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 Foundations of Data
Science with Python

Foundations of Data Science with Python introduces readers to the fundamentals of data science, includ-
ing data manipulation and visualization, probability, statistics, and dimensionality reduction. This book
is targeted toward engineers and scientists, but it should be readily understandable to anyone who knows
basic calculus and the essentials of computer programming. It uses a computational-first approach to data
science: the reader will learn how to use Python and the associated data-science libraries to visualize,
transform, and model data, as well as how to conduct statistical tests using real data sets. Rather than rely-
ing on obscure formulas that only apply to very specific statistical tests, this book teaches readers how to
perform statistical tests via resampling; this is a simple and general approach to conducting statistical tests
using simulations that draw samples from the data being analyzed. The statistical techniques and tools are
explained and demonstrated using a diverse collection of data sets to conduct statistical tests related to
contemporary topics, from the effects of socioeconomic factors on the spread of the COVID-19 virus to
the impact of state laws on firearms mortality.

This book can be used as an undergraduate textbook for an Introduction to Data Science course or to
provide a more contemporary approach in courses like Engineering Statistics. However, it is also intended
to be accessible to practicing engineers and scientists who need to gain foundational knowledge of data
science.

Key Features:
• Applies a modern, computational approach to working with data
• Uses real data sets to conduct statistical tests that address a diverse set of contemporary issues
• Teaches the fundamentals of some of the most important tools in the Python data-science stack
• Provides a basic, but rigorous, introduction to Probability and its application to Statistics
• Offers an accompanying website that provides a unique set of online, interactive tools to help the
reader learn the material
John M. Shea, PhD is a Professor in the Department of Electrical and Computer Engineering at the Uni-
versity of Florida, where he has taught classes on stochastic methods, data science, and wireless com-
munications for over 20 years. He earned his PhD in Electrical Engineering from Clemson University in
1998 and later received the Outstanding Young Alumni award from the Clemson College of Engineering
and Science. Dr. Shea was co-leader of Team GatorWings, which won the Defense Advanced Research
Project Agency’s (DARPA’s) Spectrum Collaboration Challenge (DARPA’s fifth Grand Challenge) in 2019.
He received the Lifetime Achievement Award for Technical Achievement from the IEEE Military Com-
munications Conference (MILCOM) and is a two-time winner of the Ellersick Award from the IEEE Com-
munications Society for the Best Paper in the Unclassified Program of MILCOM. He has been an editor
for IEEE Transactions on Wireless Communications, IEEE Wireless Communications magazine, and IEEE
Transactions on Vehicular Technology.
Chapman & Hall/CRC
The Python Series
About the Series

Python has been ranked as the most popular programming language, and it is widely used in education and
industry. This book series will offer a wide range of books on Python for students and professionals. Titles
in the series will help users learn the language at an introductory and advanced level, and explore its many
applications in data science, AI, and machine learning. Series titles can also be supplemented with Jupyter
notebooks.

Image Processing and Acquisition using Python, Second Edition

Ravishankar Chityala, Sridevi Pudipeddi

Python Packages
Tomas Beuzen and Tiffany-Anne Timbers

Statistics and Data Visualisation with Python

Jesús Rogel-Salazar

Introduction to Python for Humanists

William J.B. Mattingly

Python for Scientific Computation and Artificial Intelligence

Stephen Lynch

Learning Professional Python Volume 1: The Basics

Usharani Bhimavarapu and Jude D. Hemanth

Learning Professional Python Volume 2: Advanced

Usharani Bhimavarapu and Jude D. Hemanth

Learning Advanced Python from Open Source Projects

Rongpeng Li

Foundations of Data Science with Python

John Mark Shea

For more information about this series please visit: https://www.crcpress.com/Chapman--HallCRC/book-

series/PYTH
Foundations of Data
Science with Python

John M. Shea
Designed cover image: © Agnes Shea

MATLAB is a trademark of The MathWorks, Inc. and is used with permission. The MathWorks does
not warrant the accuracy of the text or exercises in this book. This book’s use or discussion of MATLAB
software or related products does not constitute endorsement or sponsorship by The MathWorks of a
particular pedagogical approach or particular use of the MATLAB software.
First edition published 2024
by CRC Press
2385 NW Executive Center Drive, Suite 320, Boca Raton FL 33431

and by CRC Press

4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN

CRC Press is an imprint of Taylor & Francis Group, LLC

© 2024 John Mark Shea

Reasonable efforts have been made to publish reliable data and information, but the author and publisher
cannot assume responsibility for the validity of all materials or the consequences of their use. The authors
and publishers have attempted to trace the copyright holders of all material reproduced in this publica-
tion and apologize to copyright holders if permission to publish in this form has not been obtained. If any
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mitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter
invented, including photocopying, microfilming, and recording, or in any information storage or retrieval
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contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-
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Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used
only for identification and explanation without intent to infringe.

ISBN: 978-1-032-34674-8 (hbk)

ISBN: 978-1-032-35042-4 (pbk)
ISBN: 978-1-003-32499-7 (ebk)

DOI: 10.1201/9781003324997

Typeset in Latin Modern font

by KnowledgeWorks Global Ltd.

Publisher’s note: This book has been prepared from camera-ready copy provided by the authors.
 For Tucker, Charlotte, and Amelia—

proof that events with zero probability

(having three children that are this wonderful)
happen!
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
Contents

Acknowledgments xi

Preface xiii

1 Introduction 1
1.1 Who is this book for? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Why learn data science from this book? . . . . . . . . . . . . . . . . . . . . 1
1.3 What is data science? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.4 What data science topics does this book cover? . . . . . . . . . . . . . . . . 5
1.5 What data science topics does this book not cover? . . . . . . . . . . . . . 6
1.6 Extremely Brief Introduction to Jupyter and Python . . . . . . . . . . . . . 6
1.7 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

2 First Simulations, Visualizations, and Statistical Tests 17

2.1 Motivating Problem: Is This Coin Fair? . . . . . . . . . . . . . . . . . . . . 17
2.2 First Computer Simulations . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.3 First Visualizations: Scatter Plots and Histograms . . . . . . . . . . . . . . 20
2.4 First Statistical Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.5 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

3 First Visualizations and Statistical Tests with Real Data 33

3.1 Introduction to Pandas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.2 Visualizing Multiple Data Sets – Part 1: Scatter Plots . . . . . . . . . . . . 39
3.3 Partitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
3.4 Summary Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
3.5 Visualizing Multiple Data Sets – Part 2: Histograms for Partitioned Data . 56
3.6 Null Hypothesis Testing with Real Data . . . . . . . . . . . . . . . . . . . . 61
3.7 A Quick Preview of Two-Dimensional Statistical Methods . . . . . . . . . . 73
3.8 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

