Doctor DUNN. I am afraid I have not been thoroughly understood in what I said before. In order to grasp this situation thoroughly it requires that judgment which comes from years of observation and training, not only in treating large numbers, but also in having had the opportunity to see hundreds or thousands of people who apparently got results 5, 10, and 15 years ago, to see what happens to them in subsequent life under different economic conditions. We can not get men with such experience to enter the bureau service, and when those in the bureau have gotten such experience the bureau is very apt to lose them.

The CHAIRMAN. The committee will stand adjourned until 10 o'clock a. m. to-morrow, at which time Doctor Dunham is requested to appear before the committee.

(Thereupon, at 12 o'clock m., the committee adjourned to meet again at 10 o'clock a. m., Tuesday, January 12, 1926.)

HOUSE OF REPRESENTATIVES,

Tuesday, January 12, 1926.

COMMITTEE ON WORLD WAR VETERANS' LEGISLATION,

The committee met at 10 o'clock a. m., Hon. Royal C. Johnson (chairman) presiding.

The CHAIRMAN. The committee will be in order. We have with us this morning Doctor Dunham, tuberculosis expert, and the committee will be very glad to hear from him.

STATEMENT OF DR. KENNON DUNHAM, UNIVERSITY OF CINCINNATI, CINCINNATI, OHIO

Doctor DUNHAM. I am head of the department of tuberculosis in the University of Cincinnati. I have charge of the care and treatnent of tuberculosis patients and the teaching of students in the study and treatment of disease. I am also a member of the national rehabilitation of the American Legion committee on tuberculosis, member of the bureau's medical consultants, known as the medical council, and I represent the diagnostic group on tuberculosis in the diagnostic center in Cincinnati for the Veterans' Bureau.

The CHAIRMAN. What experience did you have in the Army? Doctor DUNHAM. Chief of the laboratories. Most of my service was chief of the laboratories at Oteen. I was in the tuberculosis division of the Army. I am very glad to have been one of the men who during the war helped to make Oteen what we thought was the best t. b. hospital in the country.

The CHAIRMAN. You have specialized on tuberculosis practically your entire medical life?

Doctor DUNHAM. I have been studying the subject very carefully about 27 years.

The CHAIRMAN. On page 19, line 5, of H. R. 4474, you will find a proposed amendment to the existing law, providing for permanent total ratings for tubercular ex-service men. You are familiar with that section and its history, and I think you testified before the committee when this same subject was under consideration a year ago. Doctor DUNHAM. Two years ago.

The CHAIRMAN. Yes, by administrative action rather than by statute.

Doctor DUNN. The reason I am in favor of this thing is because we can not have a Doctor Dunham or a Dr. Roy Adams on all our rating boards. If we had a Doctor Dunham or a Doctor Adams on all our rating boards, I think this provision would be superfluous. However, without that sort of experience and background and sound judgment to rate these men it is out of the question and can not be done by administrative action. There really are not enough sufficiently experienced men in the United States to do it if they devoted all their time to it.

The CHAIRMAN. Do you think a more equitable rating can be had by arbitrary provisions of law than trusting the cases to the individual judgment of whoever may examine them on the board? Doctor DUNN. That is the only excuse for asking it.

The CHAIRMAN. You think that is the best thing to do?

Doctor DUNN. Yes. That is the reason for it, and it is not any reflection at all on the personnel of the bureau.

Mr. MILLIGAN. You would just apply that to tubercular cases, would you not?

Doctor DUNN. I would not be quite sure of that. There are cases in which I am particularly interested that deserve just that sort of thing. The N. P. cases have a tremendous appeal to me. I am not in position where I can properly qualify to answer your question, except that I have the same information that every man in medicine has, as well as every layman. It is common knowledge that in neuropsychiatric cases, very much the same question of permanent handicap exists as in tuberculous. I have not the experience to discuss intelligently this question, but it is a self-evident fact that at least certain classes of N. P. cases are in the same category.

Mr. MILLIGAN. Carrying that out the proper thing to do would be to put them all on a pension.

The CHAIRMAN. I would say this argument leads to exactly the statement of the gentleman from Missouri.

Mr. MILLIGAN. I think this provision of law leads to it.

The CHAIRMAN. In other words, there is no discretion as to handicap. You put them on a flat basis.

