 forts should be made to start to work out the proper landscape 
 features, the proper recreational facilities, the question of trans- 
 portation and community relationships. There are no transporta- 
 tion facilities nearer than two miles except the spur of the Illinois 
 Central, which might furnish transportation for some. The Speed- 
 way will help to solve some of the difficult hospitalization j)rob- 
 lems but in order to do it adequately, action must be taken at once 
 so that ex-service men hospitalized there may have, as far as pos- 
 sible, conditions of normal, happy, healthy life about them. 
 
 B — A State Hospital for Mental Cases 
 
 The best memorial — the finest appreciation for the service of 
 men throughout the war will be a splendid state hospital for re- 
 habilitation and care of mental cases erected in memory of their 
 service. Such a hospital well located would assure the men of this 
 state who have suffered from the War and their families, the very 
 best medical care during the next ten years, when physical and 
 medical conditions growing out of the war will warrant the ex- 
 penditure at this time of this amount of money. ,Otlier states are 
 considering the matter very seriously. Wisconsin is building a 
 memorial hospital at the Universitj' at Madison. New York ap- 
 propriated three million dollars for a hospital for mental diseases 
 and citizens of Illinois may well consider the matter as a contri- 
 bution of the State to a great and worthy- purpose. In view of the 
 fact that up to date Illinois has never officially taken any cogni- 
 zance of the condition of men who were sick or disabled in the serv- 
 ice, no better way could be discovered for covering up this failure in 
 the past than by doing her full share at this time and protecting 
 the future of these men. 
 
 C — Training Farm for After Hospital Care for Mental Cases 
 
 Great difficulty has been experienced by the Federal Board in 
 arranging the proper training facilities for mental cases after they 
 have left the hospital. It has been proposed that a farm be secured 
 with all the proper buildings for living accommodations together 
 Avith sufficient space for work shops and school rooms. An investi- 
 
 43
 
 gat ion is at this time being made for such an arrangement. It is 
 expected that this project for mental cases, which will parallel the 
 Nauvoo, Illinois school which is taking care of 150 ex-service men 
 with inactive tuberculosis, may be made by the board of vocational 
 education. 
 
 D — Complete Unification, Departmentalization and Decentral- 
 ization of Bureaus 
 
 It is generally agreed that the situation in this state with 
 reference to compensation and care of the disabled and sick ex-serv- 
 ice man will never be satisfactorily solved until the various depart- 
 ments are in one office when he can receive complete attention in 
 the matter of compensation and hospitalization and vocational 
 training, where one complete file will contain everything affecting 
 his case ; when there will be no shifting of responsibility, no passing 
 of the buck from one bureau to another. 
 
 One office in Washington will not do this. There must be a 
 number of regional offices throughout the country with power to 
 act. To this end the American Legion, through its national hos- 
 pitalization committee of which General Abel Davis of Chicago is 
 chairman and its legislative committee, have been working for 
 some time. The Committee of the American Legion favors and is 
 working for legislation which will bring about a unified, depart- 
 mentized and decentralized agency for the care of disabled soldiers. 
 
 All activities of the Government for the purpose of general 
 direction should be placed in one department of the Government, 
 in such a way as to avoid duplication of functions or conflict of 
 authority. 
 
 Every phase of the problem is important enough to be handled 
 in a separate department. As an illustration, the department of 
 insurance would find enough work in looking after that one phase 
 of the problem. Similarly, the department of compensation is im- 
 portant in itself and should in no way conflict with or overlap the 
 work of hospitalization. All medical service and hospitalization 
 should be placed in a separate department. It is believed that the 
 United States Public Health Service, which has the personnel and 
 the necessary experience, might be given the task of perfecting 
 such a department. The Federal Board of vocational training is 
 also of sufficient importance to be a separate department. All of 
 these departments should function under the direct supervision and 
 authorit}^ of the one head — The Assistant Secretary. 
 
 It is not fair to the disabled man to make Washington the only 
 place where he can get a hearing on this case. Each state or other 
 subdivision agreed to should have an office where final decisions 
 can l)e reached on all matters affecting the soldier, whether it is 
 compensation, hospitalization or vocational training. This is now 
 true of vocational training and hospitalization. On appeal, or for 
 other specially stated reasons, a case might be reviewed and finally 
 decided in Washington. The main cause of delay and much in- 
 
 44
 
 convenience and discomfort to the soldier is the fact that the main 
 office in Washington decided each individual case at long distance, 
 acting on reports, without an opportunitj' to see the man and his 
 actual surroundings. 
 
 £ — Clinics and Home Visitation 
 
 It is of great importance that medical facilities be made easily 
 accessible for men who are claimants of the War Risk Bureau but 
 who are not hospitalized. Frequently the Public Health Service 
 must take the initiative in the treatment of those claimants. The 
 development of Public Health Service clinics will meet this need. 
 
 Home visitation work by the Public Health Service and by 
 the Red Cross are of the greatest importance in order that men 
 may receive satisfactory medical treatment, not in the hospitals. 
 By early c^re much diffi<3ult work of hospitalization can be pre- 
 vented to the mutual advantage of the men and the Government. 
 
 THE STATE AT WORK 
 
 Our communities throughout the state have been interested in 
 the disabled soldier. Difficulty has been experienced in having 
 such interest manifest itself along helpful lines. Chicago finally 
 found a way for an expression of such interest along highly con- 
 structive lines. The Union League Club, through its Committee 
 on Public Affairs, headed by Britten I. Budd, after consultation 
 with the Service Department of the American Legion and a number 
 of individuals who had been interested in the situation, assumed 
 the responsibility for a specific plan, (a) completion of the Speed- 
 way Hospital, the beautification of its surroundings, providing 
 recreational facilities and transportation, general supervision of 
 the hospital as a public interest, and (b) to secure from the legisla- 
 ture the necessary appropriation for the erection of a State 
 Memorial Hospital for the treatment of insane cases among ex- 
 service men, and the establishment of a committee to continue its 
 interest and supervision in the whole field of treatment of the dis- 
 abled veterans. 
 
 With his own plans as a basis, Mr. Budd has secured the co- 
 operation of the Illinois Chamber of Commerce and made the con- 
 crete suggestion that, through this organization, each community, 
 after ascertaining the local situation, assume responsibility along 
 certain specific lines of helpfulness. You can express best your 
 interest in the soldier by helping in each community the organiza- 
 tion of a group of men who will charge themselves with the re- 
 sponsibility of putting into execution Illinois' plan for the future: 
 
 The good will of the American people must he made to express 
 itself fully through the efficient work of Government departments. 
 But each and every American citizen should do his share tvhenever 
 he crosses the path of a sick or disabled ex-service man, to make 
 his life as useful, as self-respecting, as strong as the united efforts 
 of a grateful people can make it. 
 
 45

 
 l^nZf'*^'^ OF ILLINOB-URBANA 
 
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