4 Introduction to Probability 77
4.1 Outcomes, Sample Spaces, and Events . . . . . . . . . . . . . . . . . . . . . 77
4.2 Relative Frequencies and Probabilities . . . . . . . . . . . . . . . . . . . . . 78
4.3 Fair Experiments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
4.4 Axiomatic Probability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.5 Corollaries to the Axioms of Probability . . . . . . . . . . . . . . . . . . . . 94
4.6 Combinatorics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
4.7 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

vii
viii Contents

5 Null Hypothesis Tests 113

5.1 Statistical Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
5.2 General Resampling Approaches for Null Hypothesis Significance Testing . 120
5.3 Calculating p-Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
5.4 How to Sample from the Pooled Data . . . . . . . . . . . . . . . . . . . . . 132
5.5 Example Null Hypothesis Significance Tests . . . . . . . . . . . . . . . . . . 138
5.6 Bootstrap Distribution and Confidence Intervals . . . . . . . . . . . . . . . 141
5.7 Types of Errors and Statistical Power . . . . . . . . . . . . . . . . . . . . . 147
5.8 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

6 Conditional Probability, Dependence, and Independence 151

6.1 Simulating and Counting Conditional Probabilities . . . . . . . . . . . . . . 152
6.2 Conditional Probability: Notation and Intuition . . . . . . . . . . . . . . . . 157
6.3 Formally Defining Conditional Probability . . . . . . . . . . . . . . . . . . . 159
6.4 Relating Conditional and Unconditional Probabilities . . . . . . . . . . . . . 162
6.5 More on Simulating Conditional Probabilities . . . . . . . . . . . . . . . . . 164
6.6 Statistical Independence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
6.7 Conditional Probabilities and Independence in Fair Experiments . . . . . . 172
6.8 Conditioning and (In)dependence . . . . . . . . . . . . . . . . . . . . . . . . 176
6.9 Chain Rules and Total Probability . . . . . . . . . . . . . . . . . . . . . . . 178
6.10 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186

7 Introduction to Bayesian Methods 187

7.1 Bayes’ Rule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
7.2 Bayes’ Rule in Systems with Hidden State . . . . . . . . . . . . . . . . . . . 195
7.3 Optimal Decisions for Discrete Stochastic Systems . . . . . . . . . . . . . . 197
7.4 Bayesian Hypothesis Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
7.5 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215

8 Random Variables 217

8.1 Definition of a Real Random Variable . . . . . . . . . . . . . . . . . . . . . 217
8.2 Discrete Random Variables . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
8.3 Cumulative Distribution Functions . . . . . . . . . . . . . . . . . . . . . . . 237
8.4 Important Discrete RVs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
8.5 Continuous Random Variables . . . . . . . . . . . . . . . . . . . . . . . . . . 265
8.6 Important Continuous Random Variables . . . . . . . . . . . . . . . . . . . 279
8.7 Histograms of Continuous Random Variables and Kernel Density Estimation 299
8.8 Conditioning with Random Variables . . . . . . . . . . . . . . . . . . . . . . 301
8.9 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305

9 Expected Value, Parameter Estimation, and Hypothesis Tests on

Sample Means 306
9.1 Expected Value . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
9.2 Expected Value of a Continuous Random Variable with SymPy . . . . . . . 312
9.3 Moments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
9.4 Parameter Estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
9.5 Confidence Intervals for Estimates . . . . . . . . . . . . . . . . . . . . . . . 333
9.6 Testing a Difference of Means . . . . . . . . . . . . . . . . . . . . . . . . . . 342
9.7 Sampling and Bootstrap Distributions of Parameters . . . . . . . . . . . . . 356
9.8 Effect Size, Power, and Sample Size Selection . . . . . . . . . . . . . . . . . 360
9.9 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362
Contents ix

10 Decision-Making with Observations from Continuous Distributions 364

10.1 Binary Decisions from Continuous Data: Non-Bayesian Approaches . . . . . 364
10.2 Point Conditioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
10.3 Optimal Bayesian Decision-Making with Continuous Random Variables . . 380
10.4 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386

11 Categorical Data, Tests for Dependence, and Goodness of Fit for

Discrete Distributions 387
11.1 Tabulating Categorical Data and Creating a Test Statistic . . . . . . . . . . 388
11.2 Null Hypothesis Significance Testing for Dependence in Contingency Tables 394
11.3 Chi-Square Goodness-of-Fit Test . . . . . . . . . . . . . . . . . . . . . . . . 400
11.4 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408

12 Multidimensional Data: Vector Moments and Linear Regression 409

12.1 Summary Statistics for Vector Data . . . . . . . . . . . . . . . . . . . . . . 410
12.2 Linear Regression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
12.3 Null Hypothesis Tests for Correlation . . . . . . . . . . . . . . . . . . . . . . 435
12.4 Nonlinear Regression Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
12.5 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445

13 Working with Dependent Data in Multiple Dimensions 446

13.1 Jointly Distributed Pairs of Random Variables . . . . . . . . . . . . . . . . 446
13.2 Standardization and Linear Transformations . . . . . . . . . . . . . . . . . . 456
13.3 Decorrelating Random Vectors and Multi-Dimensional Data . . . . . . . . . 467
13.4 Principal Components Analysis . . . . . . . . . . . . . . . . . . . . . . . . . 475
13.5 Chapter Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 484

Index 485
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
Acknowledgments

I want to thank the many people who helped make this book possible.

My love and thanks go to my wife, Jill, for twenty-five years of love and friendship;
this book would not be possible without the wonderful family and home we have created
together. I love that we can enjoy quiet times at home or adventures together all over the
world. This book is better because of your careful editing.

To my children, Tucker, Charlotte, and Amelia: I treasure every moment with you,
whether it is trading funny memes, solving the New York Times crossword puzzle, battling
at Ping Pong, running our family 5Ks, trying to guess the winner of Survivor, reading to-
gether, or just working side-by-side on the couch.

I thank my parents, Larry and Agnes Shea, for their unwavering love and support. Mom,
you are missed every day.

I have been inspired by too many dedicated engineering educators to list them all. I
have to especially thank my Ph.D. advisor, Dr. Michael Pursley, for mentoring me on how
to conduct research, how to teach, and how to write technically. Thank you to Dr. John
Harris, who convinced me to develop the data-science course on which this book is based.
Thank you to Dr. Catia Silva, who was my co-instructor for one of the semesters teaching
the data-science course.

