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FOREIGN PATIENTS.

The CHAIRMAN. I understood you to say that a good many of these patients are foreigners. Are there any of those cases that . are deportable ?

Dr. Busby, Numbers of cases have come into this country, and, in fact, we receive applications probably once a week in regard to deportable cases, or cases that can be deported under the existing laws. In those cases action is taken to send them out of the country.

The CHAIRMAN. What is done with them?

Dr. Busby. They are sent back to their original haunts, I imagine.

The CHAIRMAN. Is any investigation being made by the Public · Health Service to ascertain whether or not any of those cases of foreigners are such as would make them come within the deportation laws?

Dr. LAVINDER. Yes, sir. Under the quarantine laws, of course, any leper that is picked up on any vessel is always returned. Those cases that get into the country in spite of the immigration inspection service, when they turn up within a certain time, are reported to the Government at once and they are deported.

Dr. CREEL. Under the immigration statutes they can be deported within five years if it can be shown that the disease was present on their entry.

The CHAIRMAN. What investigation is being made to ascertain the status of those people?

Dr. CREEL. Whenever cases are reported they are investigated. Just last week a case came up in Detroit of a Mexican who has been in the country about four years. While the symptoms of the disease were obscure and developed slowly, it was ascertained from his own statement that he had some of the symptoms of leprosy before he left Mexico, but they did not become evident until two years after he came into this country.

DEVELOPMENT OF DISEASE.

The CHAIRMAN. How long does it take the disease to develop, or how soon is it ascertainable?

Dr. LAVINDER. That differs in different cases, and on account of the form of leprosy the person may have. If he has the anesthetic form of leprosy, he may not have any of the visible symptoms of leprosy, except he may experience a loss of sensation or loss of feeling, but if he has the tubercular type, the tubercles will soon appear on his face.

The CHAIRMAN. Is the disease curable ?

Dr. LAVINDER. There is no specific cure for it, but a certain percentage of cases do get well under one form of treatment or another. However, the leprosariums discharge or parole patients right along as cured, and some of them recur.

The CHAIRMAX. When they are discharged, do they go back into the communities from which they came?

Dr. LAVINDER. They keep them under observation. I think they keep them under parole for five years.

The CHAIRMAN. Nobody knows how the disease originated ?
Dr. LAVINDER. No, sir.
The CHAIRMAN. They do not know what is the cause?

Dr. LAVINDER. The cause is a germ, very much like the tuberculosis germ.

Mr. Wood. Is it not pretty generally believed that it is only communicable by actual contact ?

Dr. LAVINDER. It is generally understood that it is only communicable upon close and prolonged contact, but this disease does spread in communities if the cases are not isolated.

Mr. Wood. Is the disease one that is peculiar to any particular climate?

Dr. LAVINDER. No, sir; it is not peculiar to any climate, but certain · races seem to be peculiarly subject to it.

Mr. Wood. That is true of the Asiatic races?

Dr. LAVINDER. Yes, sir; although it is quite common in Norway and Sweden and in certain parts of Russia. However, certain races seem to be more subject to it than others. The native-born American is not prone to contract the disease.

NUMBER OF AMERICAN LEPERS.

The CHAIRMAN. How many cases are there of American citizens now?

Dr. LAVINDER. It has been estimated that in the United States there are about from twelve to fifteen hundred cases. There are supposed to be that many cases in the United States, but whether they are Americans or not, I can not say.

The CHAIRMAX. What is the plan that is to be followed? Is it contemplated that all of those cases in the country shall be taken over by the Government?

Dr. LAVINDER. The law is mandatory in requiring that the Gor. ernment must take any cases presented, and the Government must also transport the cases to the institution. If you could isolate them, or if you could get the cases out of the communities, you would soon clean up the disease, and that would be the end of it. That has been done in some countries where they do not have this disease any more. If we could isolate all of these lepers, we could soon clean up the disease.

The CHAIRMAN. In what countries has that been done?

Dr. LAVINDER. It has been done in England and Australia. If you isolate the disease it will cease, but it is something that requires isolation.

The CHAIRMAN. How long do they live after contracting the disease?

Dr. LAVINDER. Eight or ten years. It is a very slow and chronic process.

The CHAIRMAN. Do they suffer much?

Dr. LAVINDER. No, sir; not a great deal, but the disease is very disfiguring.

Mr. Wood. In some cases the flesh drops from the bones, does it not?

Dr. LAVINDER. Yes, sir; the nose, ears, and fingers drop off, the patients sometimes presenting a horrible sight. However, they are

not so repulsive as you might imagine. As I have said, it is a very slow chronic process. If we had the money, we would like very much to enlarge that plant out there. To be able to take care of all of these people we should expend $500,000 there. With that amount we could put in enough beds to take care of them.

The CHAIRMAN. How long would it take to do that?

Dr. LAVINDER. Not long. It could be done in just a few months if we had the money.

MONEY TO BE USED FOR OPERATING EXPENSES.

The CHAIRMAN. How much of this $200,000 will be used for administration, how much for construction, and how much for the actual care of the patients ?

Dr. LAVINDER. All of it is for operating expenses.

