Mr. LUCE. What does your medical council say? Are they with you or Doctor Cooley?

Doctor DUNHAM. This is what the medical council said.

Mr. LUCE. Do they say that a graduated rating table for tuberculosis is impracticable?

Doctor DUNHAM. No; I do not think they have ever said that. I do not believe we doctors who are working with tuberculosis have done that much with mathematics; we throw up our hands on the rating table and say, Doctor Cooley is better on that than we are.

Mr. LUCE. Now, we are getting back to the beginning of your statement commending Doctor Cooley.

Doctor DUNHAM. I do not mean he is God Almighty, but I think he is right on that.

Mr. LUCE. What does the medical council say?

Doctor DUNHAM. We have not discussed that question.

Mr. LUCE. You have not discussed the question of whether a graduated rating table for tuberculosis is practicable?

Doctor DUNHAM. No.

Mr. MILLIGAN. Did not your medical board say that we should have a minimum rating of 25 per cent for all arrested cases? Doctor DUNHAM. Absolutely.

Mr. MILLIGAN. And do you not believe that if you had a minimum of 25 per cent for all cases and not go below that in any cases and then have your graduated table, that would work out?

Doctor ĎUNHAM. That is what I should think likely. As I have tried to say, I know nothing about graduating tables. If I could see that finally worked out and presented to me, after working up half a dozen cases, I could tell you, but I have not the ability to sit here and argue with you whether or not it is going to produce good results.

Mr. MILLIGAN. You have been talking about the minimum all the time.

Doctor DUNHAM. Yes.

Mr. MILLIGAN. And you agree there should be a minimum rating of 25 per cent for all cases arrested and apparently cured or whatever you might call it?

Doctor DUNHAM. Yes.

Mr. MILLIGAN. I agree with you.

Mr. BROWNING. Is there not a large number of cases in the bureau that will fall absolutely without the provision of this rating table as now drawn below 10, those where there is no disability shown?

Doctor DUNHAM. Yes.

Mr. BROWNING. Your proposition includes those where they have had a definite active tuberculosis?

Doctor DUNHAM. I do not think you will have anything below 10, ought not to have anything below 25, whenever they have had a definite tuberculosis.

Mr. BROWNING. Doesn't this rating table of Doctor Cooley show that a number of cases fall below 10?

Doctor DUNHAM. That is where we differ.

Mr. BROWNING. Does not his table show that?

Doctor DUNHAM. Yes, it is based on that. He bases on the point that it would start below and end up below that in many cases, but I do not think so.

Mr. BROWNING. His proposition is that there is no handicap in these apparently cured cases.

Doctor DUNHAM, Yes.

The CHAIRMAN. Judge Marks is to appear before the Supreme Court very shortly and does not want to make a speech here, but I would like to have him say a word to the committee. He is past and present commander and was of very great assistance when the veterans' organizations met with us.

STATEMENT OF JUDGE ROBERT S. MARKS, CINCINNATI, OHIO

Mr. MARKS. I feel highly honored at being permitted to say a word. I have no specific recommendations to make to you at this time, but I do want to congratulate you upon the excellent work that you have done and are doing. Only those who were with me like Doctor Dunham in the preliminary stage of the fight to secure some justice for the disabled in 1919 and 1920 can realize it, and those of you who know something of the scrap made to clean up the tangle that existed then, the maladministration of the Veterans' Bureau under Colonel Forbes can appreciate what tremendous progress has been made, and what great things have been done. It is a fine thing to have lived through this period of growth and progress and development until we now have a unified administration, a unified legislative organization, and an efficient head of the Veterans' Bureau itself. Those are all great things, and they have really been done in a remarkably short space of time.

So I am delighted to be here, and see you so hard at work, and I want to thank you again for the consideration that you have always given to recommendations of the disabled veterans' organization, which has pioneered along with other associations in this work, specifically Mr. Kirby, who is quite competent and quite able to speak for the disabled veterans of the United States. He represents them, and represents them exclusively, and I am not going to trespass upon any specific ground except to say these few words, and to thank you for the consideration you have given to the recommendations of our organizations, and in turn we will try to keep you in mind and the welfare of the entire Nation in presenting the claims of the disabled. [Applause.]

