General HINES. Yes; but you have another amendment

Representative RANKIN (interposing). Well, I am going to ask you about that in a minute. Now, also there is a provision in this bill that carries out the ideas of the bill introduced by Mr. Fish, of New York, and Mrs. Rogers, of Massachusetts, to pay the veterans who are in hospitals and uncompensated, or to pay their dependents at home, an allowance up to $30 a month. It is estimated that that would cost about $9,000,000.

General HINES. Yes, sir. I think the original bill you are speaking of our estimate showed would cost about $10,000,000.

The CHAIRMAN. Mrs. Rogers says it is estimated that this amendment would affect the dependents of practically 27,560 veterans, and during the fiscal year 1930 would cost approximately $4,000,000. General HINES. It is about $5,000,000.

Senator WALSH of Massachusetts. Is that for payment of money to veterans who are in hospitals without proof of disability? General HINES. Uncompensated veterans.

Representative RANKIN. It goes to their dependents. If they are put on the roll by this bill, that amount then should be taken from the total cost.

General HINES. At the start, yes.

Representative RANKIN. Yes, because they would be compensated and because compensated their families would not draw this compensation.

General HINES. We have some of course with disabilities that occurred between then and up to this date, and they will then begin to go up to a new date.

Representative RANKIN. The Johnson bill, by going outside the limits prescribed by the Rankin-Walsh bill, and putting on men suffering from disabilities on the pay roll, increased the cost of the bill the difference between $44,000,000 for the first year and $108,000,000, did it not?

General HINES. That together with wiping out any rebuttable evidence.

Representative RANKIN. No, your letter came before that was wiped out.

General HINES. Well, I am speaking of your bill plus the Johnson bill, and in that conncetion our letter is correct. But you are now asking me about this bill as it stands here.

Representative RANKIN. No, I am asking you about the Johnson bill, all spread out and taking in all acute cases, we will say, and cases that are not chronic, has entailed an additional cost of the difference between $44,000,000 and your estimate of $108,000,000 a year. General HINES. That is correct.

Representative RANKIN. Of course I agree with you, Senator, that the matter of rebuttable evidence should be put back in the bill. And I will say that I opposed striking it out.

Senator SHORTRIDGE. Pardon me right there. That means that evidence should be admitted to rebut the claim made?

Representative RANKIN. Except in certain cases.

General HINES. It means that if a man is knocked over by a street car and that his disability resulted from that, evidence that it happened in that way would be evidence to prevent the payment of compensation. Under the law as it now exists there is no rebuttal as I understand it.

Representative RANKIN. Under the bill as originally introduced by me and by Senator Walsh of Massachusetts there are certain diseases that are not rebuttable, and tuberculosis is one of them.

Senator SHORTRIDGE. I see. Now, let me ask you: Practically all chronic diseases are constitutional, are they?

General HINES. I believe so, but I have two witnesses here who will be better able to answer that than I am. May I have Doctor Cooley answer that?

Senator SHORTRIDGE. Will you please explain that?

Dr. MARTIN COOLEY, Medical Service, United States Veterans' Bureau. If it is desired.

General HINES. I should like to have him explain that so that you may get the information from a doctor rather than from a layman. Representative RANKIN. Yes; explain that.

Doctor COOLEY. The term chronic is a more inclusive term. A condition may be chronic but not constitutional.

Representative RANKIN. There would be very few cases of that kind, would there not?

Doctor COOLEY. Well, roughly speaking, your question might be answered in this way: That most constitutional diseases are chronic. Senator SHORTRIDGE. For my own information, let me ask: You use two terms, chronic and constitutional.

Doctor COOLEY. Yes.

Senator SHORTRIDGE. Is a chronic disease considered permanent? Doctor COOLEY. It is very apt to be so and yet is not essentially so. Senator SHORTRIDGE. And now as to a constitutional disease. Doctor COOLEY. A constitutional disease may not necessarily be permanent.

Representative RANKIN. As I understood the testimony before the Veterans' Committee in the House, the word "chronic" might be defined as long-drawn-out.

General HINES. Long standing.

Senator THOMAS of Oklahoma. Give us an example of the difference. Doctor COOLEY. A constitutional disease is a disease which arises from within, that is, which develops in the interior of the body itself. It assumes some defect, or wear of and tear of the mechanism, by which the body breaks down. The term is used in contradistinction to an extraneous cause, like an infection from without the body. I might further explain that the term "constitutional" has lost a good deal of its significance in medicine. It was formerly an omnibus group, into which we threw those conditions of which we knew very little. With the advance in pathology, chemistry, and other branches we have been able to take most of these diseases out of that group and put them into more scientific classifications. For example, take diabetes; it was formerly known as a constitutional disease. We know now that diabetes is of a certain origin, and our knowledge of it has allowed us to put it in the class of metabolism disorders. The term "constitutional," in popular significance, is taken to mean what involves the system. But in medicine it has a more restricted and special meaning, it is applied to only a certain group of diseases.