Mr. Chairman, may I show you our cost sheet for that hospital? I want to show you the cost-accounting system that we have installed. We have been criticised a great deal for saying here that we have no figures to submit. This sheet shows our cost-accounting system for hospital service, and accompanying that are complete directions for carrying out the system. You will notice that it is divided into two parts, and this sheet I submit covers Hospital No. 66, which is the leper hospital. The statement of operating expenses is divided into five divisions here, showing salaries, material and supplies, repairs, traveling expenses, and expenses not otherwise classified. There are 14 different items of expenditure indicated here, and there are, as you can see, 70 different ways by which you can analyze the hospital expenditures. You will notice at the bottom the figures representing the number of hospital service days, and it appears that in this hospital we had 3,556 hospitalservice days. The statement also shows the gross cost per patientday, and the net cost per patient-day. That cost for this hospital is very low because of the fact that we have not the money to go on. It appears that our expenditures per patient per day are $3.11. That is the net cost per patient per day in that hospital.

The CHAIRMAN. Does that include everything?

Dr. LAVINDER. That includes everything. Under this system we make a distribution of everything in the way of costs, and we can find out easly what the cost is per day per patient. In this case by dividing the total expenditures by the number of hospital service days, or 3,556, we can get the cost per day per patient. With this information of expenditures we arrive at the gross cost, and when we deduct from that these other expenditures sindicating] it will give the net cost per patient day. Then below that we have a summary of all the transactions to date. We can prepare, if necessary, one of these sheets for every hospital in the service. Sometimes things are a little bit exaggerated, and if we check up our complete expenditures for the last fiscal year, including everything, overhead, equipment, construction, and everything else, and divide it by the number of hospital days, it shows a cost of a little less than $6 per day.

The CHAIRMAN. Does that include construction and everything? Dr. LAVINDER. Yes, sir: that includes every expenditure we made. The CHAIRMAN. What do you charge to the Veterans' Bureau ?

Dr. LAVINDER. I think it is $3 per day.
The CHAIRMAN. I think it is more than that.
Dr. LAVINDER. $3.50 is what we charged them.

The CHAIRMAN. This cost sheet may be inserted in the record at this point.

(The matter referred to is as follows:)

United States Public Health Service Hospital Vo. 66, located at Carrille, La.

Statement shouing analysis of the total operating e.rpenses, also the total capital expenditures, total number of patient-days relief furnished, the gro88 and net cost per patient-day, and the nerage cost per out-patient treatment furnished during the month of Ootober, 1921.

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Total number patient days relief furnished during month..
Gross cost per patient day-----
Net cost per patient day-----
Total number of out patient treatments furnished during month.
Average cost per treatment---

$3.11

None. - None.

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Equipment.

$51, 152.09

..........

$1,292.34 Live stock.....

1,537.99 Stores..........

7, 357.99 Vouchers payable...

$33, 27.68 Purveying service...

5, 177. 28 Transfer vouchers issued. Transfer vouchers received...

16, 643.93 Operating expenses......

10,994.64 Inventory adjustments...

45,671. 43. Contingencies and losses..

72.71 .. Operating income.....

Total................... 104, 393.05, 104,393.05 14, 824.16

143. 39

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16.61

17,787.31 45,6718

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Salaries include congressional bonus in the amount of $360.

Mr. Wood. Why does it cost more to take care of leper cases than tuberculosis cases?

Dr. LAVINDER. Leper patients require exceptional care. The cost shown here is relatively cheap, but, as a matter of fact, that will not take care of them completely, including clothing.

The CHAIRMAN. Do you provide nurses for them?
Dr. LAVINDER. Yes, sir.
The CHAIRMAN. Do they not become affected with leprosy?

Dr. LAVINDER. No, sir. At the present time we have some Sisters of Charity going in there also.

The CHAIRMAN. Do you give them extra compensation? Dr. LAVINDER. The personnel receives full pay plus half pay. They receive one-half more than anybody else gets.

The CHAIRMAN. Is there not danger of infection to those waiting on the patients ?

Dr. LAVINDER. There are some cases that have been developed in that way, but the number is very small. I think there have been two or three such cases, notably that of a Catholic priest, Father Damien, at the Honolulu Leprosorium.

PROPOSED EXPENDITURE.

The CHAIRMAN. How do you arrive at $200,000 as being the amount of money needed ?

Dr. LAVINDER. I think it will be well to let Dr. Busby state that.

Dr. Busby. For the first six months of the year, on a very curtailed basis, we expended at the rate of $1.20 per day. It is estimated that during the last half of this fiscal year we will have 200 beds, and the administration of those beds will cost something over $160,000— that is, for the whole number we have now and 77 additional beds. There will be required to equip the present cottages we have approximately $31,000, which, added to the present per diem of $4.20, which can not be reduced, in my opinion, at the present time, at least, will amount to $200,000. In fact, it will run a little over that, but we think that possibly we can get along with $200,000.

CHARACTER OF EQUIPMENT TO BE PURCHASED.

The CHAIRMAN. What is the character of the equipment that you propose to purchase?

Dr. Busby. It is the ordinary equipment of a room, including dressers, beds, and window blinds. In fact, it is a matter of equipping a house for the patient to live in. They spend the rest of their lives there, and this provides homes for them. This also includes the clothing of the patients, and one of the rather expensive items is shoes.

The CHAIRMAN. Why is that?

Dr. Busby. In leprosy the feet become very much deformed, and they require very careful fitting of shoes. Shoes are rather expensive.

The CHAIRMAN. The shoes must be made especially for them?

Dr. Busby. Yes, sir; in many cases, but that does not apply to all the cases. I would like to say a word about this difference between $3.11 and $4.20 : At the present time we have only two doctors

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