The CHAIRMAN. It has been a pleasure to have had the commander with us. You are always welcome. You may proceed, doctor.

Mr. MONTGOMERY. Can a man with arrested tuberculosis have more than 50 per cent disability handicap?

Doctor DUNHAM. Yes.

Mr. MONTGOMERY. To justly pass by him you have to resort to some sort of table of graduations up over 50 per cent?

Doctor DUNHAM. Yes.

Mr. MONTGOMERY. The question I am in doubt about is whether or not this 50 per cent minimum is a correct figure. There is a lot of diverse testimony on that fact.

Doctor DUNHAM. I am not wise enough to say to you that that is the final word. I only want to say to you that we have threshed it over, and we have come to $50, not 50 per cent, as being fair and in our judgment. We are not trying to recommend to you a pork barrel or anything of that nature, but we have given it careful consideration and tried it out in our minds and think it fair, many of us, and that is the reason that we have recommended that provision. Now, a rating is different; I do not presume to know that. Mr. LUCE. In advocating a flat rating, do you contemplate periodical examinations?

Doctor DUNHAM. I see no reason-I do not know how periodic they would have to be. I certainly would not handicap the director in trying to reach justice; I think that is his particular business, and I would not want to interfere with that at all.

Mr. LUCE. What would be the result of any subsequent reexaminations?

Doctor DUNHAM. I should think if the doctor had definitely determined that a man had a definite lesion in the lung tissue that reexaminations would be very few and far between.

Mr. LUCE. Yet what would be the benefit of a reexamination if you put him on a straight pension?

Dr. DUNHAM. None, except for this reason, he might get worse. But if he was bedridden and could not work you would want that man to be rated according to his evident handicap like any other

man.

Mr. LUCE. You have gone on that assumption and thrown overboard the graduated system as impracticable, unfair, and unjust. The just system is to give a man a flat rate, and, therefore, you have pensioned him for the rest of his life. Why pay any more attention to the man?

Doctor DUNHAM. I beg pardon; you have said that; I have not. Mr. LUCE. That is the impression that was given to me, that the proposal is to abandon any attempt to apportion Government aid in relation to the extent of the affliction on the ground that the extent of the affliction can not be determined. You abandon the proposition, not yourself, but the proposition in general seems to be to abandon that and substitute. We do not know whether you are going to suffer much or little, but by and large, give you a pension for the rest of your life.

Doctor DUNHAM. I believe, in answer to the question, you would probably all be interested-I believe there is no effort to abandon the general handicap that would come from tuberculosis. It is an effort to enable you men to pass a law that will help the bureau to be just to those cases which are thought to be arrested, and, therefore, cured, and therefore needing no more help just as is expressed in this rating table. There is that particular phase of tuberculosis which means danger to the economic life of not only the man but the Nation. It is that long period of doubt when you can not see whether the man is getting better or worse that we want to cover here, because in making a study of it we know there is a great potential handicap, more than people realize and more than the medical profession as a whole realize, that only men trained in tuberculosis realize, and some of the laity who have given their minds to it. In

no way would you want to punish and say that no man with tuberculosis ought to get more than $50. In no way have you said that at all. I never know what a law does mean until it gets in the statutes. I am trying to call your attention to that phase of the so-called arrested tuberculosis that in two years or two and a half years is called a cured tuberculosis and which this rating table per cent has written at the zero mark because that is the way a logical mind will meet it.

Mr. LUCE. Is it fair to say in substance that a man can not get better and may get worse?

Doctor DUNHAM. Yes. I can say that is perfectly fair. He can not get better than arrested. He can never grow that lung back any more than a leg. It is gone. It is not something that you cure like smallpox, scarlet fever, or measles. The damage is done. The lung is destroyed, in my judgment, and every T. B. doctor that General Hines has will say that lung or that bone is definitely destroyed.

Mr. BROWNING. May I call attention there to the phraseology where it says this is to apply as long as the arrested condition shall continue. The provision only applies to the arrested condition?

Doctor DUNHAM. Yes; cases where those men break down and come back on you as a charge again. Many of these men will be saved by just this law.

