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Mr. Rich. You cannot put those patients into a general hospital, can you?

Dr. Hall. Oh, no. They are transferred to Veterans' Administration hospitals.

Mr. Rich. I know that, but I am speaking of the syphilis cases. Do they have a hospital that deals exclusively with diseases of this kind?

Dr. Hall. No.
Mr. Rich. You have them segregated in your hospital, do you not!
Dr. Hall. No.
Mr. Rich. You do not?

Dr. Hall. No. These cases are noninfectious. I mean, this is a late stage of the disease, when there is never any question of infection to others. It is only in the earlier stages of the disease that it is infectious.


Mr. LAMBERTSON. These are not all of the Indians that the Government is supporting in institutions of this kind, are they? There are in other places that you know of?

Mr. SANGER. There are the Alaskan Indians, who are cared for in a private institution in Oregon. But these are all of the regularly accepted Indians that are wards of the C'nited States and are in mriental institutions.


Mr. LAMBERTSON. I see that your estimate this year is a little less than it was last year.

Mr. Sanger. That is due to the following: On account of the overcrowded conditions, great efforts were made to discharge all patients that could be trusted to be cared for in their own homes or where there was a good possibility of early recovery. Every effort was made during the year to get out the patients. The estimate was based on Ĩ

The 1,750 is going to be too low, however, because at the present time we have 1,785 chargeable to the appropriation for the hospital, and we have had an average since July 1 of $1,741. But that is how the estimate was made.


Mr. LAMBERTSox. In the item of repairs and improvements, what do you have to say about this estimate of $185.000

Mr. SANGER. That is based upon a careful estimate of the condition of the buildings and the necessity for keeping them in repair.

Many of the buildings have been built at various times from 1955 up to the present time. These buildings when originally built had no modern improvements. Electricity was unknown at that time, naturally. The water conditions were entirely different. Fireproofing was lacking.

We have been gradually and continuously remodeling and renovating in order to continue the use of a good outside structure and try to bring it as near as possible up to the modern-day practice in order to avoid new construction.

In addition, in 1918, during the war period, we had an unusually large number of patients come to the hospital. We secured an appropriation of $200,000 to build some semipermanent buildings, about nine, seven of them containing beds, one a dining room, and one a kitchen, which we estimated would have a life of 50 years.

Much of the lumber that was used in those buildings was green, and it has warped; and those buildings have almost outlived their usefulness.

Mr. LAMBERTSON. They are on the east side, are they not?

Mr. SANGER. Yes. They should be replaced. The cost of repairing those buildings we have figured to be 5 percent of the original cost each year.

I have here a statement of what enters into that repair item, which I will present. This shows how the item of $185,000 in the 1938 appropriation is divided up.

We have estimated for 1938 that for general repairs to the S. P. B. group of buildings we can go ahead with $10,000. That is the one that I just spoke of.

New floors in the Howard Hall group, which is the colored and criminal section, and the original central group of buildings, $12,000.

Replacing glass and putting in additional glass will cost us $8,000 a year.

Replacing wooden doors to basements with fireproof doors opening on stairways, $4,500.

Fireproofing elevator shafts and replacing elevator doors $5,500. Repairing and renewing roofs, $6,000.

Renewing wooden stairways in the hall of the center building, from the first to the fourth floors, and installing enclosed fireproof stairway, $18,000.

That is the original building. It has narrow stairways about 5 feet wide. In this building is the present chapel, where all the patients go. The fire department and the Federal Fire Council both have strongly recommended the replacement of these stairways.

New roads and replacing and repairing old walks and roads, $20,000. Mr. Rich. Is that what you spent last year?

Mr. SANGER. We spent $16,000 last year, but we had some money the year before from Public Works funds.

Mr. Rich. Then you spent for doing the work around the property only $20,000?

Mr. Sanger. $20,000.

We have 11 miles of walks and roads in the grounds. Many of the roads were constructed before we had automobiles, and they are so narrow that if an automobile is parked on one side, a machine has difficulty in passing.

Mr. ŘICH. Do they have a substantial road base good enough to handle traffic outside of the fact that they are narrow?

Vír. SANGER. Not heavy traffic. We have had several occasions where heavy trucks have broken through when bringing supplies to the hospital. Evidently they didn't foresee the heavy class of traffic that we are having on those roads today.

Steamfitting and plumbing repairs, remodeling heating, additional radiators and piping, $63,000..

Painting and plastering old buildings, $17,000.
Repairs to shop buildings, laundry, and storerooms, $8,000.

Repairs to 10 kitchens, including floors, walls, and ceilings, and su forth, $5,000.

Repairs and extension of sewers, $8,000.
Total, $185,000.

We have an investment there of $15,000,000. I think a fair percentage based on depreciation and repairs is 2 percent, which would be $300,000. Each year we have been trying to save at least 1 percent and bring it down to just $185,000.

Mr. LAMBERTSON. This new tank would be an improvement. Where is this well? Is that right close to the tank?

Mr. SANGER. This well is right adjacent to the pumping house and the railroad tracks. That was constructed out of money allocated by the Public Works.

Mr. LAMBERTON. I see that under your personnel you are asking for 53 new ones. You had 144 last year.


Mr. LAMBERTSON. What about this request for finishing the female receiving wards?

Mr. SANGER. That is for furnishing our female receiving building. We had an additional appropriation for that purpose, but the building was not completed until at the end of the fiscal year. So, instead of employing the additional personnel for that purpose, we turned the money back. We turned that back, because you had given that money for a specific purpose and we had no right to keep it if we could not use it for the purpose that we requested it for.

