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against all other potential beneficiaries under section 202 (10) who are suffering from all other diseases. And, if it is contemplated to amend section 202 (10) to authorize out-patient treatment for the veterans of all wars, occupations and expeditions, or even for only veterans of the World War, a very considerable augmentation of expenditures, necessitated by increases of personnel, equipment, and supplies, must be anticipated. The Congress has heretofore consistently rejected proposals to authorize out-patient treatment under 202 (10).
There is another phase of this matter which, it is thought, has not been sufficiently kept in mind, viz, that even if a veteran can not secure treatment from the Federal Government under the provisions of the statutes governing the operation of the United States Veterans' Bureau, he is, nevertheless, not totally deprived of treatment opportunities, even if he is not financially in a position to employ a private physician. For these veterans' still have their rights as citizens of their respective States.
With particular reference to the opportunities afforded for venereal diseases, attention is invited to the accompanying publication of the United States Public Health Service, Hospitals and Dispensaries for Treatment of Venereal Diseases, reprint No. — July 20, 1927, from which it is evident that there are a large number of clinics throughout the United States which will provide treatment for venereal diseases, as a public-health measure.
When venereal diseases are required to be reported by the State health laws, this bureau cooperates, and by reporting these patients insures their treatment. And even if the State laws do not require the reporting of these communicable diseases, it is the practice of physicians in bureau stations to refer these patients to State or city clinics where they can get treatment. Finally, it may be explained that where a beneficiary under treatment for a service-connected disease has a concurrent venereal infection which is held to be aggravating the disability from the service-connected disease, the bureau treats the associated venereal diseases, either by in-patient or out-patient service, as indicated.
STATEMENT OF SENATOR H. D. HATFIELD OF WEST VIRGINIA
Senator HATFIELD. Mr. Chairman, how any expert in the medical profession can testify as to the time when a tubercular infection actually started and how long it remained dormant in the human system before developing into active tuberculosis is beyond my comprehension as a physician, in view of the history of this disease as described by nearly every author dealing with this subject.
I quote from a Textbook of Medicine by American Authors, edited by Dr. Russell L. Cecil (associate editor, Dr. Foster Kennedy), which incorporates in its text the views of some of the most outstanding specialists on the subject of tuberculosis:
Tuberculosis is almost unique among infections, in that it has, properly speaking, no period of incubation. Infection of the body is accomplished, and the anatomic marks of infection come into being and many remain indefinitely long (for months, years, or a natural lifetime) and the body meanwhile never exhibits symptoms of disease. On the other hand, it is certain that, when active tuberculosis does make its appearance, in the vast majority of instances it is an expression of an infection that originated a comparatively long time previously (weeks, months, or even years before), and during all this time has resided in tne body in a state of clinical quiescence; that is, without noticeable effect on the body economy
It is largely a matter of resistance of the body, from a standpoint of health, that continuously prevents death from a latent infection of tuberculosis. Wholesome food, healthful surroundings, and mental contentment play an important part in maintaining the resistance of the human body of any individual so infected and these elements are also the surest guarantee against such infection. There is no doubt in my mind that a majority of the veterans who have developed active tuberculosis since the World War really contracted this disease during their service. In a large number of these cases there was no outward manifestations during and immediately following their service, such as temperature, cough, lung irritation, and so forth, because the body resistance was capable of overcoming and controlling the growth of this tubercular infection, isolating it in the body for the time being by surrounding the involvement with a wall of tissue and organic material built up by nature. In these cases the infection has remained dormant until that period in the veteran's life was reached when his resistence was not as great as it had formerly been due to the lack of proper surroundings and food, or because he was subjected to long and arduous labor for the support of his family, bringing about a lowering of his resistence when the break comes and the active process of this latent tubercular condition develops and becomes an outspoken tubercular manifestation.
I quote from a Textbook of Medicine by American Authors, published in 1927, again:
Environment factors comprise all postnatal personal experiences that can be shown to have an influence on the manner in which the body receives the tubercle bacilli and on the course of whatever tubercules may be established.
There is no other infection that reacts so definitely and yet so delicately to outside or environmental influences. It can be stated almost as an axiom that both morbidity and mortality curves of tuberculosis for a community will run parallel with the curves for disease and death in general; which means that where the general standards of public health and hygiene are low; there is much tuberculosis and many deaths from it, and visa versa.
Active tuberculosis is a disease of every age, with its death rate highest in the fifth decade among city-dwelling males, and lowest in the second half of the first decade. But it is probable that more first outbreaks of the disease occur in the third and fourth decade of life than at any other period; that is, the breakdown from active tuberculosis is most likely to come not at the age of diminished vigor, but at the time of the greatest stress of environment.
I desire to mention particularly at this point that more first outbreaks of the disease occur in the third and fourth decade. It was in exactly this period of life from which the military forces were collected. In other words, it would be between 20 and 40 years. The average age of the drafted man was 23 years and a point that should not be overlooked in the discussion of this matter is that a comparison of diseases among civilians is opposite of the soldiers due to the fact that the soldier was a picked man in the service and was compelled to undergo strict examinations and was rejected if his health was not good. It follows that these young men at the height of their physical manhood were probably better able to temporarily resist these infections, even though they were subject to the rigors of military life, exposure, separation from family, changed food, and a routine to which they were entirely unfamiliar.
There can be no justifiable contention made from medical history that the presumptive period of tuberculosis if extended to January i, 1930, would be more than conservative in time as to the period of incubation between the initial invasion and the time of its outward manifestation.
In many cases veterans with infections hitherto inactive will suffer the ravages of the dreaded white plague known as tuberculosis long after 1930 if the limitation is extended to this period.