Doctor DUNN. As far as tuberculous cases are concerned, for the purpose of what we are considering, and for the purposes of the Government, every man has a permanent handicap who once has had a manifest tuberculosis.

The CHAIRMAN. Then if this is enacted we might properly say the same rule should be applied to other diseases, which practically involves abolition of the Veterans' Bureau and placing all men on a pension status.

Mr. MONTGOMERY. You state that the reason you suggest such a proviso as this is because of the fact that you do not have trained men to carry on these examinations and make correct disability ratings as experts. You also stated there was a movement on foot to educate doctors so that they might be competent judges of these cases. Would you deem it advisable if the facts justified it to make this particular proviso only until such men can be trained and then let them be rated as other disability patients when we have men that can really make just, correct ratings of these particular cases?

Doctor DUNN. I am afraid I have not been thoroughly understood in what I said before. In order to grasp this situation thoroughly it requires that judgment which comes from years of observation and training, not only in treating large numbers, but also in having had the opportunity to see hundreds or thousands of people who apparently got results 5, 10, and 15 years ago, to see what happens to them in subsequent life under different economic conditions. We can not get men with such experience to enter the bureau service, and when those in the bureau have gotten such experience the bureau is very apt to lose them.

The CHAIRMAN. The committee will stand adjourned until 10 o'clock a. m. to-morrow, at which time Doctor Dunham is requested to appear before the committee.

(Thereupon, at 12 o'clock m., the committee adjourned to meet again at 10 o'clock a. m., Tuesday, January 12, 1926.)

COMMITTEE ON WORLD WAR VETERANS' LEGISLATION,

HOUSE OF REPRESENTATIVES,

Tuesday, January 12, 1926.

The committee met at 10 o'clock a. m., Hon. Royal C. Johnson (chairman) presiding.

The CHAIRMAN. The committee will be in order. We have with us this morning Doctor Dunham, tuberculosis expert, and the committee will be very glad to hear from him.

STATEMENT OF DR. KENNON DUNHAM, UNIVERSITY OF CINCINNATI, CINCINNATI, OHIO

Doctor DUNHAM. I am head of the department of tuberculosis in the University of Cincinnati. I have charge of the care and treatnent of tuberculosis patients and the teaching of students in the study and treatment of disease. I am also a member of the national rehabilitation of the American Legion committee on tuberculosis, member of the bureau's medical consultants, known as the medical council, and I represent the diagnostic group on tuberculosis in the diagnostic center in Cincinnati for the Veterans' Bureau.

The CHAIRMAN. What experience did you have in the Army? Doctor DUNHAM. Chief of the laboratories. Most of my service was chief of the laboratories at Oteen. I was in the tuberculosis division of the Army. I am very glad to have been one of the men who during the war helped to make Oteen what we thought was the best t. b. hospital in the country.

The CHAIRMAN. You have specialized on tuberculosis practically your entire medical life?

Doctor DUNHAM. I have been studying the subject very carefully about 27 years.

The CHAIRMAN. On page 19, line 5, of H. R. 4474, you will find a proposed amendment to the existing law, providing for permanent total ratings for tubercular ex-service men. You are familiar with that section and its history, and I think you testified before the committee when this same subject was under consideration a year ago. Doctor DUNHAM. Two years ago.

The CHAIRMAN. Will you for the information of the committee discuss that section in your own way?

Doctor DUNHAM. You refer to this particular $50. There are two or three questions as to this proposed legislation which should be met. First of all, is it fair to give those men a flat $50? I would like to go back just a minute and say to you that there are one or two things about tuberculosis which are not generally understood. The first, I should think, that would come in your mind is, why pick out tuberculosis and make a special case for a man suffering from tuberculosis? Remember that tuberculosis is an infectious disease, that it is a disease which is spread from one patient to another through this infection. Next, tuberculosis is a most insidious disease; it is very difficult to recognize as any one knows who will see a lot of diagnoses, where the patient is said to have it now and not supposed to have it after a while. One doctor's opinion is one thing and the next doctor's opinion is another, and a man's life is often put in jeopardy by this lack of unanimity of opinion. On the other hand, in a case of acute smallpox or acute scarlet fever, it is not often good doctors will differ very long. The result is that you have a condition which undermines the patient, the man is liable to breed infection which is difficult to recognize, and the testimony of Doctor Dunn yesterday morning brings that out even better that I could.