Mr. LAMBERTSON. This new building was authorized last year, was it?

Mr. SANGER. No. A similar type building was authorized and one of the same type this year.

Mr. LAMBERTSON. Oh, yes. One was built?

Mr. SANGER. As to the one that was authorized last year, when we opened the bids for that, we found that the lowest bid was $15,000 more than the amount that was appropriated. So we now have an item before the Budget of $40,000 additional in order to complete that building and equip it. So, if consideration is given to this item. we would suggest that it be kept in mind, because the cost is going to be increased by that amount.


Mr. LAMBERTSON. On page 530 of the committee bill, what is that language that is inserted at the top of the page there? What are you contemplating there?

Mr. SANGER. You understand that there is no additional appropri. ation required by that language.

Mr. LAMBERTSON. What is the need of that additional new language?

Dr. Hall. You probably know that hospitals that have a research department are generally more progressive. It is not only a matter of adding new information, new facts, but it reflects on the staff. keeps the staff alert and on their toes and looking for new findings with their patients.

In the past I understand that we have been rather handicapped because the funds from other organizations—I don't think it is necessary to mention their names—which allot a certain amount of money to progressive institutions for research purposes have not been available to St. Elizabeths Hospital. We have been rather handicapped, I understand, by not being able to participate in such possible donations in cooperation with these outside funds.

Mr. Rich. May I ask a question on that?

Mr. Rich. Before we get away from this scientific research, let me ask you this: Is it your idea to establish a new department in the hospital service over there?

Dr. Hall. No. Not at all. Most of the research, I suppose, that we have in mind in this case would be in the laboratory. We have a very well-built and fairly well equipped laboratory. It would not mean the establishment of a new department.

Mr. Rich. Because of that wording there do you expect to develop it to the extent that you are going to require any additional help to do the work?

Dr. Hall. Yes; but not payable out of Federal funds
Mr. Rich. How many?

Dr. HALL. We cannot say that now. Two or three or half a dozen. It would depend on the problems to be done and the funds allocated.

Mr. Rich. Isn't it a fact that these foundations that have been established by Rockefeller and men of that kind have sections of their investigations that are devoted to this particular branch of the medical science?

Dr. Hall. Not the Rockefeller Foundation, as far as I know.

Mr. Rich. Are there any foundations that have already been established for this purpose?

Dr. Hall. Not exclusively.

Mr. Rich. Are there any, then, that do work that would naturally be applicable to insane institutions?

Dr. Hall. Oh, yes.
Mr. Rich. And for the work that they do they publish bulletins?
Dr. Hall. Yes.
Mr. Rich. And those bulletins would be accessible to you?
Dr. Hall. Yes. Quite.

Mr. Rich. Therefore, would it not be the wise thing to do to develop those other institutions and make them almost perfect institutions for that purpose? Would not that then benefit you in the same manner if it were conducted even in some other place than it would in your own institution?

Dr. Hall. I don't think so.
Mr. Rich. Why not?

Dr. Hall. As you probably know, there is a very free interchange of ideas and experiences among scientific people and among hospitals. We have medical journals and that sort of thing. One is benefited by the experiences of others. But to substitute that for one's own experience

Mr. Rich. Your doctors keep changing all the time on your staff, don't they?

Dr. Hall. Yes, sir.

Mr. Rich. In other words, you have a man today and in 10 years from now some of your present doctors will have gone and other new ones will have come?

Dr. HALL. Yes.

Mr. Rich. And they in turn have gone to college and medical schools and have obtained the benefits of these new discoveries in medicine?

Dr. Hall. Yes.
Mr. Rich. With insane patients?
Dr. Hall. Yes.

Vr. Rich. What I am trying to do here is not in any way to permit this hospital over there to expand and enlarge their scope and field of work as you have it now into some other branch that will be an advantage from a medical standpoint and give you that knowledge where you can get that information from these other institutions. I don't think you should go ahead and spend additional money to duplicate the work that they are doing.

Dr. Hall. I quite understand that.

Mr. Rich. If you have this new wording in here, is it going to require any more funds this year than it did last year?

Dr. HALL. No.
Mr. Rich. Have you asked for any more?
Mr. LAMBERTSOV. Vo. They have not.

Mr. O'NEAL. It says. including cooperation with organizations or individuals in scientific research.

That does not mean the creation of a new department in the hospital, dues it?

Dr. HALL. No.

Mr. O'NEAL. It merely means that if they furnish some money for specified work, you are going to carry on that special work?

Dr. HALL. Yes.

Mr. SANGER. There is a certain class of scientific students which we could not hire at a stated salary to come and take positions with us. But on account of the clinical material which we have that they can take advantage of they are willing to come and cooperate with us for that purpose.

St. Elizabeths Hospital, on account of the wealth of clinical material which it can give, offers an opportunity to students which perhaps they could get in very few other places. That sets up a picture through which the hospital can attract a class of internes and other doctors that will help in the treatment of our patients.

Dr. HALL. I don't know how familiar you are with our problems in mental disorders. But aside from the cases that are due to syphilis and due to arteriosclerosis and due to senile conditions, we know very little about the cause of mental disorders as they occur in a hospital like St. Elizabeths, or any other mental hospital such as the Harris. burg State Hospital, Sorristown, or any other State hospital. As to the majority of cases in our hospital, we know a great deal about the manifestations, naturally, because we can see them; but as far as the cause of the mental disorder is concerned, we, franhly, know very little. And it is in connection with this that it is very important to encourage research in a mental hospital.

You are probably familiar with the malaria treatment of general paralysis

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