Senator THOMAS of Oklahoma. Now, what about chronic diseases? Doctor COOLEY. Diseases of joints may be chronic, such as chronic. rheumatism. That would be considered a local disease of the joints, and would be so classified, but would not necessarily be a constitutional disease.

Senator WALSH of Massachusetts. I take it that Congressman Rankin's purpose was to connect the matter up with that of expense. Representative RANKIN. Yes; diseases or disabilities that would not be classed as chronic would be classed under the head of acute or temporary.

Doctor COOLEY. Yes.

Representative RANKIN. The reason I am asking these questions is that one or two cases such as you mention have been brought up, I take it, rheumatism.

General HINES. And arthritis.

Representative RANKIN. And phlebitis, and a few of those cases. Now, General Hines, I want to ask you this: After all the amendments refer, or let us say the amendments of section 200, and that is what the most of this is about, and we understand that, for the controversy is over the amending of section 200 of the World War veterans' act of 1924 and just how far we shall go. Somehow more has gotten before the House, and the idea has gotten abroad that I was alluding to, whereas my bill would have cost about one-third and would have reached those men now suffering from chronic constitutional diseases. If the Senate committee should strike out the amendments to section 200 that were adopted in the House, and substitute that provision of the Walsh-Rankin bill, it would make that amendment cost about $44,000,000 instead of around $100,000,000. General HINES. I am assuming that the rebuttable feature goes back

Representative RANKIN (interposing). I will come to that. I think, General Hines, we can pretty safely presume that that rebuttable clause will be restored; and I might add that it would likely not have been stricken out if the House had understood it, and I think everybody was surprised when it carried, even the author of the bill. If that were done it would cost what?

General HINES. That section is $103,200,000.

Representative RANKIN. It would bring it down to $44,000,000. General HINES. Approximately. I think I told you at the time that the estimate was conservative, but we would be willing to stand on it. Representative RANKIN. If we would strike out the word "constitutional" and just say "chronic diseases," would that materially increase the cost, and if so to what extent?

General HINES. Do you mean to exclude that and just leave it with the word "chronic" in it?

Representative RANKIN. Yes.

General HINES. It would increase the cost, but to what extent I am not quite sure. Doctor Cooley, do you think that would affect it materially?

Doctor COOLEY. I would not attempt to estimate it.

Representative RANKIN. I am speaking about the cost of the amendment in the Walsh-Rankin bill.

General HINES. It would increase it. As I understand it, your amendment takes in chronic constitutional diseases.

Doctor COOLEY. Yes; I so understand it.

Representative RANKIN. No. General Hines you have the same idea that others had in the beginning, that the provision means chronic or constitutional, but it says "chronic constitutional." The point I am making is that if we should strike out the word "constitutional"

and just say "chronic diseases" and put them on by presumption, those who break down up to 1930, it would mean what in cost? General HINES. I think our estimate of $44,000,000 would be low. Representative RANKIN. It would not increase by means of the Walsh-Rankin amendment the section known as 200.

General HINES. No; assuming that the rebuttable feature goes back in. That is just section 200 that we are talking about now? Representative RANKIN. Of course you are aware, General Hines, that that was the section included in my bill to amend the World War veterans' act, and that was also included in the bill of Senator Walsh of Massachusetts, over which this trouble arose.

General HINES. Of course, Congressman, that does not in any way affect the underlying principles I have referred to.

Representative RANKIN. I understand that, but we have thrown principles to the winds in some of this veterans' legislation; but we will not discuss it here; that has much more prospect than that feature in the case of enlisted men who have chronic diseases.

Senator WALSH of Massachusetts. Now, Mr. Chairman, I think the Congressman has concluded his examination, if you or the other members of the subcommittee have any questions.

The CHAIRMAN. General Hines, now if you will take up section by section the bill that is before us, we will be glad to hear you tell us about it.

General HINES. I have the tabulated statement here to which I was referring awhile ago.

The CHAIRMAN. You may make that a part of the record.
General HINES. I will furnish it to the committee reporter.

(The tabulated statement entitled "H. R. 9687, comparison of United States Veterans' Bureau and Pension Bureau estimates" is here made a part of the record, as follows:)