Several students provided feedback on the book, including Caleb Bowyer, Walter Acosta,
Cortland Bailey, Brennan Borchert, Alexander Braun, Patrick Craig, Justin Nagovskiy,
Allison Neil, Michael Russo, Dieter Steinhauser, Phillip Thompson, and Marisa Younger.

xi
Taylor & Francis
Taylor & Francis Group
http://taylorandfrancis.com
Preface

This book is an introduction to the foundations of data science, including loading and
manipulating data, data visualization, statistics, probability, and dimensionality reduction.
This book is targeted toward engineers and scientists, but it should be easily accessible
to anyone who knows basic calculus and the essentials of computer programming. By
leveraging this background knowledge, this book fits a unique niche in the books on data
science and statistics:
• This book applies a modern, computational approach to work with data.
In particular, it uses simulations (an approach called resampling) to answer statistical
questions.
– Many books on statistics (especially those for engineers) teach students how to
answer statistical questions using only analytical approaches that many learners
find difficult to understand. Most learners can easily understand how resampling
works, in contrast to some arcane formula.
• This book uses real data sets and addresses contemporary issues.
– Many statistics books use contrived examples that are small enough to print in
a book and work with using a calculator, but this results in data sets that are
unrealistic and uninteresting. The computational approach used in this book allows
the use of data sets from across the web to conduct statistical tests on topics from
the effects of socioeconomic factors on the spread of the COVID-19 virus to the
impact of state firearm laws on firearm mortality.
• This book provides a basic, but rigorous, introduction to probability and its
application to statistics.
– Some of the other books that use the resampling approach to statistics omit the
mathematical foundations because they are targeted toward a broader audience
who may not have the rigorous mathematical background of engineers and scien-
tists.

xiii
xiv Preface

• This book shows how to work with some of the most important tools in the
Python data-science stack, including:

– NumPy for working with vectors and matrices, as well as many types of numerical
functions,
– SciPy for working with random distributions and conducting statistical tests,
– Pandas for loading, manipulating, and summarizing data,
– Matplotlib for plotting data, and
– scikit-learn for accessing standard data sets and for advanced statistical process-
ing.

• This book was co-written with a book that covers linear algebra and its
application to data science using Python and NumPy.

– Techniques like dimensionality reduction require linear algebra. Although linear

algebra is not covered in this book, the companion book Introduction to Linear
Algebra for Data Science with Python provides the necessary background knowledge
with the same mix of analysis and Python implementation.
• This book provides a unique set of online, interactive tools to help students
learn the material, including:

– interactive self-assessment quizzes,

– interactive flashcards to aid in learning terminology,
– interactive Python widgets and animated plots.

Interactive elements are available on the book’s web site: fdsp.net.

View the quiz and flaschards for this preface at

fdsp.net/intro,
which can also be accessed using this QR code:

Credits: The image at the top of this page is made using the Wee People font made by
ProPublica: https://github.com/propublica/weepeople. Inspired by a Tweet by Matthew
Kay: https://twitter.com/mjskay/status/1519156106588790786.
Other documents randomly have
different content
RGEON M. J. WHITE: Early in 1919, when I first opened Palo Alto, I
made recommendation for the amendment of the Act, so that the
Compensation of a patient might be held until he had completely
recovered, and I see no reason why there is a legal bar to it. I think
Congress can say that Compensation is payable when a man has
completely recovered and is discharged from the hospital. We cannot
undertake to protect the patients from sharks. For instance, we give a
man a pass; he goes down town and spends his money. As long as he has
money in his pocket, he will spend it. I think it would be legal for
Congress to say that Compensation will be payable when the man has
reached maximum hospital treatment or when he is properly
discharged. Otherwise, if a patient has accumulated, say, $160, he starts
a disturbance and you have to give him the money.

PTAIN F. W. Wieber, U.S.N.:—I am glad to say that we have had very

little trouble with our Veterans’ Bureau patients. We have, however, had
trouble occasionally, but I have always been able to attend to these
matters myself, for I have a good understanding with a U. S. Attorney,
who helps me out.
Regarding money, it would be the best thing if most of the
Compensation to the men could be withheld. They may have dependent
families, so no uniform rule could guide us in our action. I do not think
it should be left to the Commanding Officer, for in the first place, we do
not know how much money the men should receive.
With regard to the matter of smuggling into the reservation, I sent a
request to the Surgeon General to be allowed to put up a fence but I
have never heard from it. I am going to recommend to my successor that
he call attention to that matter again. The reservation at Fort Lyon
covers 1100 acres, and a portion should be enclosed with a fence. There
has been much stealing there, and we have often found the stolen
articles in houses around the reservation. The building of a fence would
be expensive, but it would counter-balance the loss of government
property.
For the benefit of the gentlemen who may succeed at Fort Lyon
soon, I might say that when I was ordered to Fort Lyon I was very much
grieved; I knew it was in a desert, and everybody who had been there
gave such a discouraging report. My sentiment in that matter has
changed to such an extent that if the place had remained in the hands of
the Navy, I should have liked to have remained there. We are a happy
family of about fourteen commissioned officers and we have formed a
little community of ourselves, being independent of the outside world to
a large extent. We have our power house, ice plant, community house,
social meetings, and in fact we are as independent as can be.
During the flood, we were able, for about two weeks to attend to our
own things, and after that we were able to help the outsiders. So, to
those gentlemen I want to say that they need not be disconsolate upon
receiving orders to go to Fort Lyon.
I think it is ideal for the T. B. patients. We have the dry climate,
constant sun-shiny days, cool nights, and everything conducive to the
proper treatment of T. B. Everything is complete, and the people are
greatly benefited by their stay in our vicinity, as can be attested by the
fact that many former Navy People, who had been in the institution, are
now living there and are as strong as any person in the East.
I might say that the people who have had T. B. and who are doing
well out west had better make up their minds to stay our there for fear
that change of conditions might bring about activity again in their cases.
Regarding a uniform system of treatment as suggested, I do not
believe any strict rules should be set. We can have a sort of general
system, but no uniform method as to the hours of rest, food, etc. At Fort
Lyon, rest is now being enforced, and every patient gets two rest
periods, i. e., from 9 to 11 A.M. and from 1 to 3 P.M. Liberty is allowed
only once a week; and overnight, once a month. Those who would be
discontented anywhere have left, and those who have stayed feel they
have our sympathy and support and are doing well.

NERAL SAWYER asked for resolutions from the Resolutions Committee.

NERAL IRELAND: “Your committee has gone over the resolutions that
have been presented, and we find all of them in order, with the
exception of one submitted by Colonel Bratton with reference to
transportation home. We would inform you that there will have to be
legislation to carry out that resolution. We have changed the resolution
to read as follows:
‘That the Director of the U.S. Veterans’ Bureau be requested to
secure legislation so that the expenses of the patient’s
transportation to his bona fide home, when he has been discharged
 for disciplinary reasons, be deducted from his compensation, when
compensation is being given, or may be given thereafter.’
As changed, I recommend that the resolution be adopted by the
meeting as read.”
This M o t i o n was seconded, and carried.