The disability of which that man suffers is not seen as the_man who stands right in front of you. If you went into one of our tuberculosis hospitals a few years ago, you wondered why those men were there. Everybody was well and strong. You go into our tuberculosis hospitals now and you find very many more sick patients there. They are in bed to a large extent. The proof of what I am saying rests in just that, that the man's life has finally been sacrified unless he had the proper diagnosis and proper care. Now, the man who knows best how to treat pulmonary tuberculosis or any form of tuberculosis, the doctor who knows best how to treat, care for, and cure that patient is the man who knows best how and when to put that patient to bed, and how and when to get him up.

Coming back to Doctor Dunn's testimony yesterday morning to which I listened with great interest, no one could have heard that and not realized that there was a very great disability that would be very easy to overlook, but you would not realize just on the face of the case that it exists. You have, therefore, that particular phase of disability that is not going to be recognized just in the rapid turn-over. Doctor Dunn spoke of the difficulty of knowing the disability, recognizing it, and really teaching to the patient the handicap with which he suffers and for which he must prepare throughout life. Probably no man in this country knows better how to handle a case of tuberculosis over a long time than Doctor Dunn; just because he pays infinite attention to the details of how to get that patient up and how and when to put him down and take care of himself. Therefore, for a long time, actually throughout life, those men are definitely handicapped.

Doctor Cooley yesterday morning brought up the subject of Mount McGregor. I want to say to you that Mount McGregor is beautifully located up there in the mountains above Saratoga, near

where General Grant died; it is as ideal an institution as can possibly be, and Doctor Houke, who has charge of it, is one of the finest men in this country. What Doctor Cooley did not say to you yesterday was the fact that every one of those men who are sent out to Mount McGregor as cured, as arrested, goes out with a definite handicap, is so taught to each patient and the insurance of that man's extra handicap is met by the Metropolitan Life Insurance Co. by giving those patients particular care and consideration. Those men are every one of them considered to be very definitely handicapped men in their future work in life, and that company takes that particular extra care that we want this Government to take of our men.

I can not help feel and say to you with all the strength that I have that tuberculosis, lung tuberculosis, even when it is well, cuts off a piece of that lung as definitely as an amputated limb, the amount depending on where the amputation takes place. You have no trouble seeing when a leg is off, it is easy to visualize, but often physicians have the greatest trouble in trying to visualize the amount of lung destruction following pulmonary tuberculosis. It is for that reason, as a very conservative recommendation considered to be very conservative, that the medical council met and recommended that the minimum of disability for pulmonary tuberculosis for the rest of the man's life, should be a minimum of 25 per cent. That was the concensus of the men in tuberculosis on that medical council, and that was sent back to the general council, discussed and passed and made as a recommendation.

Now, Doctor Dunn, as well as myself, fought shy at the 'very thought of paying 25 per cent or 50 per cent or 75 per cent, because we know that some men will be much more disabled than that, and if you say 50 per cent, or 25 per cent, the man may not get any more. We know the difficulty in estimating that disability. This has been gone over carefully and has been talked over in the best counsel of the Legion, as well as in the best counsels of the medical council, and after we thought it out, taking it up and down, by and large, it seemed to us that probably the fairest thing we could do was to sidestep on this particular thing a lot of intricate, difficult medical judgment, and make it as simple as possible, and say, if a man has had tuberculosis, give him $50, do not let us talk in percentages of whether he is half a man or a whole man, and get mixed up with mathematics, just recommend to Congress to put over a $50 proposition as a pension for the man, and not have to do so much thinking on the whole subject. That is the situation. We feel that is wise and is the best thing to do. You men in your wisdom must determine it, but that is the nearest to a fair thing we could recommend to you. I am sure that is the way we felt about it after we got through. Mr. RANKIN. Do you mean $50 a month for life, or a stipulated number of years?

Doctor DUNHAM. I think you will have to make it for life; as long as that man does not break down and become active again. He has a definite handicap.

Mr. RANKIN. Suppose we were to pass a law here giving him this status and pay monthly compensation at the rate agreed upon by the

83103-26-PT 1-13