Mr. BULWINKLE. Do you not think it possibly would be betterthis is an experiment that the bureau is trying to limit this for a term of years, three or five years, in order that the bureau could thoroughly investigate and keep up with these cases.

Doctor DUNHAM. I see no objection to that at all.

Mr. MILLIGAN. If it is an experiment would it not be better for the bureau to change their rating table and say that arrested cases shall receive a minimum of 25 per cent and allow them to be rated up to 100 per cent? You would get away from this pension feature, and if this class of cases should be put on a flat rate, why not Bright's disease and any other cases?

Doctor DUNHAM. The only reason for other cases is that it is almost impossible for the average doctor to exactly evaluate your disability in tuberculosis. You could do that in other diseases. I think your point is well taken and it might be worked out for tuberculosis. I would like to ask you that point. Do not ask me about n. p.; it is out of my class. I run from an insane asylum like the average man does from a tuberculosis sanitarium. But let me say this. You asked me whether you could have a flat rate. You will have to ask Doctor Cooley and Director Hines if they could write that in. I believe they really need your authority to write in a minimum rate of 25 per cent.

Mr. MILLIGAN. Would they to write in a minimum rate of 10 per cent?

Doctor DUNHAM. Will they do it? I do not know.

The CHAIRMAN. In his testimony the other day Doctor Cooley gave the impression to some members of the committee that everyone under this new rating schedule would receive a minimum of 10 per cent. I think he did not intend to convey that impression. As a matter of fact, under that new rating schedule there would be many cases of arrested tuberculosis that will not get marked apparently cured.

Doctor DUNHAM. Apparently cured after one and a half to two years. It is a matter of time.

The CHAIRMAN. There is not a reason in the world, if you were in charge of the Veterans' Bureau, that under existing law you could not immediately put in a minimum of 25 per cent.

Doctor DUNHAM. I do not know. I certainly, if I was rating it, would try to do that.

The CHAIRMAN. If you were in charge of it you would do it? Doctor DUNHAM. I would try to.

Mr. MILLIGAN. I do not see why under the law that could not be done.

Doctor DUNHAM. I do not either.

Mr. MILLIGAN. It is the course we took in the Schwartz case, amended the law because the legal department of the bureau refused to reverse themselves.

Mr. CONNERY. Referring to the 25 per cent minimum in arrested cases of tuberculosis, although they are all arrested, there is more danger of one case becoming active than another.

Doctor DUNHAM. Yes.

Mr. CONNERY. Would it not be fairer to have a minimum of 25 per cent and graduate it up to 100, to men whose cases had been more active or had more serious cases of loss of tissue? Would not that be fairer to those men, or if you put them on a flat basis of $50, that is not fair to many cases that are more serious than others. Doctor DUNHAM. There is a fairness about it, an abstract fairness about it, but I will tell you why we have recommended $50 in preference to the rating system. Remember the cost of reexamining these men to see how they are all the time. Remember the expense of trying to keep these examinations going. General Hines wants to and everybody that is trying to plan for this Veterans' Bureau is trying to reduce the cost, expense of overhead, to get away from as many reexaminations as possible and put as many men on permanent status as is possible, honestly. That is working all the time. If those men have had to keep coming back there is an economic loss to them and to the Government, and if we know all these men have reached the full degree of recovery as far as they were able, you then could average all of them according to their disability. This is just a possibility of getting in that direction, but you will eventually try to get to that and as far as I am concerned, either way, either 25 per cent graded up, or $50. This law will cover what we are driving at. It is a question for you men to determine which is the better. I do not know.

Mr. BULWINKLE. Are you not a little fearful that something under 25 per cent would do men injustice on account of the doctors not being tuberculosis experts?

Doctor DUNHAM. No, on the other hand, I believe frankly if we can put over a good fundamental principle fixed in your mind so that we could get some law to the effect that would give General Hines the right to do these things. He is not working only with the tuberculosis specialists; he has to work with doctors in all classes. If we could establish that fundamental principle that arrested tuberculosis is a minimum 25 per cent disability I would not be worried about it, but the point is that a great many people will agree with Doctor Cooley that there is a zero point. That is what we find,