PTAIN N. J. BLACKWOOD, U. S. N.:—The Committee on Forms has held

two meetings at which the general subject of this work was discussed
and plans agreed upon. This work is so great that your Committee finds
it impossible to report more than progress at present. The whole matter
must be gone into carefully and thoroughly in order to avoid mistakes
and duplications of the past. The work, to be a success, will require
frequent meetings, careful study and cooperation. Therefore, it seems
wise that all members of the Committee be officers on duty in
Washington, and I recommend that the present chairman, Captain
Blackwood, be relieved, and that his place be filled by Captain M. S.
Elliott, Commanding Officer of the Naval Hospital; also, that all
Commanding Officers here present shall, as soon as possible after
returning to their respective commands, take up the subject of forms
and paper work regarding Veterans’ Bureau patients, and as soon
thereafter as possible submit to the Veterans’ Bureau, Washington,
recommendations and suggestions for the elimination, provision and
simplification both of the forms themselves and their numbers.
Upon receipt of these letters, your Committee will then take up the
whole subject in a more comprehensive way and will, as soon as
possible, submit its recommendations for your consideration and
approval.
The M O T I O N was seconded and carried.
Meeting adjourned at 12:30 P. M.
 Eighth Friday, January 20, 1922.
Session
Honorable Charles H. Burke presiding.
The roll was called by Dr. W. A. White.

R. BURKE: “We will proceed with the afternoon program. The first
subject is “Foreign Relations of the U.S. Veterans’ Bureau in care of ex-
soldiers of the former allied countries.” It will be discussed by Dr. F. D.
Hester of the Veterans’ Bureau”.

R. HESTER: read as follows:

“FOREIGN RELATIONS OF THE U.S. VETERANS’ BUREAU

IN CARE OF

EX-SOLDIERS OF THE FORMER ALLIED COUNTRIES.

Mr. Chairman, Ladies and Gentlemen:

As I note that the program upon which I have been placed refers to
foreign relations of the U.S. Veterans’ Bureau in care of ex-soldiers of
the formed-allied countries, with your permission I will add to that, the
care of U.S. ex-service men in foreign countries. The care of U.S. ex-
service men in this country has been discussed from every angle, and it
would seem proper that we should also refer to his care in foreign
countries from a medical standpoint, as well as to the care of the allied
ex-service man in this country.
THE LAW As act of Congress, Public 104, Sixty-sixth
PROVIDING FOR Congress, approved December 24, 1919,
THE CARE OF U.S. provides that the Bureau of War Risk
EX-SERVICE MEN
Insurance, now the Veterans’ Bureau, is
IN FOREIGN authorized, to furnish transportation, also
COUNTRIES medical, surgical, and hospital services to
discharged members of the military or naval forces of those
Governments which have been associated in war with the United States
since April 6, 1917, and come within the provisions of laws of such
Governments similar to the War Risk Insurance Act, at such rates and
under such regulations as the Director of the Bureau of War Risk
Insurance may prescribe, etc.
AUTHORIZATION You will note that this provision of the law
FOR SERVICE stipulates at such rates and under such
regulations as the Director of the Bureau of War Risk Insurance may
prescribe. The regulation that has been issued by the Director of the
U.S. Veterans’ Bureau provides that in all cases where application for
treatment is made by ex-members of the military or naval forces of the
allies, such treatment will be furnished only on the specific
authorization of the Director of the U.S. Veterans’ Bureau upon
authority obtained from the Government concerned, to incur the
expense of treatment in each case. When treatment is so authorized, the
same procedure is to be followed as in cases of application made by ex-
members of the Canadian forces, which is as follows:
RECIPROCAL AGREEMENT WITH CANADA:
An agreement entered into between the Canadian and this
Government upon reciprocal lines provides that when an honorably
discharged member of the military or naval forces of the Allies, resident
in the United States or its territorial possessions, requires medical or
surgical treatment for a disability contracted in, due to, or increased by
his military or naval service, he shall apply to the nearest medical
representative of the U.S. Veterans’ Bureau. If such representative is not
available, information regarding the address of the nearest medical
representative of the U.S. Veterans’ Bureau may be secured through any
local representative of the American Red Cross, the American Legion,
the Y.M.C.A., the Salvation Army, the Knights of Columbus, or other
volunteer agency.
METHOD OF PROCEDURE WHEN
APPLICATION IS MADE FOR TREATMENT:
When application for treatment is made by an ex-member of the
Canadian forces, the medical representative of the U.S. Veterans’
Bureau to whom such application is made will communicate with the
District Manager in order to obtain particulars regarding the man’s
military or naval status and medical history, and the District Manager
will communicate with the Bureau (Assistant Director, Medical
Division, Attention Foreign Relations Section), which will obtain from
the Government of Canada the necessary information. If additional
information is required, the District Manager, if speed be necessary, will
request such additional information by telegram. In no case should
treatment be undertaken pending receipt of authority from the U.S.
Veterans’ Bureau, unless the call be one of emergency, and in all
emergency cases the medical officer in the field is authorized to give
prompt service.
LETTER OF INSTRUCTIONS:
The articles of agreement with Canada have been supplemented
with a letter of instructions that clearly sets forth just how service is to
be given by representatives of this Bureau to beneficiaries of the
Canadian Government. This letter of instruction is a guide for the
representatives of this Bureau in the field as to proper procedure when
any doubtful situation should arise, and has been sent to the District
Managers in such numbers as to furnish each medical officer with a
copy.
It is possible that some of you gentlemen are not in possession of
these instructions; should such be the case, a number of copies are at
your disposal here, and may be obtained from the stenographers’ table.
NUMBER OF CANADIAN EX-SERVICE MEN
CARED FOR BY THIS BUREAU:
It may not be out of order to mention at this time that the U.S.
Veterans’ Bureau through its Foreign Relations Section, Medical
Division, has cared for over 9,000 Canadian ex-service men. When I say
Canadian ex-service men, please know that these are not in reality
Canadians, but that 95% of the number are American boys, who,
through their valor and enthusiasm, rushed into the breach in the early
stages of the conflict, having crossed the Canadian border in 1914, 1915,
1916 and 1917. Their Services having been rendered under the English
flag in Canadian organizations, these boys are properly beneficiaries of
the Canadian Government, and are being cared for by that Government
through the U.S. Veterans’ Bureau, Foreign Relations Section, Medical
Division, by cooperation with the Department of Soldiers’ Civil Re-
Establishment, which is an organization of the Canadian Government,
similar to the U. S. Veterans’ Bureau. The personnel of the Department
of Soldiers’ Civil Re-Establishment is something over 6,000, divided
into 10 medical units, or districts. The Foreign Relations Section,
Medical Division, of the Bureau is constantly in receipt of requests for
service from allied ex-service men with whose government this Bureau
has no reciprocal agreement. These cases are promptly referred to the
representative of that government located in Washington with a view of
giving service if the Government under whose flag the man served will
authorize the service.
REPORTS TO BE MADE UPON CANADIAN
FORMS 346,399 and 76.:
Your attention is particularly called to the necessity of forwarding
to the Bureau reports required by the Canadian Government regarding
the hospitalization of Canadian ex-service men; and I desire to stress
this point, that, when a medical examination is made of a Canadian ex-
service man, the report of your findings should be furnished on S. C.R.
Form 346 (S.C.R. meaning Soldiers’ Civil Re-Establishment), this Form
being similar in requirements to the Bureau Medical Division Form
2545. It is upon the findings in this report mode upon S.C.R. 346 that
the Canadian Government gives its approval for hospitalization. S.C.R.
Form 399 is a Progress Report, and should be rendered monthly during
the man’s stay in hospital, for the reason that until this report is
received no pension will be paid to the man or to his dependents. When
a Canadian beneficiary is hospitalized his compensation is reduced, but
the family allowance, should he have dependents, is increased. $40 is
the maximum pension payable to a man while in hospital, $10 of which
is paid to him and $30 held in reserve, which is accumulative, and is
given to him upon discharge from hospital. The family allowance is
increased according to the number of his dependents, and is paid to his
family direct. S.C.R. Form. 76 is a discharge report from hospital and
should be rendered promptly in triplicate, as all these reports should be.
If you are not in possession of these Canadian Forms, 346, 399 and 76,
they may be obtained from the District Manager in whose district you
are located.
EX-MEMBERS OF THE MILITARY AND NAVAL
FORCES OF THE UNITED KINGDOM:
At this time the Veterans’ Bureau has completed agreements
whereby service is being given to British ex-service men, which includes
ex-members of the military and naval forces of the United Kingdom of
Great Britain and Ireland, New Zealand and South Africa, as well as
those of Canada.
RUSSIAN ALLIED EX-SERVICE MEN:
In addition to the above named may be included the Russian allied
ex-service men, an agreement having been entered into with the
Russian Ambassador now located in Washington, whose official status
has not changed since his appointment as a representative of the late
Czar. When medical, surgical, or hospital treatment is requested for a
Russian ex-service man, it must be approved in advance by the Russian
Ambassador, who certifies that any expense incident to this service will
be reimbursed by the Russian Ambassador.
CZECHOSLOVAKIAN EX-SERVICE MEN:
Through an agreement with the Czechoslovakian Minister, this
service is also furnished to the Czechoslovakian allied ex-service men
upon request from the Minister of that country, accompanied by a
statement that any expense incident to service will be reimbursed by his
Government.
RECIPROCAL AGREEMENT WITH THE
BRITISH GOVERNMENT:
An agreement is pending at this time with the British Government
to provide service for all U.S. ex-service men who may be permanently
or temporarily domiciled in the United Kingdom.
CO-OPERATION OF THE STATE DEPARTMENT
IN GIVING SERVICE TO U.S. EX-SERVICE MEN
IN FOREIGN COUNTRIES.:
All medical, surgical, or hospital service that may be required for
U.S. ex-service men now in foreign countries is provided for by this
Bureau through co-operation with representatives abroad of the
Department of State, this Bureau authorizing such service upon receipt
of information that the man is in need of such service, and upon the
establishment of his identity and the fact that the disability for which
treatment is requested was due to or aggravated by his U.S. military
service. Any expense incident to this service is provided for by this
Bureau and is paid for through the State Department by transfer of
appropriation. This procedure has been found very satisfactory, for the
reason that it expedites the service to the man and simplifies the
accounting problem by the prompt payment of any expense that may
have been incurred.
MEDICAL EXAMINATIONS IN FOREIGN
COUNTRIES MADE BY PHYSICIANS
DESIGNATED BY U.S. CONSUL:
For the past six months a ruling has been in effect that where a
Bureau beneficiary in a foreign country was ordered for examination, he
must appear before a physician designated by the U.S. Consul only, and
that unless a report was received within three months from the date of
the letter directing him to appear, or to furnish satisfactory evidence to
the Bureau as to the cause of his inability to report, his compensation, if
he received such, would be held in suspense pending the report of his
medical examination. The result of this procedure in securing an
examination by competent physicians has been that more satisfactory
reports are received.
CHECKS SENT TO BENEFICIARIES IN
FOREIGN COUNTRIES:
The records of the Bureau for the month of December show that at
this time there were 5,977 beneficiaries of the Bureau to whom checks
were sent, totalling in value $489,714. These beneficiaries are resident
in foreign countries located in all parts of the earth, as is shown by the
tabulated statement submitted.
SOME CASES OF INTEREST:
In order that you may have a slight conception of the far-reaching
effect of the strong arm of this Government in giving aid to its ex-service
men wherever located, which means that they are scattered all over the
earth, I believe that it will serve my purpose if I cite a few cases that may
prove of interest to you. I shall with-hold the names of these men and
refer to them by numbers only.