The same can be said of many of the diseases known and designated as neuropsychiatric as well as other pathologies of the body due to lack of proper metabolism, resulting in chronic forms of diseases, which possibly never take unto themselves or at least seldom, acute manifestations. The neuropsychiatric and other mental conditions differ widely as to cause. Many of the neuropsychiatric conditions are due to ordinary infection, such as the bacteria of influenza and many other bacteria responsible for acute diseases, such as pneumonia, bronchitis, and so forth. Following up its primary infection as a secondary condition involving membranes of the brain which more or less extends into the superficial brain structures causing encephalitis which may be mild in its local manifestation, resulting only in annoying headache. The infection, however, continues to exist, ultimately involving the normal nerve and brain substances, resulting first in an infiltration or swelling of these tissues, and the displacement of these normal substances capable of producing reaction to motion, sensation, and thinking, displacing them by way of new growths, destroying or wiping out their normal substance and reducing to a minimum these sensory and motor impulses that were in the normal state an integral part of the thinking and acting of the individual. The primary infection, finally resulting in tremor of the extremities, ultimately interferring with locomotion, such as is witnessed in paralysis agitans, a disease brought about in many instances by depression, emotion, physical exhaustion, and injuries. Also acute infections may precede the onset of the disease and result in its cause.
In part, I again quote from the Textbook of Medicine by American Authors, taken from the section on nervous diseases edited by Dr. Foster Kennedy, professor of neurology at Cornell University and head of the neurological department of Bellevue Hospital, New York City, his description of the symptoms indicating how this disease manifests itself:
The onset of the disease is insidious, and, as a rule, progress is slow and gradual. The first symptom may be a fine rythmatical tremor of the hands or fingers, which is at first slight and inconstant, but soon becomes permanent and continues during rest.
This proves conclusively that paralysis agitans and other kindred morbidities which are frequent terminal manifestations found in the World War veteran are due to infectious processes which in all probability can be reasonably presumed to be traceable to one of the infections heretofore referred to as being primarily the cause of these maladies and many others of the central nervous system found in the soldier.
I quote again from the same authority:
The syndrome is a frequent sequel of encephalitis lethargia, referable to a localization of the inflammatory processes in the corpus striatum and subjacent structures.
Considering the presumptive period in the beginning of the administration of the World War veterans act of 1924, and the suggested amendments in H. R. 10381 extending this period, it is inconceivable to conclude as a matter of justice and equity to the veteran, that neuropsychiatric diseases, the seeds of which were planted while the veteran was in the service of the Government, should be limited to 1925 as the outside presumption during which disease could develop from an exposure that the soldier was subjected to during his service in the war, as it is not in harmony with the conclusions of authors in dealing with this subject of paralysis agitans and kindred diseases.
The same conclusion will be controlling in a great majority of nervous and mental maladies to which the World War veteran is heir.
As supportive of this statement, I quote again from that section of the Textbook on Medicine, by American authors, dealing with diseases of the nervous system in which he states:
The course of the disease is slowly progressive, but the patient may live for many years; when the infection appears in young adults it may persist for two or even three decades, but the condition is incurable.
With these facts submitted to your honorable committee, attested by authorities in the profession of medicine, whose reputations are beyond question, and taking into consideration again that these unfortunate men who fall by the wayside, stricken by disease contracted primarily in the service of their country, I feel certain you will give this matter the favorable consideration it merits. Whether the Congress of the United States is willing to be liberal in extending the presumptive period to the first of this year or not, in the final analysis these veterans will necessarily have to be supported by some branch of this Government. It may be in many instances, city, county or State, but whatever division of Government takes care of them. This responsibility rests upon society in the final analysis. The cost will necessarily have to be borne by the public, and why should it not be by the largest unit of Government, for the reason that these veterans gave their services unflinchingly when their country needed them. These men were not members of military establishments in any city, county or State, but were soldiers of the United States and should be taken care of by the Federal Government. They are entitled, therefore, Mr. Chairman, to the benefit of every doubt, and surely there should be no question so far as extending the presumptive period from 1925 to January 1, 1930. You have a preponderance of evidence, conclusive in its proof, that even if the presumptive period is extended to January 1, 1930, it will leave many of those who contracted these ills while in the service of the Government to be provided for in the future.
I am firmly convinced that as a matter of equity there is justification for a presumptive extension to the first of this year for all chronic disabilities. It is most imperative, however, as a matter of justice, that this Congress should at least extend the presumptive period of tuberculosis and neuropsychiatric diseases to January 1, 1930, because of their more rapid progress to the end than the ordinary chronic maladies from a medical viewpoint.
The time has arrived that a solution should be worked out looking to the relief of all veteran problems as near as is humanly possible. We should not be unmindful of the condition of our noncompensable veterans. They are now dying according to Veterans' Bureau statistics at the rate of 73 per day or 25,000 a year, which to me and no doubt to your honorable committee is a most urgent problem and should have the most serious consideration by Congress at this session.
In West Virginia we have a hospital waiting list numbering approximately a hundred, and many of these unfortunate men have died waiting for admission to and treatment in hospitals. Some of them have been on the waiting list for more than a year and only recently I came in contact with a veteran who was suffering from a exophthalmic goiter and had been sent to a neuropsychiatric hospital located at Chillicothe, Ohio, where, in my judgment, he should have gone to a surgical institution and there prepared for an operation with the hope of eradicating the disease, which is the only method known to the profession that relieves this condition.
I wish to thank the committee for permitting me to add my testimony, with the hope that it might shed some light upon this subject, because of my training in the profession, which extends over a period of more than 35 years.
The CHAIRMAN. The committee will stand adjourned. (Whereupon, at 4.15 o'clock p. m., the comiittee adjourned.)