CASE NO. 1:

In this case a member of Congress came to the Veterans’ Bureau

and stated that he had been excursioned around from department to
department in his effort to obtain assistance in coming to the rescue of a
boy who had been discharged from the U.S. military service against
medical advice, suffering from melancholia, and who was sent to his
home at the earnest request of his parents, as it was believed that his
return to normalcy would be more quickly effected in the environment
of his home and under parental care, than in a hospital. The
Congressman went on to relate that after remaining home for about four
months, the boy was one day reported missing. Diligent inquiry and
searching parties failed to locate him, and a river nearby suggested the
possibility of an accident or suicide. We will drop the curtain on this
distressing situation, for we know by the law of the universal heart of
the suffering that must have followed in that afflicted home.

LOCATED IN SYDNEY, AUSTRALIA:

After a lapse of fourteen months a letter was received from Sydney,

Australia, addressed to a small town in a Southern State, signed by the
Christian name of the writer, Henry, we will call him. The letter was a
rambling, disconnected communication, addressed to no one, not even
to the Postmaster, but simply to the town. The Postmaster, being the
self-appointed recipient of the Communication, incidentally mentioned
it to the father of the missing boy. The father did not associate the letter
in any way with his lost son, but that evening upon returning home, he
told his wife of the letter which the Postmaster had mentioned. I can
almost see in your faces now that you have read the sequel to my story,
that the mother’s love quickly put the question: “Did you see that
letter?” and when the father said, “No”, the mother insisted that the
letter must be from her lost boy. A visit to the Postmaster was made
immediately, the letter was produced and identified by the mother as
having been written by her boy. The letter was then two months old. The
Congressman had come to see what could be done as to locating the boy
in far away Australia.
Although the distance between the yearning mother and her lost
boy was over 12,000 miles, I do not think I am exaggerating when I
state that within thirty minutes after learning the facts a cablegram was
under the water, requesting that the Consul General at Sydney cause a
thorough search to be made in the hospitals and other institutions in the
city with a view of finding the boy whose personal description was
furnished, and to hospitalize if necessary and cable results. Within two
days a reply was received, stating that the boy had been found and
placed in a hospital. He has subsequently been returned to the United
States, where he is now being cared for as a beneficiary of this Bureau,
and I am glad to say that he is progressing satisfactorily. Is it strange
that the Congressman and the Bureau should have the gratitude of these
parents?

CASE NO. 2.:

A medical officer of the U.S. Army while traveling in Northern

Africa stopped over night at a hotel in Algiers and there learned of the
presence and illness of a U.S. Ex-service man. This young officer was out
of funds and in need of hospitalization. The attention of the Surgeon
General of the Army was called to the case, who in turn advised the
Veterans’ Bureau of the man’s distress. The State Department was called
by telephone and requested to cable the U.S. Consul at Algiers, directing
him to give immediate service to this American boy and report action
taken, with the result that the boy was promptly cared for and sent by
first available transportation to Marseilles, France, where he was
hospitalized.

CASE NO. 3.:

 This case is that of a navy man whose disappearance was a mystery
to his family. The first information as to his location was obtained
through the U.S. Veterans’ Bureau, Medical Division, as the result of a
telegram received from the Director Medical Services, Department of
Soldiers’ Civil Re-Establishment, Ottawa, Canada, which stated that a
man had been arrested there as a vagrant; that he was apparently a
mental case, and had been in the U.S. Navy. His name was furnished
and his identity established through the Bureau of Medicine and
Surgery of the Navy. He was promptly hospitalized by the Bureau
through the co-operation of the Canadian officials and returned to this
country with an attendant, where he is under treatment at St.
Elizabeth’s Hospital.
 PURPOSE OF THE BUREAU’S ENDEAVORS:
I might go on to cite many such cases, but my time allotted is
insufficient. My purpose is simply to inform you that it is the wish of the
Director and his associates in the Veterans’ Bureau that it and its co-
operating agencies may give to each case a human touch, reflecting
personal interest and I can think of no better maxim for our guidance
than the title of Charles Reade’s book, “Put Yourself In His Place,”—and
give service as you would have it given unto you.”

R. BURKE: stated that in the absence of Major Fraser his subject would be
taken up by Mr. Milliken.

R. J. B. MILLIKEN, of the U. S. Veterans’ Bureau, discussed the subject

“Relation of U. S. Veterans’ Bureau to other existing bureaus in caring
for its beneficiaries”, as follows:
“Ladies, Mr. Chairman, and Gentlemen: The subject of my twenty
minutes talk to you might more appropriately be termed the relation of
the U. S. Veterans’ Bureau to all the Executive Departments of the
Government, for indeed, there is not a Department of this government
with which the U. S. Veterans’ Bureau does not have a vital and
immediate contact.
Probably there are three Executive Departments of the Government
with which the Bureau has more contact than with the other Executive
Departments—that of the Treasury Department, the War Department,
and the Navy Department. Inasmuch as the U. S. Public Health Service
is a part of the Treasury Department our contact with this Department
of the government is immediate and vital, and is of more immediate
importance than our contact with the other Executive Departments.
As is appreciated, no hospitals are operated directly by the U. S.
Veterans’ Bureau, and all hospitals with the exception of contract
hospitals are operated by the other independent establishments of the
government, the Public Health Service of course having the lion’s share
in providing facilities, and prior to the Act of August 9, 1921 creating the
U. S. Veterans’ Bureau, the U. S. Public Health Service had charge of the
various fourteen district offices where was stationed at each district
office a Supervisor.
The Secretary of the Treasury’s order of April 19, 1921 transferred
the functions of the District Supervisor’s Office to the then Bureau of
War Risk Insurance, and the Act of August 9, 1921 transferred by law
the activities of these offices to the U. S. Veterans’ Bureau, but left
unhampered the jurisdiction and authority of the U. S. Public Health
Service concerning matters of hospitalization.
Without the work of the facilities afforded by the U. S. Public
Health Service it would indeed be impossible for the U. S. Veterans’
Bureau to function and discharge its obligations relative to the
hospitalization, medical care, and treatment of disabled ex-service men
and women. Co-ordination of their work has led to the fullest
cooperation on the part of every agency, to the end that the disabled ex-
service man is receiving the best treatment which a grateful government
can provide. You have, of course, before you all the data and
information relative to the extent of the work carried on by the U. S.
Public Health Service as it relates to the beneficiaries of the U. S.
Veterans’ Bureau.
The relation of this Bureau to the War and Navy Departments is
fundamental, for the reason that before any person can be accorded the
benefits provided for under the act creating the U. S. Veterans’ Bureau,
a record must be obtained from the War or Navy Department showing
the military or naval record of the person seeking benefits either for
compensation, insurance, vocational training, or medical care and
treatment. Something over 900,000 requests have been made to date
on the War and Navy Departments requesting a transcript of the
military or naval record of the person while in the active service and
there has been no diminution in the number of reports requested daily,
in that our average number of requests each day is about 1,000. The
matter of furnishing adequately the transcript of record of an ex-service
man or woman, showing whether or not they received any medical
treatment while in the active service is indeed a most difficult problem.
It must be remembered cases are now arising where a given individual
has been discharged from the military or naval service for a period of
approximately three years, and that in all probability they did not
receive medical care or treatment while in the service, but their health
has become impaired subsequent to their discharge from the service.
Quite true they might have had some slight attack of influenza while in
the service or some other disability, but did not report for medical care
and treatment.
The most of these individuals believe that the War or the Navy
Department should have had a record of such indisposition on their
part, and that, in turn, it is up to the U. S. Veterans’ Bureau to secure
such a record upon which to predicate the service origin of a given
disability. Certainly not in the history of this government has the
military and naval establishments been called upon to complete and
compile the records of statistics and facts comparable to that resulting
from the late war, and while there have been many mistakes made both
on the part of the U. S. Veterans’ Bureau in requesting the information
and on the part of the War and Navy Departments in submitting
information, the great bulk of work has been performed in a most
satisfactory manner, and great benefits have been accorded to those
applying for the same under the beneficent laws passed by our
Congress.
On January 1st, 1922 there had been filed with the U. S. Veterans’
Bureau 81400 claims for compensation. In each and every claim filed it
was necessary to request the War or Navy Department for the military
or naval record of the person applying for compensation benefits, and in
many instances it was necessary to make duplicate requests because of
inadequate identification given or of additional evidence which the
claimant submitted which would make it possible for the War or Navy
Department to make a more exhaustive search of their records. To show
the promptness with which reports have been received from the War
and Navy Departments for no claim is either allowed or disallowed
without a report from the War or Navy Department—out of the 814,000
claims filed, 51% have been allowed, 41% have been disallowed, and 8%
are pending awaiting information either from the War or Navy
Departments or from the claimant himself.
Also to December 15th, 1921, 486,884 former service men had
requested vocational training. It was necessary for the Rehabilitation
Division of the Federal Board for Vocational Education, (now a part of
the U. S. Veterans’ Bureau), to request the military or naval record from
the War or Navy Department, and out of that number 299,000 had been
declared eligible for training; 135,000 had been declared ineligible for
training; and 51,000 cases were pending to determine their rights to
vocational training. These figures also represent a tremendous work
required of the War and Navy Departments in that the records of each
man must be obtained before final disposition was made of the case.
 When viewed from the stupendous task, the results accomplished
are indeed commendable.
The great assistance of the War and Navy Departments should also
not be overlooked when it is remembered that at the date of the signing
of the Armistice there were approximately $40,000,000,000 worth of
insurance in force which had been written through the service of the
War and Navy Departments in providing insurance officers to make
contact with every man who was a member of the military or naval
forces.
The War and navy Departments have always been of tremendous
assistance in the matter of hospitalization of ex-service men and
women. On December 1st, there were 1,410 beds occupied in Army
Hospitals, and 2,032 beds occupied in Naval Hospitals. Certainly then
from this resumé of facts the contact with the War and Navy
Departments is most vital.
The contact of the U. S. Veterans’ Bureau with the Post Office
Department is apparent. It need only be mentioned that to date the U.S.
Veterans’ Bureau, representing the consolidated agencies since their
organization have received approximately 90,000,000 incoming pieces
of mail, and have dispatched approximately 105,000,000 pieces of mail,
and the daily average receipt of incoming mail in the Bureau, even
under decentralization, is approximately 41,000 pieces of mail per day
and the outgoing pieces of mail from the Central Office of the Veterans’
Bureau is approximately 58,000 pieces of mail per day.
The Veterans’ Bureau as you have been informed relative to the
care of ex-service men of foreign allied countries and of American
soldiers residing in allied countries has a vital contact with the State
Department in addressing their communications to the various foreign
countries and in the utilization of the various U. S. Consuls.
The Department of Justice has charge of all suits filed against the
U. S. Veterans’ Bureau where suit is brought on an insurance contract.
The department of Justice also handles all prosecutions where
irregularities are found under the act creating the U. S. Veterans’
Bureau.
Under the Interior Department you know of the use made of the St.
Elizabeth’s Hospital and of hospitals under the jurisdiction of the
Commissioners of Indian Affairs.
The contact is also quite vital with the Department of the Interior in
obtaining various information from the Pension Bureau as a person may
be filing an application for compensation and also an application for a
pension.
The Department of Agriculture has been of very great assistance to
the Bureau in rendering advice relative to the training of disabled ex-
service men with a vocational handicap who desire to take up
agricultural pursuits, and at the present time the Department of
Agriculture is rendering most valuable service in mapping out
agricultural courses for the first Vocational School of the Government
located at Chillicothe, Ohio.
Many disabled ex-service men taking vocational training have been
assisted by the Department of Commerce in mapping out their careers
for work incident to that of the Department of Commerce.
The Department of Labor has been of very great assistance in aiding
the Bureau to find employment objectives for disabled ex-service men
undergoing training or who have been rehabilitated by the U. S.
Veterans’ Bureau.
This will give you a general view of the relation of the U. S.
Veterans’ Bureau to the Executive Departments of the government. The
U. S. Veterans’ Bureau naturally must have a close contact with the
Congress. Congress continually calls upon the Bureau for data and
information which can only be obtained from the other Executive
Departments of the government but which immediately relate to the
work of the U. S. Veterans’ Bureau.
Inasmuch as you Gentlemen are essentially interested in hospital
administration, I should like to speak briefly on the question of hospital
records, and what data the Bureau is required to have when it is called
before Congress relative to Appropriations. As you know, Congress
makes one appropriation to the U. S. Veterans’ Bureau for Medical and
Hospitals Services. Sums from this appropriation are in turn allotted to
the U.S. Public Health Service, the War and the Navy Departments, the
Interior Department, and the National Homes for Disabled Volunteer’
Soldiers. When the U. S. Veterans’ Bureau is called before Congress for
every appropriation it must show specifically how the money has been
allotted, for what purposes it has been allotted, and the result
accomplished.
It has become imperative for the U. S. Veterans’ Bureau to have
available comprehensive records concerning all hospitals in which there
are being treated its beneficiaries. It is not sufficient that these records
be only those concerning the admission and discharge of patients and
the physical examination report in each instance, but equally
fundamental data concerning the results of treatment, periodical turn-
over of patients, the hospitals’ administration, and of equal importance,
but from a different angle, the cost of operation with the resulting per
diem cost per patient.
A considerable part of the records on patients, their flow in and out
of hospitals and similar data are available or can be made available, the
value of these data so derived, of course, will be proportionate to the
accuracy or thoroughness with which the records of admission and
discharge are prepared and transmitted. The report of admission and
discharge of patients and the report of physical examination are at
present the only reports common to all Government Hospitals. The
necessity for the prompt rendering of accurate admission and discharge
reports and physical examination reports in all instances is apparent.
Such reports are of very great importance to the U. S. Veterans’ Bureau,
for upon them is determined the medical rating of the hospitalized
beneficiaries and any delay or omission in the rendering of records of
this character reflects upon the administration of the U. S. Veterans’
Bureau.
In regard to the individual hospital operation costs, until very
recently the U. S. Veterans’ Bureau has been operating in the dark on
unit costs. It is demanded that the U. S. Veterans’ Bureau have complete
knowledge of the cost of operating all government hospitals, not merely
as a gross item, but classified by purpose of expenditure and by
department of hospital for which spent. The reason for this point is
made two-fold—First, that the Bureau before it can allot money to the
several services for hospital expense, must be in a position to know for
what purpose the money should be disbursed; and second, because the
Congress of the United States is holding the Bureau accountable for all
moneys appropriated to it and unless this Bureau can tell Congress in
detail this money has been spent, or is to be disbursed, our
hospitalization program will be jeopardized until such information can
be secured.
The per diem rates for hospitals of the several services vary
materially so far as our estimates are concerned. The degree to which
such a variation in rates is only an apparent variation due to the
different bases upon which they are calculated is not at present
ascertainable, but it should be. Not only should this Bureau know what
it costs for its own patients at any one institution, but it should know the
per diem cost over a given period for all the patients hospitalized there.
The cost to this Bureau affects not only our appropriation; the cost to
the service operating the hospital, including this Bureau’s share, but it
affects the U. S. Treasury. If the cost of maintenance of certain hospitals
is excessive, it would be poor business not to evacuate that hospital, if
other conditions made it practicable, or if impracticable to attempt to
reduce its operating cost.
Recently the U. S. Public Health Service inaugurated a system of
cost accounting by individual hospitals. With the perfection of this
procedure the U. S. Veterans’ Bureau will be in a position to talk
intelligently about operating costs with these hospitals whether by
departments of hospitals, purposes of disbursement, such as salaries,
repairs, etc., or by unit costs.
The U. S. Veterans’ Bureau looks forward to the time when similar
data are available and regularly submitted by the War Department, the
Navy Department and the National Homes for Volunteer Disabled
Soldiers, not merely as reimbursements due certain appropriations, but
by actual disbursements of detailed purpose of not only for this Bureau’s
share, but for total operations.
The U. S. Veterans’ Bureau also maintains contact with the various
miscellaneous Departments and institutions of the government. Time
will not permit of going into any details or of mentioning these contacts.
The U. S. Veterans’ Bureau when viewed from its huge task of
running an insurance company with over three and one-half billions of
insurance in force, of making payments on 149,000 insurance claims
each month, making payment on 204,000 compensation claims each
month, with approximately 29,000 ex-service men and women
undergoing hospitalization, and having caused to be made over
1,000,000 medical examinations and responsible for 104,000 disabled
ex-service men undergoing vocational training, representing a task
which calls for the closest cooperation and assistance from every
department of the government and only by having the closest
cooperation possible will the government, through the U. S. Veterans’
Bureau, be able to discharge its obligations to the host of disabled ex-
service men and women of this country.
The Bureau has always enjoyed the fullest cooperation from the
various departments of the government and knows that the same
cooperation will be extended with unstinted measure in the future, to
the end that every pledge will be redeemed concerning the care and
treatment of the defenders of this Republic, and to the end that this
administration will go down in history as an administration that did not
forget its sick and wounded soldiers, and brought peace and
contentment to every fireside where assistance on the part of the
government was requested and was due.”

LONEL JAMES A. MATTISON, N. H. D. V. S, gave the following

discussion of “Economy of Administration in U. S. Veterans’ Hospitals”:
“The subject is so broad that we can only consider certain phases of
it within the time allotted for this paper. We all recognize that there are
certain fundamental essentials which must of necessity be provided in
every hospital regardless of the number of patients cared for. This
necessarily means that overhead expenses of an institution hospitalizing
small numbers of patients will be out of proportion to those of a hospital
caring for a large number.
The general business management, the purchasing of supplies and
equipment, the conservation and dispensing of the same, the
elimination of waste, etc,. will be considered only casually for the
purpose of emphasizing the importance of adhering as closely to strict
business methods as is done in the case of every successful business
man, whether he be a hospital executive, a merchant, or a man in any
other line of business.
In this connection, it might be said that a mistake which is made in
many government institutions, and one which is not made by the most
successful business men, is to attempt to start on economy at a place
where one can least afford to economize, that is in the pay and
allowances of the personnel immediately responsible for the
management of the institution, the responsible heads of departments,
etc. In other words, we are not always willing to pay for brains, a price
commensurate with the business responsibility involved. Again when we
have been fortunate enough to secure the right man the right place, we
do not always recognize his value by paying him a price commensurate
with the value of his work. Furthermore, when we have made the
mistake of getting the wrong man, who in reality is receiving a greater
compensation than his services are worth, and one who, in reality, is a
very expensive employee, we oftentimes make the mistake of not
recognizing inefficiency and promptly correcting it,
In case there is any decided handicap along the lines of inefficiency
in the responsible personnel in the administrative, utility, service or
professional departments, it should be promptly corrected, as it is to
those in such petitions to whom we constantly look to be on the alert in
recognizing the short comings of all subordinate personnel.
In visiting our own or other hospitals we promptly recognize the
presence or absence of evidence of the proper vigilance or efficiency in
every department. In case of a tour of inspection of one of these
institutions there should be found spurting steam valves, leaking water
faucets, extravagant use of electric lights, overheated buildings, garbage
and swill tanks running over with waste food supplies, evidence of lack
of organization and co-operation on the part of the personnel,
professional or otherwise, we should immediately recognize the fact that
there was inefficiency existing in the personnel of such an institution,
and as a result of this, a decided lack of economical and efficient
administration. Finding such conditions in other departments, we
should expect to find unsatisfactory conditions when the patient
population was reached. We should expect to find histories poorly
written or not written at all, patients waiting over-time for special
examinations or special treatments, lack of accurate laboratory and X-
ray records, etc. The matter of such inefficiency and consequent poor
administration on the part of the personnel in any institution would
naturally lead to great dissatisfaction on the part of the patients of such
an institution and to the greatest lack of economy on the part of the
administration, of the hospital.
In connection with the professional department proper, again the
attainment of the most satisfactory results from the standpoint, both of
economy and efficiency, is dependent upon the capacity and co-
operation of the responsible personnel. There has been much discussion
in regard to the number of professional personnel doctors, nurses,
attendants, etc., and on this subject there has been apparently wide
differences of opinion. However, these differences have been based
upon differences of viewpoints of what the actual conditions to be met
were.
A definite agreement has been reached in regard to the required
personnel, nurses, doctors, attendants, social service, workers, etc., to
each two hundred patients in a hospital caring for all acute patients,
whether they be major surgical, acute active neuro-psychiatric, active
tuberculosis, or other type of acute condition requiring active,
constructive treatment.
As a matter of fact, however, we all know that in none of our
Veterans’ Hospitals, especially the larger ones of 500 to 1000 or more
beds, are all the patients or even a majority of them represented by this
type of patients, on the contrary we have a large group of convalescent
patients who require professionally very much less attention from the
standpoint of active constructive treatment, dietetic attention, etc., and
hence require vastly less personnel, and the expense of their
maintenance in the hospital will be very greatly reduced from that of the
acute type. Again, we have another group which represents the semi-
domiciliary type, many of whom require very slight constructive
treatment, and yet they belong to a type of patients who are capable of
being finally rehabilitated and restored to an earning status in life. This
group requires still less care than the former, and naturally less
personnel and proportionately less per capita cost to the institution
caring for them. Lastly, we pass to a purely domiciliary group who are to
a large measure permanently disabled and are, therefore, many of them,
to be permanent charges oh the Veterans’ Hospitals. The great majority
of the latter group will require little or no special treatment, but will
require only general care and maintenance. In this group we are dealing
with a type who will represent the minimum per capita cost.
As time goes on we shall realize, especially in our larger hospitals,
that the above condition will exist to a larger and larger measure and the
necessity of a very close checking system and a very careful classification
of the patients along the lines indicated above will be a matter of the
very highest importance.
This does not mean that as long as special treatment along any line
is needed that each patient will not have such expert examinations, care
and treatment as his condition calls for. Quite the contrary, the most
careful and competent examinations should be directed by hospital
units composed of the most competent staff of men including surgical;
medical; ear, nose and throat; X-ray., etc., at such intervals as the
condition of the patient calls for. It will be by this system alone that we
are to keep a check on the progress toward recovery of each individual
patient and prevent an undue accumulation of a domiciliary group. By
proper cooperation of such a group with the rehabilitation section,
many men may be selected as suitable persons for rehabilitation in the
vocational schools. The importance of this we all realize as there is a
certain percentage of patients who will be quite content with their state
as long as they are receiving complete maintenance and a liberal
compensation of from $80 to $150 per month and no cares and no
responsibilities to assume in life. That is we should be constantly on the
alert to prevent making permanent residents or charges of any man who
can be restored to an earning status in life.
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